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Yoon HI, Seong J. Optimal Selection of Radiotherapy as Part of a Multimodal Approach for Hepatocellular Carcinoma. Liver Cancer 2016; 5:139-51. [PMID: 27386432 PMCID: PMC4906424 DOI: 10.1159/000367762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A multimodal approach to treatment is a basic oncologic principle with proven survival benefits for most cancer types. However, existing guidelines recommend single modalities for treating each stage of hepatocellular carcinoma (HCC). Nonetheless, multimodal approaches can be considered for HCC, depending on the characteristics of the disease in individual cases. Radiotherapy (RT), an effective local modality, is a critical element of most multimodal approaches. Improved RTtechnology and increased understanding of the tolerance of the liver to radiation have contributed to the popularity of RT for treating liver tumors in clinical practice. Consequently, numerous reports have described the effects of RT on liver cancer, despite a lack of stringent evidence for its benefits. RT can be delivered using various technologies and approaches, which may be the source of some confusion. For example, high-dose ablative RT can be curative on its own, or high-dose ablative or conventional RT can complement other treatments such as radiofrequency ablation and transarterial chemoembolization. Combinations of systemic agents and RT can also be applied. This review discusses the optimal selection of RT as part of a multimodal approach for HCC.
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Affiliation(s)
| | - Jinsil Seong
- *Jinsil Seong, MD, PhD, Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Republic of Korea), Tel. +82 2 2228 8111, E-mail
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Bodensohn R, Söhn M, Ganswindt U, Schupp G, Nachbichler SB, Schnell O, Belka C, Niyazi M. Hippocampal EUD in primarily irradiated glioblastoma patients. Radiat Oncol 2014; 9:276. [PMID: 25480148 PMCID: PMC4268826 DOI: 10.1186/s13014-014-0276-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/26/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Radiation delivery for malignant brain tumors is gradually becoming more precise. Particularly the possibilities of sparing adjacent normal structures such as the hippocampus are increasing. To determine its radiation exposure more exactly, the equivalent uniform dose (EUD) of the hippocampus was compared with further treatment parameters. This way sparing options could be found. METHODS From the database of the University hospital of Munich 61 glioblastoma patients were selected who received primary radiotherapy in 2011. General data about the etiology, treatment course, survival of the patients and dose parameters were retrieved. RESULTS In a linear regression analysis the side of the tumor (left hippocampus: p < 0.001/right hippocampus: p = 0.009) and its temporal location (left hippocampus: p = 0.015/right hippocampus: p = 0.033) were identified as factors with a significant influence on the EUD of the respective hippocampus. Besides this, the size of the planning target volume (PTV) and the EUD of the hippocampus correlated significantly (p = 0.027; Pearson correlation = 0.291). The median PTV size of the tumor in the right hemisphere was 386.1 ml (range 131.2-910.7 ml), and in the left hemisphere 291.3 ml (range 146.0-588.9 ml) (Kruskal-Wallis test: p = 0.048). A dose quartile analysis showed that 31 patients had a high dose exposure of the hippocampus on one side while having a moderate dose exposure in the other side. CONCLUSIONS The radiation exposure of the respective hippocampus is dependent on the side where the tumor is located as well as on whether it is temporally located. The exposure of the contralateral hippocampus is further dependent on multiple additional factors - nevertheless a reasonable protection seems to be possible in about half of all cases.
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JANKOWSKA P, TEOH EM, FISHER C, RHYS EVANS P, NUTTING CM, HARRINGTON KJ. Isolated intrathyroid metastasis from undifferentiated and squamous carcinoma of the head and neck: the case for surgery and re-irradiation. Br J Radiol 2008; 81:e154-61. [DOI: 10.1259/bjr/26919796] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Abstract
High-resolution computed tomography (CT) and magnetic resonance imaging (MRI) have become indispensable tools for the evaluation of conditions involving the head and neck. Complex anatomic structures and regions, such as the orbit, skull base, paranasal sinuses, deep spaces of the neck, larynx, and lymph nodes, require that the radiologist be familiar with the imaging modalities available and their appropriate applications. The purpose of this article is to review the techniques of CT and MRI and the roles they play in clinical practice, including head and neck disorders.
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Affiliation(s)
- Franz J Wippold
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Bangalore M, Matthews S, Suntharalingam M. Recent Advances in Radiation Therapy for Head and Neck Cancer. ORL J Otorhinolaryngol Relat Spec 2006; 69:1-12. [PMID: 17085946 DOI: 10.1159/000096710] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 05/26/2005] [Indexed: 11/19/2022]
Abstract
The treatment of locally advanced or recurrent head and neck cancers has improved from single modality interventions of surgery and radiation therapy alone to include combined modality therapy with surgery, chemotherapy and radiation. Combined therapy has led to improved local control and disease-free survival. New developments in radiation oncology such as altered fractionation, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery, fractionated stereotactic radiotherapy, charged-particle radiotherapy, neutron-beam radiotherapy, and brachytherapy have helped to improve this outlook even further. These recent advances allow for a higher dose to be delivered to the tumor while minimizing the dose delivered to the surrounding normal tissue. This article provides an update of the new developments in radiotherapy in the management of head and neck cancers.
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Saran F. New technology for radiotherapy in paediatric oncology. Eur J Cancer 2004; 40:2091-105. [PMID: 15341984 DOI: 10.1016/j.ejca.2003.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2003] [Revised: 11/26/2003] [Accepted: 12/03/2003] [Indexed: 10/26/2022]
Affiliation(s)
- Frank Saran
- Department of Radiotherapy, Royal Marsden Hospital NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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Colevas AD. Organ preservation-induction chemotherapy. Cancer Treat Res 2003; 114:213-34. [PMID: 12619543 DOI: 10.1007/0-306-48060-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Giraud P, Jaulerry C, Brunin F, Zefkili S, Helfre S, Chauvet I, Rosenwald JC, Cosset JM. [Upper aerodigestive tract cancers: clinical benefits of conformal radiotherapy and intensity modulation]. Cancer Radiother 2002; 6 Suppl 1:37s-48s. [PMID: 12587382 DOI: 10.1016/s1278-3218(02)00211-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of normal tissues. These techniques would then allow further tumor dose escalation. Head-and-neck tumors are some of the most attractive localizations to test conformal radiotherapy. They combine ballistic difficulties due to particularly complex shapes (nasopharynx, ethmoid) and problems due to the number and low tolerance of neighbouring organs like parotids, eyes, brainstem and spinal cord. The therapeutic irradiation of head-and-neck tumors thus remains a challenge for the radiation oncologist. Conformal radiotherapy does have a significant potential for improving local control and reducing toxicity when compared to standard radiotherapy. However, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from 3DCRT and IMRT. The published clinical reports on the use of conformal radiotherapy are essentially dealing with dosimetric comparisons on relatively small numbers of patients. Recently, a few publications have emphasized the clinical experience of several precursor teams with a suitable follow-up. This paper describes the current state-of-the-art of 3DCRT and IMRT in order to evaluate the impact of these techniques on head-and-neck cancers irradiation.
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Affiliation(s)
- P Giraud
- Département d'oncologie-radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Abstract
Cross-sectional imaging has become essential in the evaluation of the treated oral cavity and oropharynx. The purpose of this paper is to review the imaging guidelines for the evaluation of this region and to detail the typical changes encountered on imaging following surgical and radiation treatment for cancer.
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Affiliation(s)
- Franz J Wippold
- Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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Chou RH, Wilder RB, Wong MS, Forster KM. Recent Advances in Radiotherapy for Head and Neck Cancers. EAR, NOSE & THROAT JOURNAL 2001. [DOI: 10.1177/014556130108001008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Advancements in surgery have made it possible to resect cancers that had previously been regarded as incurable. Similarly, new developments in radiation oncology have helped improve the outlook for patients with locally advanced or recurrent head and neck cancers. Among these advancements are refinements in altered fractionation, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery and fractionated stereotactic radiotherapy, neutron-beam radiotherapy, charged-particle radiotherapy, and intraoperative radiotherapy. These recent developments have allowed radiation oncologists to escalate the dose of radiation delivered to tumors while minimizing the dose delivered to surrounding normal tissue. Additionally, more continues to be learned about the optimum delivery of chemotherapy. This article provides an update on the status of these new developments in the treatment of head and neck cancers.
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Affiliation(s)
- Rachel H. Chou
- Department of Radiation Oncology, Duke University Medical Center, Durham, N.C
| | - Richard B. Wilder
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston
| | - Michael S. Wong
- Department of Surgery, Duke University Medical Center, Durham, N.C
| | - Kenneth M. Forster
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston
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Wurstbauer K, Sedlmayer F, Kogelnik HD. Skin markings in external radiotherapy by temporary tattooing with henna: improvement of accuracy and increased patient comfort. Int J Radiat Oncol Biol Phys 2001; 50:179-81. [PMID: 11316562 DOI: 10.1016/s0360-3016(01)01439-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To guarantee invariable skin markings in patients undergoing a course of external radiotherapy, especially using conformal techniques. Cutaneous markings with henna also increase patient comfort, because washing and showering are allowed. METHODS AND MATERIALS Henna, a completely natural product, is a skin colorant with a history of 5,000 years. It is applied to the skin in the form of a paste. While drying, henna stains the superficial skin layers for several weeks, and the marked area can be exposed to water arbitrarily. In case of fading of the stain before the end of radiotherapy, the marking procedure can be repeated. From November 1998 until March 2000, we performed skin markings with henna in 158 patients with different tumor sites. The majority of patients received conformal radiotherapy techniques. All patients have been evaluated concerning durability of the markings, the RESULTS The median durability of henna staining is 23 days (range 12-48 days). On average, two marking procedures (range 1-4) are necessary for a patient treated with curative intent. Although washing and showering are freely permitted, no adverse cutaneous side effects (e.g., erythema, allergic reactions) have been observed. CONCLUSIONS Skin marking by temporary tattooing with henna increases the accuracy of external radiotherapy. It yields stable and invariable markings for the entire course of radiotherapy and also increases the comfort of patients.
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Affiliation(s)
- K Wurstbauer
- Landesklinik fuer Radiotherapie und Radio-Onkologie, Landeskliniken Salzburg, Muellner Hauptstr. 48, A-5020 Salzburg, Austria.
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Abstract
Intensity modulated radiotherapy represents a significant advance in conformal radiotherapy. In particular, it allows the delivery of dose distributions with concave isodose profiles such that radiosensitive normal tissue close to, or even within a concavity of, a tumour may be spared from radiation injury. This article reviews the clinical application of this technique to date, and discusses the practical issues of treatment planning and delivery from the clinician's perspective.
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Affiliation(s)
- C Nutting
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Sutton, Surrey, UK
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Brizel DM, Light K, Zhou SM, Marks LB. Conformal radiation therapy treatment planning reduces the dose to the optic structures for patients with tumors of the paranasal sinuses. Radiother Oncol 1999; 51:215-8. [PMID: 10435816 DOI: 10.1016/s0167-8140(99)00043-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Compare dose distributions of traditional versus conformal beam orientations in paranasal sinus malignancies. MATERIALS AND METHODS Maximum normal tissue doses, dose volume histograms (DVH), normal tissue complication probabilities (NTCP), and the percentage of each normal tissue receiving >80% of the average target dose (V80) were calculated. RESULTS/CONCLUSIONS Conformal planning reduced the V80 to the optic nerves and chiasm as well as the normal tissue maximum doses to the ipsilateral and contralateral optic nerves and chiasm, and mean NTCPs.
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Affiliation(s)
- D M Brizel
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
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