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Cecchi DD, Ploquin NP, Faruqi S, Morrison H. Impact of abdominal compression on heart and stomach motion for stereotactic arrhythmia radioablation. J Appl Clin Med Phys 2024:e14346. [PMID: 38661250 DOI: 10.1002/acm2.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To evaluate the effectiveness of abdominal compression (AC) as a respiratory motion management method for the heart and stomach during stereotactic arrhythmia radioablation (STAR). METHODS 4D computed tomography (4DCT) scans of patients imaged with AC or without AC (free-breathing: FB) were obtained from ventricular-tachycardia (VT) (n = 3), lung cancer (n = 18), and liver cancer (n = 18) patients. Patients treated for VT were imaged both FB and with AC. Lung and liver patients were imaged once with FB or with AC, respectively. The heart, left ventricle (LV), LV components (LVCs), and stomach were contoured on each phase of the 4DCTs. Centre of mass (COM) translations in the left/right (LR), ant/post (AP), and sup/inf (SI) directions were measured for each structure. Minimum distances between LVCs and the stomach over the respiratory cycle were also measured on each 4DCT phase. Mann-Whitney U-tests were performed between AC and FB datasets with a significance of α = 0.05. RESULTS No statistical difference (all p values were >0.05) was found in COM translations between FB and AC patient datasets for all contoured cardiac structures. A reduction in COM translation with AC relative to FB was patient, direction, and structure specific for the three VT patients. A significant decrease in the AP range of motion of the stomach was observed under AC compared to FB. No statistical difference was found between minimum distances to the stomach and LVCs between FB and AC. CONCLUSIONS AC was not a consistent motion management method for STAR, nor does not uniformly affect the separation distance between LVCs and the stomach. If AC is employed in future STAR protocols, the motion of the target volume and its relative distance to the stomach should be compared on two 4DCTs: one while the patient is FB and one under AC.
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Affiliation(s)
- Daniel David Cecchi
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Nicolas Paul Ploquin
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Oncology, Division of Medical Physics, University of Calgary, Calgary, Alberta, Canada
| | - Salman Faruqi
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Hali Morrison
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Oncology, Division of Medical Physics, University of Calgary, Calgary, Alberta, Canada
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Meredith EG, Filion E, Faria S, Kundapur V, Thuc TVTT, Lok BH, Raman S, Bahig H, Laba JM, Lang P, Louie AV, Hope A, Rodrigues GB, Bezjak A, Campeau MP, Duclos M, Bratman S, Swaminath A, Salunkhe R, Warner A, Palma DA. Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00480-2. [PMID: 38614279 DOI: 10.1016/j.ijrobp.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The use of stereotactic body radiotherapy (SBRT) for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (BLINDED FOR REVIEW) aimed to determine the maximally tolerated dose (MTD) of SBRT for ultra-central (UC) non-small cell lung carcinoma (NSCLC), using a time-to-event continual reassessment methodology (TITE-CRM). METHODS Patients with T1-3N0M0 (≤ 6 cm) NSCLC were eligible. The MTD was defined as the dose of radiotherapy associated with a ≤ 30% rate of grade (G) 3-5 pre-specified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume (PTV); tumors with endobronchial invasion were excluded. This primary analysis occurred two years after completion of accrual. RESULTS Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range: 65-87) and 17 (57%) were female. PTV was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%) and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range: 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia; the latter had CT findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% confidence interval [CI]: 52.3-85.3%), progression-free survival 66.1% (95% CI: 46.1-80.2%), local control 89.6% (95% CI: 71.2-96.5%), regional control 96.4% (95% CI: 77.2-99.5%) and distant control 85.9% (95% CI: 66.7-94.5%). Quality of life scores declined numerically over time, but the decreases were not clinically or statistically significant. CONCLUSIONS 60 Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the pre-specified acceptability criteria, and results in excellent control for UC tumors.
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Affiliation(s)
| | - Edith Filion
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Sergio Faria
- McGill University Health Centre, Montréal, Canada
| | | | | | | | | | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | | | - Marie Duclos
- McGill University Health Centre, Montréal, Canada
| | | | | | | | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada.
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
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Bilski M, Szklener K, Szklener S, Rudzińska A, Kluz N, Klas J, Rodzajewska A, Kuryło W, Korga M, Baranowska I, Mańdziuk S. Stereotactic radiosurgery in the treatment of essential tremor - a systematic review. Front Neurol 2024; 15:1370091. [PMID: 38633530 PMCID: PMC11021759 DOI: 10.3389/fneur.2024.1370091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Essential tremor (ET) is the most common movement disorder in adults, with an estimated incidence of up to 1% of the population and 5% of people older than 65 years of age. ET is manifested primarily by bilateral postural and kinetic tremor of the upper limbs with or without neurological symptoms and cognitive deficits. ET disrupts daily tasks and significantly lowers quality of life. Currently available medications alone are often insufficient to control severe symptoms. Several surgical treatment options are available, including stereotactic radiosurgery (SRS)-a minimally invasive treatment option aimed at relieving and controlling tremors. Methods We conducted a systematic review of the scientific literature on the use of SRS in the treatment of ET using PubMed, Scopus, Web of Science, Cochrane, ScienceDirect, and ClinicalTrials.gov registry and adhered to the PRISMA guidelines. Results The results obtained confirm the high efficacy and safety of the SRS procedure in treating drug-resistant intention tremor. The study results present high response rate reaching 80% and achievement of manual task improvement, lessening of the tremor and increase in the quality of life of the majority of the operated patients. The method also stands out for its favorable balance between efficiency and cost. Disscusion Stereotactic radiosurgery is a favourable, safe, efficient and cost-effective method in treatment of the essential tremor. Ongoing research is crucial to refine patient selection criteria for this procedure and further improve the effectiveness of the technique.
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Affiliation(s)
- Mateusz Bilski
- Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
- Radiotherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Katarzyna Szklener
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | | | - Anna Rudzińska
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | - Natalia Kluz
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Jakub Klas
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Anna Rodzajewska
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Weronika Kuryło
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Mateusz Korga
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Izabela Baranowska
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Sławomir Mańdziuk
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
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Martins Coelho Junior VDP, Dhaliwal JS, Chakravarthy VB. MIS technique for separation surgery in lumbar spine metastatic disease. Neurosurg Focus Video 2024; 10:V11. [PMID: 38616899 PMCID: PMC11013336 DOI: 10.3171/2024.1.focvid23222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
Around 40% of cancer patients present with spinal metastases (SM), the lumbar spine being the second most involved site (15%-30%) after the thoracic (60%-80%). Since the development of separation surgery, minimally invasive surgery (MIS) has increasingly been applied to approach SM, mirroring benefits yielded in the degenerative realm. Moreover, preoperative embolization potentially enhances local control for certain radioresistant histologies. Carbon fiber-reinforced PEEK hardware reduces image artifact, facilitating more accurate follow-up and radiotherapeutic planning. Additionally, short-segment cement-augmented constructs may be beneficial to decrease surgical morbidity and operative risk in this population. The authors present a lumbar spinal metastasis treated with MIS techniques. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23222.
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Affiliation(s)
| | - Joravar S Dhaliwal
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vikram B Chakravarthy
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Koç İ, Yüce Sarı S, Yazıcı G, Kapucu Y, Kıratlı H, Zorlu F. Role of hypofractionated stereotactic radiotherapy for primary optic nerve sheath meningioma. Neurooncol Pract 2024; 11:150-156. [PMID: 38496921 PMCID: PMC10940822 DOI: 10.1093/nop/npad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Optic nerve sheath meningiomas (ONSM) are rare tumors potentially causing visual deficits. This study aims to report the anatomic and visual outcomes of patients with primary ONSM treated with hypofractionated stereotactic radiotherapy (HF-SRT). Methods Data of 36 patients treated with HF-SRT between 2008 and 2019 were retrospectively collected. The clinical target volume (CTV) was equal to the gross tumor volume and a 2 mm was added for the planning target volume. All responses other than progression were accepted as local control (LC). The VA grading was performed under 3 groups to provide an even distribution; 20/400 or worse, 20/40-20/400, and 20/40 or better. Results Median HF-SRT dose was 25 Gy and the median CTV was 1.94 cc. After a median of 106 months of follow-up, the tumor regressed in 23 (64%), was stable in 9 (25%), and progressed in 4 (11%) eyes. The overall rate of LC was 89% with 2-, 5-, 10-, and 15-year rate of 100%, 94%, 84%, and 84%, respectively. Treatment-related late toxicity rate was 11%. The VA was stable in 27 (75%) eyes, improved in 5 (14%) eyes, and worsened in 4 (11%) eyes, respectively, after HF-SRT. Female gender was the only independent predictor of an improved VA. Conclusions Hypofractionated stereotactic radiotherapy is a safe and satisfactory treatment option for primary ONSM without severe toxicity. It may be advisable to commence treatment before an established visual deficit of 20/400 or worse occurs, to make the most of the functional benefit.
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Affiliation(s)
- İrem Koç
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sezin Yüce Sarı
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gözde Yazıcı
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yasemin Kapucu
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hayyam Kıratlı
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Faruk Zorlu
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
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Li MP, Yeo A, Gunewardena R, Drum G, Wiltshire K, Phillips C, Sia J, Wheeler G, Hall L. Is proton beam therapy always better than photon irradiation? Lessons from two cases. J Med Radiat Sci 2024; 71 Suppl 2:90-98. [PMID: 38504608 PMCID: PMC11011607 DOI: 10.1002/jmrs.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
Proton beam therapy (PBT) is increasingly used to treat cancers, especially in the paediatric and adolescent and young adult (AYA) population. As PBT becomes more accessible, determining when PBT should be used instead of photon irradiation can be difficult. There is a need to balance patient, tumour and treatment factors when making this decision. Comparing the dosimetry between these two modalities plays an important role in this process. PBT can reduce low to intermediate doses to organs at risk (OAR), but photon irradiation has its dosimetric advantages. We present two cases with brain tumours, one paediatric and one AYA, in which treatment plan comparison between photons and protons showed dosimetric advantages of photon irradiation. The first case was an 18-month-old child diagnosed with posterior fossa ependymoma requiring adjuvant radiotherapy. Photon irradiation using volumetric modulated arc therapy (VMAT) had lower doses to the hippocampi but higher doses to the pituitary gland. The second case was a 21-year-old with an optic pathway glioma. There was better sparing of the critical optic structures and pituitary gland using fractionated stereotactic radiation therapy over PBT. The dosimetric advantages of photon irradiation over PBT have been demonstrated in these cases. This highlights the role of proton-to-photon comparative treatment planning to better understand which patients might benefit from photon irradiation versus PBT.
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Affiliation(s)
- Michelle P Li
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Adam Yeo
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
- School of Applied ScienceRMIT UniversityMelbourneVictoriaAustralia
| | | | | | - Kirsty Wiltshire
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Claire Phillips
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Joseph Sia
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Greg Wheeler
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Lisa Hall
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
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Berthet C, Lucia F, Bourbonne V, Schick U, Lecouillard I, Le Deroff C, Barateau A, de Crevoisier R, Castelli J. The dosimetric parameters impact on local recurrence in stereotactic radiotherapy for brain metastases. Br J Radiol 2024; 97:820-827. [PMID: 38377402 PMCID: PMC11025672 DOI: 10.1093/bjr/tqae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/15/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVES Stereotactic radiotherapy (SRT) for brain metastases (BM) allows very good local control (LC). However, approximately 20%-30% of these lesions will recur. The objective of this retrospective study was to evaluate the impact of dosimetric parameters on LC in cerebral SRT. METHODS Patients treated with SRT for 1-3 BM between January 2015 and December 2018 were retrospectively included. A total of 349 patients with 538 lesions were included. The median gross tumour volume (GTV) was 2 cm3 (IQR, 0-7). The median biological effective dose with α/β = 10 (BED10) was 60 Gy (IQR, 32-82). The median prescription isodose was 71% (IQR, 70-80). Correlations with LC were examined using the Cox regression model. RESULTS The median follow-up period was 55 months (min-max, 7-85). Median overall survival was 17.8 months (IQR, 15.2-21.9). There were 95 recurrences and LC at 1 and 2 years was 87.1% (95% CI, 84-90) and 78.1% (95% CI, 73.9-82.4), respectively. Univariate analysis showed that systemic treatment, dose to 2% and 50% of the planning target volume (PTV), BED10 > 50 Gy, and low PTV and GTV volume were significantly correlated with better LC. In the multivariate analysis, GTV volume, isodose, and BED10 were significantly associated with LC. CONCLUSION These results show the importance of a BED10 > 50 Gy associated with a prescription isodose <80% to optimize LC during SRT for BM. ADVANCES IN KNOWLEDGE Isodose, BED, and GTV volume were significantly associated with LC. A low isodose improves LC without increasing the risk of radionecrosis.
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Affiliation(s)
- Camille Berthet
- Radiation Oncology Department, CLCC Eugene Marquis, Rennes, 35000, France
| | - François Lucia
- Radiation Oncology Department, University Hospital, Brest, 29200, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, Brest, 29200, France
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, 29200, France
| | | | - Coralie Le Deroff
- Radiation Oncology Department, CLCC Eugene Marquis, Rennes, 35000, France
| | - Anais Barateau
- Radiation Oncology Department, CLCC Eugene Marquis, Rennes, 35000, France
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI – UMR 1099, Rennes, 35000, France
| | - Renaud de Crevoisier
- Radiation Oncology Department, CLCC Eugene Marquis, Rennes, 35000, France
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI – UMR 1099, Rennes, 35000, France
| | - Joel Castelli
- Radiation Oncology Department, CLCC Eugene Marquis, Rennes, 35000, France
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI – UMR 1099, Rennes, 35000, France
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Xu H, Tan J, Fu D. Malignant transformation of primary ameloblastoma of skull: case report and review of current literature. Front Oncol 2024; 14:1365625. [PMID: 38577340 PMCID: PMC10991779 DOI: 10.3389/fonc.2024.1365625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background Since 1964, there has been a scarcity of reported cases of primary ameloblastoma (AM) or ameloblastic carcinoma (AMCa) of the skull. The clinical presentation and distinctive features of this uncommon condition at specific anatomical sites remain unclear. We report a case of malignant transformation of a primary AM of the skull situated in the frontal-temporal-parietal region and highlight its similarities to other cases reported in the literature. Clinical presentation A 53-year-old female patient presented with a 20-day history of headaches and bilateral lower limb weakness for 10 days. Physical examination revealed slow and unsteady gait. An occupying lesion was observed in the right frontal-temporal-parietal region of the skull on the Cranial imaging. A right cranial bone tumor margin expansion resection was performed. The patient's motor functions recovered normally after surgery. Postoperative imaging examinations showed10 tumor resection. Follow-up imaging examinations showed tumor recurrence. The patient underwent resection of the recurrent tumor. Postoperative pathological analysis revealed malignant transformation of the AM.Follow-up imaging examinations showed tumor recurrence again. The patient was admitted for stereotactic radiotherapy. Follow-up imaging examinations demonstrated no evidence of tumor recurrence and subsequent chest CT revealed no signs of metastasis. Conclusion Primary AM or AMCa of the skull is increasingly being described in the literature, but detailed reports on the malignant transformation of primary AM of the skull are lacking. The pathogenesis of this condition remains unclear. Aggressive treatment and close follow-up may be crucial for preventing disease recurrence and malignant transformation.
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Affiliation(s)
| | - Jialiang Tan
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Dongxiang Fu
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China
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Akingbemi W, Kurtz G, Yegya-Raman N, Plastaras JP, Schuster SJ, Chong EA. Stereotactic radiotherapy and CART for treatment of secondary CNS lymphoma. Leuk Lymphoma 2024:1-4. [PMID: 38451075 DOI: 10.1080/10428194.2024.2322033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Wisdom Akingbemi
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Goldie Kurtz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Elise A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Xu H, Zhang B, Zhang Y, Yang C, Bo C, Guo Y, Cheng Y, He L. Prognostic Significance of the Cachexia Index in Patients with Non-Small-Cell Lung Cancer and Brain Metastases after Stereotactic Radiotherapy. Clin Med Insights Oncol 2024; 18:11795549231222362. [PMID: 38440045 PMCID: PMC10910881 DOI: 10.1177/11795549231222362] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/12/2023] [Accepted: 12/04/2023] [Indexed: 03/06/2024] Open
Abstract
Background The cachexia index (CXI) has been proposed as a novel biomarker of cancer cachexia. We aimed to investigate the association between CXI and survival outcomes after stereotactic radiotherapy (SRT) in patients with non-small cell lung cancer (NSCLC) and brain metastases. Methods Data from 145 patients with NSCLC, who underwent SRT for brain metastases between April 2016 and August 2020, were retrospectively analyzed. Cachexia index was calculated as skeletal muscle index (SMI) × serum albumin level/neutrophil-to-lymphocyte ratio, whereas SMI was calculated from computed tomography images captured at the L1 level. Kaplan-Meier curves and Cox proportional hazards models were used to assess progression-free survival (PFS) and overall survival (OS). The prognostic values of CXI and other cachexia biomarkers were assessed using receiver operating characteristic (ROC) curve analysis. Results Lower pretreatment CXI (<30.8) was significantly associated with older age (P = .039), lower Karnofsky performance score (P = .009), and a high likelihood of extracranial metastases (P = .001). Patients with a lower pretreatment CXI had a significantly shorter PFS and OS than those with a higher CXI (P < .001). Multivariate analysis revealed that pretreatment CXI was an independent risk factor for both PFS, hazard ratio (HR) = 2.375; 95% confidence interval (CI) = 1.610-3.504; P < .001, and OS, HR = 2.340; 95% CI = 1.562-3.505; P < .001. Compared with other biomarkers, pretreatment CXI had the highest area under the ROC curve value for prognostic assessment, reaching 0.734. Moreover, the loss of CXI was a strong risk factor for survival independent of pretreatment CXI (P = .011). Conclusions Cachexia index may serve as a clinically useful tool for predicting survival outcomes of patients with NSCLC and brain metastases who undergo SRT.
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Affiliation(s)
- Hui Xu
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Zhang
- Department of Emergency, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongqian Zhang
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chunchun Yang
- Department of Digestion, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Changwen Bo
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanyuan Guo
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Cheng
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Li He
- Department of Oncology, First Hospital of Hebei Medical University, Shijiazhuang, China
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Guo HL, Wu WW, Huan Y, Zhang HW. SGRT-based stereotactic body radiotherapy for lung cancer setup accuracy and margin of the PTV. J Appl Clin Med Phys 2024; 25:e14195. [PMID: 37915300 DOI: 10.1002/acm2.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/09/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Surface-guided radiation therapy (SGRT, AlignRT) was used to analyze motion during stereotactic body radiotherapy (SBRT) in lung cancer patients and to explore the margin of the planning target volume (PTV). METHODS The residual errors of the AlignRT were evaluated based on grayscale cone-beam computed tomography registration results before each treatment. AlignRT log file was used to analyze the correlation between the frequency and longest duration of errors larger than 2 mm and lasting longer than 2 s and maximum error with age and treatment duration. The displacement value at the end of treatment, the average displacement value, and the 95% probability density displacement interval were defined as intrafraction errors, and PTV1, PTV2, PTV3 were calculated by Van Herk formula or Z score analysis. Organ dosimetric differences were compared after the experience-based margin was replaced with PTV3. RESULTS The interfraction residual errors were Vrt0 , 0.06 ± 0.18 cm; Lng0 , -0.03 ± 0.19 cm; Lat0 , 0.02 ± 0.15 cm; Pitch0 , 0.23 ± 0.7°; Roll0 , 0.1 ± 0.69°; Rtn0 , -0.02 ± 0.79°. The frequency, longest duration and maximum error in vertical direction were correlated with treatment duration (r = 0.404, 0.353, 0.283, p < 0.05, respectively). In the longitudinal direction, the frequency was correlated with age and treatment duration (r = 0.376, 0.283, p < 0.05, respectively), maximum error was correlated with age (r = 0.4, P < 0.05). Vertical, longitudinal, lateral margins of PTV1, PTV2, PTV3 were 2 mm, 4 mm, 2 mm; 2 mm, 2 mm, 2 mm, 3 mm, 5 mm, 3 mm, respectively. After replacing the original PTV, mean lung dose (MLD), 2-cm3 chest wall dose (CD), lung V20 decreased by 0.2 Gy, 2.1 Gy, 0.5%, respectively (p < 0.05). CONCLUSION AlignRT can be used for interfraction setup and monitoring intrafraction motion. It is more reasonable to use upper and lower limits of the 95% probability density interval as an intrafraction error.
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Affiliation(s)
- Hai-Liang Guo
- Department of Oncology, the First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wei-Wei Wu
- Department of Radiotherapy, the Affiliated Cancer Hospital of Gannan Medical University, GanZhou Cancer Hospital, Ganzhou, China
| | - Yan Huan
- Department of Oncology, People's Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Qian xinan, China
| | - Huai-Wen Zhang
- Department of Radiotherapy, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Nanchang, China
- Department of Oncology, The Third People's Hospital of Jingdezhen, Jingdezhen, China
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Buddhavarapu A. A comparison of three-film analysis software for stereotactic radiotherapy patient-specific quality assurance. J Appl Clin Med Phys 2024; 25:e14203. [PMID: 37937814 DOI: 10.1002/acm2.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/01/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
AIM The aim of this study was to investigate the suitability of three radiochromic film analysis software for stereotactic radiotherapy patient-specific quality assurance (PSQA): FilmQA Pro v5.0, SNC Patient v6.2, and eFilmQA v5.0. METHODS Film calibration was conducted for each software followed by three sets of measurements. The first set assessed calibration accuracy by comparing measured and delivered doses at increments different from those used for calibration. The second set used each software to conduct PSQA through gamma analysis on 10 stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) patients. The third set utilized SNC Patient and eFilmQA to carry out gamma analysis on a collection of four digital test images, eliminating delivery and scanning uncertainties from impacting the analysis. Key supporting features within each software for conducting gamma analysis were identified. RESULTS Overall, FilmQA Pro and eFilmQA were deemed comparable and favoured over SNC Patient due to the presence of key features such as triple-channel dosimetry, auto-optimization, and dose scaling. FilmQA Pro has a substantial user base and established reputation. eFilmQA, having been introduced more recently, serves as a viable alternative to FilmQA Pro, having been further refined for stereotactic radiotherapy PSQA. CONCLUSION This study investigated the suitability of three film analysis software (FilmQA Pro, eFilmQA, and SNC Patient) for stereotactic radiotherapy PSQA. Results from the investigation indicated that both FilmQA Pro and eFilmQA are comparably suitable and are preferred over SNC Patient. Both FilmQA Pro and eFilmQA are recommended for radiotherapy clinics.
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Breazeale A, Rahmani R, Gallagher K, Nabavizadeh N. Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes. J Med Radiat Sci 2024; 71:110-113. [PMID: 37712320 PMCID: PMC10920930 DOI: 10.1002/jmrs.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION For liver stereotactic body radiation therapy (SBRT), the placement of fiducial markers or retained ethiodized oil by transarterial chemoembolisation (TACE) provides a landmark for consistent target localisation. TACE and fiducial markers are invasive procedures that harbour additional risks. We hypothesise that liver SBRT can be accurately delivered without the use of these invasive surrogate markers. METHODS We retrospectively identified 50 consecutive patients who underwent liver SBRT with respiratory motion management to a single lesion which exhibited retained ethiodized oil per prior TACE delivery. For each SBRT fraction, two manual rigid image registrations were performed by the treating physician. One using the liver contour as a surrogate for the target and second aligning only to the radio-opaque retained ethiodized oil of the treated lesion. The magnitude of the displacement vector between the two registration methods was used to assess the accuracy of target localisation if ethiodized oil was not present. RESULTS For the 50 patients, a total of 244 analysable cone-beam CTs (CBCTs) were included (six CBCTs excluded due to poor ethiodized oil visualisation). Respiratory motion management techniques consisted of active breathing control for 13 and abdominal compression for 37 patients. Forty-two patients had peripheral lesions and eight had central lesions (<2 cm from left and right portal veins). The average target localisation offset between the two registration methods (i.e. liver contour vs. retained ethiodized oil alignment) for patients with a single peripheral or central liver lesion was 5.8 and 5.3 mm, respectively. CONCLUSIONS Across all patients, the average change in target position exceeded 5 mm for image registration methods based on the liver contour alone versus the retained ethiodized oil region. This suggests that margins greater than 5 mm may be required for respiratory motion-managed liver SBRT treatments in patients who do not undergo prior TACE or fiducial placement.
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Affiliation(s)
- Alec Breazeale
- Department of Radiation MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Ramtin Rahmani
- Department of Radiation MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Kyle Gallagher
- Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Nima Nabavizadeh
- Department of Radiation MedicineOregon Health & Science UniversityPortlandOregonUSA
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Doğan B, Demir H, Işık N, Gunalp G, Günbey HP, Yaprak G. Investigation of the risk factors in the development of radionecrosis in patients with brain metastases undergoing stereotactic radiotherapy. Br J Radiol 2024:tqae051. [PMID: 38426391 DOI: 10.1093/bjr/tqae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To investigate the incidence, timing and the factors predictors radionecrosis (RN) development in brain metastases (BMs) undergoing stereotactic radiotherapy (SRT). METHODS The study evaluated 245 BMs who exclusively received SRT between 2010 and 2020. RN was detected pathologically or radiologically. RESULTS The median of follow-up was 22.6 months. RN was detected in 18.4% of the metastatic lesions, and 3.3% symptomatic, 15.1% asymptomatic. The median time of RN was 22.8 months (2.5-39.5), and the rates at 6, 12, and 24 months were 16.8%, 41.4% and 66%, respectively. Univariate analysis revealed that Graded Prognostic Assessment (p = 0.005), Score Index of Radiosurgery (p = 0.015), Recursive Partitioning Analysis (p = 0.011), the presence of primary cancer (p = 0.004) and localization (p = 0.048) significantly increased the incidence of RN. No significant relationship between RN and brain-gross tumor volume doses, planning target volume, fractionation, dose (p > 0.05). Multivariate analysis identified SIR > 6 (OR : 1.30, p = 0.021), primary of breast tumor (OR : 2.33 p = 0.031) and supratentorial localization (OR : 3.64, p = 0.025) as risk factors. CONCLUSIONS SRT is used effectively in BMs. The incidence of RN following SRT is undeniably frequent. It was observed that the incidence rate increased as the follow-up period increased. We showed that brain-GTV doses are not predictive of RN development, unlike other publications. In study, a high SIR score and supratentorial localization were identified as factors that increased the risk of radionecrosis. ADVANCES IN KNOWLEDGE RN is still a common complication after SRT. Symptomatic RN is a significant cause of morbidity. The causes of RN are still not clearly identified. In many publications, brain dose and volumes have been found to be effective in RN. But, with this study, we found that brain dose volumes and fractionation did not increase the incidence of RN when brain doses were taken into account. The most important factor in the development of RN was found to be related to long survival after SRT.
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Affiliation(s)
- Bedriye Doğan
- Department of Radiation Oncology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Harun Demir
- Department of Radiation Oncology, Konya City Hospital, Konya, Turkey
| | - Naciye Işık
- Department of Radiation Oncology, Kartal Dr Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Gun Gunalp
- Department of Radiation Oncology, Medical Physics Specialist, Kartal Dr Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Hediye Pınar Günbey
- Department of Radiology, Kartal Dr Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Gökhan Yaprak
- Department of Radiation Oncology, Kartal Dr Lutfi Kırdar City Hospital, İstanbul, Turkey
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Zhelev K, Mihaylova-Hristov M, Conev N, Cholakova M, Korabova B, Petrov I, Georgieva N, Nedev N, Mihaylova I, Petrova M, Zahariev Z, Donev I. Lower fluorodeoxyglucose positron emission tomography maximum standardized uptake value may show a better response to stereotactic body radiotherapy of adrenals in oligometastatic disease. Contemp Oncol (Pozn) 2024; 27:263-268. [PMID: 38405207 PMCID: PMC10883199 DOI: 10.5114/wo.2023.135288] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/03/2023] [Accepted: 01/02/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Stereotactic body radiotherapy (SBRT) is well established for oligometastatic disease, and it is increasingly used to treat adrenal metastases. Material and methods In this retrospective study we performed an analysis of 75 metastatic adrenal lesions in 64 patients with oligometastatic disease. According to the fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) maximum standardized uptake value (SUVmax) of adrenal metastases, patients were categorized into three groups: low, intermediate, and high SUVmax. Results For all clinicopathological characteristics we found significant relationships for levels of SUVmax and objective response rate (Kendall Tau-c = 0.290; p = 0.017). Patients who responded to SBRT had a significantly lower SUVmax value than those who did not respond (7.6 ±2.4 vs. 9.7 ±3.8; p = 0.015). At the appropriate SUVmax cut-off values, the biomarker distinguished between patients with and without a response significantly and moderately (area under the curve = 0.670, 95% confidence intervals: 0.540-0.790; p = 0.015). Conclusions Lower SUVmax is associated with a better response to SBRT in patients whose disease progressed mainly in the adrenal glands.
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Affiliation(s)
- Kiril Zhelev
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | | | | | - Manoela Cholakova
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | - Bilyana Korabova
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | - Ivaylo Petrov
- Department of Radiotherapy, MHAT “Heart and Brain”, Pleven, Bulgaria
| | | | - Nikolay Nedev
- Department of Radiotherapy, MHAT “City Clinic”, Sofia, Bulgaria
| | | | - Mila Petrova
- Clinic of Medical Oncology, MHAT “Nadezhda”, Sofia, Bulgaria
| | - Zahari Zahariev
- Department of Radiotherapy, Uni Hospital, Panagyurishte, Bulgaria
| | - Ivan Donev
- Clinic of Medical Oncology, MHAT “Nadezhda”, Sofia, Bulgaria
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Singh T, Singh D, Murphy SC, Bin Sumaida A, Shanbhag NM. Initial Experience With 6D Skull Tracking and Intrafractional Motion Monitoring in the United Arab Emirates' First CyberKnife® Radiosurgery Center. Cureus 2024; 16:e52143. [PMID: 38222986 PMCID: PMC10784719 DOI: 10.7759/cureus.52143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/16/2024] Open
Abstract
Introduction The introduction of the CyberKnife® system has marked a significant advancement in the field of radiosurgery, offering unparalleled precision in targeting and treating cranial and extracranial lesions. This paper details the first experience from the United Arab Emirates in implementing 6D skull tracking and intrafractional motion monitoring in CyberKnife® radiosurgery. The study aims to evaluate the system's efficacy in tracking and adjusting patient movement during treatment, enhancing treatment accuracy and patient safety. Methods and materials This retrospective study analyzed 732 images from six patients treated at the UAE's first CyberKnife® center. Patients were divided into two groups based on their treatment regimens: Patients 1 to 4 (P1 to P4) received multifractionated stereotactic radiotherapy, while Patients 5 and 6 (P5 and P6) underwent single-fraction stereotactic radiosurgery (SRS). The movements recorded included supero-inferior, lateral, antero-posterior, roll, pitch, and yaw. Statistical tools were employed to interpret the data, including heat maps, box-and-whisker plots, and correlation analysis. Results The study's results indicate varied patterns of intrafractional movement across the different axes and between the two treatment groups. Multifractionated therapy patients exhibited a specific range and frequency of movements compared to those undergoing single-fraction treatment. The most significant movements were observed in the supero-inferior and lateral axes. Discussion The findings suggest that the CyberKnife® system's real-time tracking and adaptive capabilities are crucial in managing patient movements, especially in prolonged treatment sessions. The differences in movement patterns between multifractionated and single-fraction treatments underscore the need for tailored approaches in intrafractional motion monitoring. Conclusion The initial experience of the UAE's first CyberKnife® center demonstrates the system's effectiveness in addressing intrafractional movements, enhancing the precision and safety of radiosurgery treatments. This study contributes valuable insights into optimizing treatment protocols and underscores the importance of continuous monitoring and adaptive strategies in advanced radiosurgery.
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Affiliation(s)
- Teekendra Singh
- Oncology and Radiosurgery, Neuro Spinal Hospital, Dubai, ARE
| | - Dimpi Singh
- Health Informatics, Mahatma Gandhi Institute of Health Informatics, Jaipur, IND
| | | | | | - Nandan M Shanbhag
- Oncology, Tawam Hospital, Al Ain, ARE
- Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE
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Mochizuki Z, Saito M, Suzuki T, Mochizuki K, Hasegawa J, Nemoto H, Satani K, Takahashi H, Onishi H. Cycle-generative adversarial network-based bone suppression imaging for highly accurate markerless motion tracking of lung tumors for cyberknife irradiation therapy. J Appl Clin Med Phys 2024; 25:e14212. [PMID: 37985163 PMCID: PMC10795441 DOI: 10.1002/acm2.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Lung tumor tracking during stereotactic radiotherapy with the CyberKnife can misrecognize tumor location under conditions where similar patterns exist in the search area. This study aimed to develop a technique for bone signal suppression during kV-x-ray imaging. METHODS Paired CT images were created with or without bony structures using a 4D extended cardiac-torso phantom (XCAT phantom) in 56 cases. Subsequently, 3020 2D x-ray images were generated. Images with bone were input into cycle-consistent adversarial network (CycleGAN) and the bone suppressed images on the XCAT phantom (BSIphantom ) were created. They were then compared to images without bone using the structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR). Next, 1000 non-simulated treatment images from real cases were input into the training model, and bone-suppressed images of the patient (BSIpatient ) were created. Zero means normalized cross correlation (ZNCC) by template matching between each of the actual treatment images and BSIpatient were calculated. RESULTS BSIphantom values were compared to their paired images without bone of the XCAT phantom test data; SSIM and PSNR were 0.90 ± 0.06 and 24.54 ± 4.48, respectively. It was visually confirmed that only bone was selectively suppressed without significantly affecting tumor visualization. The ZNCC values of the actual treatment images and BSIpatient were 0.763 ± 0.136 and 0.773 ± 0.143, respectively. The BSIpatient showed improved recognition accuracy over the actual treatment images. CONCLUSIONS The proposed bone suppression imaging technique based on CycleGAN improves image recognition, making it possible to achieve highly accurate motion tracking irradiation.
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Affiliation(s)
- Zennosuke Mochizuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Toshihiro Suzuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Koji Mochizuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Junichi Hasegawa
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hikaru Nemoto
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Kenichiro Satani
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hiroshi Takahashi
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
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Royal-Preyra B. The Impact of Immune Checkpoint Inhibition on the Risk of Radiation Necrosis Following Stereotactic Radiotherapy for Metastatic Brain Cancer. Cureus 2023; 15:e51381. [PMID: 38161546 PMCID: PMC10757743 DOI: 10.7759/cureus.51381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose/objective Forty percent of cancer patients develop brain metastases (BM) and are often treated with stereotactic radiation (SRS/SRT). Checkpoint inhibitor (CI) use is suspected of increasing the risk of radiation necrosis (RN). Our aim is to determine whether treatment with CI is associated with an increased risk of RN in BM patients treated with SRS/SRT. Methods We retrospectively identified the medical records of BM patients treated with SRS/SRT between 1/2017 and 12/2021 using an institutional database. RN was defined by MRI imaging read by neuroradiologists and/or surgical pathology. V12GY of patients with and without RN was compared using the Mann-Whitney test. The chi-square test was used to see if RN was associated with CI use, histology, particular CI agent used, > 1 course SRS/SRT, SRS/SRT dose, chemotherapy, whole brain radiotherapy (WBRT), age, or sex. Results Two hundred and fifty-nine patients treated with 455 courses of SRS/SRT were analyzed. The most common primary histologies were lung 56% (N=146), breast 14% (N= 37), melanoma 9% (N=24), and renal cancer 7% (N=18). A total of 53.8% (N = no. of patients) were treated with CI. The overall rate of any RN was 21.8% (N=27) in the CI group compared to 14.8% (N=141) in the non-CI group (p=0.174). Mean V12Gy was 15.525 cc and 9.419 cc in patients with and without RN (p=0.02768). Mean number of SRS/SRT courses was 2 and 1.53 for patients with and without RN, and >1 course of SRS/SRT was a predictor of RN (p <0.01). Other features analyzed were not significant. Conclusion RN was higher in the BM patients treated with SRS/SRT receiving CI compared to non-CI patients (21.8%, N=27, versus 14.6%, N= 16), but failed to reach statistical significance. V12Gy and > 1 course of SRS/SRT was associated with RN. Caution should be taken in treating patients with SRS/SRT and CI there might be an increased risk of RN.
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Affiliation(s)
- Ben Royal-Preyra
- Radiation Oncology, Centre Hospitalier Affilié Universitaire Regional, Trois-Rivières, CAN
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Demir H, Doğan B, Günbey HP, Işık N, Yaprak G. Predictors of local control after robotic stereotactic radiotherapy for brain metastases: 10-years-experience after Cyberknife installation. ANZ J Surg 2023. [PMID: 37984534 DOI: 10.1111/ans.18786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND To evaluate the factors influencing brain metastases (BM) local control (LC) after stereotactic radiotherapy (SRT). METHODS Between 2010 and 2020, a cohort of 145 patients (246 BM) treated consecutively with robotic radiosurgery was analysed. RESULTS Median age was 61 years (range, 29-90 years). Median radiological follow-up of the lesions was 21.7 months (range, 3-115 months). The mean overall survival and LC were 33.0 and 82.7 months, respectively. On univariate analysis, sex, primary cancer site, histological type, use of systemic steroids, maximum diameter, volume, early MRI response, isodose line, number of fractions, BED10 value, and BED10 value proportional to volume and maximum diameter were significant factors for LC. On multivariate analysis, female sex (hazard ratio [HR]: 2.10 P: 0.035), adenocarcinoma histology (HR: 6.54 P: 0.001), no steroid use (HR: 3.60 P: 0.001), maximum diameter (≤1 cm) (HR: 2.64 P: 0.018), complete response of lesion at first follow-up MRI compared to stable or progressive disease (HR: 4.20, P = 0.024; HR: 19.15, P < 0.001), isodose line (≥90%) (HR: 2.00 P: 0.036), and tumour volume (PTV ≤2 cc) (HR: 5.19 P: 0.001) were independent factors improving LC. CONCLUSIONS SRT is an effective treatment for patients with a limited number of BM with a high LC rate. There are many factors related to the patient, tumour, and radiotherapy plan that have an impact on LC after SRT in brain metastases. These results warrant further investigation in a prospective setting.
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Affiliation(s)
- Harun Demir
- Department of Radiation Oncology, Konya City Hospital, Konya, Turkey
| | - Bedriye Doğan
- Department of Radiation Oncology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Hediye Pınar Günbey
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Naciye Işık
- Department of Radiation Oncology, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
| | - Gökhan Yaprak
- Department of Radiation Oncology, Kartal Dr. Lutfi Kırdar City Hospital, İstanbul, Turkey
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Yoshikawa H, Lafferty MH, Griffin LR, LaRue SM. A retrospective study of sinonasal tumors in 182 dogs treated with stereotactic radiotherapy (3 × 10 Gy) (2010-2015). J Vet Intern Med 2023; 37:2356-2367. [PMID: 37688322 PMCID: PMC10658520 DOI: 10.1111/jvim.16838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) is an emerging treatment for sinonasal tumors in dogs. Reported results regarding tumor control and incidence of acute and late radiation morbidities are inconsistent. OBJECTIVES To determine treatment efficacy and prognostic indicators of SRT in dogs with sinonasal tumors and to quantify acute and late radiation morbidities. ANIMALS One hundred and eighty-two client-owned dogs with sinonasal tumors diagnosed cytologically, histologically, or radiographically that underwent SRT. METHODS Single-arm retrospective study by reviewing medical records of dogs treated with SRT (10 Gy × 3) between 2010 and 2015. Kaplan-Meier analysis was used to determine overall survival (OST; from the first day of SRT to death by any cause) and disease-specific survival times (DSST; OST but censoring tumor/treatment-unrelated death). Tumors were staged using modified Adams criteria. RESULTS Median OST and DSST of dogs treated with 1 course of SRT was 441 (95% CI: 389-493 days) and 482 (428-536 days) days, respectively with skin/oral cavity acute morbidities observed in 3% of dogs. DSST in dogs with stage 4 disease showed no statistical difference compared to other stages (P = .64). Oro-nasal (n = 2) or naso-cutaneous (n = 11) fistula development occurred in 7.1% of dogs with median time of 425 days (range: 83-1733 days). Possible chronic rhinitis after SRT was recorded in 54 of 88 dogs (61%) where information was available. CONCLUSIONS AND CLINICAL IMPORTANCE Results are comparable to other reports of treatment of SRT. Acute morbidities were minimal. Modified Adams stage scheme appeared to be inappropriate for prognostication for dogs with sinonasal tumors treated with SRT.
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Affiliation(s)
- Hiroto Yoshikawa
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Mary H. Lafferty
- Flint Animal Cancer CenterColorado State UniversityFort CollinsColoradoUSA
| | - Lynn R. Griffin
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
| | - Susan M. LaRue
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsColoradoUSA
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Lee YC, Wieczorek DJ, Chaswal V, Kotecha R, Hall MD, Tom MC, Mehta MP, McDermott MW, Gutierrez AN, Tolakanahalli R. A study on inter-planner plan quality variability using a manual planning- or Lightning dose optimizer-approach for single brain lesions treated with the Gamma Knife ® Icon™. J Appl Clin Med Phys 2023; 24:e14088. [PMID: 37415385 PMCID: PMC10647977 DOI: 10.1002/acm2.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/11/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE The purpose of this study is to investigate inter-planner plan quality variability using a manual forward planning (MFP)- or fast inverse planning (FIP, Lightning)-approach for single brain lesions treated with the Gamma Knife® (GK) Icon™. METHODS Thirty patients who were previously treated with GK stereotactic radiosurgery or radiotherapy were selected and divided into three groups (post-operative resection cavity, intact brain metastasis, and vestibular schwannoma [10 patients per group]). Clinical plans for the 30 patients were generated by multiple planners using FIP only (1), a combination of FIP and MFP (12), and MFP only (17). Three planners (Senior, Junior, and Novice) with varying experience levels re-planned the 30 patients using MFP and FIP (two plans per patient) with planning time limit of 60 min. Statistical analysis was performed to compare plan quality metrics (Paddick conformity index, gradient index, number of shots, prescription isodose line, target coverage, beam-on-time (BOT), and organs-at-risk doses) of MFP or FIP plans among three planners and to compare plan quality metrics between each planner's MFP/FIP plans and clinical plans. Variability in FIP parameter settings (BOT, low dose, and target max dose) and in planning time among the planners was also evaluated. RESULTS Variations in plan quality metrics of FIP plans among three planners were smaller than those of MFP plans for all three groups. Junior's MFP plans were the most comparable to the clinical plans, whereas Senior's and Novice's MFP plans were superior and inferior, respectively. All three planners' FIP plans were comparable or superior to the clinical plans. Differences in FIP parameter settings among the planners were observed. Planning time was shorter and variations in planning time among the planners were smaller for FIP plans in all three groups. CONCLUSIONS The FIP approach is less planner dependent and more time-honored than the MFP approach.
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Affiliation(s)
- Yongsook C. Lee
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - D Jay Wieczorek
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Vibha Chaswal
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Rupesh Kotecha
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
- Department of Translational MedicineHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Matthew D. Hall
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Martin C. Tom
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Minesh P. Mehta
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Michael W. McDermott
- Department of Translational MedicineHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
- Department of NeurosurgeryMiami Neuroscience InstituteBaptist Health South FloridaMiamiUSA
| | - Alonso N. Gutierrez
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
| | - Ranjini Tolakanahalli
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiUSA
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Khaledi N, Khan R, Gräfe JL. Historical Progress of Stereotactic Radiation Surgery. J Med Phys 2023; 48:312-327. [PMID: 38223793 PMCID: PMC10783188 DOI: 10.4103/jmp.jmp_62_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/04/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 01/16/2024] Open
Abstract
Radiosurgery and stereotactic radiotherapy have established themselves as precise and accurate areas of radiation oncology for the treatment of brain and extracranial lesions. Along with the evolution of other methods of radiotherapy, this type of treatment has been associated with significant advances in terms of a variety of modalities and techniques to improve the accuracy and efficacy of treatment. This paper provides a comprehensive overview of the progress in stereotactic radiosurgery (SRS) over several decades, and includes a review of various articles and research papers, commencing with the emergence of stereotactic techniques in radiotherapy. Key clinical aspects of SRS, such as fixation methods, radiobiology considerations, quality assurance practices, and treatment planning strategies, are presented. In addition, the review highlights the technological advancements in treatment modalities, encompassing the transition from cobalt-based systems to linear accelerator-based modalities. By addressing these topics, this study aims to offer insights into the advancements that have shaped the field of SRS, that have ultimately enhanced the accuracy and effectiveness of treatment.
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Affiliation(s)
- Navid Khaledi
- Department of Medical Physics, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Rao Khan
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
- Department of Physics and Astronomy and Department of Radiation Oncology, Howard University, Washington, District of Columbia, USA
| | - James L. Gräfe
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
- Cancer Care Program, Dr. H. Bliss Murphy Cancer Center. 300 Prince Philip Drive St. John’s, NL, Canada
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Oudin V, Salleron J, Marchesi V, Peiffert D, Khadige M, Faivre JC. CyberKnife ® stereotactic radiation therapy for stage I lung cancer and pulmonary oligometastases: is fiducial implantation still relevant?-a cohort study. J Thorac Dis 2023; 15:4636-4647. [PMID: 37868838 PMCID: PMC10586995 DOI: 10.21037/jtd-22-1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/09/2022] [Accepted: 07/21/2023] [Indexed: 10/24/2023]
Abstract
Background Few studies have investigated whether there is a difference in local control or overall survival rates following treatment with robotic stereotactic body radiation therapy (SBRT) with or without prior fiducial marker implantation. Our study aimed to investigate this in patients with primary or secondary lung tumors. Methods A retrospective study was conducted at the Institut de Cancérologie de Lorraine of patients treated for primary lung cancer or pulmonary oligometastases with SBRT from January 2013 to July 2016. We included patients at least 18 years old who had stage I non-small cell lung cancer (NSCLC) or lung metastases and a follow-up of at least 1 month. Results A total of 294 patients were included. Tumors included 122 lung metastases, 89 stage I NSCLC, and 83 non-histologically confirmed lung lesions. The tracking methods were Synchrony® in 191 cases (119 gold seeds and 72 coils) and Xsight® Spine with 4D computed tomography in 103 cases. Median follow-up was 31.6 months [interquartile range (IQR), 18.1-50.2 months]. The two- and five-year probability of local control were respectively 92.22% [95% confidence interval (CI): 0.89-0.95] and 85.35% (95% CI: 0.79-0.99). The two- and five-year probability of overall survival were respectively 87.46% and 72.77% (P=0.586). Local control rates did not significantly differ between techniques at 2 and 5 years (P=0.685) (gold seeds, coils or Xsight® Spine) within tumors grouped by location, gross tumor volume (GTV) (respectively P=0.9, P=0.7, and P=0.4), planning target volume (PTV) (respectively P=0.4, P=0.9, and P=0.7), or PTV/GTV ratio (respectively P=0.6, P=0.6, and P=0.5). Metastasis-free survival and Overall survival rates did not significantly differ between techniques at 2 and 5 years (P=0.664 and P=0.586, respectively). There were no grade 4 or 5 toxicities and only one grade 3 pneumonitis and one grade 3 pneumothorax. Conclusions Fiducial-less SBRT using Xsight® Spine is a safe alternative to Synchrony® using gold seeds or coils, with comparable local control and overall survival rates and a similar toxicity profile.
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Affiliation(s)
- Victor Oudin
- Department of Radiation Oncology, Georges François Leclerc Hospital, Dijon, France
- Department of Radiation Oncology, Lorraine Cancer Institute-Alexis-Vautrin, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Department of Data Management and Biostatistics, Lorraine Cancer Institute-Alexis-Vautrin, Vandœuvre-lès-Nancy, France
| | - Vincent Marchesi
- Department of Radiation Oncology, Georges François Leclerc Hospital, Dijon, France
| | - Didier Peiffert
- Department of Radiation Oncology, Georges François Leclerc Hospital, Dijon, France
- EA 4360 APEMAC, University of Lorraine, Nancy, France
| | - Myriam Khadige
- Department of Radiation Oncology, Georges François Leclerc Hospital, Dijon, France
- Gray Institute, Maubeuge, France
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Faccenda V, Panizza D, Pisoni V, Trivellato S, Daniotti MC, Bianchi SP, De Ponti E, Arcangeli S. Single-Isocenter Linac-Based Radiosurgery for Brain Metastases with Coplanar Arcs: A Dosimetric and Clinical Analysis. Cancers (Basel) 2023; 15:4496. [PMID: 37760466 PMCID: PMC10526167 DOI: 10.3390/cancers15184496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The efficacy of linac-based SRS/fSRS treatments using the single-isocenter coplanar FFF-VMAT technique for both single and multiple BM was investigated. Seventy patients (129 BM) treated with 15-21 Gy in 1 (n = 59) or 27 Gy in 3 (n = 11) fractions were analyzed. For each fraction, plans involving the intra-fractional errors measured by post-treatment CBCT were recalculated. The relationships of BM size, distance-to-isocenter, and barycenter shift with the difference in target coverage were evaluated. Clinical outcomes were assessed using logistic regression and Kaplan-Meier analysis. The median delivery time was 3.78 min (range, 1.83-9.25). The median post-treatment 3D error was 0.5 mm (range, 0.1-2.7) and the maximum rotational error was 0.3° (range, 0.0-1.3). In single BM patients, the GTV D95% was never reduced by >5%, whereas PTV D95% reductions >1% occurred in only 11 cases (29%). In multiple BM patients, dose deficits >5% and >1% occurred in 2 GTV (2%) and 34 PTV (37%), respectively. The differences in target coverage showed a moderate-to-strong correlation only with barycenter shift. Local failure of at least one treated BM occurred in 13 (21%) patients and the 1-year and 2-year local control rates for all lesions were 94% and 90%, respectively. The implemented workflow ensured that the degradation of target and brain dose metrics in delivered treatments was negligible. Along with encouraging clinical outcomes, these findings warrant a reduction in the PTV margins at our institution.
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Affiliation(s)
- Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Denis Panizza
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Valerio Pisoni
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Sara Trivellato
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Martina Camilla Daniotti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Sofia Paola Bianchi
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Elena De Ponti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
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Huang Y, Liu Z. Dosimetric performance evaluation of the Halcyon treatment platform for stereotactic radiotherapy: A pooled study. Medicine (Baltimore) 2023; 102:e34933. [PMID: 37682167 PMCID: PMC10489306 DOI: 10.1097/md.0000000000034933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
With the advancement of radiotherapy equipment, stereotactic radiotherapy (SRT) has been increasingly used. Among the many radiotherapy devices, Halcyon shows promising applications. This article reviews the dosimetric performance such as plan quality, plan complexity, and gamma passing rates of SRT plans with Halcyon to determine the effectiveness and safety of Halcyon SRT plans. This article retrieved the last 5 years of PubMed studies on the effectiveness and safety of the Halcyon SRT plans. Two authors independently reviewed the titles and abstracts to decide whether to include the studies. A search was conducted to identify publications relevant to evaluating the dosimetric performance of SRT plans on Halcyon using the key strings Halcyon, stereotactic radiosurgery, SRT, stereotactic body radiotherapy, and stereotactic ablative radiotherapy. A total of 18 eligible publications were retrieved. Compared to SRT plans on the TrueBeam, the Halcyon has advantages in terms of plan quality, plan complexity, and gamma passing rates. The high treatment speed of SRT plans on the Halcyon is impressive, while the results of its plan evaluation are also encouraging. As a result, Halcyon offers a new option for busy radiotherapy units while significantly improving patient comfort in treatment. For more accurate results, additional relevant publications will need to be followed up in subsequent studies.
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Affiliation(s)
- Yangyang Huang
- Department of Radiotherapy, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zongwen Liu
- Department of Radiotherapy, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Arikawa S, Watanabe T, Yamaguchi H, Sato Y, Matsumoto F, Yokogami K, Takeshima H. Rare solitary pituitary metastasis of maxillary ameloblastic carcinoma: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23264. [PMID: 37728240 PMCID: PMC10555612 DOI: 10.3171/case23264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/12/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Ameloblastic carcinoma (AC) is a rare odontogenic carcinoma with histological features resembling ameloblastoma. Metastasis to distant organs and direct expansion into the skull base structures are associated with a poor clinical outcome. This rare case of AC metastasis to the pituitary gland presented without local recurrence at the primary focus of the maxilla. OBSERVATIONS A 47-year-old man had a 2-year history of AC in the right maxilla. Computed tomography for his regular checkup incidentally demonstrated pituitary tumor, rapidly growing over 2 months. He presented with the recent onset of panhypopituitarism and visual field defect. Magnetic resonance imaging showed a large, irregularly shaped intrasellar and suprasellar lesion with chiasmal compression. Endoscopic endonasal transsphenoidal surgery was performed for decompression of the optic apparatus to avoid intracranial spread. Histopathology confirmed metastatic AC, and a genetic panel test confirmed BRAF V600E mutation. Stereotactic radiotherapy (SRT) with the CyberKnife system was administered to the residual tumor. Remarkable tumor shrinkage was obtained, and panhypopituitarism was resolved 12 months later. LESSONS A multidisciplinary treatment strategy including maximal safe resection to avoid dissemination in combination with SRT may be crucial for local control with the preservation of pituitary and visual functions in patients with solitary pituitary metastatic AC.
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Affiliation(s)
| | | | | | - Yuichiro Sato
- Diagnostic Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Viani GA, Gouveia AG, Pavoni JF, Louie AV, Detsky J, Spratt DE, Moraes FY. A Meta-analysis of the Efficacy and Safety of Stereotactic Arrhythmia Radioablation (STAR) in Patients with Refractory Ventricular Tachycardia. Clin Oncol (R Coll Radiol) 2023; 35:611-620. [PMID: 37365062 DOI: 10.1016/j.clon.2023.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/24/2023] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
AIMS Reports of stereotactic arrhythmia radioablation (STAR) in patients with refractory ventricular tachycardia after catheter ablation are limited to small series. Here, we carried out a systematic review and meta-analysis of studies to better determine the efficacy and toxicity of STAR for ventricular tachycardia. MATERIALS AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines, eligible studies were identified on Medline, Embase, Cochrane Library and the proceedings of annual meetings to 10 February 2023. Efficacy was defined as a ventricular tachycardia burden reduction >70% at 6 months; safety was defined as <10% of any grade ≥3 toxicity. RESULTS Seven observational studies with a total of 61 patients treated were included. At 6 months, the ventricular tachycardia burden reduction was 92% (95% confidence interval 85-100%) and use of fewer than two anti-arrhythmic drugs was seen in 85% (95% confidence interval 50-100). Six months after STAR, an 86% reduction (95% confidence interval 80-93) in the number of implantable cardioverter-defibrillator shocks was observed. The rates for improved, unchanged and decreased cardiac ejection fraction were 10%, 84% and 6%, respectively. Overall survival at 6 and 12 months was 89% (95% confidence interval 81-97) and 82% (95% confidence interval 65-98). The cardiac-specific survival at 6 months was 87%. Late grade 3 toxicity occurred in 2% (95% confidence interval 0-5%) with no grade 4-5 toxicity. CONCLUSION STAR demonstrated both satisfactory efficacy and safety for the management of refractory ventricular tachycardia and was also associated with a significant decline in anti-arrhythmic drugs consumption. These findings support the continued development of STAR as a treatment option.
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Affiliation(s)
- G A Viani
- Ribeirão Preto Medical School, Department of Medical Imaging, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - A G Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department - Americas Oncologia, Rio de Janeiro, Brazil
| | - J F Pavoni
- Faculdade de Filosofia, Letras e Ciências Naturais, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - A V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - F Y Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Castelluccia A, Marchesano D, Grimaldi G, Annessi I, Bianciardi F, Borrazzo C, Dipalma A, El Gawhary R, Masi M, Rago M, Valentino M, Verna L, Portaluri M, Gentile P. Stereotactic MR-guided adaptive radiotherapy (SMART) for primary rectal cancer: evaluation of early toxicity and pathological response. Rep Pract Oncol Radiother 2023; 28:437-444. [PMID: 37795221 PMCID: PMC10547417 DOI: 10.5603/rpor.a2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/15/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023] Open
Abstract
Background The purpose of this study is to measure the effects of stereotactic MR-guided adaptive radiotherapy (SMART) for rectal cancer patients in terms of early toxicity and pathological response. Materials and methods For this prospective pilot study, patients diagnosed with locally advanced rectal cancer (LARC) with positive lymph node clinical staging underwent SMART on rectal lesion and mesorectum using hybrid MR-Linac (MRIdian ViewRay). Dose prescription at 80% isodose for the rectal lesion and mesorectum was 40 Gy (8 Gy/fr) and 25 Gy (5 Gy/fr), respectively, delivered on 5 days (3 fr/week). Response assessment by MRI was performed 3 weeks after SMART, then patients fit for surgery underwent total mesorectal excision. Primary endpoint was evaluation of adverse effect of radiotherapy. Secondary endpoint was pathological complete response rate. Early toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Results From October 2020 to January 2022, twenty patients underwent rectal SMART. No grade 3-5 toxicity was recorded. Twelve patients were eligible for total mesorectal excision (TME). Mean interval between the completion of SMART and surgery was 4 weeks. Pathological downstaging occurred in all patients; rate of pathological complete response (pCR) was 17%. pCR occurred with a prolonged time to surgery (> 7 weeks). Conclusion To our knowledge, this is the first study to use stereotactic radiotherapy for primary rectal cancer. SMART for rectal cancer is well tolerated and effective in terms of tumor regression, especially if followed by delayed surgery.
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Affiliation(s)
| | - Domenico Marchesano
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Gianmarco Grimaldi
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Ivan Annessi
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Federico Bianciardi
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
- Radiation Oncology, UPMC Hillman Cancer Center San Pietro FBF, Rome, Italy
| | - Cristian Borrazzo
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Annamaria Dipalma
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Randa El Gawhary
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Marica Masi
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Maria Rago
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Maria Valentino
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | - Laura Verna
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
| | | | - PierCarlo Gentile
- Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy
- Radiation Oncology, UPMC Hillman Cancer Center San Pietro FBF, Rome, Italy
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Ong WL, Milne RL, Foroudi F, Millar JL. Stereotactic Body Radiation Therapy for Spine Metastases-Findings from an Australian Population-Based Study. Curr Oncol 2023; 30:7777-7788. [PMID: 37623045 PMCID: PMC10453727 DOI: 10.3390/curroncol30080564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Background: To evaluate the use of stereotactic body radiation therapy (SBRT) for spine metastases and the associated factors in Australia. Methods: The Victorian Radiotherapy Minimum Dataset, which captures all episodes of radiotherapy delivered in the state of Victoria, was accessed to evaluate the patterns and trends of SBRT for spine metastases. The primary outcome was SBRT use and associated factors. Results: There were 6244 patients who received 8861 courses of radiotherapy for spine metastases between 2012 and 2017. Of these, 277 (3%) courses were SBRT, which increased from 0.4% in 2012 to 5% in 2017 (P-trend < 0.001). There was a higher proportion of SBRT use in patients with prostate cancer (6%) and melanoma (4%) compared to other cancers (2-3%) (p < 0.001). Patients from the highest socioeconomic quintiles (5%) were more likely to be treated with SBRT compared to patients from the lowest socioeconomic quintiles (3%) (p < 0.001). There was a higher proportion of SBRT use in private radiotherapy centres (6%) compared to public radiotherapy centres (1%) (p < 0.001). No spine SBRT was delivered in regional centres. In multivariate analyses, the year of treatment, age, primary cancers and radiotherapy centres were independently associated with SBRT use. Conclusion: This is the first Australian population-based study quantifying the increasing use of spine SBRT; however, the overall use of spine SBRT remains low. We anticipate an ongoing increase in spine SBRT, as spine SBRT gradually becomes the standard-of-care treatment for painful spine metastases.
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Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne 3004, Australia
- Central Clinical School, Monash University, Melbourne 3004, Australia
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne 3004, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
- Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne 3168, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg 3084, Australia
| | - Jeremy L. Millar
- Alfred Health Radiation Oncology, Melbourne 3004, Australia
- Central Clinical School, Monash University, Melbourne 3004, Australia
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Cuccia F, Tamburo M, Piras A, Mortellaro G, Iudica A, Daidone A, Federico M, Zagardo V, Ferini G, Marletta F, Spatola C, Fazio I, Filosto S, Pergolizzi S, Ferrera G. Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience. Medicina (Kaunas) 2023; 59:1442. [PMID: 37629732 PMCID: PMC10456704 DOI: 10.3390/medicina59081442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Background: The favorable role of SBRT for lymph-nodal oligometastases from prostate cancer has been reported by several retrospective and prospective experiences, suggesting a more indolent natural history of disease when compared to patients with bone oligometastases. This retrospective multicenter study evaluates the outcomes of a cohort of patients treated with stereotactic body radiotherapy for lymph-nodal oligometastases. Methods: Inclusion criteria were up to five lymph-nodal oligometastases detected either with Choline-PET or PSMA-PET in patients naïve for ADT or already ongoing with systemic therapy and at least 6 Gy per fraction for SBRT. Only patients with exclusive lymph-nodal disease were included. The primary endpoint of the study was LC; a toxicity assessment was retrospectively performed following CTCAE v4.0. Results: A total of 100 lymph-nodal oligometastases in 69 patients have been treated with SBRT between April 2015 and November 2022. The median age was 73 years (range, 60-85). Oligometastatic disease was mainly detected with Choline-PET in 47 cases, while the remaining were diagnosed using PSMA-PET, with most of the patients treated to a single lymph-nodal metastasis (48/69 cases), two in 14 cases, and three in the remaining cases. The median PSA prior to SBRT was 1.35 ng/mL (range, 0.3-23.7 ng/mL). Patients received SBRT with a median total dose of 35 Gy (range, 30-40 Gy) in a median number of 5 (range, 3-6) fractions. With a median follow-up of 16 months (range, 7-59 months), our LC rates were 95.8% and 86.3% at 1 and 2 years. DPFS rates were 90.4% and 53.4%, respectively, at 1 and 2 years, with nine patients developing a sequential oligometastatic disease treated with a second course of SBRT. Polymetastatic disease-free survival (PMFS) at 1 and 2 years was 98% and 96%. Six patients needed ADT after SBRT for a median time of ADT-free survival of 15 months (range, 6-22 months). The median OS was 16 months (range, 7-59) with 1- and 2-year rates of both 98%. In multivariate analysis, higher LC rates and the use of PSMA-PET were related to improved DPFS rates, and OS was significantly related to a lower incidence of distant progression. No G3 or higher adverse events were reported. Conclusions: In our experience, lymph-nodal SBRT for oligometastatic prostate cancer is a safe and effective option for ADT delay with no severe toxicity.
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Affiliation(s)
- Francesco Cuccia
- Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy; (G.M.)
| | - Maria Tamburo
- Radiotherapy Unit, Cannizzaro Hospital, 95100 Catania, Italy; (M.T.)
| | - Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, 90100 Palermo, Italy; (A.P.); (A.D.)
- RI.MED Foundation, 90100 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90100 Palermo, Italy
| | | | - Arianna Iudica
- Radiotherapy Unit, AOU Policlinico-VE, 95100 Catania, Italy; (A.I.); (C.S.)
| | - Antonino Daidone
- Radioterapia Oncologica, Villa Santa Teresa, 90100 Palermo, Italy; (A.P.); (A.D.)
| | - Manuela Federico
- Radiotherapy Unit, Casa di Cura Macchiarella, 90100 Palermo, Italy; (M.F.); (I.F.)
| | - Valentina Zagardo
- Radiation Oncology Unit, REM Radioterapia, 95100 Viagrande, CT, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit, REM Radioterapia, 95100 Viagrande, CT, Italy
| | | | - Corrado Spatola
- Radiotherapy Unit, AOU Policlinico-VE, 95100 Catania, Italy; (A.I.); (C.S.)
| | - Ivan Fazio
- Radiotherapy Unit, Casa di Cura Macchiarella, 90100 Palermo, Italy; (M.F.); (I.F.)
| | - Sergio Filosto
- Radiation Oncology Unit, La Maddalena Dipartimento Oncologico di III Livello, 90100 Palermo, Italy;
| | - Stefano Pergolizzi
- Department of Radiological Science, University of Messina, 98121 Messina, Italy
| | - Giuseppe Ferrera
- Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy; (G.M.)
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Yu X, He L, Wang Y, Dong Y, Song Y, Yuan Z, Yan Z, Wang W. A deep learning approach for automatic tumor delineation in stereotactic radiotherapy for non-small cell lung cancer using diagnostic PET-CT and planning CT. Front Oncol 2023; 13:1235461. [PMID: 37601687 PMCID: PMC10437048 DOI: 10.3389/fonc.2023.1235461] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Accurate delineation of tumor targets is crucial for stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). This study aims to develop a deep learning-based segmentation approach to accurately and efficiently delineate NSCLC targets using diagnostic PET-CT and SBRT planning CT (pCT). Methods The diagnostic PET was registered to pCT using the transform matrix from registering diagnostic CT to the pCT. We proposed a 3D-UNet-based segmentation method to segment NSCLC tumor targets on dual-modality PET-pCT images. This network contained squeeze-and-excitation and Residual blocks in each convolutional block to perform dynamic channel-wise feature recalibration. Furthermore, up-sampling paths were added to supplement low-resolution features to the model and also to compute the overall loss function. The dice similarity coefficient (DSC), precision, recall, and the average symmetric surface distances were used to assess the performance of the proposed approach on 86 pairs of diagnostic PET and pCT images. The proposed model using dual-modality images was compared with both conventional 3D-UNet architecture and single-modality image input. Results The average DSC of the proposed model with both PET and pCT images was 0.844, compared to 0.795 and 0.827, when using 3D-UNet and nnUnet. It also outperformed using either pCT or PET alone with the same network, which had DSC of 0.823 and 0.732, respectively. Discussion Therefore, our proposed segmentation approach is able to outperform the current 3D-UNet network with diagnostic PET and pCT images. The integration of two image modalities helps improve segmentation accuracy.
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Affiliation(s)
- Xuyao Yu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Lian He
- Perception Vision Medical Technologies Co Ltd, Guangzhou, China
| | - Yuwen Wang
- Department of Radiotherapy, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Yang Dong
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yongchun Song
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Ziye Yan
- Perception Vision Medical Technologies Co Ltd, Guangzhou, China
| | - Wei Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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Chambrelant I, Jarnet D, Bou-Gharios J, Le Fèvre C, Kuntz L, Antoni D, Jenny C, Noël G. Stereotactic Radiation Therapy of Single Brain Metastases: A Literature Review of Dosimetric Studies. Cancers (Basel) 2023; 15:3937. [PMID: 37568753 PMCID: PMC10416831 DOI: 10.3390/cancers15153937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Stereotactic radiotherapy (SRT) plays a major role in treating brain metastases (BMs) and can be delivered using various equipment and techniques. This review aims to identify the dosimetric factors of each technique to determine whether one should be preferred over another for single BMs treatment. A systematic literature review on articles published between January 2015 and January 2022 was conducted using the MEDLINE and ScienceDirect databases, following the PRISMA methodology, using the keywords "dosimetric comparison" and "brain metastases". The included articles compared two or more SRT techniques for treating single BM and considered at least two parameters among: conformity (CI), homogeneity (HI) and gradient (GI) indexes, delivery treatment time, and dose-volume of normal brain tissue. Eleven studies were analyzed. The heterogeneous lesions along with the different definitions of dosimetric indexes rendered the studied comparison almost unattainable. Gamma Knife (GK) and volumetric modulated arc therapy (VMAT) provide better CI and GI and ensure the sparing of healthy tissue. To conclude, it is crucial to optimize dosimetric indexes to minimize radiation exposure to healthy tissue, particularly in cases of reirradiation. Consequently, there is a need for future well-designed studies to establish guidelines for selecting the appropriate SRT technique based on the treated BMs' characteristics.
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Affiliation(s)
- Isabelle Chambrelant
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Delphine Jarnet
- Department of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France;
| | - Jolie Bou-Gharios
- Radiobiology Laboratory, Institut de Cancérologie Strasbourg Europe (ICANS), Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France;
| | - Clara Le Fèvre
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Laure Kuntz
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Catherine Jenny
- Department of Medical Physics, AP-HP, Sorbonne Université, CEDEX 13, 75651 Paris, France;
| | - Georges Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
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Soykut ED, Odabasi E, Sahin N, Tataroglu H, Baran A, Guney Y. Re-irradiation with stereotactic radiotherapy for recurrent high-grade glial tumors. Rep Pract Oncol Radiother 2023; 28:361-369. [PMID: 37795399 PMCID: PMC10547398 DOI: 10.5603/rpor.a2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/26/2023] [Accepted: 05/23/2023] [Indexed: 10/06/2023] Open
Abstract
Background Despite the radical treatments applied, recurrence is encountered in the majority of high-grade gliomas (HGG). There is no standard treatment when recurrence is detected, but stereotactic radiotherapy (SRT) is a preferable alternative. The aim of this retrospective study is to evaluate the efficacy of SRT for recurrent HGG, and to investigate the factors that affect survival. Materials and methods From 2013 to 2021, a total of 59 patients with 64 lesions were re-irradiated in a single center with the CyberKnife Robotic Radiosurgery System. The primary endpoints of the study were overall survival (OS), progression free survival (PFS) and local control rates (LCR). Results The median time to first recurrence was 13 (4-85) months. SRT was performed as a median prescription dose of 30 Gy (range 15-30), with a median of 5 fractions (1-5). The median follow-up time was 4 months (range 1-57). The median OS was 8 (95% CI: 4.66-11.33) months. Age, grade 3, tumor size were associated with better survival. The median PFS was 5 [95% confidence interval (CI): 3.39-6.60] months. Age, grade 3 and time to recurrence > 9 months were associated with improved PFS. Grade 3 gliomas (p = 0.027), size of tumor < 2 cm (p = 0.008) remained independent prognostic factors for OS in multivariate analysis. Conclusion SRT is a viable treatment modality with significant survival contribution. Since it may have a favorable prognostic effect on survival in patients with tumor size < 2 cm, we recommend early diagnosis of recurrence and a decision to re-irradiate a smaller tumor during follow-up.
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Affiliation(s)
- Ela Delikgoz Soykut
- Department of Radiation Oncology, Samsun Education and Research Hospital, Samsun, Türkiye
| | - Eylem Odabasi
- Department of Radiation Oncology, Samsun Education and Research Hospital, Samsun, Türkiye
| | - Nilgun Sahin
- Department of Radiation Oncology, Samsun Education and Research Hospital, Samsun, Türkiye
| | - Hatice Tataroglu
- Department of Radiation Oncology, Samsun Education and Research Hospital, Samsun, Türkiye
| | - Ahmet Baran
- Department of Medical Oncology, Samsun Education and Research Hospital, Samsun, Türkiye
| | - Yildiz Guney
- Department of Radiation Oncology, Memorial Ankara Hospital, Ankara, Türkiye
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Polanowski P, Nasiek A, Grządziel A, Pietruszka A, Składowski K, Polanowska K. Stereotactic Radiotherapy in Combination with Immunotherapy in Treatment of Advanced Recurrent Squamous Cell Carcinoma of the Larynx. Biomedicines 2023; 11:2067. [PMID: 37509706 PMCID: PMC10377655 DOI: 10.3390/biomedicines11072067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Squamous cell carcinoma (SCC) of the larynx in advanced stages is a challenging malignancy to treat with a high recurrence and death rate. An individualized approach to treatment is crucial in such patients. We present a 58-year-old male patient with SCC of the larynx in the T3N0M0 stage who was treated with concurrent radiochemotherapy. A total of 17 months after the radical treatment, the patient underwent a laryngectomy due to recurrence. A total of 11 months after the operation, local failure was diagnosed. In the next order, the patient received six cycles of palliative chemotherapy according to cisplatin 100 mg/m2 and 5-fluorouracil 1000 mg/m2. After three months, due to progression, Nivolumab-based immunotherapy was administered, ensuring disease stabilization. After the 56th cycle of Nivolumab, another progression was documented. The addition of stereotactic radiotherapy (18 Gy in three fractions) to immunotherapy led to significant regression of the disease and enabled the continuation of Nivolumab to the 70th cycle. The presented case demonstrates the usefulness of the combination of stereotactic radiotherapy with immunotherapy in prolonging the local control.
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Affiliation(s)
- Paweł Polanowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Aleksandra Nasiek
- 3rd Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Aleksandra Grządziel
- Radiotherapy Planning Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Agnieszka Pietruszka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115 Cracow, Poland
| | - Krzysztof Składowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Katarzyna Polanowska
- Ophthalmology Department, St. Barbara Provincial Hospital No 5, Plac Medyków 1, 41-200 Sosnowiec, Poland
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Cuccia F, D'Alessandro S, Carruba G, Figlia V, Spera A, Cespuglio D, Mortellaro G, Iacoviello G, Lo Casto A, Tringali G, Craparo G, Blasi L, Ferrera G. Fractionated Stereotactic Radiotherapy with Helical Tomotherapy for Brain Metastases: A Mono-Institutional Experience. J Pers Med 2023; 13:1099. [PMID: 37511711 PMCID: PMC10381210 DOI: 10.3390/jpm13071099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Background: The present study reports on the outcomes of our mono-institutional experience of Helical Tomotherapy (HT)-based SRT for brain metastases. The use of this linac is less frequently reported for this kind of treatment. Methods: This retrospective study displays a series of patients treated with HT-SRT. The eligibility of using SRT for brain metastases was defined by a Karnofsky performance status of >70, a life expectancy of >6 months, and controlled extra-cranial disease; no SRT was allowed in the case of a number of brain metastases larger than 10. All the cases were discussed by a multidisciplinary board. Toxicity assessments were performed based on CTCAE v5.0. Survival endpoints were assessed using the Kaplan-Meier method, and univariate and multivariate analyses were carried out to identify any potential predictive factor for an improved outcome. Results: Sixty-four lesions in 37 patients were treated using HT-SRT with a median total dose of 30 Gy in five fractions. The median follow-up was 7 months, and the 1- and 2-year LC rates were both 92.5%. The IPFS rates were and 56.75% and 51.35%. The OS rates were 54% and 40%. The UA showed better IPFS rates significantly related to male sex (p = 0.049), a BED12 of ≥42 Gy (p = 0.006), and controlled extracranial disease (p = 0.03); in the MA, a favorable trend towards LC (p = 0.11) and higher BED (p = 0.11) schedules maintained a correlation with improved IPFS rates, although statistical significance was not reached. Conclusions: HT-based SRT for brain metastases showed safety and efficacy in our monoinstiutional experience. Higher RT doses showed statistical significance for improved outcomes of LC and OS.
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Affiliation(s)
| | | | - Giuseppe Carruba
- Division of Internationalization and Health Research (SIRS), ARNAS Civico Hospital, 90100 Palermo, Italy
| | - Vanessa Figlia
- Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
| | - Antonio Spera
- Radiation Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
| | | | | | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, 90133 Palermo, Italy
| | | | - Giuseppe Craparo
- Neuroradiology Unit, ARNAS Civico Hospital, 90100 Palermo, Italy
| | - Livio Blasi
- Medical Oncology, ARNAS Civico Hospital, 90100 Palermo, Italy
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Uysal E, Aksaray F, Dincer S, Altın S. Robotic stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma. Indian J Cancer 2023; 60:353-358. [PMID: 36861705 DOI: 10.4103/ijc.ijc_1414_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background We aimed to evaluate the outcomes of patients reirradiated with stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma (r-NPC) in our hospital. Methods We retrospectively analyzed 10 patients with r-NPC previously irradiated with definitive radiotherapy. Local recurrences were irradiated with a dose of 25 to 50 Gy (median: 26.25 Gy) in 3 to 5 fractions (fr) (median: 5 fr). The survival outcomes calculated from the time of recurrence diagnosis were obtained using Kaplan-Meier analysis and compared with the log-rank test. Toxicities were assessed by using Common Terminology Criteria for Adverse Events Version 5.0. Results The median age was 55 years (37-79 years), and nine patients were men. The median follow-up was 26 months (3-65 months) after reirradiation. The median overall survival (OS) was 40 months, OS in 1 and 3 years were 80% and 57%, respectively. OS rate of rT4 (n = 5, 50%) was worse compared with rT1, rT2, and rT3 (P = 0.040). In addition, those with less than 24 months of interval between first treatment and recurrence had worse OS (P = 0.017). One patient exhibited Grade 3 toxicity. There is no other Grade ≥3 acute or late toxicities. Conclusion In r-NPC, reirradiation is inevitable for patients who are not suitable for radical surgical resection. However, serious complications and side effects prevent dose escalation due to the critical structures previously irradiated. Prospective studies with a large number of patients are required to find the optimal acceptable dose.
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Affiliation(s)
- Emre Uysal
- Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiation Oncology, Sisli, Istanbul, Turkey
| | - Ferdi Aksaray
- Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiation Oncology, Sisli, Istanbul, Turkey
| | - Selvi Dincer
- Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiation Oncology, Sisli, Istanbul, Turkey
| | - Suleyman Altın
- Prof. Dr. Cemil Tascioglu City Hospital, Department of Radiation Oncology, Sisli, Istanbul, Turkey
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Zarkar A, Henderson D, Carver A, Heyes G, Harrop V, Tutill S, Kilkenny J, Marshall A, Elbeltagi N, Howard H. First UK patient cohort treated with stereotactic ablative radiotherapy for primary kidney cancer. BJUI Compass 2023; 4:464-472. [PMID: 37334027 PMCID: PMC10268573 DOI: 10.1002/bco2.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 06/20/2023] Open
Abstract
Aims Stereotactic ablative radiotherapy (SABR) for primary renal cell carcinoma (RCC) is a promising non-invasive ablative treatment option. A prospective interventional clinical trial published showed that treatment was feasible and well tolerated. We present the first single-institution UK cohort of patients with primary RCC receiving protocol-based SABR with prospective follow-up. We also present a protocol that could be used to facilitate more widespread use of the treatment. Materials and methods Nineteen biopsy-proven primary RCC patients were treated with either 42 Gy in three fractions on alternate days or 26 Gy in a single fraction based on predefined eligibility criteria using either Linear Accelerator or CyberKnife platform. Prospective toxicity data using CTCAE V4.0 and outcome data such as estimated glomerular filtration rate (eGFR) and tumour response using CT thorax, abdomen and pelvis (CT-TAP) were collected at 6 weeks, 3, 6, 12, 18 and 24 months post treatment. Results The 19 patients had a median age of 76 years (interquartile range [IQR] 64-82 years) and 47.4% were males, and they had a median tumour size of 4.5 cm (IQR 3.8-5.2 cm). Single and fractionated treatment was well tolerated and there were no significant acute side effects. The mean drop from baseline in eGFR at 6 months was 5.4 ml/min and that at 12 months was 8.7 ml/min. The overall local control rate at both 6 and 12 months was 94.4%. Overall survival at 6 and 12 months was 94.7% and 78.3%, respectively. After a median follow-up of 17 months, three patients experienced a Grade 3 toxicity, which was resolved with conservative management. Conclusion SABR for primary RCC is a safe and feasible treatment for medically unfit patients, which can be delivered in most UK cancer centres using standard Linear Accelerator as well as CyberKnife platforms.
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Affiliation(s)
- Anjali Zarkar
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Dan Henderson
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Antony Carver
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Geoff Heyes
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Victoria Harrop
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Sarah Tutill
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Julie Kilkenny
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | | | - Helen Howard
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Green H, Taylor A, Khoo V. Beyond the Knife in Renal Cell Carcinoma: A Systematic Review-To Ablate or Not to Ablate? Cancers (Basel) 2023; 15:3455. [PMID: 37444565 DOI: 10.3390/cancers15133455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Intensified systemic therapy in metastatic renal cell carcinoma (mRCC) has led to improved patient outcomes. Patients commonly require local control of one or a few metastases. The aim was to evaluate metastasis-directed ablative therapies in extracranial mRCC. Two databases and one registry were searched, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, for all prospective and matched-pair case-control mRCC studies of radiofrequency ablation (RFA), cryotherapy, microwave ablation (MWA), and stereotactic body radiotherapy (SBRT). Eighteen studies were identified. Fourteen investigated SBRT in 424 patients. Four thermal ablation studies were identified: two cryotherapy (56 patients) and two RFA studies (90 patients). The median participant number was 30 (range 12-69). The combined median follow-up was 17.3 months (range 8-52). Four SBRT studies reported local control (LC) at 12 months, median 84.4% (range 82.5-93). Seven studies (six SBRT and one cryotherapy) reported an LC rate of median 87% (79-100%). Median overall survival (OS) was reported in eight studies (five SBRT, two cryotherapy, and one RFA) with a median of 22.7 months (range 6.7-not reached). Median progression-free survival was reported in seven studies (five SBRT, one cryotherapy, and one RFA); the median was 9.3 months (range 3.0-22.7 months). Grade ≥ 3 toxicity ranged from 1.7% to 10%. SBRT has excellent local control outcomes and acceptable toxicity. Only four eligible thermal ablative studies were identified and could not be compared with SBRT. Translationally rich definitive studies are warranted.
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Affiliation(s)
- Harshani Green
- Royal Marsden Hospitals NHS Foundation Trust, London SW3 6JJ, UK
- Institute of Cancer Research, London SW7 3RP, UK
| | - Alexandra Taylor
- Royal Marsden Hospitals NHS Foundation Trust, London SW3 6JJ, UK
- Institute of Cancer Research, London SW7 3RP, UK
| | - Vincent Khoo
- Royal Marsden Hospitals NHS Foundation Trust, London SW3 6JJ, UK
- Institute of Cancer Research, London SW7 3RP, UK
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, VIC 3800, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
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Falco M, Masojć B, Sulikowski T. Radiotherapy in Pancreatic Cancer: To Whom, When, and How? Cancers (Basel) 2023; 15:3382. [PMID: 37444492 DOI: 10.3390/cancers15133382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The diagnosis rate of pancreatic cancer is steadily increasing. The average age of onset is close to 70 years. In most cases, the disease is diagnosed at an advanced stage. The indications for and techniques of radiotherapy are changing over time. The aim of this thesis is to present the role and possibilities of radiotherapy from the perspective of radiation oncologist. The most common cause of treatment failure in pancreatic cancer remains generalisation. The implementation of new systemic treatment regimens contributes to improved treatment outcomes regardless of the stage of the disease. With improved treatment outcomes in terms of the incidence of distant metastases, the impact of local curability on the length and quality of life of patients increases. Modern radiotherapy offers the opportunity to achieve high local cure rates. Postoperative radiotherapy in combination with chemotherapy seems justified in the group of postoperative pancreatic cancer patients with pT3 and pN+ features. In the group of patients with borderline resectable pancreatic cancer, the impact of radiotherapy in combination with the latest chemotherapy regimens is difficult to define clearly. In the setting of a diagnosis of advanced pancreatic cancer, radiotherapy, especially stereotactic radiotherapy, in combination with chemotherapy, contributes to improved local curability and allows to achieve a significantly reduced level of pain.
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Affiliation(s)
- Michał Falco
- Radiation Oncology Department, West Pomeranian Oncology Center, Strzałowska 22, 71-730 Szczecin, Poland
- Hospicjum Św. Jana Ewnagelisty, Pokoju 77, 71-740 Szczecin, Poland
| | - Bartłomiej Masojć
- Radiation Oncology Department, West Pomeranian Oncology Center, Strzałowska 22, 71-730 Szczecin, Poland
| | - Tadeusz Sulikowski
- Department of General, Minimally Invasive, and Gastroenterological Surgery, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
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Polanowski P, Nasiek A, Grządziel A, Chmielik E, Pietruszka A, Składowski K, Polanowska K. Stereotactic Radiotherapy Boost in Treatment of Persistent Periocular Sebaceous Carcinoma after Surgery. Biomedicines 2023; 11:1538. [PMID: 37371633 DOI: 10.3390/biomedicines11061538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Sebaceous carcinoma is a rare malignancy that should be treated with surgical resection. Nonetheless, a dynamic and aggressive course of the disease may disqualify a patient from this treatment. Applying radiotherapy with the escalation dose using a stereotactic boost is worthy of consideration as a radical treatment. In this paper, we present the case study of a young patient with a tumor localized in the periocular area. The patient was treated with operation two times without a satisfactory effect. Conventional radiotherapy, 60 Gy in 30 fractions, combined with chemotherapy based on cisplatin 40 mg/m2 and the addition of a stereotactic radiosurgery boost were administered. The tolerance of this treatment was acceptable. During the 2-year follow-up, local and distant recurrences were not diagnosed. The presented case shows the usefulness of an individualized approach in the radical treatment of sebaceous carcinoma with the use of the stereotactic radiotherapy boost. This is a subsequent example of the implementation of the boost in head and neck carcinoma, which yields a positive result.
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Affiliation(s)
- Paweł Polanowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Aleksandra Nasiek
- 3rd Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Aleksandra Grządziel
- Radiotherapy Planning Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Agnieszka Pietruszka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115 Cracow, Poland
| | - Krzysztof Składowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Katarzyna Polanowska
- Ophthalmology Department, St. Barbara Provincial Hospital No 5, Plac Medyków 1, 41-200 Sosnowiec, Poland
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Ferini G, Zagardo V, Critelli P, Santacaterina A, Sava S, Harikar MM, Venkataram T, Umana GE, Viola A, Valenti V, Forte S. Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance? J Pers Med 2023; 13:jpm13050841. [PMID: 37241012 DOI: 10.3390/jpm13050841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. METHODS We retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively. RESULTS Eight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy. CONCLUSIONS Adding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness.
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Affiliation(s)
- Gianluca Ferini
- REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy
| | | | - Paola Critelli
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98122 Messina, Italy
| | - Anna Santacaterina
- Radiation Oncology Unit, Papardo Teaching Hospital, 98158 Messina, Italy
| | - Serena Sava
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | - Mandara Muralidhar Harikar
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy
| | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy
| | - Anna Viola
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
| | - Vito Valenti
- REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy
| | - Stefano Forte
- Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy
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Galietta E, Strolin S, Bisello S, Cellini F, Lovato L, Ravegnini G, Martignani C, Spadotto A, Buwenge M, Cammelli S, Strigari L, Morganti AG, Arcelli A. Stereotactic Arrhythmia Radioablation (STAR): A Multidisciplinary Narrative Minireview of Preclinical Studies. In Vivo 2023; 37:963-971. [PMID: 37103087 DOI: 10.21873/invivo.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The aim of this narrative review of the literature was to collect and analyze the results of the published preclinical studies on stereotactic arrhythmia radioablation (STAR) in the treatment of refractory cardiac arrhythmias. A literature search was conducted on PubMed using the following terms: ("stereotactic" OR "SBRT" OR "SABR" OR "radioablation" OR "radiosurgery") AND ("arrhythmia" OR "tachycardia"). Preclinical and pathological reports published in English without time limit, comprising studies of STAR in animal models and histological analyzes of explanted animal and human hearts were included. The analyzed studies confirm that doses lower than 25 Gy seem to produce sub-optimal therapeutic results whereas doses >35 Gy are less safe in terms of radiation-induced toxicity. However, long-term results (>1 year) are still missing and reporting outcomes based on low dose irradiation (≤15 Gy). Finally, STAR proved to be an effective therapy in the analyzed studies despite the irradiation of rather different cardiac targets. Therefore, additional studies are needed to: 1) compare the outcomes of STAR at doses of 25 Gy versus 30 Gy; 2) evaluate the long-term results (>1 year) in animal models irradiated at doses similar to those used in the clinic; 3) define the optimal target.
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Affiliation(s)
- Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy;
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Strolin
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Bisello
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Lovato
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology, Cardiovascular Section, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology (FABIT), University of Bologna, Bologna, Italy
| | - Cristian Martignani
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology, Cardiovascular Section, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Alberto Spadotto
- Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology, Cardiovascular Section, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Milly Buwenge
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Walls GM, McCann C, Ball P, Atkins KM, Mak RH, Bedair A, O'Hare J, McAleese J, Harrison C, Tumelty KA, Crockett C, Black SL, Nelson C, O'Connor J, Hounsell AR, McGarry CK, Butterworth KT, Cole AJ, Jain S, Hanna GG. IA PULMONARY VEIN ATLAS FOR RADIOTHERAPY PLANNING. Radiother Oncol 2023; 184:109680. [PMID: 37105303 DOI: 10.1016/j.radonc.2023.109680] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE Cardiac arrhythmia is a recognised potential complication of thoracic radiotherapy, but the responsible cardiac substructures for arrhythmogenesis have not been identified. Arrhythmogenic tissue is commonly located in the pulmonary veins (PVs) of cardiology patients with arrhythmia, however these structures are not currently considered organs-at-risk during radiotherapy planning. A standardised approach to their delineation was developed and evaluated. MATERIALS AND METHODS The gross and radiological anatomy relevant to atrial fibrillation was derived from cardiology and radiology literature by a multidisciplinary team. A region of interest and contouring instructions for radiotherapy computed tomography scans were iteratively developed and subsequently evaluated. Radiation oncologists (n=5) and radiation technologists (n=2) contoured the PVs on the four-dimensional planning datasets of five patients with locally advanced lung cancer treated with 1.8-2.75 Gy fractions. Contours were compared to reference contours agreed by the researchers using geometric and dosimetric parameters. RESULTS The mean dose to the PVs was 35% prescription dose. Geometric and dosimetric similarity of the observer contours with reference contours was fair, with an overall mean Dice of 0.80 ± 0.02. The right superior PV (mean DSC 0.83 ± 0.02) had better overlap than the left (mean DSC 0.80 ± 0.03), but the inferior PVs were equivalent (mean DSC of 0.78). The mean difference in mean dose was 0.79 Gy ± 0.71 (1.46% ± 1.25). CONCLUSION A PV atlas with multidisciplinary approval led to reproducible delineation for radiotherapy planning, supporting the utility of the atlas in future clinical radiotherapy cardiotoxicity research encompassing arrhythmia endpoints.
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Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Conor McCann
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Peter Ball
- Department of Radiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, 274 Grosvenor Rd, Belfast, Northern Ireland
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Ahmed Bedair
- North West Cancer Centre, ltnagelvin Hospital, Glenshane Road, Derry, Northern Ireland
| | - Jolyne O'Hare
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Claire Harrison
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Karen A Tumelty
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Cathryn Crockett
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Sarah-Louise Black
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Catherine Nelson
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - John O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Alan R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Conor K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Aidan J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland.
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Navez J, Bouchart C, Mans L, Devos S, Loi P, Closset J, Van Laethem JL. Neoadjuvant chemotherapy associated with isotoxic high-dose stereotactic body radiotherapy does not increase postoperative complications after pancreaticoduodenectomy for nonmetastatic pancreatic cancer. J Surg Oncol 2023. [PMID: 36999597 DOI: 10.1002/jso.27252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of radiotherapy in the therapeutic sequence of nonmetastatic pancreatic cancer (PC) is controversial, including isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT). This study aimed to compare postoperative outcome of patients with nonmetastatic PC undergoing neoadjuvant treatment (NAT) including iHD-SBRT versus upfront pancreaticoduodenectomy (PD). METHODS All patients undergoing PD for PC from 2017 to 2021 were retrospectively analyzed, identifying patients receiving NAT with iHD-SBRT. Toxicity of treatments and postoperative outcome were assessed and analyzed in a propensity score-matched population. RESULTS Eighty-nine patients underwent upfront surgery (surgery group) and 22 after NAT and iHD-SBRT (SBRT group). No major side effects SBRT-related were identified preoperatively. Postoperative morbidity was similar between groups. There was no postoperative death in SBRT group, and six in surgery group (p = 0.597). No difference was observed in the rates of complications related to pancreatic surgery. The postoperative hospital stay was shorter in SBRT versus surgery groups (p = 0.016). After propensity score matching, no significant difference in the postoperative morbidity was observed between groups. CONCLUSIONS Incorporation of iHD-SBRT in the NAT sequence before PD for PC did not increase postoperative morbidity compared with upfront surgery. These results confirm the feasibility and safety of iHD-SBRT for the upcoming STEREOPAC trial.
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Affiliation(s)
- Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Laura Mans
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Soline Devos
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrizia Loi
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Luc Van Laethem
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Shen Z, Luo H, Li S, Tan X, Tian X, Liu Q, Jin F. A novel dose fall-off index and preliminary application in brain and lung stereotactic radiotherapy. Med Phys 2023; 50:3127-3136. [PMID: 36960718 DOI: 10.1002/mp.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) has been widely used for the treatment of brain metastases and early stage non-small-cell lung cancer (NSCLC). Excellent SRT plans are characterized by steep dose fall-off, making it critical to accurately and comprehensively predict and evaluate dose fall-off. PURPOSE A novel dose fall-off index was proposed to ensure high-quality SRT planning. METHODS The novel gradient index (NGI) had two different modes: NGIx V for three-dimensions and NGIx r for one-dimension. NGIx V and NGIx r were defined as the ratios of the decreased percentage dose (x%) to the corresponding isodose volume and equivalent sphere radii, respectively. A total of 243 SRT plans at our institution between April 2020 and March 2022 were enrolled, including 126 brain and 117 lung SRT plans. Measurement-based verifications were performed using SRS MapCHECK. Ten plan complexity indexes were calculated. Dosimetric parameters related to radiation injuries were also extracted, including the normal brain volume exposed to 12 Gy (V12 ) and 18 Gy (V18 ) during single-fraction SRT (SF-SRT) and multi-fraction SRT (MF-SRT), respectively and the normal lung volume exposed to 12 Gy (V12 ). The performance of NGI and other common dose fall-off indexes, gradient index (GI), R50% and D2cm were evaluated using Spearman correlation analysis to explore their correlations with the PTV size, gamma passing rate (GPR), plan complexity indexes and dosimetric parameters. RESULTS There were statistically significant correlations between NGI and PTV size (r = -0.98, p < 0.01 for NGI50 V and r = -0.93, p < 0.01 for NGI50 r), which were the strongest correlations compared with GI (r = 0.11, p = 0.13), R50% (r = -0.08, p = 0.19) and D2cm (r = 0.84, p < 0.01). The fitted formulas of NGI50 V = 23.86V-1.00 and NGI50 r = 113.5r-1.05 were established. The GPRs of enrolled SRT plans were 98.6 ± 1.7%, 94.2 ± 4.7% and 97.1 ± 3.1% using the criteria of 3%/2 mm, 3%/1 mm and 2%/2 mm, respectively. NGI50 V achieved the strongest correlations with various plan complexity indexes (|r| ranged from 0.67 to 0.91, p < 0.01). NGI50 V also showed the highest r values with V12 (r = -0.93, p < 0.01) and V18 (r = -0.96, p < 0.01) of the normal brain during SF-SRT and MF-SRT, respectively and V12 (r = -0.86, p < 0.01) of the normal lung during lung SRT. CONCLUSIONS Compared with GI, R50% and D2cm , the proposed dose fall-off index, NGI, had the strongest correlations with the PTV size, plan complexity and V12 /V18 of the normal tissues. These correlations established on NGI are more helpful and reliable for SRT planning, quality control and reducing the risk of radiation injuries. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhengwen Shen
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Huanli Luo
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Shi Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xia Tan
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiumei Tian
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qiang Liu
- Department of Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Suzuki T, Kagawa K, Sato K, Nomura R, Irie K, Ichi S. CyberKnife radiosurgery for spinal intramedullary arteriovenous malformations: a single-center experience. World Neurosurg 2023:S1878-8750(23)00380-7. [PMID: 36940806 DOI: 10.1016/j.wneu.2023.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Intramedullary spinal AVM (ISAVM, glomus type) is a type of spinal cord arteriovenous malformation, which is a rare disease known often to have a complex vascular supply interfering with that of the spinal cord, and is in complex anatomical relations with cord structures and nerve roots. Though microsurgical and endovascular treatment has mainly been the standard options, in high-risk cases with these treatments, stereotactic radiotherapy (SRT) might be the option of choice. METHOD We retrospectively reviewed 10 consecutive patients with ISAVM who received SRT using CyberKnife® (Accuray, Inc., Sunnyvale, CA) at the Japanese Red Cross Medical Center (Tokyo, Japan) from 2011/1-2022/3. RESULTS No case in this series suffered from hemorrhage after applying SRT. One case experienced neurological impairment ten years after SRT, which we attributed to venous congestion due to the remaining lesion. No case of radiation myelopathy was observed in this series. In one case, the nidus volume reduction and loss of flow voids were obvious, though improvement in the neurological outcome was not apparent. No radiological changes were observed in the other nine patients. CONCLUSION Even in lesions without radiological changes, no hemorrhagic events were observed for an average period of 4 years. SRT may be a feasible option in treating ISAVM, especially for lesions in which microsurgical resection and endovascular treatment are inapplicable. To ascertain the safety and efficacy of this approach, further studies with more patients and longer follow up is required.
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Affiliation(s)
- Tomoya Suzuki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kenji Kagawa
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kengo Sato
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Koreaki Irie
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Lee SF, Yip PL, Chan OL, Lee VWY, Wong A, Choi HCW. Brain Metastasis Growth Kinetics: A Novel Prognosticator for Stereotactic Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00059-6. [PMID: 36890037 DOI: 10.1016/j.clon.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
AIMS The rate of size change in brain metastasis may have clinical implications on tumour biology and prognosis for patients who receive stereotactic radiotherapy (SRT). We analysed the prognostic value of brain metastasis size kinetics and propose a model for patients with brain metastases treated with linac-based SRT in predicting overall survival. MATERIALS AND METHODS We analysed the patients receiving linac-based SRT between 2010 and 2020. Patient and oncological factors, including the changes in sizes of brain metastasis between the diagnostic and stereotactic magnetic resonance imaging, were collected. The associations between prognostic factors and overall survival were assessed using Cox regression with least absolute selection and shrinkage operator (LASSO) checked by 500 bootstrap replications. Our prognostic score was calculated by evaluating the most statistically significant factors. Patients were grouped and compared according to our proposed score, Score Index for Radiosurgery in Brain Metastases (SIR) and Basic Score for Brain Metastases (BS-BM). RESULTS In total, 85 patients were included. We developed the prognostic model based on the most important predictors of overall survival: growth kinetics, i.e. percentage change in brain metastasis size per day between the diagnostic and stereotactic magnetic resonance imaging (hazard ratio per 1% increase, 1.32; 95% confidence interval 1.06-1.65), extracranial oligometastatic diseases (≤5 involvements) (hazard ratio 0.28; 95% confidence interval 0.16-0.52) and the presence of neurological symptoms (hazard ratio 2.99; 95% confidence interval 1.54-5.81). Patients with scores 0, 1, 2 and 3 had a median overall survival of 44.4 (95% confidence interval 9.6-not reached), 20.4 (95% confidence interval 15.6-40.8), 12.0 (95% confidence interval 7.2-22.8) and 2.4 (95% confidence interval 1.2-not reached) years, respectively. The optimism-corrected c-indices for our proposed model, SIR and BS-BM were 0.65, 0.58 and 0.54, respectively. CONCLUSIONS Brain metastasis growth kinetics is a valuable metric for survival outcomes of SRT. Our model is useful in identifying patients with brain metastasis treated with SRT with different overall survival.
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Lucia F, Hamya M, Pinot F, Bourhis D, Le Roux PY. Lung Stereotactic Body Radiation Therapy in a Patient with Severe Lung Function Impairment Allowed by Gallium-68 Perfusion PET/CT Imaging: A Case Report. Diagnostics (Basel) 2023; 13:diagnostics13040718. [PMID: 36832204 PMCID: PMC9955343 DOI: 10.3390/diagnostics13040718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Lung stereotactic body radiotherapy (SBRT) is increasingly proposed, especially for patients with poor lung function who are not eligible for surgery. However, radiation-induced lung injury remains a significant treatment-related adverse event in these patients. Moreover, for patients with very severe COPD, we have very few data about the safety of SBRT for lung cancer. We present the case of a female with very severe chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in one second (FEV1) of 0.23 L (11%), for whom a localized lung tumor was found. Lung SBRT was the only possible treatment. It was allowed and safely performed, based on a pre-therapeutic evaluation of regional lung function with Gallium-68 perfusion lung positron emission tomography combined with computed tomography (PET/CT). This is the first case report to highlight the potential use of a Gallium-68 perfusion PET/CT in order to safely select patients with very severe COPD who can benefit from SBRT.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- LaTIM, INSERM, UMR 1101, University of Brest, 29200 Brest, France
- Correspondence:
| | - Mohamed Hamya
- Radiation Oncology Department, University Hospital, 29200 Brest, France
| | - Fanny Pinot
- Inserm, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, University of Brest, 29238 Brest, France
| | - David Bourhis
- Inserm, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, University of Brest, 29238 Brest, France
| | - Pierre-Yves Le Roux
- Inserm, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, University of Brest, 29238 Brest, France
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Corrao G, Franchi M, Zaffaroni M, Vincini MG, de Marinis F, Spaggiari L, Orecchia R, Marvaso G, Jereczek-Fossa BA. Upfront Advanced Radiotherapy and New Drugs for NSCLC Patients with Synchronous Brain Metastases: Is the Juice Worth the Squeeze? A Real-World Analysis from Lombardy, Italy. Cancers (Basel) 2023; 15:cancers15041103. [PMID: 36831447 PMCID: PMC9953825 DOI: 10.3390/cancers15041103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
AIM Healthcare administrative databases represent a valuable source for real-life data analysis. The primary aim of this study is to compare effectiveness and cost profile in non-small-cell lung cancer (NSCLC) patients harboring synchronous brain metastases (BMs) who received non-chemo first-line systemic therapy with or without advanced radiotherapy (aRT). METHODS Diagnostic ICD-9-CM codes were used for identifying all patients with a new diagnosis of lung cancer between 2012 and 2019. Among these, patients who had started a first-line systemic treatment with either TKIs or pembrolizumab, alone or in combination with intensity-modulated or stereotactic RT, were selected. Clinical outcomes investigated included overall survival (OS), progression-free survival (PFS), and time-to-treatment failure (TTF). The cost outcome was defined as the average per capita cumulative healthcare direct costs of the treatment, including all inpatient and outpatient costs. RESULTS The final cohort included 177 patients, of whom 58 were treated with systemic treatment plus aRT (STRT) and 119 with systemic treatment alone. The addition of aRT to systemic treatment was associated with a significantly better OS (p = 0.020) and PFS (p = 0.041) than systemic therapy alone. The ICER (incremental cost-effectiveness ratio) value indicated an average cost of €3792 for each month of survival after STRT treatment and confirmed clinical effectiveness but higher healthcare costs. CONCLUSIONS This real-world study suggests that upfront aRT for NCLSC patients with synchronous BMs represents a valid treatment strategy, boosting the efficacy of novel and emerging drug classes with sustainable costs for the health service. TRANSLATIONAL RELEVANCE The present real-world study reports that the use of upfront advanced radiotherapyaRT and new-generation systemic agents, such as TKIs and pembrolizumab, may have higher oncological control and an improved cost-effectiveness profile than the use of new-generation systemic agents alone in NCLSC patients with synchronous brain metastases. Acquired evidence can also be used to inform policymakers that adding advanced radiotherapy results is a sustainable cost for the health service. Since approximately 50% of patients do not meet RCT inclusion criteria, a significant proportion of them is receiving treatment that is not evidence-informed; therefore, these results warrant further studies to identify the best radiotherapy timing and possible dose escalation approaches to improving treatment efficacy in patient subgroups not typically represented in randomized controlled trials.
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Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Correspondence:
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Huang LH, Gao ZZ, Li WY, Zhang HC, Zheng JW, Liu XP. Stereotactic body radiation therapy for refractory premature ventricular contractions that originate from the left ventricular summit: A case report. Pacing Clin Electrophysiol 2023; 46:190-194. [PMID: 36069105 DOI: 10.1111/pace.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/20/2022] [Indexed: 11/29/2022]
Abstract
The case highlights an available method to minimize the target volume and reduce the radiation dose by using a temporary catheter, to reduce the long-term risk of radiotherapy for ventricular arrhythmias.
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Affiliation(s)
- Li-Hong Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhi-Zhang Gao
- Department of Radiation Oncology, Sunshine Union Hospital, Weifang, China
| | - Wei-Yong Li
- Department of Radiation Oncology, Sunshine Union Hospital, Weifang, China
| | - Hou-Cai Zhang
- Department of Radiation Oncology, Sunshine Union Hospital, Weifang, China
| | | | - Xing-Peng Liu
- Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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