|
1
|
Bourial A, Nourallah Laraqui O, Abdillahi Mahamoud C, Elhani H, Elmjabber R, Taali L, Anajar S, Essaadi M, Snoussi K, Dahbi Z, Hajjij A. Intra-Parotid Recurrent Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241295723. [PMID: 39525331 PMCID: PMC11544682 DOI: 10.1177/11795476241295723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 10/10/2024] [Indexed: 11/16/2024]
Abstract
Introduction Intra-parotid metastasis refers to the spread of cancerous cells from a primary tumor to the lymph nodes within the parotid gland. To our best knowledge, we report the first described case in the literature of a patient who received IMRT for nasopharyngeal carcinoma (UCNT) without sparing the parotid gland and still experienced a recurrence. Case presentation A 57-year-old male patient of north African origin presented with a left parotid mass that had been evolving for 6 months. He was previously diagnosed with and treated for nasopharyngeal carcinoma 2 years prior to admission, with Intensity-Modulated Radiotherapy (IMRT) without sparing the parotid gland, as well as chemotherapy. Medical imaging was suggestive of recurrence of nasopharyngeal carcinoma and metastasis due to the patient's medical history. The patient benefited from a total parotidectomy; The histopathological analysis of the surgical specimen confirmed the presence of a poorly differentiated carcinoma (UCNT) with nodal metastasis. Conclusion Intensity-Modulated Radiation Therapy (IMRT) holds great promise as an alternative treatment option. However, it should be reserved for specific cases with minimal lymph node involvement, and always preceded by a thorough clinical and radiological examination.
Collapse
Affiliation(s)
- Abderrahim Bourial
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Othmane Nourallah Laraqui
- Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Chirwa Abdillahi Mahamoud
- Department of Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Hiba Elhani
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Reyzane Elmjabber
- Department of Radiotherapy, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Loubna Taali
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Said Anajar
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Mustapha Essaadi
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Khalid Snoussi
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Zineb Dahbi
- Department of Radiotherapy, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| | - Amal Hajjij
- Department of Oto-laryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
| |
Collapse
|
|
2
|
Scarmelotto A, Delprat V, Michiels C, Lucas S, Heuskin AC. The oxygen puzzle in FLASH radiotherapy: A comprehensive review and experimental outlook. Clin Transl Radiat Oncol 2024; 49:100860. [PMID: 39381632 PMCID: PMC11458961 DOI: 10.1016/j.ctro.2024.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 10/10/2024] Open
Abstract
FLASH radiotherapy is attracting increasing interest because it maintains tumor control while inflicting less damage to normal tissues compared to conventional radiotherapy. This sparing effect, the so-called FLASH effect, is achieved when radiation is delivered at ultra-high dose rates (≥40 Gy/s). Although the FLASH effect has already been demonstrated in several preclinical models, a complete mechanistic description explaining why tumors and normal tissues respond differently is still missing. None of the current hypotheses fully explains the experimental evidence. A common point between many of these is the role of oxygen, which is described as a major factor, either through transient hypoxia in the form of dissolved molecules, or reactive oxygen species (ROS). Therefore, this review focuses on both forms of this molecule, retracing old and more recent theories, while proposing new mechanisms that could provide a complete description of the FLASH effect based on preclinical and experimental evidence. In addition, this manuscript describes a set of experiments designed to provide the FLASH community with new tools for exploring the post-irradiation fate of ROS and their potential biological implications.
Collapse
Affiliation(s)
- Andrea Scarmelotto
- Laboratory for Analysis by Nuclear Reaction (LARN), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium
| | - Victor Delprat
- Laboratory for Analysis by Nuclear Reaction (LARN), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium
| | - Carine Michiels
- Unité de Recherche en Biologie Cellulaire (URBC), Namur Research Institute For Life Sciences (NARILIS), University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium
| | - Stéphane Lucas
- Laboratory for Analysis by Nuclear Reaction (LARN), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium
- Ion Beam Application (IBA), Chemin du Cyclotron, 6, B-1348 Louvain-La-Neuve, Belgium
| | - Anne-Catherine Heuskin
- Laboratory for Analysis by Nuclear Reaction (LARN), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium
| |
Collapse
|
|
3
|
Chophy A, Gupta S, Joseph D, Verma S, Gupta M. Assessment of Volumetric Changes Using Megavoltage-Cone Beam Computed Tomography (MV-CBCT) for Adaptive Radiotherapy in Head and Neck Cancer: A Case Series. Cureus 2024; 16:e69251. [PMID: 39398723 PMCID: PMC11470841 DOI: 10.7759/cureus.69251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 10/15/2024] Open
Abstract
Intensity-modulated radiation therapy (IMRT) has brought about interest in adaptive radiotherapy (ART) due to its benefit of accurately prescribing doses to tumors and sparing normal critical organs. Critical dosimetric errors and geometrical misses can occur due to anatomical changes during radiotherapy. In the present study, five patients with head and neck malignancies undergoing radiation therapy were assessed for changes in primary gross tumor volume (GTVp), nodal gross tumor volume (GTVn), and clinical target volume-high risk (CTV-HR) using weekly megavoltage-cone beam computed tomography (MV-CBCT) scans. All patients had a reduction in GTV and lateral neck diameter (LND). There were reductions in tumor volumes leading to re-planning in the 20th fraction. Daily CBCT can guide the decision on the need for adaptation in patients with tumor volume reduction and with volumes going outside the body.
Collapse
Affiliation(s)
- Atokali Chophy
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Deepa Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Swati Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Manoj Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| |
Collapse
|
|
4
|
Dashnamoorthy S, Jeyasingh E, Rajamanickam K, Pitchaikannu V, Nachimuthu K. Dosimetric and radiobiological advantages from deep inspiration breath-hold and free breath technique for left-sided breast radiation using 3DCRT, IMRT and Rapid Arc methods-a complete assessment. RADIATION PROTECTION DOSIMETRY 2024; 200:1274-1293. [PMID: 39003236 DOI: 10.1093/rpd/ncae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/16/2024] [Accepted: 03/14/2024] [Indexed: 07/15/2024]
Abstract
The verification and use of the best treatment approach using 3D conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and Rapid Arc methods for left breast radiation with dosimetric and radiobiological characteristics. The use of custom-built Python software for the estimation and comparison of volume, mean dose, maximum dose, monitor units and normal tissue integral dose along with radiobiological parameters such as NTCP, tumor control probability, equivalent uniform dose and LKB's effective volume from 3DCRT, IMRT and Rapid Arc planning with deep inspiration with breath holding (DIBH) and free breadth (FB) techniques. Volume growth of three-fourth in DIBH compared with FB causes a decrease in cardiac doses and complications because the left lung expands, pulling the heart away from the chest wall and the treatment area. A tiny area of the left lung was exposed during treatment, which reduced the mean dose. There was little difference in the treatment approaches because the spinal cord was immobile in both techniques. Rapid Arc is the unmatched modality for left-sided breast irradiation with significant patient breath-hold, as shown by the comparison of dosimetric and radiobiological parameters from treatment techniques with a deep inspiration breath-hold approach.
Collapse
Affiliation(s)
- Sougoumarane Dashnamoorthy
- Department of Radiotherapy, Thangam Cancer Hospital, Namakkal 637001, Tamil Nadu, India
- PG & Research Department of Physics, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620020, Tamil Nadu, India
| | - Ebenezar Jeyasingh
- PG & Research Department of Physics, Jamal Mohamed College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli 620020, Tamil Nadu, India
| | - Karthick Rajamanickam
- Department of Radiotherapy, Thangam Cancer Hospital, Namakkal 637001, Tamil Nadu, India
| | | | - Kathiresan Nachimuthu
- Department of Radiotherapy, Thangam Cancer Hospital, Namakkal 637001, Tamil Nadu, India
| |
Collapse
|
|
5
|
Aghajanzadeh S, Karlsson T, Tuomi L, Engström M, Finizia C. Postradiation trismus in head and neck cancer survivors: a qualitative study of effects on life, rehabilitation, used coping strategies and support from the healthcare system. Eur Arch Otorhinolaryngol 2024; 281:3717-3726. [PMID: 38587650 PMCID: PMC11211121 DOI: 10.1007/s00405-024-08609-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE This study aimed to explore the experiences of head and neck cancer (HNC) survivors with postradiation trismus, specifically how oncological treatment affected their lives, rehabilitation, use of coping strategies, and healthcare experiences. METHODS A qualitative descriptive approach was used and semi-structured interviews of 10 HNC survivors with postradiation trismus were conducted 6-30 months after completing oncological treatment. The interviews were transcribed verbatim and analyzed by qualitative content analysis. RESULTS The analysis of interviews yielded four main categories: Bodily symptoms, Effects on life, Support from the healthcare system, and Strategies to handle life and symptoms. Participants reported ongoing problems with xerostomia, dysgeusia, eating, and limited physical fitness. Pain related to trismus was not a major issue in this cohort. Participants expressed limitations in their social lives due to their eating difficulties, yet a sense of thankfulness for life and overall satisfaction with the healthcare they received. Psychological and practical coping strategies developed by the participants were also revealed. CONCLUSION The results highlight areas of unmet need among HNC survivors that healthcare providers can target by establishing multi-professional teams dedicated to individualizing post-cancer rehabilitation care.
Collapse
Affiliation(s)
- Susan Aghajanzadeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology- Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology- Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology- Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Surgery Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology- Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
|
6
|
Kakade NR, Kumar R, Sharma SD, Sapra BK. Dosimetry audit in advanced radiotherapy using in-house developed anthropomorphic head & neck phantom. Biomed Phys Eng Express 2024; 10:025022. [PMID: 38269653 DOI: 10.1088/2057-1976/ad222a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 01/26/2024]
Abstract
The treatment of head and neck (H&N) cancer presents formidable challenges due to the involvement of normal tissue and organs at risk (OARs) in the close vicinity. Ensuring the precise administration of the prescribed dose demands prior dose verification. Considering contour irregularity and heterogeneity in the H&N region, an anthropomorphic and heterogeneous H&N phantom was developed and fabricated locally for conducting the dosimetry audit in advanced radiotherapy treatments. This specialized phantom emulates human anatomy and incorporates a removable cylindrical insert housing a C-shaped planning target volume (PTV) alongside key OARs including the spinal cord, oral cavity, and bilateral parotid glands. Acrylonitrile Butadiene Styrene (ABS) was chosen for PTV and parotid fabrication, while Delrin was adopted for spinal cord fabrication. A pivotal feature of this phantom is the incorporation of thermoluminescent dosimeters (TLDs) within the PTV and OARs, enabling the measurement of delivered dose. To execute the dosimetry audit, the phantom, accompanied by dosimeters and comprehensive guidelines, was disseminated to multiple radiotherapy centers. Subsequently, hospital physicists acquired computed tomography (CT) scans to generate treatment plans for phantom irradiation. The treatment planning system (TPS) computed the anticipated dose distribution within the phantom, and post-irradiation TLD readings yielded actual dose measurements. The TPS calculated and TLD measured dose values at most of the locations inside the PTV were found comparable within ± 4%. The outcomes affirm the suitability of the developed anthropomorphic H&N phantom for precise dosimetry audits of advanced radiotherapy treatments.
Collapse
Affiliation(s)
- Nitin R Kakade
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
| | - Rajesh Kumar
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
| | - S D Sharma
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
- Homi Bhabha National Institute, Mumbai-400094, India
| | - B K Sapra
- Radiological Physics & Advisory Division, Bhabha Atomic Research Centre, Mumbai-400094, India
- Homi Bhabha National Institute, Mumbai-400094, India
| |
Collapse
|
|
7
|
Courtney PT, Valle LF, Raldow AC, Steinberg ML. MRI-Guided Radiation Therapy-An Emerging and Disruptive Process of Care: Healthcare Economic and Policy Considerations. Semin Radiat Oncol 2024; 34:4-13. [PMID: 38105092 DOI: 10.1016/j.semradonc.2023.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
MRI-guided radiation therapy (MRgRT) is an emerging, innovative technology that provides opportunities to transform and improve the current clinical care process in radiation oncology. As with many new technologies in radiation oncology, careful evaluation from a healthcare economic and policy perspective is required for its successful implementation. In this review article, we describe the current evidence surrounding MRgRT, framing it within the context of value within the healthcare system. Additionally, we highlight areas in which MRgRT may disrupt the current process of care, and discuss the evidence thresholds and timeline required for the widespread adoption of this promising technology.
Collapse
Affiliation(s)
- P Travis Courtney
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Luca F Valle
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Ann C Raldow
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, CA.
| |
Collapse
|
|
8
|
Jang WI, Jo S, Moon JE, Bae SH, Park HC. The Current Evidence of Intensity-Modulated Radiotherapy for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4914. [PMID: 37894281 PMCID: PMC10605127 DOI: 10.3390/cancers15204914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Intensity-modulated radiotherapy (IMRT), an advanced RT technique, is a considerable treatment option for hepatocellular carcinoma (HCC). However, the distinguishing features of IMRT for HCC have not yet been clearly defined. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PubMed/MedLine, Embase, Cochrane Library, Web of Science, and KoreaMed were used to screen eligible studies focusing on treatment outcomes after IMRT for HCC until 18 April 2023. A total of 1755 HCC patients receiving IMRT among 29 studies from 2009 to 2023 were selected for the meta-analysis. The median proportion of Barcelona Clinic Liver Cancer stage C was 100% (range: 38-100%). Nineteen studies used combined treatment. Pooled rates of response and 1-year local control were 58% (95% confidence interval [CI], 50-65%) and 84% (95% CI, 70-94%), respectively. The median overall survival (OS) was 13 months (range: 5-45 months), and pooled 1- and 3-year OS rates were 59% (95% CI, 52-66%), and 23% (95% CI, 14-33%), respectively. Pooled rates of classic radiation-induced liver disease (RILD), nonclassic RILD, and hepatic toxicity ≥ grade 3 were 2%, 4%, and 4%, respectively. Although most patients had advanced-stage HCC and combined treatment was commonly used, IMRT for HCC showed similar survival to existing RT modalities and relatively low severe toxicity.
Collapse
Affiliation(s)
- Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea;
| | - Sunmi Jo
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea;
| | - Ji Eun Moon
- Department of Biostatistics, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea;
| | - Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| |
Collapse
|
|
9
|
Beddok A, Lim R, Thariat J, Shih HA, El Fakhri G. A Comprehensive Primer on Radiation Oncology for Non-Radiation Oncologists. Cancers (Basel) 2023; 15:4906. [PMID: 37894273 PMCID: PMC10605284 DOI: 10.3390/cancers15204906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Multidisciplinary management is crucial in cancer diagnosis and treatment. Multidisciplinary teams include specialists in surgery, medical therapies, and radiation therapy (RT), each playing unique roles in oncology care. One significant aspect is RT, guided by radiation oncologists (ROs). This paper serves as a detailed primer for non-oncologists, medical students, or non-clinical investigators, educating them on contemporary RT practices. Methods: This report follows the process of RT planning and execution. Starting from the decision-making in multidisciplinary teams to the completion of RT and subsequent patient follow-up, it aims to offer non-oncologists an understanding of the RO's work in a comprehensive manner. Results: The first step in RT is a planning session that includes obtaining a CT scan of the area to be treated, known as the CT simulation. The patients are imaged in the exact position in which they will receive treatment. The second step, which is the primary source of uncertainty, involves the delineation of treatment targets and organs at risk (OAR). The objective is to ensure precise irradiation of the target volume while sparing the OARs as much as possible. Various radiation modalities, such as external beam therapy with electrons, photons, or particles (including protons and carbon ions), as well as brachytherapy, are utilized. Within these modalities, several techniques, such as three-dimensional conformal RT, intensity-modulated RT, volumetric modulated arc therapy, scattering beam proton therapy, and intensity-modulated proton therapy, are employed to achieve optimal treatment outcomes. The RT plan development is an iterative process involving medical physicists, dosimetrists, and ROs. The complexity and time required vary, ranging from an hour to a week. Once approved, RT begins, with image-guided RT being standard practice for patient alignment. The RO manages acute toxicities during treatment and prepares a summary upon completion. There is a considerable variance in practices, with some ROs offering lifelong follow-up and managing potential late effects of treatment. Conclusions: Comprehension of RT clinical effects by non-oncologists providers significantly elevates long-term patient care quality. Hence, educating non-oncologists enhances care for RT patients, underlining this report's importance.
Collapse
Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Institut Godinot, 51100 Reims, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ruth Lim
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François-Baclesse, 14000 Caen, France
| | - Helen A. Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| |
Collapse
|
|
10
|
Tello-Valenzuela G, Moyano M, Cabrera-Guerrero G. Particle Swarm Optimisation Applied to the Direct Aperture Optimisation Problem in Radiation Therapy. Cancers (Basel) 2023; 15:4868. [PMID: 37835562 PMCID: PMC10571781 DOI: 10.3390/cancers15194868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Intensity modulated radiation therapy (IMRT) is one of the most used techniques for cancer treatment. Using a linear accelerator, it delivers radiation directly at the cancerogenic cells in the tumour, reducing the impact of the radiation on the organs surrounding the tumour. The complexity of the IMRT problem forces researchers to subdivide it into three sub-problems that are addressed sequentially. Using this sequential approach, we first need to find a beam angle configuration that will be the set of irradiation points (beam angles) over which the tumour radiation is delivered. This first problem is called the Beam Angle Optimisation (BAO) problem. Then, we must optimise the radiation intensity delivered from each angle to the tumour. This second problem is called the Fluence Map Optimisation (FMO) problem. Finally, we need to generate a set of apertures for each beam angle, making the intensities computed in the previous step deliverable. This third problem is called the Sequencing problem. Solving these three sub-problems sequentially allows clinicians to obtain a treatment plan that can be delivered from a physical point of view. However, the obtained treatment plans generally have too many apertures, resulting in long delivery times. One strategy to avoid this problem is the Direct Aperture Optimisation (DAO) problem. In the DAO problem, the idea is to merge the FMO and the Sequencing problem. Hence, optimising the radiation's intensities considers the physical constraints of the delivery process. The DAO problem is usually modelled as a Mixed-Integer optimisation problem and aims to determine the aperture shapes and their corresponding radiation intensities, considering the physical constraints imposed by the Multi-Leaf Collimator device. In solving the DAO problem, generating clinically acceptable treatments without additional sequencing steps to deliver to the patients is possible. In this work, we propose to solve the DAO problem using the well-known Particle Swarm Optimisation (PSO) algorithm. Our approach integrates the use of mathematical programming to optimise the intensities and utilizes PSO to optimise the aperture shapes. Additionally, we introduce a reparation heuristic to enhance aperture shapes with minimal impact on the treatment plan. We apply our proposed algorithm to prostate cancer cases and compare our results with those obtained in the sequential approach. Results show that the PSO obtains competitive results compared to the sequential approach, receiving less radiation time (beam on time) and using the available apertures with major efficiency.
Collapse
Affiliation(s)
| | | | - Guillermo Cabrera-Guerrero
- Escuela de Ingeniería Informática, Pontificia Universidad Católica de Valparaíso, Av. Brasil 2241, Valparaíso 2362807, Chile; (G.T.-V.); (M.M.)
| |
Collapse
|
|
11
|
Kalita F, Gupta DS, Gehlot N, Mitra S, Singh S, Pillai SS. Osteonecrosis of the Jaws: An Update and Review of Literature. J Maxillofac Oral Surg 2023; 22:344-351. [PMID: 37122785 PMCID: PMC10130280 DOI: 10.1007/s12663-023-01876-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/20/2023] [Indexed: 03/07/2023] Open
Abstract
Aim To provide a concise review on risk factors, stages, pathophysiology, prevention and possible treatment options for both MRONJ and ORN individually. Methods The review was conducted according to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) guidelines. A comprehensive search of the PUBMED, Ebsco, SCOPUS, WEB OF SCIENCE and NDH for articles published up until 2021 was performed. After screening and full text analyses, 44 studies were included in this review. Definition, risk factors, etiology, symptoms, stages, pathophysiology, prevention and possible management options were explored and highlighted in this article. Results Three studies described osteonecrosis of jaw (ONJ) in general, 15 studies described ONJ associated with radiotherapy and 26 studies described ONJ associated with medications. Both the two conditions (ORN) and (MRONJ) have relatively similar clinical presentations clearing the fact that a resemblance in clinical presentations does not necessarily denote a similar pathophysiology. Conclusion However, various advancements have been made in the control and management of ONJ, but until and unless need for high tumoricidal doses exists, ONJ will certainly continue to remain as a clinical challenge demanding satisfactory treatment to improve the quality of life of the patient.
Collapse
Affiliation(s)
- Flora Kalita
- Department of Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College, and Research Centre, Teerthanker Mahaveer Universitry, Uttar Pradesh, Delhi Road, NH-24, Bagadpur, Moradabad, 244001 India
| | - Durga Shanker Gupta
- Department of Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College, and Research Centre, Teerthanker Mahaveer Universitry, Uttar Pradesh, Delhi Road, NH-24, Bagadpur, Moradabad, 244001 India
| | - Neelima Gehlot
- Department of Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College, and Research Centre, Teerthanker Mahaveer Universitry, Uttar Pradesh, Delhi Road, NH-24, Bagadpur, Moradabad, 244001 India
| | - Subhajit Mitra
- Department of Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College, and Research Centre, Teerthanker Mahaveer Universitry, Uttar Pradesh, Delhi Road, NH-24, Bagadpur, Moradabad, 244001 India
| | - Snigdha Singh
- Department of Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College, and Research Centre, Teerthanker Mahaveer Universitry, Uttar Pradesh, Delhi Road, NH-24, Bagadpur, Moradabad, 244001 India
| | - Sooraj S. Pillai
- Department of Oral and Maxillofacial Surgery, Teerthanker Mahaveer Dental College, and Research Centre, Teerthanker Mahaveer Universitry, Uttar Pradesh, Delhi Road, NH-24, Bagadpur, Moradabad, 244001 India
| |
Collapse
|
|
12
|
Erul E, Guven DC, Onur MR, Yazici G, Aksoy S. Role of sarcopenia on survival and treatment-related toxicity in head and neck cancer: a narrative review of current evidence and future perspectives. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-08014-9. [PMID: 37188907 DOI: 10.1007/s00405-023-08014-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The purpose of this article is to provide an up-to-date summary of sarcopenia and its clinical implications for patients with head and neck cancer (HNC). METHODS We conducted a literature review of recent studies investigating the prevalence of sarcopenia in HNC patients, its detection using MRI or CT scans, and its association with clinical outcomes such as disease-free and overall survival time, radiotherapy-related side effects, cisplatin toxicity, and surgical complications. RESULTS Sarcopenia, characterized by low skeletal muscle mass (SMM), is a prevalent condition in HNC patients and can be effectively detected using routine MRI or CT scans. Low SMM in HNC patients is associated with increased risks of shorter disease-free and overall survival times, as well as radiotherapy-related side effects such as mucositis, dysphagia, and xerostomia. In addition, cisplatin toxicity is more severe in HNC patients with low SMM, leading to higher dose-limiting toxicity and treatment interruptions. Low SMM may also predict higher risks of surgical complications in head and neck surgery. Identifying sarcopenic patients can aid physicians in better riskstratifying HNC patients for therapeutic or nutritional interventions to improve clinical outcomes. CONCLUSIONS Sarcopenia is a significant concern for HNC patients and can impact their clinical outcomes. Routine MRI or CT scans can effectively detect low SMM in HNC patients. Identifying sarcopenic patients can aid physicians in better risk-stratifying HNC patients for therapeutic or nutritional interventions to improve clinical outcomes. Further research is needed to explore the potential of interventions to mitigate the negative effects of sarcopenia in HNC patients.
Collapse
Affiliation(s)
- Enes Erul
- Department of Internal Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
| | | | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
| |
Collapse
|
|
13
|
Klett KC, Martin-Villa BC, Villarreal VS, Melemenidis S, Viswanathan V, Manjappa R, Ashraf MR, Soto L, Lau B, Dutt S, Rankin EB, Loo BW, Heilshorn SC. Human enteroids as a tool to study conventional and ultra-high dose rate radiation. Integr Biol (Camb) 2023; 15:zyad013. [PMID: 37874173 PMCID: PMC10594601 DOI: 10.1093/intbio/zyad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
Radiation therapy, one of the most effective therapies to treat cancer, is highly toxic to healthy tissue. The delivery of radiation at ultra-high dose rates, FLASH radiation therapy (FLASH), has been shown to maintain therapeutic anti-tumor efficacy while sparing normal tissues compared to conventional dose rate irradiation (CONV). Though promising, these studies have been limited mainly to murine models. Here, we leveraged enteroids, three-dimensional cell clusters that mimic the intestine, to study human-specific tissue response to radiation. We observed enteroids have a greater colony growth potential following FLASH compared with CONV. In addition, the enteroids that reformed following FLASH more frequently exhibited proper intestinal polarity. While we did not observe differences in enteroid damage across groups, we did see distinct transcriptomic changes. Specifically, the FLASH enteroids upregulated the expression of genes associated with the WNT-family, cell-cell adhesion, and hypoxia response. These studies validate human enteroids as a model to investigate FLASH and provide further evidence supporting clinical study of this therapy. Insight Box Promising work has been done to demonstrate the potential of ultra-high dose rate radiation (FLASH) to ablate cancerous tissue, while preserving healthy tissue. While encouraging, these findings have been primarily observed using pre-clinical murine and traditional two-dimensional cell culture. This study validates the use of human enteroids as a tool to investigate human-specific tissue response to FLASH. Specifically, the work described demonstrates the ability of enteroids to recapitulate previous in vivo findings, while also providing a lens through which to probe cellular and molecular-level responses to FLASH. The human enteroids described herein offer a powerful model that can be used to probe the underlying mechanisms of FLASH in future studies.
Collapse
Affiliation(s)
- Katarina C Klett
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Victoria S Villarreal
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - M Ramish Ashraf
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Luis Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Suparna Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Erinn B Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah C Heilshorn
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| |
Collapse
|
|
14
|
Hwang WY, Chang SJ, Kim HS, Kim NK, Kim TH, Kim Y, Kong TW, Lee EJ, Park SJ, Shim SH, Son JH, Suh DH, Yang EJ. Gastrointestinal/genitourinary perforation and fistula formation with or without bevacizumab in patients with previously irradiated recurrent cervical cancer: a Korean multicenter retrospective study of the Gynecologic Oncology Research Investigators Collaboration (GORILLA) group (GORILLA-1001). BMC Cancer 2022; 22:603. [PMID: 35655188 PMCID: PMC9161567 DOI: 10.1186/s12885-022-09695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study aims to evaluate the incidence of and identify risk factors for gastrointestinal (GI) and genitourinary (GU) fistula or perforation formation with or without bevacizumab in patients with recurrent cervical cancer who underwent pelvic radiation therapy (RT). Methods Medical records of patients with recurrent cervical cancer who previously underwent pelvic RT between 2007 and 2020 were retrospectively reviewed. Clinicopathological factors were compared between groups that are stratified according to: 1) fistula/perforation (+) versus (-); and 2) bevacizumab plus conventional chemotherapy (BC) versus chemotherapy alone (C). Univariate and multivariate regression analyses were performed to identify risk factors for fistula/perforation. Overall survival (OS) was compared between the different groups. Results Of 219 participants, fistula/perforation of any grade occurred in 36 patients (16.4%); 27 fistulas and 9 perforations. Bevacizumab was more frequently used in Bevacizumab was more frequently used ( +) group than fistula/perforation (-) group (p = 0.015). Multivariate analysis showed that bevacizumab administration was the only independent risk factor for fistula or perforation (HR, 3.27; 95% CI, 1.18–9.10; P = 0.023). F/P was observed more frequently in women receiving BC (n = 144) than those receiving C (n = 75) (20.8% vs. 8.0%; P = 0.019). During median follow-up of 33.7 months (1.2–185.6 months), no significant OS difference was observed between fistula/perforation ( +) vs. (-) (hazards ratio [HR], 1.78; median 84.2 months [95% CI, 59.3–109.0] vs. 129.5 months [95% CI, 114.1–144.9]; P = 0.065) or BC vs. C (HR, 1.03; median 119.8 months [95% CI, 97.3–142.3] vs. 115.7 months [95% CI, 96.0–135.4]; P = 0.928). Conclusions This study suggests that incorporation of bevacizumab in chemotherapy regimens for treating recurrent cervical cancer in patients who underwent pelvic RT incurs considerable risk for GI/GU fistula or perforation. There were no other independent risk factors for developing GI/GU fistula or perforation in this study population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09695-x.
Collapse
|
|
15
|
Shewalkar B, Khan A, Yerlekar D, Patel J, Khadilkar H, Sakthivel R, Kataruka R. Dose-Escalated Intensity-Modulated Radiotherapy for the Management of Locally Advanced Cervical Cancer. Cureus 2022; 14:e25965. [PMID: 35855254 PMCID: PMC9285639 DOI: 10.7759/cureus.25965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
Abstract
Objective In this study, we aimed to assess the response and toxicity related to dose escalation in external beam radiation therapy (EBRT) using intensity-modulated radiation therapy (IMRT) with weekly concurrent cisplatin followed by de-escalated brachytherapy (BT) in locally advanced carcinoma cervix of International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIB-IIIC1. Materials and methods Fifty-two patients diagnosed with cervical cancer FIGO 2018 stage IIB-IIIC1 were treated with curative intent from November 2019 to October 2021. The dose of 50 Gy was prescribed for the primary tumor volume and elective pelvic nodal volume followed by a primary boost to a dose of 20 Gy. Gross lymph node (LN) of size >1 cm after EBRT completion received a sequential nodal boost of 10 Gy. All patients received concurrent cisplatin to a dose of 40 mg/m2 for a total of five to six weekly cycles. All patients received two fractions of BT to a dose of 6 Gy after EBRT completion. Radiation-induced acute toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) criteria and hematologic toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0). Results A median follow-up of six months was available for the 40 eligible patients. All patients tolerated treatment with an acceptable toxicity profile. Grade III dermatitis, grade III gastrointestinal (GI) toxicity, and grade III genitourinary (GU) toxicity were seen in three (7.5%), six (17.5%), and three patients (7.5%) respectively. Grade I anemia was evident in all patients. At six months after EBRT completion, 37 patients (92.5%) had a complete response and only three patients (7.5%) had residual disease. Conclusion Based on our findings, patients with cervical cancer treated with dose-escalated IMRT have a satisfactory outcome with reasonably low levels of treatment-related acute GI and GU toxicities. The findings of the present study endorse the notion that the application of a high dose of external radiation to the pelvis by IMRT technique with image-guided delivery could be an acceptable alternative to the standard-dose management schedule.
Collapse
Affiliation(s)
- Balaji Shewalkar
- Radiation Oncology, Government Medical College and Cancer Hospital, Aurangabad, IND
| | - Asfiya Khan
- Radiation Oncology, Government Medical College and Cancer Hospital, Aurangabad, IND
| | - Dnyanda Yerlekar
- Radiation Oncology, Government Medical College and Cancer Hospital, Aurangabad, IND
| | - Jitendra Patel
- Radiation Oncology, Government Medical College and Cancer Hospital, Aurangabad, IND
| | - Hrishikesh Khadilkar
- Preventive Oncology, Government Medical College and Cancer Hospital, Aurangabad, IND
| | - Rajakumar Sakthivel
- Radiation Oncology, Government Medical College and Cancer Hospital, Aurangabad, IND
| | - Reeta Kataruka
- Pathology, Government Medical College and Cancer Hospital, Aurangabad, IND
| |
Collapse
|
|
16
|
Dosimetric sensitivity of leaf width on volumetric modulated arc therapy plan quality: an objective approach. Rep Pract Oncol Radiother 2022; 27:76-85. [PMID: 35402026 PMCID: PMC8989436 DOI: 10.5603/rpor.a2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Several authors investigated a dosimetric impact of leaf width on radiotherapy plan quality subjectively, and concluded that thinner leaf-width multileaf collimators (MLC) are beneficial because of their better coverage of clinically relevant structures. Study aimed to investigate the dosimetric effect of MLC leaf width on volumetric modulated arc therapy plan quality by objective approach. Materials and methods Twelve of each prostate and head-and-neck patients were planned for volumetric modulated arc therapy (VMAT) treatments for MLC leaf widths of 4 mm and 10 mm. Three different VMAT schemes single-arc, dual-arc and two combined independent single-arcs were optimized. Dose volume histogram and Isodose distribution were used for quantitative and qualitative comparison of the treatment plan, respectively. Dose-volume-indices of the planning target volume, organs at risk and number of delivered monitor units were compared. The 4 mm leaf width being reference over 10 mm and results were noted as statistically significant if p ≤ 0.05 using student t-test. Results All VMAT schemes for both tumor sites showed a gain in target coverage, similar organs at risk doses and higher monitor units to be delivered, when changing leaf width from 10 mm to 4 mm. The p-values were significant for majority of head-and-neck dose indices. Conclusion The thinner-leaf MLCs, owing to their better spatial resolution, result in an overall gain for target coverage, while maintaining permissible doses to the organs at risk.
Collapse
|
|
17
|
Dupere JM, Munro JJ, Medich DC. Intensity modulated high dose rate ocular brachytherapy using Se-75. Brachytherapy 2021; 20:1312-1322. [PMID: 34561174 DOI: 10.1016/j.brachy.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/16/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We propose an alternative to LDR brachytherapy for the treatment of ocular melanomas by coupling intensity modulation, through the use of a gold shielded ring applicator, with a middle energy HDR brachytherapy source, Se-75. In this study, we computationally test this proposed design using MCNP6. METHODS AND MATERIALS An array of discrete Se-75 sources is formed into a ring configuration within a gold shielded applicator, which collimates the beam to a conical shape. Varying this angle of collimation allows for the prescription dose to be delivered to the apex of various sized targets. Simulations in MCNP6 were performed to calculate the dosimetric output of the Se-75 ring source for various sized applicators, collimators, and target sizes. RESULTS The prescription dose was delivered to a range of target apex depths 3.5-8 mm in the eye covering targets 10-15 mm in diameter by using various sized applicators and collimators. For a 16 mm applicator with a collimator opening that delivers the prescription dose to a depth of 5 mm in the eye, the maximum percent dose rate to critical structures was 30.5% to the cornea, 35.7% to the posterior lens, 33.3% to the iris, 20.1% to the optic nerve, 278.0% to the sclera, and 267.3% to the tumor. CONCLUSIONS When using Se-75 in combination with the proposed gold shielded ring applicator, dose distributions are appropriate for ocular brachytherapy. The use of a collimator allows for the dose to more easily conform to the tumor volume. This method also reduces treatment time and cost, and it eliminates hand dose to the surgeon through the use of a remote afterloader device.
Collapse
|
|
18
|
ÖZTÜRK GA, OZTURK M. Results and adverse effect evaluations in localized prostate cancer patients undergoing intensity modulated radiotherapy with tomotherapy. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.871471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
|
19
|
Taylor ZC, Kaya EA, Bunn JD, Guss ZD, Mitchell BJ, Fairbanks RK, Lamoreaux WT, Wagner AE, Peressini BJ, Lee CM. Overall and cause-specific survival for mucoepidermoid carcinoma of the major salivary glands: Analysis of 2210 patients. World J Clin Oncol 2020; 11:1029-1044. [PMID: 33437665 PMCID: PMC7769719 DOI: 10.5306/wjco.v11.i12.1029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/05/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mucoepidermoid carcinoma (MEC) is a rare malignancy of the head and neck; however, it accounts for a majority of the tumors of the salivary glands. This study used a national population-based registry to describe the pre-treatment and treatment-related prognostic factors that influence survival in patients with MEC of the major salivary glands. To our knowledge, this is the largest population-based study examining predictors of both overall and cause-specific survival of MEC of the major salivary glands.
AIM To identify prognostic factors influencing overall survival (OS) and cause-specific survival (CSS) of patients with MEC of the major salivary glands.
METHODS We used the Surveillance, Epidemiology and End-Results Database of the National Cancer Institute to investigate a variety of factors that could influence survival of patients diagnosed with mucoepidermoid carcinoma of the major salivary glands. A total of 2210 patients diagnosed with MEC of the major salivary glands during the years of 1975-2016 were studied. The primary endpoints were OS and CSS. Cox regression analysis was used to perform univariate and multivariate analyses of clinical variables such as age at diagnosis, diagnosis year, sex, race, tumor size, stage, grade, treatment with or without surgical excision, and adjuvant radiotherapy treatment.
RESULTS A total of 2210 patients diagnosed with MEC of the major salivary glands met inclusion criteria. In this study, 95% of patients underwent surgical excision and 41% received adjuvant radiation therapy. Median OS time for Grade I, II, and III/IV was 401 mo (± 48.25, 95%CI), 340 mo (± 33.68, 95%CI) and 55 mo (± 11.05, 95%CI), respectively. Univariate analysis revealed that lack of surgical excision was associated with decreased OS [hazard ratio (HR) 4.26, P < 0.0001] and that patients with localized disease had improved OS compared to both regional and distant disease (HR 3.07 and 6.96, respectively, P < 0.0001). Additionally, univariate analysis demonstrated that male sex, age over 50 at diagnosis, Grade III tumors, and increasing tumor size were associated with worsened OS (P < 0.0006). Univariate analysis of CSS similarly revealed that lack of surgical excision and Grade III carcinoma conferred decreased CSS (HR 4.37 and 5.44, respectively, P < 0.0001). Multivariate analysis confirmed that increasing age, in 10-year age bands, advanced tumor stage, increasing tumor size, Grade III carcinoma, male sex, and lack of surgical excision were associated with a statistically significant decrease in OS and CSS (P < 0.04). Of note, multivariate analysis revealed that the use of adjuvant radiation therapy was not associated with improved OS or CSS.
CONCLUSION Multivariate analysis demonstrated increasing age, advanced tumor stage, increasing tumor size, Grade III carcinoma, male sex, and lack of surgical excision were associated with decreased OS and CSS (P < 0.04).
Collapse
Affiliation(s)
- Zachary C Taylor
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
- MD Program, Elson S. Floyd College of Medicine, Spokane, WA 99202, United States
| | - Erin A Kaya
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
- MD Program, Elson S. Floyd College of Medicine, Spokane, WA 99202, United States
| | - Jeffrey D Bunn
- Surgery, Spokane Ear, Nose, and Throat, Spokane, WA 99201, United States
| | - Zachary D Guss
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
| | - Brian J Mitchell
- Surgery, Spokane Ear, Nose, and Throat, Spokane, WA 99201, United States
| | - Robert K Fairbanks
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
| | - Wayne T Lamoreaux
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
| | - Aaron E Wagner
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
| | - Ben J Peressini
- Department of Biostatistics, DataWorks Northwest, LLC, Coeur D'Alene, ID 83815, United States
| | - Christopher M Lee
- Department of Radiation Oncology, Cancer Care Northwest, Spokane, WA 99202, United States
| |
Collapse
|
|
20
|
3D conformal, IMRT and VMAT for the treatment of head and neck cancer: a brief literature review. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
The objective of this study has been to identify monitor unit (MU) and treatment time variations, volume coverage dissimilarity among 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for head and neck cancer (HNC) based on literature review.
Methods:
A number of HNC cases were studied with the investigation of conformity and homogeneity index.
Results:
When high-dose modulation was required around small organs at risk (OARs), a clinically acceptable IMRT plan was achieved as VMAT usually required longer dose optimisation time. The greatest benefit of VMAT has been rapid treatment delivery allowing improved patient comfort, reduced intra-fraction motion and increased patient throughput. In some papers, 3D-CRT was shown not to meet well the requirements on parotid glands. One paper showed that cerebellum dose was lower for 3D-CRT than IMRT. However, it was found in other papers that OAR sparing with 3D-CRT was reasonable but in complex cases not enough.
Conclusions:
IMRT usually consists of several treatment fields with different directions, hundreds of beam lets with modulated intensity, an advantage over 3D-CRT, whereas VMAT has advantage over IMRT due to rotating beam utilisation. VMAT has lower total MU and treatment times than IMRT and 3D-CRT, while maintaining similar dosimetric endpoints.
Collapse
|
|
21
|
Silva IFVD, Omaña-Cepeda C, Marí-Roig A, López-López J, Jané-Salas E. Survival of Dental Implants in Oncology Patients versus Non-Oncology Patients: A 5-Year Retrospective Study. Braz Dent J 2020; 31:650-656. [PMID: 33237237 DOI: 10.1590/0103-6440202003622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
Patients with a history of cancer are increasingly common in the dental office. Treating cancer patients requires a multidisciplinary team, which should include the dentist, in order to control the complications that occur in the oral cavity and also to recover the patient undergoing treatment in any of its types: surgical, medical, radiotherapeutic, or its possible combinations. Dental implants can be a safe and predictable treatment option for prosthetic rehabilitation. The aim of this paper is to describe in retrospect the success rate of osseointegrated implants in oncology and non-oncology patients placed by the Master of Dentistry in Oncology and Immunocompromised Patients, as well as the Master of Medicine, Surgery and Oral Implantology of the University of Barcelona Dental Hospital, between July 2011 and March 2016. 466 patients were reviewed, with a total of 1405 implants placed, considering the oncological history of the patients and the implant success rate. The total success rate in the concerned period was 96.65%. When comparing cancer patients with healthy ones, the success rate has been 93.02% in the first case, and 97.16% in the latter. According to the literature review, our results encourage implant placement in cancer patients, it is important to recognize that this is an analysis of a complex care pathway with a large number of confounding variables. However, the findings should not be considered as generalizable.
Collapse
Affiliation(s)
| | - Carlos Omaña-Cepeda
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| | - Antonio Marí-Roig
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| | - José López-López
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| | - Enric Jané-Salas
- School of Dentistry, Department of Odonto-Stomatology, University of Barcelona Dental Hospital, Barcelona, Spain
| |
Collapse
|
|
22
|
Bohara G, Sadeghnejad Barkousaraie A, Jiang S, Nguyen D. Using deep learning to predict beam-tunable Pareto optimal dose distribution for intensity-modulated radiation therapy. Med Phys 2020; 47:3898-3912. [PMID: 32621789 PMCID: PMC7821384 DOI: 10.1002/mp.14374] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/19/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Many researchers have developed deep learning models for predicting clinical dose distributions and Pareto optimal dose distributions. Models for predicting Pareto optimal dose distributions have generated optimal plans in real time using anatomical structures and static beam orientations. However, Pareto optimal dose prediction for intensity-modulated radiation therapy (IMRT) prostate planning with variable beam numbers and orientations has not yet been investigated. We propose to develop a deep learning model that can predict Pareto optimal dose distributions by using any given set of beam angles, along with patient anatomy, as input to train the deep neural networks. We implement and compare two deep learning networks that predict with two different beam configuration modalities. METHODS We generated Pareto optimal plans for 70 patients with prostate cancer. We used fluence map optimization to generate 500 IMRT plans that sampled the Pareto surface for each patient, for a total of 35 000 plans. We studied and compared two different models, Models I and II. Although they both used the same anatomical structures - including the planning target volume (PTV), organs at risk (OARs), and body - these models were designed with two different methods for representing beam angles. Model I directly uses beam angles as a second input to the network as a binary vector. Model II converts the beam angles into beam doses that are conformal to the PTV. We divided the 70 patients into 54 training, 6 validation, and 10 testing patients, thus yielding 27 000 training, 3000 validation, and 5000 testing plans. Mean square loss (MSE) was taken as the loss function. We used the Adam optimizer with a default learning rate of 0.01 to optimize the network's performance. We evaluated the models' performance by comparing their predicted dose distributions with the ground truth (Pareto optimal) dose distribution, in terms of dose volume histogram (DVH) plots and evaluation metrics such as PTV D98 , D95 , D50 , D2 , Dmax , Dmean , Paddick Conformation Number, R50, and Homogeneity index. RESULTS Our deep learning models predicted voxel-level dose distributions that precisely matched the ground truth dose distributions. The DVHs generated also precisely matched the ground truth. Evaluation metrics such as PTV statistics, dose conformity, dose spillage (R50), and homogeneity index also confirmed the accuracy of PTV curves on the DVH. Quantitatively, Model I's prediction error of 0.043 (confirmation), 0.043 (homogeneity), 0.327 (R50), 2.80% (D95), 3.90% (D98), 0.6% (D50), and 1.10% (D2) was lower than that of Model II, which obtained 0.076 (confirmation), 0.058 (homogeneity), 0.626 (R50), 7.10% (D95), 6.50% (D98), 8.40% (D50), and 6.30% (D2). Model I also outperformed Model II in terms of the mean dose error and the max dose error on the PTV, bladder, rectum, left femoral head, and right femoral head. CONCLUSIONS Treatment planners who use our models will be able to use deep learning to control the trade-offs between the PTV and OAR weights, as well as the beam number and configurations in real time. Our dose prediction methods provide a stepping stone to building automatic IMRT treatment planning.
Collapse
Affiliation(s)
- Gyanendra Bohara
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Azar Sadeghnejad Barkousaraie
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Steve Jiang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Dan Nguyen
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| |
Collapse
|
|
23
|
Jagodinsky JC, Harari PM, Morris ZS. The Promise of Combining Radiation Therapy With Immunotherapy. Int J Radiat Oncol Biol Phys 2020; 108:6-16. [PMID: 32335187 PMCID: PMC7442714 DOI: 10.1016/j.ijrobp.2020.04.023] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022]
Abstract
The development of immunotherapy in oncology builds upon many years of scientific investigation into the cellular mechanics underlying interactions between tumor cells and immune cell populations. The past decade has brought an accelerating pace to the clinical investigation of new immunotherapy agents, particularly in the setting of metastatic disease. The integration of immunotherapy into phase 3 clinical trial design has lagged in settings of advanced locoregional disease, where combination with radiation therapy may be critical. Yet, such may be the settings where immunotherapies have their greatest potential to affect patient survival and achieve curative outcomes. In this review, we discuss the interaction of radiation with the immune system and the potential to augment antitumor immunity through combined-modality approaches that integrate radiation and immunotherapies. The dynamics of cellular and tumor response to radiation offer unique opportunities for beneficial interplay with immunotherapy that may go unrecognized with conventional screening and monotherapy clinical testing of novel pharmaceutical agents. Using immune checkpoint blockade as a primary example, we discuss recent preclinical and clinical studies that illustrate the potential synergy of such therapies in combination with radiation, and we highlight the potential clinical value of such interactions. For various immunotherapy agents, their greatest clinical effect may rest in combination with radiation, and efforts to facilitate systematic investigation of this approach are highly warranted.
Collapse
Affiliation(s)
- Justin C Jagodinsky
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Zachary S Morris
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| |
Collapse
|
|
24
|
Li B, Sarria GR, Hermansen M, Hao J, Martinez D, Garcia B, Liu J, McLeod M, Castaneda S, Oladeru OT, Lee B, Sarria GJ, Gay H, Chetty IJ, Roa D. Impact of a SBRT/SRS longitudinal telehealth training pilot course in Latin America. Crit Rev Oncol Hematol 2020; 154:103072. [PMID: 32805497 DOI: 10.1016/j.critrevonc.2020.103072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the impact of longitudinal telehealth training in stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) for clinicians in Latin America. MATERIALS AND METHODS Professionals from two Peruvian centers received an initial SBRT/SRS on-site training course and subsequently received follow-up telehealth training (interventional group) or not (negative control arm). Twelve live video conference sessions were scheduled. Surveys pre- and post-curriculum measured participants' confidence in seven practical domains of SBRT/SRS, based on Likert scales of 1-5, and post-curriculum surveys assessed educators' experiences. RESULTS Sixty-one participants were registered, with an average of 24 attendees per session. Pre- and post- surveys were completed by 22 participants. For interventional and negative-control groups, mean changes in Likert scale were satisfactory for the former and remained unmodified for the latter. CONCLUSIONS Conducting telehealth educational programs via virtual classroom sessions could be a reliable method to augment training for SBRT and SRS.
Collapse
Affiliation(s)
- Benjamin Li
- Rayos Contra Cancer, Inc. Nashville, TN, USA; University of California San Francisco, Dept. of Radiation Oncology, San Francisco, CA, USA
| | - Gustavo R Sarria
- Rayos Contra Cancer, Inc. Nashville, TN, USA; University Hospital Bonn, Department of Radiation Oncology, University of Bonn, Bonn, Germany.
| | | | - Jackie Hao
- Rayos Contra Cancer, Inc. Nashville, TN, USA; Midwestern University, Glendale, AZ, USA
| | | | - Bertha Garcia
- Clínica AUNA, Dept. of Radiation Oncology, Lima, Peru
| | - Jingxia Liu
- Washington University in St. Louis, Dept. of Radiation Oncology, St. Louis, MO, USA
| | - Megan McLeod
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Serguei Castaneda
- Rayos Contra Cancer, Inc. Nashville, TN, USA; Sidney Kimmel Cancer Center at Thomas Jefferson University, Dept. of Radiation Oncology, Philadelphia, PA, USA
| | - Oluwadamilola T Oladeru
- Rayos Contra Cancer, Inc. Nashville, TN, USA; Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - Becky Lee
- Loma Linda University, Dept. of Radiation Oncology, Loma Linda, CA, USA
| | - Gustavo J Sarria
- Instituto Nacional de Enfermedades Neoplásicas, Dept. of Radiation Oncology, Lima, Peru
| | - Hiram Gay
- Washington University in St. Louis, Dept. of Radiation Oncology, St. Louis, MO, USA
| | - Indrin J Chetty
- Henry Ford Cancer Institute, Dept. of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Dante Roa
- Rayos Contra Cancer, Inc. Nashville, TN, USA; University of California Irvine, Orange, CA, USA
| |
Collapse
|
|
25
|
Lin D, Lapen K, Sherer MV, Kantor J, Zhang Z, Boyce LM, Bosch W, Korenstein D, Gillespie EF. A Systematic Review of Contouring Guidelines in Radiation Oncology: Analysis of Frequency, Methodology, and Delivery of Consensus Recommendations. Int J Radiat Oncol Biol Phys 2020; 107:827-835. [PMID: 32311418 PMCID: PMC8262136 DOI: 10.1016/j.ijrobp.2020.04.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Clinical trials have described variation in radiation therapy plan quality, of which contour delineation is a key component, and linked this to inferior patient outcomes. In response, consensus guidelines have been developed to standardize contour delineation. This investigation assesses trends in contouring guidelines and examines the methodologies used to generate and deliver recommendations. METHODS AND MATERIALS We conducted a literature search for contouring guidelines published after 1995. Of 11,124 citations, 332 were identified for full-text review to determine inclusion. We abstracted articles for the intent of the consensus process, key elements of the methodology, and mode of information delivery. A Fisher exact test was used to identify elements that differed among the guidelines generated for clinical trials and routine care. RESULTS Overall, 142 guidelines were included, of which 16 (11%) were developed for a clinical trial. There was an increase in guideline publication over time (0 from 1995-1999 vs 65 from 2015- 2019; P = .03), particularly among recommendations for stereotactic radiation and brachytherapy. The most common disease sites were head and neck (24%), gastrointestinal (12%), and gynecologic (12%). Methods used to develop recommendations included literature review (50%) and image-based methods (45%). Panels included a median of 10 physicians (interquartile range, 7-16); 70% of panels represented multidisciplinary expertise. Guidelines developed for a clinical trial were more likely to include an image-based approach, with quantitative analysis of contours submitted by the panel members and to publish a full set of image-based recommendations (P < .005). CONCLUSIONS This review highlights an increase in consensus contouring recommendations over time. Guidelines focus on disease sites, such as head and neck, with evidence supporting a correlation between treatment planning and patient outcomes, although variation exists in the approach to the consensus process. Elements that may improve guideline acceptance (ie, image-based consensus contour analysis) and usability (ie, inclusion of a full image set) are more common in guidelines developed for clinical trials.
Collapse
Affiliation(s)
- Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael V Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Jolie Kantor
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lindsay M Boyce
- Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Walter Bosch
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
|
26
|
Ren L, Zhu D, Benson AB, Nordlinger B, Koehne CH, Delaney CP, Kerr D, Lenz HJ, Fan J, Wang J, Gu J, Li J, Shen L, Tsarkov P, Tejpar S, Zheng S, Zhang S, Gruenberger T, Qin X, Wang X, Zhang Z, Poston GJ, Xu J. Shanghai international consensus on diagnosis and comprehensive treatment of colorectal liver metastases (version 2019). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:955-966. [PMID: 32147426 DOI: 10.1016/j.ejso.2020.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
The liver is the most common anatomical site for hematogenous metastases from colorectal cancer. Therefore effective treatment of liver metastases is one of the most challenging elements in the management of colorectal cancer. However, there is rare available clinical consensus or guideline only focusing on colorectal liver metastases. After six rounds of discussion by 195 clinical experts of the Shanghai International Consensus Expert Group on Colorectal Liver Metastases (SINCE) from 29 countries or regions, the Shanghai Consensus has been finally completed, based on current research and expert experience. The consensus emphasized the principle of multidisciplinary team, provided detailed diagnosis approaches, and guided precise local and systemic treatments. This Shanghai Consensus might be of great significance to standardized diagnosis and treatment of colorectal liver metastases all over the world.
Collapse
Affiliation(s)
- Li Ren
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dexiang Zhu
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - Bernard Nordlinger
- Surgery Department, Hospital Ambroise-Pare, Boulogne-Billancourt, France
| | | | - Conor P Delaney
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Kerr
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai, China
| | - Jianping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin Gu
- Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, China; Department of Colorectal Surgery, Peking University Shougang Hospital, Beijing, China
| | - Jin Li
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Petrv Tsarkov
- Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sabine Tejpar
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Shu Zheng
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suzhan Zhang
- Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | | | - Xinyu Qin
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center of Digestive Diseases, Beijing, China
| | - Graeme John Poston
- Surgery Department, Aintree University Hospital, School of Translational Studies, University of Liverpool, Liverpool, UK.
| | - Jianmin Xu
- Department of Colorectal Surgery, Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
|
27
|
Palazzi M, Orlandi E, Pignoli E, Lualdi M, Zonca G, Sangalli C, Stucchi C, Olmi P. Target Coverage in Head and Neck Cancer Treated with Intensity-Modulated Radiotherapy: A Comparison between Conventional and Conformal Techniques. TUMORI JOURNAL 2019; 92:503-10. [PMID: 17260491 DOI: 10.1177/030089160609200607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background We designed a comparative planning study aimed at quantifying the advantages of intensity-modu-lated radiotherapy (IMRT) over the conventional 3-field technique (3FT) and a 5-field conformal technique (5FCT) for head and neck (HN) cancer. Methods We selected 9 patients treated at our institution with curative radiotherapy for a HN cancer. For all cases 4 plans were generated: 2 plans using the “standard” techniques (3FT and 5FCT), a third plan using IMRT, and a fourth “mixed” plan using IMRT followed by a conventional boost. Results Our study confirmed literature data on the ability of IMRT to significantly decrease the dose received by organs at risk, compared with previous techniques. Target coverage was systematically better with 5FCT and IMRT than with 3FT. However, the increase in coverage of both PTV2 and PTV1 was only about 3-5% and this was achieved at the price of a similar increase in maximum dose (D1%). Volumetric parameters (V100%, V95%) were much more sensitive in detecting the improvement with IMRT. Conclusions The improvement of target coverage attained by IMRT, as compared with conventional and conformal techniques, might be overestimated by data currently available in the medical literature. If treatment with conventional techniques is planned using all tools provided by currently available fully 3-D planning systems, excellent target coverage can be obtained.
Collapse
Affiliation(s)
- Mauro Palazzi
- Unit of Radiotherapy, Istituto Nazionale Tumori, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Lin D, Lehrer EJ, Rosenberg J, Trifiletti DM, Zaorsky NG. Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis. Radiother Oncol 2019; 135:147-152. [DOI: 10.1016/j.radonc.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
|
|
29
|
Thiagarajan A, Iyer NG. Genomics of radiation sensitivity in squamous cell carcinomas. Pharmacogenomics 2019; 20:457-466. [PMID: 30983507 DOI: 10.2217/pgs-2018-0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Radiotherapy is an important modality in the management of squamous cell cancers with 50% of patients receiving radiotherapy at some point. Despite technological advances, the risk of severe toxicity in a proportion of radiosensitive patients limits radiation doses that can be safely prescribed affecting the potential for cure. While comorbidities, lifestyle and treatment factors can influence interindividual variations, genetic factors are thought to play a major role, accounting for approximately 80% of the variance observed. Over the last decade, substantial progress has been made in the field of radiogenomics, with compelling associations for SNPs identified in genes involved in DNA-damage response, cell-cycle control, apoptosis, antioxidant defenses and cytokine production. Future research efforts should be collaborative, focused on validating and broadening their clinical applicability. Numerous obstacles exist to the clinical application of this knowledge, which need to be overcome before personalized radiation therapy becomes a routine component of oncologic care.
Collapse
Affiliation(s)
- Anuradha Thiagarajan
- Division of Radiation Oncology, National Cancer Centre, 11 Hospital Drive, 169610, Singapore
| | - N Gopalakrishna Iyer
- Division of Surgical Oncology, National Cancer Centre, 11 Hospital Drive, 169610, Singapore.,Cancer Therapeutics Research Laboratory, National Cancer Centre, 11 Hospital Drive, 169610, Singapore
| |
Collapse
|
|
30
|
Effect of ionizing radiation on properties of restorative materials. Dent Mater 2017; 34:221-227. [PMID: 29102159 DOI: 10.1016/j.dental.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/30/2017] [Accepted: 10/07/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the effect of ionizing radiation from high energy X-ray on properties of restorative materials. METHODS Study materials (3M-ESPE) were: Z250-microhybrid resin-based composite (Filtek Z-250); Z350-nanofilled resin-based composite (Filtek Z-350XT); VIT-resin-modified glass ionomer cement (Vitremer); and KME-conventional glass ionomer cement (Ketac Molar Easymix). Sixty bar-shaped and cylinder-shaped specimens were fabricated from each material. Specimens were light activated (980mW/cm2, Radii, SDI) for 60s (3×20s for Z250 and Z350) and 120s (3×40s for VIT) and thirty specimens from each shape were irradiated (IR) with 1.8Gy/day for 39days (total IR=70.2Gy). IR and non-irradiated (NI) specimens were evaluated for flexural strength (σ, n=30) followed by fractography (SEM), diametral tensile strength (DTS, n=30), hardness (H, n=10), surface roughness (Ra, n=10) and chemical composition (n=3). The IR effect on each material property was statistically analyzed using Student's t test (α=0.05). Data from σ and DTS were also analyzed using Weibull statistics. RESULTS IR significantly increased the mean σ values of VIT and KME and the mean DTS value of VIT (p<0.05). IR increased Ra and H values for VIT and decreased H value for Z-250 (p<0.05). The remaining materials and properties were not significantly affected by IR (p>0.05). There was no significant change on materials composition after IR. SIGNIFICANCE The recommended radiotherapy protocol for head and neck cancer altered some material properties, mainly for glass ionomer cements. Such variations on material properties are not related to chemical composition changes.
Collapse
|
|
31
|
Outcomes of Routine Intensity Modulated Radiation Therapy Quality Assurance in a Large Head and Neck Cancer Center. Int J Radiat Oncol Biol Phys 2017; 98:541-546. [DOI: 10.1016/j.ijrobp.2017.02.215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 11/20/2022]
|
|
32
|
Gomes CC, Ramos-Perez FMDM, Perez DEDC, Novaes PD, Bóscolo FN, Almeida SMD. Radioprotective effect of vitamin E in parotid glands: a morphometric analysis in rats. Braz Dent J 2015; 24:183-7. [PMID: 23969903 DOI: 10.1590/0103-6440201301781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 05/07/2013] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to evaluate the radioprotective effect of vitamin E on rat parotid glands by morphometric analysis. Sixty male rats were divided into 5 groups (n=6): control, in which animals received olive oil solution; olive oil/irradiated, in which animals received olive oil and were irradiated with a dose of 15 Gy of gamma radiation; irradiated, in which animals were irradiated with a dose of 15 Gy gamma radiation; vitamin E, which received α-tocopherol acetate solution; vitamin E/irradiated, which received α-tocopherol acetate solution before irradiation with a dose of 15 Gy gamma rays. Half of the animals were euthanized at 8 h, and the remaining at 30 days after irradiation. Both parotid glands were surgically removed and morphometric analysis of acinar cells was performed. Data were subjected to two-way ANOVA and Tukey's test (α=0.05). Morphometric analysis showed a significant reduction in the number of parotid acinar cells at 30 days in olive oil/irradiated and irradiated groups. In groups evaluated over time a significant reduction was shown at 30 days in olive oil/irradiated and irradiated groups, indicating that ionizing radiation caused tissue damage. The vitamin E/irradiated group presented more acinar cells than the irradiated group, but no statistically significant difference was observed (p>0.05). In conclusion, vitamin E seems to have failed as a radioprotective agent on acinar cells in rat parotid glands.
Collapse
Affiliation(s)
- Carolina Cintra Gomes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | | | | | | | | | | |
Collapse
|
|
33
|
Novaes P, Mottas RT, Lundgren M. Treatment of prostate cancer with intensity modulated radiation therapy (IMRT). Rev Assoc Med Bras (1992) 2015; 61:8-16. [PMID: 25909199 DOI: 10.1590/1806-9282.61.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
|
34
|
Poitevin-Chacón MA, Reséndiz González G, Alvarado Zermeño A, Flores Castro JM, Flores Balcázar CH, Rosales Pérez S, Pérez Pastenes MA, Rodríguez Laguna A, Vázquez Fernández P, Calvo Fernández A, Bastida Ventura J. Implementation of intensity modulated radiotherapy for prostate cancer in a private radiotherapy service in Mexico. Rep Pract Oncol Radiother 2015; 20:66-71. [PMID: 25535587 PMCID: PMC4268590 DOI: 10.1016/j.rpor.2014.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/23/2014] [Accepted: 06/29/2014] [Indexed: 10/24/2022] Open
Abstract
Intensity modulated radiation therapy (IMRT) allows physicians to deliver higher conformal doses to the tumour, while avoiding adjacent structures. As a result the probability of tumour control is higher and toxicity may be reduced. However, implementation of IMRT is highly complex and requires a rigorous quality assurance (QA) program both before and during treatment. The present article describes the process of implementing IMRT for localized prostate cancer in a radiation therapy department. In our experience, IMRT implementation requires careful planning due to the need to simultaneously implement specialized software, multifaceted QA programs, and training of the multidisciplinary team. Establishing standardized protocols and ensuring close collaboration between a multidisciplinary team is challenging but essential.
Collapse
Affiliation(s)
- María Adela Poitevin-Chacón
- Departamento de Radioterapia, Médica Sur Hospital, Puente de Piedra 150, Col. Toriello Guerra, 14050 Tlalpan, México, DF, Mexico
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
35
|
Tesfamicael B, Avery S, Gueye P, Lyons D, Mahesh M. Scintillating fiber based in-vivo dose monitoring system to the rectum in proton therapy of prostate cancer: A Geant4 Monte Carlo simulation. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0202.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
|
36
|
Li Q, Pei H, Mu J, Hu Q, Gu W. Segment edit and segment weight optimization: two techniques for intensity modulated radiation therapy and their application to the planning for nasopharyngeal carcinoma. Technol Cancer Res Treat 2013; 12:403-9. [PMID: 23617287 DOI: 10.7785/tcrt.2012.500340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate the two functions: segment weight optimization (SWO) and segment edit (SE) in the latest XiO 4.7 radiation treatment planning system and their effect on the planning of intensity modulated radiation therapy (IMRT) for Nasopharyngeal Carcinoma (NPC). SWO first appeared in XiO 4.5 and SE in XiO 4.7. Twelve patients with NPC were selected and there were three plans for each patient: the common step-and-shoot IMRT plan (C-IMRT); S-IMRT was based on the result of C-IMRT and the plan was further optimized with SWO; F-IMRT was based on S-IMRT and the segments were edited for lowering the dose received by normal tissues. The paired plans were analyzed by comparing the total number of segments, monitor units, the homogeneity index and conformity index of the target volumes and the dose delivered to organs at risk (OAR) including spinal cord, brain stem, optic nerves, chiasm, parotids and larynx. The study exhibited that the total number of segments and monitor units of S-IMRT and F-IMRT were around 25.3%, 3.4% less than those of C-IMRT respectively. The HI and CI indexes of target volumes among three kinds of plans did not show the significant difference. The doses received by spinal cord, brain stem, parotids, larynx were decreased at S-IMRT and F-IMRT as compared to C-IMRT; the highest doses delivered to chiasm and optic nerves were S-IMRT, the next C-IMRT, the lowest F-IMRT. This study showed that the SWO function could substantially reduce the total number of segments of step-and-shoot IMRT plans and the SE function had the incredible ability to lower the dose received by normal tissues.
Collapse
Affiliation(s)
- Qilin Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou City, 185 Ju Qian Jie, Changzhou City 213003, Jiangsu Province, China.
| | | | | | | | | |
Collapse
|
|
37
|
Lin JK, Lee LK, Chen WS, Lin TC, Jiang JK, Yang SH, Wang HS, Chang SC, Lan YT, Lin CC, Yen CC, Liu JH, Tzeng CH, Teng HW. Concurrent chemoradiotherapy followed by metastasectomy converts to survival benefit in stage IV rectum cancer. J Gastrointest Surg 2012; 16:1888-96. [PMID: 22833439 DOI: 10.1007/s11605-012-1959-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/28/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND To investigate the impact of concurrent chemoradiotherapy (CCRT) on stage IV rectum cancer. METHODS Between 2000 and 2011, 297 consecutive patients diagnosed with stage IV rectum cancer (synchronous metastasis) were enrolled. Cox proportional hazard analyses were used for prognostic factors determination, and the Kaplan-Meier method was used for survival analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matched patients for validation studies. RESULTS In total, 63 patients received CCRT and 234 did not. The patients in the CCRT group were younger, had more low-lying lesions, and had more T4 lesions, lung metastases, metastasectomies, and oxaliplatin-based upfront chemotherapy. Before propensity-score matching, a younger age (HR = 0.662, P = 0.016), lower carcinoembryonic antigen (CEA) level (≤20 ng/ml) (HR = 0.531, P = 0.001), no metastasectomy (HR = 3.214, P < 0.001), and no CCRT (HR = 1.844, P = 0.019) were independent prognostic factors after controlling for other confounding factors. After matching, only CEA and metastasectomy, but not CCRT, were independent prognostic factors. The survival benefit of CCRT was restricted to patients who undergo subsequent metastasectomy. CONCLUSIONS Upfront CCRT only provided a survival benefit in patients with stage IV rectum cancer who undergo subsequent metastasectomy.
Collapse
Affiliation(s)
- Jen-Kou Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Huang MW, Zhang JG, Tong D, Zhang J, Zheng L, Zhang Y, Yu GY. Postoperative 125I brachytherapy delivered by digital model obturators for recurrent or locally advanced maxillary cancers. Laryngoscope 2012; 122:2461-7. [PMID: 22965822 DOI: 10.1002/lary.23527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/15/2012] [Accepted: 05/29/2012] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS We aimed to evaluate the feasibility and effectiveness of postoperative (125) I brachytherapy delivered by use of digital model obturators for recurrent or locally advanced maxillary cancers. STUDY DESIGN Retrospective study. METHODS From 2006 to 2008, 12 patients (seven females; median age, 65 years; range, 22-86 years) with recurrent or locally advanced maxillary cancers showing positive margins after surgery underwent (125) I brachytherapy by use of digital model obturators and interstitial implants. The radioactivity was 18.5 to 33.3 MBq per seed, and the prescription dose was 80 to 160 Gy. Functional outcome of patients was evaluated by the Performance Status Scale (PSS) for head and neck cancer before and after brachytherapy. RESULTS The (125) I seeds and dosages were well distributed in the radiation fields, and all patients had higher PSS scores after than before treatment with obturators. During a median follow-up of 53 months (range, 28-62 months), local control at 3 and 5 years was 83.3% and 66.7%, respectively, with a mean local control time of 53.5 ± 3.79 months. Overall survival at 3 and 5 years was 91.7% and 71.4%, respectively, with a mean survival time of 56.6 ± 2.99 months. Two patients died due to local recurrence, and one patient died due to lung metastasis. No patient had severe complications during follow-up. CONCLUSIONS (125) I brachytherapy delivered by digital model obturator is effective in treating maxillary cancers with positive margins after maxillectomy for advanced or recurrent cancer. The method may improve the quality of life of patients with maxillary defects. Laryngoscope, 2012.
Collapse
Affiliation(s)
- Ming-wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
|
39
|
Parvathaneni U, Laramore GE, Liao JJ. Technical advances and pitfalls in head and neck radiotherapy. JOURNAL OF ONCOLOGY 2012; 2012:597467. [PMID: 22701482 PMCID: PMC3369487 DOI: 10.1155/2012/597467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 03/21/2012] [Indexed: 12/21/2022]
Abstract
Intensity Modulated Radiotherapy (IMRT) is the standard of care in the treatment of head and neck squamous cell carcinomas (HNSCC) based on level 1 evidence. Technical advances in radiotherapy have revolutionized the treatment of HNSCC, with the most tangible gain being a reduction in long term morbidity. However, these benefits come with a serious and sobering price. Today, there is a greater chance of missing the target/tumor due to uncertainties in target volume definition by the clinician that is demanded by the highly conformal planning process involved with IMRT. Unless this is urgently addressed, our patients would be better served with the historically practiced non conformal radiotherapy, than IMRT which promises lesser morbidity. Image guided radiotherapy (IGRT) ensures the level of set up accuracy warranted to deliver a highly conformal treatment plan and should be utilized with IMRT, where feasible. Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose". However, clinical data supporting the routine use of this technology for HNSCC are currently sparse. The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.
Collapse
Affiliation(s)
- Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA
| | | | | |
Collapse
|
|
40
|
Kataoka SH, Setzer FC, Fregnani ER, Pessoa OF, Gondim E, Caldeira CL. Effects of 3-Dimensional Conformal or Intensity-modulated Radiotherapy on Dental Pulp Sensitivity during and after the Treatment of Oral or Oropharyngeal Malignancies. J Endod 2012; 38:148-52. [DOI: 10.1016/j.joen.2011.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 09/25/2011] [Accepted: 09/30/2011] [Indexed: 02/07/2023]
|
|
41
|
Assenat E, Thezenas S, Flori N, Pere-Charlier N, Garrel R, Serre A, Azria D, Senesse P. Prophylactic percutaneous endoscopic gastrostomy in patients with advanced head and neck tumors treated by combined chemoradiotherapy. J Pain Symptom Manage 2011; 42:548-56. [PMID: 21477980 DOI: 10.1016/j.jpainsymman.2011.01.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/07/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT Few studies have evaluated outcomes of combined chemoradiotherapy for Stage III-IV head and neck squamous cell carcinoma in terms of the use of nutritional support by means of percutaneous endoscopic gastrostomy (PEG). OBJECTIVES To compare nutritional status and treatment interruption because of acute toxicity in patients with advanced head and neck tumors who were treated by combined chemoradiotherapy and received or did not receive prophylactic PEG tubes. METHODS This was a retrospective study that evaluated data obtained from a cancer center in Montpellier, France. A total of 139 consecutive patients treated for Stage III-IV head and neck squamous cell carcinoma from January 1, 1998 to June 30, 2003 were evaluated in terms of nutritional status before and after therapy, treatment interruption because of toxicity, and duration of hospitalization. RESULTS Seventy-eight of the 139 patients (58%) did not receive prophylactic PEG feeding, and 61 patients (44%) received PEG feeding. Pretreatment nutritional status was worse in the PEG group. Compared with the initial nutritional status, nutritional status at the end of treatment was unchanged in the PEG group and much worse in the group that did not receive the PEG (P<0.05). Cumulative incidence of treatment interruption because of toxicity was significantly lower in the PEG group than in the no-PEG group (100 and 236 days of interruption, respectively, P=0.03) and hospitalization was significantly shorter (P=0.003). CONCLUSION Prophylactic PEG sustains nutritional status and reduces the cumulative incidence of treatment interruption caused by toxicity and duration of hospitalization. A randomized study is warranted to validate these results.
Collapse
Affiliation(s)
- Eric Assenat
- Department of Gastro-Nutrition, Val d'Aurelle Cancer Institute, Montpellier, France
| | | | | | | | | | | | | | | |
Collapse
|
|
42
|
West CM, Barnett GC. Genetics and genomics of radiotherapy toxicity: towards prediction. Genome Med 2011; 3:52. [PMID: 21861849 PMCID: PMC3238178 DOI: 10.1186/gm268] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy is involved in many curative treatments of cancer; millions of survivors live with the consequences of treatment, and toxicity in a minority limits the radiation doses that can be safely prescribed to the majority. Radiogenomics is the whole genome application of radiogenetics, which studies the influence of genetic variation on radiation response. Work in the area focuses on uncovering the underlying genetic causes of individual variation in sensitivity to radiation, which is important for effective, safe treatment. In this review, we highlight recent advances in radiotherapy and discuss results from four genome-wide studies of radiotoxicity.
Collapse
Affiliation(s)
- Catharine M West
- School of Cancer and Enabling Sciences, The University of Manchester, Manchester Academic Health Science Centre, The Christie, Wilmslow Road, Manchester M20 4BX, UK.
| | | |
Collapse
|
|
43
|
Al-Mohammed HI. Patient specification quality assurance for glioblastoma multiforme brain tumors treated with intensity modulated radiation therapy. Int J Med Sci 2011; 8:461-6. [PMID: 21850196 PMCID: PMC3156993 DOI: 10.7150/ijms.8.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 06/02/2011] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the significance of performing patient specification quality assurance for patients diagnosed with glioblastoma multiforme treated with intensity modulated radiation therapy. The study evaluated ten intensity modulated radiation therapy treatment plans using 10 MV beams, a total dose of 60 Gy (2 Gy/fraction, five fractions a week for a total of six weeks treatment). For the quality assurance protocol we used a two-dimensional ionization-chamber array (2D-ARRAY). The results showed a very good agreement between the measured dose and the pretreatment planned dose. All the plans passed >95% gamma criterion with pixels within 5% dose difference and 3 mm distance to agreement. We concluded that using the 2D-ARRAY ion chamber for intensity modulated radiation therapy is an important step for intensity modulated radiation therapy treatment plans, and this study has shown that our treatment planning for intensity modulated radiation therapy is accurately done.
Collapse
Affiliation(s)
- H I Al-Mohammed
- King Faisal Specialist Hospital & Research Centre, Dept. of Biomedical Physics, Riyadh 11211, Saudi Arabia
| |
Collapse
|
|
44
|
Corry J, Peters LJ, Rischin D. Optimising the therapeutic ratio in head and neck cancer. Lancet Oncol 2010; 11:287-91. [DOI: 10.1016/s1470-2045(09)70384-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
|
45
|
Tao Y, Lefkopoulos D, Ibrahima D, Bridier A, Polizzi MDP, Wibault P, De Crevoisier R, Arriagada R, Bourhis J. Comparison of dose contribution to normal pelvic tissues among conventional, conformal and intensity-modulated radiotherapy techniques in prostate cancer. Acta Oncol 2009; 47:442-50. [PMID: 17906985 DOI: 10.1080/02841860701666055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
High-energy external radiotherapy has become one of the most common treatment in localized prostate cancer. We compared the difference of dose distribution, mainly at the 5-30 Gy dose level, in the irradiated pelvic volume among three modalities of radiotherapy for patients with prostate cancer: conventional, conformal and intensity-modulated radiotherapy (IMRT). We selected six patients with prostate cancer treated by conformal radiotherapy at the doses of 46 Gy to PTVN (prostate and seminal vesicles), and 70 Gy to PTV-T (prostate). The conventional technique": an 8-field arrangement was used; the conformal technique 4 fields with a boost through 6 fields. For IMRT, a five-beam arrangement was used. Dose-volume histograms (DVH) were analyzed and compared among the three techniques. The IMRT technique significantly increased the pelvic volume covered by the isodose surfaces below 15 Gy as compared with the conventional and conformal techniques. The mean absolute increase for the pelvic volume included between 5-30 Gy for the IMRT technique, was about 2 900 ml as compared with the conventional technique. However, IMRT significantly reduced the irradiated volume of the rectum in the dose range of 5 to 40 Gy, also significantly reduced the irradiated volume of bladder and femoral heads, and obtained a similar or improved isodose distribution in the PTVs. In addition, the use of IMRT slightly increased the relative dose delivered to the body volume outside the pelvis, as estimated by the use of specific software. A long-term follow-up will be needed to evaluate potential late treatment complications related to the use of IMRT and the low or moderate irradiation dose level obtained in the pelvis and in the whole body.
Collapse
Affiliation(s)
- Yungan Tao
- Department of Radiotherapy, Institut Gustave-Roussy, Villejuif, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
46
|
Barnett GC, West CML, Dunning AM, Elliott RM, Coles CE, Pharoah PDP, Burnet NG. Normal tissue reactions to radiotherapy: towards tailoring treatment dose by genotype. Nat Rev Cancer 2009; 9:134-42. [PMID: 19148183 PMCID: PMC2670578 DOI: 10.1038/nrc2587] [Citation(s) in RCA: 535] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A key challenge in radiotherapy is to maximize radiation doses to cancer cells while minimizing damage to surrounding healthy tissue. As severe toxicity in a minority of patients limits the doses that can be safely given to the majority, there is interest in developing a test to measure an individual's radiosensitivity before treatment. Variation in sensitivity to radiation is an inherited genetic trait and recent progress in genotyping raises the possibility of genome-wide studies to characterize genetic profiles that predict patient response to radiotherapy.
Collapse
Affiliation(s)
- Gillian C Barnett
- Department of Oncology, University of Cambridge, Oncology Centre, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | | | | | | | | | | | | |
Collapse
|
|
47
|
Radiotherapy for lung cancer: clinical impact of recent technical advances. Lung Cancer 2008; 64:1-8. [PMID: 18771814 DOI: 10.1016/j.lungcan.2008.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/07/2008] [Accepted: 07/21/2008] [Indexed: 12/25/2022]
Abstract
Radiation oncology plays an important role in the curative treatment of patients with lung cancer. New technological developments have enabled delivery of higher radiation doses while better sparing surrounding normal tissues, thereby increasing the likelihood of local control without increased toxicity. Multi-modality imaging enables better target definition, improved planning software allows for correct calculation of delivered doses, and tools to verify accurate treatment delivery are now available. A good example of the results of applying these developments is the high local control rates achieved in stage I NSCLC with stereotactic radiotherapy (SRT). These advances are rapidly becoming available outside academic institutions, and pulmonologists, surgeons and medical oncologists need to understand and critically assess the potential impact of such developments in the routine care of their patients. Aspects of cost-effectiveness of technical innovations, as well as the level of evidence required before widespread clinical implementation, will be addressed.
Collapse
|
|
48
|
KOMOSIŃSKA K, GIŻYŃSKA M, ZAWADZKA A, KĘPKA L. Does the IMRT technique allow improvement of treatment plans (e.g. lung sparing) for lung cancer patients with small lung volume: a planning study. Rep Pract Oncol Radiother 2008. [DOI: 10.1016/s1507-1367(10)60091-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
|
49
|
Haddad R, Annino D, Tishler RB. Multidisciplinary approach to cancer treatment: focus on head and neck cancer. Dent Clin North Am 2008; 52:1-vii. [PMID: 18154862 DOI: 10.1016/j.cden.2007.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This article focuses on squamous cell carcinoma of the head and neck (SCCHN), the most common malignancy of the head and neck area. Early detection limits morbidity of treatment and increases the chances of a cure. The treatment of SCCHN is often multidisciplinary in nature and provides a model for how multimodality therapy may be applied for optimal patient management. The role of surgery in SCCHN is continually undergoing evolution, and the surgeon's role in the multidisciplinary treatment of head and neck cancers has changed as more cancers are being treated by chemoradiotherapy. Salvage surgery has become more common, and with it the increased challenges in managing metastatic disease to neck nodes as well as managing failure of organ preservation treatments. Surgeons continue to develop and refine reconstruction techniques to optimize cosmetic and functional outcomes.
Collapse
Affiliation(s)
- Robert Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.
| | | | | |
Collapse
|
|
50
|
Hodge CW, Bentzen SM, Wong G, Palazzi-Churas KL, Wiederholt PA, Gondi V, Richards GM, Hartig GK, Harari PM. Are we influencing outcome in oropharynx cancer with intensity-modulated radiotherapy? An inter-era comparison. Int J Radiat Oncol Biol Phys 2007; 69:1032-41. [PMID: 17967300 DOI: 10.1016/j.ijrobp.2007.05.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 05/01/2007] [Accepted: 05/02/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyze the outcome in all oropharynx cancer patients treated at the University of Wisconsin during 1995-2005 and highlight the methodologic challenge in comparing outcome after intensity-modulated radiotherapy (IMRT) with that of historical controls. METHODS AND MATERIALS Outcomes were compared in 195 oropharynx cancer patients after definitive radiotherapy with curative intent in the pre-IMRT era (pre-IMRT, n = 105), after IMRT (IMRT+, n = 52) or after non-IMRT techniques during the IMRT era (IMRT-, n = 38). RESULTS With a median follow-up of 30.4 months, the 3-year overall survival rate in IMRT+, IMRT-, and pre-IMRT patients was 88.2%, 81.1%, and 67.7%, respectively; and for locoregional control was 96.1%, 78.1%, and 81.1%. Patients from the IMRT era more frequently received concurrent chemotherapy (67% vs. 6%, p < 0.001) and underwent adjuvant neck dissection (52% vs. 29%, p = 0.002). Patients with T3-4 disease and bilateral neck disease were significantly less likely to receive IMRT. Cox regression analysis identified IMRT as a significant prognostic factor (p = 0.04); however, after including T stage in the model, IMRT lost independent significance (p = 0.2). Analysis of a potential effect of IMRT on Grade 3+ mucositis or skin reaction was also hampered by the change in other treatment characteristics. CONCLUSIONS Outcomes in oropharynx cancer have improved at our institution since the introduction of IMRT. However, multiple factors have contributed to this improvement, and presentation of IMRT outcomes without the full context of historical and contemporary controls may yield data that overstate outcome after IMRT.
Collapse
Affiliation(s)
- C Wesley Hodge
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|