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Hoffmann MS. Routine consolidation of early stage primary bone lymphoma with radiation therapy does not improve outcomes. Haematologica 2024; 109:1323-1324. [PMID: 37981838 PMCID: PMC11063859 DOI: 10.3324/haematol.2023.284303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023] Open
Abstract
Not available.
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Affiliation(s)
- Marc S Hoffmann
- Division of Hematologic Malignancies and Cellular Therapeutics University of Kansas Cancer Center Kansas City, KS.
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Hörberger F, Andersson KM, Enmark M, Kristensen I, Flejmer A, Edvardsson A. Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness. Acta Oncol 2024; 63:62-69. [PMID: 38415848 DOI: 10.2340/1651-226x.2024.23964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE/BACKGROUND The aim of this study was to evaluate pencil beam scanning (PBS) proton therapy (PT) in deep inspiration breath-hold (DIBH) for mediastinal lymphoma patients, by retrospectively evaluating plan robustness to the clinical target volume (CTV) and organs at risk (OARs) on repeated CT images acquired throughout treatment. Methods: Sixteen mediastinal lymphoma patients treated with PBS-PT in DIBH were included. Treatment plans (TPs) were robustly optimized on the CTV (7 mm/4.5%). Repeated verification CTs (vCT) were acquired during the treatment course, resulting in 52 images for the entire patient cohort. The CTV and OARs were transferred from the planning CT to the vCTs with deformable image registration and the TPs were recalculated on the vCTs. Target coverage and OAR doses at the vCTs were compared to the nominal plan. Deviation in lung volume was also calculated. RESULTS The TPs demonstrated high robust target coverage throughout treatment with D98%,CTV deviations within 2% for 14 patients and above the desired requirement of 95% for 49/52 vCTs. However, two patients did not achieve a robust dose to CTV due to poor DIBH reproducibility, with D98%,CTV at 78 and 93% respectively, and replanning was performed for one patient. Adequate OAR sparing was achieved for all patients. Total lung volume variation was below 10% for 39/52 vCTs. CONCLUSION PBS PT in DIBH is generally a robust technique for treatment of mediastinal lymphomas. However, closely monitoring the DIBH-reproducibility during treatment is important to avoid underdosing CTV and achieve sufficient dose-sparing of the OARs.
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Affiliation(s)
- Filip Hörberger
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden.
| | | | - Marika Enmark
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden; Department of Medical Physics, The Skandion Clinic, Uppsala, Sweden
| | - Ingrid Kristensen
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden; Department of Clinical Sciences, Oncology, Lund University, Lund, Sweden
| | - Anna Flejmer
- Department of Medical Physics, The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Anneli Edvardsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden; Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Mazzarella C, Chiesa S, Toppi L, Hohaus S, Gaudino S, D'Alo F, Dinapoli N, Davide R, Zinicola T, Bracci S, Martino A, Beghella Bartoli F, Lepre E, Bertolini R, Mariani S, Colosimo C, Frascino V, Mattiucci GC, Gambacorta MA, Valentini V, Balducci M. May we routinely spare hippocampal region in primary central nervous system lymphoma during whole brain radiotherapy? Radiat Oncol 2023; 18:161. [PMID: 37784190 PMCID: PMC10546760 DOI: 10.1186/s13014-023-02251-2] [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: 01/12/2022] [Accepted: 03/27/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE One of the main limiting factors of whole-brain radiation therapy (WBRT) for primary central nervous system lymphoma (PCNSL) is the impairment of neurocognitive functions (NCFs), which is mainly caused by radiation-induced injury to the hippocampus. With a view to preventing NCF impairment and personalizing treatment, we explored the feasibility of sparing the hippocampus during WBRT by correlating the sites of PCNSL lesions with the hippocampus. METHODS AND MATERIALS Pre-treatment MR images from patients who underwent WBRT between 2010 and January 2020-and post-radiotherapy images in cases of relapse-were imported into the Varian Eclipse treatment-planning system and registered with the simulation CT. We constructed three 3-dimensional envelopes around the hippocampus at distances of 5, 10 and 15 mm and also contoured primary lesions and recurrences. RESULTS We analyzed 43 patients with 66 primary lesions: 9/66 (13.6%) involved the hippocampus and 11/66 (16.7%) were located within 5 mm of it. Thirty-six lesions (54.5%) were situated more than 15 mm from the hippocampus, while 10/66 (15.2%) were between 5 and 15 mm from it. The most common location was in deep brain structures (31%). Thirty-five of the 66 lesions relapsed: in field in 14/35 (40%) and outfield in 21/35 (60%) in different sites. Globally, 16/35 recurrences (45.7%) were located in the hippocampus or within 5 mm of it. CONCLUSION These data show that routinely sparing the hippocampus is not feasible. This approach could be considered in selected patients, when the lesion is more than 15 mm from the hippocampus.
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Affiliation(s)
- Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy.
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Lucrezia Toppi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Stefan Hohaus
- UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Gaudino
- UOC di Neuroradiologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco D'Alo
- UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Resta Davide
- UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Tiziano Zinicola
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Antonella Martino
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Elisabetta Lepre
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Roberta Bertolini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Silvia Mariani
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Cesare Colosimo
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Frascino
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
| | - Gian Carlo Mattiucci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Balducci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, largo A. Gemelli, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Hasapis S, Caraballo I, Sears TJ, Brock KD, Cart JB, Moding EJ, Lee CL. Characterizing the role of Phlda3 in the development of acute toxicity and malignant transformation of hematopoietic cells induced by total-body irradiation in mice. Sci Rep 2023; 13:12916. [PMID: 37558703 PMCID: PMC10412554 DOI: 10.1038/s41598-023-39678-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
The tumor suppressor p53 is a transcriptional factor that plays a crucial role in controlling acute toxicity and long-term malignant transformation of hematopoietic cells induced by genotoxic stress such as ionizing radiation. Among all transcriptional targets of p53, one gene that is robustly induced by radiation is the pleckstrin homology domain-only protein Phlda3. However, the role that Phlda3 plays in regulating the response of hematopoietic cells to radiation is unknown. Here, using isogenic cell lines and genetically engineered mouse models, we showed that radiation induces Phlda3 in human leukemia cells and mouse normal hematopoietic cells in a p53-dependent manner. However, deletion of the Phlda3 gene did not ameliorate radiation-induced acute hematologic toxicity. In addition, distinct from mice that lose p53, loss of Phlda3 did not alter the latency and incidence of radiation-induced thymic lymphoma in mice. Remarkably, whole-exome sequencing data showed that lymphomas in irradiated Phlda3+/+ mice harbor a significantly higher number of single nucleotide variants (SNVs) and indels compared to lymphomas in irradiated Phlda3+/- and Phlda3-/- littermates. Together, our results indicate that although deletion of Phlda3 does not accelerate the development of radiation-induced thymic lymphoma, fewer SNVs and indels are necessary to initiate lymphomagenesis after radiation exposure when Phlda3 is silenced.
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Affiliation(s)
- Stephanie Hasapis
- Department of Radiation Oncology, Duke University School of Medicine, Duke University Medical Center, Box 3813, Durham, NC, 27708, USA
| | - Isibel Caraballo
- Department of Radiation Oncology, Duke University School of Medicine, Duke University Medical Center, Box 3813, Durham, NC, 27708, USA
| | - Timothy J Sears
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA
| | - Kennedy D Brock
- Department of Radiation Oncology, Duke University School of Medicine, Duke University Medical Center, Box 3813, Durham, NC, 27708, USA
| | - John B Cart
- Department of Radiation Oncology, Duke University School of Medicine, Duke University Medical Center, Box 3813, Durham, NC, 27708, USA
| | - Everett J Moding
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
| | - Chang-Lung Lee
- Department of Radiation Oncology, Duke University School of Medicine, Duke University Medical Center, Box 3813, Durham, NC, 27708, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Thomas-Joulié A, Houillier C, Antoni D, Créhange G, Jouglar E, Colin P, Benchalal M, Lang P, Alfonsi M, Hamidou H, Coutte A, Ahrweiller F, Dadoun N, Pointreau Y, Ammarguellat H, Bernier-Chastagner V, Belkacemi Y, Vieillot S, Hoang-Xuan K, Soussain C, Jacob J, Feuvret L. Brain radiotherapy in patients treated for a newly diagnosed primary central nervous system lymphoma: professional practice evaluation in 19 French centers. Acta Oncol 2023; 62:648-656. [PMID: 37338525 DOI: 10.1080/0284186x.2023.2225146] [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: 01/12/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The objective of this study was a multicentric evaluation of professional practices, analyzing the irradiation technique itself and its impact on survival and recurrence sites, in primary central nervous system lymphomas (PCNSLs). METHODS We retrospectively analyzed the technical and clinical records of 79 PCNSL patients included in the database of the national expert network for oculocerebral lymphoma ('LOC') who were treated with brain radiotherapy as first-line treatment for newly diagnosed primary central nervous system lymphoma between 2011 and 2018. RESULTS The number of patients treated with brain radiotherapy gradually decreased over time. The heterogeneity of radiotherapy prescriptions was significant, and 55% of them did not comply with published recommendations in terms of irradiation dose and/or volume. The proportion of complete responders to induction chemotherapy treated with reduced-dose radiotherapy increased over time. Partial brain radiotherapy was associated with significantly lower overall survival in univariate analysis. In partial responders to induction chemotherapy, increasing the total dose to the brain >30 Gy and adding a boost to the WBRT induced a trend toward improved progression-free and overall survival. Five recurrences (13%) occurred exclusively in the eyes, all in patients whose eyes had been excluded from the irradiation target volume and including 2 patients without ocular involvement at diagnosis. CONCLUSION The visibility of recommendations for prescribing brain radiotherapy for the treatment of newly diagnosed primary central nervous system lymphoma needs to be improved to harmonize practices and improve their quality. We propose an update of the recommendations.
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Affiliation(s)
- Alice Thomas-Joulié
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Caroline Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Paris, France
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Nantes-Saint-Herblain, France
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, Nantes-Saint-Herblain, France
| | - Philippe Colin
- Department of Radiation Oncology, Institut du Cancer Courlancy, Rouen, France
| | - Mohamed Benchalal
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, Bretagne, France
| | - Philippe Lang
- Federation Universitaire d'oncologie radiothérapie d'Occitanie, ICG CHU Caremeau, Nîmes, France
| | | | - Hadji Hamidou
- Department of Radiation Oncology, ICO Cancer Center, Centre Paul Papin, Angers, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Flora Ahrweiller
- Institut de cancérologie et radiothérapie bretillien, Saint Malo, France
| | - Nathalie Dadoun
- Department of Radiation Oncology, Centre de la Baie, Avranches, France
| | - Yohan Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Hanifa Ammarguellat
- Department of Radiation Oncology, Centre Hospitalier Simone Veil, Beauvais, France
| | | | - Yazid Belkacemi
- Department of Radiation Oncology, Hôpital Universitaire Henri Mondor, Créteil, France
| | - Sabine Vieillot
- Department of Radiation Oncology, Centre Catalan d'Oncologie, Perpignan, France
| | - Khê Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie site de Saint-Cloud, Paris, France
- INSERM U932 Institut Curie, PSL Research University, Paris, France
| | - Julian Jacob
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
| | - Loïc Feuvret
- Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France
- Department of Radiation Oncology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France
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Galunic Bilic L, Santek F, Grah JJ, Basic-Kinda S, Mandac Smoljanovic I, Ostojic Kolonic S, Mitrovic Z, Vodanovic M, Dujmovic D, Aurer I. Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients: a single-centre experience. Radiol Med 2023; 128:492-500. [PMID: 36920724 DOI: 10.1007/s11547-023-01615-8] [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: 11/09/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with radiotherapy exclusively to infradiaphragmal fields. MATERIALS AND METHODS we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy. RESULTS After a median follow-up of 66 months (range 1-211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients; p < 0.001). The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure. CONCLUSION Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy.
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Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Josip J Grah
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- Department for Radiotherapy, Univ. Klinik Für Strahlentherapie-Radioonkologie- LKH Graz, Graz, Austria
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Aurer
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Kaliyath SB, Sharma DN. Have we reached the end of the road for radiation therapy in primary central nervous system lymphoma? J Cancer Res Ther 2023; 19:S1018-S1019. [PMID: 38261455 DOI: 10.4103/jcrt.jcrt_1620_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 10/07/2022] [Indexed: 01/25/2024]
Affiliation(s)
- Soorej B Kaliyath
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
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Volpini ME, Song J, Samant R, MacDonald D, Nair VJ. Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma. Curr Oncol 2022; 29:8160-8170. [PMID: 36354704 PMCID: PMC9689217 DOI: 10.3390/curroncol29110644] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 01/14/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvage cranial radiation in PCNSL. PCNSL patients who received upfront HD-MTX chemotherapy and salvage cranial radiation after treatment failure between 1995 and 2018 were selected. Radiological response to cranial radiation was assessed as per Response Assessment in Neuro-Oncology Criteria. Twenty one patients were selected (median age 59.9 years), with median follow-up of 19.9 months. Fourteen patients (66.7%) received a boost to the gross tumour volume (GTV). Four patients (19.0%) sustained grade ≥2 treatment-related neurotoxicity post-completion of cranial radiation. Of the 19 patients who had requisite MRI with gadolinium imaging available for Response Assessment in Neuro-Oncology (RANO) criteria assessment, 47.4% achieved complete response, 47.4% achieved partial response, and 5.3% of patients exhibited stable disease. Higher dose to the whole brain (>30 Gy) was associated with higher rate of complete response (63.6%) than lower dose (≤30 Gy, 37.5%), while boost dose to the gross disease was also associated with higher rate of complete response (61.5%) compared with no boost dose (33.3%). Median overall survival was 20.0 months. PCNSL patients who relapsed following upfront chemotherapy showed a high rate of response to salvage cranial radiation, especially in those receiving greater than 30 Gy to the whole brain and boost to gross disease.
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Affiliation(s)
- Matthew E. Volpini
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-7700-x73396; Fax: 613-247-3528
| | - Jiheon Song
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Rajiv Samant
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - David MacDonald
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Vimoj J. Nair
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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Salz T, Zabor EC, Brown PDN, Dalton SO, Raghunathan NJ, Matasar MJ, Steingart R, Hjalgrim H, Specht L, Vickers AJ, Oeffinger KC, Johansen C. Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors. Acta Oncol 2022; 61:1064-1068. [PMID: 36256902 PMCID: PMC9888465 DOI: 10.1080/0284186x.2022.2107402] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mediastinal radiation is associated with increased risk of myocardial infarction (MI) among non-Hodgkin lymphoma (NHL) survivors. OBJECTIVE To evaluate how preexisting cardiovascular risk factors (CVRFs) modify the association of mediastinal radiation and MI among a national population of NHL survivors with a range of CVRFs. MATERIAL AND METHODS Using Danish registries, we identified adults diagnosed with lymphoma 2000-2010. We assessed MI from one year after diagnosis through 2016. We ascertained CVRFs (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis. We used multivariable Cox regression to test the interaction between preexisting CVRFs and receipt of mediastinal radiation on subsequent MI. RESULTS Among 3151 NHL survivors (median age 63, median follow-up 6.5 years), 96 were diagnosed with MI. Before lymphoma, 32% of survivors had ≥1 CVRF. 8.5% of survivors received mediastinal radiation. In multivariable analysis, we found that mediastinal radiation (HR = 1.96; 95% CI = 1.09-3.52), and presence of ≥1 CVRF (HR = 2.71; 95% CI = 1.77-4.15) were associated with an increased risk of MI. Although there was no interaction on the relative scale (p = 0.14), we saw a clinically relevant absolute increase in risk for patients with CVRF from 10-year of MI of 10.5% without radiation to 29.5% for those undergoing radiation. CONCLUSION Patients with CVRFs have an importantly higher risk of subsequent MI if they have mediastinal radiation. Routine evaluation of CVRFs and optimal treatment of preexisting cardiovascular disease should continue after receiving cancer therapy. In patients with CVRFs, mediastinal radiation should only be given if oncologic benefit clearly outweighs cardiovascular harm.
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Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Nirupa J Raghunathan
- Department of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Lymphoma Survivorship Clinic, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christoffer Johansen
- CASTLE - Cancer Late Effect Research, Oncology Clinic, Center for Surgery and Cancer, Copenhagen, Denmark
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10
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Dionisi F, Scartoni D, Rombi B, Vennarini S, Righetto R, Farace P, Lorentini S, Schwarz M, Di Murro L, Demofonti C, D'Angelillo RM, Petrongari MG, Sanguineti G, Amichetti M. Consolidative active scanning proton therapy for mediastinal lymphoma: selection criteria, treatment implementation and clinical feasibility. Strahlenther Onkol 2022; 198:558-565. [PMID: 35394144 DOI: 10.1007/s00066-022-01918-1] [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: 09/27/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
AIMS Proton therapy (PT) represents an advanced form of radiotherapy with unique physical properties which could be of great advantage in reducing long-term radiation morbidity for cancer survivors. Here, we aim to describe the whole process leading to the clinical implementation of consolidative active scanning proton therapy treatment (PT) for mediastinal lymphoma. METHODS The process included administrative, technical and clinical issues. Authorization of PT is required in all cases as mediastinal lymphoma is currently not on the list of diseases reimbursable by the Italian National Health Service. Technically, active scanning PT treatment for mediastinal lymphoma is complex, due to the interaction between actively scanned protons and the usually irregular and large volumes to be irradiated, the nearby healthy tissues and the target motion caused by breathing. A road map to implement the technical procedures was prepared. The clinical selection of patients was of utmost importance and took into account both patient and tumor characteristics. RESULTS The first mediastinal lymphoma was treated at our PT center in 2018, four years after the start of the clinical activities. The treatment technique implementation included mechanical deep inspiration breath-hold simulation computed tomography (CT), clinical target volume (CTV)-based multifield optimization planning and plan robustness analysis. The ultimate authorization rate was 93%. In 4 cases a proton-photon plan comparison was required. Between May 2018 and February, 2021, 14 patients were treated with consolidative PT. The main clinical reasons for choosing PT over photons was a bulky disease in 8 patients (57%), patient's age in 11 patients (78%) and the proximity of the lymphoma to cardiac structures in 10 patients (71%). With a median follow-up of 15 months (range, 1-33 months) all patients but one (out-of-field relapse) are without evidence of disease, all are alive and no late toxicities were observed during the follow-up period. CONCLUSIONS The clinical implementation of consolidative active scanning PT for mediastinal lymphoma required specific technical procedures and a prolonged experience with PT treatments. An accurate selection of patients for which PT could be of advantage in comparison with photons is mandatory.
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Affiliation(s)
- F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy.
| | - D Scartoni
- Proton Therapy unit, APSS, Trento, Italy
| | - B Rombi
- Proton Therapy unit, APSS, Trento, Italy
| | | | - R Righetto
- Proton Therapy unit, APSS, Trento, Italy
| | - P Farace
- Proton Therapy unit, APSS, Trento, Italy
| | | | - M Schwarz
- Proton Therapy unit, APSS, Trento, Italy
| | - L Di Murro
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - C Demofonti
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - R M D'Angelillo
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - M G Petrongari
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - G Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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11
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Yoshimura K, Kawabata S, Kashiwagi H, Fukuo Y, Takeuchi K, Futamura G, Hiramatsu R, Takata T, Tanaka H, Watanabe T, Suzuki M, Hu N, Miyatake SI, Wanibuchi M. Efficacy of Boron Neutron Capture Therapy in Primary Central Nervous System Lymphoma: In Vitro and In Vivo Evaluation. Cells 2021; 10:cells10123398. [PMID: 34943904 PMCID: PMC8699713 DOI: 10.3390/cells10123398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Boron neutron capture therapy (BNCT) is a nuclear reaction-based tumor cell-selective particle irradiation method. High-dose methotrexate and whole-brain radiation therapy (WBRT) are the recommended treatments for primary central nervous system lymphoma (PCNSL). This tumor responds well to initial treatment but relapses even after successful treatment, and the prognosis is poor as there is no safe and effective treatment for relapse. In this study, we aimed to conduct basic research to explore the possibility of using BNCT as a treatment for PCNSL. Methods: The boron concentration in human lymphoma cells was measured. Subsequently, neutron irradiation experiments on lymphoma cells were conducted. A mouse central nervous system (CNS) lymphoma model was created to evaluate the biodistribution of boron after the administration of borono-phenylalanine as a capture agent. In the neutron irradiation study of a mouse PCNSL model, the therapeutic effect of BNCT on PCNSL was evaluated in terms of survival. Results: The boron uptake capability of human lymphoma cells was sufficiently high both in vitro and in vivo. In the neutron irradiation study, the BNCT group showed a higher cell killing effect and prolonged survival compared with the control group. Conclusions: A new therapeutic approach for PCNSL is urgently required, and BNCT may be a promising treatment for PCNSL. The results of this study, including those of neutron irradiation, suggest success in the conduct of future clinical trials to explore the possibility of BNCT as a new treatment option for PCNSL.
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Affiliation(s)
- Kohei Yoshimura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
- Correspondence: ; Tel.: +81-72-63-1221
| | - Hideki Kashiwagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
| | - Yusuke Fukuo
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
| | - Koji Takeuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
| | - Gen Futamura
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
| | - Takushi Takata
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-cho, Sennan 590-0494, Japan; (T.T.); (H.T.); (T.W.); (M.S.)
| | - Hiroki Tanaka
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-cho, Sennan 590-0494, Japan; (T.T.); (H.T.); (T.W.); (M.S.)
| | - Tsubasa Watanabe
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-cho, Sennan 590-0494, Japan; (T.T.); (H.T.); (T.W.); (M.S.)
| | - Minoru Suzuki
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-cho, Sennan 590-0494, Japan; (T.T.); (H.T.); (T.W.); (M.S.)
| | - Naonori Hu
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (N.H.); (S.-I.M.)
| | - Shin-Ichi Miyatake
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (N.H.); (S.-I.M.)
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki 569-8686, Japan; (K.Y.); (H.K.); (Y.F.); (K.T.); (G.F.); (R.H.); (M.W.)
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12
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Aznar M, Ntentas G, Enmark M, Flampouri S, Meidhal Petersen P, Ricardi U, Levis M. The role of motion management and position verification in lymphoma radiotherapy. Br J Radiol 2021; 94:20210618. [PMID: 34677090 PMCID: PMC8553184 DOI: 10.1259/bjr.20210618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
In the last decades, the substantial technical progress in radiation oncology offered the opportunity for more accurate planning and delivery of treatment. At the same time, the evolution of systemic treatment and the advent of modern diagnostic tools allowed for more accurate staging and consequently a safe reduction of radiotherapy (RT) target volumes and RT doses in the treatment of lymphomas. As a result, incidental irradiation of organs at risk was reduced, with a consequent reduction of severe late toxicity in long-term lymphoma survivors. Nevertheless, these innovations warrant that professionals pay attention to concurrently ensure precise planning and dose delivery to the target volume and safe sparing of the organs at risk. In particular, target and organ motion should be carefully managed in order to prevent any compromise of treatment efficacy. Several aspects should be taken into account during the treatment pathway to minimise uncertainties and to apply a valuable motion management strategy, when needed. These include: reliable image registration between diagnostic and planning radiologic exams to facilitate the contouring process, image guidance to limit positioning uncertainties and to ensure the accuracy of dose delivery and management of lung motion through procedures of respiratory gating and breath control. In this review, we will cover the current clinical approaches to minimise these uncertainties in patients treated with modern RT techniques, with a particular focus on mediastinal lymphoma. In addition, since uncertainties have a different impact on the dose deposition of protons compared to conventional x-rays, the role of motion management and position verification in proton beam therapy (PBT) will be discussed in a separate section.
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Affiliation(s)
| | | | | | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | | | - Mario Levis
- Department of Oncology, University of Torino, Turin, Italy
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13
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Modiri A, Vogelius I, Rechner LA, Nygård L, Bentzen SM, Specht L. Outcome-based multiobjective optimization of lymphoma radiation therapy plans. Br J Radiol 2021; 94:20210303. [PMID: 34541859 PMCID: PMC8553178 DOI: 10.1259/bjr.20210303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023] Open
Abstract
At its core, radiation therapy (RT) requires balancing therapeutic effects against risk of adverse events in cancer survivors. The radiation oncologist weighs numerous disease and patient-level factors when considering the expected risk-benefit ratio of combined treatment modalities. As part of this, RT plan optimization software is used to find a clinically acceptable RT plan delivering a prescribed dose to the target volume while respecting pre-defined radiation dose-volume constraints for selected organs at risk. The obvious limitation to the current approach is that it is virtually impossible to ensure the selected treatment plan could not be bettered by an alternative plan providing improved disease control and/or reduced risk of adverse events in this individual. Outcome-based optimization refers to a strategy where all planning objectives are defined by modeled estimates of a specific outcome's probability. Noting that various adverse events and disease control are generally incommensurable, leads to the concept of a Pareto-optimal plan: a plan where no single objective can be improved without degrading one or more of the remaining objectives. Further benefits of outcome-based multiobjective optimization are that quantitative estimates of risks and benefit are obtained as are the effects of choosing a different trade-off between competing objectives. Furthermore, patient-level risk factors and combined treatment modalities may be integrated directly into plan optimization. Here, we present this approach in the clinical setting of multimodality therapy for malignant lymphoma, a malignancy with marked heterogeneity in biology, target localization, and patient characteristics. We discuss future research priorities including the potential of artificial intelligence.
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Affiliation(s)
- Arezoo Modiri
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Ivan Vogelius
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Ann Rechner
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Nygård
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Lena Specht
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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14
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Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C, Rattarittamrong E, Tantiworawit A, Norasetthada L. Outcome of patients with newly diagnosed primary CNS lymphoma after high-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine: an 8-year cohort study. Int J Clin Oncol 2021; 26:1805-1811. [PMID: 34236556 DOI: 10.1007/s10147-021-01982-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/02/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Addition of cytarabine to high-dose methotrexate (HD-MTX) chemotherapy improves outcome of primary CNS lymphoma (PCNSL); however, the combination therapy increases toxicity. Sequential chemotherapy and cranial radiation may decrease toxicity without altering efficacy. METHODS This was a single-center, retrospective cohort study of consecutive newly diagnosed immunocompetent PCNSL patients treated with HD-MTX (5 cycles of 3 g/m2 every 2 weeks) followed by consolidation whole-brain radiotherapy (WBRT) and cytarabine (2 cycles of 3 g/m2/d for 2 days every 3 weeks) from January 2013 to December 2020. Initial WBRT before HD-MTX was allowed in patients with significant disability or brain edema at presentation. Primary outcome was progression-free survival (PFS). Key secondary outcomes were response rate, treatment-related toxicity, and overall survival (OS). RESULTS Of 41 patients, 25 patients had a complete response (CR) and ten patients had a partial response, inferring an overall response rate (ORR) of 85.4% and a CR rate of 60.9%. More than 90% of patients were able to tolerate and complete the HD-MTX. The incidence of ≥ grade 3 hematologic and non-hematologic toxicities were 4.8% and 17.1%, respectively. Treatment-related mortality rate was 2.4%. There was no difference in toxicity between patients with age < 60 and ≥ 60 years. At the median follow-up duration of 39.8 months, the median PFS was 35.2 months (95% CI 12.4-69.3) and median OS was 46.5 months (95% CI 21.8-NR). CONCLUSION High-dose methotrexate followed by consolidation whole-brain radiotherapy and cytarabine has acceptable efficacy, great tolerability, and low toxicity in newly diagnosed PCNSL patients.
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Affiliation(s)
- Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros road, Sriphum, Muang, Chiang Mai, 50200, Thailand
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15
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Abstract
RATIONALE : Despite significant advances in microsurgical techniques, simultaneous vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) surgeries may be effective for treatment of end-stage lymphedema. This case report describes the successful treatment of end-stage lymphedema with VLNT and LVA. PATIENT CONCERNS A 72-year-old patient with bilateral lower extremity lymphedema was referred to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. DIAGNOSIS According to the indocyanine green lymphography, lymphoscintigraphy, and magnetic resonance lymphangiography, the patient was diagnosed with end-stage lymphedema (International Society of Lymphology stage 3). INTERVENTION The patient underwent simultaneous VLNT and LVA for treatment of end-stage lymphedema. OUTCOMES Significant reduction in circumference and volume of lower extremity was achieved following simultaneous VLNT and LVA. LESSONS Simultaneous VLNT and LVA surgeries may be effective in patients with end-stage lymphedema.
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16
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Krishnan S, Narayan HK, Freedman G, Plastaras JP, Maity A, Demissei B, Smith AM, Berman AT, Cengel K, Levin W, Swisher-McClure S, Feigenberg S, Ky B. Early Changes in Physical Activity and Quality of Life With Thoracic Radiation Therapy in Breast Cancer, Lung Cancer, and Lymphoma. Int J Radiat Oncol Biol Phys 2021; 109:946-952. [PMID: 33223046 DOI: 10.1016/j.ijrobp.2020.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The effects of thoracic radiation therapy (RT) on physical functioning and quality of life (QoL) are incompletely defined. We determined the associations between thoracic RT dose volume metrics, physical activity, and QoL in patients with cancer. METHODS AND MATERIALS Participants with breast cancer, lung cancer, or mediastinal lymphoma treated with radiation with or without chemotherapy were enrolled in a prospective, longitudinal cohort study. Data were collected pre-RT, immediately post-RT, and 5 to 9 months post-RT. At each timepoint, self-reported physical activity was assessed via the Godin-Shephard Leisure-Time Physical Activity Questionnaire, and QoL metrics were assessed via Functional Assessment of Chronic Illness Therapy Fatigue and Dyspnea Scales. Multivariable adjusted linear regression models were stratified by breast cancer alone and lung cancer and lymphoma combined. RESULTS One hundred thirty participants were included in the study. In breast cancer (n = 80), each 1-Gy increase in mean heart dose was associated with worse Functional Assessment of Chronic Illness Therapy Fatigue scores (-1.0; 95% confidence interval [CI], -1.9 to -0.2; P = .021); similar associations were observed between V5 and fatigue (-2.5; 95% CI, -4.4 to -0.6; P = .010 for each 10% increase in V5). In lung cancer and lymphoma (n = 50), each 10% increase in V5 was associated with decreased physical activity (Godin-Shephard Leisure-Time Physical Activity Questionnaire score -2.3; 95% CI, -4.3 to -0.4; P = .017). Although the associations between baseline levels of physical activity and fatigue and dyspnea were of borderline significance in breast cancer alone (P < .10), increased physical activity over time was associated with improvements in fatigue and dyspnea across all cancer types (P < .05 for all). CONCLUSIONS Higher cardiac RT dose was associated with worse fatigue and physical activity across breast cancer, lung cancer, and mediastinal lymphoma. Longitudinal increases in physical activity were associated with concurrent improvements in QoL measures. Strategies to increase physical activity and decrease cardiac RT dose may improve physical functioning and QoL for patients with cancer.
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Affiliation(s)
- Sheela Krishnan
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hari K Narayan
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Gary Freedman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Plastaras
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Maity
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Biniyam Demissei
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda M Smith
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abigail T Berman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith Cengel
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Levin
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Feigenberg
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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17
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Oertel M, Elsayad K, Engenhart-Cabillic R, Reinartz G, Baues C, Schmidberger H, Vordermark D, Marnitz S, Lukas P, Ruebe C, Engert A, Lenz G, Eich HT. Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Strahlenther Onkol 2020; 196:1096-1102. [PMID: 33125504 PMCID: PMC7596809 DOI: 10.1007/s00066-020-01705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - K Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - G Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Marnitz
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - C Ruebe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - A Engert
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany.
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Kirova Y. [Practical guidelines for the radiotherapy for patients presented with haematological malignancies in the epidemic COVID-19 situation: International Lymphoma Radiation Oncology Group recommendations]. Cancer Radiother 2020; 24:194-195. [PMID: 32402596 PMCID: PMC7198151 DOI: 10.1016/j.canrad.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Y Kirova
- Département de radiothérapie-oncologie, institut Curie, 25, rue d'Ulm, 75005 Paris, France.
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19
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Dabaja BS, Hoppe BS, Plastaras JP, Newhauser W, Rosolova K, Flampouri S, Mohan R, Mikhaeel NG, Kirova Y, Specht L, Yahalom J. Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines. Blood 2018; 132:1635-1646. [PMID: 30108066 PMCID: PMC6212652 DOI: 10.1182/blood-2018-03-837633] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/19/2018] [Indexed: 12/25/2022] Open
Abstract
Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Jacksonville, FL
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Wayne Newhauser
- Department of Radiation Physics, University of Louisiana, Baton Rouge, LA
| | - Katerina Rosolova
- Proton Therapy Department, Proton Therapy Center Czech, Prague, Czech Republic
- Department of Oncology, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, FL
| | - Radhe Mohan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N George Mikhaeel
- Department of Radiation Oncology, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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20
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Johansen MS, Tanbo TG, Oldereid NB. Fertility after cryopreservation of ovarian tissue due to cancer treatment. Tidsskr Nor Laegeforen 2018; 138:17-0719. [PMID: 29947203 DOI: 10.4045/tidsskr.17.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BAKGRUNN Kryopreservering av ovarialvev som fertilitetsbevarende metode tilbys prepubertale jenter og kvinner i reproduktiv alder med høy risiko for å utvikle prematur ovarialsvikt i forbindelse med medisinsk eller kirurgisk behandling. I denne studien ønsket vi å kartlegge fertilitet og prematur ovarialsvikt hos kvinner som har fått gjort kryopreservering av ovarialvev i forbindelse med kreftbehandling. MATERIALE OG METODE Et spørreskjema ble i 2014 sendt til 94 kvinner over 18 år som i perioden 2004-12 hadde fått kryopreservert ovarialvev i forbindelse med behandling for en malign tilstand. Skjemaet inneholdt spørsmål om menstruasjonsfrekvens, prevensjonsbruk, fertilitet, fremtidig barneønske og sannsynlighet for at de ville benytte ovarialvevet senere. Av de 77 kvinnene som returnerte spørreskjemaet, ble 74 kvinner inkludert i studien. RESULTATER Totalt 20 av 74 kvinner (27 %) hadde prematur ovarialsvikt definert som opphør av ovarialfunksjonen før 40 års alder. Risikoen var lavest hos kvinner behandlet for brystkreft (5 %) og høyest hos kvinner behandlet for leukemi (75 %). Størst risiko for prematur ovarialsvikt fant man i pasientgruppene som hadde gjennomgått stamcelletransplantasjon, strålebehandling mot helkropp og/eller abdomen og bekken. Til sammen hadde 22 kvinner født 31 barn etter kreftbehandlingen, hvorav to etter reimplantasjon av ovarialvev. FORTOLKNING Risikoen for å utvikle prematur ovarialsvikt er avhengig av pasientens kreftdiagnose. Hvilke fertilitetsbevarende tiltak som anbefales, bør differensieres avhengig av pasienten kreftdiagnose og planlagt behandling.
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Abstract
The aim of this paper is to determine the dose received by every organ of patients subjected to intralymphatic radiotherapy with Lipiodol F181I. For this purpose external counting techniques have been devised for determining the effective half-life (Te). The determination of the initial concentration (Co) will be considered in a subsequent paper. Systematic checks were carried out on 9 patients with a Nukab scanner by means of sectorial counts, total body scanning and body profiles. By measuring the areas of successive profiles in the same patient, the effective half-life of the radioactive substance in the different body sections could be exactly determined. No shifting of the medium from the abdominal to the thoracic region by direct lymphatic route could be detected from the first day after lymphography until almost total decay of 131I. The trend of radioactivity accumulation in the lung was studied during injection and during the first few hours after lymphography. Some hypotheses as to the trend of activity in the various body districts and the possible metabolic routes of the medium in the body are advanced.
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Abstract
A 60-year-old man with AIDS and active pulmonary tubercolosis presented with a rapidly growing chorioretinal tumor. Tuberculostatics had no effect on the tumor but radiation resulted in a quick decrease in its size. It is therefore believed to be a lymphoma. No biopsy was performed. An intraocular lymphoma in a patient with AIDS has not yet been described.
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Vargo JA, Ward MC, Caudell JJ, Riaz N, Dunlap NE, Isrow D, Zakem SJ, Dault J, Awan MJ, Higgins KA, Hassanadeh C, Beitler JJ, Reddy CA, Marcrom S, Boggs DH, Bonner JA, Yao M, Machtay M, Siddiqui F, Trotti AM, Lee NY, Koyfman SA, Ferris RL, Heron DE. A Multi-institutional Comparison of SBRT and IMRT for Definitive Reirradiation of Recurrent or Second Primary Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2018; 100:595-605. [PMID: 28899556 PMCID: PMC7418052 DOI: 10.1016/j.ijrobp.2017.04.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/01/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Two modern methods of reirradiation, intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), are established for patients with recurrent or second primary squamous cell carcinoma of the head and neck (rSCCHN). We performed a retrospective multi-institutional analysis to compare methods. METHODS AND MATERIALS Data from patients with unresectable rSCCHN previously irradiated to ≥40 Gy who underwent reirradiation with IMRT or SBRT were collected from 8 institutions. First, the prognostic value of our IMRT-based recursive partitioning analysis (RPA) separating those patients with unresectable tumors with an intertreatment interval >2 years or those with ≤2 years and without feeding tube or tracheostomy dependence (class II) from other patients with unresected tumors (class III) was investigated among SBRT patients. Overall survival (OS) and locoregional failure were then compared between IMRT and SBRT by use of 2 methods to control for baseline differences: Cox regression weighted by the inverse probability of treatment and subset analysis by RPA classification. RESULTS The study included 414 patients with unresectable rSCCHN: 217 with IMRT and 197 with SBRT. The unadjusted 2-year OS rate was 35.4% for IMRT and 16.3% for SBRT (P<.01). Among SBRT patients, RPA classification retained an independent association with OS. On Cox regression weighted by the inverse probability of treatment, no significant differences in OS or locoregional failure between IMRT and SBRT were demonstrated. Analysis by RPA class showed similar OS between IMRT and SBRT for class III patients. In all class II patients, IMRT was associated with improved OS (P<.001). Further subset analysis demonstrated comparable OS when ≥35 Gy was delivered with SBRT to small tumor volumes. Acute grade ≥4 toxicity was greater in the IMRT group than in the SBRT group (5.1% vs 0.5%, P<.01), with no significant difference in late toxicity. CONCLUSIONS Reirradiation both with SBRT and with IMRT appear relatively safe with favorable toxicity compared with historical studies. Outcomes vary by RPA class, which informs clinical trial design. Survival is poor in class III patients, and alternative strategies are needed.
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Affiliation(s)
- John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Matthew C Ward
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Derek Isrow
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Sara J Zakem
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua Dault
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Musaddiq J Awan
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Comron Hassanadeh
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia; Department of Otolaryngology Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Samuel Marcrom
- Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama
| | - Drexell H Boggs
- Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama
| | - James A Bonner
- Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Robert L Ferris
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
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24
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Gunther JR, Rahman AR, Dong W, Yehia ZA, Kebriaei P, Rondon G, Pinnix CC, Milgrom SA, Allen PK, Dabaja BS, Smith GL. Craniospinal irradiation prior to stem cell transplant for hematologic malignancies with CNS involvement: Effectiveness and toxicity after photon or proton treatment. Pract Radiat Oncol 2017; 7:e401-e408. [PMID: 28666906 PMCID: PMC6033267 DOI: 10.1016/j.prro.2017.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/08/2017] [Accepted: 05/07/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE/OBJECTIVE(S) Craniospinal irradiation (CSI) improves local control of leukemia/lymphoma with central nervous system (CNS) involvement; however, for adult patients anticipating stem cell transplant (SCT), cumulative treatment toxicity is a major concern. We evaluated toxicities and outcomes for patients receiving proton or photon CSI before SCT. METHODS AND MATERIALS We identified 37 consecutive leukemia/lymphoma patients with CNS involvement who received CSI before SCT at our institution. Photon versus proton toxicities during CSI, transplant, and through 100 days posttransplant were compared using Fisher exact and Wilcoxon rank sum tests. Long-term neurotoxicity, disease response, and overall survival were analyzed. RESULTS Thirty-seven patients (23 photon, 14 proton) underwent CSI for CNS involvement of acute lymphoblastic leukemia (49%), acute myeloblastic leukemia (22%), chronic lymphocytic leukemia (3%), chronic myelocytic leukemia (14%), lymphoma (11%), and myeloma (3%). CSI was used for consolidation (30 patients, 81%) and gross disease treatment (7 patients, 19%). Median radiation dose (interquartile range) was 24 Gy (23.4-24) for photons and 21.8 Gy (21.3-23.6) for protons (P = .03). Proton CSI was associated with lower rates of Radiation Therapy Oncology Group grade 1-3 mucositis during CSI (7% vs 44%, P = .03): 1 grade 3 with protons versus 5 grade 1, 3 grade 2, and 2 grade 3 with photons. During CSI, other toxicities (infection, gastrointestinal symptoms) did not differ. Allogeneic stem cell transplant (SCT) was used in 95% of patients, with 53% of patients in remission before SCT. Myeloablative conditioning was used for 76%. During SCT admission and 100 days post-SCT, toxicities did not differ by CSI technique. Successful engraftment occurred in 95% of patients (P = .67). Progression or death occurred for 47% of patients, with only 1 CNS relapse. CONCLUSION In our cohort, CSI offered excellent local control for CNS-involved hematologic malignancies in the pre-SCT setting. Acute mucositis occurred less frequently with proton CSI with comparable peritransplant/long-term toxicity profile, suggesting the need to further explore the benefit/toxicity profile of this technique.
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Affiliation(s)
- Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmad R Rahman
- Department of University of Tennessee Health Science Center, Memphis, Tennessee
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah A Milgrom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Li P, Wuthrick E, Rappaport JA, Kraft C, Lin JE, Marszalowicz G, Snook AE, Zhan T, Hyslop TM, Waldman SA. GUCY2C Signaling Opposes the Acute Radiation-Induced GI Syndrome. Cancer Res 2017; 77:5095-5106. [PMID: 28916678 PMCID: PMC5678756 DOI: 10.1158/0008-5472.can-17-0859] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/30/2017] [Accepted: 07/18/2017] [Indexed: 02/05/2023]
Abstract
High doses of ionizing radiation induce acute damage to epithelial cells of the gastrointestinal (GI) tract, mediating toxicities restricting the therapeutic efficacy of radiation in cancer and morbidity and mortality in nuclear disasters. No approved prophylaxis or therapy exists for these toxicities, in part reflecting an incomplete understanding of mechanisms contributing to the acute radiation-induced GI syndrome (RIGS). Guanylate cyclase C (GUCY2C) and its hormones guanylin and uroguanylin have recently emerged as one paracrine axis defending intestinal mucosal integrity against mutational, chemical, and inflammatory injury. Here, we reveal a role for the GUCY2C paracrine axis in compensatory mechanisms opposing RIGS. Eliminating GUCY2C signaling exacerbated RIGS, amplifying radiation-induced mortality, weight loss, mucosal bleeding, debilitation, and intestinal dysfunction. Durable expression of GUCY2C, guanylin, and uroguanylin mRNA and protein by intestinal epithelial cells was preserved following lethal irradiation inducing RIGS. Oral delivery of the heat-stable enterotoxin (ST), an exogenous GUCY2C ligand, opposed RIGS, a process requiring p53 activation mediated by dissociation from MDM2. In turn, p53 activation prevented cell death by selectively limiting mitotic catastrophe, but not apoptosis. These studies reveal a role for the GUCY2C paracrine hormone axis as a novel compensatory mechanism opposing RIGS, and they highlight the potential of oral GUCY2C agonists (Linzess; Trulance) to prevent and treat RIGS in cancer therapy and nuclear disasters. Cancer Res; 77(18); 5095-106. ©2017 AACR.
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MESH Headings
- Animals
- Apoptosis/radiation effects
- Cell Proliferation/radiation effects
- Colonic Neoplasms/enzymology
- Colonic Neoplasms/pathology
- Colonic Neoplasms/radiotherapy
- Female
- Gamma Rays/adverse effects
- Gastrointestinal Hormones/metabolism
- Gastrointestinal Tract/radiation effects
- Humans
- Irritable Bowel Syndrome/enzymology
- Irritable Bowel Syndrome/etiology
- Irritable Bowel Syndrome/prevention & control
- Lymphoma/enzymology
- Lymphoma/pathology
- Lymphoma/radiotherapy
- Male
- Melanoma, Experimental/enzymology
- Melanoma, Experimental/pathology
- Melanoma, Experimental/radiotherapy
- Mice
- Mice, Inbred C57BL
- Natriuretic Peptides/metabolism
- Paracrine Communication/radiation effects
- Radiation Injuries, Experimental/enzymology
- Radiation Injuries, Experimental/etiology
- Radiation Injuries, Experimental/prevention & control
- Receptors, Enterotoxin
- Receptors, Guanylate Cyclase-Coupled/metabolism
- Receptors, Peptide/metabolism
- Signal Transduction/radiation effects
- Tumor Cells, Cultured
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Affiliation(s)
- Peng Li
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, The University of Florida, Gainesville, Florida
| | - Evan Wuthrick
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jeff A Rappaport
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Crystal Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jieru E Lin
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Glen Marszalowicz
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam E Snook
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Divisions of Clinical Pharmacology and Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Terry M Hyslop
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Scott A Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania.
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England CG, Rui L, Cai W. Lymphoma: current status of clinical and preclinical imaging with radiolabeled antibodies. Eur J Nucl Med Mol Imaging 2016; 44:517-532. [PMID: 27844106 DOI: 10.1007/s00259-016-3560-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022]
Abstract
Lymphoma is a complex disease that arises from cells of the immune system with an intricate pathology. While lymphoma may be classified as Hodgkin or non-Hodgkin, each type of tumor is genetically and phenotypically different and highly invasive tissue biopsies are the only method to investigate these differences. Noninvasive imaging strategies, such as immunoPET, can provide a vital insight into disease staging, monitoring treatment response in patients, and dose planning in radioimmunotherapy. ImmunoPET imaging with radiolabeled antibody-based tracers may also assist physicians in optimizing treatment strategies and enhancing patient stratification. Currently, there are two common biomarkers for molecular imaging of lymphoma, CD20 and CD30, both of which have been considered for investigation in preclinical imaging studies. In this review, we examine the current status of both preclinical and clinical imaging of lymphoma using radiolabeled antibodies. Additionally, we briefly investigate the role of radiolabeled antibodies in lymphoma therapy. As radiolabeled antibodies play critical roles in both imaging and therapy of lymphoma, the development of novel antibodies and the discovery of new biomarkers may greatly affect lymphoma imaging and therapy in the future.
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Affiliation(s)
- Christopher G England
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI, 53705-2275, USA.
| | - Lixin Rui
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Weibo Cai
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Madison, WI, 53705-2275, USA.
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Room 7137, 1111 Highland Ave, Madison, WI, 53705-2275, USA.
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27
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Osinde TA, Adamu A, Jimeta JD, Chukwuocha IC. Palliative care in patients who receive whole brain radiotherapy for brain metastases in Ahmadu Bello University Teaching Hospital, Zaria. Niger J Med 2016; 25:215-219. [PMID: 30011165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Brain Metastases is a devastating complication of Cancer affecting 10-50% of patients with systemic disease. It by far outnumbers primary Brain tumor in a 10:1 ratio. AIMS AND OBJECTIVE To determine the age distribution, gender distribution, tumor of origin, commonest radiotherapy regimen and median survival of patients who received Whole Brain Radiotherapy for Brain Metastases. MATERIALS AND METHODS Between May 2006-May 2015 patients who received Whole Brain Radiotherapy for Brain Metastases for confirmed Brain Metastases were studied in a Retrospective study and evaluated with respect to age, gender, tumor of origin and radiotherapy regimen. Patients Case files and treatment files were reviewed and results were analyzed using SPSS version 20th Edition. RESULTS A total of 30 cases were reviewed. The age range of patients was between 16-70 years with a mean age of 43.5 years. Median age of 41.5 years. 83.4% of patients were female with remaining 16.7% males. The commonest tumor of origin was Breast Cancer (76.7%) followed by Lymphoma (6.7%),Lung (3.3%), Colon(3.3%), Endometrium(3.3%), Pancrease (3.3%), Paranasal Sinus (3.3%). Majority of patients 73.3% received 30Gy in 10# over 2 weeks. Median Survival is 3 months. The most common clinical presentation is Headache (46.6%). CONCLUSION Most Patients presented at advanced stages of their diseases. The mean age of patients that received Whole Brain Radiotherapy were in the fifth decade of life. More Females than Males received Whole Brain Radiotherapy.
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Iwabuchi M, Shibamoto Y, Sugie C, Ayakawa S, Ogino H, Baba F. Partial-brain radiotherapy for primary central nervous system lymphoma: multi-institutional experience. J Radiat Res 2016; 57:164-168. [PMID: 26661856 PMCID: PMC4795951 DOI: 10.1093/jrr/rrv085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 06/05/2023]
Abstract
Whole-brain radiotherapy (WBRT) has been an important component of treatment for primary central nervous system lymphoma (PCNSL), but delayed neurotoxicity has been a matter of concern. We have employed partial-brain radiotherapy (PBRT) with wide margins for PCNSL patients with a single lesion or a few lesions. In this study, we evaluated the treatment outcome in PCNSL patients undergoing PBRT. Between 2003 and 2014, 24 patients were treated with PBRT; 16 received high-dose-methotrexate (MTX) -containing chemotherapy before PBRT. Conventional fractionation with a median dose of 54 Gy was used. For reference, 15 patients undergoing MTX-based chemotherapy and WBRT were also analyzed. The 3-year overall survival rate was 60% for all 24 patients undergoing PBRT and 68% for the 16 patients undergoing MTX-based chemotherapy plus PBRT. The 3-year progression-free survival rate was 41% for all 24 patients undergoing PBRT and 36% for the 16 patients undergoing MTX-based chemotherapy. The in-field recurrence rate was 26% and the out-of-field recurrence rate was 15% at 3 years for all 24 patients undergoing PBRT. The rates for in-field recurrence and the out-of-field recurrence were 27% and 21%, respectively, for the 16 patients undergoing MTX-based chemotherapy. CNS-recurrence rates were similar in patients undergoing MTX-based chemotherapy and PBRT to the rates in those undergoing MTX-based chemotherapy and WBRT. Neurocognitive dysfunction developed in 3 of the 16 patients undergoing MTX + PBRT and in 4 of 15 patients undergoing MTX + WBRT (P = 0.68). PBRT seems to be a feasible treatment option for solitary PCNSL. Further investigations are warranted to evaluate the advantages of PBRT over WBRT.
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Affiliation(s)
- Michio Iwabuchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shiho Ayakawa
- Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjyou, Minami-ku, Nagoya, Aichi, 457-8510, Japan
| | - Hiroyuki Ogino
- Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Fumiya Baba
- Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
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Bano R, Zafar W, Khan AI, Fiaz SA, Abid M, Chaudhary MZ, Siddique N, Khan HM. Breast Lymphoma Treatment Outcomes in a Pakistani Population: 20 Years of Experience at a Single Center. Asian Pac J Cancer Prev 2016; 17:3631-3635. [PMID: 27510022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Breast lymphomas constitute a rare disease entity. To date, limited relevant data have been reported. We therefore here present a review of breast lymphoma patients treated at a single center over a 20 year period, focusing on histological types, treatment modalities and outcomes. MATERIALS AND METHODS We identified patients who were diagnosed and treated for breast lymphoma at a single center from January 1995 to January 2014 and extracted data regarding patient demographics and clinical data. RESULTS Twenty-seven patients with breast lymphoma were identified, of which 3 were males. The median age at diagnosis was 37 years (range: 22-76 years). Chemotherapy was the main stay of treatment and 55.6% patients also received radiation to the affected breast. At our institute, only 3 patients, all with progressive disease, had surgery performed to achieve local palliation. Complete response after chemotherapy was seen in 63% patients and partial response in 7.4%, while 26% patients demonstrated disease progression. The mean follow up was 46.8 months. Seven patients (33.3%) who were alive at last follow up, as well as 1 patient who died, survived more than 5 years after diagnosis. CONCLUSIONS Patients with breast lymphoma should receive aggressive treatment, with combination of chemotherapy and radiation therapy. Surgery should be limited for diagnosis and palliation of local symptoms in cases of progressive disease.
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Affiliation(s)
- Razia Bano
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore Pakistan Email : ,
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Affiliation(s)
- T C Lo
- Department of Radiotherapy, Lahey Clinic Medical Center, Burlington, Mass
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Affiliation(s)
- S S Donaldson
- Department of Therapeutic Radiology, Stanford University Medical Center, Calif
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Peckham MJ. Combined chemotherapy-radiotherapy for the non-Hodgkin lymphomas. Antibiot Chemother (1971) 2015; 24:134-8. [PMID: 655674 DOI: 10.1159/000401509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Patients with malignant lymphoma, diffuse type, have an unfavorable prognosis when compared to those patients with modular patterns. Prior to the introduction of combination chemotherapy, 50% survival rates for MC-D or PDL-D were about 2 years, HL-D about 1 year. Aggressive combination chemotherapy for advanced MC-D or PDL-D results in complete remission rates of 22-82%, with median survivals of 1-2 years. Patients with localized HL-D are probably curable with radiotherapy alone in 75% of cases. Patients with advanced disease are best treated with intensive combination chemotherapy, achieving a long-lasting complete remission in over one-half of cases, with median survivals now at 1-3 years. Many of these patients are probably cured, central nervous system relapse may now be a concern. The results of treatment of advanced histiocytic lymphoma are now approaching the results reported for advanced Hodgkin disease.
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Frost SHL, Frayo SL, Miller BW, Orozco JJ, Booth GC, Hylarides MD, Lin Y, Green DJ, Gopal AK, Pagel JM, Bäck TA, Fisher DR, Press OW. Comparative efficacy of 177Lu and 90Y for anti-CD20 pretargeted radioimmunotherapy in murine lymphoma xenograft models. PLoS One 2015; 10:e0120561. [PMID: 25785845 PMCID: PMC4364776 DOI: 10.1371/journal.pone.0120561] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/05/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Pretargeted radioimmunotherapy (PRIT) is a multi-step method of selectively delivering high doses of radiotherapy to tumor cells while minimizing exposure to surrounding tissues. Yttrium-90 (90Y) and lutetium-177 (177Lu) are two of the most promising beta-particle emitting radionuclides used for radioimmunotherapy, which despite having similar chemistries differ distinctly in terms of radiophysical features. These differences may have important consequences for the absorbed dose to tumors and normal organs. Whereas 90Y has been successfully applied in a number of preclinical and clinical radioimmunotherapy settings, there have been few published pretargeting studies with 177Lu. We therefore compared the therapeutic potential of targeting either 90Y or 177Lu to human B-cell lymphoma xenografts in mice. METHODS Parallel experiments evaluating the biodistribution, imaging, dosimetry, therapeutic efficacy, and toxicity were performed in female athymic nude mice bearing either Ramos (Burkitt lymphoma) or Granta (mantle cell lymphoma) xenografts, utilizing an anti-CD20 antibody-streptavidin conjugate (1F5-SA) and an 90Y- or 177Lu-labeled 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-biotin second step reagent. RESULTS The two radionuclides displayed comparable biodistributions in tumors and normal organs; however, the absorbed radiation dose delivered to tumor was more than twice as high for 90Y (1.3 Gy/MBq) as for 177Lu (0.6 Gy/MBq). More importantly, therapy with 90Y-DOTA-biotin was dramatically more effective than with 177Lu-DOTA-biotin, with 100% of Ramos xenograft-bearing mice cured with 37 MBq 90Y, whereas 0% were cured using identical amounts of 177Lu-DOTA-biotin. Similar results were observed in mice bearing Granta xenografts, with 80% of the mice cured with 90Y-PRIT and 0% cured with 177Lu-PRIT. Toxicities were comparable with both isotopes. CONCLUSION 90Y was therapeutically superior to 177Lu for streptavidin-biotin PRIT approaches in these human lymphoma xenograft models.
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Affiliation(s)
- Sofia H. L. Frost
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- * E-mail:
| | - Shani L. Frayo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Brian W. Miller
- Pacific Northwest National Laboratory, Richland, WA, United States of America
- College of Optical Sciences, The University of Arizona, Tucson, AZ, United States of America
| | - Johnnie J. Orozco
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Garrett C. Booth
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Mark D. Hylarides
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Yukang Lin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Departments of Medicine and Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Departments of Medicine and Bioengineering, University of Washington, Seattle, WA, United States of America
| | - John M. Pagel
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Departments of Medicine and Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Tom A. Bäck
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Oliver W. Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Departments of Medicine and Bioengineering, University of Washington, Seattle, WA, United States of America
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Saxena P, Joyce LD, Daly RC, Kushwaha SS, Schirger JA, Rosedahl J, Dearani JA, Kara T, Edwards BS. Cardiac transplantation for radiation-induced cardiomyopathy: the Mayo Clinic experience. Ann Thorac Surg 2014; 98:2115-21. [PMID: 25443015 DOI: 10.1016/j.athoracsur.2014.06.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND High-dose radiotherapy to the mediastinum for the treatment of malignancies causes injury to the intrathoracic organs. Coronary artery disease, valvular dysfunction, cardiomyopathy, and chronic constrictive pericarditis are common cardiovascular sequelae during long-term follow-up. Cardiac transplantation is indicated for the surgical treatment of heart failure due to radiation-induced end-stage cardiac disease. METHODS A retrospective study of radiation-induced cardiomyopathy requiring cardiac transplantation was undertaken from December 1992 to August 2010. RESULTS Twelve patients (7 men, 5 women), with a mean age of 47.4 years, underwent orthotopic cardiac transplantation. Redo cardiac operations were performed in 9 patients. Lymphoma was the primary malignancy in all patients. Adjuvant chemotherapy was used in 9 patients, and splenectomy was performed in 7. Restrictive cardiomyopathy (n = 8) was the predominant diagnosis. Restrictive lung disease was present in 10 patients (83%). Postoperative chronic kidney injury developed in 3 patients (25%). Hospital mortality was 8.3%. Survival at 1, 5, and 10 years was 91.7%, 75%, and 46.7%, respectively. The overall mean follow-up was 7.7 years (median, 6.1; range, 1.8 to 16.4 years). Late respiratory failure accounted for 3 deaths. CONCLUSIONS Cardiac transplantation provides satisfactory medium-term to long-term outcome in patients with radiation-induced cardiomyopathy. Secondary malignancies, kidney injury, and respiratory failure contribute to significant postoperative morbidity and death.
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Affiliation(s)
- Pankaj Saxena
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lyle D Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jordan Rosedahl
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tomas Kara
- International Clinical Research Center, Department of Cardiovascular Diseases, St. Anne's University Hospital, Brno, Czech Republic
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Oguchi M, Hasegawa M, Ishibashi N, Isobe K, Imai M, Ejima Y, Kasuya T, Katayama E, Sasai K, Soejima T, Hayafuchi N. [ILROG guideline of radiation therapy for nodal lymphomas: involved site radiation therapy]. Rinsho Ketsueki 2014; 55:1903-1911. [PMID: 25297754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Kawamori J, Tanaka Y. Hypothyroidism after radiotherapy for primary thyroid lymphoma. Anticancer Res 2014; 34:4427-4431. [PMID: 25075081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Thyroid lymphoma is rare, with no standard therapeutic protocol. Radiotherapy is often employed. PATIENTS AND METHODS Nine patients who had received radiotherapy for thyroid lymphoma in our Institute, from September 2005 to August 2013, were reviewed for hypothyroidism. The median radiation dose was 40 Gy. Thyroid-stimulating hormone (TSH) levels were measured before and after radiotherapy, and hypothyroidism was defined as a TSH level exceeding 10 mIU/l. Peak TSH was defined as the highest TSH level during the follow-up period. RESULTS The complete response rate was 77.8%, and the 5-year overall survival rate was 74.1%. The median time-to-peak TSH was 162.5 days after the start of radiotherapy. Hypothyroidism was diagnosed in three (37.5%) out of eight patients without thyroidectomy. CONCLUSION Hypothyroidism is a frequent complication of radiotherapy for thyroid lymphoma.
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Affiliation(s)
- Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tsutomu Saito
- Radiology Clinic, Sonoda Medical Corporations, Adachi-ku, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Yoshiaki Tanaka
- Department of Radiation Oncology, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
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Abstract
BACKGROUND Prior to the introduction of the chemotherapeutic agent methotrexate, radiotherapy was the sole, first-line option for the treatment of individuals with primary central nervous system lymphoma (PCNSL), Now that methotrexate is available, the role of radiotherapy in the treatment of PCNSL has been called into question. Although various studies suggest promising results with regard to overall and progression-free survival with the use of chemotherapeutic regimens alone as well as in combination with radiotherapy, no evidence-based standard regimen has yet been defined. OBJECTIVES The objective of this review was to assess and summarise the evidence available regarding the efficacy and tolerability of radiotherapy in addition to chemotherapy in the treatment of immunocompetent individuals with PCNSL. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 01.2014), MEDLINE from January 1950 to February 2014 and conference proceedings from 2005 to 2013. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing chemotherapy plus radiotherapy with chemotherapy alone in individuals with PCNSL. Outcomes defined in this review were overall survival, progression-free survival, response to treatment, adverse events, treatment related mortality and quality of life. We excluded trials in which the chemotherapy regimen differed between treatment arms, trials in which fewer than 80% of participants had PCNSL or those recruiting immunocompromised individuals with PCNSL. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the search strategies for eligibility for this review. Both assessed risk of bias. Where relevant data was unavailable, we contacted the investigator by email. MAIN RESULTS Of the 556 potentially relevant studies only two met the inclusion criteria. One of those was excluded as the trial was abandoned prematurely and reported only preliminary results. The only analysed trial enrolled 551 participants receiving first-line chemotherapy (methotrexate) followed by whole brain radiotherapy (WBR) or receiving chemotherapy only (methotrexate followed by cytarabine in case of incomplete response). In this non-inferiority trial, the intention-to-treat (ITT) population consisted of 411 participants and the per-protocol (PP) population of 318 participants. We judged the potential for risk of bias in this open-label study as moderate.The estimated effect of chemotherapy plus WBR on survival was similar to that with chemotherapy alone but due to a wide CI we could not rule out the superiority of either therapy. This applied to both the ITT population (HR 1.01, 95% CI 0.79 to 1.30; P = 0.94) and the PP population (HR 1.06, 95% CI 0.80 to 1.40; P = 0.71) (moderate-quality evidence). Due to the low number of participants and a risk of detection bias we found low-quality evidence for an improvement in progression-free survival in participants in the ITT population receiving WBR in addition to chemotherapy (HR 0.79, 95% CI 0.63 to 0.99; P = 0.041). An improvement in PFS was also observed with WBR plus chemotherapy in participants in the PP population, but the CI was slightly wider and the result not significant (HR 0.82,95% CI 0.64 to 1.07; P = 0.14). Treatment-related mortality and health-related quality of life were not evaluated. Treatment-related neurotoxicity was assessed clinically in 79 participants, revealing signs of neurotoxicity in 49% of those receiving chemotherapy plus radiotherapy and in 26% of those receiving chemotherapy only (RR 1.85, 95% CI 0.98 to 3.48; P = 0.054) (very-low-quality evidence). AUTHORS' CONCLUSIONS In summary, the currently available evidence (one RCT) is not sufficient to conclude that WBR plus chemotherapy and chemotherapy alone have similar effects on overall survival in people with PCNSL. The findings suggest that the addition of radiotherapy (WBR) to chemotherapy may increase progression-free survival, but may also increase the incidence of neurotoxicity compared to chemotherapy only (methotrexate monotherapy). As the role of chemoradiotherapy in the treatment of PCNSL remains unclear, further prospective, randomised trials are needed before definitive conclusions can be drawn.
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Affiliation(s)
- Jonas Zacher
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
| | - Benjamin Kasenda
- University Hospital BaselMedical OncologyPetersgraben 4BaselBaselSwitzerland4031
| | - Andreas Engert
- University of Cologne, Faculty of Medicine and University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane CancerUniversity of CologneKerpener Str. 62CologneGermany50937
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Hart A, Baars JW, Kersten MJ, Brandsma D, van Tinteren H, de Jong D, Spiering M, Dewit L, Boogerd W. Outcome of patients with primary central nervous system lymphoma treated outside clinical trials. Neth J Med 2014; 72:218-223. [PMID: 24829178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Reports on the outcome of patients with primary central nervous system lymphoma (PCNSL) are mainly based on results obtained in the context of clinical trials. However, due to poor performance status and cognitive impairment, most patients are actually treated outside clinical studies. The aim of this retrospective study was to get more insight into the outcome of HIV-negative PCNSL patients, treated between 2000-2010 in two hospitals (one academic centre and one categorical cancer centre). Fifty-two patients were identified. Eight patients were treated with corticosteroids only. Sixteen patients received high-dose methotrexate (MTX)-based chemotherapy, ten received radiotherapy and 18 patients were treated with a combination of MTX-based chemotherapy and radiotherapy. At a median follow-up of 63.1 months, the median overall survival for all patients was 24.4 months (95% CI: 11.5-39.8 months), with an event-free survival of 14 months (95% CI: 7.3-24.4 months). Causes of death were progressive PCNSL in 29 patients, MTX toxicity in four patients and epileptic seizures in one patient. These results are comparable with the outcome of prospective clinical trials in this disease, which still has a relatively poor prognosis.
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Affiliation(s)
- A Hart
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Asakawa I, Tamamoto T, Hasegawa M. [Radiation therapy for malignant lymphoma]. Nihon Rinsho 2014; 72:468-472. [PMID: 24724405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Malignant lymphoma is usually radiosensitive and radiation therapy is an effective modality for local control of lymphoma. However, lymphoma is a typical systemic disease, and chemotherapy is performed for many cases. Recently, the late adverse events associated with radiotherapy (especially extended field radiation therapy), such as cardiovascular disease and secondary cancers, become a serious problem for long-term lymphoma survivors. In combination with chemotherapy, it is possible to reduce both the treatment volume and the overall treatment dose to minimise the risks of late adverse events.
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Abstract
Cancer is the second most common cause of death in the reproductive years and complicates up to one in 1000 pregnancies. When cancer is diagnosed during pregnancy, the management strategy must take into account both the mother and developing fetus. In this article, the four most common malignancies diagnosed in pregnant patients--cervical and breast cancer, malignant melanoma and lymphoma--will be reviewed, with an emphasis on the impact of the diagnosis and management on the pregnant patient and the developing fetus.
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Affiliation(s)
- Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
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Muylle K, Vanderlinden B. Reply to letter re: general theory of predictive dosimetry for yttrium-90 radioembolization to sites other than the liver. Cardiovasc Intervent Radiol 2013; 37:1118-9. [PMID: 24218175 DOI: 10.1007/s00270-013-0784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Kristoff Muylle
- Department of Nuclear Medicine, Jules Bordet Institute, ULB, Héger Bordetstraat 1, 1000, Brussels, Belgium,
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Abstract
The major retinal tumor that requires radiotherapy (RT) is retinoblastoma (RB); to a lesser degree, RT is used for some cases of retinal capillary hemangioma and lymphoma of the retina. Although there are concerns about the risk of RT-induced second malignancy in patients who carry a germline mutation in the RB1 gene, RT remains a very important part of our approach to intra-ocular and extra-ocular RB. Technical innovations in RT allow more precise targeting of retinal tumors and decreased exposure of adjacent normal tissue, an advance that is particularly significant for patients with hereditary RB who are at risk of additional malignancies.
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Affiliation(s)
- Roshan V Sethi
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Han JW, Kim HS, Kim BS, Kwon SY, Shin YJ, Kim SH, Ko JH, Lyu CJ. Increasing and worsening late effects in childhood cancer survivors during follow-up. J Korean Med Sci 2013; 28:755-62. [PMID: 23678269 PMCID: PMC3653090 DOI: 10.3346/jkms.2013.28.5.755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/15/2013] [Indexed: 11/20/2022] Open
Abstract
Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.
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Affiliation(s)
- Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Seoul, Korea
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Masunaga SI, Sakurai Y, Tanaka H, Suzuki M, Kondo N, Narabayashi M, Maruhashi A, Ono K. Wortmannin efficiently suppresses the recovery from radiation-induced damage in pimonidazole-unlabeled quiescent tumor cell population. J Radiat Res 2013; 54:221-9. [PMID: 23097299 PMCID: PMC3589932 DOI: 10.1093/jrr/rrs094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Labeling of proliferating (P) cells in mice bearing EL4 tumors was achieved by continuous administration of 5-bromo-2'-deoxyuridine (BrdU). Tumors were irradiated with γ-rays at 1 h after pimonidazole administration followed by caffeine or wortmannin treatment. Twenty-four hours later, assessment of the responses of quiescent (Q) and total (= P + Q) cell populations were based on the frequencies of micronucleation and apoptosis using immunofluorescence staining for BrdU. The response of the pimonidazole-unlabeled tumor cell fractions was assessed by means of apoptosis frequency using immunofluorescence staining for pimonidazole. The pimonidazole-unlabeled cell fraction showed significantly enhanced radio-sensitivity compared with the whole cell fraction more remarkably in Q cells than total cells. However, a significantly greater decrease in radio-sensitivity in the pimonidazole-unlabeled than the whole cell fraction, evaluated using an assay performed 24 hours after irradiation, was more clearly observed in Q cells than total cells. In both the pimonidazole-unlabeled and the whole cell fractions, wortmannin efficiently suppressed the reduction in sensitivity due to delayed assay. Wortmannin combined with γ-ray irradiation is useful for suppressing the recovery from radiation-induced damage especially in the pimonidazole-unlabeled cell fraction within the total and Q tumor cell populations.
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Affiliation(s)
- Shin-Ichiro Masunaga
- Particle Radiation Oncology Research Center, Research Reactor Institute, Kyoto University, 2-1010, Asashiro-nishi, Kumatori-cho, Sennan-gun, Osaka, 590-0494, Japan.
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48
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Dědečková K, Móciková H, Belada D, Janíková A, Dolečková M, Malinová B, Feltl D, Vošmik M, Svoboda T, Marková J, Trněný M. [The role of radiotherapy in the treatment of malignant lymphomas - recommendations of the Czech Lymphoma Study Group]. Klin Onkol 2013; 26:99-109. [PMID: 23718668 DOI: 10.14735/amko201399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Indication of radiotherapy in lymphoma treatment is an important strategic decision requiring comprehensive expertise. It also calls for a better definition of the position of radiotherapy in clinical practice. DESIGN This position paper represents a consensus between hematooncologists and radiation oncologists on the role of RT in treatment of different histological types and stages of malignant lymphomas. The discussion was underway within professional societies of both specializations (Czech Lymphoma Study Group for the hematooncologists and the Society of Radiation Oncology, Biology and Physics for the radiation oncologists). RESULTS The consensus presented here was reached in early 2012 and draws on evidence-based medicine and clinical practice. Besides defining the role of radiotherapy in lymphoma treatment, this paper also gives specific recommendations on total doses of radiotherapy in lymphoma treatment. CONCLUSION These recommendations will supplement 7th edition of "Diagnostic and treatment guidelines in patients with malignant lymphoma" scheduled for publication in 2013.
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Affiliation(s)
- K Dědečková
- Ustav radiacni onkologie 1. LF UK a Nemocnice Na Bulovce, Praha.
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Abstract
Patients with primary gastric lymphoma (PGL) are often treated with three-dimensional conformal radiotherapy (3D-CRT) in three to four fields to reduce the dose to the left kidney. However, the liver dose is higher than conventional parallel-opposed fields. This study was designed to evaluate hepatic dysfunction after 3D-CRT in patients with PGL. The data of 20 PGL patients treated with 3D-CRT were analyzed. Of the 20 patients, 3 had mucosa-associated lymphoid tissue (MALT) lymphoma and 17 had diffuse large B-cell lymphoma (DLBCL). The median dose used to treat MALT lymphoma was 30 Gy and 40 Gy for DLBCL. Pretreatment and post-treatment transaminase and alkaline phosphatase (ALP) values were compared. Radiation-induced hepatic dysfunction (RIHD) was defined as a more than 2-fold increase in transaminase or ALP levels, exceeding the upper limit within 4 months of the completion of radiotherapy. Increased transaminase or ALP levels were observed in 19 patients (95%). RIHD was observed in 14 patients (70%). The transaminase and ALP values were significantly different between pretreatment and post-treatment. There were significant differences in liver volumes receiving ≥5, ≥10, ≥15 and ≥20 Gy (V5, V10, V15 and V20) and in the mean liver doses between patients with and without RIHD. For patients with V10 > 60%, V15 > 50% or V20 > 30% in particular, the incidence rates of RIHD were significantly high. After radiotherapy for PGL, hepatic dysfunction occurred at a high rate. Thus, radiotherapy treatment should be planned in order to reduce liver doses.
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Affiliation(s)
- Hidekazu Tanaka
- Department of Radiology, Gifu University Hospital, Yanagido 1-1, Gifu 501-1194, Japan.
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50
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Motyčková M, Smolej L, Belada D, Malý J, Zák P. [Our experience with the treatment of primary lymphomas of the central nervous system]. Vnitr Lek 2012; 58:915-921. [PMID: 23427949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The aim of this study was to assess treatment efficiency, overall survival (OS) and identify risk factors with the influence on patients prognosis in patients with primary central nervous system lymphomas (PCNSL) who were treated with intensive chemotherapy based on high-dose methotrexate and cytosin-arabinoside followed by whole-brain radiotherapy (MPV regimen). PATIENTS AND METHODS From January 1998 to February 2011, 39 patients with PCNSL were diagnosed on our department. The median from the first clinical symptomatology to histological diagnosis was 4 weeks (range, 2-19). Thirty-seven patients were treated with MPV regimen. RESULTS The therapeutic response was evaluated in 35 patients (2 patients died early during treatment). The overall response/complete remission rate was 63/60%. At the time of analysis (november 2011), the median of follow-up was 16,5 months; 31 patients died (the most often causes of death were poor treatment effect and treatment complications). The 2-year OS was 30% and median PFS and OS were 9 and 12 months. Patients with WHO performance status 0-1 and those with normal serum lactate dehydrogenase serum had significantly longer OS (p = 0.0495 and p = 0.0232). CONCLUSION The treatment results of our patients appear to be inferior than data from literature. The reason is probably high occurrence of negative prognostic factors. Early diagnosis and intensive treatment are crucial for improvement of prognosis.
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Affiliation(s)
- M Motyčková
- Interni hematologicka klinika lekarske fakulty UK a FN Hradec Kralove.
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