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Ferini G, Viola A, Valenti V, Tripoli A, Molino L, Marchese VA, Illari SI, Rita Borzì G, Prestifilippo A, Umana GE, Martorana E, Mortellaro G, Ferrera G, Cacciola A, Lillo S, Pontoriero A, Pergolizzi S, Parisi S. Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life. Clin Transl Radiat Oncol 2021; 32:52-58. [PMID: 34926839 PMCID: PMC8649107 DOI: 10.1016/j.ctro.2021.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023] Open
Abstract
The main aim of MBM treatment is to palliate neurological symptoms and to maintain an adequate QoL. SRT could be the “new standard” over WBI in the management of MBM patients. Neurocognitive functions could deteriorate more after WBI than after SRT.
Aims To evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). Methods This multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). Discussion Several studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement that allows, in a context of a significant time saving, improved patient comfort and minimizing radiation dose to off-target brain, a selective treatment of MBM simultaneously, otherwise attackable only by WBI. The achievement of a local control rate comparable to that obtained with WBI remains the fundamental prerequisite. Trial registration NCT number: NCT04891471.
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Key Words
- 3D-CRT, 3Dimensional-ConformalRadioTherapy
- Autonomy in daily activities
- BSC, Best Supportive Care
- Brain metastases
- CRF, Case Report Form
- CT, Computerized Tomography
- CTV, Clinical Target Volume
- EORTC QLQ-C15-PAL, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care
- FSRT, Fractionated Stereotactic Radiation Therapy
- GTV, Gross Tumor Volume
- KPS, Karnofsky Performance Status
- LINAC, Linear Accelerator
- MBM, Multiple Brain Metastastes
- MRI, Magnetic Resonance Imaging
- MoCA, Montreal Cognitive Assessment
- NCCN, National Comprehensive Cancer Network
- Neurocognitive decay
- Neurocognitive performance
- Neurocognitive tests
- OAR, Organ At Risk
- OS, Overall Survival
- PTV, Planning Target Volume
- Palliative care
- QLQ-BN20, Quality of Life Questionnaire - Brain Neoplasm 20
- QoL, Quality of Life
- Quality of life
- RT, Radiation Therapy
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy for multiple brain metastases
- SBI, Stereotactic Brain Irradiation
- SRS, Stereotactic RadioSurgery
- SRT, Stereotactic Radiation Therapy
- Stereotactic Brain RadioSurgery
- Stereotactic Brain Radiotherapy
- Supportive care in cancer patients
- VEGF, Vascular Endothelial Growth Factor
- Whole Brain Radiotherapy
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Affiliation(s)
| | - Anna Viola
- Fondazione IOM, Viagrande, I-95029 Catania, Italy
| | - Vito Valenti
- REM Radioterapia srl, Viagrande, I-95029 Catania, Italy
| | | | - Laura Molino
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | | | | | | | - Angela Prestifilippo
- Medical Oncology Unit, Mediterranean Institute of Oncology, Viagrande, I-95029 Catania, Italy
| | - Giuseppe Emmanuele Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, I-95125 Catania, Italy
| | | | - Gianluca Mortellaro
- Department of Radiation Oncology, ARNAS Ospedale Civico, I-90127 Palermo, Italy
| | - Giuseppe Ferrera
- Department of Radiation Oncology, ARNAS Ospedale Civico, I-90127 Palermo, Italy
| | - Alberto Cacciola
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Sara Lillo
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Antonio Pontoriero
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Stefano Pergolizzi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Silvana Parisi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
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Ferdinand S, Mondal M, Mallik S, Goswami J, Das S, Manir KS, Sen A, Palit S, Sarkar P, Mondal S, Das S, Pal B. Dosimetric analysis of Deep Inspiratory Breath-hold technique (DIBH) in left-sided breast cancer radiotherapy and evaluation of pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. Tech Innov Patient Support Radiat Oncol 2021; 17:25-31. [PMID: 33681484 PMCID: PMC7930610 DOI: 10.1016/j.tipsro.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The risk of radiotherapy-associated cardiovascular disease has been a concern for decades in breast cancer survivors. The objective of our study is to evaluate the dosimetric benefit of Deep Inspiratory Breath-hold technique (DIBH) on organs-at-risk (OAR) sparing in left-sided breast cancer radiotherapy and to find out pre-treatment predictors of cardiac doses for guiding patient selection for DIBH. Material and methods Pre-radiotherapy planning CT scans were done in Free Breathing (FB) and in DIBH [using Active Breathing Coordinator system (ABC™)] in 31 left sided breast cancer patients. 3DCRT plans were generated for both scans. Comparison of anatomical and dosimetric variables were done using paired t test and correlation was evaluated using Pearson correlation. Linear regression was used to get independent predictors of cardiac sparing and Receiver Operating Characteristic (ROC) curve analysis was done to find out the specific threshold of the predictors. Results There was a 39.15% reduction in mean heart dose in DIBH compared to FB (2.4 Gy vs 4.01 Gy) (p < 0.001), 19% reduction in maximum Left Anterior Descending (LAD) dose and a 9.9% reduction in ipsilateral lung mean dose (p = 0.036) with DIBH. A significant correlation was observed between reduction in Heart Volume in Field (HVIF) and Maximum Heart Depth (MHD) with reduction in mean heart dose. Reduction in HVIF (ΔHVIF) independently predicted cardiac sparing. Conclusion DIBH leads to significant reduction in OAR doses and is suggested for all patients of left-sided breast cancer undergoing radiotherapy. However, HVIF and MHD predicted for cardiac sparing and threshold criteria of ΔHVIF and ΔMHD may be used by centres with high workload to select patients for DIBH.
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Key Words
- 3DCRT, Three-Dimensional Conformal Radiation Therapy
- ABC™, Active Breathing Coordinator™
- AUC, Area under the curve
- BCS, Breast Conservation Surgery
- BMI, Body Mass Index
- Breast cancer
- CCD, Cardiac Contact Distance
- CD, Chest Depth
- CLD, Central Lung Distance
- CS, Chest Separation
- CT, Computer Tomography
- DIBH, Deep Inspiratory Breath-hold
- DVH, Dose Volume Histograms
- Deep inspiratory breath-hold
- Dosimetric predictors
- EORTC, European Organization for Research and Treatment of Cancer
- FB, Free Breathing
- HCWD, Heart Chest Wall Distance
- HCWL, Heart Chest Wall Length
- HH, Heart Height
- HV, Heart Volume
- HVIF, Heart Volume in Field
- IMC, Internal Mammary Chain
- LAD, Left Anterior Descending
- LOD, Lung Orthogonal Distance
- LV, Lung Volume
- MHD, Maximum Heart Depth
- MRM, Modified Radical Mastectomy
- NTCP, Normal Tissue Complications Probability
- OAR, Organs-at-risk
- PTV, Planning target volume
- RNI, Regional Nodal Irradiation
- ROC, Receiver Operating Characteristic
- RPM, Real-time Position Management
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy
- SCF, Supraclavicular Fossa
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Affiliation(s)
- Soujanya Ferdinand
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Monidipa Mondal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Suman Mallik
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Jyotirup Goswami
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Sayan Das
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Kazi S Manir
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Arijit Sen
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Soura Palit
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Papai Sarkar
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Subhayan Mondal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Suresh Das
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
| | - Bipasha Pal
- Radiation Oncology, Narayana Superspeciality Hospital, Andul Road, Howrah, West Bengal 711103, India
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Jethwa KR, Day CN, Sandhyavenu H, Gonuguntla K, Harmsen WS, Breen WG, Routman DM, Garda AE, Hubbard JM, Halfdanarson TR, Neben-Wittich MA, Merrell KW, Hallemeier CL, Haddock MG. Intensity modulated radiotherapy for anal canal squamous cell carcinoma: A 16-year single institution experience. Clin Transl Radiat Oncol 2021; 28:17-23. [PMID: 33732911 PMCID: PMC7943964 DOI: 10.1016/j.ctro.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction To report long-term efficacy and adverse events (AEs) associated with intensity modulated radiotherapy (IMRT) for patients with anal canal squamous cell carcinoma (ASCC). Materials and methods This was a retrospective review of patients with ASCC who received curative-intent IMRT and concurrent chemotherapy (98%) between 2003 and 2019. Overall survival (OS), colostomy-free survival (CFS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method. The cumulative incidence of local recurrence (LR), locoregional recurrence (LRR), and distant metastasis (DM) were reported. Acute and late AEs were recorded per National Cancer Institute Common Terminology Criteria for AEs. Results 127 patients were included. The median patient age was 63 years (interquartile range [IQR] 55-69) and 79% of patients were female. 33% of patients had T3-4 disease and 68% had clinically involved pelvic or inguinal lymph nodes (LNs).The median patient follow-up was 47 months (IQR: 28-89 months). The estimated 4-year OS, CFS, and PFS were 81% (95% confidence interval [CI]: 73%-89%), 77% (95% CI: 68%-86%), and 78% (95% CI: 70%-86%), respectively. The 4-year cumulative incidences of LR, LRR, and DM were 3% (95% CI: 1%-9%), 9% (95% CI: 5%-17%), and 10% (95% CI: 6%-18%), respectively. Overall treatment duration greater than 39 days was associated with an increased risk of LRR (Hazard Ratio [HR]: 5.2, 95% CI: 1.4-19.5, p = 0.015). The most common grade 3+ acute AEs included hematologic (31%), gastrointestinal (GI) (17%), dermatologic (16%), and pain (15%). Grade 3+ late AEs included: GI (3%), genitourinary (GU) (2%), and pain (1%). Current smokers were more likely to experience grade 3+ acute dermatologic toxicity compared to former or never smokers (34% vs. 7%, p < 0.001). Conclusions IMRT was associated with favorable toxicity rates and long-term efficacy. These data support the continued utilization of IMRT as the preferred treatment technique for patients with ASCC.
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Key Words
- 3DCRT, 3-dimensional conformal radiotherapy
- 5-FU, 5-fluorouracil
- ACT II, United Kingdom Anal Cancer Trial II
- AE, adverse events
- ASCC, anal canal squamous cell carcinoma
- Anal cancer
- BED, biologically effective dose
- CFS, colostomy-free survival
- CI, confidence interval
- CRT, chemoradiotherapy
- CTCAE v 4.0, common terminology criteria for adverse events version 4.0
- CTV, clinical target volume
- DM, distant metastasis
- DP-IMRT, dose-painted intensity modulated radiotherapy
- DVH, dose-volume histogram
- G, grade
- GI, gastrointestinal
- GU, genitourinary
- HIV, human immunodeficiency virus
- HR, hazard ratio
- IMRT
- IMRT, intensity modulated radiotherapy
- IQR, interquartile range
- LN, lymph node
- LR, local recurrence
- LRR, locoregional recurrence
- MMC, mitomycin-C
- OS, overall survival
- PFS, progression-free survival
- PTV, planning target volume
- RT, radiotherapy
- RTOG, Radiation Therapy Oncology Group
- Radiation
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Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, United States
| | - Courtney N Day
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | | | - Karthik Gonuguntla
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Allison E Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Joleen M Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
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Liskamp CP, Donswijk ML, van der Poel HG, Schaake EE, Vogel WV. Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer. Clin Transl Radiat Oncol 2020; 22:9-14. [PMID: 32154392 PMCID: PMC7056599 DOI: 10.1016/j.ctro.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/25/2022] Open
Abstract
Recurrence patterns on PET/CT after RT for PCN+ were correlated with nodal fields. In-field nodal recurrences were uncommon. Out-field nodal recurrences occurred mostly just above the elective nodal field. Expanding elective fields to the aorta bifurcation may prolong disease-free survival.
Purpose Biochemical failure after external beam radiotherapy (RT) for node-positive prostate cancer (PCN+) frequently involves nodal recurrences, in most cases out of field. This raises the question if current RTOG-based elective nodal fields can still be considered optimal. Modern diagnostic tools like PSMA PET/CT and choline PET/CT can visualize nodal recurrences with unprecedented accuracy. We evaluated recurrence patterns on PET/CT after RT for PCN+, with the aim to explore options for improved nodal target definition. Methods and materials Data of all patients treated with curative intent EBRT for PCN+ in NKI-AVL from 2008 to 2018 were retrospectively reviewed. EBRT comprised 70 Gy to the prostate or 66–70 Gy to the prostate bed, 60 Gy to involved nodes, and 52,5–56 Gy (46 Gy EQD2) to RTOG-based elective nodal fields, in 35 fractions. Locations of recurrences on PET/CT were noted, and nodal locations were correlated with the applied EBRT fields. Results 42 patients received PSMA (28) or choline (14) PET/CT at biochemical recurrence. 35 patients (83%) had a positive scan. At their first positive scan 17 patients had nodal metastasis, in some cases together with a local recurrence or distant disease. In-field nodal recurrences were uncommon (n = 3). Out-field nodal recurrences occurred more frequently (n = 14), with the majority (n = 12) just above the elective nodal field. These nodes were the single area of detectable failure in 6 patients (14%). Conclusions Current RT with RTOG-based nodal fields for PCN+ provides good in-field tumour control, but frequent out-field nodal recurrences suggest missed microscopic locations. Expanding elective fields to include the aorta bifurcation may prolong recurrence-free survival. Future research must address whether the potential benefits of this strategy outbalance additional toxicity.
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Key Words
- BCR, biochemical recurrence
- Choline PET/CT
- GS, Gleason Score
- IMRT, Intensity-Modulated Radiation Therapy
- IRB, Institutional Review Board
- LND, Lymph Node Dissection
- NKI-AVL, Nederlands Kanker Instituut Antoni van Leeuwenhoek
- PCN+, node-positive prostate cancer
- PET/CT, positron emission tomography / computed tomography
- PSMA PET/CT
- PSMA, Prostate-Specific Membrane Antigen
- Prostate cancer
- RP, radical prostatectomy
- RT, external beam radiotherapy
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy
- Recurrence patterns
- SNB, Sentinel Node Biopsy
- SNP, Sentinel Node Procedure
- Target definition
- VMAT, Volumetric Arc Therapy
- ePLND, extended pelvic lymph node dissection
- rLND, retroperitoneal lymph node dissection (rLND)
- sRT, Salvage Radiotherapy
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Affiliation(s)
- C P Liskamp
- Department of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - M L Donswijk
- Department of Nuclear Medicine, NKI-AVL, Amsterdam, The Netherlands
| | | | - E E Schaake
- Department of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - W V Vogel
- Department of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands.,Department of Nuclear Medicine, NKI-AVL, Amsterdam, The Netherlands
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Mangan S, Leech M. Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer? Tech Innov Patient Support Radiat Oncol 2019; 11:1-13. [PMID: 32095544 PMCID: PMC7033803 DOI: 10.1016/j.tipsro.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Proton Therapy (PR) is an emerging treatment for prostate cancer (Pca) patients. However, limited and conflicting data exists regarding its ability to result in fewer bladder and rectal toxicities compared to Photon Therapy (PT), as well as its cost efficiency and plan robustness. MATERIALS AND METHODS An electronic literature search was performed to acquire eligible studies published between 2007 and 2018. Studies comparing bladder and rectal dosimetry or Gastrointestinal (GI) and Genitourinary (GU) toxicities between PR and PT, the plan robustness of PR relative to motion and its cost efficiency for Pca patients were assessed. RESULTS 28 studies were eligible for inclusion in this review. PR resulted in improved bladder and rectal dosimetry but did not manifest as improved GI/GU toxicities clinically compared to PT. PR plans were considered robust when specific corrections, techniques, positioning or immobilisation devices were applied. PR is not cost effective for intermediate risk Pca patients; however PR may be cost effective for younger or high risk Pca patients. CONCLUSION PR offers improved bladder and rectal dosimetry compared to PT but this does not specifically translate to improved GI/GU toxicities clinically. The robustness of PR plans is acceptable under specific conditions. PR is not cost effective for all Pca patients.
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Key Words
- 3DC-PR, 3D Conformal- Proton Therapy
- BT, Brachytherapy
- CT, Computed Tomography
- CTCAE, Common Terminology Criteria Adverse Effects
- EPIC, Expanded Prostate Cancer Index Composite
- GI, Gastrointestinal
- GU, Genitourinary
- HT, Helical Tomography
- IGRT, Image Guidance Radiation Therapy
- IMPR, Intensity Modulated Proton Therapy
- IMRT, Intensity Modulated Radiation Therapy
- IPSS, International Prostate Symptom Scale
- ITV, Internal Target Volume
- LR, Low Risk
- MFO-IMPR, Multi Field Optimisation-Intensity Modulated Proton Therapy
- PBS, Pencil Beam Scanning
- PR, Proton Therapy
- PT, Photon Therapy
- Photon therapy
- Prostate cancer
- Proton therapy
- QALY, Quality-Adjusted Life Year
- RA, Rapid Arc
- RBE, Radiobiological Effectiveness
- RTOG, Radiation Therapy Oncology Group
- SBRT, Stereotactic Body Radiation
- SFUD, Single Field Uniform-Dose
- SW, Sliding Window
- US, Uniform Scanning
- USPT, Uniform Scanning Proton Therapy
- VMAT, Volumetric Modulated Arc Therapy
- int/HR, intermediate/High risk
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Affiliation(s)
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin 2, Ireland
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Sabater S, Leon R, Esteban C, Añon JL, Arenas M. Patients' view of the differences in topical creams for radiation dermatitis prevention. A pilot study of cosmetic properties. Rep Pract Oncol Radiother 2019; 24:347-54. [PMID: 31198411 DOI: 10.1016/j.rpor.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 12/18/2018] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Aim To investigate the feasibility of including patients' reports on the cosmetic properties of topical formulations for acute radiation dermatitis (ARD). Background No topical agent tested for acute radiation dermatitis (ARD) has proven to be better than any other, all achieving similar objective outcomes. No clear guidelines have therefore been established in clinics. Because the vehicle for such creams has shown to be an important factor in patient adherence to treatments in other dermatological diseases, patients' opinions are evaluated. Material and methods Seventy breast cancer patients referred for postoperative radiotherapy after conservative surgery were enrolled. Patients were assigned to use one of the 7 topical agents that are most-commonly used in the prevention of ARD. Patients' reports were assessed using continuous visual analogue scales (VAS), objective signs and symptoms produced by ARD, and were rated using the RTOG and RISRAS scales. Results The creams tested differed in their cosmetic properties significantly (p = 0.044). The performance of the agent, their absorption and any residue left over were also significantly different (p = 0.022, 0.014 and 0.02, respectively). Conclusions Topical agents for preventive ARD are reported by patients to show different cosmetic properties. Cosmetic properties are important when choosing topical agents for ARD prevention. Recommending those with better cosmetic profiles would improve patient adherence to treatments.
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Franco P, Arcadipane F, Trino E, Gallio E, Martini S, Iorio GC, Piva C, Moretto F, Ruo Redda MG, Verna R, Tseroni V, Bona C, Pozzi G, Fiandra C, Ragona R, Bertetto O, Ricardi U. Variability of clinical target volume delineation for rectal cancer patients planned for neoadjuvant radiotherapy with the aid of the platform Anatom-e. Clin Transl Radiat Oncol 2018; 11:33-39. [PMID: 29928706 PMCID: PMC6008279 DOI: 10.1016/j.ctro.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting. Materials and methods Two clinical cases of locally advanced rectal cancer were chosen. Participants were instructed to follow the 2009 Radiation Therapy Oncology Group consensus atlas and asked to manually segment clinical target volumes (CTVs), for both patient 1 and 2, on day 1 with and without the use of Anatom-e. After one week (day 2), the same radiation oncologist contoured again, with and without Anatom-e, the same CT series. Intraobserver (Intra-OV) and interobserver (Inter-OV) variability were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA). Results For clinical case 1, no significant difference was found for Intra-OV and Inter-OV. For clinical case 2, no significant difference was found for Intra-OV but a statistically significant difference was found for Inter-OV in DSC when using or not the platform. Mean DCS was 0.65 (SD: ±0.64; range: 0.58-0.79) for day 1 vs reference volume without Anatom-e and 0.72 (SD: ±0.39; range: 0.67-0.77) (p = 0.03) with it. Mean MDA was lower with Anatom-e (3.61; SD: ±1.33; range: 2.85-4.78) than without (4.14; SD: ±2.97; range: 2.18-5.21), with no statistical significance (p = 0.21) The use of Anatom-e decreased the SD from 2.97 to 1.33. Mean HD was lower with Anatom-e (26.06; SD: ±2.05; range: 24.08-32.62), with no statistical significance (p = 0.14) compared to that without (31.39; SD: ±1.31; range: 26.14-48.72). Conclusions The use of Anatom-e decreased the Inter-OV in the CTV delineation process for locally advanced rectal cancer with complex disease presentation planned for neoadjuvant RT. This system may be potentially helpful in increasing the compliance to follow shared guidelines and protocols.
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Key Words
- AJCC/UICC, American Joint Committee on Cancer/Union Internationale Contre le Cancer
- CHT, chemotherapy
- CT, computed tomography
- CTV, clinical target volume
- Contouring
- DSC, Dice similarity coefficient
- GTV, gross tumor volume
- HD, Hausdorff distance
- Inter-OV, inter-observer variability
- Interobserver variability
- Intra-OV, intra-observer variability
- MDA, mean distance to agreement
- MR, magnetic resonance imaging
- Neoadjuvant radiotherapy
- OARs, organs at risk
- RT, radiotherapy
- RTOG, Radiation Therapy Oncology Group
- Rectal cancer
- Ros, radiation oncologists
- SD, standard deviation
- SWOG, Radiation Committee of the Southwest Oncology Group
- Target volume delineation
- VMAT, volumetric modulated arc therapy
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Elisabetta Trino
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Elena Gallio
- Department of Medical Physics, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Giuseppe Carlo Iorio
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Cristina Piva
- Department of Radiation Oncology, Ivrea Community Hospital, Ivrea, Italy
| | - Francesco Moretto
- Department of Radiation Oncology, 'Cardinal Massaia' Community Hospital, Asti, Italy
| | - Maria Grazia Ruo Redda
- Department of Oncology, Radiation Oncology, University of Turin, AO Ordine Mauriziano, Turin, Italy
| | - Roberta Verna
- Department of Radiation Oncology, AOU San Luigi Gonzaga, Orbassano (TO), Italy
| | - Vassiliki Tseroni
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Presidio San Giovanni Antica Sede, Turin, Italy
| | - Cristina Bona
- Department of Radiation Oncology, ASL Verbano Cusio Ossola, Verbania, Italy
| | - Gabriele Pozzi
- Department of Radiation Oncology, AO 'SS Antonio e Biagio e Cesare Arrigo', Alessandria, Italy
| | - Christian Fiandra
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
| | | | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, AOU Citta' della salute e della Scienza, Turin, Italy
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8
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Hobbs CJ, Ko SJ, Paryani NN, Accurso JM, Olivier KR, Garces YI, Park SS, Hallemeier CL, Schild SE, Vora SA, Ashman JB, Rule WG, Bowers JR, Heckman MG, Diehl NN, Miller RC. Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non-Small Cell Lung Cancer: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2017; 2:40-48. [PMID: 30225431 PMCID: PMC6124323 DOI: 10.1016/j.mayocpiqo.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective To examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non-small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes. Patients and Methods We retrospectively reviewed the cases of consecutive patients with FDG-PET-staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models. Results Among 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02). Conclusion Disease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.
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Key Words
- BED, biologically effective dose
- CT, computed tomography
- DFS, disease-free survival
- EBUS, endobronchial ultrasonography
- FDG-PET, 18F-fludeoxyglucose–positron emission tomography
- HR, hazard ratio
- ITV, internal target volume
- LC, local control
- NSCLC, non–small cell lung cancer
- OS, overall survival
- PET, positron emission tomography
- RTOG, Radiation Therapy Oncology Group
- SBRT, stereotactic body radiotherapy
- SUVmax, maximum standardized uptake value
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Affiliation(s)
- Corey J Hobbs
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Johnny R Bowers
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | | | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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9
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Lemanska A, Byford RC, Correa A, Cruickshank C, Dearnaley DP, Griffin C, Hall E, de Lusignan S, Faithfull S. Linking CHHiP prostate cancer RCT with GP records: A study proposal to investigate the effect of co-morbidities and medications on long-term symptoms and radiotherapy-related toxicity. Tech Innov Patient Support Radiat Oncol 2017; 2:5-12. [PMID: 32095558 PMCID: PMC7033766 DOI: 10.1016/j.tipsro.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/17/2017] [Accepted: 06/07/2017] [Indexed: 12/25/2022] Open
Abstract
Background Patients receiving cancer treatment often have one or more co-morbid conditions that are treated pharmacologically. Co-morbidities are recorded in clinical trials usually only at baseline. However, co-morbidities evolve and new ones emerge during cancer treatment. The interaction between multi-morbidity and cancer recovery is significant but poorly understood. Purpose To investigate the effect of co-morbidities (e.g. cardiovascular and diabetes) and medications (e.g. statins, antihypertensives, metformin) on radiotherapy-related toxicity and long-term symptoms in order to identify potential risk factors. The possible protective effect of medications such as statins or antihypertensives in reducing radiotherapy-related toxicity will also be explored. Methods Two datasets will be linked. (1) CHHiP (Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy for Prostate Cancer) randomised control trial. CHHiP contains pelvic symptoms and radiation-related toxicity reported by patients and clinicians. (2) GP (General Practice) data from RCGP RSC (Royal College of General Practitioners Research and Surveillance Centre). The GP records of CHHiP patients will be extracted, including cardiovascular co-morbidities, diabetes and prescription medications. Statistical analysis of the combined dataset will be performed in order to investigate the effect. Conclusions Linking two sources of healthcare data is an exciting area of big healthcare data research. With limited data in clinical trials (not all clinical trials collect information on co-morbidities or medications) and limited lengths of follow-up, linking different sources of information is increasingly needed to investigate long-term outcomes. With increasing pressures to collect detailed information in clinical trials (e.g. co-morbidities, medications), linkage to routinely collected data offers the potential to support efficient conduct of clinical trials.
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Key Words
- ANOVA, analysis of variance
- BNF, British National Formulary
- Big data
- CHHiP
- CHHiP, Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy for Prostate Cancer
- Data linkage
- EPIC, Expanded Prostate Cancer Index Composite
- FACT-P, Functional Assessment of Cancer Therapy-Prostate
- GEE, Generalized Estimating Equations
- GP, General Practitioner
- ICD10, International Classification of Disease version 10
- ICR, Institute of Cancer Research
- IMRT, Intensity Modulated Radiotherapy
- LENT/SOMA, Late Effects Normal Tissue Toxicity; subjective, objective, management, and analytic
- Late-effects
- PCa, Prostate cancer
- PROs, Patient Reported Outcomes
- QOL, Quality of life
- RCGP RSC
- RCGP, Royal College of General Practitioners
- RCT, Randomised Control Trial
- REC, Research Ethics Committee
- RSC, Research & Surveillance Centre
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy-related side-effects
- SHA2-512, Secure Hash Algorithm 2 with 512 bit hash values
- UCLA-PCI, University of California, Los Angeles Prostate Cancer Index
- UK, United Kingdom
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Affiliation(s)
- Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Rachel C Byford
- Department of Health Care Management and Policy, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ana Correa
- Department of Health Care Management and Policy, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Clare Cruickshank
- The Institute of Cancer Research - Clinical Trials and Statistics Unit, London, UK
| | - David P Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Trust, London, UK
| | - Clare Griffin
- The Institute of Cancer Research - Clinical Trials and Statistics Unit, London, UK
| | - Emma Hall
- The Institute of Cancer Research - Clinical Trials and Statistics Unit, London, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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