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Sample records for accelerated hypofractionated radiotherapy

  1. Does accelerated hypofractionated adjuvant whole-breast radiotherapy increase mammographic density or change mammographic features?

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    Milanesio, Luisella; Brachet Cota, Piero B; Berrino, Carla; Cataldi, Aldo; Gatti, Giovanni; Mondini, Guido; Paino, Ovidio; Comello, Erika G; Orlassino, Renzo; Pasquino, Massimo; Cante, Domenico; La Porta, Maria R; Patania, Sebastiano; La Valle, Giovanni

    2015-01-01

    Objective: To compare mammographic features before and after accelerated hypofractionated adjuvant whole-breast radiotherapy (AWB-RT) and to evaluate possible appearance of modifications. Methods: A retrospective review of 177 females before and after an AWB-RT treatment (follow-up ranging from 5 to 9 years) was performed by four radiologists focused in breast imaging who independently evaluated diffuse mammographic density patterns and reported on possible onset of focal alterations; modifications in density and fibrosis with parenchymal distortion were deemed as indicators of AWB-RT treatment impact in breast imaging. Results: Prevalent mammographic density (D) patterns in the 177 females evaluated were according to the American College of Radiology–Breast Imaging Reporting and Data System (ACR-BIRADS): D1, fibroadipose density (score percentage from 55.9% to 43.5%); and D2, scattered fibroglandular density (from 42.9% to 32.7%). No change in diffuse mammographic density and no significant difference in mammographic breast parenchymal structure were observed. “No change” was reported with score percentage from 87% to 79.6%. Appearance of fibrosis with parenchymal distortion was reported by all radiologists in only two cases (1.1%, p = 0.3); dystrophic calcification was identified with percentage score from 2.2% to 3.3% (small type) and from 9.6% to 12.9% (coarse type). Conclusion: No statistically significant changes in follow-up mammographies 5–9 years after AWB-RT were detected, justifying large-scale selection of AWB-RT treatment with no risk of altering radiological breast parameters of common use in tumour recurrence detection. Advances in knowledge: The hypofractionated radiotherapy (AWB-RT treatment) is a new proven, safe and effective modality in post-operative patients with early breast cancer with excellent local control and survival. In our study, the absence of changes in mammographic density patterns and in breast imaging before and after

  2. Accelerated hypofractionated adjuvant whole breast radiotherapy with concomitant photon boost after conserving surgery for early stage breast cancer: a prospective evaluation on 463 patients.

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    Cante, Domenico; Rosa La Porta, Maria; Casanova-Borca, Valeria; Sciacero, Piera; Girelli, Giuseppe; Pasquino, Massimo; Franco, Pierfrancesco; Ozzello, Franca

    2011-01-01

    The current standard therapeutic option for early stage breast cancer (EBC) employs a multimodality treatment approach including conservative surgery, radiotherapy, chemotherapy, and hormone therapy. The most common adjuvant radiotherapeutic strategy consists of external beam radiation therapy (EBRT) delivered to the whole breast using 1.8-2 Gy fractions given five times a week, up to a total dose of 45-50 Gy over a period of 5 weeks. In recent years, altered schedules employing larger dose per fraction delivered in fewer treatment sessions over a shorter overall treatment time began to be explored. We herein present clinical data on accelerated hypofractionated adjuvant whole-breast radiotherapy delivered on a daily basis for a total treatment time of 20 fractions. Between February 2005 and June 2009, a total of 463 patients underwent hypofractionated accelerated adjuvant radiation after conservative surgery for early breast cancer (pathological stage pTis, pT1 or pT2, pN0-N1). The basic course of radiotherapy consisted of 45 Gy, to the whole breast in 20 fractions with 2.25 Gy/fraction; an additional daily boost dose of 0.25 Gy was concomitantly delivered, to the lumpectomy cavity, for an additional total dose of 5 Gy. The cumulative nominal dose was 50 Gy. At follow-up, patients were examined at 3 and 6 months after the end of radiotherapy and twice a year afterward. Toxicity was scored according to the Common Terminology Criteria for Adverse Events, using the Radiation Therapy Oncology Group /European Organization for Research and Treatment of Cancer toxicity scale. Cosmetic results were assessed in agreement with the Harvard criteria. All the 463 patients treated with the accelerated hypofractionated adjuvant whole-breast radiotherapy schedule achieved at least 6 months' follow-up and subsequently were considered for the present analysis. With a median follow-up of 27 months, 5-year DFS is 93.1%. Only three patients experienced disease recurrence: two of them

  3. Evolution of Hypofractionated Accelerated Radiotherapy for Prostate Cancer – The Sunnybrook Experience

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    Hima Bindu Musunuru

    2014-11-01

    Full Text Available Stereotactic Ablative Body Radiotherapy (SABR is a newer method of ultra hypo fractionated radiotherapy that uses combination of image guided radiotherapy (IGRT and intensity modulated radiotherapy(IMRT or volumetric modulated arc therapy(VMAT, to deliver high doses of radiation in a few fractions to a target, at the same time sparing the surrounding organs at risk(OAR.SABR is ideal for treating small volumes of disease and has been introduced in a number of disease sites including brain, lung, liver, spine and prostate. Given the radiobiological advantages of treating prostate cancer with high doses per fraction, SABR is becoming a standard of care for low and intermediate risk prostate cancer patients based upon the results from Sunny Brook and also the US-based prostate SABR consortium. This review examines the development of moderate and ultra hypo fractionation schedules at the Odette Cancer centre, Sunnybrook Health Sciences. Moderate hypo fractionation protocol was first developed in 2001 for intermediate risk prostate cancer and from there on different treatment schedules including SABR evolved for all risk groups.

  4. Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years

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    Marucci Laura

    2010-01-01

    Full Text Available Abstract Background Accelerated hypofractionation is an attractive approach for adjuvant whole breast radiotherapy. In this study we evaluated the adverse effects at least 3 years post an accelerated hypofractionated whole breast radiotherapy schedule. Methods From October 2004 to March 2006, 39 consecutive patients aged over 18 years with pTis, pT1-2, pN0-1 breast adenocarcinoma who underwent conservative surgery were treated with an adjuvant accelerated hypofractionated radiotherapy schedule consisting of 34 Gy in 10 daily fractions over 2 weeks to the whole breast, followed after 1 week by an electron boost dose of 8 Gy in a single fraction to the tumour bed. Skin and lung radiation toxicity was evaluated daily during therapy, once a week for one month after radiotherapy completion, every 3 months for the first year and from then on every six months. In particular lung toxicity was investigated in terms of CT density evaluation, pulmonary functional tests, and clinical and radiological scoring. Paired t-test, Chi-square test and non-parametric Wilcoxon test were performed. Results After a median follow-up of 43 months (range 36-52 months, all the patients are alive and disease-free. None of the patients showed any clinical signs of lung toxicity, no CT-lung toxicity was denoted by radiologist on CT lung images acquired about 1 year post-radiotherapy, no variation of pulmonary density evaluated in terms of normalised Hounsfield numbers was evident. Barely palpable increased density of the treated breast was noted in 9 out of 39 patients (in 2 patients this toxicity was limited to the boost area and teleangectasia (2 limited to the boost area was evident in 2 out of 39 patients. The compliance with the treatment was excellent (100%. Conclusion The radiotherapy schedule investigated in this study (i.e 34 Gy in 3.4 Gy/fr plus boost dose of 8 Gy in single fraction is a feasible and safe treatment and does not lead to adjunctive acute and late

  5. Hypofractionated whole breast radiotherapy: current perspectives

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    Koulis TA

    2015-10-01

    Full Text Available Theodora A Koulis, Tien Phan, Ivo A Olivotto Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada Abstract: Adjuvant radiotherapy (RT is an important part of breast cancer management but the dose and fractionation schedules used are variable. A total of 50 Gy in 25 daily fractions delivered over 5 weeks is often considered the "standard" adjuvant RT prescription. Hypofractionated regimes such as 42.5 Gy in 16 daily fractions or 40 Gy in 15 daily fractions following breast-conserving surgery have proven to be equally effective and achieve similar or better cosmetic and normal tissue outcomes for both invasive and in situ diseases and when treating the regional nodes. Hypofractionation is more convenient for patients and less costly. However, certain patients at higher risk of RT late effects may benefit from a less intense, even more extended fractionation schedule. This review describes the indications for whole breast hypofractionated adjuvant RT for patients with breast cancer following breast-conserving surgery and proposes that hypofractionation should be the new "standard" for adjuvant breast cancer RT. Keywords: fractionation, breast cancer, cosmesis, radiotherapy

  6. [Hypofractionation and radiotherapy: "the eternal return"].

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    Cosset, J-M; Mornex, F; Eschwège, F

    2013-10-01

    Hypofractionation is not a new idea in radiotherapy. The use of a few high-dose fractions has been proposed by some pioneers of our specialty in the early years of the 20th century. Hypofractionation then reappeared several times in the next decades, based on successive radiobiological concepts, a number of them having been shown to be wrong. The nominal single dose (NSD), for example, so fashionable in the 1970's, dramatically underestimated the late toxicity of the high-dose fractions. Consequently, the NSD was directly responsible for a significant increase of the incidence and of the severity of late complications in large cohorts of patients. The linear-quadratic model (LQ) unequivocally improved our understanding of fractionation sensitivity, but one has to keep in mind its limitations, both in the areas of low and high doses per fraction. For more than a decade, prostate cancer has been the subject of fierce discussions about its sensitivity to fractionation. A number of studies have suggested an unusually low (for a malignant tumor) alpha/beta ratio. However, the available data do not allow a precise evaluation of this ratio; "very low" (1.5 Gy), with an advantage of hypofractionation in terms of local control? Or simply "low" (3-4 Gy), only allowing a reduction of the total number of fractions (with a dose adequately reduced)? While waiting for complementary data, it is advised to remain very careful when modifying the classical schemes towards hypofractionation.

  7. Hypofractionated radiotherapy for localized prostate cancer

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    Hoecht, Stefan [Xcare Gruppe, Radiologie, Nuklearmedizin und Strahlentherapie, Saarlouis (Germany); Aebersold, Daniel M. [University of Bern, Universitaetsklinik fuer Radio-Onkologie, Inselspital, Bern (Switzerland); Albrecht, Clemens [Universitaetsklinikum der Paracelsus Medizinischen Privatuniversitaet, Klinik fuer Radioonkologie und Gemeinschaftspraxis fuer Strahlentherapie, Klinikum Nuernberg Nord, Nuremberg (Germany); Boehmer, Dirk [Charite Universitaetsmedizin, Klinik fuer Radioonkologie und Strahlentherapie, Berlin (Germany); Flentje, Michael [Universitaetsklinikum Wuerzburg, Klinik und Poliklinik fuer Strahlentherapie, Wuerzburg (Germany); Ganswindt, Ute [Ludwig-Maximilians-Universitaet Muenchen, Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie, Munich (Germany); Hoelscher, Tobias [Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie, Dresden (Germany); Martin, Thomas [Klinikum Bremen-Mitte, Klinik fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Sedlmayer, Felix [Universitaetsklinikum der Paracelsus Medizinischen Privatuniversitaet, Universitaetsklinik fuer Radiotherapie und Radio-Onkologie, Landeskrankenhaus, Salzburg (Austria); Wenz, Frederik [Universitaetsmedizin Mannheim, Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Zips, Daniel [Universitaetsklinikum Tuebingen, Universitaetsklinik fuer Radioonkologie, Tuebingen (Germany); Wiegel, Thomas [Universitaetsklinikum Ulm, Abteilung Strahlentherapie, Ulm (Germany)

    2017-01-15

    This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use. Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control. Several large-scale trials on moderate hypofractionation with single doses from 2.4-3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2-3 years. Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials. (orig.) [German] Diese Uebersichtsarbeit soll den aktuellen Status der hypofraktionierten Radiotherapie des Prostatakarzinoms mit dem Fokus auf die Anwendung in der Routinetherapie darstellen. Basierend auf einem kuerzlich erschienen systematischen Review zur Hypofraktionierung sind durch das DEGRO Expertengremium zusaetzliche, in der Zwischenzeit verfuegbar gewordene Informationen mit beruecksichtigt worden. Die Validitaet der Aussagen zu Ergebnissen wurde speziell im Hinblick auf die Langzeittoxizitaet und -erkrankungskontrolle bewertet. Mehrere grosse Phase-3-Studien zur moderaten Hypofraktionierung mit Dosen von 2,4-3,4 Gy pro Fraktion

  8. Pushing the limits of hypofractionation for adjuvant whole breast radiotherapy.

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    Yarnold, John; Haviland, Joanne

    2010-06-01

    Randomised trials report no disadvantages for hypofractionation based on 2.67 Gy fractions of adjuvant whole breast radiotherapy in terms of local tumour control and late adverse effects. Current 15- or 16-fraction schedules may not represent the limits of this approach, and limited data suggest that fewer larger fractions can be delivered safely provided appropriate downward adjustments are made to the total dose. Therapeutic gain will be undermined if breast cancer proves to be, on average, significantly less sensitive to fraction size than the dose-limiting late reacting normal tissues. If so, shortening overall treatment time might wholly or partially offset these limitations, and these uncertainties are addressed in ongoing or planned trials. Meanwhile, the experience of accelerated partial breast irradiation suggests a strong volume effect for late normal tissue damage. Schedules that may be safe when delivered to small partial volumes cannot be assumed to be safe if delivered to larger partial volumes or to the whole breast. Based on current evidence, testing the effectiveness of a 5-fraction schedule of hypofractionated whole breast radiotherapy appears to be a realisable research objective.

  9. Hypofractionated Adjuvant Whole Breast Radiotherapy: Progress and Prospects

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    Yarnold, John (Section of Radiotherapy, Inst. of Cancer Research, Royal Marsden Hospital, Sutton (United Kingdom)), E-mail: john.yarnold@icr.ac.uk; Haviland, Joanne (Clinical Trials and Statistics Unit (ICR-CTSU), Section of Clinical Trials, Inst. of Cancer Research, Sutton (United Kingdom))

    2010-11-15

    Published results of randomised trials involving >7000 women confirm the safety and efficacy of hypofractionated schedules of adjuvant radiotherapy for women with early breast cancer using fraction sizes between 2 and 3 Gy assuming appropriate downward adjustments to total dose. Unnecessary concerns relating to heart tolerance, suboptimal dose distribution and duration of follow up need not discourage the routine adoption of 15- or 16-fraction schedules in women treated by breast conservation surgery for early breast cancer. Regardless of fractionation regimen, dose escalation to the index quadrant in high risk subgroups will result in a greater relative increase in late adverse effects than tumour control, a therapeutic disadvantage that can only be overcome by exploiting a marked dose-volume effect. A 15-fraction schedule of whole breast radiotherapy is unlikely to represent the lower limits of hypofractionation, and the preliminary results of a 5-fraction regimen are encouraging

  10. Accelerated partial breast irradiation: an advanced form of hypofractionation.

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    Budrukkar, Ashwini

    2008-01-01

    Altered fractionation schedules are being increasingly investigated in the treatment of breast cancer. Two such schedules that are frequently compared are hypofractionated external beam radiation therapy (HERT) and accelerated partial breast irradiation (APBI). Though these two modalities are considered separately, APBI is an actually an advanced form of hypofractionation, where acceleration of the treatment is possible due to the smaller volume being irradiated. HERT as well as APBI are investigational at present and are being tested in randomized trials. This article looks at the advantages of APBI as a hypofractionation schedule.

  11. Accelerated partial breast irradiation: An advanced form of hypofractionation

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    Budrukkar Ashwini

    2008-01-01

    Full Text Available Altered fractionation schedules are being increasingly investigated in the treatment of breast cancer. Two such schedules that are frequently compared are hypofractionated external beam radiation therapy (HERT and accelerated partial breast irradiation (APBI. Though these two modalities are considered separately, APBI is an actually an advanced form of hypofractionation, where acceleration of the treatment is possible due to the smaller volume being irradiated. HERT as well as APBI are investigational at present and are being tested in randomized trials. This article looks at the advantages of APBI as a hypofractionation schedule.

  12. Hypofractionation regimens for stereotactic radiotherapy for large brain tumors.

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    Yuan, Jiankui; Wang, Jian Z; Lo, Simon; Grecula, John C; Ammirati, Mario; Montebello, Joseph F; Zhang, Hualin; Gupta, Nilendu; Yuh, William T C; Mayr, Nina A

    2008-10-01

    To investigate equivalent regimens for hypofractionated stereotactic radiotherapy (HSRT) for brain tumor treatment and to provide dose-escalation guidance to maximize the tumor control within the normal brain tolerance. The linear-quadratic model, including the effect of nonuniform dose distributions, was used to evaluate the HSRT regimens. The alpha/beta ratio was estimated using the Gammaknife stereotactic radiosurgery (GKSRS) and whole-brain radiotherapy experience for large brain tumors. The HSRT regimens were derived using two methods: (1) an equivalent tumor control approach, which matches the whole-brain radiotherapy experience for many fractions and merges it with the GKSRS data for few fractions; and (2) a normal-tissue tolerance approach, which takes advantages of the dose conformity and fractionation of HSRT to approach the maximal dose tolerance of the normal brain. A plausible alpha/beta ratio of 12 Gy for brain tumor and a volume parameter n of 0.23 for normal brain were derived from the GKSRS and whole-brain radiotherapy data. The HSRT prescription regimens for the isoeffect of tumor irradiation were calculated. The normal-brain equivalent uniform dose decreased as the number of fractions increased, because of the advantage of fractionation. The regimens for potential dose escalation of HSRT within the limits of normal-brain tolerance were derived. The designed hypofractionated regimens could be used as a preliminary guide for HSRT dose prescription for large brain tumors to mimic the GKSRS experience and for dose escalation trials. Clinical studies are necessary to further tune the model parameters and validate these regimens.

  13. Concurrent Boost with Adjuvant Breast Hypofractionated Radiotherapy and Toxicity Assessment

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    Mona M. Sayed

    2015-01-01

    Full Text Available Background: The use of shorter radiotherapy schedules has an economic and logistic advantage for radiotherapy departments, as well as a high degree of patient convenience. The aim of this study is to assess the acute and short-term late toxicities of a hypofractionated radiotherapy schedule with a concomitant boost. Methods: We enrolled 57 eligible patients as group A. These patients received 42.5 Gy in 16 fractions of 2.66 Gy each to the whole breast over 3.2 weeks. A concomitant electron boost of 12 Gy in 16 fractions was also administered which gave an additional 0.75 Gy daily to the lumpectomy area for a total radiation dose of 54.5 Gy. Toxicity was recorded at three weeks and at three months for this group as well as for a control group (group B. The control group comprised 76 eligible patients treated conventionally with 50 Gy to the whole breast over five weeks followed by a sequential electron boost of 12 Gy in 2 Gy per fraction. Results: There were no statistically significant differences observed in the incidence of acute skin toxicity, breast pain, and edema recorded at three weeks or pigmentation and fibrosis recorded at three months between the two groups (P0.05. Conclusion: The results of this study suggest there are no increased acute and shortterm late toxicities affiliated with the hypofractionated schedule plus a concomitant boost as prescribed compared to the conventional fractionation of adjuvant breast radiotherapy. Large randomized trials and long-term follow-up are needed to confirm these favorable findings.

  14. Hypofractionated radiotherapy in carcinoma breast: What we have achieved?

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    Tapesh Bhattacharyya

    2015-01-01

    Full Text Available Healthy breast tissue is sensitive to radiation fraction size, such that small changes in fraction size can lead to larger changes in radiation effects on these tissues. Conventional breast and/or chest wall irradiation uses 2 Gy daily fractions, for 5-6 weeks. Such a long treatment schedule has major implications on both patient quality of life and burden of radiotherapy (RT departments. Some investigators have hypothesized that breast cancer is as sensitive as normal breast tissue to fraction size. According to the hypothesis, small fraction sizes of 2.0 Gy or less offer no therapeutic advantage, and a more effective strategy would be to deliver fewer, larger fractions that result in a lower total radiation dose. This short (hypofractionated RT schedule would be more convenient for patients (especially those coming from remote areas to RT facilities and for healthcare providers, as it would increase the turnover in RT departments. This thought has prompted us to write a systematic review on role of hypofractionated RT in breast cancer in a developing country like ours where patient burden is an alarming problem.

  15. Accelerated hypofractionated adjuvant whole breast radiation with simultaneous integrated boost using volumetric modulated arc therapy for early breast cancer: A phase I/II dosimetric and clinical feasibility study from a tertiary cancer care centre of India

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    Dodul Mondal

    2017-03-01

    Mini abstract: Simultaneous integrated boost with accelerated hypofractionated whole breast radiotherapy using Volumetric Modulated Arc Therapy is a novel approach. Patient selection and technical considerations are of paramount importance. The present study describes successful implementation of this approach.

  16. Image Fusion for Radiosurgery, Neurosurgery and Hypofractionated Radiotherapy.

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    Inoue, Hiroshi K; Nakajima, Atsushi; Sato, Hiro; Noda, Shin-Ei; Saitoh, Jun-Ichi; Suzuki, Yoshiyuki

    2015-03-01

    Precise target detection is essential for radiosurgery, neurosurgery and hypofractionated radiotherapy because treatment results and complication rates are related to accuracy of the target definition. In skull base tumors and tumors around the optic pathways, exact anatomical evaluation of cranial nerves are important to avoid adverse effects on these structures close to lesions. Three-dimensional analyses of structures obtained with MR heavy T2-images and image fusion with CT thin-sliced sections are desirable to evaluate fine structures during radiosurgery and microsurgery. In vascular lesions, angiography is most important for evaluations of whole structures from feeder to drainer, shunt, blood flow and risk factors of bleeding. However, exact sites and surrounding structures in the brain are not shown on angiography. True image fusions of angiography, MR images and CT on axial planes are ideal for precise target definition. In malignant tumors, especially recurrent head and neck tumors, biologically active areas of recurrent tumors are main targets of radiosurgery. PET scan is useful for quantitative evaluation of recurrences. However, the examination is not always available at the time of radiosurgery. Image fusion of MR diffusion images with CT is always available during radiosurgery and useful for the detection of recurrent lesions. All images are fused and registered on thin sliced CT sections and exactly demarcated targets are planned for treatment. Follow-up images are also able to register on this CT. Exact target changes, including volume, are possible in this fusion system. The purpose of this review is to describe the usefulness of image fusion for 1) skull base, 2) vascular, 3) recurrent target detection, and 4) follow-up analyses in radiosurgery, neurosurgery and hypofractionated radiotherapy.

  17. Hypofractionated radiotherapy has the potential for second cancer reduction

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    Besserer Jürgen

    2010-02-01

    Full Text Available Abstract Background and Purpose A model for carcinoma and sarcoma induction was used to study the dependence of carcinogenesis after radiotherapy on fractionation. Materials and methods A cancer induction model for radiotherapy doses including fractionation was used to model carcinoma and sarcoma induction after a radiation treatment. For different fractionation schemes the dose response relationships were obtained. Tumor induction was studied as a function of dose per fraction. Results If it is assumed that the tumor is treated up to the same biologically equivalent dose it was found that large dose fractions could decrease second cancer induction. The risk decreases approximately linear with increasing fraction size and is more pronounced for sarcoma induction. Carcinoma induction decreases by around 10% per 1 Gy increase in fraction dose. Sarcoma risk is decreased by about 15% per 1 Gy increase in fractionation. It is also found that tissue which is irradiated using large dose fractions to dose levels lower than 10% of the target dose potentially develop less sarcomas when compared to tissues irradiated to all dose levels. This is not observed for carcinoma induction. Conclusions It was found that carcinoma as well as sarcoma risk decreases with increasing fractionation dose. The reduction of sarcoma risk is even more pronounced than carcinoma risk. Hypofractionation is potentially beneficial with regard to second cancer induction.

  18. Use of hypofractionated radiotherapy regimens after organ-sparing surgery for Stages I–IIA breast cancers

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    Yu. V. Efimkina

    2010-01-01

    Full Text Available There have been recent reports on the expediency of applying postoperative hypofractionated accelerated radiotherapy (RT regimens in patients who have undergone breast-sparing surgery. The concept of accelerated hypofractionation (AH includes daily high-dose radiation for a shorter total period of time. In most radiologists’ opinion, the AH RT regimen may be as effective as more conventional treatments that use lower daily radiation doses for a longer period. The appeal of this method is that shorter treatment provides more convenience for patients. By taking into account the fact that the α/β ratio for intact breast tissues is about 3.5 Gy, larger fraction RT regi- mens are likely to be more effective, which will reduce the frequency of recurrences as compared with conventional therapy approaches without increasing the incidence of postradiation intact tissue damage.

  19. [Hypofractionated adjuvant radiotherapy for breast cancer: no signs of increased risk of cardiotoxicity].

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    Aleman, Berthe M P; van Leeuwen, Floor E

    2015-01-01

    Adjuvant radiotherapy is frequently used in women with breast cancer to improve both local control of the tumour and overall survival. Hypofractionated regimens are increasingly being used as they involve fewer treatment sessions and, in terms of tumour control, the effects of conventionally fractionated and hypofractionated radiotherapy seem to be comparable. However, there is concern regarding increased cardiotoxicity following hypofractionated radiotherapy treatment to the left side. In order to determine if cardiac mortality increases with hypofractionation relative to conventional fractionation, a Canadian research group performed a retrospective analysis in 5334 women with breast cancer treated between 1990-1998 with postoperative radiotherapy to the breast/chest wall only. At 15-year follow-up the authors concluded that cardiac mortality was not statistically different among patients with left-sided breast cancer whether treated with hypofractionated or conventionally fractionated whole breast/chest wall irradiation. This commentary discusses the data presented in the paper, puts them into perspective and describes the clinical implications.

  20. Effect of image-guided hypofractionated stereotactic radiotherapy on peripheral non-small-cell lung cancer

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    Wang, Shu-wen; Ren, Juan; Yan, Yan-li; Xue, Chao-fan; Tan, Li; Ma, Xiao-wei

    2016-01-01

    The objective of this study was to compare the effects of image-guided hypofractionated radiotherapy and conventional fractionated radiotherapy on non-small-cell lung cancer (NSCLC). Fifty stage- and age-matched cases with NSCLC were randomly divided into two groups (A and B). There were 23 cases in group A and 27 cases in group B. Image-guided radiotherapy (IGRT) and stereotactic radiotherapy were conjugately applied to the patients in group A. Group A patients underwent hypofractionated radiotherapy (6–8 Gy/time) three times per week, with a total dose of 64–66 Gy; group B received conventional fractionated radiotherapy, with a total dose of 68–70 Gy five times per week. In group A, 1-year and 2-year local failure survival rate and 1-year local failure-free survival rate were significantly higher than in group B (P0.05) were lower in group A than in group B. The overall survival rate of group A was significantly higher than that of group B (P=0.03), and the survival rate at 1 year was 87% vs 63%, (P0.05). Compared with conventional fractionated radiation therapy, image-guided hypofractionated stereotactic radiotherapy in NSCLC received better treatment efficacy and showed good tolerability. PMID:27574441

  1. The role of hypofractionation radiotherapy for diffuse intrinsic brainstem glioma in children: a pilot study.

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    Janssens, G.O.; Gidding, C.E.M.; Lindert, E.J. van; Oldenburger, F.R.; Erasmus, C.E.; Schouten-Meeteren, A.Y.; Kaanders, J.H.A.M.

    2009-01-01

    PURPOSE: Most children with a diffuse intrinsic brainstem glioma will die within 1 year after diagnosis. To reduce patient burden, we investigated the feasibility of a radical hypofractionation radiotherapy schedule, given over 3 weeks, as an alternative to the standard regimen (30 fractions over 6

  2. Clinical Usefulness of Implanted Fiducial Markers for Hypofractionated Radiotherapy of Prostate Cancer

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    Choi, Young Min; Ahn, Sung Hwan; Lee, Hyung Hwan; Lee, Hyung Sik; Hur, Woo Joo; Yoon, Jin Han; Kim, Tae Hyo; Kim, Soo Dong; Yun, Seong Guk [Dong-A University School of Medicine, Busan (Korea, Republic of)

    2011-06-15

    To assess the usefulness of implanted fiducial markers in the setup of hypofractionated radiotherapy for prostate cancer patients by comparing a fiducial marker matched setup with a pelvic bone match. Four prostate cancer patients treated with definitive hypofractionated radiotherapy between September 2009 and August 2010 were enrolled in this study. Three gold fiducial markers were implanted into the prostate and through the rectum under ultrasound guidance around a week before radiotherapy. Glycerin enemas were given prior to each radiotherapy planning CT and every radiotherapy session. Hypofractionated radiotherapy was planned for a total dose of 59.5 Gy in daily 3.5 Gy with using the Novalis system. Orthogonal kV X-rays were taken before radiotherapy. Treatment positions were adjusted according to the results from the fusion of the fiducial markers on digitally reconstructed radiographs of a radiotherapy plan with those on orthogonal kV X-rays. When the difference in the coordinates from the fiducial marker fusion was less than 1 mm, the patient position was approved for radiotherapy. A virtual bone matching was carried out at the fiducial marker matched position, and then a setup difference between the fiducial marker matching and bone matching was evaluated. Three patients received a planned 17-fractionated radiotherapy and the rest underwent 16 fractionations. The setup error of the fiducial marker matching was 0.94{+-}0.62 mm (range, 0.09 to 3.01 mm; median, 0.81 mm), and the means of the lateral, craniocaudal, and anteroposterior errors were 0.39{+-}0.34 mm, 0.46{+-}0.34 mm, and 0.57{+-}0.59 mm, respectively. The setup error of the pelvic bony matching was 3.15{+-}2.03 mm (range, 0.25 to 8.23 mm; median, 2.95 mm), and the error of craniocaudal direction (2.29{+-}1.95 mm) was significantly larger than those of anteroposterior (1.73{+-}1.31 mm) and lateral directions (0.45{+-}0.37 mm), respectively (p< 0.05). Incidences of over 3 mm and 5 mm in setup

  3. Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

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    Tunesi Sara

    2010-11-01

    Full Text Available Abstract Background A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series. Methods Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected. Results Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85% patients treated with hypofractionation and in 67/70 (96% patients treated with conventional fractionation (p = 0.01. Late toxicity was observed in 8 patients (10% in the hypofractionation group and in 10 patients (15% in the conventional fractionation group, respectively (p = 0.4. Conclusions The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.

  4. Reproducibility and geometric accuracy of the fixster system during hypofractionated stereotactic radiotherapy

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    Henriksson Roger

    2008-05-01

    Full Text Available Abstract Background Hypofractionated radiotherapy has been used for the treatment of AVMs and brain metastases. Hypofractionation necessitates the use of a relocatable stereotactic frame that has to be applied on several occasions. The stereotactic frame needs to have a high degree of reproducibility, and patient positioning is crucial to achieve a high accuracy of the treatment. Methods In this study we have, by radiological means, evaluated the reproducibility of the isocenter in consecutive treatment sessions using the Fixster frame. Deviations in the X, Y and Z-axis were measured in 10 patients treated with hypofractionated radiotherapy. Results The mean deviation in the X-axis was 0.4 mm (range -2.1 – 2.1, median 0.7 mm and in the Y-axis -0.3 mm (range -1.4 – 0.7, median -0.2 mm. The mean deviation in the Z-axis was -0.6 (range -1.4 – 1.4, median 0.0 mm. Conclusion There is a high degree of reproducibility of the isocenter during successive treatment sessions with HCSRT using the Fixster frame for stereotactic targeting. The high reducibility enables a safe treatment using hypofractionated stereotactic radiotherapy.

  5. Hypofractionated Radiotherapy for Small-sized Hepatocellular Carcinoma as Salvage Therapy: Sustained Local Control and Safety

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    Bae, Sun Hyun; Park, Hee Chul; Lim, Do Hoon; Lee, Jung Ae; Choi, Moon Seok; Lee, Joon Hyoek; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2010-11-15

    To evaluate the rate of tumor response, local control, and treatment-related complications after hypofractionated radiotherapy for recurrent hepatocelluar carcinoma (HCC) less than 5 cm in size. Among the HCC patients who were treated by radiotherapy (RT) between 2006 and 2007 after the failure of previous treatment, a total of 12 patients were treated with hypofractionated RT. The criteria for hypofractionated RT was as follows: 1) HCC less than 5 cm, 2) HCC not adjacent to a critical organ, 3) HCC without portal vein tumor thrombosis, and 4) less than 15% of normal liver volume that irradiated 50% of the prescribed dose. Hypofractionated RT was performed with 50 Gy delivered in 10 fractions, at a rate of 5 fractions per week. The evaluation of tumor response was determined by CT scans performed at 3 months after the cessation of RT, followed by the evaluation of toxicity by Common Terminology Criteria for Adverse Events version 3.0. The median follow-up period after radiotherapy was 18 months. A complete response (CR) was achieved in 5 of 12 lesions (41.7%) at CT performed at 3 months after the cessation, whereas the overall complete response was observed in 7 of 12 cases (58.3%). In-field local control rate was sustained in 83.3% of patients. All patients developed intra-hepatic metastases except for 2 patients. The overall survival rate was 90.0% at 1 year and 67.5% at 2 years, respectively. Three patients developed Grade 1 nausea during RT and 1 patient showed a progression of ascites after RT. There was no grade 3 or greater treatment-related toxicities. Hypofractionated RT for small-sized HCC as a salvage therapy showed a 58.3% CR rate and 83.3% of local control. Fifty Gy administered in 10 fractions of partial liver irradiation is considered as a tolerable dose that does not cause severe complications.

  6. Hypofractionation in the era of modulated radiotherapy (RT).

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    Mouw, Kent W; Harris, Jay R

    2013-08-01

    The use of radiation therapy (RT) as a component of breast-conserving therapy (BCT) has been shown to reduce the risk of local-regional recurrence and improve overall survival. As has been the common practice in the United States and Continental Europe, the majority of studies that demonstrated these benefits utilized daily radiation doses ranging from 1.8 to 2.0 Gray (Gy) per day given for approximately 5 weeks. However, due to geographic limitations, patient preferences, and financial considerations, there have been continued attempts to evaluate the efficacy and safety of abbreviated or hypofractionated courses of whole-breast radiation. Two key factors in these attempts have been: 1) advances in radiobiology allowing for a more precise estimation of equivalent dosing, and 2) advances in the delivery of RT ('modulation') that have resulted in substantially improved dose homogeneity in the target volume. Hypofractionated schedules have been compared to conventional radiation courses in several randomized controlled trials, as well as many prospective and retrospective experiences. These studies, now with about 10 years of follow-up, have demonstrated equivalent rates of local-regional recurrence, disease-free survival, and overall survival. The rates of toxicity have generally not been increased with hypofractionated regimens; however, certain toxicities may take decades to manifest. The generalizability of these results is unclear, as the majority of patients in the trials were elderly with early-stage hormone-receptor positive disease. Nevertheless, there is now sufficient evidence to recommend hypofractionated whole breast RT for a substantial percentage of patients.

  7. Extreme Hypofractionated Image-Guided Radiotherapy for Prostate Cancer

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    Carlo Greco

    2013-09-01

    Full Text Available An emerging body of data suggests that hypofractionated radiation schedules, where a higher dose per fraction is delivered in a smaller number of sessions, may be superior to conventional fractionation schemes in terms of both tumour control and toxicity profile in the management of adenocarcinoma of the prostate. However, the optimal hypofractionation scheme is still the subject of scientific debate. Modern computer-driven technology enables the safe implementation of extreme hypo fractionation (often referred to as stereotactic body radiation therapy [SBRT]. Several studies are currently being conducted to clarify the yet unresolved issues regarding treatment techniques and fractionation regimens. Recently, the American Society for Radiation Oncology (ASTRO issued a model policy indicating that data supporting the use of SBRT for prostate cancer have matured to a point where SBRT could be considered an appropriate alternative for select patients with low-to-intermediate risk disease. The present article reviews some of the currently available data and examines the impact of tracking technology to mitigate intra-fraction target motion, thus, potentially further improving the clinical outcomes of extreme hypofractionated radiation therapy in appropriately selected prostate cancer patients. The Champalimaud Centre for the Unknown (CCU’s currently ongoing Phase I feasibility study is described; it delivers 45 Gy in five fractions using prostate fixation via a rectal balloon, and urethral sparing via catheter placement with on-line intra-fractional motion tracking through beacon transponder technology.

  8. Hypofractionated versus conventional radiotherapy with or without chemotherapy in head and neck cancer: A comparative study

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    Somnath Roy

    2015-01-01

    Full Text Available Background: To investigate tumor response and toxicities in head and neck squamous cell cancer (HNSCC upon hypofractionated radiotherapy compared with conventional fractionation. Settings and Design: Data from patients with squamous cell cancer of oral cavity, oropharynx, hypopharynx, and larynx (AJCC, 2010 Stage II to IVB; who received hypofractionated (n = 30 or conventionally fractionated (n = 30 radiotherapy, with or without chemotherapy, between January 2010 to June 2011 were retrieved and retrospectively analyzed. Materials and Methods: In conventional arm (Arm A, each patient received 70 Gy at 2 Gy per fraction over 7 weeks, along with concurrent cisplatin (100 mg/m 2 on days 1, 22, and 43 for locally advanced stage. In hypofractionated arm (Arm B, each patient received 55 Gy at 2.75 Gy per fraction over 4 weeks, along with concurrent cisplatin (100 mg/m 2 on days 1 and 22 for locally advanced stage. The end points were tumor response, acute and late toxicities, overall survival (OS, and diseases-free survival (DFS. Results: The tumor response distribution was comparable - 24 (80% patients in arm A and 23 (76% in arm B achieved a complete response. Significant differences in frequencies of acute grade ≥ 2 skin toxicity, mucositis were found, with higher frequencies in Arm B. Higher frequencies of late grade ≥ 2 dysphagia, laryngeal edema, xerostomia, and confluent mucositis were encountered in Arm B at 6 months from start of chemoradiation. However, OS, DFS, and loco-regional recurrence rates were comparable between the two arms. Conclusions: Hypofractionated radiotherapy can achieve similar tumor response to conventionally fractionated radiotherapy in HNSCC, although with some increase of toxicity.

  9. Radiobiology of hypofractionated stereotactic radiotherapy: what are the optimal fractionation schedules?

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    Shibamoto, Yuta; Miyakawa, Akifumi; Otsuka, Shinya; Iwata, Hiromitsu

    2016-01-01

    In hypofractionated stereotactic radiotherapy (SRT), high doses per fraction are usually used and the dose delivery pattern is different from that of conventional radiation. The daily dose is usually given intermittently over a longer time compared with conventional radiotherapy. During prolonged radiation delivery, sublethal damage repair takes place, leading to the decreased effect of radiation. In in vivo tumors, however, this decrease in effect may be counterbalanced by rapid reoxygenation. Another issue related to hypofractionated SRT is the mathematical model for dose evaluation and conversion. The linear–quadratic (LQ) model and biologically effective dose (BED) have been suggested to be incorrect when used for hypofractionation. The LQ model overestimates the effect of high fractional doses of radiation. BED is particularly incorrect when used for tumor responses in vivo, since it does not take reoxygenation into account. Correction of the errors, estimated at 5–20%, associated with the use of BED is necessary when it is used for SRT. High fractional doses have been reported to exhibit effects against tumor vasculature and enhance host immunity, leading to increased antitumor effects. This may be an interesting topic that should be further investigated. Radioresistance of hypoxic tumor cells is more problematic in hypofractionated SRT, so trials of hypoxia-targeted agents are encouraged in the future. In this review, the radiobiological characteristics of hypofractionated SRT are summarized, and based on the considerations, we would like to recommend 60 Gy in eight fractions delivered three times a week for lung tumors larger than 2 cm in diameter. PMID:27006380

  10. Phase II Study to Assess the Efficacy of Hypofractionated Stereotactic Radiotherapy in Patients With Large Cavernous Sinus Hemangiomas

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    Wang Xin; Liu Xiaoxia; Mei Guanghai; Dai Jiazhong; Pan Li [Departments of Neurosurgery and CyberKnife, Huashan Hospital, Fudan University, Shanghai (China); Wang Enmin, E-mail: wangem@fudan.edu.cn [Departments of Neurosurgery and CyberKnife, Huashan Hospital, Fudan University, Shanghai (China)

    2012-06-01

    Purpose: Cavernous sinus hemangioma is a rare vascular tumor. The direct microsurgical approach usually results in massive hemorrhage. Although radiosurgery plays an important role in managing cavernous sinus hemangiomas as a treatment alternative to microsurgery, the potential for increased toxicity with single-session treatment of large tumors is a concern. The purpose of this study was to assess the efficacy of hypofractionated stereotactic radiotherapy in patients with large cavernous sinus hemangiomas. Methods: Fourteen patients with large (volume >20 cm{sup 3}) cavernous sinus hemangiomas were enrolled in a prospective Phase II study between December 2007 and December 2010. The hypofractionated stereotactic radiotherapy dose was 21 Gy delivered in 3 fractions. Results: After a mean follow-up of 15 months (range, 6-36 months), the magnetic resonance images showed a mean of 77% tumor volume reduction (range, 44-99%). Among the 6 patients with cranial nerve impairments before hypofractionated stereotactic radiotherapy, 1 achieved symptomatic complete resolution and 5 had improvement. No radiotherapy-related complications were observed during follow-up. Conclusion: Our current experience, though preliminary, substantiates the role of hypofractionated stereotactic radiotherapy for large cavernous sinus hemangiomas. Although a longer and more extensive follow-up is needed, hypofractionated stereotactic radiotherapy of 21 Gy delivered in 3 fractions is effective in reducing the tumor volume without causing any new deficits and can be considered as a treatment modality for large cavernous sinus hemangiomas.

  11. Hypofractionated radiotherapy for localized prostate cancer using three-dimensional conformal radiotherapy technique: 3 years toxicity analysis

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    R White

    2015-01-01

    Full Text Available BACKGROUND: Hypofractionated radiotherapy in the radical treatment of localized prostate cancer has potential biological advantages relative to conventional fractionation. We report prospectively collected toxicity data from a cohort of patients treated with a 3D conformal technique (3DCRT. MATERIALS AND METHODS: 90 patients receiving curative intent hypofractionated radiotherapy with 57Gy in 19 daily fractions over 3.8 weeks were evaluated prospectively for the development of radiation related toxicity over a 3 year period. RESULTS: All patients completed treatment. Maximal acute toxicity experienced was 58.6, 10 and 1.1% for grade 1, 2 and 3 genitourinary (GU toxicity respectively and 75.6, 9 and 0% for gastrointestinal (GI toxicity. For late toxicity the three year actuarial rates of grade 1, 2 and 3 GU and GI toxicity respectively were 47.3, 2.4 and 0%; and 40, 9.3 and 4.7%. There were no grade 4 or worse acute or late toxicities. 97.6% of evaluable patients remained free of biochemical failure 36 months post radiotherapy. CONCLUSIONS: A 57Gy in 19 daily fraction radiotherapy schedule using 3D conformal radiotherapy for the definitive treatment of localized prostate cancer has acceptable early and late toxicity.

  12. Image Guided Hypofractionated Radiotherapy by Helical Tomotherapy for Prostate Carcinoma: Toxicity and Impact on Nadir PSA

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    Salvina Barra

    2014-01-01

    Full Text Available Aim. To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT of prostate cancer as well as the value of the nadir PSA (nPSA and time to nadir PSA (tnPSA as surrogate efficacy of treatment. Material and Methods. Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT. A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy. Results. Most of patients (83% did not develop acute gastrointestinal (GI toxicity and 50% did not present genitourinary (GU toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL of the conventionally treated cohort (P=0.02. Conclusions. Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.

  13. Hypofractionated intensity-modulated radiotherapy in patients with localized prostate cancer: a preliminary study

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    Kang, Hye Jin; Kay, Chul Seung; Son, Seok Hyun; Kim, Myung Soo; Jo, In Young; Lee, So Jung; Lee, Dong Hwan; Suh, Hong Jin; Choi, Yong Sun [Incheon St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Incheon (Korea, Republic of)

    2016-03-15

    The aim of this work was to assess the efficacy and tolerability of hypofractionated intensity-modulated radiotherapy (IMRT) in patients with localized prostate cancer. Thirty-nine patients who received radical hypofractionated IMRT were retrospectively reviewed. Based on a pelvic lymph node involvement risk of 15% as the cutoff value, we decided whether to deliver treatment prostate and seminal vesicle only radiotherapy (PORT) or whole pelvis radiotherapy (WPRT). Sixteen patients (41%) received PORT with prostate receiving 45 Gy in 4.5 Gy per fraction in 2 weeks and the other 23 patients (59%) received WPRT with the prostate receiving 72 Gy in 2.4 Gy per fraction in 6 weeks. The median equivalent dose in 2 Gy fractions to the prostate was 79.9 Gy based on the assumption that the α/β ratio is 1.5 Gy. The median follow-up time was 38 months (range, 4 to 101 months). The 3-year biochemical failure-free survival rate was 88.2%. The 3-year clinical failure-free and overall survival rates were 94.5% and 96.3%, respectively. The rates of grade 2 acute genitourinary (GU) and gastrointestinal (GI) toxicities were 20.5% and 12.8%, respectively. None of the patients experienced grade ≥3 acute GU and GI toxicities. The grade 2-3 late GU and GI toxicities were found in 8.1% and 5.4% of patients, respectively. No fatal late toxicity was observed. Favorable biochemical control with low rates of toxicity was observed after hypofractionated IMRT, suggesting that our radiotherapy schedule can be an effective treatment option in the treatment of localized prostate cancer.

  14. Hypofractionated radiotherapy as local hemostatic agent in advanced cancer

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    Malik Tariq Rasool

    2011-01-01

    Full Text Available Purpose : Tumor bleeding continues to remain a challenge in an oncological setting, and radiotherapy has been studied as a local hemostatic agent. We studied the role of local radiotherapy in controlling bleeding at our center. Materials and Methods : We reviewed 25 treated cases (cancer urinary bladder: 12, lung cancer: 5, cervical cancer: 4, uterine cancer: 1, rectal cancer: 2, schwanoma: 1 at our center from March 2008 to December 2010. All patients had either an advanced or recurrent disease. Radiotherapy schedule was either 20 Gray in 5 fractions or 15 Gray in 5 fractions and was delivered with Cobalt 60. Results and Conclusion : Of 25 patients, 22 (88% responded, and there was complete cessation of bleeding. Both 15 Gray and 20 Gray dose schedule had equal efficacy. Treatment was well tolerated without any intermission. Radiotherapy is a safe and effective option in controlling tumor bleeding.

  15. Feasibility of PET-CT based hypofractionated accelerated dose escalation in oropharyngeal cancers: Final dosimetric results of the VORTIGERN study. (Secondary endpoint of UK NCRI portfolio: MREC No: 08/H0907/127, UKCRN ID 7341

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    Sanjoy Chatterjee

    2015-01-01

    Conclusion: Hypofractionated, slightly accelerated dose escalation in oropharyngeal cancers is likely to be safe and the chance of trismus is not any higher than when standard dose radiotherapy is used. Active measures to reduce dose to the MA achieves acceptable dose volume parameters even at escalated doses.

  16. Hypofractionation in radiotherapy. An investigation of injured Swedish women, treated for cancer of the breast

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    Friberg, Sten; Ruden, Bengt-Inge (Division of Medical Radiation Physics, Karolinska Institute and Stockholm University, Stockholm (Sweden))

    2009-07-15

    Background. The Swedish Insurance Company for Patient Injuries asked the two authors of this report to identify the Swedish women with cancer of the breast who had been injured by radiotherapy with a hypofractionated schedule. The purpose was to provide a basis on which the Company could decide if indemnification could be given. Material and methods. We define hypo-fractionation as any fraction dose exceeding 2.0 gray (Gy) per day. We set the lower limit for the 'late effect' at 53.0 Gy with 2 Gy/fraction. All departments of radiotherapy in Sweden were asked to identify women who had developed brachial plexus neuropathy (BPN). Their medical records were obtained. The clinical picture of their injuries was recorded, and the absorbed dose was calculated or reconstructed. All doses, no matter in what way they were expressed, were recalculated to 'late effect', presented in EQD2Gy (Equalized Total Dose in 2 Gy/fraction). The latency period from therapy to onset of symptoms was also noted. Results. A variety of treatment techniques was used, fractions ranging in size from 2.5 to 6.0 Gy. Absorbed doses up to a Biologically Equivalent Dose (BED) 146 EQD2Gy in late effects were recorded (6 Gyx13). More than 95% of the injured women had a combination of stiff shoulder, paralysis, pain, oedema and atrophy of the muscles to the arm and/or hand. Latency from end of radiotherapy to onset of symptoms could be as long as 30 years. Discussion. Hypofractionated radiotherapy has injured severely numerous patients. The lesions have become a medico-legal issue in some countries. The life of many of these women has been ruined: physically, mentally, socially and economically. Conclusion. Hypofractionated radiotherapy can cause injuries if the target volume is not exact, or the total dose is not adjusted to a tolerable level as compared to conventional treatments employing 2 Gy/day fractions

  17. [The hypofractionated radiotherapy in the treatment of the prostate cancer: radiate less to treat more].

    Science.gov (United States)

    Boissier, R; Gross, E

    2010-05-01

    The principle of the hypofractionation in radiotherapy is to deliver a higher dose by session and to reduce the duration of treatment. In the particular case of the cancer of prostate, a hypofractionned protocol allows to deliver an equivalent radiobiological dose identical even higher than a standard plan of irradiation. The hypofractionation is presented as a solution to improve the access to the care (fewer processing times by patient, more patients treated by machine) while increasing the quality of the care: better carcinologic control, less radiotoxicity. The objective of this article is to make a clarification on the hypofractionned radiotherapy in first intention in the treatment of the localized prostate cancer. We count three studies on large cohorts, comparing standard plans to 1.8-2 Gy/session and hypofractionned plans (2.5-3 Gy/session). The inferior carcinologic results of the two first comparative studies with regard to the study of phase I/II of the Cleveland clinic were owed to a sub-dosage of hypofractionned plans. The administered equivalent biological doses were lower than the at present recommended total doses and lower than the theoretical doses, calculated on the bases of an erroneous evaluation of the radiosensibility of the prostate cancer. In the comparative study of Arcangeli, the rate of survival without biological recurrence in 4 years (82%) was significantly to the advantage of the hypofractionned group, while reducing the duration of treatment of 3 weeks. Four comparative studies reported aigues/late toxicity, gastrointestinal (GI)/genito-urinary acceptable (GU) even lower with a hypofractionned plan. The hypofractionation is potentially the future of the radiotherapy in the treatment of the localized prostate cancer thanks to the technological innovation, but for all that does not constitute at present a standard.

  18. Factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy.

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    De Santis, M C; Bonfantini, F; Di Salvo, F; Dispinzieri, M; Mantero, E; Soncini, F; Baili, P; Sant, M; Bianchi, G; Maggi, C; Di Cosimo, S; Agresti, R; Pignoli, E; Valdagni, R; Lozza, L

    2016-10-01

    To evaluate toxicity in breast cancer patients treated with anthracycline and taxane based chemotherapy and whole breast hypofractionated radiotherapy, and to identify the risk factors for toxicity. 537 early breast cancer patients receiving hypofractionated radiotherapy after conservative surgery were enrolled from April 2009 to December 2014, in an Italian cancer institute. The dose was 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction. The boost to the tumor bed was administered only in grade III breast cancer patients and in patients with close or positive margins. Acute and late toxicity were prospectively assessed during and after radiotherapy according to RTOG scale. The impact of patients clinical characteristics, performed treatments and dose inhomogeneities on the occurrence of an higher level of acute skin toxicity and late fibrosis has been evaluated by univariate and multivariate analysis. The mean age was 74 (range 46-91 yrs). 27% of patients received boost. 22% of cases (n = 119) received also chemotherapy. The median follow-up was 32 months. G1 and G2/G3 acute skin toxicity were 61.3% and 20.5% and G1 and G2/G3 late fibrosis 12.6% and 4.3% respectively. Chemotherapy (p = 0.04), diabetes (p = 0.04) and boost administration (p breast volume (p = 0.05), dose inhomogeneities (p skin reaction at the univariate analysis, but only the boost administration (p = 0.02), at multivariate analysis. The results of our study, according to the large randomized trials, confirmed that hypofractionated whole breast irradiation is safe, and only the boost administration seems to be an important predictor for toxicity. Chemotherapy does not impact on acute and late skin toxicity. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Salvage Treatment With Hypofractionated Radiotherapy in Patients With Recurrent Small Hepatocellular Carcinoma

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    Bae, Sun Hyun [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Park, Hee Chul, E-mail: rophc@skku.edu [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lim, Do Hoon; Lee, Jung Ae [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Gwak, Geum Yeon; Choi, Moon Seok; Lee, Joon Hyoek; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul [Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Purpose: To investigate the rates of tumor response and local control in patients with recurrent small hepatocellular carcinoma (HCC) treated with hypofractionated radiotherapy (RT) as a salvage treatment and to evaluate treatment-related toxicities. Methods and Materials: Between 2006 and 2009, a total of 20 patients with recurrent small HCC were treated with hypofractionated RT after the failure of previous treatment. The eligibility criteria for hypofractionated RT were as follows: 1) HCC less than 5 cm, 2) HCC not adjacent to critical organs, 3) HCC without portal vein tumor thrombosis, and 4) less than 15% of normal liver volume that would be irradiated with 50% of prescribed dose. The RT dose was 50 Gy in 10 fractions. The tumor response was determined by CT scans performed 3 months after the end of RT. Results: The median follow-up period after RT was 22 months. The overall survival rates at 1 and 2 years were 100% and 87.9%, respectively. Complete response (CR) was achieved in seven of 20 lesions (35%) evaluated by CT scans performed 3 months after the end of RT. In-field local control was achieved in 85% of patients. Fourteen patients (70%) developed intra-hepatic metastases. Six patients developed grade 1 nausea or anorexia during RT, and two patients had progression of ascites after RT. There was no grade 3 or greater treatment-related toxicities. Conclusions: The current study showed a favorable outcome with respect to hypofractionated RT for small HCC. Partial liver irradiation with 50 Gy in 10 fractions is considered tolerable without severe complications.

  20. Changes in breast radiotherapy: prone positioning and hypofractionation.

    Science.gov (United States)

    Fenton-Kerimian, Maria; Maisonet, Olivier; Formenti, Silvia C

    2013-10-01

    Breast cancer management has drastically changed since the 1990s. Many patients with breast cancer now can opt to conserve their breast through a lumpectomy and radiation (breast conservation therapy), rather than a full mastectomy. Advances in the techniques of delivery and length of breast radiotherapy have been rapidly evolving. This article attempts to summarize some of those changes for nurses caring for patients with breast cancer during radiation therapy.

  1. Outcomes in Newly Diagnosed Elderly Glioblastoma Patients after Concomitant Temozolomide Administration and Hypofractionated Radiotherapy

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    Nguyen, Ludovic T. [Neurology Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Touch, Socheat [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Nehme-Schuster, Hélène [Oncology Geriatric Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Antoni, Delphine [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Eav, Sokha [Radiation Oncology Department, Soviet-Khmer Friendship Hospital, Pnom-Pehn 12400 (Cambodia); Clavier, Jean-Baptiste; Bauer, Nicolas; Vigneron, Céline [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Schott, Roland [Oncology Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Kehrli, Pierre [Neurosurgery Department, CHU Hautepierre, rue Molière, Strasbourg 67000 (France); Noël, Georges, E-mail: gnoel@strasbourg.unicancer.fr [Radiation Oncology University Department, Paul Strauss Center, 3, rue de la Porte de l’Hôpital, BP 42, Strasbourg cedex 67065 (France); Laboratoire EA 3430, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg 67000 (France)

    2013-09-24

    This study aimed to analyze the treatment and outcomes of older glioblastoma patients. Forty-four patients older than 70 years of age were referred to the Paul Strauss Center for chemotherapy and radiotherapy. The median age was 75.5 years old (range: 70–84), and the patients included 18 females and 26 males. The median Karnofsky index (KI) was 70%. The Charlson indices varied from 4 to 6. All of the patients underwent surgery. O{sub 6}-methylguanine–DNA methyltransferase (MGMT) methylation status was determined in 25 patients. All of the patients received radiation therapy. Thirty-eight patients adhered to a hypofractionated radiation therapy schedule and six patients to a normofractionated schedule. Neoadjuvant, concomitant and adjuvant chemotherapy regimens were administered to 12, 35 and 20 patients, respectively. At the time of this analysis, 41 patients had died. The median time to relapse was 6.7 months. Twenty-nine patients relapsed, and 10 patients received chemotherapy upon relapse. The median overall survival (OS) was 7.2 months and the one- and two-year OS rates were 32% and 12%, respectively. In a multivariate analysis, only the Karnofsky index was a prognostic factor. Hypofractionated radiotherapy and chemotherapy with temozolomide are feasible and acceptably tolerated in older patients. However, relevant prognostic factors are needed to optimize treatment proposals.

  2. Tumor perfusion increases during hypofractionated short-course radiotherapy in rectal cancer : Sequential perfusion-CT findings

    NARCIS (Netherlands)

    Janssen, Marco H. M.; Aerts, Hugo J. W. L.; Kierkels, Roel G. J.; Backes, Walter H.; Ollers, Michel C.; Buijsen, Jeroen; Lambin, Philippe; Lammering, Guido

    2010-01-01

    Purpose: The purpose of this study was to investigate perfusion of rectal tumors and to determine early responses to short-course hypofractionated radiotherapy (RT). Material and methods: Twenty-three rectal cancer patients were included, which underwent perfusion-CT imaging before (pre-scan) and af

  3. Hypofractionated ablative radiotherapy for locally advanced pancreatic cancer

    Science.gov (United States)

    Crane, Christopher H.

    2016-01-01

    The role of radiation in locally advanced unresectable pancreatic cancer (LAPC) is controversial. Randomized trials evaluating standard doses of chemoradiation have not shown a significant benefit from the use of consolidative radiation. Results from non-randomized studies of 3–5-fraction stereotactic body radiotherapy (SBRT) have been similar to standard chemoradiation, but with less toxicity and a shorter treatment time. Doses of SBRT have been reduced to subablative levels for the sake of tolerability. The benefit of both options is unclear. In contrast, ablative doses can be delivered using an SBRT technique in 15–28 fractions. The keys to the delivery of ablative doses are computed tomography (CT) image guidance and respiratory gating. Higher doses have resulted in encouraging long-term survival results. In this review, we present a comprehensive solution to achieving ablative doses for selected patients with pancreatic tumors by using a combination of classical, modern and novel concepts of radiotherapy: fractionation, CT image guidance, respiratory gating, intentional dose heterogeneity, and simultaneous integrated protection. PMID:27029741

  4. Equivalent normalized total dose estimates in cyberknife radiotherapy dose delivery in prostate cancer hypofractionation regimens.

    Science.gov (United States)

    Sudahar, H; Kurup, P G G; Murali, V; Mahadev, P; Velmurugan, J

    2012-04-01

    As the α/β value of prostate is very small and lower than the surrounding critical organs, hypofractionated radiotherapy became a vital mode of treatment of prostate cancer. Cyberknife (Accuray Inc., Sunnyvale, CA, USA) treatment for localized prostate cancer is performed in hypofractionated dose regimen alone. Effective dose escalation in the hypofractionated regimen can be estimated if the corresponding conventional 2 Gy per fraction equivalent normalized total dose (NTD) distribution is known. The present study aims to analyze the hypofractionated dose distribution of localized prostate cancer in terms of equivalent NTD. Randomly selected 12 localized prostate cases treated in cyberknife with a dose regimen of 36.25 Gy in 5 fractions were considered. The 2 Gy per fraction equivalent NTDs were calculated using the formula derived from the linear quadratic (LQ) model. Dose distributions were analyzed with the corresponding NTDs. The conformity index for the prescribed target dose of 36.25 Gy equivalent to the NTD dose of 90.63 Gy (α/β = 1.5) or 74.31 Gy (α/β = 3) was ranging between 1.15 and 1.73 with a mean value of 1.32 ± 0.15. The D5% of the target was 111.41 ± 8.66 Gy for α/β = 1.5 and 90.15 ± 6.57 Gy for α/β = 3. Similarly, the D95% was 91.98 ± 3.77 Gy for α/β = 1.5 and 75.35 ± 2.88 Gy for α/β = 3. The mean values of bladder and rectal volume receiving the prescribed dose of 36.25 Gy were 0.83 cm3 and 0.086 cm3, respectively. NTD dose analysis shows an escalated dose distribution within the target for low α/β (1.5 Gy) with reasonable sparing of organs at risk. However, the higher α/β of prostate (3 Gy) is not encouraging the fact of dose escalation in cyberknife hypofractionated dose regimen of localized prostate cancer.

  5. Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing.

    Science.gov (United States)

    Vrána, David; Študentová, Hana; Matzenauer, Marcel; Vlachová, Zuzana; Cwiertka, Karel; Gremlica, David; Kalita, Ondřej

    2016-06-01

    Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm3, with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience.

  6. Hadron accelerators for radiotherapy

    Science.gov (United States)

    Owen, Hywel; MacKay, Ranald; Peach, Ken; Smith, Susan

    2014-04-01

    Over the last twenty years the treatment of cancer with protons and light nuclei such as carbon ions has moved from being the preserve of research laboratories into widespread clinical use. A number of choices now exist for the creation and delivery of these particles, key amongst these being the adoption of pencil beam scanning using a rotating gantry; attention is now being given to what technologies will enable cheaper and more effective treatment in the future. In this article the physics and engineering used in these hadron therapy facilities is presented, and the research areas likely to lead to substantive improvements. The wider use of superconducting magnets is an emerging trend, whilst further ahead novel high-gradient acceleration techniques may enable much smaller treatment systems. Imaging techniques to improve the accuracy of treatment plans must also be developed hand-in-hand with future sources of particles, a notable example of which is proton computed tomography.

  7. [Exclusive radiotherapy and concurrent endocrine therapy for the management of elderly breast cancer patients: case study and review of hypofractionated schemes].

    Science.gov (United States)

    Auberdiac, P; Chargari, C; Cartier, L; Mélis, A; Malkoun, N; Chauleur, C; Jacquin, J-P; de Laroche, G; Magné, N

    2011-12-01

    Normofractionated radiotherapy is standard for adjuvant management of patients treated with breast conservative surgery for breast cancer. However, many elderly patients are not eligible to such strategy, either because of concurrent diseases, or because the tumor is inoperable. Several protocols of exclusive radiotherapy have been reported in the literature, frequently using hypofractionated radiotherapy and endocrine therapy. We report a case of a patient treated with exclusive endocrine and radiotherapy and address the state of the art on hypofractionated schemes for the management of elderly breast cancer patients. While hypofractionated radiotherapy does not compromise the oncologic or cosmetic outcome, there is no prospective data that assesses the place of radiotherapy for the exclusive treatment of elderly patients. This strategy should be further assessed in clinical randomized trial.

  8. Hypofractionated stereotactic radiotherapy for brain metastases. Results from three different dose concepts

    Energy Technology Data Exchange (ETDEWEB)

    Fahrig, A.; Grabenbauer, G.; Sauer, R. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center of the Univ. of Erlangen (Germany); Ganslandt, O. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center of the Univ. of Erlangen (Germany); Dept. of Neurosurgery of the Univ. of Erlangen (Germany); Lambrecht, U. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center of the Univ. of Erlangen (Germany); Div. of Medical Physics of the Dept. of Radiation Therapy of the Univ. of Erlangen (Germany); Kleinert, G.; Hamm, K. [Dept. for Stereotactic Neurosurgery and Radiosurgery, Helios Klinikum Erfurt (Germany)

    2007-11-15

    Purpose: To evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (hfSRT) with three different dose concepts for irresectable brain metastases not amenable to radiosurgery (SRS) using non-invasive fixation of the skull. Patients and Methods: From 6/2000 to 6/2005, 150 patients with 228 brain metastases were treated at the dedicated stereotactic radiosurgery system Novalis trademark (BrainLAB, Feldkirchen, Germany) in two German treatment centers. Three different dose concepts were applied: 5 x 6-7 Gy (A: 72 brain metastases), 10 x 4 Gy (B: 59 brain metastases) and 7 x 5 Gy (C: 97 brain metastases). Median planning target volume (PTV) was 6.1 cm{sup 3} (range, 0.02-95.97). Results: Rates of complete remission (CR), partial remission (PR), no change (NC) and progressive disease (PD) were 42%, 30%, 21% and 7%, respectively (median follow-up 28 months). Median survival was 16 months. Survival at 6 and 12 months was 83% and 66%, respectively. Side effects were dependent on the PTV and on dose concept (median PTV in case of increasing edema or necrosis: 17 cm{sup 3}, A: 22%, C: 7%). HfSRT with 10 x 4 Gy (B) was well tolerated without side effects. Conclusion: Hypofractionated stereotactic radiotherapy is an effective and safe treatment. In case of brain metastases > 15 cm{sup 3} (diameter > 3 cm) and concerning toxicity, 10 x 4 Gy seem to be more advantageous than shorter fractionation with higher doses while 5 x 6-7 Gy and 7 x 5 Gy were followed by higher response rates. Further specification of tolerance doses and tolerance according to the different brain regions has to be done. (orig.)

  9. Accelerated hypofractionated radiation therapy compared to conventionally fractionated radiation therapy for the treatment of inoperable non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Amini Arya

    2012-03-01

    Full Text Available Abstract Background While conventionally fractionated radiation therapy alone is an acceptable option for poor prognostic patients with unresectable stage III NSCLC, we hypothesized that accelerated hypofractionated radiotherapy will have similar efficacy without increasing toxicity. Methods This is a retrospective analysis of 300 patients diagnosed with stage III NSCLC treated between 1993 and 2009. Patients included in the study were medically or surgically inoperable, were free of metastatic disease at initial workup and did not receive concurrent chemotherapy. Patients were categorized into three groups. Group 1 received 45 Gy in 15 fractions over 3 weeks (Accelerated Radiotherapy (ACRT while group 2 received 60-63 Gy (Standard Radiation Therapy 1 (STRT1 and group 3 received > 63 Gy (Standard Radiation Therapy (STRT2. Results There were 119 (39.7% patients in the ACRT group, 90 (30.0% in STRT1 and 91 (30.3% in STRT2. More patients in the ACRT group had KPS ≤ 60 (p 5% (p = 0.002, and had stage 3B disease (p Conclusions Despite the limitations of a retrospective analysis, our experience of accelerated hypofractionated radiation therapy with 45 Gy in 15 fractions appears to be an acceptable treatment option for poor performance status patients with stage III inoperable tumors. Such a treatment regimen (or higher doses in 15 fractions should be prospectively evaluated using modern radiation technologies with the addition of sequential high dose chemotherapy in stage III NSCLC.

  10. Hypofractionated radiotherapy for primary or secondary oligometastatic lung cancer using Tomotherapy

    Directory of Open Access Journals (Sweden)

    Chang Heng-Jui

    2012-12-01

    Full Text Available Abstract Background To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy. Methods Between April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy, and the median total dose was 49.5 Gy (range, 45–72 Gy. The median estimated biological effective dose at 10 Gy (BED10 was 71.8 Gy (range, 65.3–119.0 Gy, and that at 3 Gy (BED3 was 123.8 Gy (range, 112.5–233.3 Gy. The mean lung dose (MLD was constrained mainly under 1200 cGy. The median gross tumor volume (GTV was 27.9 cm3 (range: 2.5–178.1 cm3. Results The median follow-up period was 25.8 months (range, 3.0–60.7 months. The median overall survival (OS time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD was 11.2 months versus >50 months (not reached in the patients without EPD (p 3 had a better survival than those with larger GTV (>27.9 cm3: >40 months versus 12.85 months (p = 0.047. The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065. The 2-year local control (LC rate was 94.7%. Only 2 patients (6.1% developed ≧grade 3 radiation pneumonitis. Conclusion Using Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with

  11. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial

    NARCIS (Netherlands)

    Aluwini, S.; Pos, F.; Schimmel, E.; Lin, E.N.J.T. van; Krol, S.; Toorn, P.P. van der; Jager, H.; Dirkx, M.; Alemayehu, W.G.; Heijmen, B.; Incrocci, L.

    2015-01-01

    BACKGROUND: In 2007, we began the randomised phase 3 multicentre HYPRO trial to investigate the effect of hypofractionated radiotherapy compared with conventionally fractionated radiotherapy on relapse-free survival in patients with prostate cancer. Here, we examine whether patients experience diffe

  12. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): Acute toxicity results from a randomised non-inferiority phase 3 trial

    NARCIS (Netherlands)

    S. Aluwini (Shafak); F.J. Pos (Floris); E. Schimmel (Erik); E. van Lin (Emile); S. Krol (Stijn); P.-P. van der Toorn (Peter-Paul); H. de Jager (Hanja); M.L.P. Dirkx (Maarten); W.G. Alemayehu (Wendimagegn Ghidey); B.J.M. Heijmen (Ben); L. Incrocci (Luca)

    2015-01-01

    textabstractBackground: In 2007, we began the randomised phase 3 multicentre HYPRO trial to investigate the effect of hypofractionated radiotherapy compared with conventionally fractionated radiotherapy on relapse-free survival in patients with prostate cancer. Here, we examine whether patients expe

  13. Adjuvant chemotherapy and acute toxicity in hypofractionated radiotherapy for early breast cancer

    Science.gov (United States)

    Kouloulias, Vassilis; Zygogianni, Anna; Kypraiou, Efrosini; Georgakopoulos, John; Thrapsanioti, Zoi; Beli, Ivelina; Mosa, Eftychia; Psyrri, Amanta; Antypas, Christos; Armbilia, Christina; Tolia, Maria; Platoni, Kalliopi; Papadimitriou, Christos; Arkadopoulos, Nikolaos; Gennatas, Costas; Zografos, George; Kyrgias, George; Dilvoi, Maria; Patatoucas, George; Kelekis, Nikolaos; Kouvaris, John

    2014-01-01

    AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy (HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0Mx. The patients received 3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity. RESULTS: The acute radiation induced skin toxicity was as following: grade I 27.6%, grade II 7.8% and grade III 2.6%. No significant correlation was noted between toxicity grading and chemotherapy (P = 0.154, χ2 test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively (P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions (P = 0.47, χ2 test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse. CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions. PMID:25405195

  14. Fractionation effects in particle radiotherapy: implications for hypo-fractionation regimes

    Energy Technology Data Exchange (ETDEWEB)

    Carabe-Fernandez, A; Paganetti, H [Department of Radiation Oncology, Harvard Medical School, Francis H Burr Proton Therapy Center, Massachusetts General Hospital, Boston, MA 02114 (United States); Dale, R G [Department of Radiation Physics and Radiobiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF (United Kingdom); Hopewell, J W; Jones, B, E-mail: acarabe@partners.or [Particle Therapy Cancer Research Institute, University of Oxford, Oxford OX1 3RH (United Kingdom)

    2010-10-07

    The aim is to demonstrate the potential impact of changes in the value of the {beta} parameter in the linear quadratic (LQ) model on the calculation of clinical relative biological effectiveness (RBE) values used for high linear energy transfer (LET) radiotherapy. The parameter RBE{sub min} is introduced into the LQ formulation to account for possible changes in the {beta} radiosensitivity coefficient with changing LET. The model is used to fit fractionated data under two conditions, where RBE{sub min} = 1 and RBE{sub min} {ne} 1. Nonlinear regression and analysis of variance are used to test the hypothesis that the inclusion of a non-unity value of RBE{sub min} better predicts the total iso-effective dose required at low number of fractions for fast neutrons, carbon ions, {pi}-meson and proton fractionation data obtained for various tissues from previous publications. For neutrons the assumption of RBE{sub min} {ne} 1 provided a better fit in 89% of the cases, whereas for carbon ions RBE{sub min} {ne} 1 provided a better fit only for normal tissue at the spread-out Bragg peak. The results provide evidence of the impact that variations in the {beta} parameter may have when calculating clinically relevant RBE values, especially when using high doses per fraction (i.e. hypofractionation) of high-LET radiations.

  15. Carbon Ion Radiotherapy in Advanced Hypofractionated Regimens for Prostate Cancer: From 20 to 16 Fractions

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tohru [National Institute of Radiological Sciences, Chiba (Japan); Tsuji, Hiroshi, E-mail: h_tsuji@nirs.go.jp [National Institute of Radiological Sciences, Chiba (Japan); Kamada, Tadashi [National Institute of Radiological Sciences, Chiba (Japan); Akakura, Koichiro; Suzuki, Hiroyoshi; Shimazaki, Jun [Department of Urology, Graduate School of Medicine, Chiba University, Chiba (Japan); Tsujii, Hirohiko [National Institute of Radiological Sciences, Chiba (Japan)

    2012-11-15

    Purpose: To assess the effects of differences in dose fractionation on late radiation toxicity and biochemical control in patients with prostate cancer treated with carbon ion radiotherapy (C-ion RT). Methods and Materials: A total of 740 prostate cancer patients who received C-ion RT between April 2000 and February 2009 were analyzed. Of those, 664 patients followed for at least 1 year were analyzed with regard to late radiation toxicity. Biochemical relapse-free (BRF) and overall survival (OS) rates in patient subgroups with each dose-fractionation were analyzed. Results: Only 1 case of grade 3 genitourinary (GU) morbidity was observed in 20 fractions, and none of the patients developed higher grade morbidities. The incidence of late GU toxicity in patients treated with 16 fractions was lower than that of patients treated with 20 fractions. The OS rate and BRF rate of the entire group at 5 years were 95.2% and 89.7%, respectively. The 5-year BRF rate of the patients treated with 16 fractions of C-ion RT (88.5%) was comparable to that of the patients treated with 20 fractions (90.2%). Conclusion: C-ion RT of 57.6 GyE (the physical C-ion dose [Gy] Multiplication-Sign RBE) in 16 fractions could offer an even lower incidence of genitourinary toxicity and comparable BRF rate than that in 20 fractions. Advancement in hypofractionation could be safely achieved with C-ion RT for prostate cancer.

  16. Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

    Science.gov (United States)

    Johansson, Silvia; Åström, Lennart; Sandin, Fredrik; Isacsson, Ulf; Montelius, Anders; Turesson, Ingela

    2012-01-01

    Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT) of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT). The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU) and gastrointestinal (GI) toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity. PMID:22848840

  17. Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Silvia Johansson

    2012-01-01

    Full Text Available Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT. The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU and gastrointestinal (GI toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity.

  18. The Impact of Hypofractionated Whole Breast Radiotherapy on Local Relapse in Patients With Grade 3 Early Breast Cancer: A Population-Based Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Herbert, Christopher, E-mail: cherbert@bccancer.bc.ca [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Nichol, Alan [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Olivotto, Ivo [Department of Radiation Oncology, BC Cancer Agency, Victoria, British Columbia (Canada); Weir, Lorna [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Woods, Ryan; Speers, Caroline [Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver, British Columbia (Canada); Truong, Pauline [Department of Radiation Oncology, BC Cancer Agency, Victoria, British Columbia (Canada); Tyldesley, Scott [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada)

    2012-04-01

    Purpose: To determine whether patients with Grade 3 early breast cancer have an inferior rate of local disease control at 10 years with hypofractionated radiotherapy compared with more conventionally fractionated schedules. Methods and Materials: Local relapse rates were compared between patients receiving hypofractionated radiotherapy or conventionally fractionated radiotherapy to the whole breast in a population-based cohort of women with early-stage (T1-T2, N0, M0) Grade 3 breast cancers diagnosed between 1990 and 2000 and referred to the British Columbia Cancer Agency. Cumulative rates of local relapse were estimated using a competing risk method, and factors significant on univariate analysis were included with fractionation group in a multivariate model. The primary end point was local control at 10 years. Results: A total of 1,335 patients with Grade 3 tumors were treated with adjuvant radiotherapy, 252 with conventional fractionation, and 1,083 with a hypofractionated schedule. The 10-year cumulative incidence of local relapse was 6.9% in the hypofractionated group and 6.2% in the conventionally fractionated group (p = 0.99). Conclusions: There is no evidence that hypofractionation is inferior to conventional fractionation for breast conserving therapy in patients with Grade 3 breast cancer in this large population-based series after 10 years of follow-up.

  19. Adjuvant therapy after resection of brain metastases. Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Broemme, J.; Aebersold, D.M.; Pica, A. [Bern Univ., Bern Univ. Hospital (Switzerland). Dept. of Radiation Oncology; Abu-Isa, J.; Beck, J.; Raabe, A. [Bern Univ., Bern Univ. Hospital (Switzerland). Neurosurgery; Kottke, R.; Wiest, R. [Bern Univ., Bern Univ. Hospital (Switzerland). Neuroradiology; Malthaner, M.; Schmidhalter, D. [Bern Univ., Bern Univ. Hospital (Switzerland). Div. of Medical Radiation Physics

    2013-09-15

    Background: Tumor bed stereotactic radiosurgery (SRS) after resection of brain metastases is a new strategy to delay or avoid whole-brain irradiation (WBRT) and its associated toxicities. This retrospective study analyzes results of frameless image-guided linear accelerator (LINAC)-based SRS and stereotactic hypofractionated radiotherapy (SHRT) as adjuvant treatment without WBRT. Materials and methods: Between March 2009 and February 2012, 44 resection cavities in 42 patients were treated with SRS (23 cavities) or SHRT (21 cavities). All treatments were delivered using a stereotactic LINAC. All cavities were expanded by {>=} 2 mm in all directions to create the clinical target volume (CTV). Results: The median planning target volume (PTV) for SRS was 11.1 cm{sup 3}. The median dose prescribed to the PTV margin for SRS was 17 Gy. Median PTV for SHRT was 22.3 cm{sup 3}. The fractionation schemes applied were: 4 fractions of 6 Gy (5 patients), 6 fractions of 4 Gy (6 patients) and 10 fractions of 4 Gy (10 patients). Median follow-up was 9.6 months. Local control (LC) rates after 6 and 12 months were 91 and 77 %, respectively. No statistically significant differences in LC rates between SRS and SHRT treatments were observed. Distant brain control (DBC) rates at 6 and 12 months were 61 and 33 %, respectively. Overall survival (OS) at 6 and 12 months was 87 and 63.5 %, respectively, with a median OS of 15.9 months. One patient treated by SRS showed symptoms of radionecrosis, which was confirmed histologically. Conclusion: Frameless image-guided LINAC-based adjuvant SRS and SHRT are effective and well tolerated local treatment strategies after resection of brain metastases in patients with oligometastatic disease. (orig.)

  20. Ten-year results of accelerated hypofractionated adjuvant whole-breast radiation with concomitant boost to the lumpectomy cavity after conserving surgery for early breast cancer.

    Science.gov (United States)

    Cante, Domenico; Petrucci, Edoardo; Sciacero, Piera; Piva, Cristina; Ferrario, Silvia; Bagnera, Silvia; Patania, Sebastiano; Mondini, Guido; Pasquino, Massimo; Casanova Borca, Valeria; Vellani, Giorgio; La Porta, Maria Rosa; Franco, Pierfrancesco

    2017-09-01

    Accelerated hypofractionated whole-breast radiotherapy (WBRT) is considered a standard therapeutic option for early breast cancer (EBC) in the postoperative setting after breast conservation (BCS). A boost to the lumpectomy cavity may further increase local control. We herein report on the 10-year results of a series of EBC patients treated after BCS with hypofractionated WBRT with a concomitant photon boost to the surgical bed over 4 weeks. Between 2005 and 2007, 178 EBC patients were treated with a basic course of radiotherapy consisting of 45 Gy to the whole breast in 20 fractions (2.25 Gy daily) with an additional boost dose of 0.25 Gy delivered concomitantly to the lumpectomy cavity, for an additional dose of 5 Gy. Median follow-up period was 117 months. At 10-year, overall, cancer-specific, disease-free survival and local control were 92.2% (95% CI 88.7-93.4%), 99.2% (95% CI 96.7-99.7%), 95.5% (95% CI 91.2-97.2%) and 97.3% (95% CI 94.5-98.9%), respectively. Only eight patients recurred. Four in-breast recurrences, two axillary node relapses and two metastatic localizations were observed. Fourteen patients died during the observation period due to other causes while breast cancer-related deaths were eight. At last follow-up, ≥G2 fibrosis and telangiectasia were seen in 7% and 5% of patients. No major lung and heart toxicities were observed. Cosmetic results were excellent/good in 87.8% of patients and fair/poor in 12.2%. Hypofractionated WBRT with concomitant boost to the lumpectomy cavity after BCS in EBC led to consistent clinical results at 10 years. Hence, it can be considered a valid treatment option in this setting.

  1. Radiogenic Side Effects After Hypofractionated Stereotactic Photon Radiotherapy of Choroidal Melanoma in 212 Patients Treated Between 1997 and 2007

    Energy Technology Data Exchange (ETDEWEB)

    Dunavoelgyi, Roman [Department of Ophthalmology, Medical University of Vienna, Vienna (Austria); Dieckmann, Karin [Department of Radiology, Medical University of Vienna, Vienna (Austria); Gleiss, Andreas [Section of Clinical Biometrics, Medical University of Vienna, Vienna (Austria); Sacu, Stefan; Kircher, Karl; Georgopoulos, Michael [Department of Ophthalmology, Medical University of Vienna, Vienna (Austria); Georg, Dietmar [Department of Radiology, Medical University of Vienna, Vienna (Austria); Zehetmayer, Martin, E-mail: martin.zehetmayer@meduniwien.ac.at [Department of Ophthalmology, Medical University of Vienna, Vienna (Austria); Poetter, Richard [Department of Radiology, Medical University of Vienna, Vienna (Austria)

    2012-05-01

    Purpose: To evaluate side effects of hypofractionated stereotactic photon radiotherapy for patients with choroidal melanoma. Patients and Methods: Two hundred and twelve patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at the Medical University of Vienna between 1997 and 2007 with a Linac with 6-MV photon beams in five fractions with 10, 12, or 14 Gy per fraction. Examinations for radiogenic side effects were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and then once a year thereafter until 10 years after radiotherapy. Adverse side effects were assessed using slit-lamp examination, funduscopy, gonioscopy, tonometry, and, if necessary, fundus photography and fluorescein angiography. Evaluations of incidence of side effects are based on an actuarial analysis. Results: One hundred and eighty-nine (89.2%) and 168 (79.2%) of the tumors were within 3 mm of the macula and the optic disc, respectively. The five most common radiotherapy side effects were retinopathy and optic neuropathy (114 cases and 107 cases, respectively), cataract development (87 cases), neovascular glaucoma (46 cases), and corneal epithelium defects (41 cases). In total, 33.6%, 38.5%, 51.2%, 75.5%, and 77.6% of the patients were free of any radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, or corneal epithelium defects 5 years after radiotherapy, respectively. Conclusion: In centrally located choroidal melanoma hypofractionated stereotactic photon radiotherapy shows a low to moderate rate of adverse long-term side effects comparable with those after proton beam radiotherapy. Future fractionation schemes should seek to further reduce adverse side effects rate while maintaining excellent local tumor control.

  2. Tumor Control Outcomes After Hypofractionated and Single-Dose Stereotactic Image-Guided Intensity-Modulated Radiotherapy for Extracranial Metastases From Renal Cell Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Greco, Carlo [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Motzer, Robert [Solid Tumor Service, Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Magsanoc, Juan Martin; Pei Xin [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lovelock, Michael; Mechalakos, Jim [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zatcky, Joan; Fuks, Zvi; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-04-01

    Purpose: To report tumor local progression-free outcomes after treatment with single-dose, image-guided, intensity-modulated radiotherapy and hypofractionated regimens for extracranial metastases from renal cell primary tumors. Patients and Methods: Between 2004 and 2010, 105 lesions from renal cell carcinoma were treated with either single-dose, image-guided, intensity-modulated radiotherapy to a prescription dose of 18-24 Gy (median, 24) or hypofractionation (three or five fractions) with a prescription dose of 20-30 Gy. The median follow-up was 12 months (range, 1-48). Results: The overall 3-year actuarial local progression-free survival for all lesions was 44%. The 3-year local progression-free survival for those who received a high single-dose (24 Gy; n = 45), a low single-dose (<24 Gy; n = 14), or hypofractionation regimens (n = 46) was 88%, 21%, and 17%, respectively (high single dose vs. low single dose, p = .001; high single dose vs. hypofractionation, p < .001). Multivariate analysis revealed the following variables were significant predictors of improved local progression-free survival: 24 Gy dose compared with a lower dose (p = .009) and a single dose vs. hypofractionation (p = .008). Conclusion: High single-dose, image-guided, intensity-modulated radiotherapy is a noninvasive procedure resulting in high probability of local tumor control for metastatic renal cell cancer generally considered radioresistant according to the classic radiobiologic ranking.

  3. Hypofractionated helical intensity-modulated radiotherapy of the prostate bed after prostatectomy with or without the pelvic lymph nodes - the PRIAMOS trial

    Directory of Open Access Journals (Sweden)

    Krause Sonja

    2012-10-01

    Full Text Available Abstract Background While evidence on safety and efficacy of primary hypofractionated radiotherapy in prostate cancer is accumulating, data on postoperative hypofractionated treatment of the prostate bed and of the pelvic lymph nodes is still scarce. This phase II trial was initiated to investigate safety and feasibility of hypofractionated treatment of the prostate bed alone or with the pelvic lymph nodes. Methods/design A total of 80 prostate cancer patients with the indication for adjuvant radiotherapy will be enrolled, where 40 patients with a low risk of lymph node involvement (arm 1 and another 40 patients with a high risk of lymph node involvement (arm 2 will each receive 54 Gy in 18 fractions to the prostate bed. Arm 2 will be given 45 Gy to the pelvic lymph nodes additionally. Helical Tomotherapy and daily image guidance will be used. Discussion This trial was initiated to substantiate data on hypofractionated treatment of the prostate bed and generate first data on adjuvant hypofractionated radiotherapy of the pelvic lymph nodes. Trial registration ClinicalTrials.gov; NCT01620710

  4. Hypofractionated conformal radiotherapy (HCRT) for primary and metastatic lung cancers with small dimension. Efficacy and toxicity

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    Mirri, Maria Alessandra; Arcangeli, Giorgio; Pinzi, Valentina [S.C. Radioterapia Oncologica, Regina Elena National Cancer Inst., Rome (Italy); Benassi, Marcello; D' Angelo, Annelisa; Strigari, Lidia [S.C. Lab. di Fisica Medica e Sistemi Esperti, Regina Elena National Cancer Inst., Rome (Italy); Caterino, Mauro [S.C. Radiologia e Diagnostica per Immagini, Regina Elena National Cancer Inst., Rome (Italy); Rinaldi, Massimo [S.C. Oncologia Medica B. Regina Elena National Cancer Inst., Rome (Italy); Ceribelli, Anna [S.C. Oncologia Medica A. Regina Elena National Cancer Inst., Rome (Italy)

    2009-01-15

    Purpose: to report on the clinical outcome of hypofractionated conformal radiotherapy (HCRT) for medically inoperable stage I non-small cell lung carcinoma (NSCLC) or limited pulmonary metastases {<=} 5 cm in diameter. Patients and methods: from June 2003 to March 2007, 40 patients (42 lesions) underwent HCRT consisting of 40 Gy in five fractions over 2.5 weeks received by at least 95% of planning target volume. All patients underwent CT simulation and treatment under free shallow breathing. To evaluate target displacement under respiratory activity, two additional CT scans were performed with breath-holding during the expiratory and inspiratory phases. Of all patients enrolled, those with a follow-up {>=} 4 months were considered suitable for analysis. Local response was evaluated with CT imaging 4 months after the end of HCRT and every 3 months thereafter. Local relapse-free survival (LRFS) and overall survival (OS) were calculated with the Kaplan-Meier method. Results: local response to the treatment was complete response, partial response, no change, and progressive disease as seen in 29%, 43%, 14%, and 7% of tumors, respectively. LRFS at 1 year and 3 years was 76% and 63%, respectively. Lung toxicities {>=} grade 2 were observed in 4/40 patients, but no grade 4. Pericardial effusion occurred in one patient. In stage I NSCLC patients (n = 15) with a median follow-up of 25 months, the 1-year LRFS and OS rates were 88% and 81%, respectively, and the 3-year rates 72% and 61%, respectively. Conclusion: HCRT is an effective and low-toxic treatment for medically inoperable early-stage lung cancers and pulmonary metastases for all clinicians lacking the aid of a dedicated stereotactic system. (orig.)

  5. Hypofractionated stereotactic radiotherapy to the rat hippocampus. Determination of dose response and tolerance

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    Ernst-Stecken, A.; Roedel, F.; Grabenbauer, G.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center; Jeske, I.; Bluemcke, I. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Neuropathology; Hess, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Experimental and Clinical Pharmacology and Toxicology; Ganslandt, O. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Neurosurgery; Brune, K. [Erlangen-Nuernberg Univ., Erlangen (Germany). Doerenkamp Professor for Innovations in Animal and Consumer Protection

    2007-08-15

    Purpose: To determine the effect of hypofractionated stereotactic radiotherapy (hfSRT) on adult rat brain tissue (necrosis, impact on blood-brain barrier, signal changes on high-field magnetic resonance imaging [MRI]). Material and Methods: Adult male Wistar rats underwent MRI and CT scanning of the brain and respective images were introduced into the Novalis trademark radiosurgery device (BrainLab, Feldkirchen, Germany). All animals (body weight 350 g) were irradiated weekly with doses of 2 x 10 Gy (n = 3 animals), 3 x 10 Gy (n = 3 animals) and 4 x 10 Gy (n = 3 animals), targeted to the left hippocampus after image-guided positioning. 4.7-T T2-weighted MRI scanning was performed in each animal. Animals were sacrificed 8, 12, and 16 weeks after hfSRT and brains were immersion-fixed in 4% paraformaldehyde for subsequent histopathologic analysis. Results: In concordance with isodose distributions, pathologic signal hyperintensities in MRI were recorded from 4 x 10 Gy after 8 weeks, 3 x 10 Gy after 12 weeks, while 2 x 10 Gy induced slight detectable alterations only after 16 weeks. Subsequent histopathologic analysis revealed hippocampal cell necrosis with significantly earlier and stronger occurrence for higher doses (40 Gy > 30 Gy > 20 Gy). Pial microvessel permeability also increased after 40 Gy, whereas 30 Gy induced moderate changes. Conclusion: Conclusion: Partial-brain irradiation with hfSRT (Novalis trademark System) was successfully adopted for small animals and histopathologic analysis confirmed its repositioning accuracy. The neuropathologic effects correlated with dose and observation time. The approach will be further developed for quality assurance in hfSRT of normal brain tissue, as well as novel treatment modalities in epileptic rats and orthotopic tumor models. (orig.)

  6. Hypofractionated Dose Escalated 3D Conformal Radiotherapy for Prostate Cancer: Outcomes from a Mono-Institutional Phase II Study.

    Science.gov (United States)

    Tramacere, Francesco; Arcangeli, Stefano; Pignatelli, Antonietta; Castagna, Roberta; Portaluri, Maurizio

    2015-05-01

    Based on a radiobiological assumption of a low alpha/beta (α/β) ratio for prostate cancer, hypofractionated radiotherapy has increasingly gained traction in the clinical practice and recent guidelines have confirmed the non-inferiority of this approach. Nevertheless, the largest studies that have used hypofractionation so far, employed image-guided radiation therapy/intensity modulated radiation therapy (IGRT/IMRT) facilities that might have overcome the radiobiological advantages, which remain to be fully confirmed. The aim of this trial was to evaluate the feasibility of a hypofractionated schedule delivered with 3D-Conformal Radiotherapy to prostate and seminal vesicles in combination with hormonal therapy. The study included 97 consecutive patients with localized prostate cancer (PCa), irrespective of risk class, treated with a schedule of 62 Gy in 20 fractions over 5 weeks (4 fractions of 3.1 Gy each per week). According to National Comprehensive Cancer Network (NCCN) prognostic classification, patients were divided into a favourable group (19%), intermediate group (41%) and unfavourable group (40%). Early and late toxicities were scored using the radiation toxicity grading/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) criteria. Additionally, the international prostate symptom index (IPSS) for benign prostate hypertrophy was used to evaluate obstructive urinary symptoms. Biochemical outcome was reported according to the Phoenix definition for biochemical failure. Hormonal therapy (HT) was administrated in 92% of patients. After a median follow-up of 39 months (range=25-52), maximum ≥G2 late genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 8% and 11% patients, respectively. The corresponding figures for acute toxicities were 24% and 15%. Patients with higher IPSS score before enrolment had significantly worse urinary function after treatment. Only 2% of patients died from PCa. Biochemical non-evidence of disease

  7. Individualized Dose Prescription for Hypofractionation in Advanced Non-Small-Cell Lung Cancer Radiotherapy: An in silico Trial

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    Hoffmann, Aswin L.; Troost, Esther G.C.; Huizenga, Henk; Kaanders, Johannes H.A.M. [Radboud University Nijmegen Medical Centre, Department of Radiation Oncology, Nijmegen (Netherlands); Bussink, Johan, E-mail: j.bussink@rther.umcn.nl [Radboud University Nijmegen Medical Centre, Department of Radiation Oncology, Nijmegen (Netherlands)

    2012-08-01

    Purpose: Local tumor control and outcome remain poor in patients with advanced non-small-cell lung cancer (NSCLC) treated by external beam radiotherapy. We investigated the therapeutic gain of individualized dose prescription with dose escalation based on normal tissue dose constraints for various hypofractionation schemes delivered with intensity-modulated radiation therapy. Methods and Materials: For 38 Stage III NSCLC patients, the dose level of an existing curative treatment plan with standard fractionation (66 Gy) was rescaled based on dose constraints for the lung, spinal cord, esophagus, brachial plexus, and heart. The effect on tumor total dose (TTD) and biologic tumor effective dose in 2-Gy fractions (TED) corrected for overall treatment time (OTT) was compared for isotoxic and maximally tolerable schemes given in 15, 20, and 33 fractions. Rescaling was accomplished by altering the dose per fraction and/or the number of fractions while keeping the relative dose distribution of the original treatment plan. Results: For 30 of the 38 patients, dose escalation by individualized hypofractionation yielded therapeutic gain. For the maximally tolerable dose scheme in 33 fractions (MTD{sub 33}), individualized dose escalation resulted in a 2.5-21% gain in TTD. In the isotoxic schemes, the number of fractions could be reduced with a marginal increase in TED. For the maximally tolerable dose schemes, the TED could be escalated up to 36.6%, and for all patients beyond the level of the isotoxic and the MTD{sub 33} schemes (range, 3.3-36.6%). Reduction of the OTT contributed to the therapeutic gain of the shortened schemes. For the maximally tolerable schemes, the maximum esophageal dose was the dominant dose-limiting constraint in most patients. Conclusions: This modeling study showed that individualized dose prescription for hypofractionation in NSCLC radiotherapy, based on scaling of existing treatment plans up to normal tissue dose constraints, enables dose

  8. Predictive parameters in hypofractionated whole-breast 3D conformal radiotherapy according to the Ontario Canadian trial

    Science.gov (United States)

    Lazzari, Grazia; Terlizzi, Angela; Della Vittoria Scarpati, Giuseppina; Perri, Francesco; De Chiara, Vincenzo; Turi, Barbara; Silvano, Giovanni

    2017-01-01

    Aim To evaluate the possible role of dosimetric parameters according Normal Tissue Complication Probability (NTCP) model as predictive of late toxicity and cosmesis in hypofractionated whole-breast three-dimensional conformal radiotherapy. Patients and methods A retrospective analysis on 215 consecutive early breast cancer patients treated with breast conserving surgery and adjuvant hypofractionated whole-breast radiotherapy (according the Ontario Canadian trial), with a 6 years median follow-up was conducted. To assess the impact of 10%–20% dose hotspots on different percent values of planning target volume (PTV) of the breast, we retrospectively employed the NTCP model of Lyman. PTV breast (PTVbr), V110 were identified. For statistical analysis the χ2 and paired t-test were used to find a correlation between late skin and subcutaneous toxicity and cosmetic outcome with dosimetrical parameters Multivariate analysis was performed with the aim to assess independently the impact of dosimetric and clinical parameters on late toxicity and cosmesis using Pearson’s covariance. Results Late skin toxicity was recorded in 47/215 (22%); and G3 toxicity occurred in 11 patients (5%). Cosmesis with excellent–good score was found in 172 patients (80%) while fair–poor score was found in 43 patients (20%). In univariate χ2 analysis the V110 >10% of the PTV breast significantly correlated with higher toxicity (P10% and PTV breast volume over 1,300 cc was significant at multivariate analysis (Phypofractionated radiotherapy schedules, we found some predictive paramaters on the basis of NTCP model by Lyman. These parameters may be useful in selection of elegible patients. PMID:28392704

  9. Hypofractionated stereotactic radiotherapy for low grade glioma at McGill University: long-term follow-up.

    Science.gov (United States)

    Roberge, D; Souhami, L; Olivier, A; Leblanc, R; Podgorsak, E

    2006-02-01

    Small, well-defined, unresectable low-grade gliomas are attractive targets for stereotactic irradiation. Fractionated stereotactic irradiation of these targets has the theoretical benefit of increased normal tissue sparing beyond that provided by the physical characteristics of stereotactic radiosurgery. From July 1987 to November 1992, 21 patients were treated for low-grade glioma at our institution using a hypofractionated regimen of stereotactic radiotherapy. All patients had well-circumscribed, < 40 mm tumors. No patient had had prior radiotherapy. All lesions were histologically proven WHO grade I or II glial tumors. Lesions involved sensitive brain structures and were deemed unresectable. A typical dose of 42 Gy was delivered in 6 fractions over a two-week period using rigid immobilization and a linac-based dynamic stereotactic radiosurgical technique. Patients had a median age of 23 years (9-74) and were predominantly female (60%). Median tumor diameter was 20 mm. With a median follow-up for living patients of 13.3 years, the actuarial 5, 10, and 15-year overall survival rates are 76%, 71%, and 63%, respectively. Treatment was acutely well tolerated although three patients experienced late post-therapy complications. Our results and those of 241 patients treated in nine other institutional series are reviewed. Despite some examples of favorable short-term outcomes, all reported series are highly selected and thus likely biased. The data regarding the use of SRS is limited and, in our opinion, insufficient to claim a clear therapeutic advantage to SRS in the initial management of low-grade glioma. Our own results with hypofractionated stereotactic radiotherapy are similar to those expected with standard therapy.

  10. Dose-Escalated Hypofractionated Intensity-Modulated Radiotherapy in High-Risk Carcinoma of the Prostate: Outcome and Late Toxicity

    Directory of Open Access Journals (Sweden)

    David Thomson

    2012-01-01

    Results. Median followup was 84 months. Five-year overall survival (OS was 83% and biochemical progression-free survival (bPFS was 50% for 57 Gy. Five-year OS was 75% and bPFS 58% for 60 Gy. At 7 years, toxicity by RTOG criteria was acceptable with no grade 3 or above toxicity. Compared with baseline, there was no significant change in urinary symptoms at 2 or 7 years. Bowel symptoms were stable between 2 and 7 years. All patients continued to have significant sexual dysfunction. Conclusion. In high-risk prostate cancer, dose-escalated hypofractionated radiotherapy using IMRT results in encouraging outcomes and acceptable late toxicity.

  11. Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy.

    Science.gov (United States)

    Rudat, Volker; Nour, Alaa; Ghaida, Salam Abou; Alaradi, Aziz

    2016-07-30

    The purpose of the study was to evaluate the impact of multiple prognostic factors on the acute skin reaction in adjuvant breast cancer radiotherapy, in particular the impact of hypofractionation (HF) compared to conventional fractionation (CF) and tangential beam (TB) IMRT compared to three-dimensional conformal radiotherapy (3DCRT). Two-hundred and sixty-six breast cancer patients with postoperative radiotherapy after breast conserving surgery or mastectomy were retrospectively evaluated. Patients were treated with HF (15 fractions of 2.67 Gy; n = 121) or CF (28 fractions of 1.8 Gy or 25 fractions of 2.0 Gy; n = 145) and TB-IMRT (n = 151) or 3DCRT (n = 115). The acute skin reactions were prospectively assessed using the CTCAE v4 grading scale. Ordinal regression analysis was used to assess the impact of possible prognostic factors on the maximal acute skin reaction. Grade 2 skin reactions were observed in 19 % of the patients treated with CF compared to 2 % treated with HF. On univariate analysis, the fractionation regimen, the PTV (breast versus chest wall), the volume of the PTV and the body mass index were significant prognostic factors for the maximum acute skin reaction. On multivariate analysis, the fractionation regimen (p skin reaction compared to CF.

  12. Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas

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    Maranzano, Ernesto; Draghini, Lorena; Casale, Michelina; Arcidiacono, Fabio; Anselmo, Paola; Trippa, Fabio; Giorgi, Cesare [Hospital, Radiotherapy Oncology Centre, Terni (Italy)

    2015-12-15

    The aim of this work was to evaluate long-term results of moderate hypofractionated stereotactic radiotherapy (hFSRT) for intracranial meningiomas. In all, 77 consecutive patients with 80 lesions were included. Median age was 65 years (range 23-82 years), male/female ratio was 21/56, and the median Karnofsky performance status was 90 (range 60-100). In 31 lesions (39 %), diagnosis was based upon clinical and radiological data; 37 lesions were histologically proven as World Health Organization (WHO) grade I and 12 grade II meningiomas. Median treatment volume was 23 cc. Prescribed doses were 45 Gy in 15 fractions of 3 Gy (15 x 3 Gy) or 42 Gy in 14 fractions of 3 Gy (14 x 3 Gy). After a median follow-up of 56 months, 49 (61 %) lesions received 14 x 3 Gy and 31 (39 %) 15 x 3 Gy. Local control (LC) rate remained unchanged at 84 % at 5 and 10 years. Overall survival and disease-specific survival (DSS) were 76 and 93 % at 5 years, 72 and 89 % at 10 years, respectively. With univariate analysis, previous surgery and WHO grade II tumor were negative prognostic factors for LC and DSS. With multivariate analysis only tumor grade was an independent prognostic factor for LC. No clinically significant acute and/or late toxicities were observed. Moderate hFSRT was effective and safe with an excellent tolerance profile. It can be an alternative treatment option for patients with recurrent or inoperable large meningiomas. The low number of fractions administered with hFSRT led to reduce treatment-related discomfort for patients. Grade II tumor and previous surgery were negative prognosis factors. (orig.) [German] Untersucht wurden die Langzeitergebnisse von moderater hypofraktionierter stereotaktischer Strahlentherapie (hFSRT) bei intrakraniellen Meningeomen. Es wurden 77 konsekutive Patienten mit 80 Laesionen ausgewaehlt. Das durchschnittliche Alter betrug 65 Jahre (Spanne 23-82 Jahre), das Verhaeltnis Maenner/Frauen lag bei 21/56, der mediane Karnofsky-Index betrug 90 (Spanne 60

  13. Treatment outcome of localized prostate cancer by 70 Gy hypofractionated intensity-modulated radiotherapy with a customized rectal balloon

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    Kim, Hyun Jung; Kim, Jun Won; Hong, Sung Joon; Rha, Koon Ho; Lee, Chang Geol; Yang, Seung Choul; Choi, Young Deuk; Suh, Chang Ok; Cho, Jae Ho [Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-09-15

    We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity > or =grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

  14. Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy. Results of a single, institutional, retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Rudat, Volker; Nour, Alaa; Hammoud, Mohamed; Abou Ghaida, Salam [Saad Specialist Hospital, Department of Radiation Oncology, Al Khobar (Saudi Arabia)

    2017-05-15

    The aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy. Patients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction. In all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3-4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF. HF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF. (orig.) [German] Ziel der Untersuchung war es, Faktoren zu identifizieren, die mit ungeplanten Behandlungsunterbrechungen bei der adjuvanten Strahlentherapie des Mammakarzinoms assoziiert sind. Es wurden Patienten untersucht, die eine adjuvante Strahlentherapie der Mamma oder Brustwand zwischen Maerz 2014 und August 2016 erhielten. Zur Anwendung kamen als Fraktionierungsprotokoll und strahlentherapeutische Technik eine konventionell fraktionierte (CF; 28 Fraktionen mit

  15. Sci—Thur AM: YIS - 02: Radiogenomic Modeling of Normal Tissue Toxicities in Prostate Cancer Patients Receiving Hypofractionated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Coates, J [Department of Oncology, Medical Physics Unit, McGill University Health Center, Montreal, QC (Canada); Jeyaseelan, K; Ybarra, N; David, M; Faria, S; Souhami, L; Cury, F; Duclos, M; El Naqa, I [Department of Oncology, Medical Physics Unit, McGill University Health Center, Montreal, QC (Canada); Department of Oncology, Radiation Oncology Division, McGill University Health Centre, Montreal, QC Canada (Canada)

    2014-08-15

    Inter-patient radiation sensitivity variability has recently been shown to have a genetic component. This genetic component may play a key role in explaining the fluctuating rates of radiation-induced toxicities (RITs). Single nucleotide polymorphisms (SNPs) have thus far yielded inconsistent results in delineating RITs while copy number variations (CNVs) have not yet been investigated for such purposes. We explore a radiogenomic modeling approach to investigate the association of CNVs and SNPs, along with clinical and dosimetric variables, in radiation induced rectal bleeding (RB) and erectile dysfunction (ED) in prostate cancer patients treated with curative hypofractionated irradiation. A cohort of 62 prostate cancer patients who underwent hypofractionated radiotherapy (66 Gy in 22 fractions) between 2002 to 2010 were retrospectively genotyped for CNV and SNP rs5489 in the xrcc1 DNA repair gene. Late toxicity rates for RB grade 2 and 3 and grade 3 alone were 29.0% and 12.9%, respectively. ED toxicity was found to be 62.9%. Radiogenomic model performance was evaluated using receiver operating characteristic area under the curve (AUC) and resampling by cross-validation. Binary variables were evaluated using Chi-squared contingency table analysis and multivariate models by Spearman's rank correlation coefficient (rs). Ten patients were found to have three copies of xrcc1 CNV (RB: χ{sup 2}=14.6, p<0.001 and ED: χ{sup 2}=4.88, p=0.0272) and twelve had heterozygous rs25489 SNP (RB: χ{sup 2}=0.278, p=0.599 and ED: χ{sup 2}=0.112, p=0.732). Radiogenomic modeling yielded significant, cross-validated NTCP models for RB (AUC=0.665) and ED (AUC=0.754). These results indicate that CNVs may be potential predictive biomarkers of both late ED and RB.

  16. Radiobiological rationale and clinical implications of hypo-fractionated radiation therapy; Bases radiobiologiques et applications cliniques de la radiotherapie hypofractionnee

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    Ko, E.C.; Forsythe, K.; Buckstein, M.; Kao, J.; Rosenstein, B.S. [Department of Radiation Oncology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1236, New York, NY (United States)

    2011-06-15

    Recent clinical trials of hypo-fractionated radiation treatment have provided critical insights into the safety and efficacy of hypo-fractionation. However, there remains much controversy in the field, both at the level of clinical practice and in our understanding of the underlying radiobiological mechanisms. In this article, we review the clinical literature on hypo-fractionated radiation treatment for breast, prostate, and other malignancies. We highlight several ongoing clinical trials that compare outcomes of a hypo-fractionated approach versus those obtained with a conventional approach. Lastly, we outline some of the preclinical and clinical evidence that argue in favor of differential radiobiological mechanisms underlying hypo-fractionated radiation treatment. Emerging data from the ongoing studies will help to better define and guide the rational use of hypo-fractionation in future years. (authors)

  17. Later Outcomes and Alpha/Beta Estimate From Hypofractionated Conformal Three-Dimensional Radiotherapy Versus Standard Fractionation for Localized Prostate Cancer

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    Leborgne, Felix [Department of Radiation Oncology, Hospital Italiano, Montevideo (Uruguay); Fowler, Jack, E-mail: jackfowlersbox@gmail.com [Department of Human Oncology, University of Wisconsin Medical School, Madison, WI (United States); Leborgne, Jose H.; Mezzera, Julieta [Department of Radiation Oncology, Hospital Italiano, Montevideo (Uruguay)

    2012-03-01

    Purpose: Now that the follow-up time has exceeded 5 years, an estimate of the {alpha}/{beta} ratio can be presented. The additional late outcomes in patients treated with three-dimensional conformal external beam radiotherapy for localized prostate cancer using a hypofractionated vs. a standard fractionation regimen are reported from this prospective nonrandomized contemporary comparison. Methods and Materials: A total of 114 nonrandomized patients chose hypofractionation delivered in 20 fractions of 3 Gy or 3.15 Gy (mean 3.06 Gy) for localized prostate cancer within a median overall time of 32 days (range, 29-49) using four fractions weekly. A total of 160 comparable patients were contemporarily treated within a median of 55 days (range 49-66). The median follow-up was 66 months (range, 24-95) for the hypofractionated arm and 63 months (range, 36-92) for the standard arm. The percentage of patients in the low-, medium-, and high-risk groups was 36%, 46%, and 18% in the hypofractionated arm and 44%, 50%, and 6% in standard arm (2 Gy), respectively. Results: The 5-year actuarial biochemical absence of disease (prostate-specific antigen nadir + 2 ng/mL) and disease-free survival rate was the same at 89% in both arms, making the {alpha}/{beta} calculation unambiguous. The point ratio of {alpha}/{beta} was 1.86 (95% confidence interval, 0.7-5.1 Gy). The 95% confidence interval was determined entirely by the binomial confidence limits in the numbers of patients. Rectal reactions of grade 3 and 4 occurred in 1 of 114 (hypofractionated) and 2 of 160 (standard) patients. Conclusions: The presented three-dimensional conformal regimen was acceptable, and the {alpha}/{beta} value was 1.8, in agreement with other very recent low meta-analyses (reviewed in the '' section).

  18. Hypofractionated stereotactic radiotherapy for primary and secondary intrapulmonary tumors. First results of a phase I/II study

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    Ernst-Stecken, A.; Sauer, R.; Grabenbauer, G. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center, Univ. Hospital Erlangen (Germany); Lambrecht, U.; Mueller, R. [Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center, Univ. Hospital Erlangen (Germany); Div. of Medical Physics, Dept. of Radiation Therapy, Univ. Hospital Erlangen (Germany)

    2006-12-15

    Purpose: to evaluate the feasibility, efficacy, and side effects of dose escalation in hypofractionated stereotactic radiotherapy (hfSRT) for intrapulmonary tumors with the Novalis trademark system (BrainLAB AG, Heimstetten, Germany). Patients and methods: from 07/2003 to 01/2005, 21 patients/39 tumors were treated with 5 x 7 Gy (n = 21; total dose 35 Gy) or 5 x 8 Gy (n = 18; total dose 40 Gy). There were three cases of primary lung cancer, the remainder were metastases. Median gross tumor volume (GTV) and planning target volume (PTV) were 2.89 cm{sup 3} (range, 0.15-67.94 cm{sup 3}) and 25.75 cm{sup 3} (range, 7.18-124.04 cm{sup 3}), respectively. Results: rates of complete remission, partial remission, no change, and progressive disease were 51%, 33%, 3%, and 13%, respectively. No grade 4 toxicity occurred, nearly all patients had grade 1 initially. One grade 3 toxicity, i.e., dyspnea, was documented for a period of 6 months after therapy. Radiosurgery quality assurance guidelines could be met. Conclusion: hfSRT of primary and secondary lung tumors using a schedule of five fractions at 7-8 Gy each was well tolerated. Further dose escalation is planned. (orig.)

  19. [Clinical experience in image-guided ultra-conformal hypofractionated radiotherapy in case of metastatic diseases at the University of Pécs].

    Science.gov (United States)

    László, Zoltán; Boronkai, Árpád; Lõcsei, Zoltán; Kalincsák, Judit; Szappanos, Szabolcs; Farkas, Róbert; Al Farhat, Yousuf; Sebestyén, Zsolt; Sebestyén, Klára; Kovács, Péter; Csapó, László; Mangel, László

    2015-06-01

    With the development of radiation therapy technology, the utilization of more accurate patient fixation, inclusion of PET/CT image fusion into treatment planning, 3D image-guided radiotherapy, and intensity-modulated dynamic arc irradiation, the application of hypofractionated stereotactic radiotherapy can be extended to specified extracranial target volumes, and so even to the treatment of various metastases. Between October 2012 and August 2014 in our institute we performed extracranial, hypofractionated, image-többguided radiotherapy with RapidArc system for six cases, and 3D conformal multifield technique for one patient with Novalis TX system in case of different few-numbered and slow-growing metastases. For the precise definition of the target volumes we employed PET/CT during the treatment planning procedure. Octreotid scan was applied in one carcinoid tumour patient. Considering the localisation of the metastases and the predictable motion of the organs, we applied 5 to 20 mm safety margin during the contouring procedure. The average treatment volume was 312 cm3. With 2.5-3 Gy fraction doses we delivered 39-45 Gy total dose, and the treatment duration was 2.5 to 3 weeks. The image guidance was carried out via ExacTrac, and kV-Cone Beam CT equipment based on an online protocol, therefore localisation differences were corrected before every single treatment. The patients tolerated the treatments well without major (Gr>2) side effects. Total or near total regression of the metastases was observed at subsequent control examinations in all cases (the median follow-up time was 5 months). According to our first experience, extracranial, imageguided hypofractionated radiotherapy is well-tolerated by patients and can be effectively applied in the treatment of slow-growing and few-numbered metastases.

  20. Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer

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    Oorschot, B. van; Assenbrunner, B.; Beckmann, G.; Flentje, M. [Universitaetsklinikum Wuerzburg, Interdisziplinaeres Zentrum Palliativmedizin, Klinik und Poliklinik fuer Strahlentherapie, Wuerzburg (Germany); Schuler, M. [Universitaet Wuerzburg, Abteilung fuer Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Wuerzburg (Germany)

    2014-03-15

    Survival and prognostic variables in patients with advanced or metastatic non-small cell lung cancer (NSCLC) requiring thoracic palliative radiotherapy using a moderately hypofractionated regime (13-15 x 3 Gy) were evaluated. From March 2006 to April 2012, 120 patients with a physician estimated prognosis of 6-12 months were treated with this regime using CT-based 3D conformal radiotherapy. We collected data on patient characteristics, comorbidities, toxicity, and treatment parameters. Radiotherapy was completed as prescribed in 114 patients (95.0 %, premature termination 5.0 %). Acute grade 3 toxicity was seen in 6.4 % of patients. The median survival of all patients was 5.8 months. Nonmetastatic patients survived significantly longer than patients with metastatic disease (median 11.7 months vs 4.7 months, p = 0.0001) and 18.6 % of nonmetastatic patients survived longer than 2 years. In 12.7 % radiotherapy started less than 30 days before death and 14.2 % of patients received radiotherapy within 14 days before death. In the multivariate analysis, good general condition, nonmetastatic disease, and a stable or improved general condition at the end of radiotherapy were significant. The treatment parameters, age, and comorbidities were not statistically significant. Our data confirm considerable effectiveness of 13 x 3 Gy with conformal radiotherapy for patients with locally confined NSCLC not fit for radical treatment and raise doubt for this regimen in metastatic patients and ECOG ≥ 2 when burden, acute toxicity, and resources are considered. (orig.) [German] Analyse der Ueberlebenszeiten und prognoserelevanter Variablen von Patienten mit lokal fortgeschrittenem und metastasiertem nicht-kleinzelligen Lungenkrebs nach moderat hypofraktionierter Strahlentherapie (13- bis 15-mal 3 Gy). Zwischen Maerz 2006 und April 2012 wurden 120 Patienten mit aerztlich eingeschaetzter Lebenserwartung von 6-12 Monaten mit diesem Regime mittels CT-basierter 3-D

  1. Prone Hypofractionated Whole-Breast Radiotherapy Without a Boost to the Tumor Bed: Comparable Toxicity of IMRT Versus a 3D Conformal Technique

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    Hardee, Matthew E.; Raza, Shahzad; Becker, Stewart J.; Jozsef, Gabor; Lymberis, Stella C. [Department of Radiation Oncology, New York University School of Medicine, New York, NY (United States); Hochman, Tsivia; Goldberg, Judith D. [Division of Biostatistics, New York University School of Medicine, New York, NY (United States); DeWyngaert, Keith J. [Department of Radiation Oncology, New York University School of Medicine, New York, NY (United States); Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York, NY (United States)

    2012-03-01

    Purpose: We report a comparison of the dosimetry and toxicity of three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT) among patients treated in the prone position with the same fractionation and target of the hypofractionation arm of the Canadian/Whelan trial. Methods and Materials: An institutional review board-approved protocol identified a consecutive series of early-stage breast cancer patients treated according to the Canadian hypofractionation regimen but in the prone position. Patients underwent IMRT treatment planning and treatment if the insurance carrier approved reimbursement for IMRT; in case of refusal, a 3D-CRT plan was used. A comparison of the dosimetric and toxicity outcomes during the acute, subacute, and long-term follow-up of the two treatment groups is reported. Results: We included 97 consecutive patients with 100 treatment plans in this study (3 patients with bilateral breast cancer); 40 patients were treated with 3D-CRT and 57 with IMRT. IMRT significantly reduced the maximum dose (Dmax median, 109.96% for 3D-CRT vs. 107.28% for IMRT; p < 0.0001, Wilcoxon test) and improved median dose homogeneity (median, 1.15 for 3D-CRT vs. 1.05 for IMRT; p < 0.0001, Wilcoxon test) when compared with 3D-CRT. Acute toxicity consisted primarily of Grade 1 to 2 dermatitis and occurred in 92% of patients. Grade 2 dermatitis occurred in 13% of patients in the 3D-CRT group and 2% in the IMRT group. IMRT moderately decreased rates of acute pruritus (p = 0.03, chi-square test) and Grade 2 to 3 subacute hyperpigmentation (p = 0.01, Fisher exact test). With a minimum of 6 months' follow-up, the treatment was similarly well tolerated in either group, including among women with large breast volumes. Conclusion: Hypofractionated breast radiotherapy is well tolerated when treating patients in the prone position, even among those with large breast volumes. Breast IMRT significantly improves dosimetry but yields only a modest

  2. Postmastectomy Hypofractionated and Accelerated Radiation Therapy With (and Without) Subcutaneous Amifostine Cytoprotection

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    Koukourakis, Michael I., E-mail: targ@her.forthnet.gr [Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis (Greece); Panteliadou, Marianthi; Abatzoglou, Ioannis M.; Sismanidou, Kyriaki [Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis (Greece); Sivridis, Efthimios; Giatromanolaki, Alexandra [Department of Pathology, Democritus University of Thrace, Alexandroupolis (Greece)

    2013-01-01

    Purpose: Postmastectomy radiation therapy (PMRT) provides major local control and survival benefits. More aggressive radiation therapy schemes may, however, be necessary in specific subgroups, provided they are safely administered. We report the tolerance and efficacy of a highly accelerated and hypofractionated regimen (HypoARC). Methods and Materials: One hundred twelve high-risk patients who had undergone mastectomy received 10 consecutive fractions of 3.5 Gy in 12 days (thoracic wall and axillary/supraclavicular areas). Two consecutive additional fractions of 4 Gy were given to the surgical scar area (electrons 8-10 MeV) and 1 3.5-Gy fraction to the axilla (in cases with extensive nodal involvement). A minimum follow-up of 24 months (median, 44 months) was allowed before analysis. Of 112 patients, 21 (18.7%) refused to receive amifostine, the remaining receiving tolerance-based individualized doses (500-1000 mg/day subcutaneously). Results: By use of a dose individualization algorithm, 68.1%, 11%, and 18.7% of patients received 1000 mg, 750 mg, and 500 mg/day of amifostine. Patchy moist skin desquamation outside and inside the booster fields was noted in 14 of 112 (12.5%) and 26 of 112 (23.2%) patients, respectively. No case of acute pneumonitis was recorded. High amifostine dose offered a significant skin protection. Within a median follow-up time of 44 months, moderate subcutaneous edema outside and within the booster thoracic area was noted in 5 of 112 (4.4%) and 8 of 112 (7.1%) cases, respectively. Intense asymptomatic radiographic findings of in field lung fibrosis were noted in 4 of 112 (3.6%) patients. Amifostine showed a significant protection against lung and soft tissue fibrosis. A 97% projected 5-year local relapse free survival and 84% 5-year disease-specific survival were recorded. Lack of steroid receptor expression, simple human epidermal growth factor 2 positivity, or triple negative phenotype defined higher metastasis rates but had no effect on

  3. Five-Year Follow-Up of Concomitant Accelerated Hypofractionated Radiation in Advanced Squamous Cell Carcinoma of the Buccal Mucosa: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Hassan Iqbal

    2015-01-01

    Full Text Available In resource limited settings, induction chemotherapy with Gemcitabine and Cisplatinum and concurrent hypofractionated chemoradiation for locally advanced carcinoma of buccal mucosa (BMSCC are a cost effective option but remain under reported. The objective of this study was to report long term survival outcome after concurrent hypofractionated radiotherapy in locally advanced BMSCC. Between February 2005 and 2009, 63 patients received treatment. Induction chemotherapy (IC regimen consisted of two drugs: Gemcitabine and Cisplatin. All patients received 55 Gy of radiation in 20 fractions with concurrent single agent Cisplatin (75 mg/m2. Five-year overall survival (OS, disease-free survival (DFS, and progression-free survival (PFS were determined. Based on AJCC staging, 7 (11% patients were stage III, 31 (49% stage IV a, and 25 (40% stage IVb at presentation. After IC, 8 (18% patients had complete radiological response, 33 (73% had partial response, and 4 (9% had stable disease. After concurrent hypofractionated chemoradiation, thirty-nine (62% patients were complete responders and 24 (38% had stable disease. With a minimum follow-up of 60 months, 5-year OS, DFS, and PFS were 30%, 49%, and 30%, respectively. In locally advanced buccal mucosa squamous cell carcinoma, concurrent hypofractionated chemoradiation results in acceptable survival and regimen related toxicity.

  4. Hypofractionated radiotherapy for non-small-cell lung cancer%非小细胞肺癌大分割放疗

    Institute of Scientific and Technical Information of China (English)

    管尚慧; 李彩云; 程玉峰

    2012-01-01

    大分割三维适形放疗(3DCRT)为进一步改善非小细胞肺癌(NSCLC)患者局部控制率、生存率及生活质量提供了可能,但最佳剂量分割方案尚不明确,有待进一步研究.立体定向体部放疗(SBRT)在早期NSCLC中取得了令人满意的局部控制率和生存率,且不良反应在可接受的范围内,有望成为早期NSCLC患者新的标准治疗手段.%Hypofractionated three-dimensional confornul radiotherapy (3DCRT) makes it possible to further improve loeal control,overall survival and the quality of life for the patients with non-small-cell lung cancer (NSCLC).But the dose-fractionation and total dose are not yet clear,which need further study.Hypofractionated stereotactic body radiotherapy (SBRT) for early-stage NSCLC patients is well tolerated and results in excellent local control and overall survival.SBRT is expected to become a new standard treatment in patients with early stage NSCLC.

  5. Five Year Outcome of 145 Patients With Ductal Carcinoma In Situ (DCIS) After Accelerated Breast Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ciervide, Raquel [Department of Radiation Oncology, New York University School of Medicine, NYU Langone Medical Center, New York, New York (United States); Dhage, Shubhada; Guth, Amber; Shapiro, Richard L.; Axelrod, Deborah M.; Roses, Daniel F. [Department of Surgery, New York University School of Medicine, NYU Langone Medical Center, New York, New York (United States); Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, NYU Langone Medical Center, New York, New York (United States)

    2012-06-01

    Background: Accelerated whole-breast radiotherapy (RT) with tumor bed boost in the treatment of early invasive breast cancer has demonstrated equivalent local control and cosmesis when compared with standard RT. Its efficacy in the treatment of ductal carcinoma in situ (DCIS) remains unknown. Methods and Materials: Patients treated for DCIS with lumpectomy and negative margins were eligible for 2 consecutive hypofractionated whole-breast RT clinical trials. The first trial (New York University [NYU] 01-51) prescribed to the whole breast 42 Gy (2.8 Gy in 15 fractions) and the second trial (NYU 05-181) 40.5 Gy (2.7 Gy in 15 fractions) with an additional daily boost of 0.5 Gy to the surgical cavity. Results: Between 2002 and 2009, 145 DCIS patients accrued, 59 to the first protocol and 86 to the second trial. Median age was 56 years and 65% were postmenopausal at the time of treatment. Based on optimal sparing of normal tissue, 79% of the patients were planned and treated prone and 21% supine. At 5 years' median follow-up (60 months; range 2.6-105.5 months), 6 patients (4.1%) experienced an ipsilateral breast recurrence in all cases of DCIS histology. In 3/6 patients, recurrence occurred at the original site of DCIS and in the remaining 3 cases outside the original tumor bed. New contralateral breast cancers arose in 3 cases (1 DCIS and 2 invasive carcinomas). Cosmetic self-assessment at least 2 years after treatment is available in 125 patients: 91% reported good-to-excellent and 9% reported fair-to-poor outcomes. Conclusions: With a median follow-up of 5 years, the ipsilateral local recurrence rate is 4.1%, comparable to that reported from the NSABP (National Surgical Adjuvant Breast and Bowel Project) trials that employed 50 Gy in 25 fractions of radiotherapy for DCIS. There were no invasive recurrences. These results provide preliminary evidence that accelerated hypofractionated external beam radiotherapy is a viable option for DCIS.

  6. Dosimetric characterization of hypofractionated Gamma Knife radiosurgery of large or complex brain tumors versus linear accelerator-based treatments.

    Science.gov (United States)

    Dong, Peng; Pérez-Andújar, Angélica; Pinnaduwage, Dilini; Braunstein, Steve; Theodosopoulos, Philip; McDermott, Michael; Sneed, Penny; Ma, Lijun

    2016-12-01

    OBJECTIVE Noninvasive Gamma Knife (GK) platforms, such as the relocatable frame and on-board imaging, have enabled hypofractionated GK radiosurgery of large or complex brain lesions. This study aimed to characterize the dosimetric quality of such treatments against linear accelerator-based delivery systems that include the CyberKnife (CK) and volumetric modulated arc therapy (VMAT). METHODS Ten patients treated with VMAT at the authors' institution for large brain tumors (> 3 cm in maximum diameter) were selected for the study. The median prescription dose was 25 Gy (range 20-30 Gy) in 5 fractions. The median planning target volume (PTV) was 9.57 cm(3) (range 1.94-24.81 cm(3)). Treatment planning was performed using Eclipse External Beam Planning V11 for VMAT on the Varian TrueBeam system, Multiplan V4.5 for the CyberKnife VSI System, and Leksell GammaPlan V10.2 for the Gamma Knife Perfexion system. The percentage of the PTV receiving at least the prescription dose was normalized to be identical across all platforms for individual cases. The prescription isodose value for the PTV, conformity index, Paddick gradient index, mean and maximum doses for organs at risk, and normal brain dose at variable isodose volumes ranging from the 5-Gy isodose volume (V5) to the 15-Gy isodose volume (V15) were compared for all of the cases. RESULTS The mean Paddick gradient index was 2.6 ± 0.2, 3.2 ± 0.5, and 4.3 ± 1.0 for GK, CK, and VMAT, respectively (p 0.06). The average prescription isodose values were 52% (range 47%-69%), 60% (range 46%-68%), and 88% (range 70%-94%) for GK, CK, and VMAT, respectively, thus producing significant variations in dose hot spots among the 3 platforms. Furthermore, the mean V5 values for GK and CK were similar (p > 0.79) at 71.9 ± 36.2 cm(3) and 73.3 ± 31.8 cm(3), respectively, both of which were statistically lower (p < 0.01) than the mean V5 value of 124.6 ± 67.1 cm(3) for VMAT. CONCLUSIONS Significantly better near-target normal brain

  7. Efficacy and toxicity of an accelerated hypofractionated radiation therapy protocol in cats with oral squamous cell carcinoma.

    Science.gov (United States)

    Poirier, Valérie J; Kaser-Hotz, Barbara; Vail, David M; Straw, Rodney C

    2013-01-01

    Squamous cell carcinoma (SCC) is the most common feline oral tumor. Standard radiation protocols have been reported to achieve tumor control durations of 1.5-5.5 months (45-165 days). The purpose of this study was to describe the efficacy and toxicity of an accelerated hypofractionated radiation therapy protocol in cats with oral SCC. Twenty-one cats with histologically confirmed oral SCC and T1-3N0M0 were treated with 10 once-daily fractions (Monday-Friday) of 4.8 Gy. Seventeen cats had macroscopic disease and four were microscopic after incomplete excision. Acute toxicity consisted of grade 2 mucositis in all cats and this was effectively managed using esophageal or gastric tube feeding, pain medication, and antibiotics. Late toxicity effects for cats with available follow-up data included alopecia (4 cats), leukotricia (6), tongue ulceration (1), and oronasal fistula (1). Response could be assessed in 17 cats (seven complete response and five partial response). Four cats (19%) developed metastatic disease without evidence of local progression. The median progression-free survival (PFS) was 105 days (1 year PFS of 23%), median local progression-free survival (LPFS) was 219 days (1 year LPFS of 41%), and median overall survival (OS) was 174 days (1 year OS of 29%). Only tumor stage was prognostic, with T1 having a median PFS of 590 days. Findings indicated that this accelerated hypofractionated radiation therapy protocol was well tolerated in cats with oral SCC, with manageable adverse events. Tumor response was observed in most cats and long tumor control durations were achieved in some cats.

  8. The radiobiology of hypofractionation.

    Science.gov (United States)

    Nahum, Alan E

    2015-05-01

    If the α/β ratio is high (e.g. 10 Gy) for tumour clonogen killing, but low (e.g. 3 Gy) for late normal tissue complications, then delivering external beam radiotherapy in a large number (20-30) of small (≈2 Gy) dose fractions should yield the highest 'therapeutic ratio'; this is demonstrated via the linear-quadratic model of cell killing. However, this 'conventional wisdom' is increasingly being challenged, partly by the success of stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) extreme hypofractionation regimens of three to five large fractions for early stage non-small cell lung cancer and partly by indications that for certain tumours (prostate, breast) the α/β ratio may be of the same order or even lower than that characterising late complications. It is shown how highly conformal dose delivery combined with quasi-parallel normal tissue behaviour (n close to 1) enables 'safe' hypofractionation; this can be predicted by the (α/β)eff concept for normal tissues. Recent analyses of the clinical outcomes of non-small cell lung cancer radiotherapy covering 'conventional' hyper- to extreme hypofractionation (stereotactic ablative radiotherapy) regimens are consistent with linear-quadratic radiobiology, even at the largest fraction sizes, despite there being theoretical reasons to expect 'LQ violation' above a certain dose. Impairment of re-oxygenation between fractions and the very high (α/β) for hypoxic cells can complicate the picture regarding the analysis of clinical outcomes; it has also been suggested that vascular damage may play a role for very large dose fractions. Finally, the link between high values of (α/β)eff and normal-tissue sparing for quasi-parallel normal tissues, thereby favouring hypofractionation, may be particularly important for proton therapy, but more generally, improved conformality, achieved by whatever technique, can be translated into individualisation of both prescription dose and fraction

  9. Determination of action thresholds for electromagnetic tracking system-guided hypofractionated prostate radiotherapy using volumetric modulated arc therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Pengpeng; Mah, Dennis; Happersett, Laura; Cox, Brett; Hunt, Margie; Mageras, Gig [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021 (United States); Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York 10467 (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021 (United States); Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021 (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021 (United States)

    2011-07-15

    Purpose: Hypofractionated prostate radiotherapy may benefit from both volumetric modulated arc therapy (VMAT) due to shortened treatment time and intrafraction real-time monitoring provided by implanted radiofrequency(RF) transponders. The authors investigate dosimetrically driven action thresholds (whether treatment needs to be interrupted and patient repositioned) in VMAT treatment with electromagnetic (EM) tracking. Methods: VMAT plans for five patients are generated for prescription doses of 32.5 and 42.5 Gy in five fractions. Planning target volume (PTV) encloses the clinical target volume (CTV) with a 3 mm margin at the prostate-rectal interface and 5 mm elsewhere. The VMAT delivery is modeled using 180 equi-spaced static beams. Intrafraction prostate motion is simulated in the plan by displacing the beam isocenter at each beam assuming rigid organ motion according to a previously recorded trajectory of the transponder centroid. The cumulative dose delivered in each fraction is summed over all beams. Two sets of 57 prostate motion trajectories were randomly selected to form a learning and a testing dataset. Dosimetric end points including CTV D95%, rectum wall D1cc, bladder wall D1cc, and urethra Dmax, are analyzed against motion characteristics including the maximum amplitude of the anterior-posterior (AP), superior-inferior (SI), and left-right components. Action thresholds are triggered when intrafraction motion causes any violations of dose constraints to target and organs at risk (OAR), so that treatment is interrupted and patient is repositioned. Results: Intrafraction motion has a little effect on CTV D95%, indicating PTV margins are adequate. Tight posterior and inferior action thresholds around 1 mm need to be set in a patient specific manner to spare organs at risk, especially when the prescription dose is 42.5 Gy. Advantages of setting patient specific action thresholds are to reduce false positive alarms by 25% when prescription dose is low, and

  10. Protracted Hypofractionated Radiotherapy for Graves' Ophthalmopathy: A Pilot Study of Clinical and Radiologic Response

    Energy Technology Data Exchange (ETDEWEB)

    Casimiro de Deus Cardoso, Cejana; Giordani, Adelmo Jose [Department of Clinical and Experimental Oncology, Division of Radiotherapy, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Borri Wolosker, Angela Maria [Department of Radiology, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Souhami, Luis [Department of Radiotherapy, McGill University Heath Centre, Montreal, Quebec (Canada); Gois Manso, Paulo [Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Souza Dias, Rodrigo; Comodo Segreto, Helena Regina [Department of Clinical and Experimental Oncology, Division of Radiotherapy, Federal University of Sao Paulo, Sao Paulo, SP (Brazil); Araujo Segreto, Roberto, E-mail: segreto.dmed@epm.br [Department of Clinical and Experimental Oncology, Division of Radiotherapy, Federal University of Sao Paulo, Sao Paulo, SP (Brazil)

    2012-03-01

    Purpose: To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation. Methods and Materials: Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. Of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging. Results: Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing (p < 0.001) diplopia (p = 0.008), conjunctival hyperemia (p = 0.002), and ocular grittiness (p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy. Conclusion: RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy.

  11. Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma

    Science.gov (United States)

    Kim, Hun Jung; Phak, Jeong Hoon; Kim, Woo Chul

    2016-01-01

    Purpose Stereotactic body radiotherapy (SBRT) takes advantage of low α/β ratio of prostate cancer to deliver a large dose in few fractions. We examined clinical outcomes of SBRT using CyberKnife for the treatment of low- and intermediate-risk prostate cancer. Materials and Methods This study was based on a retrospective analysis of the 33 patients treated with SBRT using CyberKnife for localized prostate cancer (27.3% in low-risk and 72.7% in intermediate-risk). Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. The acute and late toxicities were recorded using the Radiation Therapy Oncology Group scale. Prostate-specific antigen (PSA) response was monitored. Results Thirty-three patients with a median 51 months (range, 6 to 71 months) follow-up were analyzed. There was no biochemical failure. Median PSA nadir was 0.27 ng/mL at median 33 months and PSA bounce occurred in 30.3% (n = 10) of patients at median at median 10.5 months after SBRT. No grade 3 acute toxicity was noted. The 18.2% of the patients had acute grade 2 genitourinary (GU) toxicities and 21.2% had acute grade 2 gastrointestinal (GI) toxicities. After follow-up of 2 months, most complications had returned to baseline. There was no grade 3 late GU and GI toxicity. Conclusion Our experience with SBRT using CyberKnife in low- and intermediate-risk prostate cancer demonstrates favorable efficacy and toxicity. Further studies with more patients and longer follow-up duration are required. PMID:27306777

  12. Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hun Jung; Phak, Jeong Hoon; Kim, Woo Chul [Dept. of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of)

    2016-12-15

    Stereotactic body radiotherapy (SBRT) takes advantage of low α/β ratio of prostate cancer to deliver a large dose in few fractions. We examined clinical outcomes of SBRT using CyberKnife for the treatment of low- and intermediate-risk prostate cancer. This study was based on a retrospective analysis of the 33 patients treated with SBRT using CyberKnife for localized prostate cancer (27.3% in low-risk and 72.7% in intermediate-risk). Total dose of 36.25 Gy in 5 fractions of 7.25 Gy were administered. The acute and late toxicities were recorded using the Radiation Therapy Oncology Group scale. Prostate-specific antigen (PSA) response was monitored. Thirty-three patients with a median 51 months (range, 6 to 71 months) follow-up were analyzed. There was no biochemical failure. Median PSA nadir was 0.27 ng/mL at median 33 months and PSA bounce occurred in 30.3% (n = 10) of patients at median at median 10.5 months after SBRT. No grade 3 acute toxicity was noted. The 18.2% of the patients had acute grade 2 genitourinary (GU) toxicities and 21.2% had acute grade 2 gastrointestinal (GI) toxicities. After follow-up of 2 months, most complications had returned to baseline. There was no grade 3 late GU and GI toxicity. Our experience with SBRT using CyberKnife in low- and intermediate-risk prostate cancer demonstrates favorable efficacy and toxicity. Further studies with more patients and longer follow-up duration are required.

  13. Prostate-specific antigen kinetics following hypofractionated stereotactic body radiotherapy boost as post-external beam radiotherapy versus conventionally fractionated external beam radiotherapy for localized prostate cancer

    OpenAIRE

    Phak, Jeong Hoon; Kim, Hun Jung; Kim, Woo Chul

    2015-01-01

    Background Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment for localized prostate cancer. The purpose of this study was to compare the prostate-specific antigen (PSA) kinetics between conventionally fractionated external beam radiotherapy (CF-EBRT) and SBRT boost after whole pelvis EBRT (WP-EBRT) in localized prostate cancer. Methods A total of 77 patients with localized prostate cancer [T-stage, T1–T3; Gleason score (GS) 5–9; PSA 

  14. Short-term hypofractionated radiotherapy followed by total mesorectal excision; Kleinvolumige hypofraktionierte Radiotherapie vor totaler mesorektaler Exzision

    Energy Technology Data Exchange (ETDEWEB)

    Lammering, G. [Duesseldorf Univ. (Germany). Klinik fuer Strahlentherapie und Radioonkologie; Medical Coll. of Virginia., Richmond, VA (United States). Dept. of Radiation Oncology; Hartmann, K.A.; Aryus, B.; Doeker, R. [Duesseldorf Univ. (Germany). Klinik fuer Strahlentherapie und Radioonkologie; Frenken, M.; Ulrich, B. [Staedtische Kliniken Duesseldorf-Gerresheim (Germany). Chirurgische Klinik

    2000-12-01

    As of December 1996 to March 1999, 34 patients with locally advanced rectal cancer have been irradiated preoperatively with 5 times 5 Gy. After CT-planning, radiotherapy was administered using a 3-field or 4-field box technique with 2 anterior-posterior fields or a posterior field of 9 {+-} 2 cm x 11.5 {+-} 2.4 cm and 2 opposed bilateral fields of 9 {+-} 1.5 cm x 11.5 {+-} 2 cm with 6- to 25-MV photons. Surgery was performed 14 {+-} 6 days after irradiation in 33/34 patients (82% anterior resection with total mesorectal excision, 18% abdomino-perineal resection). Patients with a positive lymph node status or pT3/4 lesions underwent adjuvant chemotherapy with 5-Fluorouracil (5-FU). The median follow-up period is 189 days (range: 15 to 548 days). Results: The following early side reactions were registered: Increased bowel movements (4/34), fatigue (2/34), pain in the groins (1/34), nausea and perianal smart (1/34), vertigo (1/34), temporary urinary obstruction (1/34). One patient with heart failure NYHA Grade III died of a heart attack after 21 days. Preoperative T and N categories showed a distribution of 3,29 and 2 for T4, T3 and unknown and 20, 11 and 3 for N+, N- and unknown; postoperative T and N categories showed a distribution of 3/19 and 11 for T4, T3 and T2 and 19 and 14 for N+ and N-. In 32 of 33 patients tumor free margins were achieved. One patient with peritoneal metastases had a R1 resection. In 3 patients metastases were detected intraoperatively. Perioperative complications were: 2 cases of leaking anastomosis and postoperative bowel atonia, 1 case with bowel obstruction, delayed wound healing, wound dehiscence and temporary renal dysfunction. (orig.) [German] Von Dezember 1996 bis Maerz 1999 wurden 34 Patienten mit lokal fortgeschrittenem Rektumkarzinom einer praeoperativen Strahlentherapie mit 5-mal 5 Gy zugefuehrt. Die kleinvolumige Bestrahlung erfolgte in CT-geplanter Drei- oder Vier-Felder-Technik mit ventrodorsalen Gegenfeldern bzw. dorsalen

  15. Hypofractionated Volumetric Modulated Arc Radiotherapy with simultaneous Elective Nodal Irradiation is feasible in prostate cancer patients: A single institution experience

    Directory of Open Access Journals (Sweden)

    Mohamed W. Hegazy

    2016-06-01

    Conclusions: Hypo-fractionation dose escalation VMAT–SIB–ENI–WPRT using 2 arcs is a feasible technique for intermediate/high risk OC prostate cancer patients, with acceptable rates of acute/late toxicities, much favorable planning target volume (PTV coverage, and shorter overall treatment time. Prospective randomized controlled trials are encouraged to confirm its equivalence to other fractionation schemes.

  16. Exclusive radiotherapy and concurrent endocrine therapy for the management of elderly breast cancer patients: Case study and review of hypo-fractionated schemes; Hormonoradiotherapie exclusive dans la prise en charge du cancer du sein de la personne agee: cas clinique et revue de la litterature des schemas hypofractionnes

    Energy Technology Data Exchange (ETDEWEB)

    Auberdiac, P.; Cartier, L.; Malkoun, N.; Chauleur, C.; De Laroche, G.; Magne, N. [Departement de radiotherapie, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France); Chargari, C. [Service d' oncologie radiotherapie, hopital d' instruction des armees du Val-de-Grace, 74, boulevard de Port-Royal, 75230 Paris cedex 5 (France); Melis, A.; Jacquin, J.P. [Departement d' oncologie medicale, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France)

    2011-12-15

    Normo-fractionated radiotherapy is standard for adjuvant management of patients treated with breast conservative surgery for breast cancer. However, many elderly patients are not eligible to such strategy, either because of concurrent diseases, or because the tumor is inoperable. Several protocols of exclusive radiotherapy have been reported in the literature, frequently using hypo-fractionated radiotherapy and endocrine therapy. We report a case of a patient treated with exclusive endocrine and radiotherapy and address the state of the art on hypo-fractionated schemes for the management of elderly breast cancer patients. While hypo-fractionated radiotherapy does not compromise the oncologic or cosmetic outcome, there is no prospective data that assesses the place of radiotherapy for the exclusive treatment of elderly patients. This strategy should be further assessed in clinical randomized trial. (authors)

  17. Hypo-fractionated treatment in radiotherapy: radio-biological models Tcp and NTCP; Tratamiento hipofraccionado en radioterapia: modelos radiobiologicos TCP y NTCP

    Energy Technology Data Exchange (ETDEWEB)

    Astudillo V, A. J.; Mitsoura, E. [Universidad Autonoma del Estado de Mexico, Facultad de Medicina, Paseo Tollocan s/n, 50180 Toluca, Estado de Mexico (Mexico); Paredes G, L. [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico); Resendiz G, G., E-mail: lydia.paredes@inin.gob.mx [Hospital Medica Sur, Departamento de Radioterapia, Puente de Piedra 150, Col. Toriello Guerra, 14050 Mexico D. F. (Mexico)

    2014-08-15

    At the present time the breast cancer in Mexico has the first place of incidence of the malignant neoplasia s in the women, and represents 11.34% of all the cancer cases. On the other hand, the treatments for cancer by means of ionizing radiations have been dominated under the approaches of the medical radio-oncologists which have been based on test and error by many years. The radio-biological models, as the Tcp, NTCP and dosimetric variables, for their clinical application in the conventional radiotherapy with hypo-fractionation have as purpose predicting personalized treatment plans that they present most probability of tumor control and minor probability of late reactions, becoming this way support tools in the decisions taking for the patient treatments planning of Medical Physicists and Radio-oncologists. (Author)

  18. Hypofractionated stereotactic radiotherapy for dumbbell-shaped hypoglossal schwannomas: Two cases of long-term follow-up and a review of the literature

    Science.gov (United States)

    Li, Yong; Lou, Jinrong; Qiu, Shujun; Guo, Yutian; Pan, Mianshun

    2016-01-01

    Cases of hypoglossal schwannoma are extremely rare. Historically, microsurgical resection has been the standard treatment, but it may not always be feasible; thus, it is crucial to investigate alternative treatments. We herein present the cases of two patients, both of whom presented with tongue deviation and hemiatrophy, accompanied by headaches. Magnetic resonance imaging revealed a dumbbell-shaped tumor originating from the hypoglossal nerve that was adjacent to the cranial base in each patient. Hypofractionated stereotactic radiotherapy was used to treat the tumors, with a total dose of 30 Gy in 3-Gy fractions delivered to the planning target volume. Several months later, the tumors had significantly decreased in size and the symptoms of the two patients had gradually improved. PMID:27446582

  19. Hypo-fractionated radiotherapy of breast cancer: long term results of a set of 80 cases treated in the radiotherapy department of the Oran university hospital; Radiotherapie hypofractionnee dans le cancer du sein: resultats a long terme d'une serie de 80 cas traites dans le service de radiotherapie du centre hospitalier universitaire d'Oran

    Energy Technology Data Exchange (ETDEWEB)

    Boukerche, A.; Yahia, A.; Madouri, R.; Belmiloud, H.; Dali-Youcef, A.F. [Service de radiotherapie, CHU d' Oran, Oran (Algeria)

    2011-10-15

    The authors report the assessment of the local and locoregional control and of the acute and late toxicity of adjuvant hypo-fractionated radiotherapy in breast cancer treatment. During 1998, 80 women have been treated by conservative or radical surgery and hypo-fractionated tele-cobalto-therapy (36 Gy in five fractions of 3 Gy a week, and a boost of 15 Gy in five fractions in case of conservative surgery). Results are discussed in terms of local and locoregional recurrence, tolerance, late toxicity, global survival, and tumour classification. The irradiation scheme seems perfectly achievable but a greater number of patients and a longer follow-up are required to better assess the efficiency and aesthetic results. Short communication

  20. Transformation of Physical DVHs to Radiobiologically Equivalent Ones in Hypofractionated Radiotherapy Analyzing Dosimetric and Clinical Parameters: A Practical Approach for Routine Clinical Practice in Radiation Oncology

    Directory of Open Access Journals (Sweden)

    Zoi Thrapsanioti

    2013-01-01

    Full Text Available Purpose. The purpose of this study was to transform DVHs from physical to radiobiological ones as well as to evaluate their reliability by correlations of dosimetric and clinical parameters for 50 patients with prostate cancer and 50 patients with breast cancer, who were submitted to Hypofractionated Radiotherapy. Methods and Materials. To achieve this transformation, we used both the linear-quadratic model (LQ model and the Niemierko model. The outcome of radiobiological DVHs was correlated with acute toxicity score according to EORTC/RTOG criteria. Results. Concerning the prostate radiotherapy, there was a significant correlation between RTOG acute rectal toxicity and ( and ( dosimetric parameters, calculated for  Gy. Moreover, concerning the breast radiotherapy there was a significant correlation between RTOG skin toxicity and dosimetric parameter, calculated for both  Gy ( and  Gy (. The new tool seems reliable and user-friendly. Conclusions. Our proposed model seems user-friendly. Its reliability in terms of agreement with the presented acute radiation induced toxicity was satisfactory. However, more patients are needed to extract safe conclusions.

  1. Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer. Evaluation of indications and predictors of local control

    Energy Technology Data Exchange (ETDEWEB)

    Ishihara, Takeaki [Kobe University Graduate School of Medicine, Division of Radiation Oncology, Hyogo (Japan); Seirei Mikatahara General Hospital, Department of Radiation Oncology, Shizuoka (Japan); Yamada, Kazunari; Isogai, Kenta; Tonosaki, Yoshihiro [Seirei Mikatahara General Hospital, Department of Radiation Oncology, Shizuoka (Japan); Harada, Aya [Kobe Minimum Invasive Cancer Medical Center, Department of Radiation Oncology, Hyogo (Japan); Demizu, Yusuke [Hyogo Ion Beam Medical Center, Department of Radiology, Hyogo (Japan); Miyawaki, Daisuke; Yoshida, Kenji; Ejima, Yasuo; Sasaki, Ryohei [Kobe University Graduate School of Medicine, Division of Radiation Oncology, Hyogo (Japan)

    2016-06-15

    To evaluate the efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) for brain metastases (BMs) from lung cancer, and to explore prognostic factors associated with local control (LC) and indication. We evaluated patients who were treated with linac-based HSRT for BMs from lung cancer. Lesions treated with stereotactic radiosurgery (SRS) in the same patients during the same periods were analysed and compared with HSRT in terms of LC or toxicity. There were 53 patients with 214 lesions selected for this analysis (HSRT: 76 lesions, SRS: 138 lesions). For HSRT, the median prescribed dose was 35 Gy in 5 fractions. The 1-year LC rate was 83.6 % in HSRT; on multivariate analysis, a planning target volume (PTV) of <4 cm{sup 3}, biologically effective dose (BED{sub 10}) of ≥51 Gy, and adenocarcinoma were significantly associated with better LC. Moreover, in PTVs ≥ 4 cm{sup 3}, there was a significant difference in LC between BED{sub 10} < 51 Gy and ≥ 51 Gy (p = 0.024). On the other hand, in PTVs < 4 cm{sup 3}, both HSRT and SRS had good LC with no significant difference (p = 0.195). Radiation necrosis emerged in 5 of 76 lesions (6.6 %) treated with HSRT and 21 of 138 (15.2 %) lesions treated with SRS (p = 0.064). Linac-based HSRT was safe and effective for BMs from lung cancer, and hence might be particularly useful in or near an eloquent area. PTV, BED{sub 10}, and pathological type were significant prognostic factors. Furthermore, in BMs ≥ 4 cm{sup 3}, a dose of BED ≥ 51 Gy should be considered. (orig.) [German] Beurteilung von Wirksamkeit und Toxizitaet einer hypofraktionierten stereotaktischen Strahlentherapie (HSRT) zur Behandlung von Hirnmetastasen (HM) eines Lungenkarzinoms und Erforschung von mit der lokalen Kontrolle (LK) und der Indikation assoziierten Prognosefaktoren. Analysiert wurden Daten von Patienten (n = 53), die sich einer Linearbeschleuniger-basierten HSRT unterzogen (mit HSRT behandelte Laesionen n = 76; Median der

  2. A biologically competitive 21 days hypofractionation scheme with weekly concomitant boost in breast cancer radiotherapy feasibility acute sub-acute and short term late effects

    Directory of Open Access Journals (Sweden)

    Garelli Stefania

    2010-11-01

    Full Text Available Abstract Background Radiation therapy after lumpectomy is a standard part of breast conserving therapy for invasive breast carcinoma. The most frequently used schedule worldwide is 60 Gy in 30 fractions in 6 weeks, a time commitment that sporadically may dissuade some otherwise eligible women from undertaking treatment. The purpose and primary endpoint of this perspective study is to evaluate feasibility and short-term late toxicity in a hypofractionated whole breast irradiation schedule. Methods Between February and October 2008 we treated 65 consecutive patients with operable invasive early-stage breast cancer with a hypofractionated schedule of external beam radiation therapy. All patients were assigned to 39 Gy in 13 fractions in 3 weeks to the whole breast plus a concomitant weekly boost dose to the lumpectomy cavity of 3 Gy in 3 fractions. Results All the patients had achieved a median follow up of 24 months (range 21-29 months. At the end of treatment 52% presented grade 0 acute toxicity 39% had grade 1 and 9% had grade 2. At 6 months with all the patients assessed there were 34% case of grade 1 subacute toxicity and 6% of grade 2. At 12 months 43% and 3% of patients presented with clinical grade 1 and grade 2 fibrosis respectively and 5% presented grade 1 hyperpigmentation. The remaining patients were free of side effects. At 24 months, with 56 assessed, just 2 patients (3% showed grade 2 of late fibrosis. Conclusions The clinical results observed showed a reasonably good feasibility of the accelerated hypofractionated schedule in terms of acute, subacute and short-term late toxicity. This useful 13 fractions with a concomitant boost schedule seems, in selected patients, a biologically acceptable alternative to the traditional 30 days regime.

  3. Hypofractionated radiotherapy and stereotactic boost with concurrent and adjuvant temozolamide for glioblastoma in good performance status elderly patients – early results of a phase II trial.

    Directory of Open Access Journals (Sweden)

    Scott eFloyd

    2012-10-01

    Full Text Available Glioblastoma Multiforme (GBM is an aggressive primary brain neoplasm with dismal prognosis. Based on successful phase III trials, 60 Gy involved-field radiotherapy in 30 fractions over 6 weeks (Standard RT with concurrent and adjuvant temozolomide is currently the standard of care. In this disease, age and Karnofsky Performance Status (KPS are the most important prognostic factors. For elderly patients, clinical trials comparing standard RT with radiotherapy abbreviated to 40 Gy in 15 fractions over 3 weeks demonstrated similar outcomes, indicating shortened radiotherapy may be an appropriate option for elderly patients. However, these trials did not include temozolomide chemotherapy, and included patients with poor KPS, possibly obscuring benefits of more aggressive treatment for some elderly patients. We conducted a prospective Phase II trial to examine the efficacy of a hypofractionated radiation course followed by a stereotactic boost with concurrent and adjuvant temozolomide chemotherapy in elderly patients with good performance status. In this study, patients 65 years and older with a KPS >70 and histologically confirmed GBM received 40 Gy in 15 fractions with 3D conformal technique followed by a 1-3 fraction stereotactic boost to the enhancing tumor. All patients also received concurrent and adjuvant temozolomide. Patients were evaluated 1 month post-treatment and every 2 months thereafter. Between 2007 and 2010, 20 patients (9 males and 11 females were enrolled in this study. The median age was 75.4 years (range 65-87 years. At a median follow-up of 11 months (range 7-32 months, 12 patients progressed and 5 are alive. The median progression free survival was 11 months and the median overall survival was 13 months. There was no additional toxicity. These results indicate that elderly patients with good KPS can achieve outcomes comparable to the current standard of care using an abbreviated radiotherapy course, radiosurgery boost and

  4. A phase 1 dose-escalation study of the oral histone deacetylase inhibitor abexinostat in combination with standard hypofractionated radiotherapy in advanced solid tumors

    Science.gov (United States)

    Deutsch, Eric; Moyal, Elizabeth Cohen-Jonathan; Gregorc, Vanesa; Zucali, Paolo Andrea; Menard, Jean; Soria, Jean-Charles; Kloos, Ioana; Hsu, Jeff; Luan, Ying; Liu, Emily; Vezan, Remus; Graef, Thorsten; Rivera, Sofia

    2017-01-01

    Current treatments for advanced solid tumors tend to be only palliative. Although radiotherapy is administered with a curative intent, radioresistance and dose-limiting toxicities pose limitations to treatment. Abexinostat, an oral pan-histone deacetylase inhibitor, demonstrated enhanced sensitivity to radiation in various solid tumor cell lines. We conducted an exploratory, phase 1, dose-escalation study of abexinostat in combination with standard hypofractionated radiotherapy in patients with advanced solid tumors treated in a palliative setting. Among 58 treated patients, the median age was 61.5 years (range, 20-82); 47% of the patients had M1 stage disease, and 95% had received previous chemotherapy alone or chemotherapy in combination with surgery and/or radiotherapy. The recommended phase 2 dose was determined to be 90 mg/m2 (140 mg). Of the 51 patients evaluable for response, best overall response was 8% (1 complete response [CR], 3 partial responses [PRs]), and best loco-regional response was 12% (1 CR and 5 PRs) at a median follow-up of 16 weeks. Of note, patients with target or non-target brain lesions showed encouraging responses, with 1 patient achieving a best loco-regional response of CR. Treatment-emergent grade ≥3 adverse events (AEs) were few, with most common being thrombocytopenia (17%), lymphopenia (12%), and hypokalemia (7%). Six patients (10%) discontinued treatment due to AEs. No grade ≥3 prolongation of the QTc interval was observed, with no treatment discontinuations due to this AE. Oral abexinostat combined with radiotherapy was well tolerated in patients with advanced solid tumors. The combination may have potential for treatment of patients with brain lesions. PMID:28915584

  5. A phase 1 dose-escalation study of the oral histone deacetylase inhibitor abexinostat in combination with standard hypofractionated radiotherapy in advanced solid tumors.

    Science.gov (United States)

    Deutsch, Eric; Cohen-Jonathan Moyal, Elizabeth; Gregorc, Vanesa; Zucali, Paolo Andrea; Menard, Jean; Soria, Jean-Charles; Kloos, Ioana; Hsu, Jeff; Luan, Ying; Liu, Emily; Vezan, Remus; Graef, Thorsten; Rivera, Sofia

    2016-12-24

    Current treatments for advanced solid tumors tend to be only palliative. Although radiotherapy is administered with a curative intent, radioresistance and dose-limiting toxicities pose limitations to treatment. Abexinostat, an oral pan-histone deacetylase inhibitor, demonstrated enhanced sensitivity to radiation in various solid tumor cell lines. We conducted an exploratory, phase 1, dose-escalation study of abexinostat in combination with standard hypofractionated radiotherapy in patients with advanced solid tumors treated in a palliative setting. Among 58 treated patients, the median age was 61.5 years (range, 20-82); 47% of the patients had M1 stage disease, and 95% had received previous chemotherapy alone or chemotherapy in combination with surgery and/or radiotherapy. The recommended phase 2 dose was determined to be 90 mg/m2 (140 mg). Of the 51 patients evaluable for response, best overall response was 8% (1 complete response [CR], 3 partial responses [PRs]), and best loco-regional response was 12% (1 CR and 5 PRs) at a median follow-up of 16 weeks. Of note, patients with target or non-target brain lesions showed encouraging responses, with 1 patient achieving a best loco-regional response of CR. Treatment-emergent grade ≥3 adverse events (AEs) were few, with most common being thrombocytopenia (17%), lymphopenia (12%), and hypokalemia (7%). Six patients (10%) discontinued treatment due to AEs. No grade ≥3 prolongation of the QTc interval was observed, with no treatment discontinuations due to this AE. Oral abexinostat combined with radiotherapy was well tolerated in patients with advanced solid tumors. The combination may have potential for treatment of patients with brain lesions.

  6. High resolution computed tomography findings on the lung of early breast-cancer patients treated by postoperative breast irradiation with a hypofractionated radiotherapy schedule

    Directory of Open Access Journals (Sweden)

    Plataniotis G

    2005-01-01

    Full Text Available Context: Hypofractionated breast radiotherapy (RT, although convenient for patients and health care systems, could have a negative impact on normal tissues such as lung. Aims: To evaluate radiation-induced lung toxicity in early breast-cancer patients treated by hypofractionated RT. Settings and Design: We have been using the 42.5 Gy/16 fractions RT schedule since May 2003. As large fraction size is related to increased normal tissue toxicity we intended to investigate the possible radiation-induced lung toxicity to these patients, by performing high-resolution computed tomography (HRCT 6 months after the completion of the treatment. Methods and Material: A group of 30 consecutive early breast cancer patients (T1-2N0M0 have been treated by the above-mentioned RT schedule, using a pair of opposing tangential fields. The impact of chemotherapy and hormonotherapy and various breast size-related parameters on HRCT lung changes were investigated. Acute skin and breast tissue reactions were also recorded. Statistical analysis: used Correlation of numerical variables was investigated by Pearson correlation coefficient. Logistic regression analysis was used to investigate correlation between HRCT findings (present vs absent with other variables. Results: Minimal HRCT findings were evident in 15/30 patients. These included small septal lines, linear and subpleural opacities and to a lesser extend, focal-ground glass opacification. The HRCT findings were positively correlated only to field separation (distance between the entrance points of the tangential beams on the breast (H.R.=1.33, 95% CI: 1.013-1.75. Conclusions: The short 16-fraction RT schedule for early breast-cancer patients appears to have a minor effect on the underlying lung parenchyma.

  7. Radiotherapy using a laser proton accelerator

    CERN Document Server

    Murakami, Masao; Miyajima, Satoshi; Okazaki, Yoshiko; Sutherland, Kenneth L; Abe, Mitsuyuki; Bulanov, Sergei V; Daido, Hiroyuki; Esirkepov, Timur Zh; Koga, James; Yamagiwa, Mitsuru; Tajima, Toshiki

    2008-01-01

    Laser acceleration promises innovation in particle beam therapy of cancer where an ultra-compact accelerator system for cancer beam therapy can become affordable to a broad range of patients. This is not feasible without the introduction of a technology that is radically different from the conventional accelerator-based approach. The laser acceleration method provides many enhanced capabilities for the radiation oncologist. It reduces the overall system size and weight by more than one order of magnitude. The characteristics of the particle beams (protons) make them suitable for a class of therapy that might not be possible with the conventional accelerator, such as the ease for changing pulse intensity, the focus spread, the pinpointedness, and the dose delivery in general. A compact, uncluttered system allows a PET device to be located in the vicinity of the patient in concert with the compact gantry. The radiation oncologist may be able to irradiate a localized tumor by scanning with a pencil-like particle...

  8. Volumetric Modulated Arc-Based Hypofractionated Stereotactic Radiotherapy for the Treatment of Selected Intracranial Arteriovenous Malformations: Dosimetric Report and Early Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Subramanian, Sai; Srinivas, Chilukuri; Ramalingam, K.; Babaiah, M.; Swamy, S. Thirumalai; Arun, G.; Kathirvel, M.; Ashok, S. [Yashoda Super Specialty Hospital, Hyderabad (India); Clivio, Alessandro [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Fogliata, Antonella, E-mail: antonella.fogliata-cozzi@eoc.ch [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Nicolini, Giorgia [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Rao, K. Srinivasa; Reddy, T. Pratap; Amit, Jotwani [Yashoda Super Specialty Hospital, Hyderabad (India); Vanetti, Eugenio; Cozzi, Luca [Oncology Institute of Southern Switzerland, Bellinzona (Switzerland)

    2012-03-01

    Purpose: To evaluate, with a dosimetric and clinical feasibility study, RapidArc (a volumetric modulated arc technique) for hypofractionated stereotactic radiotherapy treatment of large arteriovenous malformations (AVMs). Methods and Materials: Nine patients were subject to multimodality imaging (magnetic resonance, computed tomography, and digital subtraction angiography) to determine nidus and target volumes, as well as involved organs at risk (optical structures, inner ear, brain stem). Plans for multiple intensity-modulated arcs with a single isocenter were optimized for a fractionation of 25 Gy in 5 fractions. All plans were optimized for 6-MV photon beams. Dose-volume histograms were analyzed to assess plan quality. Delivery parameters were reported to appraise technical features of RapidArc, and pretreatment quality assurance measurements were carried out to report on quality of delivery. Results: Average size of AVM nidus was 26.2 cm{sup 3}, and RapidArc plans provided complete target coverage with minimal overdosage (V{sub 100%} = 100% and V{sub 110%} < 1%) and excellent homogeneity (<6%). Organs at risk were highly spared. The D{sub 1%} to chiasm, eyes, lenses, optic nerves, and brainstem (mean {+-} SD) was 6.4 {+-} 8.3, 1.9 {+-} 3.8, 2.3 {+-} 2.2, 0.7 {+-} 0.9, 4.4 {+-} 7.2, 12.2 {+-} 9.6 Gy, respectively. Conformity index (CI{sub 95%}) was 2.2 {+-} 0.1. The number of monitor units per gray was 277 {+-} 45, total beam-on time was 2.5 {+-} 0.3 min. Planning vs. delivery {gamma} pass rate was 98.3% {+-} 0.9%. None of the patients developed acute toxicity. With a median follow-up of 9 months, 3 patients presented with deterioration of symptoms and were found to have postradiation changes but responded symptomatically to steroids. These patients continue to do well on follow-up. One patient developed headache and seizures, which was attributed to intracranial bleed, confirmed on imaging. Conclusion: Hypofractionated stereotactic radiotherapy can be

  9. Five-year outcomes from a prospective trial of image-guided accelerated hypofractionated proton therapy for prostate cancer.

    Science.gov (United States)

    Henderson, Randal H; Bryant, Curtis; Hoppe, Bradford S; Nichols, R Charles; Mendenhall, William M; Flampouri, Stella; Su, Zhong; Li, Zuofeng; Morris, Christopher G; Mendenhall, Nancy P

    2017-07-01

    To report 5-year outcomes of a prospective trial of image-guided accelerated hypofractionated proton therapy (AHPT) for prostate cancer. 215 prostate cancer patients accrued to a prospective institutional review board-approved trial of 70Gy(RBE) in 28 fractions for low-risk disease (n = 120) and 72.5Gy(RBE) in 29 fractions for intermediate-risk disease (n = 95). This trial excluded patients with prostate volumes of ≥60 cm(3) or International Prostate Symptom Scores (IPSS) of ≥15, patients on anticoagulants or alpha-blockers, and patients in whom dose-constraint goals for organs at risk (OAR) could not be met. Toxicities were graded prospectively according to Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. This trial can be found on ClinicalTrials.gov (NCT00693238). Median follow-up was 5.2 years. Five-year rates of freedom from biochemical and clinical disease progression were 95.9%, 98.3%, and 92.7% in the overall group and the low- and intermediate-risk subsets, respectively. Actuarial 5-year rates of late radiation-related CTCAE v3.0 grade 3 or higher gastrointestinal and urologic toxicities were 0.5% and 1.7%, respectively. Median IPSS before treatment and at 4+ years after treatment were 6 and 5 for low-risk patients and 4 and 6 for intermediate-risk patients. Image-guided AHPT 5-year outcomes show high efficacy and minimal physician-assessed toxicity in selected patients. These results are comparable to the 5-year results of our prospective trials of standard fractionated proton therapy for patients with low-risk and intermediate-risk prostate cancer. Longer follow-up and a larger cohort are necessary to confirm these findings.

  10. Application of hypofractionated conformal radiotherapy in non-small cell lung cancer%大分割适形放射治疗在非小细胞肺癌中的应用

    Institute of Scientific and Technical Information of China (English)

    盛李明; 许亚萍; 马胜林

    2011-01-01

    大分割适形放疗技术较常规分割技术能给予肿瘤更高的生物有效剂量,近年来研究显示,对早期不能手术非小细胞肺癌(NSCLC)患者,大分割适形放疗高效低毒,是可选择的治疗方案.许多临床Ⅰ、Ⅱ期研究显示,局部晚期NSCLC患者对大分割适形放疗耐受性良好.放射物理学模型和相关临床研究显示,与常规分割放疗模式相比大分割适形放疗不会增加放射性肺炎发生率.%Hypofractionated conformal radiotherapy is capable to deliver much higher doses to the cancer than is possible with standard techniques. Recently there is data suggesting that the early stage nonsmall cell lung cancer ( NSCLC) which is not suitable to surgery is likely to benefit from this regimen, with low lung toxicity. Manyphase Ⅰ-Ⅱ studies showed that the patients with locally advanced NSCLC are well-tolerated to hypofractionated conformal radiotherapy. The model of radio-physic and relative clinical studies suggest that hy-pofractionation would not increase the risk of radiation pneumonitis compared to standard therapy.

  11. Moderate hypofractionated image-guided thoracic radiotherapy for locally advanced node-positive non-small cell lung cancer patients with very limited lung function: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Manapov, Farkhad; Roengvoraphoj, Olarn; Li, Ming Lun; Eze, Chukwuka [Dept. of Radiation Oncology, Ludwig-Maximilian University of Munich, Munich (Germany)

    2017-06-15

    Patients with locally advanced lung cancer and very limited pulmonary function (forced expiratory volume in 1 second [FEV1] ≤ 1 L) have dismal prognosis and undergo palliative treatment or best supportive care. We describe two cases of locally advanced node-positive non-small cell lung cancer (NSCLC) patients with very limited lung function treated with induction chemotherapy and moderate hypofractionated image-guided radiotherapy (Hypo-IGRT). Hypo-IGRT was delivered to a total dose of 45 Gy to the primary tumor and involved lymph nodes. Planning was based on positron emission tomography-computed tomography (PET/ CT) and four-dimensional computed tomography (4D-CT). Internal target volume (ITV) was defined as the overlap of gross tumor volume delineated on 10 phases of 4D-CT. ITV to planning target volume margin was 5 mm in all directions. Both patients showed good clinical and radiological response. No relevant toxicity was documented. Hypo-IGRT is feasible treatment option in locally advanced node-positive NSCLC patients with very limited lung function (FEV1 ≤ 1 L)

  12. 乳腺癌改良根治术后大分割放疗的研究%Clinical trial of postmastectomy hypofractionation radiotherapy in breast cancer

    Institute of Scientific and Technical Information of China (English)

    赵淑红; 曹席明; 刘国强; 高晖; 于娇; 王青

    2014-01-01

    Objective:To investigate the efficacy and toxicity of hypofractionation radiotherapy in patients with breast cancer after postmastectomy.Methods:A total of 85 postmastectomy with breast cancer after postmastectomy were included,treated by ipsilateral chest wall and supraclavicular nodal radiation.41 patients received to 42.56Gy/16f,22-24 days(HF group),44 patients received to 50Gy/25f,33-35 days(CF group).The incidence of local con-trol,distant metastasis and acute radiation toxicity were evaluated.Results:After a median follow up of 15 months,the follow-up rate was 100%.The 2-year overall survival rate was 100%.No patient had locoregional recurrence within radiation field.The distant metastasis rates in HF and CF were 12.2%,11.4%(P=0.843).Grade 1 neutropenia oc-curred,developed grade 2 radiation dermatitis,developed grade 2 radiation pneumonitis in HF and CF were 24.4%vs 27.3%(P=0.762),17.1% vs 13.6%(P=0.660),4.9% vs 6.8%(P=0.704).Conclusion:Postmastectomy hypofractionation radiotherapy provides similar results to conventional radiotherapy in survival rate and toxicity.%目的:探讨乳腺癌改良根治术后大分割放疗的疗效及不良反应。方法:2011年-2012年陕西省人民医院收治高危乳腺癌患者85例,行同侧胸壁和锁骨上下区照射,其中41例行大分割放疗(大分割组),DT 42.56Gy/16f,总疗程22-24天;44例行常规分割放疗(常规组),DT 50Gy/25f,总疗程33-35天。观察肿瘤的局部控制率、远处转移率及急性放疗反应的发生率。结果:中位随访时间为15个月,随访率为100%。全组2年生存率均为100%,无照射野内复发。大分割组和常规组远处转移率分别为12.2%、11.4%(χ2=0.039,P=0.843)。大分割组和常规组1级白细胞减少、2级放射性皮炎、2级放射性肺炎发生率分别为24.4%与27.3%(χ2=0.092,P=0.762)、17.1%与13.6%(χ2=0.194,P=0.660)、4.9

  13. Hypofractionation for radiotherapy of prostate cancer using a low alfa/beta ratio - possible reasons for concerns? An example of five dimensional radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lennernaes, Bo (Dept. of Oncology, Sahlgrenska Hospital and Academy, Univ. of Gothenburg, Gothenburg (Sweden)), e-mail: bo.lennernas@telia.com; Nilsson, Sten; Levitt, Seymour (Dept. of Oncology/Pathology, Karolinska Univ. Hospital and Institutet, Stockholm (Sweden))

    2011-06-15

    It is very attractive, due to the assumed low alfa/beta ratio of prostate cancer (PC), to construct new treatment schedules for prostate cancer using only a few large fractions of radiation (hypofractionation). This will widen the therapeutic window since the ratio for PC might be lower than that of the organs at risk (OAR). PC is an extremely variable disease and often contains both highly and poorly differentiated cells. It is reasonable to assume that different cells have different patterns of radiosensitivity, i.e. alfa/beta ratios and proliferation. In this study we will simulate the effect on the outcome of the treatment with different fractionations and different ratios. Material and methods. In this simulation we use an extension of the Linear Quadratic (LQ)/Biological Effective Dose (BED) formula called the dose volume inhomogeneity corrected BED (DVIC-BED). In the formula the tumour volume is divided in 50 subvolumes (step of 2%) and it is possible to calculate the relative effect of the treatment with different ratios (1.5, 4 and 6.5) in different subvolumes. Results. The simulations demonstrate that only a small portion (5-10%) of cells with a higher ratio will dramatically change the effect of the treatment. Increasing the total dose can compensate this, but this will on the other hand increase the dose to the OAR and also the risk for severe side effects. Conclusion. These simulations highlight possible reasons for concerns about the use of hypofractionation for pathologically heterogeneous tumours, such as prostate cancer, and also demonstrate the need for testing new treatment schedules using both high and low ratios

  14. Hypofractionated Prostate Radiotherapy with or without Conventionally Fractionated Nodal Irradiation: Clinical Toxicity Observations and Retrospective Daily Dosimetry

    Directory of Open Access Journals (Sweden)

    Andrew M. McDonald

    2012-01-01

    Methods and Materials. Fifty-seven patients received pelvic image-guided IMRT to 50.4 Gy in 28 fractions with a hypofractionated simultaneous boost to the prostate to 70 Gy. Thirty-one patients received prostate-only treatment to 70 Gy in 28 fractions. Results. Median followup was 41.1 months. Early grade ≥2 urinary toxicity rates were 49% (28 of 57 for patients receiving ENI and 58% (18 of 31 for those not (P=0.61. Early grade ≥2 rectal toxicity rates were 40% (23 of 57 and 23% (7 of 31, respectively (P=0.09. The addition of ENI resulted in a 21% actuarial rate of late grade ≥2 rectal toxicity at 4 years, compared to 0% for patients treated to the prostate only (P=0.02. Retrospective daily dosimetry of patients experiencing late rectal toxicity revealed an average increase of 2.67% of the rectal volume receiving 70 Gy compared to the original plan. Conclusions. The addition of ENI resulted in an increased risk of late rectal toxicity. Grade ≥2 late rectal toxicity was associated with worse daily rectal dosimetry compared to the treatment plan.

  15. Advances in hypofractionated-high-dose radiotherapy for prostate cancer%前列腺癌高剂量大分割放射治疗研究进展

    Institute of Scientific and Technical Information of China (English)

    刘海霞; 马林

    2015-01-01

    Prostate cancer (PC) is a common male malignant tumor with increasing morbidity and mortality in China. With the development of technologies of accurate radiotherapy, external beam radiation therapy (EBRT) has become one of the radical therapeutic methods for localized PC. Due to the special biological characteristics of PC, hypofractionated-high-dose radiotherapy can achieve better therapeutic results in clinic. The current state of hypofractionated-high-dose radiotherapy in PC is summarized in this review.%前列腺癌是常见的男性恶性肿瘤之一,在我国,其发病率和死亡率呈逐年上升趋势。随着精确放疗技术的飞速发展,外照射放疗已成为局限期前列腺癌的根治性手段之一。由于前列腺癌特殊的组织学特点,大分割放疗越来越多地应用于临床。本文就前列腺癌大分割剂量根治性放疗的研究进展做一综述。

  16. Radical hypo-fractionated radiotherapy with volumetric modulated arc therapy in lung cancer. A retrospective study of elderly patients with stage III disease

    Energy Technology Data Exchange (ETDEWEB)

    Franceschini, D. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Istituto Clinico Humanitas Cancer Center, Rozzano (Milan) (Italy); De Rose, F.; Navarria, P.; Clerici, E.; Franzese, C.; Comito, T.; Tozzi, A.; Iftode, C.; D' Agostino, G. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Cozzi, L.; Sorsetti, M. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Humanitas University, Department of Biomedical Sciences, Milan (Italy)

    2017-05-15

    This study aimed to analyse the feasibility and acute toxicity of radical hypo-fractionated radiotherapy (RT) for elderly patients with non-small-cell lung cancer (NSCLC). We conducted a retrospective evaluation of treatment with volumetric modulated arc therapy (VMAT) of elderly patients affected by stage III inoperable NSCLC. The dose prescription was 56 Gy in 20 fractions, 55 Gy in 22 fractions, or 50 Gy in 20 fractions. Target volume included only the primary lesion and the infiltrated lymph nodes. The primary end point was acute and late toxicity, while secondary end points were progression-free survival (PFS), and overall survival (OS). In all, 41 patients were included in this analysis. The mean age of the patients was 78.6 years, and 22 patients had staged IIIA while 19 patients had stage IIIB disease. All but one patient had pathological nodal involvement; 15 patients received chemotherapy before RT. Acute grade 1-2 toxicity was recorded in 25 (61%) patients. Late toxicity was recorded in 13 (32%) patients. No cases of G3 or G4 toxicity were recorded. Complete response was obtained in two (5%) patients, 26 (63%) showed a partial response, and two (5%) experience disease progression. At a mean follow-up of 9.9 months (range, 1.1-25.4), 17 patients had died from disease progression, one died from other causes, and 23 were alive. Median OS was 13.7 ± 1.5 months (95% CI: 10.7-16.7), OS at 12 and 18 months was 51.3 ± 9.5% and 35.1 ± 10.1%, respectively. Median PFS was 13.7 ± 2.3 months (95% CI: 9.1-18.2), and PFS at 12 and 18 months was 50.1 ± 9.9% and 38.9 ± 10.4%, respectively. Radical hypo-fractionated VMAT is a promising treatment for locally advanced NSCLC in the elderly. The use of hypo-fractionated radiotherapy for lung cancer in older patients can be considered a valuable approach, particularly for patients with poor performance status or refusing other treatment approaches. (orig.) [German] Durchfuehrbarkeit und Nebenwirkungen der radikalen

  17. Hypofractionated external beam radiotherapy as retreatment for symptomatic non-small-cell lung carcinoma: an effective treatment?

    NARCIS (Netherlands)

    Kramer, G.W.P.M.; Gans, S.; Ullmann, E.F.; Meerbeeck, J.P. van; Legrand, C.; Leer, J.W.H.

    2004-01-01

    PURPOSE: To evaluate prospectively the efficacy, toxicity, and duration of the palliative effect of retreatment with external beam radiotherapy in symptomatic patients with recurrent non-small-cell lung cancer. METHODS AND MATERIALS: Twenty-eight symptomatic patients with local recurrence of

  18. Individualized dose prescription for hypofractionation in advanced non-small-cell lung cancer radiotherapy: an in silico trial.

    NARCIS (Netherlands)

    Hoffmann, A.L.; Troost, E.G.C.; Huizenga, H.; Kaanders, J.H.A.M.; Bussink, J.

    2012-01-01

    PURPOSE: Local tumor control and outcome remain poor in patients with advanced non-small-cell lung cancer (NSCLC) treated by external beam radiotherapy. We investigated the therapeutic gain of individualized dose prescription with dose escalation based on normal tissue dose constraints for various h

  19. Hypofractionated stereotactic radiotherapy of acoustic neuroma. Volume changes and hearing results after 89-month median follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Kranzinger, Manfred; Fastner, Gerd [Paracelsus Medical University Clinics (PMU), University Clinic of Radiotherapy and Radio-Oncology, Salzburg County Hospital, Salzburg (Austria); Zehentmayr, Franz; Sedlmayer, Felix [Paracelsus Medical University Clinics (PMU), University Clinic of Radiotherapy and Radio-Oncology, Salzburg County Hospital, Salzburg (Austria); Salzburg County Hospital, Paracelsus Medical University Clinics, radART - Institute for Research and Development on Advanced Radiation Technologies, Salzburg (Austria); Oberascher, Gerhard [Paracelsus Medical University Clinics (PMU), University Clinic of Ear, Nose and Throat Diseases, Salzburg County Hospital, Salzburg (Austria); Merz, Florian; Rahim, Hassan [Salzburg County Hospital, Paracelsus Medical University Clinics, Medical Radiation Protection Unit, Salzburg (Austria); Nairz, Olaf [Clinic Bad Trissl, Oberaudorf (Germany)

    2014-09-15

    The goal of this work was to evaluate toxicity and local control following hypofractionated stereotactic radiation treatment with special focus on changes in tumor volume and hearing capacity. In all, 29 patients with unilateral acoustic neuroma were treated between 2001 and 2007 within a prospective radiation protocol (7 x 4 Gy ICRU dose). Median tumor volume was 0.9 ml. Follow-up started at 6 months and was repeated annually with MRI volumetry and audiometry. Hearing preservation was defined as preservation of Class A/B hearing according to the guidelines of the American Academy of Otolaryngology (1995). No patient had any intervention after a median imaging follow-up of 89.5 months, one patient showed radiological progression. Transient increase of tumor volume developed in 17/29 patients, whereas 22/29 patients (75.9 %) presented with a volume reduction at last follow-up. A total of 21 patients were eligible for hearing evaluation. Mean pure tone average (PTA) deteriorated from 39.3 to 65.9 dB and mean speech discrimination score (SDS) dropped from 74.3 to 38.1 %. The 5-year actuarial Class A/B hearing preservation rate was 50.0 ± 14.4 %. Radiation increases only minimally, if at all, the hearing deterioration which emerges by observation alone. Presbyacusis is not responsible for this deterioration. Transient tumor enlargement is common. Today radiation of small- and medium-sized acoustic neuroma can be performed with different highly conformal techniques as fractionated treatment or single low-dose radiosurgery with equal results regarding tumor control, hearing preservation, and side effects. Hypofractionation is more comfortable for the patient than conventional regimens and represents a serious alternative to frameless radiosurgery. (orig.) [German] Ziel der Studie war die Evaluierung der Toxizitaet und der lokalen Tumorkontrolle einer hypofraktionierten stereotaktischen Bestrahlung mit besonderem Augenmerk auf Veraenderungen von Tumorvolumen und

  20. Myelopathy following hyperfractionated accelerated radiotherapy for anaplastic thyroid carcinoma.

    Science.gov (United States)

    Wong, C S; Van Dyk, J; Simpson, W J

    1991-01-01

    From 1975 to 1982, 32 patients with a diagnosis of anaplastic carcinoma of the thyroid were entered into a protocol of hyperfractionated accelerated radiotherapy. The tumor dose was 30-45 Gy at 1 Gy per fraction given 4 times a day at 3-h intervals. The results were disappointing with a median survival of less than 6 months. Two patients developed radiation myelopathy at 8 and 13 months, total spinal cord dose being 39.9 and 48.3 Gy, respectively. The risk of spinal cord damage was much higher than expected. The possible radiobiological causes and clinical implications are discussed.

  1. Dosimetric effect of intrafraction motion and residual setup error for hypofractionated prostate intensity-modulated radiotherapy with online cone beam computed tomography image guidance.

    LENUS (Irish Health Repository)

    Adamson, Justus

    2012-02-01

    PURPOSE: To quantify the dosimetric effect and margins required to account for prostate intrafractional translation and residual setup error in a cone beam computed tomography (CBCT)-guided hypofractionated radiotherapy protocol. METHODS AND MATERIALS: Prostate position after online correction was measured during dose delivery using simultaneous kV fluoroscopy and posttreatment CBCT in 572 fractions to 30 patients. We reconstructed the dose distribution to the clinical tumor volume (CTV) using a convolution of the static dose with a probability density function (PDF) based on the kV fluoroscopy, and we calculated the minimum dose received by 99% of the CTV (D(99)). We compared reconstructed doses when the convolution was performed per beam, per patient, and when the PDF was created using posttreatment CBCT. We determined the minimum axis-specific margins to limit CTV D(99) reduction to 1%. RESULTS: For 3-mm margins, D(99) reduction was <\\/=5% for 29\\/30 patients. Using post-CBCT rather than localizations at treatment delivery exaggerated dosimetric effects by ~47%, while there was no such bias between the dose convolved with a beam-specific and patient-specific PDF. After eight fractions, final cumulative D(99) could be predicted with a root mean square error of <1%. For 90% of patients, the required margins were <\\/=2, 4, and 3 mm, with 70%, 40%, and 33% of patients requiring no right-left (RL), anteroposterior (AP), and superoinferior margins, respectively. CONCLUSIONS: For protocols with CBCT guidance, RL, AP, and SI margins of 2, 4, and 3 mm are sufficient to account for translational errors; however, the large variation in patient-specific margins suggests that adaptive management may be beneficial.

  2. A randomized trial comparing hypofractionated and conventionally fractionated three-dimensional external-beam radiotherapy for localized prostate adenocarcinoma. A report on acute toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Norkus, Darius; Miller, Albert; Kurtinaitis, Juozas; Valuckas, Konstantinas Povilas [Dept. of Radiotherapy, Inst. of Oncology, Vilnius Univ. (Lithuania); Haverkamp, Uwe [Dept. of Radiology, Clemenshospital, Muenster (Germany); Popov, Sergey [Dept. of Radiotherapy, Riga Eastern Hospital, Latvian Oncology Center, Riga (Latvia); Prott, Franz-Josef [Inst. of Radiology and Radiotherapy (RNS), St. Josefs Hospital, Wiesbaden (Germany)

    2009-11-15

    Purpose: to compare acute gastrointestinal (GI) and genitourinary (GU) toxicity between patient groups with localized prostate adenocarcinoma, treated with conventionally fractionated (CFRT) and hypofractionated (HFRT) three-dimensional conformal external-beam radiotherapy (3D-CRT). Patients and methods: 91 patients were enrolled into a randomized study with a minimum follow-up of 3 months. 44 men in the CFRT arm were irradiated with 74 Gy in 37 fractions at 2 Gy per fraction for 7.5 weeks. 47 men in the HFRT arm were treated with 57 Gy in 17 fractions for 3.5 weeks, given as 13 fractions of 3 Gy plus four fractions of 4.5 Gy. The clinical target volume (CTV) included the prostate and the base of seminal vesicles. The CTV-to-PTV (planning target volume) margin was 8-10 mm. Study patients had portal imaging and/or simulation performed on the first fractions and repeated at least weekly. Results: no acute grade 3 or 4 toxicities were observed. The grade 2 GU acute toxicity proportion was significantly lower in the HFRT arm: 19.1% versus 47.7% ({chi}{sup 2}-test, p = 0.003). The grade 2 GU acute toxicity-free survival was significantly better in the HFRT arm (log-rank test, p = 0.008). The median duration of overall GI acute toxicity was shorter with HFRT: 3 compared to 6 weeks with CFRT (median test, p = 0.017). Conclusion: in this first evaluation, the HFRT schedule is feasible and induces acceptable or even lower acute toxicity compared with the toxicities in the CFRT schedule. Extended follow-up is needed to justify this fractionation schedule's safety in the long term. (orig.)

  3. Whole Brain Irradiation and Hypo-fractionation Radiotherapy for the Metastases in Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Xingting GU

    2016-04-01

    Full Text Available Up to 40% non-small cell lung cancer patients developed brain metastasis during progression. Multiple brain metastases are common in non-small cell lung cancer. The prognosis of brain metastasis is poor with median survival of less than 1 year. Radio therapy for brain metastases has gradually developed from whole brain radiotherapy (WBRT to various radiation strategies. WBRT, surgery+WBRT, stereotactic radiotherapy+WBRT or WBRT with simultaneous integrated boost (SIB, etc. have better overall survival than those untreated patients. The damage of the cognitive function from WBRT has been realized recently, however, options of radiation strategies for long expected survival patients remain controversial. This paper will discuss different WBRT strategies and treatment side effects of non-small cell lung cancer with brain metastases.

  4. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours.

    Science.gov (United States)

    Arcangeli, Stefano; Falcinelli, Lorenzo; Bracci, Stefano; Greco, Alessandro; Monaco, Alessia; Dognini, Jessica; Chiostrini, Cinzia; Bellavita, Rita; Aristei, Cynthia; Donato, Vittorio

    2017-03-01

    To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume. 52% of the lesions received a biological equivalent dose (BED10) ≥100 Gy. Assessment of tumour response was based on the Response Evaluation Criteria in Solid Tumours 1.1 criteria coupled with fluorine-18 fludeoxyglucose/positron emission tomography-CT. Toxicity monitoring was focused on treatment-related pulmonary adverse events according to the Common Terminology Criteria for Adverse Events v. 4.0. Acute and late events were classified as radiation pneumonitis (RP) and radiation fibrosis (RF), respectively. Survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate analyses of survival were performed using the Cox proportional hazards model. After a median follow-up of 12 months (range, 3-31 months), no instances of ≥Grade 4 RP was documented, and clinically severe (Grade 3) RP occurred in 5.8% of the patients. 2 (3%) patients developed a late severe (≥Grade 3) symptomatic RF. No specific pattern of CT lung injury was demonstrated, in both acute and late settings. Median overall survival (OS) and progression-free survival (PFS) for the entire population were 30.8 and 14.1 months, respectively. At multivariate analysis (MVA), BED10 ≥ 100 Gy and KPS ≥ 90 emerged as significant prognostic factors for OS (p = 0.01 and p = 0.001, respectively), and BED10 ≥ 100 Gy for PFS (p = 0.02). Our findings show that HHT adjusted for tumour location and/or target volume is an effective treatment with an acceptable toxicity profile in patients who are medically inoperable with lung tumours and is not

  5. 11C choline PET guided salvage radiotherapy with volumetric modulation arc therapy and hypofractionation for recurrent prostate cancer after HIFU failure: preliminary results of tolerability and acute toxicity.

    Science.gov (United States)

    Alongi, Filippo; Liardo, Rocco L E; Iftode, Cristina; Lopci, Egesta; Villa, Elisa; Comito, Tiziana; Tozzi, Angelo; Navarria, Pierina; Ascolese, Anna M; Mancosu, Pietro; Tomatis, Stefano; Bellorofonte, Carlo; Arturo, Chiti; Scorsetti, Marta

    2014-10-01

    The purpose of this work was to evaluate tolerance, feasibility and acute toxicity in patients undergoing salvage radiotherapy after high-intensity focused ultrasound (HIFU) failure. From 2005 to 2011 a total of 15 patients were treated with HIFU as primary radical treatment. Between July 2011 and February 2013, all 15 patients presented biochemical relapse after HIFU and 11C choline PET documenting intrapostatic-only failure. Salvage EBRT was performed with moderate hypofractionation schedule in 28 fractions with volumetric modulation arc therapy (VMAT). Genito-urinary (GU) and rectal and bowel toxicity were scored by common terminology criteria for adverse events version 4 (CTCAE V.4) scale. Biochemical response was assessed by ASTRO Phoenix criteria. Median age of patients was 67 years (range: 53-85). The median Gleason score was 7 (range: 6-9). The median prostate specific antigen (PSA) at the time of biochemical relapse after HIFU was 5.2 ng/mL (range: 2-64.2). Seven of the 15 patients received androgen deprivation therapy (ADT) started after HIFU failure, interrupted before 11C choline PET and radiotherapy. Median prescribed dose was 71.4 Gy (range: 71.4-74.2 Gy) in 28 fractions. No radiation related major upper gastrointestinal (GI), rectal and GU toxicity were experienced. GU, acute grade 1 and grade 2 toxicities were recorded in 7/15 and 4/15 respectively; bowel acute grade 1 and grade 2 toxicities in 4/15 and 1/15; rectal acute grade 1 and grade 2 toxicities in 3/15 and 2/15 respectively. No grade 3 or greater acute or late toxicities occurred. Biochemical control was assessed in 12/15 (80%) patients. With a median follow up of 12 months, three out of 15 patients, with biochemical relapse, showed lymph-nodal recurrence. Our early clinical results and biochemical data confirm the feasibility and show a good tolerance of the 11C choline PET guided salvage radiation therapy after HIFU failure. The findings of low acute toxicity is encouraging, but longer

  6. Hypofractionation does not increase radiation pneumonitis risk with modern conformal radiation delivery techniques

    DEFF Research Database (Denmark)

    Vogelius, Ivan R; Westerly, David C; Cannon, George M

    2010-01-01

    To study the interaction between radiation dose distribution and hypofractionated radiotherapy with respect to the risk of radiation pneumonitis (RP) estimated from normal tissue complication probability (NTCP) models.......To study the interaction between radiation dose distribution and hypofractionated radiotherapy with respect to the risk of radiation pneumonitis (RP) estimated from normal tissue complication probability (NTCP) models....

  7. Accelerated Deformable Registration of Repetitive MRI during Radiotherapy in Cervical Cancer

    DEFF Research Database (Denmark)

    Noe, Karsten Østergaard; Tanderup, Kari; Kiritsis, Christian;

    2006-01-01

    Tumour regression and organ deformations during radiotherapy (RT) of cervical cancer represent major challenges regarding accurate conformation and calculation of dose when using image-guided adaptive radiotherapy. Deformable registration algorithms are able to handle organ deformations, which can...... be useful with advanced tools such as auto segmentation of organs and dynamic adaptation of radiotherapy. The aim of this study was to accelerate and validate deformable registration in MRI-based image-guided radiotherapy of cervical cancer.    ...

  8. Phase I Trial of Hypofractionated Intensity-Modulated Radiotherapy With Temozolomide Chemotherapy for Patients With Newly Diagnosed Glioblastoma Multiforme

    Energy Technology Data Exchange (ETDEWEB)

    Chen Changhu, E-mail: changhu.chen@ucdenver.edu [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO (United States); Damek, Denise [Department of Neurology, University of Colorado School of Medicine, Aurora, CO (United States); Gaspar, Laurie E. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO (United States); Waziri, Allen; Lillehei, Kevin [Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO (United States); Kleinschmidt-DeMasters, B.K. [Department of Pathology, University of Colorado School of Medicine, Aurora, CO (United States); Robischon, Monica; Stuhr, Kelly; Rusthoven, Kyle E.; Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO (United States)

    2011-11-15

    Purpose: To determine the maximal tolerated biologic dose intensification of radiotherapy using fractional dose escalation with temozolomide (TMZ) chemotherapy in patients with newly diagnosed glioblastoma multiforme. Methods and Materials: Patients with newly diagnosed glioblastoma multiforme after biopsy or resection and with adequate performance status, bone marrow, and organ function were eligible. The patients underwent postoperative intensity-modulated radiotherapy (IMRT) with concurrent and adjuvant TMZ. All patients received a total dose of 60 Gy to the surgical cavity and residual tumor, with a 5-mm margin. IMRT biologic dose intensification was achieved by escalating from 3 Gy/fraction (Level 1) to 6 Gy/fraction (Level 4) in 1-Gy increments. Concurrent TMZ was given at 75 mg/m{sup 2}/d for 28 consecutive days. Adjuvant TMZ was given at 150-200 mg/m{sup 2}/d for 5 days every 28 days. Dose-limiting toxicity was defined as any Common Terminology Criteria for Adverse Events, version 3, Grade 3-4 nonhematologic toxicity, excluding Grade 3 fatigue, nausea, and vomiting. A standard 3+3 Phase I design was used. Results: A total of 16 patients were accrued (12 men and 4 women, median age, 69 years; range, 34-84. The median Karnofsky performance status was 80 (range, 60-90). Of the 16 patients, 3 each were treated at Levels 1 and 2, 4 at Level 3, and 6 at Level 4. All patients received IMRT and concurrent TMZ according to the protocol, except for 1 patient, who received 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 7.5 (range, 0-12). The median survival was 16.2 months (range, 3-33). One patient experienced vision loss in the left eye 7 months after IMRT. Four patients underwent repeat surgery for suspected tumor recurrence 6-12 months after IMRT; 3 had radionecrosis. Conclusions: The maximal tolerated IMRT fraction size was not reached in our study. Our results have shown that 60 Gy IMRT delivered in 6-Gy fractions within 2 weeks with

  9. WE-D-BRE-02: BEST IN PHYSICS (THERAPY) - Radiogenomic Modeling of Normal Tissue Toxicities in Prostate Cancer Patients Receiving Hypofractionated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Coates, J; Jeyaseelan, K; Ybarra, N; David, M; Faria, S; Souhami, L; Cury, F; Duclos, M; Naqa, I El [McGill University, Montreal, QC (Canada)

    2014-06-15

    Purpose: It has been realized that inter-patient radiation sensitivity variability is a multifactorial process involving dosimetric, clinical, and genetic factors. Therefore, we explore a new framework to integrate physical, clinical, and biological data denoted as radiogenomic modeling. In demonstrating the feasibility of this work, we investigate the association of genetic variants (copy number variations [CNVs] and single nucleotide polymorphisms [SNPs]) with radiation induced rectal bleeding (RB) and erectile dysfunction (ED) while taking into account dosimetric and clinical variables in prostate cancer patients treated with curative irradiation. Methods: A cohort of 62 prostate cancer patients who underwent hypofractionated radiotherapy (66 Gy in 22 fractions) was retrospectively genotyped for CNV and SNP rs25489 in the xrcc1 DNA repair gene. Dosevolume metrics were extracted from treatment plans of 54 patients who had complete dosimetric profiles. Treatment outcomes were considered to be a Result of functional mapping of radiogenomic input variables according to a logit transformation. Model orders were estimated using resampling by leave-one out cross-validation (LOO-CV). Radiogenomic model performance was evaluated using area under the ROC curve (AUC) and LOO-CV. For continuous univariate dosimetric and clinical variables, Spearmans rank coefficients were calculated and p-values reported accordingly. In the case of binary variables, Chi-squared statistics and contingency table calculations were used. Results: Ten patients were found to have three copies of xrcc1 CNV (RB: χ2=14.6 [p<0.001] and ED: χ2=4.88[p=0.0272]) and twelve had heterozygous rs25489 SNP (RB: χ2=0.278[p=0.599] and ED: χ2=0.112[p=0.732]). LOO-CV identified penile bulb D60 as the only significant QUANTEC predictor (rs=0.312 [p=0.0145]) for ED. Radiogenomic modeling yielded statistically significant, cross-validated NTCP models for RB (rs=0.243[p=0.0443], AUC=0.665) and ED (rs=0.276[p=0

  10. Observation of short-term curative effect of hypofractionated conformal radiotherapy in advanced esophageal cancer%中晚期食管癌大分割适形放疗近期疗效观察

    Institute of Scientific and Technical Information of China (English)

    魏洁; 吕星旺; 杜兴龙; 丁仁平

    2014-01-01

    目的:探讨采用大分割适形放射治疗中晚期食管癌的近期疗效和毒副反应。方法将符合入组条件的49例中晚期食管癌患者行适形放射治疗,并随机分为两组。常规分割适形放疗组21例,每次剂量2.0 Gy,总剂量60.0~68.0 Gy;大分割适形放疗组28例,每次剂量2.4~3.0 Gy,总剂量60.0~62.5 Gy。两组均为每天照射1次,每周5次,以95%等剂量曲线作为剂量参考线。结果常规分割组和大分割组有效率分别为90.5%和92.9%;1年局控率分别为76.2%和82.1%;1年生存率分别为66.7%和71.4%;大分割组放射性食管炎及白细胞下降略高于常规分割组,差异无统计学意义(P>0.05)。结论采用大分割三维适形放疗治疗中晚期食管癌是可行的。%Objective To explore the short-term curative effect and adverse reaction of hypofractionated conformal radiation therapy in treating advanced esophageal carcinoma .Methods Forty-nine patients with advanced esophageal carcinoma that would be treated with conformal radiotherapy were recruited in this study and were divided into two groups ,i.e.the conventional fractionation group which included 21 patients and were treated with the routine dose (2.0 Gy daily and the accumulated total dose was 60.0~68.0 Gy);the hypofractionated group which included 28 patients and were treated with hypofractionated conformal radiation therapy (2.4~3.0 Gy daily and the accumulated total dose was 60.0~62.5 Gy).Two groups were all treated once a day ,five times a week.The 95% of the isodose curve was taken as the reference dose curve.Results The response rates of the conventional group and the hypofractionated were 90.5%and 92.9%,respectively, 1-year local control rates were 76.2%and 82.1%,respectively,and 1-year survival rates were 66.7%and 71.4%,respectively.Besides,the rates of acute radiation-induced esophagitis and leucopenia in the hypofractionated

  11. CyberKnife stereotactic radiotherapy as monotherapy for low- to intermediate-stage prostate cancer: Early experience, feasibility, and tolerance

    NARCIS (Netherlands)

    S. Aluwini (Shafak); P.H. van Rooij (Peter); M.S. Hoogeman (Mischa); C.H. Bangma (Chris); W.J. Kirkels (Wim); L. Incrocci (Luca); I.-K.K. Kolkman-Deurloo (Inger-Karina)

    2010-01-01

    textabstractPurpose: The CyberKnife (CK), a linear accelerator mounted on a robotic device, enables excellent dose conformation to the target and minimizes dose to surrounding normal tissue. It is a very suitable device for performing hypofractionated stereotactic body radiotherapy as monotherapy fo

  12. Intrafraction Variation of Mean Tumor Position During Image-Guided Hypofractionated Stereotactic Body Radiotherapy for Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Grills, Inga S., E-mail: igrills@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Kestin, Larry L.; McGrath, Samuel; Ye Hong; Martin, Shannon K.; Yan Di [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2012-04-01

    Purpose: Prolonged delivery times during daily cone-beam computed tomography (CBCT)-guided lung stereotactic body radiotherapy (SBRT) introduce concerns regarding intrafraction variation (IFV) of the mean target position (MTP). The purpose of this study was to evaluate the magnitude of the IFV-MTP and to assess target margins required to compensate for IFV and postonline CBCT correction residuals. Patient, treatment, and tumor characteristics were analyzed with respect to their impact on IFV-MTP. Methods and Materials: A total of 126 patients with 140 tumors underwent 659 fractions of lung SBRT. Dose prescribed was 48 or 60 Gy in 12 Gy fractions. Translational target position correction of the MTP was performed via onboard CBCT. IFV-MTP was measured as the difference in MTP between the postcorrection CBCT and the posttreatment CBCT excluding residual error. Results: IFV-MTP was 0.2 {+-} 1.8 mm, 0.1 {+-} 1.9 mm, and 0.01 {+-} 1.5 mm in the craniocaudal, anteroposterior, and mediolateral dimensions and the IFV-MTP vector was 2.3 {+-} 2.1 mm. Treatment time and excursion were found to be significant predictors of IFV-MTP. An IFV-MTP vector greater than 2 and 5 mm was seen in 40.8% and 7.2% of fractions, respectively. IFV-MTP greater than 2 mm was seen in heavier patients with larger excursions and longer treatment times. Significant differences in IFV-MTP were seen between immobilization devices. The stereotactic frame immobilization device was found to be significantly less likely to have an IFV-MTP vector greater than 2 mm compared with the alpha cradle, BodyFIX, and hybrid immobilization devices. Conclusions: Treatment time and respiratory excursion are significantly associated with IFV-MTP. Significant differences in IFV-MTP were found between immobilization devices. Target margins for IFV-MTP plus post-correction residuals are dependent on immobilization device with 5-mm uniform margins being acceptable for the frame immobilization device.

  13. 放射外科治疗面肌抽搐的初步研究%Treatment of idiopathic hemifacial spasm with with radiosurgery or hypofractionated stereotactic radiotherapy:preliminary results

    Institute of Scientific and Technical Information of China (English)

    吕学明; 袁绍纪; 孙希炎; 陈援朝; 吕福林; 吕晓彦; 解相礼; 许呈来

    2011-01-01

    Objective In this article we present four patients affected by idiopathic hemifa-cial spasm, refractory to medical therapy and botulinum toxin injections, who were treated by ra-diosurgery and hypofractionated stereotactic radiotherapy in four cases. Methods Radiosurgery, with a single dose of 5 Gy, was used in the first patient affected by idiopathic hemifacial spasm and autoimmune polyneuropathy with severe hypoacusia; hypofractionated stereotactic radiotherapy, with 15 Gy in 5 fractions of 3 Gy each, was preferred in the other 3 cases. In all patients, the target consisted of the vestibulocochlear-facial bundle immediately before its entry into the internal acoustic foramen. Results A marked improvement of symptoms was observed in 2 patients, and almost complete disappearance in the other cases, with no complications, particularly, auditory. Conclusion Radiosurgery or hypofractionated stereotactic radiotherapy could represent a therapeutic alternative to microvascular decompression for idiopathic hemifacial spasm for patients not suitable for surgery.%目的 探讨放射治疗对原发性面肌抽搐的效果及并发症分析.方法 其中1例听觉减弱的患者单次给予一次性剂量8 Gy治疗,其余3位听觉正常患者给予5天5次连续不同部位每次3Gy剂量,共计15Gy.所有患者靶点选择在面听神经束出脑干处至进人内听道前部分.结果 2例患者症状消失,1例症状明显减轻.另1例口服药物治疗下症状未见发作.未见明显并发症,特别是听、面神经功能无损伤.4例患者均放疗后2~4周短期随访及18个月到42个月的中期随访,放疗结果满意.结论 放疗治疗原发性面肌抽搐仍为不适于手术患者的一种治疗选择方法,疗效确切.

  14. Hypofractionated image-guided breath-hold SABR (Stereotactic Ablative Body Radiotherapy of liver metastases – clinical results

    Directory of Open Access Journals (Sweden)

    Boda-Heggemann Judit

    2012-06-01

    Full Text Available Abstract Purpose Stereotactic Ablative Body Radiotherapy (SABR is a non-invasive therapy option for inoperable liver oligometastases. Outcome and toxicity were retrospectively evaluated in a single-institution patient cohort who had undergone ultrasound-guided breath-hold SABR. Patients and methods 19 patients with liver metastases of various primary tumors consecutively treated with SABR (image-guidance with stereotactic ultrasound in combination with computer-controlled breath-hold were analysed regarding overall-survival (OS, progression-free-survival (PFS, progression pattern, local control (LC, acute and late toxicity. Results PTV (planning target volume-size was 108 ± 109cm3 (median 67.4 cm3. BED2 (Biologically effective dose in 2 Gy fraction was 83.3 ± 26.2 Gy (median 78 Gy. Median follow-up and median OS were 12 months. Actuarial 2-year-OS-rate was 31%. Median PFS was 4 months, actuarial 1-year-PFS-rate was 20%. Site of first progression was predominantly distant. Regression of irradiated lesions was observed in 84% (median time to detection of regression was 2 months. Actuarial 6-month-LC-rate was 92%, 1- and 2-years-LC-rate 57%, respectively. BED2 influenced LC. When a cut-off of BED2 = 78 Gy was used, the higher BED2 values resulted in improved local control with a statistical trend to significance (p = 0.0999. Larger PTV-sizes, inversely correlated with applied dose, resulted in lower local control, also with a trend to significance (p-value = 0.08 when a volume cut-off of 67 cm3 was used. No local relapse was observed at PTV-sizes 3 and BED2 > 78 Gy. No acute clinical toxicity > °2 was observed. Late toxicity was also ≤ °2 with the exception of one gastrointestinal bleeding-episode 1 year post-SABR. A statistically significant elevation in the acute phase was observed for alkaline-phosphatase; in the chronic phase for alkaline-phosphatase, bilirubine, cholinesterase and C

  15. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): Late toxicity results from a randomised, non-inferiority, phase 3 trial

    NARCIS (Netherlands)

    S. Aluwini (Shafak); F.J. Pos (Floris); E. Schimmel (Erik); S. Krol (Stijn); P.-P. van der Toorn (Peter-Paul); H. de Jager (Hanja); W.G. Alemayehu (Wendimagegn Ghidey); W.D. Heemsbergen (Wilma); B.J.M. Heijmen (Ben); L. Incrocci (Luca)

    2016-01-01

    textabstractBackground: Several studies have reported a low α to β ratio for prostate cancer, suggesting that hypofractionation could enhance the biological tumour dose without increasing genitourinary and gastrointestinal toxicity. We tested this theory in the phase 3 HYPRO trial for patients with

  16. Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

    Energy Technology Data Exchange (ETDEWEB)

    Rasmussen, Rune, E-mail: rune333@gmail.com [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Claesson, Magnus [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Stangerup, Sven-Eric [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Roed, Henrik [Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); Christensen, Ib Jarle [Finsen Laboratory, Rigshospitalet, Copenhagen (Denmark); Caye-Thomasen, Per [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Juhler, Marianne [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark)

    2012-08-01

    Objective: To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hearing preservation was also investigated. Methods and Materials: Forty-two patients receiving FSRT between 1997 and 2008 with a minimum follow-up of 2 years were included. All patients received 54 Gy in 27-30 fractions during 5.5-6.0 weeks. Clinical and audiometry data were collected prospectively. From a 'wait-and-scan' group, 409 patients were selected as control subjects, matched by initial audiometric parameters. Radiation dose to the cochlea was measured using the original treatment plan and then related to changes in acoustic parameters. Results: Actuarial 2-, 4-, and 10-year tumor control rates were 100%, 91.5%, and 85.0%, respectively. Twenty-one patients had serviceable hearing before FSRT, 8 of whom (38%) retained serviceable hearing at 2 years after FSRT. No patients retained serviceable hearing after 10 years. At 2 years, hearing preservation rates in the control group were 1.8 times higher compared with the group receiving FSRT (P=.007). Radiation dose to the cochlea was significantly correlated to deterioration of the speech reception threshold (P=.03) but not to discrimination loss. Conclusion: FSRT accelerates the naturally occurring hearing loss in patients with vestibular schwannoma. Our findings, using fractionation of radiotherapy, parallel results using single-dose radiation. The radiation dose to the cochlea is correlated to hearing loss measured as the speech reception threshold.

  17. Hypofractionation for prostate cancer: a critical review.

    Science.gov (United States)

    Miles, Edward F; Lee, W Robert

    2008-01-01

    In ideal circumstances, the fractionation schedule of radiotherapy should match the fractionation sensitivity of the tumor relative to the nearby normal tissues. A number of recent publications have suggested that the alpha-beta ratio (alpha/beta) for prostate is low, in the range of 1 to 3 Gy. If alpha/beta is truly low, then hypofractionated schedules using fewer, larger fractions should improve the therapeutic ratio. This critical review examines the clinical experience with hypofractionation. Several prospective trials indicate that toxicity is limited with sophisticated dose delivery and compact clinical target volume to planning target volume margins, but the single-arm nature of these trials precludes definitive statements on efficacy. Several large randomized trials comparing conventional fractionation to hypofractionation are ongoing and are described. Until these trials are completed and the results submitted for rigorous peer review, the notion that alpha/beta for prostate cancer is low remains an unconfirmed hypothesis.

  18. 用图像引导技术提高胸腹部肿瘤大分割放疗的治疗精度%Image-guided radiotherapy improves the precision of hypofractionated radiotherapy for thoracic and abdominal tumors

    Institute of Scientific and Technical Information of China (English)

    张寅; 张连胜; 肖建平; 翟万聪; 李明辉; 戴建荣; 李晔雄

    2008-01-01

    Objective To study image-guided hypofractionated radiotherapy for thoracic and abdominal tumors,and to determine the margins extended from internal target volume(ITV) to planning target volume(PTV). Methods Twenty-four patients who received image-guided hypofractionated radiotherapy for thoracic and abdominal tumors were included in this study. X-ray cone beam CT was regularly performed before the treatment. The shift and Rotation in right-left ( R-L), superior-inferior(S-I) and anterior-posterior (A-P) directions were recorded and analyzed. The shift margin from ITV to PTV was calculated with the equation,margin =2'mean+0.7'standard deviation. Results Before online correction,the shift errors in R-L,S-I and A-P directions were [2.1±2.0] mm, [3.9±3.2] mm and [2.9±2.8] mm,and the corresponding margins were 5.6 mm, 10.2 mm and 7.7 mm. After the correction the shift errors were [0.8±0.7] mm, [0.9±0.7] mm and [0.9±0.7] mm, and the margins were 2.1 mm,2.3 mm and 2.3 mm. The set-up error was markedly decreased after the correction. There was no change in rotation after the correction. Conclusions The positioning error decreases after the correction in IGRT,and the precision of radiotherapy is improved. Measuring set-up error in radiotherapy can provide institution-specific margins for PTV designing.%目的 探讨图像引导放疗技术应用于胸腹部肿瘤大分割放疗以提高治疗精度,测最其摆位误差并确定由内靶体积(ITV)外放产生计划靶体积(PTV)的间距.方法 入组24例胸腹部肿瘤病例,采用大分割放疗,每次治疗前行锥形束CT扫描,在线校正摆位误差并记录误差值.统计校正前后的误差数据,采用二参数法计算由ITV外扩产生PTV间距.结果 校正前摆位平移误差在左右(x)、头脚(y)和腹背(z)方向I:分别为(2.1±2.0)、(3.9±3.2)、(2.9±2.8)mm,校正后分别为(0.8±0.7)、(0.9±0.7)、(0.9±0.7)mm;外扩间距校正前分别为5.6、10.2、7.7 mm,校正后分别为2.1、2.3

  19. [The come-back of hypofractionation?].

    Science.gov (United States)

    Cosset, Jean-Marc

    2005-11-01

    Hypofractionation (i.e. the use of fewer higher fractional doses than usual) is not a new concept. It had actually been proposed in the early year of Radiotherapy by the German and Austrian specialists. In the seventy's, supported by the - wrong - hypotheses which gave birth to the NSD (Nominal Standard Dose), hypofractionation reappears. The consequential increase of late complications which was observed led the radiation oncologists to give up again using large doses per fraction, except for a few specific situations, such as palliative treatments. We are recently facing a new "come-back" of hypofractionation, in particular for breast and prostate cancers. In the case of breast cancer, the aim is clearly to look for more "convenience" for both the patients and the physicians, proposing shorter irradiation schedules including a lesser number of fractions. Some "modestly" hypofractionated schemes have been proposed and used, without apparently altering the efficacy/toxicity ratio, but these results have been seriously questioned. As for prostate cancer, the situation is different, since in that case new radiobiological data are at the origin of the newly proposed hypofractionation schedules. A number of papers actually strongly suggested that the fractionation sensitivity of prostate cancer could be higher than the one of the tissues responsible for late toxicity (i.e the exact opposite of the classical dogma). Based on those data, several hypofractionated schemes have been proposed, with a few preliminary results looking similar to the ones obtained by the classical schedules. However, no randomised study is available so far, and a few recent radiobiological data are now questioning the new dogma of the high fractionation sensitivity of prostate cancer. For those two - frequent - cancers, it seems therefore that prudence should prevail before altering classical irradiation schedules which have proven their efficacy, while staying open to new concepts and proposing

  20. 低分割放疗治疗老年非小细胞肺癌的临床观察%Clinical observation of elderly non-small-cell lung cancer patients treated by hypofractionated high-dose radiotherapy

    Institute of Scientific and Technical Information of China (English)

    李小龙; 党亚正; 卫伟; 陆婉玲; 赵宏亮; 陆宙; 胡飚; 杨婷

    2013-01-01

    目的:探讨老年非小细胞肺癌低分割放疗的临床疗效.方法:收集接受胸部放疗的老年肺癌35例,单次分割剂量2.5Gy,总剂量50Gy.TNM分期Ⅱ、Ⅲ、Ⅳ期各6、18、11例.结果:随访6-24个月,随访率100%.放射性食管炎发生率22.9%、2级以上放射性肺炎发生率8.6%.近期疗效:CR 11.4%、PR 51.4%、SD 28.6%、PD 8.6%;1年生存率57.1%,2年生存率17.1%.结论:低分割放疗对老年肺癌患者近期疗效确切,放疗毒副反应可以耐受.%Objective:To investigate the clinical efficacy of hypofractionated high -dose radiotherapy for elderly non - small - cell lung cancer. Methods: To analyze 53 cases of lung cancer received chest radiation therapy with dose fractionation 2.5Gy/d,5f/w,total dose 50Gy. TNM staging Ⅱ , Ⅲ and Ⅳ were respectively,6,18 and 11 cases. Results:Followed up for 6-24 months,follow - up rate was 100%. Radiation esophagitis incidence was 22. 9%. The radiation pneumonia rate was 8. 6% . Short term efficacy: CR 11. 4% , PR 51. 4% , SD 28. 6% , PD 8. 6% . 1 - year survival rate was 57. 1% ,2 - year survival rate was 17. 1%. Conclusion: Curative effect of non - small cell lung cancer patients treated by three - dimensional conformal hypofractionated high - dose radiotherapy is definitely, radiation side effects can be tolerated.

  1. Fractionated stereotactic radiotherapy of vestibular schwannomas accelerates hearing loss

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Claesson, Magnus; Stangerup, Sven-Eric

    2012-01-01

    To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea...... and hearing preservation was also investigated....

  2. Clinical study of hypofractionated radiotherapy in breast cancer after modified radical mastectomy%乳腺癌改良根治术后大分割放疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    毕利萍; 李玉军; 宫学华; 刘莹; 张洪岩

    2011-01-01

    Objective To study the effect and toxicity of post- mastectomy radiotherapy with different fractionated dose schemes for local advanced breast cancer. Methods A total of 100 patients with local advanced breast cancer, who received mastectomy and 6~8 cycles of chemotherapy after the surgery, were randomized to hypofractionation group and conventional fractionation group. The hypofractionation group received 43.5Gy (2.9 Gy per fraction and five fraction per week); the conventional group received 50 Gy (2.0 Gy per fraction and five fraction per week). Results The 3 - year overall survival rate was 82.4 % and 85.7 % in each group respectively (P > 0.05). The local relapse rate was 7.8 % and 6.1% (P > 0.05). The rate of grade 2 and 3 acute skin toxicity was 7.8 % and 6.1%, respectively(P >0.05). No severe toxicity, including brachial plexus injury, skin ulcer, radiation pneumonitis, was found in both groups. ECG did not show any change of myocardial ischemia in both groups. Conclusion Hypofractionated radiotherapy can shorten the time of treatment, while it has the same overall rate, local relapse rate and toxicity as conventional radiation, which could be used as an alternative of the conventional radiation in patients with local advanced breast cancer.%目的 研究局部晚期乳腺癌改良根治术后大分割放疗与常规分割放疗的疗效、副反应.方法 100例局部晚期乳腺癌病例,病人均接受乳腺癌改良根治术和术后6~8周期化疗,随机分为大分割放疗和常规分割放疗2组:大分割放射治疗组2.9 Gy/次,每周5次,总剂量43.5 Gy; 常规分割治疗组2 Gy/次,每周5次,总剂量50 Gy.结果 大分割放射治疗组和常规分割放射治疗组的3年总生存率分别为82.4%和85.7%,局部区域复发率分别为7.8%和6.1%,急性2~3级放射性皮肤损伤发生率分别为7.8%和6.1%(P>0.05),两组均无严重的后期反应发生(臂丛损伤、皮肤溃疡形成、放射性肺炎等),心

  3. Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme

    Energy Technology Data Exchange (ETDEWEB)

    Guckenberger, Matthias; Mayer, Mario; Sweeney, Reinhart A.; Flentje, Michael [University Hospital Wuerzburg (Germany). Dept. of Radiation Oncology; Buttmann, Mathias [University Hospital Wuerzburg (Germany). Dept. of Neurology; Vince, Giles H. [University Hospital Wuerzburg (Germany). Dept. of Neurosurgery

    2011-09-15

    The goal of this study was to evaluate accelerated radiotherapy with and without temozolomide (TMZ) for glioblastoma multiforme (GBM). This retrospective analysis evaluated 86 patients with histologically proven GBM who were treated with accelerated radiotherapy of 1.8 Gy twice daily to a total dose of 54 Gy within 3 weeks. Median age was 62 years and median Karnofsky index was 90. A total of 41 patients received radiotherapy only from 2002-2005 and 45 patients were treated with TMZ concomitantly and after radiotherapy from 2005-2007. Median overall survival (OS) was 12.5 months and 2-year OS was 15.4%. Patient characteristics were well balanced between the two groups except for better performance status (p = 0.05) and higher frequency of retreatment for the first recurrence (p = 0.02) in the TMZ group. Age at diagnosis (HR 2.83) and treatment with TMZ (HR 0.60) were correlated with OS in the multivariate analysis: treatment with and without TMZ resulted in median OS of 16 months and 11.3 months, respectively. Hematological toxicity grade > II was observed in 2/45 patients and 5/37 patients during simultaneous radiochemotherapy and adjuvant TMZ. TMZ added to accelerated radiotherapy for GBM resulted in prolonged overall survival with low rates of severe hematological toxicity. (orig.)

  4. Phase 2 Study of Accelerated Hypofractionated Thoracic Radiation Therapy and Concurrent Chemotherapy in Patients With Limited-Stage Small-Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Xia, Bing [Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai (China); Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou (China); Hong, Ling-Zhi [Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing (China); Cai, Xu-Wei; Zhu, Zheng-Fei; Liu, Qi; Zhao, Kuai-Le; Fan, Min; Mao, Jing-Fang; Yang, Huan-Jun; Wu, Kai-Liang [Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai (China); Fu, Xiao-Long, E-mail: xlfu1964@hotmail.com [Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (China)

    2015-03-01

    Purpose: To prospectively investigate the efficacy and toxicity of accelerated hypofractionated thoracic radiation therapy (HypoTRT) combined with concurrent chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC), with the hypothesis that both high radiation dose and short radiation time are important in this setting. Methods and Materials: Patients with previously untreated LS-SCLC, Eastern Cooperative Oncology Group performance status of 0 to 2, and adequate organ function were eligible. HypoTRT of 55 Gy at 2.5 Gy per fraction over 30 days was given on the first day of the second or third cycle of chemotherapy. An etoposide/cisplatin regimen was given to 4 to 6 cycles. Patients who had a good response to initial treatment were offered prophylactic cranial irradiation. The primary endpoint was the 2-year progression-free survival rate. Results: Fifty-nine patients were enrolled from July 2007 through February 2012 (median age, 58 years; 86% male). The 2-year progression-free survival rate was 49.0% (95% confidence interval [CI] 35.3%-62.7%). Median survival time was 28.5 months (95% CI 9.0-48.0 months); the 2-year overall survival rate was 58.2% (95% CI 44.5%-71.9%). The 2-year local control rate was 76.4% (95% CI 63.7%-89.1%). The severe hematologic toxicities (grade 3 or 4) were leukopenia (32%), neutropenia (25%), and thrombocytopenia (15%). Acute esophagitis and pneumonitis of grade ≥3 occurred in 25% and 10% of the patients, respectively. Thirty-eight patients (64%) received prophylactic cranial irradiation. Conclusion: Our study showed that HypoTRT of 55 Gy at 2.5 Gy per fraction daily concurrently with etoposide/cisplatin chemotherapy has favorable survival and acceptable toxicity. This radiation schedule deserves further investigation in LS-SCLC.

  5. Hypofractionated radiotherapy and tumor immunity—new concepts and new combination%大剂量分割放疗与肿瘤免疫——新概念与新结合

    Institute of Scientific and Technical Information of China (English)

    刘思涵; 田野; 张大昕

    2016-01-01

    Modern immunology has established that tumor immune escape is associated with hidden or missing tumor-specific antigens and tumor-associated antigens,as well as immune suppressors that are released from tumor cells to inhibit the immune cytotoxicity and antigen-presenting cells (APCs).The changes in tumor microenvironment have an impact on tumor immunity and treatment outcomes.The immune effects finally depend on activation and inhibition of T cell receptors and other co-regulated receptors (CD28,CD80/CD86,and CTLA-4) in spite of the existence of APCs and cytotoxic T lymphocytes in tumor microenvironment.Recent studies have revealed that radiotherapy induced not only DNA damage but also immunogenesis in tumor cells.Both conventionally fractionated radiotherapy and hypofractionated radiotherapy can induce immunogenesis in tumor cells.Immunogenic regulation makes many tumor antigens expressed in cells exposed to irradiation,which induces immune recognition and cytotoxicity;cell content (DNA,HMGB1,etc.) released from dead immunogenic cells can trigger immune effects and in situ tumor vaccination,which further induce an abscopal effect of radiotherapy.A lot of anti-tumor immunotherapy fails to achieve satisfactory treatment outcomes.Therefore,how to combine radiotherapy,especially stereotactic body radiotherapy,with anti-tumor immunotherapy has recently become a new challenge for researchers.%现代免疫学认为肿瘤的逃逸机制与肿瘤特异抗原(TSA)和肿瘤相关抗原(TAA)的隐藏、丢失,肿瘤自身分泌一些免疫抑制因子抑制免疫杀伤和抗原呈递细胞(APC)有关.肿瘤微环境的变化对肿瘤免疫变化及肿瘤治疗的转归也有影响.在肿瘤局部,尽管抗原呈递细胞(APC)和免疫效应细胞CTL都存在,但是,免疫作用效果却取决于T细胞受体(TCR)和其他共调节受体(CD28、CD80/CD86、CTLA-4)的活化或抑制.近年来研究发现,放疗不仅能造成肿瘤细胞DNA损伤,还能引起肿瘤细胞的

  6. Hypofractionated three-dimensional conformal radiotherapy plus transcatheter arterial chemoembolization for primary liver cancer%大分割三维适形放疗联合TACE治疗原发性肝癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    潘平生; 邹瑜斌; 万林林; 梅华; 陈丽萍; 李小兵

    2013-01-01

    目的:观察大分割三维适形放疗(3DCRT)联合肝动脉化疗栓塞(TACE)治疗效果,分析其预后因素.方法:对50例不能手术的原发性肝癌(PLC)进行大分割3DCRT,分割剂量3~6 Gy,生物效应剂量(BED) 52~84 Gy,中位剂量61 Gy.放疗前行TACE治疗1~3次.结果:50例肝癌患者中,完全缓解(CR) 16% (8/50),部分缓解(PR)62%(31/50),无变化(NC) 14% (7/50),进展(PD) 8% (4/50),总有效率(CR+ PR)78%.1、2、3年生存率分别为74%(37/50)、58%(29/50)和34%(17/50),中位生存期22.5个月.多因素分析结果显示,肿瘤数目、大体肿瘤体积(GTV)、Child-pugh分级是影响生存率的主要预后因素.结论:大分割3DCRT联合TACE治疗中晚期肝癌值得临床推广应用,不良反应可以耐受,特别是对于肿瘤数目少、肿瘤体积小和肝功能较好的肝癌患者不失为一种非手术治疗的理想选择.%OBJECTIVE: To evaluae the therapeutic effect and prognostic factors of hypofractionated three-dimen sional conformal radiotherapy (3DCRT) combined with transcathether arterial chemoembdization(TACE). METHODS: Fifty patients with primary liver cancer(PLC) who were not suitable for surgery conducted hypofractionated 3DCRT,divi sion dose 3 — 6 Gy,biological effectiveness dose 52 — 84 Gy, Median dose 61 Gy. The patients acceped TACE treatment 1 — 3 times before radiotherapy. RESULTS: In the fifty patients with hepatic cancer complete remission(CR) was 16% (8/50), partial remission(PR) was 62%(31/50) ,no change(NC) was 14%(7/50) .advance was 8% (4/50), and total ef fective rate(CR+PR) was 78%. And 1,2,3 year survival rate was 74% (37/50) , 58% (29/50) and 34%(17/50) respec tively. Median survival time was 22. 5 months. Multivariate analysis demonstrated that the amount of tumor,gross tumor volume,Child-pugh scale were the major prognostic factors which influenced survival rate. CONCLUSION: Hypofraction ated 3DCRT associaed with TACE is a effective method in the treatment of

  7. 浸润性乳腺癌保乳术后常规分割放疗与大分割放疗的疗效比较%Comparison of the efficacy between conventional radiotherapy and hypofractionated radiotherapy for invasive breast cancer after breast conserving surgery

    Institute of Scientific and Technical Information of China (English)

    韩彦辉; 李向平; 贺会江; 闫俊丽; 张高高

    2014-01-01

    Objective To investigate the differences in disease free survival time ,adverse reaction between conventional radiotherapy and hypofractionated radiotherapy for early‐stage invasive breast cancer patients who have received breast conserving operation .Methods Sixty early‐stage invasive breast cancer patients who had re‐ceived breast conserving operation in our department were divided into CRT group and HOFRT group ,30 patients in each group .Group CRT received conventional radiotherapy ,accepting 2 Gy/time ,1 time/d ,5 times/week ,to‐tal 50 Gy ,25 times ,completed irradiation in 5 weeks .Group HOFRT received hypofractionated radiotherapy ,ac‐cepting 3 .4 Gy/time ,1 time/d ,5 times/week ,total 44 .2 Gy ,13 times ,completed irradiation in 2 .5 weeks .In follow‐up ,the occurrence of adverse reaction and disease free survival time were recorded .Kaplan‐Meier method was used to compare the disease free survival time between two groups .Two independent samples test method was used to compare the adverse reaction between two groups .Results The median disease free survival time of CRT group patients was 89 .9 months ,and the median disease free survival time of HOFRT group patients was 93 months .There was no significant difference between the survival time of two groups patients (P>0.05) .For ad‐verse reaction of two groups patients ,there are differences ,there are more serious reaction in the hypofractionated radiotherapy than the conventional radiotherapy in acute skin reaction and suppression of bone marrow ( P<0.05) .Conclusion Patients in the two groups had no significant difference in disease free survival time ,but has great difference in the adverse reaction after treatment .Patients in the HOFRT group had more severe toxicity re‐action .We should apply different treatments according to different financial condition and body condition of pa‐tients to improve the efficacy in treatments .For the patients who have weaker physical condition and

  8. 局部晚期前列腺癌大分割适形放疗初探%Preliminary investigation of hypofractionated conformal radiotherapy for locally advanced prostate cancer

    Institute of Scientific and Technical Information of China (English)

    夏火生; 韩守云; 李月敏; 张玉海; 解放军

    2010-01-01

    目的:初步评价大分割三维适形放疗(hypofractionated 3dimensional conformal radiotherapy,HFCRT)对局部晚期前列腺癌的治疗作用.方法:回顾18例曾接受HFCRT的局部晚期(T4期)前列腺癌病例资料.9例单纯HFCRT,40-56Gy/10-16次/2.5-4周;另9例先全盆腔照射36-40Gy/18-20次/3.5-4周,再以HFCRT加量16-20Gy/4-5次/2-3周.分析放疗的生物效应剂量、肿瘤局控效果及临床疗效和不良反应.结果:肿瘤平均生物效应剂量约(125±9.8)Gy(α/β值取2.6Gy).肿瘤局部疗效CR 8例,PR 10例.主要临床症状体征明显改善;无≥Ⅲ级放射损伤 (RGOT和EORTC毒性标准).结论:HFCRT对局部晚期前列腺癌有很好的治疗作用,高分次剂量可能是重要的有利因素之一.

  9. The feasibility analysis of hypofractionated high-dose three-dimensional conformal radiotherapy in the treatment of esophageal carcinoma%食管癌三维适形大分割放疗的可行性分析

    Institute of Scientific and Technical Information of China (English)

    王红旗; 刘永志

    2011-01-01

    Objective To evaluate the instant response and side effects of hypofractionated high-dose 3-dimensional conformal radiotherapy (3-DCRT) for esophageal carcinoma treatment.MethodsSixty-nine patients with esophageal carcinoma were treated by 3-DCRT and 91 patients with routine radiotherapy.The prescribed dose was from 3000 to 4500 cGy in 3-DCRT group, with fractionated dose 300 cGy, one dose a day and five doses a week.The reference dose curve was the 90% of the isodose curve.For the routine radiotherapy group,the prescribed dose was from 4000 to 6600 cGy,fractionated by 180 ~200 cGy a time,once a day and 5 times a week.Results At the end of the radiotherapy, 3-DCRT produced CR 42.0% (29/69) , PR 49.3% (34/69) and instant response rate 91.3%, while routine radiotherapy produced CR 35.2% (32/91), PR 59.3% (54/91) and instant response rate 94.5%, respectively.The difference was not significant between the two groups(P > 0.05) .The survival rates one year after the treatment were 82.6.0% (57/69) and 84.6% (77/91) ,respectively.The acute radiation esophagitis rate was 66.7% (46/69) in 3-DCRT group and was 64.8% (59/91) in routine radiotherapy grouprespectively.Conclusion Hypofractionated high-dose 3-DCRT is feasible for treatment of esophageal carcinoma.%目的 评价三维适形大分割放疗在食管癌放射治疗中的近期疗效和放射反应。方法 食管癌患者160例,设为适形放疗组69例、常规放疗组91例,分别采用三维适形大分割放疗和常规放疗进行治疗。适形放疗组处方剂量3000~4500 cGy,分割剂量300 cGy,1次/d,5次/周,照射剂量参考线为90%等剂量曲线。常规放疗组处方剂量4000 ~6600 cGy,分割剂量180~200 cGy,1次/d,5次/周。比较2组的近期疗效、生存期,以及放射治疗的副反应。结果 适形放疗组完全缓解(CR)为42.0% (29/69),部分缓解(PR) 49.3% (34/69),近期有效率91.3%;常规放疗组CR为35.2%(32/91),PR 59.3% (54/91),

  10. Five-year results of a prospective case series of accelerated hypofractionated whole breast radiation with concomitant boost to the surgical bed after conserving surgery for early breast cancer.

    Science.gov (United States)

    Cante, Domenico; Franco, Pierfrancesco; Sciacero, Piera; Girelli, Giuseppe; Marra, Anna Maria; Pasquino, Massimo; Russo, Giuliana; Borca, Valeria Casanova; Mondini, Guido; Paino, Ovidio; Barmasse, Roberto; Tofani, Santi; Numico, Gianmauro; La Porta, Maria Rosa; Ricardi, Umberto

    2013-06-01

    Accelerated hypofractionation (HF) using larger dose per fraction, delivered in fewer fractions over a shorter overall treatment time, is presently a consistent possibility for adjuvant whole breast radiation (WBRT) after breast-conserving surgery for early breast cancer (EBC). Between 2005 and 2008, we submitted 375 consecutive patients to accelerated hypofractionated WBRT after breast-conserving surgery for EBC. The basic course of radiation consisted of 45 Gy in 20 fractions over 4 weeks to the whole breast (2.25 Gy daily) with an additional daily concomitant boost of 0.25 Gy up to 50 Gy to the surgical bed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) and local control (LC) were assessed. Late toxicity was scored according to the CTCAE v3.0; acute toxicity using the RTOG/EORTC toxicity scale. Cosmesis was assessed comparing treated and untreated breast. Quality of life (QoL) was determined using EORTC QLQ-C30/QLQ-BR23 questionnaires. With a median follow-up of 60 months (range 42-88), 5 years OS, CSS, DFS and LC were 97.6, 99.4, 96.6 and 100 %, respectively. Late skin and subcutaneous toxicity was generally mild, with few events > grade 2 observed. Cosmetic results were excellent in 75.7 % of patients, good in 20 % and fair in 4.3 %. QoL, assessed both through QLQ-C30/QLQ-BR23, was generally favorable, within the functioning and symptoms domains. Our study is another proof of principle that HF WBRT with a concurrent boost dose to the surgical cavity represents a safe and effective postoperative treatment modality with excellent local control and survival, consistent cosmetic results and mild toxicity.

  11. Clinical Research of Hypofractionated Radiotherapy for Early-stage Non-Small-Cell Lung Cancer%早期非小细胞肺癌大分割放射治疗临床研究

    Institute of Scientific and Technical Information of China (English)

    刘子莹; 卢冰; 欧阳伟炜; 甘家应; 姜彬

    2008-01-01

    目的:探讨三维适形放疗(3-dimensional conformal radiotherapy,3D-CRT)大分割放射治疗早期非小细胞肺癌的疗效和毒性反应.方法:11例早期非小细胞肺癌(I期8例,IIB期3例;中位年龄72岁)三维适形大分割放射治疗(hypofractionation radiotherapy,HORT)全程或后程推量,肿瘤剂量60Gy~76Gy,3Gy~8Gy/次,1次/天,3次~5次/周.生物等效剂量76.8Gy~105.6 Gy.中位随访时间54个月.根据WHO标准评价近期疗效,RTOG标准评价毒性反应.结果:完全缓解(CR)9.09 %(1/11),部分缓解(PR)81.8 %(9/11),稳定(NC) 9.09 % (1/11).中位生存时间39个月.1,3及5年总生存率分别为81.8%,58.4%和18%,1,3及5年肿瘤相关生存率分别为91%,91%和18%.放射性食管炎27.3%(2级2例,3级1例),急性放射性肺炎(2级1例)9.09%.结论:三维适形大分割放射治疗早期非小细胞肺癌近期疗效和生存率优于常规分割放疗,放疗毒性未见明显增加,耐受性好,是一种有效安全的局部治疗手段.

  12. Acceleration of pubertal development following pituitary radiotherapy for Cushing's disease

    Energy Technology Data Exchange (ETDEWEB)

    Nicholl, R.M.; Kirk, J.M.W.; Grossman, A.B.; Plowman, P.N.; Besser, G.M.; Savage, M.O. (Saint Bartholomew' s Hospital, London (United Kingdom))

    1993-01-01

    A 7-year-old boy with pituitary dependent Cushing's disease was treated with pituitary irradiation following unsuccessful microadenomectomy. This led to normalization of the hypercortisolaemia, but was followed by GH deficiency. Two years after radiotherapy he had the onset of pubertal development with testicular enlargement to 8 ml bilaterally. Pubertal regression was induced using the long-acting GnRH analogue goserelin. Acceleration of skeletal maturation was also arrested, resulting in improvement of final height prediction. Irradiation directly to the hypothalamo-pituitary region, as well as whole brain irradiation, may thus be associated with accelerated pubertal development. (author).

  13. Monte Carlo calculation of dose distribution in early stage NSCLC patients planned for accelerated hypofractionated radiation therapy in the NCIC-BR25 protocol

    Energy Technology Data Exchange (ETDEWEB)

    Moiseenko, V; Bergman, A M; Gill, B; Popescu, I A [British Columbia Cancer Agency-Vancouver, 600 W.10th Ave, Vancouver, BC, V5Z 4E6 (Canada); Liu, M; Kristensen, S [British Columbia Cancer Agency-Fraser Valley, 13750 96th Ave, Surrey, BC, V3V 1Z2 (Canada); Teke, T [Department of Physics and Astronomy, University of British Columbia, 6224 Agricultural Road Vancouver, BC, V6 T 1Z1 (Canada)], E-mail: vmoiseenko@bccancer.bc.ca

    2010-02-07

    The dosimetric consequences of plans optimized using a commercial treatment planning system (TPS) for hypofractionated radiation therapy are evaluated by re-calculating with Monte Carlo (MC). Planning guidelines were in strict accordance with the Canadian BR25 protocol which is similar to the RTOG 0236 and 0618 protocols in patient eligibility and total dose, but has a different hypofractionation schedule (60 Gy in 15 fractions versus 60 Gy in 3 fractions). A common requirement of the BR25 and RTOG protocols is that the dose must be calculated by the TPS without tissue heterogeneity (TH) corrections. Our results show that optimizing plans using the pencil beam algorithm with no TH corrections does not ensure that the BR25 planning constraint of 99% of the PTV receiving at least 95% of the prescription dose would be achieved as revealed by MC simulations. This is due to poor modelling of backscatter and lateral electronic equilibrium by the TPS. MC simulations showed that as little as 75% of the PTV was actually covered by the 95% isodose line. The under-dosage of the PTV was even more pronounced if plans were optimized with the TH correction applied. In the most extreme case, only 23% of the PTV was covered by the 95% isodose.

  14. Monte Carlo calculation of dose distribution in early stage NSCLC patients planned for accelerated hypofractionated radiation therapy in the NCIC-BR25 protocol

    Science.gov (United States)

    Moiseenko, V.; Liu, M.; Bergman, A. M.; Gill, B.; Kristensen, S.; Teke, T.; Popescu, I. A.

    2010-02-01

    The dosimetric consequences of plans optimized using a commercial treatment planning system (TPS) for hypofractionated radiation therapy are evaluated by re-calculating with Monte Carlo (MC). Planning guidelines were in strict accordance with the Canadian BR25 protocol which is similar to the RTOG 0236 and 0618 protocols in patient eligibility and total dose, but has a different hypofractionation schedule (60 Gy in 15 fractions versus 60 Gy in 3 fractions). A common requirement of the BR25 and RTOG protocols is that the dose must be calculated by the TPS without tissue heterogeneity (TH) corrections. Our results show that optimizing plans using the pencil beam algorithm with no TH corrections does not ensure that the BR25 planning constraint of 99% of the PTV receiving at least 95% of the prescription dose would be achieved as revealed by MC simulations. This is due to poor modelling of backscatter and lateral electronic equilibrium by the TPS. MC simulations showed that as little as 75% of the PTV was actually covered by the 95% isodose line. The under-dosage of the PTV was even more pronounced if plans were optimized with the TH correction applied. In the most extreme case, only 23% of the PTV was covered by the 95% isodose.

  15. Hypofractionation for prostate cancer.

    Science.gov (United States)

    Ritter, Mark; Forman, Jeffrey; Kupelian, Patrick; Lawton, Colleen; Petereit, Daniel

    2009-01-01

    Hypofractionation for prostate cancer was originally carried out in the pursuit of efficiency and convenience but has now attracted greatly renewed interest based upon a hypothesis that prostate cancers have a higher sensitivity to fraction size, reflected in a low alpha/beta ratio, than do late responding organs at risk such as the rectum or bladder. Tumor control and acceptable toxicity outcomes from several hypofractionation or brachytherapy analyses do in fact support an alpha/beta ratio for prostate cancer that is low, perhaps even lower that that for the normal organs that ordinarily constrain the delivery of radiation therapy. However, many of these studies lack sufficient patient numbers and follow-up, are clouded by dose inhomogeneity issues in the case of brachytherapy, or delivered effective doses that were too low by contemporary standards. Thus, the clinical efficacy of the approach has yet to be fully validated. However, a number of newer prospective trials, some randomized, are underway or have reached accrual but await sufficient follow-up for analysis. These studies, which cover a wide range of doses per fraction, should ultimately be capable of validating the utility of prostate hypofractionation and the models that predict its effects. With hypofractionation's significant potential for therapeutic gain, cost savings, and improved patient convenience, the future management of localized prostate cancer could be profoundly altered in the process.

  16. Prospective phase Ⅱ trial of hypofractionated intensity-modulated radiotherapy for localized prostate cancer%局限期前列腺癌大分割调强放疗临床Ⅱ期研究

    Institute of Scientific and Technical Information of China (English)

    刘跃平; 余子豪; 戴建荣; 李晔雄; 王维虎; 房辉; 金晶; 王淑莲; 宋永文; 任骅; 刘新帆

    2012-01-01

    目的 观察前列腺癌2.7Gy25次大分割调强适形放疗的疗效和不良反应.方法 2009-2011年52例局限于盆腔的前列腺癌接受前列腺加或不加精囊腺2.7 Gy 25次(总量67.5 Gy)调强放疗,其中20例仅为前列腺加或不加精囊腺照射,32例为前列腺加精囊腺和盆腔淋巴引流区预防照射,盆腔剂量50 Gy分25次照射.35例采用了图像引导放疗,48例同时接受内分泌治疗.结果 中位随诊13个月,平均前列腺特异抗原由疗前(40.3±36.6)ng/ml降至随诊时的(0.5±1.7)ng/ml.2例治疗失败,其中生化失败1例、盆腔淋巴结复发1例.放疗毒性反应:消化道急性反应2级为25%、3级为4%,泌尿道急性反应2级为15%、3级为2%.消化道晚期损伤2级为17%、3级为0%,泌尿道晚期损伤2级为8%、3级为2%.因大部份病例放疗同时接受了内分泌治疗故无法评价性功能影响.结论 局限期前列腺癌大分割调强放疗近期疗效较满意,严重不良反应少见,长期疗效和不良反应有待更长时间随诊评价.%Objective To prospectively evaluate the efficacy and toxicity of hypofractionated intensity-modulated radiotherapy (IMRT) for prostate cancer.Methods Fifty-two consecutive patients with localized prostate cancer were enrolled in this study between Feb.2009 and Mar.2011.All patients received hypofractionated IMRT (2.7 Gy/fx,25 fractions,total 67.5 Gy) to the prostate and seminal vesicles.32 high risk patients also received prophylactic irradiation to the pelvic lymph nodes concurrently (2 Gy/fx,25 fractions).Imaging-guided radiotherapy was employed in 35 patients.Androgen deprivation therapy was adopted in 48 of 52 patients.Results After a median follow-up of 13 months,the mean prostate specific antigen (PSA) was reduced from (40.3 ± 36.6) ng/ml before treatment to (0.5 ± 1.7)ng/ml at the last follow-up.By the time of last follow-up,2 patients (4%) failed.One had PSA failure and the other had both PSA failure and

  17. Long-Term Tumor Control despite Late Pseudoprogression on 18F-FDG-PET following Extremely Hypofractionated Stereotactic Radiotherapy for Retropharyngeal Lymph Node Metastasis from Esthesioneuroblastoma

    Directory of Open Access Journals (Sweden)

    Kazuhiro Ohtakara

    2014-08-01

    Full Text Available 18F-FDG-PET is a valuable adjunct to conventional imaging for evaluating treatment response following stereotactic body radiotherapy (SBRT for head and neck malignancies (HNM. The effect of treatment-related inflammation is generally deemed negligible after 12 weeks following conventionally fractionated radiotherapy. Herein, we describe an unusual case showing pseudoprogression on 18F-FDG-PET 2 years after SBRT for retropharyngeal lymph node metastasis (RPLNm from esthesioneuroblastoma. A 36-year-old man presented with right RPLNm 32 months after the diagnosis of esthesioneuroblastoma associated with ectopic adrenocorticotropic hormone production. The RPLNm was treated with SBRT in 2 fractions over 8 days using dynamic conformal arcs with concomitant chemotherapy with cisplatin and etoposide. Although follow-up MRI showed sustained lesion regression, the early/delayed maximum standardized uptake (SUVmax values on dual-time-point 18F-FDG-PET obtained 1 and 2 years after SBRT were 7.7/8.3 and 8.5/10.1, respectively, suggesting local progression. Despite no subsequent focal or systemic treatment, the SUVmax values gradually decreased thereafter over a period of 4 years (3.3/3.4 at 76 months. MRI obtained 7 years after SBRT revealed sustained tumor regression. No obvious relevant toxicities have occurred. Thus, caution should be exercised in the interpretation of the SUVmax change following ablative irradiation for HNM.

  18. Radiotherapy

    Directory of Open Access Journals (Sweden)

    Rema Jyothirmayi

    1999-01-01

    Full Text Available Purpose. Conservative treatment in the form of limited surgery and post-operative radiotherapy is controversial in hand and foot sarcomas, both due to poor radiation tolerance of the palm and sole, and due to technical difficulties in achieving adequate margins.This paper describes the local control and survival of 41 patients with soft tissue sarcoma of the hand or foot treated with conservative surgery and radiotherapy. The acute and late toxicity of megavoltage radiotherapy to the hand and foot are described. The technical issues and details of treatment delivery are discussed. The factors influencing local control after radiotherapy are analysed.

  19. Long-term outcome and toxicity of hypofractionated stereotactic body radiotherapy as a boost treatment for head and neck cancer: the importance of boost volume assessment

    Directory of Open Access Journals (Sweden)

    Lee Dong

    2012-06-01

    Full Text Available Abstract Background The aim of this study was to report the long-term clinical outcomes of patients who received stereotactic body radiotherapy (SBRT as a boost treatment for head and neck cancer. Materials and methods Between March 2004 and July 2007, 26 patients with locally advanced, medically inoperable head and neck cancer or gross residual tumors in close proximity to critical structures following head and neck surgery were treated with SBRT as a boost treatment. All patients were initially treated with standard external beam radiotherapy (EBRT. SBRT boost was prescribed to the median 80% isodose line with a median dose of 21 (range 10–25 Gy in 2–5 (median, 5 fractions. Results The median follow-up after SBRT was 56 (range 27.6 − 80.2 months. The distribution of treatment sites in 26 patients was as follows: the nasopharynx, including the base of the skull in 10 (38.5%; nasal cavity or paranasal sinus in 8 (30.8%; periorbit in 4 (15.4%; tongue in 3 (11.5%; and oropharyngeal wall in 1 (3.8%. The median EBRT dose before SBRT was 50.4 Gy (range 39.6 − 70.2. The major response rate was 100% with 21 (80.8% complete responses (CR. Severe (grade ≥ 3 late toxicities developed in 9 (34.6% patients, and SBRT boost volume was a significant parameter predicting severe late complication. Conclusions The present study demonstrates that a modern SBRT boost is a highly efficient tool for local tumor control. However, we observed a high frequency of serious late complications. More optimized dose fractionation schedule and patient selection are required to achieve excellent local control without significant late morbidities in head and neck boost treatment.

  20. Hypofractionated stereotactic body radiotherapy for primary and metastatic liver tumors using the novalis image-guided system: preliminary results regarding efficacy and toxicity.

    Science.gov (United States)

    Iwata, Hiromitsu; Shibamoto, Yuta; Hashizume, Chisa; Mori, Yoshimasa; Kobayashi, Tatsuya; Hayashi, Naoki; Kosaki, Katsura; Ishikawa, Tetsuya; Kuzuya, Teiji; Utsunomiya, Setsuo

    2010-12-01

    www.tcrt.org The purpose of this study was to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for primary and metastatic liver tumors using the Novalis image-guided radiotherapy system. After preliminarily treating liver tumors using the Novalis system from July 2006, we started a protocol-based study in February 2008. Eighteen patients (6 with primary hepatocellular carcinoma and 12 with metastatic liver tumor) were treated with 55 or 50 Gy, depending upon their planned dose distribution and liver function, delivered in 10 fractions over 2 weeks. Four non-coplanar and three coplanar static beams were used. Patient age ranged from 54 to 84 years (median: 72 years). The Child-Pugh classification was Grade A in 17 patients and Grade B in 1. Tumor diameter ranged from 12 to 35 mm (median: 23 mm). Toxicities were evaluated according to the Common Terminology Criteria of Adverse Events version 4.0, and radiation-induced liver disease (RILD) was defined by Lawrence's criterion. The median follow-up period was 14.5 months. For all patients, the 1-year overall survival and local control rates were 94% and 86%, respectively. A Grade 1 liver enzyme change was observed in 5 patients, but no RILD or chronic liver dysfunction was observed. SBRT using the Novalis image-guided system is safe and effective for treating primary and metastatic liver tumors. Further investigation of SBRT for liver tumors is warranted. In view of the acceptable toxicity observed with this protocol, we have moved to a new protocol to shorten the overall treatment time and escalate the dose.

  1. Clinical trial of hypofractionation radiotherapy for early stage breast cancer after breast conserving surgery%早期乳腺癌保乳术后大分割放疗的研究

    Institute of Scientific and Technical Information of China (English)

    赵淑红; 王宏; 张润莉; 侯东祥; 马缠过; 张宪斌

    2013-01-01

    Objective To investigate the efficacy,cosmetic outcome and adverse reaction of hypofractionation radiotherapy for early stage breast cancer after breast conserving surgery.Methods A total of 69 patients with early stage breast cancer after breast conserving surgery in People's Hospital of Shaanxi Province from 2006 to 2009 were included.36 patients (HF group) were received whole-breast radiation to 42.56 Gy in 16 fractions followed by tumor bed boost of 7.98 Gy in 3 fractions; 33 patients (CF group) were received whole-breast radiation to 50 Gy in 25 fractions followed by tumor bed boost of 10 Gy in 5 fractions.Kaplan-Meier of SPSS 16.0 was used to calculate local recurrence rates and the survival rates,the differences were compared by Log-rank test.Chi-square test was used to compared the differences of the clinical characteristics,cosmetic outcome and toxicity between the two groups.Results The median follow-up time was 61 months,the follow-up rate was 100%.The 5-year overall survival rates were 100% in both groups.The local recurrence in HF and CF group was 0.0%,3.0% respectively (x2=0.28,P=-0.600).The incidence of grade 1 acute skin toxicity developed in CF and HF group was 55.6% and 51.5% respectively (x2=0.11,P=0.737).Grade 1 late skin and subcutaneous tissue toxicity developed in HF and CF groups was 13.9% and 9.1% respectively (x2=0.06,P=0.806).Grade 1 neutropenia occurred in HF and CF groups was 8.3% and 12.1% respectively (x2=0.02,P=0.903).The 1-,3-,5-year excellent and good rates of cosmetic outcomes of patients in HF and CF groups were 85.7% and 84.8% (x2=0.01,P=0.920); 88.2% and 87.1% (x2=0.02,P=0.889); 87.1% and 88.0% (x2=0.01,P=0.919).Conclusion Hypofractionation radiotherapy provides similar results to conventional radiotherapy in survival rate cosmetic outcome and toxicity.%目的 探讨早期乳腺癌保乳术后大分割放疗的疗效、美容效果及不良反应.方法 选择2006~2009年陕西省人民医院

  2. 前列腺癌大分割调强放疗副反应初步分析%Toxicity of hypofractionated intensity-modulated radiotherapy in patients with prostate cancer

    Institute of Scientific and Technical Information of China (English)

    房辉; 刘清峰; 戴建荣; 余子豪; 李晔雄; 刘跃平; 王维虎; 金晶; 王淑莲; 宋永文; 刘新帆; 亓姝楠

    2009-01-01

    目的 分析前列腺癌大分割照射患者的早期和晚期副反应,初步探讨副反应的影响因素.方法 2006-2008年间37例前列腺痛患者接受大分割调强放疗(IMRT).13例临床靶体积(CTV)包括前列腺±精囊或术后瘤床,24例包括前列腺、精囊(或术后瘤床)和盆腔淋巴引流区.分次照射剂量为2.3~2.8 Gy(2.7 Gy占26例).95%PTV处方剂量前列腺精囊为62.5~75.0 Gy,盆腔为50.0 Gy.结果 全组中位随访时间为14个月.早期胃肠反应发生率0级38%,1级2,4%,2级35%,3级3%;直肠V50>27%与V55>20%的≥1级早期直肠反应发生率不同(P10%的≥1级泌尿系统反应发生率也不同(X2=6.02,P=0.038).晚期直肠反应发生率0级70%,1级24%,2级5%,无3、4级反应;直肠V6510%的≥1级晚期胃肠反应发生率不同(X2=5.58,P=0.020).晚期泌尿系统反应发生率0级38%,1级49%,2级11%,3级3%,无4级反应;膀胱平均剂量>40Gy、V40>32%与V50>29%的≥2级晚期泌尿系统反应发生率均不同.结论 前列腺癌大分割IMRT初步研究结果 显示急件和晚期副反应均在可接受范围内.%Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly

  3. Moderate Hypofractionation in High-Risk, Organ-Confined Prostate Cancer: Final Results of a Phase III Randomized Trial.

    Science.gov (United States)

    Arcangeli, Giorgio; Saracino, Biancamaria; Arcangeli, Stefano; Gomellini, Sara; Petrongari, Maria Grazia; Sanguineti, Giuseppe; Strigari, Lidia

    2017-03-29

    Purpose To report the final results on treatment outcomes of a randomized trial comparing conventional and hypofractionated radiotherapy in high-risk, organ-confined prostate cancer (PCa). Patients and Methods This single-institution, randomized clinical trial, conducted from January 2003 to December 2007, enrolled 168 patients with high-risk PCa who were randomly assigned in a 1:1 ratio to conventional (80 Gy in 40 fractions in 8 weeks) or hypofractionated radiotherapy (62 Gy in 20 fractions in 5 weeks) to prostate and seminal vesicles. The primary outcome measure was late toxicity. Additional outcomes were freedom from biochemical failure (FFBF), prostate cancer-specific survival (PCaSS), and overall survival (OS), evaluated on an intention-to-treat basis. Results A total of 85 patients were assigned to conventional and 83 to hypofractionated radiotherapy. At a median follow-up of 9 years (interquartile range, 7.5 to 10.1 years), no differences was observed in physician-assessed late gastro intestinal and genitourinary toxicity greater than or equal to grade 2 ( P = .68 and .57, respectively) were found between the two arms. The 10-year FFBF rate was 72% in the hypofractionation group and 65% in the conventional fractionation group ( P = .148). Ten-year OS rates were 75% in the hypofractionation group and 64% in the conventional group, respectively ( P = .22). The same features for 10-year PCaSS were 95% and 88%, respectively ( P = .066). Hypofractionation, pretreatment prostate-specific antigen level, Gleason score, and clinical tumor stage for FFBF, and hypofractionation and Gleason score for PCaSS were significant prognostic variables on the multivariate analysis. Conclusion Long-term findings showed that hypofractionated radiotherapy failed the intent of either reducing physician-assessed late toxicity or maintaining the same efficacy. A postrandomization analysis, however, revealed that hypofractionation was a significant prognostic factor for FFBF and PCa

  4. Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir

    OpenAIRE

    Anwar, Mekhail; Weinberg, Vivian; Albert J. Chang; Hsu, I-Chow; Roach, Mack; Gottschalk, Alexander

    2014-01-01

    Background Patients with early stage prostate cancer have a variety of curative radiotherapy options, including conventionally-fractionated external beam radiotherapy (CF-EBRT) and hypofractionated stereotactic body radiotherapy (SBRT). Although results of CF-EBRT are well known, the use of SBRT for prostate cancer is a more recent development, and long-term follow-up is not yet available. However, rapid post-treatment PSA decline and low PSA nadir have been linked to improved clinical outcom...

  5. Evidence from a breast cancer hypofractionated schedule: late skin toxicity assessed by ultrasound.

    Science.gov (United States)

    Landoni, Valeria; Giordano, Carolina; Marsella, Annelisa; Saracino, Biancamaria; Petrongari, Maria; Ferraro, Anna; Strigari, Lidia; Pinnarò, Paola

    2013-10-24

    Feasibility of whole breast hypofractionated radiotherapy schedules in breast conserving therapy is recognized however concerns remain about the role of the boost dose on the overall treatment's potential toxicity. In this study we report on the possibility to quantitatively evaluate radiation induced toxicity in patients treated with an abbreviated course with major concern in the irradiated boost region. Eighty-nine patients who underwent conservative surgery for early-stage breast cancer followed by adjuvant accelerated hypofractionated whole breast radiotherapy were included in this study to assess skin and subcutaneous tissue late toxicity by means of ultrasonographic quantitative examination. For each patient the skin thickness was measured at four positions: on the irradiated breast, in the boost region and in the corresponding positions in the contra-lateral not treated breast. All patients were scanned by the same radiologist to reduce potential inter-operator variability, the operator was blind to the scoring of the patient CTCv3 late toxicity as well as patient treatment characteristics. Ultrasound assessment and clinical evaluation were compared. The median time between the end of adjuvant radiotherapy and ultrasound examination was 20.5 months. The measured mean skin thickness in the irradiated breast was 2.13 ± 0.72 mm while in the mirror region of the contra-lateral healthy breast was 1.61 ± 0.29 mm. The measured mean skin thickness in the irradiated boost region was 2.25 ± 0.79 mm versus 1.63 ± 0.33 mm in the corresponding region of contra-lateral healthy breast. The mean increment in skin thickness respect to the counterpart in the healthy breast was 0.52 ± 0.67 mm and 0.62 ± 0.74 mm for the breast and the boost region respectively. A significant direct correlation was found between the increment in skin thickness in the irradiated breast and in the boost region with fibrosis (G ≥ 1). In this study results from a breast cancer

  6. Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Stiebel-Kalish, Hadas, E-mail: kalishhadas@gmail.com [Neuro-Ophthalmology Unit, Rabin Medical Center, Petah Tikva (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Reich, Ehud [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Department of Ophthalmology, Rabin Medical Center, Petah Tikva (Israel); Gal, Lior [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Rappaport, Zvi Harry [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Department of Neurosurgery, Rabin Medical Center, Petah Tikva (Israel); Nissim, Ouzi [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan (Israel); Department of Neurosurgery, Sheba Medical Center, Ramat Gan (Israel); Pfeffer, Raphael [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan (Israel); Spiegelmann, Roberto [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan (Israel); Department of Neurosurgery, Sheba Medical Center, Ramat Gan (Israel)

    2012-02-01

    Purpose: Meningiomas threatening the anterior visual pathways (AVPs) and not amenable for surgery are currently treated with multisession stereotactic radiotherapy. Stereotactic radiotherapy is available with a number of devices. The most ubiquitous include the gamma knife, CyberKnife, tomotherapy, and isocentric linear accelerator systems. The purpose of our study was to describe a case series of AVP meningiomas treated with linear accelerator fractionated stereotactic radiotherapy (FSRT) using the multiple, noncoplanar, dynamic conformal rotation paradigm and to compare the success and complication rates with those reported for other techniques. Patients and Methods: We included all patients with AVP meningiomas followed up at our neuro-ophthalmology unit for a minimum of 12 months after FSRT. We compared the details of the neuro-ophthalmologic examinations and tumor size before and after FSRT and at the end of follow-up. Results: Of 87 patients with AVP meningiomas, 17 had been referred for FSRT. Of the 17 patients, 16 completed >12 months of follow-up (mean 39). Of the 16 patients, 11 had undergone surgery before FSRT and 5 had undergone FSRT as first-line management. Tumor control was achieved in 14 of the 16 patients, with three meningiomas shrinking in size after RT. Two meningiomas progressed, one in an area that was outside the radiation field. The visual function had improved in 6 or stabilized in 8 of the 16 patients (88%) and worsened in 2 (12%). Conclusions: Linear accelerator fractionated RT using the multiple noncoplanar dynamic rotation conformal paradigm can be offered to patients with meningiomas that threaten the anterior visual pathways as an adjunct to surgery or as first-line treatment, with results comparable to those reported for other stereotactic RT techniques.

  7. Feasibility report of image guided stereotactic body radiotherapy (IG-SBRT) with tomotherapy for early stage medically inoperable lung cancer using extreme hypofractionation

    Energy Technology Data Exchange (ETDEWEB)

    Hodge, Wes; Tome, Wolfgang A.; Jaradat, Hazim A.; Orton, Nigel P.; Khuntia, Deepak; Mehta, Minesh P. [Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States). Dept. of Human Oncology; Traynor, Anne [Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States). Dept. of Medicine; Weigel, Tracey [Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States). Dept. of Surgery

    2006-09-15

    We report on the technical feasibility, dosimetric aspects, and daily image-guidance capability with megavoltage CT (MVCT) of stereotactic body radiotherapy (SBRT) using helical tomotherapy for medically inoperable T1/2 N0 M0 non-small cell lung cancer. Nine patients underwent treatment planning with 4D-CT in a double vacuum based immobilization system to minimize tumor motion and to define a lesion-specific 4D-motion envelope. Patients received 60 Gy in 5 fractions within 10 days to a PTV defined by a motion envelope plus a 6 mm expansion for microscopic extension and setup error using tomotherapy, with daily pretreatment MVCT image guidance. The primary endpoint was technical feasibility. Secondary endpoints were defining the acute and sub-acute toxicities and tumor response. Forty three of 45 fractions were successfully delivered, with an average delivery time of 22 minutes. MVCT provided excellent tumor visualization for daily image guidance. No significant tumor regression was observed on MVCT in any patient during therapy. Median mean normalized total doses were: tumor 117 Gy{sub 10}; residual lung 9 Gy{sub 3}. Maximum fraction-size equivalent dose values were: esophagus 5 Gy{sub 3}{sup 9}; cord 7 Gy{sub 3}{sup 6}. No patient experienced = grade 2 pulmonary toxicity. 3 complete, 4 partial and 2 stable responses were observed, with <3 months median follow-up. The mean tumor regression is 72%. SBRT using tomotherapy proved to be feasible, safe and free of major technical limitations or acute toxicities. Daily pretreatment MVCT imaging allows for precise daily tumor targeting with the patient in the actual treatment position, and therefore provides for precise image guidance.

  8. Hypofractionation and concomitant boost to deliver adjuvant whole-breast radiation in ductal carcinoma in situ (DCIS): a subgroup analysis of a prospective case series.

    Science.gov (United States)

    Cante, Domenico; Franco, Pierfrancesco; Sciacero, Piera; Girelli, Giuseppe; Marra, Anna Maria; Pasquino, Massimo; Russo, Giuliana; Casanova Borca, Valeria; Mondini, Guido; Paino, Ovidio; Numico, Gianmauro; Tofani, Santi; La Porta, Maria Rosa; Ricardi, Umberto

    2014-02-01

    To report the four-year outcomes of accelerated hypofractionated whole-breast radiotherapy (WBRT) with a concomitant boost (CB) to the tumor bed in ductal carcinoma in situ (DCIS), we performed a subgroup analysis of 103 patients affected with DCIS within a cohort of 960 early breast cancer patients treated with breast conservation and hypofractionated WBRT. Prescription dose to the whole breast was 45 Gy (2.25 Gy/20 fractions) with an additional daily CB of 0.25 Gy to the surgical cavity (2.5 Gy/20 fractions up to 50 Gy). With a median follow-up of 48 months (range 12-91), no local recurrence was observed. Maximum detected acute skin toxicity was as follows: G0 in 35 % of patients, G1 in 54 %, G2 in 9 % and G3 in 2 %. Late skin and subcutaneous toxicity were generally mild with only 1 % of patients experiencing ≥G3 events (telangiectasia). No major lung and heart toxicity were detected. Cosmetic results were excellent in 50 % of patients, good in 37 %, fair in 9 % and poor in 4 %. Quality of life had a generally favorable profile both within the functioning and symptoms domains. The present result supports the hypothesis that DCIS patients could be safely treated with a hypofractionated schedule employing a CB to the lumpectomy cavity.

  9. Hypofractionation in Prostate Cancer: Radiobiological Basis and Clinical Appliance

    Directory of Open Access Journals (Sweden)

    M. Mangoni

    2014-01-01

    Full Text Available External beam radiation therapy with conventional fractionation to a total dose of 76–80 Gy represents the most adopted treatment modality for prostate cancer. Dose escalation in this setting has been demonstrated to improve biochemical control with acceptable toxicity using contemporary radiotherapy techniques. Hypofractionated radiotherapy and stereotactic body radiation therapy have gained an increasing interest in recent years and they have the potential to become the standard of care even if long-term data about their efficacy and safety are not well established. Strong radiobiological basis supports the use of high dose for fraction in prostate cancer, due to the demonstrated exceptionally low values of α/β. Clinical experiences with hypofractionated and stereotactic radiotherapy (with an adequate biologically equivalent dose demonstrated good tolerance, a PSA control comparable to conventional fractionation, and the advantage of shorter time period of treatment. This paper reviews the radiobiological findings that have led to the increasing use of hypofractionation in the management of prostate cancer and briefly analyzes the clinical experience in this setting.

  10. Hypofractionation in prostate cancer: radiobiological basis and clinical appliance.

    Science.gov (United States)

    Mangoni, M; Desideri, I; Detti, B; Bonomo, P; Greto, D; Paiar, F; Simontacchi, G; Meattini, I; Scoccianti, S; Masoni, T; Ciabatti, C; Turkaj, A; Serni, S; Minervini, A; Gacci, M; Carini, M; Livi, L

    2014-01-01

    External beam radiation therapy with conventional fractionation to a total dose of 76-80 Gy represents the most adopted treatment modality for prostate cancer. Dose escalation in this setting has been demonstrated to improve biochemical control with acceptable toxicity using contemporary radiotherapy techniques. Hypofractionated radiotherapy and stereotactic body radiation therapy have gained an increasing interest in recent years and they have the potential to become the standard of care even if long-term data about their efficacy and safety are not well established. Strong radiobiological basis supports the use of high dose for fraction in prostate cancer, due to the demonstrated exceptionally low values of α / β . Clinical experiences with hypofractionated and stereotactic radiotherapy (with an adequate biologically equivalent dose) demonstrated good tolerance, a PSA control comparable to conventional fractionation, and the advantage of shorter time period of treatment. This paper reviews the radiobiological findings that have led to the increasing use of hypofractionation in the management of prostate cancer and briefly analyzes the clinical experience in this setting.

  11. Vertical mammaplasty associated with accelerated partial breast radiotherapy: how oncoplastic surgery techniques associated with modern techniques of radiotherapy can improve the aesthetic outcome in selected patients

    Energy Technology Data Exchange (ETDEWEB)

    Couto, Henrique Lima, E-mail: enriquecouto@hotmail.com [Santa Fe Women' s and Maternity Hospital, Belo Horizonte, MG (Brazil); Amorim, Washington Cancado; Guimaraes, Rodrigo [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Hospital Geral; Ramires, Leandro Cruz; Castilho, Marcus Simoes [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Fac. de Medicina; Dominguez, Lorena Lima Coto [Universidade Estacio de Sa (UNESA), Rio de Janeiro, EJ (Brazil)

    2014-07-15

    Breast cancer is the second most common type of cancer in the world, being the most common among women, responsible for 22% of new cases each year. It's surgical and radiation treatment evolved from radical procedures (Halsted radical mastectomy and total external breast radiotherapy) to less radical and more conservative procedures. With the use of modern oncoplastic surgery techniques and accelerated partial breast radiotherapy, selected patients can benefit with better aesthetic results, fewer side effects, and more comfortable and brief treatments. (author)

  12. A Treatment Planning and Acute Toxicity Comparison of Two Pelvic Nodal Volume Delineation Techniques and Delivery Comparison of Intensity-Modulated Radiotherapy Versus Volumetric Modulated Arc Therapy for Hypofractionated High-Risk Prostate Cancer Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Myrehaug, Sten [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Chan, Gordon [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Craig, Tim [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Weinberg, Vivian [Biostatistics Core, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA (United States); Cheng, Chun [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Roach, Mack [Department of Radiation Oncology, University of California San Francisco, San Francisco, CA (United States); Cheung, Patrick [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)

    2012-03-15

    Purpose: To perform a comparison of two pelvic lymph node volume delineation strategies used in intensity-modulated radiotherapy (IMRT) for high risk prostate cancer and to determine the role of volumetric modulated arc therapy (VMAT). Methods and Materials: Eighteen consecutive patients accrued to an ongoing clinical trial were identified according to either the nodal contouring strategy as described based on lymphotropic nanoparticle-enhanced magnetic resonance imaging technology (9 patients) or the current Radiation Therapy Oncology Group (RTOG) consensus guidelines (9 patients). Radiation consisted of 45 Gy to prostate, seminal vesicles, and lymph nodes, with a simultaneous integrated boost to the prostate alone, to a total dose of 67.5 Gy delivered in 25 fractions. Prospective acute genitourinary and gastrointestinal toxicities were compared at baseline, during radiotherapy, and 3 months after radiotherapy. Each patient was retrospectively replanned using the opposite method of nodal contouring, and plans were normalized for dosimetric comparison. VMAT plans were also generated according to the RTOG method for comparison. Results: RTOG plans resulted in a significantly lower rate of genitourinary frequency 3 months after treatment. The dosimetric comparison showed that the RTOG plans resulted in both favorable planning target volume (PTV) coverage and lower organs at risk (OARs) and integral (ID) doses. VMAT required two to three arcs to achieve adequate treatment plans, we did not observe consistent dosimetric benefits to either the PTV or the OARs, and a higher ID was observed. However, treatment times were significantly shorter with VMAT. Conclusion: The RTOG guidelines for pelvic nodal volume delineation results in favorable dosimetry and acceptable acute toxicities for both the target and OARs. We are unable to conclude that VMAT provides a benefit compared with IMRT.

  13. Acute toxicity profile and compliance to accelerated radiotherapy plus carbogen and nicotinamide for clinical stage T2-4 laryngeal cancer: results of a phase III randomized trial.

    NARCIS (Netherlands)

    Janssens, G.O.R.J.; Terhaard, C.H.J.; Doornaert, P.A.; Bijl, H.P.; Ende, P. van den; Chin, A.; Pop, L.A.M.; Kaanders, J.H.A.M.

    2012-01-01

    PURPOSE: To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. METHODS AND MATERIALS: From April 2001 to February 2008, 345 patients with

  14. ACUTE TOXICITY PROFILE AND COMPLIANCE TO ACCELERATED RADIOTHERAPY PLUS CARBOGEN AND NICOTINAMIDE FOR CLINICAL STAGE T2-4 LARYNGEAL CANCER : RESULTS OF A PHASE III RANDOMIZED TRIAL

    NARCIS (Netherlands)

    Janssens, Geert O.; Terhaard, Chris H.; Doornaert, Patricia A.; Bijl, Hendrik P.; van den Ende, Piet; Chin, Alim; Pop, Lucas A.; Kaanders, Johannes H.

    2012-01-01

    Purpose: To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. Methods and Materials: From April 2001 to February 2008, 345 patients with

  15. 乳腺癌根治术后大分割放疗与常规分割放疗的急性不良反应比较%Acute adverse reactions of hypofractionated and conventional fractionated radiotherapy in patients after radical mastectomy

    Institute of Scientific and Technical Information of China (English)

    何汇朗; 刘辉明; 许森奎; 姚文燕

    2016-01-01

    Objective To observe acute adverse reactions of hypofractionated and conventional fractionated radiotherapy in patients after radical mastectomy.Methods 111 patients after radical mastectomy prepared for radiotherapy in our hospital from June 2014 to June 2015 were selected and divided into conventional fractionated radiotherapy (CRT) group and hypofractionated radiotherapy (HOFRT) group according to the dose fractionation schemes.63 cases in CRT group received 50 Gy (2.0 Gy per fraction and 5 fractions per week);while 48 cases in HOFRT group received 40.05 Gy (2.67 Gy per fraction and 5 fractions per week).Results The rate of class Ⅱ or above acute radiation skin reactions was 36.5% in CRT group and 12.5% in HOFRT group (x 2=8.14,P<0.01).The rate of radiation pneumonitis was 34.9% in CRT group and 27.1% in HOFRT group (x 2=0.78,P>0.05).Conclusion The rate of acute adverse reactions of hypofractionated radiotherapy in patients after radical mastectomy is better than that of conventional fractionated radiotherapy.%目的 观察乳腺癌根治术后大剂量分割放疗和常规分割放疗的急性不良反应.方法 随机选取我院2014年6月至2015年6月收治的乳腺癌改良根治术后放疗的111例患者,根据放疗的不同剂量分割方案分为常规分割组(CRT)和大分割组(HOFRT).常规分割组63例,总DT 50 Gy,每次剂量2Gy,每周5次;大剂量分割组48例,总DT 40.05 Gy,每次2.67 Gy,每周5次.结果 常规分割组和大分割组的Ⅱ级或以上急性放射性皮肤反应、放射性肺炎的发生率分别为36.5%与12.5%(x2=8.14,P<0.01)、34.9%与27.1%(x2=0.78,P>0.05).结论 乳腺癌根治术后大分割放疗方案的急性不良反应优于常规分割方案.

  16. Toxicity and cosmetic outcome of three-dimensional conformal radiotherapy for accelerated partial breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Gatti, M.; Bresciani, S.; Ponzone, R.; Panaia, R.; Salatino, A.; Stasi, M.; Gabriele, P. [IRCC, Candiolo (Italy)

    2011-10-15

    Full text of publication follows: Purpose.- To analyse the incidence and severity of acute and late normal tissue toxicity and cosmetic outcome using three - dimensional conformal radiotherapy to deliver accelerated partial breast irradiation. Patients and Methods.- 70 patients with stage I disease were treated with three-dimensional conformal radiotherapy for accelerated partial breast irradiation, in an approved protocol. The prescribed dose was 34 Gy in all patients delivered in 10 fractions over 5 consecutive days. On all CT scans gross tumor volume (GTV ) was defined around surgical clips. A 1.5 cm margin was added in order to account for clinical target volume (CTV) . A margin of 1 cm was added to CTI to define the planning target volume (PTV). The dose-volume constraints were followed in accordance with the specifications as dictated in the NSABP/RTOG protocol. After treatment, patients underwent a clinical and cosmetic evaluation every 3 months. Late toxicity was evaluated according to the RTOG grading schema. The cosmetic assessment was performed by the physicians using the controlateral untreated breast as the reference (Harvard scale). Results.- Median patient age was 66 years (range 51-80). Median follow-up was 15 months (range 6-46). Tumor size was < 10 mm in 33 patients (53%) and > 2 cm in 4(6%). The mean value of the ratio between the PTV and the whole ipsilateral breast volume was 38 % and the median percentage whole breast volume that received 95 % of prescribed dose was 34% (range 16%-55%). The rate of G1 and G2 acute skin toxicity was 28% and 2% respectively and the late toxicity was 17% (G1). G2 or greater toxicities were not observed. The most pronounced G1 late toxicity was subcutaneous fibrosis, developed in 3 patients. The cosmetic outcome was excellent in 83% and good in 17%. Conclusion.- Accelerated partial breast irradiation using three-dimensional conformal radiotherapy is technically feasible with very low acute and late toxicity. Long

  17. Correlation between egfr expression and accelerated proliferation during radiotherapy of head and neck squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Pedicini Piernicola

    2012-08-01

    Full Text Available Abstract Purpose To investigate the correlation between the expression of Epidermal Growth Factor receptor (EGFr and the reduction of the effective doubling time (TD during radiotherapy treatment and also to determine the dose per fraction to be taken into account when the overall treatment time (OTT is reduced in accelerated radiotherapy of head and neck squamous cell carcinoma (HNSCC. Methods A survey of the published papers comparing 3-years of local regional control rate (LCR for a total of 2162 patients treated with conventional and accelerated radiotherapy and with a pretreatment assessment of EGFr expression, was made. Different values of TD were obtained by a model incorporating the overall time corrected biologically effective dose (BED and a 3-year clinical LCR for high and low EGFr groups of patients (HEGFr and LEGFr, respectively. By obtaining the TD from the above analysis and the sub-sites’ potential doubling time (Tpot from flow cytometry and immunohistochemical methods, we were able to estimate the average TD for each sub-site included in the analysis. Moreover, the dose that would be required to offset the modified proliferation occurring in one day (Dprolif, was estimated. Results The averages of TD were 77 (27-9095% days in LEGFr and 8.8 (7.3-11.095% days in HEGFr, if an onset of accelerated proliferation TK at day 21 was assumed. The correspondent HEGFr sub-sites’ TD were 5.9 (6.6, 5.9 (6.6, 4.6 (6.1, 14.3 (12.9 days, with respect to literature immunohistochemical (flow cytometry data of Tpot for Oral-Cavity, Oro-pharynx, Hypo-pharynx, and Larynx respectively. The Dprolif for the HEGFr groups were 0.33 (0.29, 0.33 (0.29, 0.42 (0.31, 0.14 (0.15 Gy/day if α = 0.3 Gy-1 and α/β = 10 Gy were assumed. Conclusions A higher expression of the EGFr leads to enhanced proliferation. This study allowed to quantify the extent of the effect which EGFr expression has in terms of reduced TD and Dprolif for each head and neck

  18. 前列腺癌大分割精确放疗分次治疗间和分次治疗内位置变动分析%An analysis of interfractional and intrafractional prostate motion in hypofractionated precise radiotherapy for prostate cancer

    Institute of Scientific and Technical Information of China (English)

    刘跃平; 许晶; 张连胜; 方浩; 张彦新; 陈冰; 戴建荣; 李晔雄

    2016-01-01

    guidance two weeks before computed tomography ( CT) simulation. All patients underwent CT scans in the supine position with full bladders and rectal balloons filled with 60 ml air. The Pinnacle planning system was used to design the treatment plans. Twenty⁃three patients were treated with a Synergy accelerator. Those patients underwent cone⁃beam CT ( CBCT) scans prior to treatment. The set⁃up error was recorded by bone alignment between CBCT images and planning CT images. The prostate displacement was then recorded by gold fiducial alignment. The interfraction prostate displacement was defined by the difference between the above two parameters. The other 5 patients were treated with a Novalis accelerator. Based on gold fiducial alignment,the real⁃time tracking of gold fiducials was carried out by the ExacTrac system to evaluate the intrafractional prostate displacement. Results A total of 207 measurements of interfractional prostate displacement were made in the 23 patients before treatment. The mean interfractional prostate displacements in the left⁃right (LR),superior⁃inferior (SI),and anterior⁃posterior (AP) directions were (0.05±0�10),(0.20±0�22),and (0.19±0�18) cm,respectively. The displacements larger than 0�3 cm in the above three directions were observed in 1,52,and 49 measurements,respectively,while the displacements larger than 0�5 cm in the three directions were observed in 1,29,and 16 measurements,respectively. A total of 225 measurements of gold fiducial displacement were made in the 5 patients during treatment. The mean intrafractional prostate displacements in LR,SI,and AP directions were (0.61±0�50),(0.68±0�69),and (0.70±0�67) mm, respectively. The displacements larger than 3 mm in the three directions were observed in 0, 1, and 1 measurement, respectively. Conclusions In hypofractionated precise radiotherapy for prostate cancer, the interfractional prostate displacement is significantly larger than the intrafractional

  19. Short treatment time and excellent treatment outcome in accelerated hyperfractionated radiotherapy for T1 glottic cancer.

    Science.gov (United States)

    Tamaki, Yukihisa; Hieda, Yoko; Yoshida, Rika; Yoshizako, Takeshi; Fuchiwaki, Takafumi; Aoi, Noriaki; Sekihara, Kazumasa; Kitajima, Kazuhiro; Kawauchi, Hideyuki; Kitagaki, Hajime; Sasaki, Ryohei; Inomata, Taisuke

    2015-11-01

    Accelerated hyperfractionated radiotherapy was performed as treatment for patients with T1 glottic cancer, and its utility was evaluated based on treatment outcomes and adverse effects. Fifty-eight men who had undergone radiotherapy were retrospectively reviewed. Tumor classification was Tis in 4 patients, T1a in 38, and T1b in 16. Histological examination revealed squamous cell carcinoma in 55 patients. Travel time from home to hospital was 0-1 hour for 24 patients, 1-2 hours for 9, and >2 hours for 25. Laser vaporization was performed prior to radiotherapy in 38 patients, and 19 patients received concurrent chemotherapy with an agent such as S-1. Patients were irradiated twice daily using an irradiation container. Most patients received a dose of 1.5 Gy/fraction up to a total of 60 Gy. The median overall treatment time was 30 days, with a median observation period of 59.6 months. A complete response was observed in all patients. The 5-year overall survival, disease-free survival, and local control rates were 97.2%, 93.2%, and 97.8%, respectively. Although grade 3 pharyngeal mucositis was observed in 2 patients, there were no other grade 3 or higher acute adverse events. As late toxicity, grade 2 laryngeal edema and grade 1 laryngeal hemorrhage were observed in 1 patient each, but no serious events such as laryngeal necrosis or laryngeal stenosis were observed. In conclusion, this treatment method brings excellent outcome and will substantially reduce the treatment duration among patients who need to stay at nearby hotels while undergoing treatment at hospitals in rural areas.

  20. Effects and prognostic factors of hypofractionated stereotactic radiotherapy for brain metastasis in non-small cell lung cancer%大分割立体定向放射治疗NSCLC脑转移的临床观察

    Institute of Scientific and Technical Information of China (English)

    斯琴高娃; 李墨

    2012-01-01

    OBJECTIVE: To study the effects and prognostic factors for patients with brain metastases in non-small cell lung cancer (NSCLC) treated by hypofractionated stereotactic radiotherapy (HSRT). METHODS: A total of 60 patients with brain metastasis were recruited, which included 124 metastatic lesions. All patients received the treatment of HSRT. Ninety metastasis lesions received the HSRT plus whole brain radiotherapy, and thirty-four lesions received the HSRT alone. Median follow up time was 12 months. The effective rate and prognostic factors were observed and analyzed accordingly. RESULTS: In group of receiving HSRT with whole brain radiotherapy, forty-six of metastasis lesions were reached to complete remission (CR) , 28 to partial remision (PR), 9 to stable disease(SD), and 7 to progressive disease(PD). Local-control (LC) rate at 6- and 12-month was 92. 3% and 66. 9%, and the overall survival (OS) rate was 73. 2% and 47.6%, respectively. In group of receiving HSRT alone, twenty of metastasis lesions were reached for CR, 7 for PR, 4 for SD, and 3 for PD. LC rate at 6- and 12- month was 92. 7% and 65. 9% and the OS rate was 70. 2% and 45. 8% , respectively. Multivariate analysis showed that the amount of the metastasis lesions (OR= 1. 675, P=0. 001), extracranial metastasis (OR=1. 934, P. 036) and the control of the primary tumor (OR=7. 936, P=0. 033) were the independent factors for the OS. CONCLUSIONS; HSRT is one of the efficacious methods for the treatment in NSCLC patients with brain metastases. Numbers of brain metastasis lesions, extracranial metastasis and controlled primary lesion are independent prognostic factors.%目的:分析大分割立体定向放射治疗(HSRT)非小细胞肺癌(NSCLC)脑转移的有效性及预后因素.方法:选取60例有1 24个脑转移病灶的NSCLC患者进行HSRT,其中90个病变进行全脑放射治疗加HSRT,34个病变初始进行HSRT,中位随访12个月.观察近期疗效及预后因素.结果:全脑放疗加HSRT组46

  1. Cost-benefit analysis on radiotherapy services for cancer treatment, with LINAC type equipments (linear accelerators

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Blois

    2014-12-01

    Full Text Available This work consists in analyzing the economic feasibility of the investment to implement a Radiotherapy sector for radiological of cancer treatment by type linear accelerators equipments, based on the case of a public hospital in São Paulo. From technical and financial details of the project and the survey reference values for health care to their procedures, the statistical outcome of treatment on patients' life expectancy and average income indicators of the state's population, were estimated to income (private and social and expenses of this health service and other elements that make up the flow of the investment project box. From these estimates we evaluated public and private investment return, ie, if it fits only on the public sector or if private sector could also implement this projects geared exclusively to free admittance.

  2. An intercomparison of neutron measurments for a 25 MV x-ray radiotherapy accelerator.

    Science.gov (United States)

    Nath, R; Price, K W; Holeman, G R

    1980-01-01

    High-energy x-ray radiotherapy machines produce neutrons by photonuclear reactions which present a potential radiation hazard to the personnel and patient. A series of measurements of the neutron flux from a 25 MV x-ray linear accelerator, inside and outside the treatment room, have been performed using a multisphere spectrometer, Nemo dosimeter, and activation detectors. These results are compared with other mixed photon-neutron field measurements for the same machine performed using an argon/propane ionization chamber, silicon diode, track-etching detectors, and Monte Carlo calculations. It is found that these measurements agree with each other within a factor of two except for silicon diode measurements in the photon beam. Measured neutron spectra at various locations in the treatment room are also compared with the results of Monte Carlo transport calculations.

  3. SU-E-T-776: Use of Quality Metrics for a New Hypo-Fractionated Pre-Surgical Mesothelioma Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, S; Mehta, V [Swedish Cancer Institute, Seattle, WA (United States)

    2015-06-15

    Purpose: The “SMART” (Surgery for Mesothelioma After Radiation Therapy) approach involves hypo-fractionated radiotherapy of the lung pleura to 25Gy over 5 days followed by surgical resection within 7. Early clinical results suggest that this approach is very promising, but also logistically challenging due to the multidisciplinary involvement. Due to the compressed schedule, high dose, and shortened planning time, the delivery of the planned doses were monitored for safety with quality metric software. Methods: Hypo-fractionated IMRT treatment plans were developed for all patients and exported to Quality Reports™ software. Plan quality metrics or PQMs™ were created to calculate an objective scoring function for each plan. This allows for an objective assessment of the quality of the plan and a benchmark for plan improvement for subsequent patients. The priorities of various components were incorporated based on similar hypo-fractionated protocols such as lung SBRT treatments. Results: Five patients have been treated at our institution using this approach. The plans were developed, QA performed, and ready within 5 days of simulation. Plan Quality metrics utilized in scoring included doses to OAR and target coverage. All patients tolerated treatment well and proceeded to surgery as scheduled. Reported toxicity included grade 1 nausea (n=1), grade 1 esophagitis (n=1), grade 2 fatigue (n=3). One patient had recurrent fluid accumulation following surgery. No patients experienced any pulmonary toxicity prior to surgery. Conclusion: An accelerated course of pre-operative high dose radiation for mesothelioma is an innovative and promising new protocol. Without historical data, one must proceed cautiously and monitor the data carefully. The development of quality metrics and scoring functions for these treatments allows us to benchmark our plans and monitor improvement. If subsequent toxicities occur, these will be easy to investigate and incorporate into the

  4. Hypofractionation for clinically localized prostate cancer.

    Science.gov (United States)

    Cabrera, Alvin R; Lee, W Robert

    2013-07-01

    This manuscript reviews the clinical evidence for hypofractionation in prostate cancer, focusing on data from prospective trials. For the purposes of this manuscript, we categorize hypofractionation as moderate (2.4-4 Gy per fraction) or extreme (6.5-10 Gy per fraction). Five randomized controlled trials have evaluated moderate hypofractionation in >1500 men, with most followed for >4-5 years. The results of these randomized trials are inconsistent. No randomized trials or other rigorous comparisons of extreme hypofractionation with conventional fractionation have been reported. Prospective single-arm studies of extreme hypofractionation appear favorable, but small sample sizes preclude precise estimates of efficacy and short follow-up prevents complication estimates beyond 3-5 years. Over the next several years, the results of 3 large noninferiority trials of moderate hypofractionation and 2 randomized trials of extreme hypofractionation should help clarify the role of hypofractionation in prostate cancer therapy.

  5. Effect of hypofractionated palliative thoracic radiotherapy for ad-vanced non-small cell lung cancer%进展期非小细胞肺癌短疗程大分割姑息放疗疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘维帅; 赵路军; 刘志艳; 李博; 袁智勇; 王平

    2013-01-01

    Objective:To investigate the effect and toxicity of short-course and hypofractionated palliative thoracic radiotherapy (PTR) for advanced non-small cell lung cancer (NSCLC). Methods:A total of 25 patients with stageⅢB and stageⅣNSCLC, who underwent PTR from September 2010 to July 2006, were retrospectively analyzed. The PTR regime was 45 Gy in 15 fractions. Symptom relief, effect, and toxicity after completion of PTR were assessed. Survival was analyzed using the Kaplan-Meier method. Results:Except for one patient who completed only 36 Gy in 12 fractions, all other patients completed all plans. The thoracic symptoms of 18 patients were relieved. The response rates for the five main symptoms were:hemoptysis 87.5%(7/8), cough 70.6%(12/17), pain 73.3%(11/15), dyspnea 57.1%(8/14), and hoarseness 50%(1/2). The complete response and partial response after PTR was 28%, and no grade 3 or higher toxicities occurred. The median time of overall survival (OS) is 13 months (95%CI:6.6 months to 19.5 months), and one-year OS is 51.5%. According to the univariate analysis, KPS before PTR, the number of post-PTR was significantly related to the survival. Conclusion:For advanced NSCLC patients, the PTR regime given as 45 Gy in 15 fractions evidently relieved thoracic symptoms, improved OS, and shortened treatment time. Recent relevant adverse radiotherapy reactions are low, and more prospective clinical studies must be conducted.%目的:分析进展期非小细胞肺癌患者采用短疗程、大分割胸部姑息放疗(palliative thoracic radiotherapy,PTR)的疗效及其不良反应。方法:回顾性分析天津医科大学肿瘤医院2010年9月至2012年7月行PTR的ⅢB期及Ⅳ期非小细胞肺癌患者共25例,其计划靶区(PTV)剂量为45 Gy/15 f,单次剂量3 Gy。评价PTR后症状缓解情况、放疗疗效及相关不良反应。Kaplan-Meier法进行生存分析并用Log-rank进行检验。结果:除1例患者只完成36 Gy/12f外,其余24

  6. 全基因组表达谱芯片筛选非小细胞肺癌常规分割和大分割放疗差异基因的初步研究*%Identifying the genetic pattern of conventional fractionated and hypofractionated radiotherapy using whole genome expression microarray in a non-small-cell lung cancer cell line

    Institute of Scientific and Technical Information of China (English)

    孙健; 刘宁波; 曲晨慧; 王宝虎; 郭华; 王平

    2013-01-01

    目的:获得稳定的非小细胞肺癌(NSCLC)放射抗拒细胞系,明确常规分割和大分割放疗后肿瘤基因表达改变。方法:采用A549细胞系,6MV X线常规照射(2 Gy×17 f)和大分割照射(4 Gy×7 f),克隆形成实验和γ-H2AX免疫荧光染色结合共聚焦显微镜验证细胞的放射抗拒特性。提取mRNA,全基因组表达谱芯片检测差异基因表达,分析2倍以上改变的基因(P<0.05),同时对芯片结果行Pathway分析(Q<0.05)。结果:获得了2株放疗抗拒细胞系A549R2Gy-R和A549R4Gy-R。表达谱芯片显示,A549与A549R2Gy-R相比,差异表达基因为1701个(357个上调,1344个下调);A549与A549R4Gy-R相比,944个基因上调,2602个基因下调。A549R2Gy-R与A549R4Gy-R相比,318个基因上调,699个基因下调。常规分割照射与大分割照射的pathway显著性富集分析显示,PI3K和Erb B通路等多条信号通路激酶出现显著性差异。结论:多种基因和信号通路参与了NSCLC常规分割和大分割放疗抗拒过程,进一步研究能明确NSCLC放射抗拒机制和为放疗增敏药物开发提供新靶点。%Objective:To obtain stable radioresistant non-small-cell lung cancer (NSCLC) cell lines and identify the genetic pattern of conventional fractioned and hypofractionated radiotherapy. Methods:A549 NSCLC cells were treated with 6 MV of x-rays through conventional fractionated (2 Gy, 17 f) and hypofractionated irradiation (4 Gy, 7 f) to establish a radiation resistance cell model. Tumor cell radioresistance was determined using a clonogenic assay andγ-H2AX immunofluorescence staining combined with confocal microscopy. After extracting total mRNA from the cells, a whole genome expression microarray was applied to detect differential gene expression. The genes with at least a twofold increase in expression (P<0.05) were analyzed, and the pathway (Q<0.05) methods were used to further analyze the chip results

  7. Phase Ⅱ clinical trial of central hypofractionated three-dimensional radiotherapy for patients with early-stage breast cancer after breast-conserving surgery%早期乳腺癌保乳术后大分割三维放疗Ⅱ期临床观察

    Institute of Scientific and Technical Information of China (English)

    邓垒; 惠周光; 王淑莲; 陈波; 唐玉; 余子豪; 刘新帆; 金晶; 王维虎

    2013-01-01

    目的 观察早期乳腺癌保乳术后大分割三维放疗的疗效、美容效果和不良反应.方法 2009-2010年45例pTis-2No-1M0期乳腺癌患者保乳术后行三维适形或简化调强放疗,全乳43.5 Gy,瘤床补量8.7Gy,2.9 Gy/次,总疗程24 d.33例接受了化疗,其中新辅助化疗2例、术后化疗31例.局部区域控制率和总生存率用Kapian-Meier法计算.结果 随访率100%.2年局部区域控制率、生存率均为100%;1例单发骨转移.2级乳房水肿1例,2级乳房纤维化6例,2级上肢水肿1例.2级放射性皮炎4例,1、2级放射性肺炎分别为5、2例.与同期保乳术后常规分割放疗相比,放疗次数由30次降至18次,疗程由40 d缩短至24 d,费用由30450元降至19770元.结论 乳腺癌保乳术后全乳大分割放疗的疗效和美容效果较好,不良反应可接受,且能显著降低治疗时间和费用.%Objective To observe the therapeutic effects,cosmetic results,and toxicities of central hypofractionated three-dimensional radiotherapy for patients with early-stage breast cancer after breastconserving surgery.Methods From February 2009 to February 2010,45 patients with pTis-2N0-1 M0 breast cancer after breast-conserving surgery were enrolled in the trial.Three-dimensional conformal radiotherapy or simplified intensity-modulated radiotherapy was applied to each patient.The hypofractionated radiotherapy schedule was 43.5 Gy/15 fractions/3 weeks to the whole breast,with a boost of 8.7 Gy/3 fractions/3 days to the tumor bed.The dose was 2.9 Gy per fraction;the total course of treatment was 24 days.Thirty-three patients received chemotherapy,including neoadjuvant chemotherapy in 2 patients and postoperative adjuvant chemotherapy in 31 patients.Locoregional control and overall survival were calculated by Kaplan-Meier method.Results The follow-up rate was 100%.The 2-year locoregional control and overall survival were both 100%,and one patient had a single bone metastasis.Of the patients,1

  8. 大剂量多次分割立体定向放疗对听神经瘤的疗效分析%Clinical Efficacy of Hypofractionated Stereotactic Radiotherapy in Five Fractions for Acoustic Neuromas

    Institute of Scientific and Technical Information of China (English)

    陈志萍; 溝脇尚志; 小倉健; 宇藤惠; 平岡眞寛

    2015-01-01

    目的:评价大剂量分割立体定向放疗(hypo-FSRT)治疗听神经瘤患者在肿瘤局部控制及有效听力保存等方面的临床价值。方法回顾性分析47例单侧听神经瘤患者,中位年龄61岁,放疗前19例患者持有有效听力,肿瘤最大径中位值20 mm,处方剂量:等中心总剂量25 Gy,5次分割,每日1次,80%剂量曲线包绕计划靶区( PTV)边缘。采用实体瘤消退评价标准( RECIST)改良版1.1评估肿瘤消退情况。采用Gardner-Robertson Class 评估听力保存情况。 SPSS 18.0软件进行统计分析。结果中位随访及听力随访时间分别为61及52个月,30例(63.8%)、13例(27.67%)及4例(8.5%)患者分别出现肿瘤部分缩退(PR)、稳定(SD)、进展(PD),根据Kaplan-Meier生存分析,5年肿瘤局部控制率为90.4%,放疗前肿瘤是否合并囊变成分在肿瘤控制方面存在显著性差异(P=0.015),合并囊变的肿瘤预示放疗后出现肿瘤进展的可能性大。放疗后14例(29.8%)患者出现肿瘤暂时性增大。1、3、5年患者有效听力保存率分别为68.4%,62.1%及35.5%。有效听力保存与未保存患者在肿瘤消退情况方面存在明显差异(P=0.017)。1例(2.1%)患者行挽救性手术,2例(4.3%)患者行VP-脑室分流术,2例(4.3%)患者新出现三叉神经轻度麻痹。结论 Hypo-FSRT (25 Gy/5次)治疗单侧听神经瘤可有效控制肿瘤,放疗后并发症发生率低。影像定期随访中观察到肿瘤暂时性增大及逐渐缩退过程。放疗前肿瘤合并囊变预示患者放疗后出现肿瘤进展的机率更高。%Objective To study the clinical outcomes of hypofractionated stereotactic radiotherapy ( hypo-FSRT) for a-coustic neuromas (ANs).Methods 47 patients with unilateral acoustic neuroma were treated consecutively with hypo -FSRT. The median age was 61 years old

  9. Can pure accelerated radiotherapy given as six fractions weekly be an option in locally advanced carcinoma cervix: Results of a prospective randomized phase III trial

    Directory of Open Access Journals (Sweden)

    Mukesh Sharma

    2016-01-01

    Conclusions: Accelerated radiotherapy given as six fractions per week is an effective alternative to concomitant chemoradiation in locally advanced carcinoma cervix and has shown lesser toxicities in our study.

  10. Theoretical aspects of implementation of kilovoltage cone-beam CT onboard linear accelerator for image-guided radiotherapy.

    Science.gov (United States)

    Rodríguez Cordón, Marta; Ferrer Albiach, Carlos

    2009-08-01

    The main objective of image-guided radiation therapy (IGRT) equipment is to reduce and correct inherent errors in external radiotherapy processes. At the present time, there are different IGRT systems available, but here we will refer exclusively to the kilovoltage cone-beam CT onboard linear accelerator (CBkVCT) and the different aspects that, from a clinical point of view, should be taken into consideration before the implementation of this equipment.

  11. Retrospective study on therapy options of brain metastases surgery versus stereotactic radiotherapy with the linear accelerator

    CERN Document Server

    Fortunati, M K S

    2001-01-01

    Background: in the therapy of brain metastases there has been a great progress in the last years. It was shown, that more aggressive therapies can not only extend the survival of the patients, but also improve quality of life. The major question of this study was, whether surgery or stereotactic radiotherapy with the linear accelerator show better results in behalf of the survival. Beside this major question many parameters regarding the patient or his primary cancer were examined. Methods: from the 1st of January 1995 until the 30th of June 2000 233 patients with one or more brain metastases have been treated in the Wagner Jauregg Landesnervenkrankenhaus Oberoesterreich (WJ LNKH OeO). The LINAC has been established on the 1st of July 1997. The patients have been distributed in three groups: 1. LINAC-group: 81 patients have been treated from the 1st of July 1997 until the 30th of June 2000 with the LINAC. 2. Surgery-group: 81 patients have been operated from the 1st of July 1997 until the 30th June 2000. 3 Co...

  12. T1-2 N0-1 M0期乳腺癌保乳术后大分割调强放疗近期临床观察%The retrospective study of hypofractionated intensity -modulated radiotherapy in breast cancer after breast conserving surgery with stage T1-2N0-1M0

    Institute of Scientific and Technical Information of China (English)

    景娜; 王玉; 杨君; 王仙玲; 马永强

    2015-01-01

    Objective:To observe the efficacy,cosmetic outcome and adverse reaction of hypofractionated intensity-modulated radiotherapy for T1 -2 N0 -1 M0 breast cancer after breast conserving surgery.Methods:From November 2011 to November 2012,41 patients with T1 -2 N0 -1 M0 breast cancer after breast conserving surgery in Shanxi Tumor Hospital were enrolled in the trial.The hypofractionated intensity -modulated radiotherapy was applied to each pa-tient.The hypofractionated intensity -modulated radiotherapy was 43.5Gy/(15f·3w)to the whole breast,with a boost of 8.7Gy/(3f·3d)to the tumor bed.The dose was 2.9Gy per fraction,the total course of treatment was 24 days.Locoregional control and overall survival were calculated by Kaplan -Meier method.Results:The follow -up rate was 100%,the 3 -year locoregional control and overall survival were both 100%.4 developed grade Ⅰ acute ra-diodermatitis,3 developed grade Ⅱ acute radiodermatitis,5 developed grade Ⅰ leukocyte reduction,3 developed grade Ⅱ leukocyte reduction,2 developed grade Ⅲ leukocyte reduction,2 developed grade Ⅰ acute radioactive pneu-monia,1 developed grade late radioactive pneumonia,2 developed grade Ⅰ limb edema.The excellent and good rates of cosmetic outcomes before and after radiotherapy were 95.1%,87.8%,The 1 -,3 -,6 -,12 -month excellent and good rates of cosmetic outcomes after radiotherapy were 90.2%.Conclusion:The hypofractionated intensity -modula-ted radiotherapy for the patients with early -stage breast cancer after breast -conserving surgery have good therapeu-tic effects and cosmetic results,acceptable toxicities,low adverse reaction,as well as can shorten the time of radiother-apy.%目的:观察 T1-2 N0-1 M0期乳腺癌保乳术后大分割调强放疗的疗效、美容效果及不良反应。方法:选择2011年11月-2012年11月间就诊于山西省肿瘤医院乳腺疾病诊治中心的乳腺癌保乳患者41例,予大分割调强放疗,全乳计划靶体积43.5Gy

  13. Hypofractionated Radiation Therapy for Breast Ductal Carcinoma In Situ

    Energy Technology Data Exchange (ETDEWEB)

    Hathout, Lara [Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Centre affilié à l' Université de Montréal, Montreal, Quebec (Canada); Hijal, Tarek [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Théberge, Valérie [Department of Radiation Oncology, Centre hospitalier universitaire de Québec, L' Hôtel-Dieu de Québec, Quebec (Canada); Centre des maladies du sein Deschênes-Fabia, Quebec (Canada); Fortin, Bernard [Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Centre affilié à l' Université de Montréal, Montreal, Quebec (Canada); Vulpe, Horia [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Hogue, Jean-Charles [Centre des maladies du sein Deschênes-Fabia, Quebec (Canada); Centre hospitalier universitaire de Québec, Hôpital St-Sacrement, Quebec (Canada); Lambert, Christine [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Bahig, Houda [Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Centre affilié à l' Université de Montréal, Montreal, Quebec (Canada); and others

    2013-12-01

    Purpose: Conventional radiation therapy (RT) administered in 25 fractions after breast-conserving surgery (BCS) is the standard treatment for ductal carcinoma in situ (DCIS) of the breast. Although accelerated hypofractionated regimens in 16 fractions have been shown to be equivalent to conventional RT for invasive breast cancer, few studies have reported results of using hypofractionated RT in DCIS. Methods and Materials: In this multicenter collaborative effort, we retrospectively reviewed the records of all women with DCIS at 3 institutions treated with BCS followed by hypofractionated whole-breast RT (WBRT) delivered in 16 fractions. Results: Between 2003 and 2010, 440 patients with DCIS underwent BCS followed by hypofractionated WBRT in 16 fractions for a total dose of 42.5 Gy (2.66 Gy per fraction). Boost RT to the surgical bed was given to 125 patients (28%) at a median dose of 10 Gy in 4 fractions (2.5 Gy per fraction). After a median follow-up time of 4.4 years, 14 patients had an ipsilateral local relapse, resulting in a local recurrence-free survival of 97% at 5 years. Positive surgical margins, high nuclear grade, age less than 50 years, and a premenopausal status were all statistically associated with an increased occurrence of local recurrence. Tumor hormone receptor status, use of adjuvant hormonal therapy, and administration of additional boost RT did not have an impact on local control in our cohort. On multivariate analysis, positive margins, premenopausal status, and nuclear grade 3 tumors had a statistically significant worse local control rate. Conclusions: Hypofractionated RT using 42.5 Gy in 16 fractions provides excellent local control for patients with DCIS undergoing BCS.

  14. 三维适形低分割放疗治疗Ⅲ、Ⅳ期非小细胞肺癌疗效观察%Three-dimensional conformal hypofractionated high-dose radiotherapy treatment for Ⅲ, Ⅳ stage non-small-cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    党亚正; 李小龙; 陆婉玲; 卫伟; 赵宏亮; 陆宙; 杨婷

    2013-01-01

    Objective: To investigate the clinical efficacy of hypofractionated high - dose radiotherapy treatment for staging Ⅲ, Ⅳ non - small - cell lung cancer. Methods: To analyze 43 lung cancer patients received chest radiation therapy dose fractionation 2. 5Gy/d,5f/w, total dose 50Gy. TNM staging were HI 17 cases, IV 26 cases. Results: Followed up for 4 - 12 months, follow - up rate was 100% ; Radiation esophagitis incidence was 34. 9% . The second class above radioactive pneumonia rate was 11.6%. CR 25. 6% ,PR 51. 2% SD 14.0% PD 9. 3% ; 1 - year survival rate was 65. 1%. Conclusion: Recent curative effect of non - small cell lung cancer patients with stage Ⅲ, Ⅳ treated by three - dimensional conformal hypofractionated high — dose radiotherapy is good, side effects can be tolerated.%目的:探讨低分割放疗治疗Ⅲ、Ⅳ期非小细胞肺癌的临床疗效.方法:分析接受胸部放疗肺癌患者43例,分割剂量2.5Gy/天,5次/周,总剂量50Gy; TNM分期Ⅲ、Ⅳ期17、26例.结果:随访4-12个月,随访率100%.放射性食管炎发生率34.9%,2级以上放射性肺炎发生率11.6%.近期疗效:CR 25.6%、PR51.2%、SD 14.0%、PD 9.3%;1年生存率65.1%.结论:三维适形低分割放疗对Ⅲ、Ⅳ期非小细胞肺癌患者近期疗效确切,放疗毒副反应可以耐受.

  15. Short-Course Accelerated Radiotherapy in Palliative Treatment of Advanced Pelvic Malignancies: A Phase I Study

    Energy Technology Data Exchange (ETDEWEB)

    Caravatta, Luciana [Department of Radiation Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Padula, Gilbert D.A. [Department of Radiation Oncology, Lacks Cancer Center Saint Mary' s Health Care, Grand Rapids, MI (United States); Macchia, Gabriella, E-mail: gmacchia@rm.unicatt.it [Department of Radiation Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Ferrandina, Gabriella [Department of Gynecologic Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Bonomo, Pierluigi; Deodato, Francesco; Massaccesi, Mariangela [Department of Radiation Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Mignogna, Samantha; Tambaro, Rosa [Department of Palliative Therapies, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Rossi, Marco [Department of Anaesthesia, Intensive Care, and Pain Medicine, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Flocco, Mariano [' Madre Teresa di Calcutta' Hospice, Larino (Italy); Scapati, Andrea [Department of Radiation Oncology, ' San Francesco' Hospital, Nuoro (Italy); and others

    2012-08-01

    Purpose: To define the maximum tolerated dose of a conformal short-course accelerated radiotherapy in patients with symptomatic advanced pelvic cancer. Methods and Materials: A phase I trial in 3 dose-escalation steps was designed: 14 Gy (3.5-Gy fractions), 16 Gy (4-Gy fractions), and 18 Gy (4.5-Gy fractions). The eligibility criteria included locally advanced and/or metastatic pelvic cancer and Eastern Cooperative Oncology Group performance status of {<=}3. Treatment was delivered in 2 days with twice-daily fractionation and at least an 8-hour interval. Patients were treated in cohorts of 6-12 to define the maximum tolerated dose. The dose-limiting toxicity was defined as any acute toxicity of grade 3 or greater, using the Radiation Therapy Oncology Group scale. Pain was recorded using a visual analog scale. The effect on quality of life was evaluated according to Cancer Linear Analog Scale (CLAS). Results: Of the 27 enrolled patients, 11 were male and 16 were female, with a median age of 72 years (range 47-86). The primary tumor sites were gynecologic (48%), colorectal (33.5%), and genitourinary (18.5%). The most frequent baseline symptoms were bleeding (48%) and pain (33%). Only grade 1-2 acute toxicities were recorded. No patients experienced dose-limiting toxicity. With a median follow-up time of 6 months (range 3-28), no late toxicities were observed. The overall (complete plus partial) symptom remission was 88.9% (95% confidence interval 66.0%-97.8%). Five patients (41.7%) had complete pain relief, and six (50%) showed >30% visual analog scale reduction. The overall response rate for pain was 91.67% (95% confidence interval 52.4%-99.9%). Conclusions: Conformal short course radiotherapy in twice-daily fractions for 2 consecutive days was well tolerated up to a total dose of 18 Gy. A phase II study is ongoing to confirm the efficacy on symptom control and quality of life indexes.

  16. Phase 2 Trial of Accelerated, Hypofractionated Whole-Breast Irradiation of 39 Gy in 13 Fractions Followed by a Tumor Bed Boost Sequentially Delivering 9 Gy in 3 Fractions in Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ja Young [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Jung, So-Youn; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Park, In Hae; Lee, Keun Seok; Ro, Jungsil [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Lee, Nam Kwon [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Korea University Medical Center, Collage of Medicine, Seoul (Korea, Republic of); Shin, Kyung Hwan, E-mail: radiat@ncc.re.kr [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Korea University Medical Center, Collage of Medicine, Seoul (Korea, Republic of)

    2013-12-01

    Purpose: To report a phase 2 trial of accelerated, hypofractionated whole-breast irradiation (AH-WBI) delivered as a daily dose of 3 Gy to the whole breast followed by a tumor bed boost. Methods and Materials: Two hundred seventy-six patients diagnosed with breast cancer (pT1-2 and pN0-1a) who had undergone breast-conserving surgery in which the operative margins were negative were treated with AH-WBI delivered as 39 Gy in 13 fractions of 3 Gy to the whole breast once daily over 5 consecutive working days, and 9 Gy in 3 sequential fractions of 3 Gy to a lumpectomy cavity, all within 3.2 weeks. Results: After a median follow-up period of 57 months (range: 27-75 months), the rate of 5-year locoregional recurrence was 1.4% (n=4), whereas that of disease-free survival was 97.4%. No grade 3 skin toxicity was reported during the follow-up period. Qualitative physician cosmetic assessments of good or excellent were noted in 82% of the patients at 2 months after the completion of AH-WBI. The global cosmetic outcome did not worsen over time, and a good or excellent cosmetic outcome was reported in 82% of the patients at 3 years. The mean pretreatment percentage breast retraction assessment was 12.00 (95% confidence interval [CI]: 11.14-12.86). The mean value of percentage breast retraction assessment increased to 13.99 (95% CI: 12.17-15.96) after 1 year and decreased to 13.54 (95% CI: 11.84-15.46) after 3 years but was not significant (P>.05). Conclusions: AH-WBI consisting of 39 Gy in 13 fractions followed by a tumor bed boost sequentially delivering 9 Gy in 3 fractions can be delivered with excellent disease control and tolerable skin toxicity in patients with early-stage breast cancer after breast-conserving surgery.

  17. Development and Dosimetric Characterization of a Tissue Substitute (Bolus) For Use in Linear Accelerator Electron Radiotherapy

    Science.gov (United States)

    Estrada Trujillo, Jorge; Villaseñor Navarro, Luis Felipe; Mitsoura, Eleni

    2003-09-01

    We propose the design of a new custom made material, to be used as a tissue substitute in external beam electron radiotherapy, based on cotton fabric and beeswax. Due to its inexpensive, easy preparation, constant thickness, flexibility, uniform density and physical properties similar to those of soft tissue, this bolus will insure personalized optimal dose build up and dose distribution in irregular treatment regions. Materials and Methods: We used commercial Campeche beeswax and 100% cotton fabric to prepare the bolus. Beeswax's physical characteristics were determined by thermal and density analysis. Its chemical properties are to be determined by electronic microcopy. We performed quality control tests and calibration of the Varian 2100C linear accelerator. The tissue equivalence of the material is established for a range of electron energies (6, 9, 12, 16, 20 MeV) using a water equivalent solid phantom (PTW; Freiburg, Germany) and a plane parallel ionization chamber (PTW) associated to a PTW electrometer. Results: Beeswax's absolute density was found to be 0.9181g/ml at 21°C, with a melting point of 45°C. For the bolus elaboration, the cotton fabric was soaked in liquid beeswax and thin sheets of approximately 1 mm were obtained. These presented high flexibility, physical stability (color, texture, thickness) and homogeneity. Determination of this dosimetric characteristics and equivalent thickness are still in process. Discussion and conclusions: Our preliminary results suggest that the tissue substitute is easily made, inexpensive to produce, molds well to the treatment area and its positioning is easy and reproducible over the course of the treatment. So we consider that it's a good alternative to the commercial bolus.

  18. Output trends, characteristics, and measurements of three megavoltage radiotherapy linear accelerators.

    Science.gov (United States)

    Hossain, Murshed

    2014-07-08

    The purpose of this study is to characterize and understand the long-term behavior of the output from megavoltage radiotherapy linear accelerators. Output trends of nine beams from three linear accelerators over a period of more than three years are reported and analyzed. Output, taken during daily warm-up, forms the basis of this study. The output is measured using devices having ion chambers. These are not calibrated by accredited dosimetry laboratory, but are baseline-compared against monthly output which is measured using calibrated ion chambers. We consider the output from the daily check devices as it is, and sometimes normalized it by the actual output measured during the monthly calibration of the linacs. The data show noisy quasi-periodic behavior. The output variation, if normalized by monthly measured "real' output, is bounded between ± 3%. Beams of different energies from the same linac are correlated with a correlation coefficient as high as 0.97, for one particular linac, and as low as 0.44 for another. These maximum and minimum correlations drop to 0.78 and 0.25 when daily output is normalized by the monthly measurements. These results suggest that the origin of these correlations is both the linacs and the daily output check devices. Beams from different linacs, independent of their energies, have lower correlation coefficient, with a maximum of about 0.50 and a minimum of almost zero. The maximum correlation drops to almost zero if the output is normalized by the monthly measured output. Some scatter plots of pairs of beam output from the same linac show band-like structures. These structures are blurred when the output is normalized by the monthly calibrated output. Fourier decomposition of the quasi-periodic output is consistent with a 1/f power law. The output variation appears to come from a distorted normal distribution with a mean of slightly greater than unity. The quasi-periodic behavior is manifested in the seasonally averaged output

  19. 图像引导大分割调强放疗同步化疗治疗局部晚期非小细胞肺癌的临床研究∗%An Analysis of Local Advanced Non-small Cell Lung Cancer Treated with Image-guided Hypofractionated Intensity Modulated Radiotherapy combined with Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    吕家华; 李涛; 李昉; 王奇峰; 刘丽; 李厨荣; 宋宴琼

    2015-01-01

    Objective: To observe the efficacy and the toxicity of the image-guided intensity modulated hypofrac-tionated radiotherapy combined with chemotherapy for the treatment of local advanced non-small cell lung cancer (NSCLC). Methods: From August 2011 to April 2013, 44 patients with local advanced non-small cell lung cancer(Stage IIIA:20 pts,Stage IIIB:24 pts) were treated with image-guided intensity modulated hypofractionated radiotherapy combined with chemotherapy. A total dose of 60Gy ~ 72Gy was given to the planning target volume (PTV) of thoracic primary tumor. Hypofractionated radiotherapy scheme was 3Gy ~ 8Gy/ f/ d,3 ~ 5f/ w. All patients received at least 2 cycles of concurrent platinum-based double medicine combination chemotherapy. Results: The response rate was 81. 8% . A complete response was achieved in 7 patients (15. 9% ), and 29 patients (65. 9% ) achieved a partial response. The 1-, 2-year overall sur-vival rate (OS) and median survival time (MST) were 79. 5% , 51. 3% and 25 months, respectively. The 1-, 2-year local control rates (LCR) were 86. 4% and 59. 1% . The 1-, 2-year progression-free survival (PFS) and median progression-free survival were 61. 2% , 38. 7% and 18 months, respectively. The incidence rates of grade 3 + acute radiation pneumo-nitis and radiation esophagitis were 6. 8% and 9. 1% . The main chemotherapy-induced acute toxic reactions were bone marrow depression ( grade 3 + ) included 17 patients ( 38. 6% ) with leukopenia, 3 patients ( 6. 8% ) with anemia, 6 patients (13. 6% ) with thrombocytopenia. Con-clusion: Image-guided intensity modulated hypofractionated radiotherapy combined with chemotherapy is safe and results in excellent local control and survival for local advanced NSCLC with tolerable toxicity.%目的::探讨图像引导大分割调强放疗同步化疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法:2011年8月至2013年4月,44例局部晚期 NSCLC 患者(ⅢA 期20例,ⅢB 期24例)

  20. Clinical efficacy of hypofractionated high-dose radiotherapy combined with gefitinib for the elderly non-small cell lung cancer%低分割放疗联合吉非替尼治疗老年非小细胞肺癌疗效观察

    Institute of Scientific and Technical Information of China (English)

    李小龙; 党亚正; 陆婉玲

    2013-01-01

    Objective To investigate the efficacy and toxicity of three-dimensional conformal radiotherapy combined with gefitinib in elderly NSCLC.Methods 27 cases of elderly NSCLC patients were analyzed.Results The efficacy rate was 66.7%.1-year survival rates were 63.0%.The incidence of radiation pneumonitis was 25.9%.The incidence of radiation esophagitis was 29.6%.The incidence of rash was 37.0%,and the incidence of diarrhea was 22.2%.Conclusion The three-dimensional conformal Hypofractionated high-dose radiotherapy combined with gefitinib for elderly non-small cell lung cancer is safely and definitely.%目的 探讨三维适形低分割放疗联合吉非替尼治疗老年非小细胞肺癌(NSCLC)的疗效及不良反应.方法 对27例老年NSCLC患者实施低分割放疗联合吉非替尼治疗,分割方案:2.5Gy/d、5f/w,总剂量:35~55Gy;口服吉非替尼250mg,1次/日.结果 3个月近期有效率(CR+PR)66.7%,1年生存率63.0%;放射性肺炎发生率25.9%,放射性食管炎发生率29.6%,皮疹发生率37.0%,腹泻发生率22.2%.结论 三维适形低分割放疗联合吉非替尼治疗安全有效,不良反应未见明显增加.

  1. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Ming Li

    2016-01-01

    Conclusions: To deliver the hypofractionated radiotherapy in prostate cancer, VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent normal tissues comparing to 7-field, step-and-shoot IMRT. Daily online image-guidance and better management of bladder and rectum could make a more precise treatment delivery.

  2. Development of PI3K/AKT/mTOR signaling pathway and hypofractionated radiotherapy in non-small cell lung cancer%非小细胞肺癌大分割放疗敏感性与PI3K/AKT/mTOR信号通路研究进展*

    Institute of Scientific and Technical Information of China (English)

    刘宁波(综述); 王平(审校)

    2013-01-01

    常规分割放疗在中晚期非小细胞肺癌治疗中疗效有限,大分割放疗地位越来越重要,但仍有相当部分肿瘤细胞具有放射线抗拒,其分子机制未明。PI3K/AKT/mTOR信号通路与非小细胞肺癌常规分割放疗抗拒有关,但与大分割放疗抗拒关系尚未明确。调控PI3K/AKT/mTOR信号通路的基因表达及蛋白磷酸化水平有望增加NSCLC肿瘤细胞对大分割放疗的敏感性,并可能达到逆转放疗抗拒的效果;在PI3K/AKT/mTOR信号通路的诸多基因中,有望从临床样本中筛选获得预测NSCLC大分割放疗疗效的分子标记。%Radiotherapy is a primary treatment for lung cancer, especially for non-small cell lung cancer (NSCLC). Compared with conventional fractionated radiotherapy, hypofractionated radiotherapy (HFRT) is a powerful method in NSCLC treatment because of its convenience and excellent clinical efficacy. Although HFRT has been significantly developed for treating NSCLC, radiation resistance with an unknown molecular mechanism is still observed in tumors. The PI3K/AKT/mTOR signaling pathway significantly affects resistance to conventional fractionated radiotherapy. However, whether this pathway induces radiation resistance to HFRT remains unclear. The underlying molecular mechanisms between HFRT and the PI3K/AKT/mTOR signal pathway may be used as targets in radiation sensitivity or in the modification of radiation resistance in NSCLC patients. New predictive biomarkers can also be expected in the PI3K/AKT/mTOR signaling pathway when the clinical specimen is screened using HFRT.

  3. [Alpha/beta ratio revisited in the era of hypofractionation].

    Science.gov (United States)

    Hennequin, C; Dubray, B

    2013-10-01

    Large doses per fraction are not recommended in daily radiotherapy due to a higher risk of late normal tissue injury. The technical refinements of modern radiotherapy and suggestions that some tumors could be sensitive to dose per fraction have renewed the interest in hypofractionated schedules. The estimation of α/β ratio value requires large samples of carefully evaluated patients in whom total and fractional doses have varied independently. Tumor repopulation has to be considered when the treatment duration is altered. Without setting aside conflicting publication, the α/β ratio values for prostate and breast (after lumpectomy) cancers could be as low as 2.5 Gy and 4 Gy, respectively. While it is too early to change our routine protocols, the time has come to conduct clinical trials comparing different fractionation schedules.

  4. Postmastectomy hypofractionation radiotherapy in high-risk breast cancer patients: A phase Ⅰ/Ⅱ clinical trial%乳腺癌改良根治术后大分割放疗Ⅰ~Ⅱ期临床试验的近期结果

    Institute of Scientific and Technical Information of China (English)

    王淑莲; 刘新帆; 李晔雄; 宋永文; 金晶; 房辉; 曲媛; 惠周光; 王维虎; 余子豪

    2009-01-01

    目的 探讨乳腺癌改良根治术后大分割放疗的近期疗效和副反应.方法 38例高危乳腺癌患者改良根治术后化疗后,同侧胸壁和锁骨上下放疗43.5 Gy分15次3周完成,观察急性放疗反应发生率和肿瘤的局部区域控制率.结果 中位随访13个月,入组38例患者全部生存,无照射野内复发,远处转移率为13%(5例).5例患者出现3级放射性皮炎,均发生在放疗结束后2~3周.3例患者出现2级放射性肺炎.结论 乳腺癌改良根治术后43.5 Gy分15次3周完成的大分割放疗方案的急性副反应可以接受,近期疗效较好.%Objective To investigate the efficacy and toxicity of postmastectomy hypofractionation radiotherapy in patients with high-risk breast cancer. Methods Postmastectomy radiation of 43.5 Gy in 15 fractions of 2.9 Gy over 3 weeks was delivered to 38 patients with breast cancer. The incidence of acute radi-ation toxicity and lecoregional recurrence was evaluated. Results With a median follow up of 13 months, all patients were alive. No patient had locoregional recurrence within radiation field. Five (13%) had dis-tant metastases. Five (13%) developed grade 3 radiation dermatitis at 2 to 3 weeks after the course of radia-tion. Three (8%) had grade 2 radiation pneumonitis. Conclusions Hypofractionation radiation of 43.5 Gy in 15 fractions of 2.9 Gy over 3 weeks is effective in the near time for patients with high-risk breast cancer after mastectomy, and the acute toxicities are tolerable.

  5. Results on accelerator production of innovative radionuclides for metabolic radiotherapy and PET and on related nuclear data

    Energy Technology Data Exchange (ETDEWEB)

    Groppi, Flavia [LASA, Radiochemistry Laboratory, Universita degli Studi di Milano and INFN-Milano, via F.lli Cervi 201, I-20090 Segrate, Milan (Italy)]. E-mail: Flavia.Groppi@mi.infn.it; Bonardi, Mauro L. [LASA, Radiochemistry Laboratory, Universita degli Studi di Milano and INFN-Milano, via F.lli Cervi 201, I-20090 Segrate, Milan (Italy); Menapace, Enzo [ENEA, Division for Advanced Physics Technologies, Via Don Fiammelli 2, I-40128 Bologna (Italy); Morzenti, Sabrina [LASA, Radiochemistry Laboratory, Universita degli Studi di Milano and INFN-Milano, via F.lli Cervi 201, I-20090 Segrate, Milan (Italy); Zona, Cristiano [LASA, Radiochemistry Laboratory, Universita degli Studi di Milano and INFN-Milano, via F.lli Cervi 201, I-20090 Segrate, Milan (Italy); Canella, Lea [LASA, Radiochemistry Laboratory, Universita degli Studi di Milano and INFN-Milano, via F.lli Cervi 201, I-20090 Segrate, Milan (Italy); Alfassi, Zeev B. [Department Nuclear Engineering, Ben Gurion University, Beer Sheva (Israel)

    2006-06-23

    A range of high specific activity accelerator-produced radionuclides in no-carrier-added (NCA) form, for uses in metabolic radiotherapy and for PET, has been investigated. To this aim it was necessary optimizing the irradiation parameters by determining the excitation functions of the nuclear reactions involved, as needed for the following selective radiochemical separations of the radionuclides of interest. For the NCA radionuclides investigated, the spectrometry measurements, done at LASA-INFN on {gamma}, X and on {alpha} spectra are discussed together with the measurements of radionuclidic, radiochemical and chemical purities by analytical and radioanalytical techniques.

  6. Hypofractionated Stereotactic Radiosurgery in a Large Bilateral Thalamic and Basal Ganglia Arteriovenous Malformation

    Directory of Open Access Journals (Sweden)

    Janet Lee

    2013-01-01

    Full Text Available Purpose. Arteriovenous malformations (AVMs in the basal ganglia and thalamus have a more aggressive natural history with a higher morbidity and mortality than AVMs in other locations. Optimal treatment—complete obliteration without new neurological deficits—is often challenging. We present a patient with a large bilateral basal ganglia and thalamic AVM successfully treated with hypofractionated stereotactic radiosurgery (HFSRS with intensity modulated radiotherapy (IMRT. Methods. The patient was treated with hypofractionated stereotactic radiosurgery to 30 Gy at margin in 5 fractions of 9 static fields with a minimultileaf collimator and intensity modulated radiotherapy. Results. At 10 months following treatment, digital subtraction angiography showed complete obliteration of the AVM. Conclusions. Large bilateral thalamic and basal ganglia AVMs can be successfully treated with complete obliteration by HFSRS with IMRT with relatively limited toxicity. Appropriate caution is recommended.

  7. 大剂量放疗联合经皮注射骨水泥椎体成形术治疗脊柱骨转移癌临床疗效观察%The clinical investigation of hypofractionated radiotherapy combined with percutaneous vertebraplasty for the treatment of spinal vertebra metastases

    Institute of Scientific and Technical Information of China (English)

    柯庆华; 施水彬; 杜伟; 梁赅; 雷勇; 罗斐; 竺炎

    2015-01-01

    目的:观察大分割放射治疗联合经皮注射骨水泥椎体成形术(PVP)在脊椎骨转移瘤中的治疗效果。方法:骨转移疼痛患者52例,有明显疼痛椎体68个。以大分割放射治疗,分割剂量3Gy/次,或4Gy/次,1次/d,5次/周。总剂量:DT 30Gy/10次,或20Gy/5次;3天后应用 PVP 治疗脊柱转移性肿瘤52例共68个椎体,在 CT 引导下或 X 线电视监视下经皮穿刺至病变椎体后注入适量骨水泥(聚甲基丙烯酸甲酯,PMMA),观察放疗及 PVP 术后止痛效果、并发症及脊椎稳定性情况。结果:52例患者中,48例 DT 30Gy/10次,4例20Gy/5次,52例穿刺全部成功。放疗及 PVP 术后,患者的疼痛均有不同程度缓解:疼痛完全缓解(CR)42例(54个椎体)、疼痛部分缓解(PR)9例(12个椎体)、轻度缓解(MR)1例(2个椎体)、疼痛无缓解(NR)0例。病变脊椎稳定性良好,术后影学检查显示38例49个病椎的肿瘤区域被 PMMA 完全均匀充填加固,另14例19个椎体大部分充填。放疗中、PVP 术中及术后均无严重并发,随访3~6个月效果良好。结论:大分割放射治疗联合经皮注射骨水泥椎体成形术(PVP)治疗脊椎骨转移瘤缓解疼痛疗效好,并可加强病变椎体的稳定性。%Objective:To investigate the efficacy of hypofractionated radiotherapy combined with percutaneous ver-tebraplasty for the treatment of spinal vertebra metastases. Methods:Fifty - two patients with 68 sites of painful verte-bral body metastases were treated by hypofractionated radiotherapy with 3Gy or 4Gy each time and once a day,five times a week. The total dosage was 30Gy/ 10 for 20Gy/ 5f. Three days later,52 cases with 68 vertebral body metastases underwent PVP under the guidance of CT or luoroscopy. The analgesic effect,complications after radiotherapy and op-eration and vertebral body stability were observed. Results:In 52 cases,48 cases received 30Gy

  8. Observation of curative effect of hypo-fractionated conformal radiotherapy for 12 patients with non-small cell lung cancer%大分割适形放射治疗非小细胞肺癌12例疗效观察

    Institute of Scientific and Technical Information of China (English)

    罗树春; 兰海涛; 吴琦

    2013-01-01

    目的 观察大分割适形放射治疗非小细胞肺癌的疗效和毒副反应.方法 对12例非小细胞肺癌采用三维适形放疗,6GY/次,5次/周,共60GY/10次.结果 近期疗效:完全缓解(CR)3例占25.0%,部分缓解(PR)5例占41.7%,稳定(SD)和疾病进展(PD)各2例,肿瘤客观缓解率(CR+PR)为66.7%,局部控制率(CR+PR+SD)83.3%.放射性肺炎0级8例、Ⅰ级3例、Ⅱ级1例;放射性食道炎0级9例、Ⅰ级2例、Ⅲ级1例.结论 大分割适形放射治疗非小细胞肺癌近期疗效较好,副反应未明显增加.%Objective To analyze the efficacy and complications of hypo-fractionated conformal radiotherapy for non-small cell lung cancer. Methods Twelve patients with non-small cell lung cancer were treated with hypo-fraction conformal radiotherapy. A dose of 60 GY was given in 10 fractions,once a day,and 5 fractions a week. Results The short-term results showed that the complete re-sponse( CR)rate,the partial response( PR) rate, the overall response( CR+PR) rate and the local regional control rate( CR+PR+SD) were 25. 0% ,41. 7% ,66. 7% and 83. 3% Respectively. There patients suffered from radiation penumonitis of grade Ⅰ ,one patient had radiation penumonitis of gradeⅡ ,and no patient developed serious ( grade Ⅲ ) radiation penumonitis. Two cases suffered from radiation esophagitis of gradeⅠ , and one patient had radiation esophagitis of grade Ⅲ. Conclusions The hypo-fraction conformal radiotherapy may be good for non-small cell lung cancer without incensement of complications.

  9. Targeted Alpha Therapy: The US DOE Tri-Lab (ORNL, BNL, LANL) Research Effort to Provide Accelerator-Produced 225Ac for Radiotherapy

    Science.gov (United States)

    John, Kevin

    2017-01-01

    Targeted radiotherapy is an emerging discipline of cancer therapy that exploits the biochemical differences between normal cells and cancer cells to selectively deliver a lethal dose of radiation to cancer cells, while leaving healthy cells relatively unperturbed. A broad overview of targeted alpha therapy including isotope production methods, and associated isotope production facility needs, will be provided. A more general overview of the US Department of Energy Isotope Program's Tri-Lab (ORNL, BNL, LANL) Research Effort to Provide Accelerator-Produced 225Ac for Radiotherapy will also be presented focusing on the accelerator-production of 225Ac and final product isolation methodologies for medical applications.

  10. A unique hypofractionated radiotherapy schedule with 51.3 Gy in 18 fractions three times per week for early breast cancer: outcomes including local control, acute and late skin toxicity.

    Science.gov (United States)

    Vassilis, Kouloulias; Ioannis, Gogalis; Anna, Zygogianni; Christina, Armpilia; Christos, Antypas; John, Kokakis; Porfyrios, Koromperlis; Vassiliki, Gennimata; John, Kouvaris

    2017-03-01

    Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule for breast cancer patients. Between October 2007 and October 2009, 80 women with early breast cancer were treated by 42.75 Gy in 15 fractions over 5 weeks. This treatment involved three fractions per week (Monday-Wednesday-Friday). All patients received an additional boost dose to the tumor bed of 8.55 Gy in 3 fractions using 6 MV photons. The primary endpoint included any local recurrence in the treated breast. Secondary endpoint included acute and late radiation skin toxicity. The median follow-up time was 63 months (range 60-72). Radiation toxicity was graded according the RTOG/EORTC criteria. Neither local nor distant recurrence was noted in any patient during this 3-year follow-up. Grade 0, 1, 2 acute skin toxicity was observed in 56/80 (70.0 %), in 19/80 (23.8 %) and in 5/80 (6.3 %), respectively. Three months post-RT, toxicity grades 0, 1, 2 skin toxicity were 64/80 (80 %), 14/80 (17.5 %) and 2/80 (2.5 %), respectively. Late toxicity as grade 0, 1 was observed in 72/80 (90.0 %) and in 8/80 (10.0 %), respectively, 6 months post-RT, whereas after 1 year they were 78/80 (97.5 %) and 2/80 (2.5 %), respectively. Preliminary results regarding skin reactions, cosmetic appearance and local control are consistent with published data that support the use of shorter fractionation schedules in early breast cancer patients after breast conservative surgery. Longer follow-up and a randomized prospective study stand in need for the extraction of safe conclusions.

  11. Accelerated partial breast irradiation with external beam radiotherapy. First results of the German phase 2 trial

    Energy Technology Data Exchange (ETDEWEB)

    Ott, Oliver J.; Strnad, Vratislav; Stillkrieg, Wilhelm; Fietkau, Rainer [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Uter, Wolfgang [University Erlangen-Nuremberg, Dept. of Medical Informatics, Biometry and Epidemiology, Erlangen (Germany); Beckmann, Matthias W. [University Hospital Erlangen, Dept. of Gynecology, Erlangen (Germany)

    2017-01-15

    To evaluate the feasibility and efficacy of external beam three-dimensional (3D) conformal accelerated partial breast irradiation (APBI) for selected patients with early breast cancer. Between 2011 and 2016, 72 patients were recruited for this prospective phase 2 trial. Patients were eligible for APBI if they had histologically confirmed breast cancer or pure ductal carcinoma in situ (DCIS), a tumor diameter ≤3 cm, clear resection margins ≥2 mm, no axillary lymph node involvement, no distant metastases, tumor bed clips, and were aged ≥50 years. Patients were excluded if mammography showed a multicentric invasive growth pattern, or if they had residual diffuse microcalcifications postoperatively, an extensive intraductal component, or vessel invasion. Patients received 3D conformal external beam APBI with a total dose of 38 Gy in 10 fractions in 1-2 weeks. The trial had been registered at the German Clinical Trials Register, DRKS-ID: DRKS00004417. Median follow-up was 25.5 months (range 1-61 months). Local control was maintained in 71 of 72 patients. The 3-year local recurrence rate was 2.1% (95% confidence interval, CI: 0-6.1%). Early toxicity (grade 1 radiodermatitis) was seen in 34.7% (25/72). Late side effects ≥ grade 3 did not occur. Cosmetic results were rated as excellent/good in 96.7% (59/61). APBI with external beam radiotherapy techniques is feasible with low toxicity and, according to the results of the present and other studies, on the way to becoming a standard treatment option for a selected subgroup of patients. (orig.) [German] Untersuchung der Vertraeglichkeit und Sicherheit der externen, 3-D-konformalen akzelerierten Teilbrustbestrahlung (APBI) fuer ausgewaehlte Patientinnen mit einem fruehen Mammakarzinom. Von 2011 bis 2016 wurden 72 Patientinnen in diese prospektive Phase-2-Studie eingebracht. Einschlusskriterien waren ein histologisch gesichertes Mammakarzinom oder DCIS, ein Tumordurchmesser ≤ 3 cm, tumorfreie Resektionsraender ≥ 2

  12. 低分割适形放疗同步单药吉西他滨治疗不可切除胰腺癌的疗效分析%Effect of hypofractionated three dimensional conformal radiotherapy with concurrent weekly medium-dose gemcitabine in patients with unresectable pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    穆晓峰; 曹京旭; 王迎选; 史铭; 宁健; 吴芳; 宋薇; 李韧; 付淑云

    2011-01-01

    目的:采用低分割和高剂量适形放疗同步中等剂量单药吉西他滨治疗不可切除胰腺癌患者的疗效及安全性.方法:23例不可手术切除的胰腺癌患者接受同步放化疗,放疗采用低分割、高剂量适形放疗模式,单次剂量为3~4 Gy,3次/周,Dr:36~58 Gy;同步化疗采用单药吉西他滨每周600~750 mg/m2,静脉滴入,1次/周,共7周;观察有效率、中位生存期和1年生存率及不良反应.结果:有效率(CR+PR)为34.8%1年生存率为39.1%;中位生存期为10.2个月.单因素分析生存期与肿瘤临床分期、肿瘤标志下降程度、放疗剂量和临床疗效及是否维持化疗密切相关P<0.05.有7例患者出现Ⅲ~Ⅳ级不良反应,其中5例表现为血小板下降,对症治疗可恢复,无治疗相关死亡事件发生.结论:低分割、高剂量适形放疗同步中等剂量单药吉西他滨是不可切除胰腺癌一种有效安全的治疗模式.%OBJECTIVE: To examine the feasibility and safety of concurrent use of medium-dose gemcitabine (GEM) and hypofractionated three dimensional conformal radiotherapy for unresectable pancreatic cancer. METHODS: Twenty-three concurred chemoradiotherapy (GEM 600-750 mg/m2 weekly for 7 works). They received limited-field and hypo fractionated ( 36~58 Gy in 3~4 Gy,3 F/week) irradiation by three-dimen sional rad.otherapy planning. RESULTS: Of the 23 patients, the response rate amounted to 34, 8%, the median survival 39.1%. MST was associated with clinical stage,level of tumor therapy (P<0. 05). Grade Ⅲ-Ⅳ toxicity was detected in seven patienls, 5 patients was thrombocytopenia. CONCLU SION: Limited-field and hypofractionated radiotherapy enables the safe concurrent administration of GEM for unresectable pancreatic cancer.

  13. 局部晚期食管鳞癌诱导化疗联合大分割放疗的近期疗效分析%Analysis of the short term effect of hypofractionated radiotherapy combined with induction chemotherapy for advanced esophageal squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    何振宇; 李群; 梁培炎; 徐俊杰

    2012-01-01

    目的:探讨采用诱导化疗联合大分割模式治疗食管癌的急性反应和近期疗效.方法:将符合入组条件的33例食管鳞癌患者先行多西他赛和顺铂诱导化疗2个周期,然后进行适形放射治疗,其中每次肿瘤区域的剂量为2.5 Gy,临床靶区的剂量为2 Gy;5次/周,共26次.结果:治疗结束时全组患者总有效率为93.9%(31/33),其中完全缓解(CR)率为60.6%(20/33),部分缓解(PR)率为33.3%(11/33).1和2年生存率分别为83.0%和51.1%.30.3%(10/33)的患者出现3级白细胞计数降低,t5.2%(5/33)的患者出现3级急性放射性食管炎,均无4级急性反应.9.1%(3/33)的患者治疗后出现食管狭窄,需行食管扩张术.未发现放射性肺炎.结论:采用大分割放射治疗联合诱导化疗治疗局部晚期食管鳞癌是安全的,能提高部分患者的局部控制率和生存率,且急性反应小.%OBJECTIVE: To investigate the acute toxicities and short-term effect 01 hypofractionated radiotherapy combined with induction chemotherapy for advanced esophageal squamous cell carcinoma. METHODS: Thirty-three patients with advanced esophageal squamous cell carcinoma received the induction chemotherapy for two cycles using do-cetaxel and cisplatin followed by conformal radiation therapy. The prescribed dose to gross tumor volume was 2. 5 Gy.and the clinical target volume was 2 Gy, total 26 orders. RESULTS: The overall response rate was 93. 9% (31/33) .while the complete reaponse rate and the partial response rate were 60. 6%(20/33) and 33. 3%(ll/33). The 1-year survival and the 2-year survival were 83. 0% and 51. 1%. The grade 3 of leucocytopenia occurred in 30. 3%<10/33). The grade 3 of acute radiation esophagitis occurred in 15. 2%(5/33). There were 9. l%(3/33) patients with esophageal stenosis needed bou-gienage of oesophagus. No patient had radiation pneumonitis. CONCLUSION: Hypofractionated radiotherapy combined with induction chemotherapy for advanced esophageal

  14. Body-Fix(R)装置对脊椎转移瘤大分割调强放疗摆位误差的影响%The clinical effect of Body-Fix(R) device in improving the positioning accuracy of the hypofractionated radiotherapy in the vertebral metastatic patients

    Institute of Scientific and Technical Information of China (English)

    章雅琴; 刘裕杰; 许青; 朱国培; 章真

    2013-01-01

    Objective To study the immobilization effect and keep the accurate treating position of Body-Fix (R) device in the patients with vertebral metastatic tumor treated by hypofractionated intensitymodulated radiotherapy.Methods From October 2008 to February 2010,six nasopharyngeal carcinoma patients with 10 treated lesion with vertebral metastasis who were treated by hypofractionated intensitymodulated radiotherapy and immobilized by the Body-Fix (R) device were enrolled in this study.Three sets cone beam CT images were taken and recorded when patient was underway the initial setup,position correction and after radiation delivery.Comparing these images with the planning CT images to get the setup errors and the intrafractional position shifting,and the immobilization effect of Body-Fix (R) device was analyzed.Results In the upper,middle and lower sections of the vertebrae,the intrafractional setup errors in the left-right direction were (-0.6±0.5) mm,(-0.1 ±1.0) mm,(0.0±0.4) mm,with in the superior-inferior direction (1.0 ± 1.4) mm,(4.8 ± 5.7) mm,(0.0 ± 0.3) mm and in the anterior-posterior direction (1.2 ± 5.2) mm,(-0.3 ± 0.3) mm,(0.0 ± 0.5) mm,respectively.Conclusions With Body-Fix (R) device,the intrafractional setup errors can be minimized within 2 mm which make the accurate spinal radiosurgery technique possible.%目的 观察Body-Fix(R)装置用于脊椎转移瘤大分割调强放疗的误差改变,为广泛开展骨转移大分割治疗提供参考资料.方法 选择2008-2009年在本院接受大分割调强放疗的6例鼻咽癌椎体转移患者,均使用Body-Fix(R)装置进行固定、摆位和治疗.利用千伏级锥形束CT采集放疗前、摆位纠正后、放疗后图像,与计划CT图像进行配准,对摆位纠正后和放疗后位置误差变化情况(分次内误差)进行统计分析.结果 上、中、下段椎体左右方向分次内误差分别为(-0.6±0.5)、(-0.1 ±1.0)、(0.0±0.4)mm,头脚方向分次内误差分别为(1.0±1.4)

  15. Research of IGRT in Modifying Positioning Error of Hypofractionated Radiotherapy for Thoracic ;and Abdominal Tumors%IGRT技术在校正胸腹部恶性肿瘤大分割放疗误差中的应用价值

    Institute of Scientific and Technical Information of China (English)

    黄艳萍; 张国军; 马国锋

    2016-01-01

    Objective The radiation positioning error and clinical value of IGRT in modifying hypofractionated radiotherapy for thoracic and abdominal tumors were discussed. Methods Thirty-one cases of patients who received image-guide hypofractionated radiotherapy for thoracic and abdominal tumors were included in this study. Fractionated irradiation dose was 3 to 8 Gy, total dose was 30 to 54 Gy, and there were fractionated dose of 3 Gy 3 cases, 5 Gy 8 cases, 6 Gy 9 cases, 8 Gy 7 cases and 12 Gy 4 cases. Each treatment forward Cone-beam CT and online correction setup errors and record the error value. Results After online correction, standard deviation of the mean in R-L(X), S-I(Y), and A-P(Z) directions were (2.02±2.18) mm, (2.26±2.28) mm and (2.02±2.13) mm. Conclusion The positioning error was decreased effectively after the correction in IGRT, it is the significance to find the changes of gross tumor volume timely and adjust the clinical treatment of radiation correctly.%目的:探讨图像引导放射治疗(IGRT)技术在校正胸腹部恶性肿瘤大分割放疗时的误差及价值。方法对31例经病理诊断明确为胸腹部恶性肿瘤患者行大分割放疗。分次照射剂量为3~12 Gy,总剂量为30~54 Gy,其中分次剂量3 Gy 为3例,5 Gy 为8例,6 Gy 为9例,8 Gy 为7例,12 Gy 为4例。每次治疗前行锥型束 CT,在线校正摆位误差并记录误差值。结果校正后均数标准差在左右(X)、头脚(Y)和腹背(Z)方向上分别为(2.02±2.18)mm、(2.26±2.28)mm 和(2.02±2.13)mm。结论应用 IGRT 技术在线校位能有效减小摆位误差,对及时发现肿瘤靶区变化情况和适时调整临床放射治疗方案有重要意义。

  16. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

    Institute of Scientific and Technical Information of China (English)

    Ming Li; Gao-Feng Li; Xiu-Yu Hou; Hong Gao; Yong-Gang Xu; Ting Zhao

    2016-01-01

    Background:Image-guided radiation therapy (IGRT) is the preferred method for curative treatment of localized prostate cancer,which could improve disease outcome and reduce normal tissue toxicity reaction.IGRT using cone-beam computed tomography (CBCT) in combination with volumetric-modulated arc therapy (VMAT) potentially allows smaller treatment margins and dose escalation to the prostate.The aim of this study was to compare the difference of dosimetric diffusion in conventional IGRT using 7-field,step-and-shoot intensity-modulated radiation therapy (IMRT) and hypofractionated IGRT using VMAT for patients with localized prostate cancer.Methods:We studied 24 patients who received 78 Gy in 39 daily fractions or 70 Gy in 28 daily fractions to their prostate with/without the seminal vesicles using IMRT (n =12) or VMAT (n =12) for prostate cancer between November 2013 and October 2015.Image guidance was performed using kilovoltage CBCT scans equipped on the linear accelerator.Offline planning was performed using the daily treatment images registered with simulation computed tomography (CT) images.A total of 212 IMRT plans in conventional cohort and 292 VMAT plans in hypofractionated cohort were enrolled in the study.Dose distributions were recalculated on CBCT images registered with the planning CT scanner.Results:Compared with 7-field,step-and-shoot IMRT,VMAT plans resulted in improved planning target volume (PTV) D95% (7663.17 ± 69.57 cGy vs.7789.17 ± 131.76 cGy,P < 0.001).VMAT reduced the rectal D25 (P < 0.001),D35 (P < 0.001),and D50 (P < 0.001),bladder V50 (P < 0.001),D25 (P =0.002),D35 (P =0.028),and D50 (P =0.029).However,VMAT did not statistically significantly reduce the rectal V50,compared with 7-field,step-and-shoot IMRT (25.02 ± 5.54% vs.27.43 ± 8.79%,P =0.087).Conclusions:To deliver the hypofractionated radiotherapy in prostate cancer,VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent

  17. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

    Science.gov (United States)

    Li, Ming; Li, Gao-Feng; Hou, Xiu-Yu; Gao, Hong; Xu, Yong-Gang; Zhao, Ting

    2016-01-01

    Background: Image-guided radiation therapy (IGRT) is the preferred method for curative treatment of localized prostate cancer, which could improve disease outcome and reduce normal tissue toxicity reaction. IGRT using cone-beam computed tomography (CBCT) in combination with volumetric-modulated arc therapy (VMAT) potentially allows smaller treatment margins and dose escalation to the prostate. The aim of this study was to compare the difference of dosimetric diffusion in conventional IGRT using 7-field, step-and-shoot intensity-modulated radiation therapy (IMRT) and hypofractionated IGRT using VMAT for patients with localized prostate cancer. Methods: We studied 24 patients who received 78 Gy in 39 daily fractions or 70 Gy in 28 daily fractions to their prostate with/without the seminal vesicles using IMRT (n = 12) or VMAT (n = 12) for prostate cancer between November 2013 and October 2015. Image guidance was performed using kilovoltage CBCT scans equipped on the linear accelerator. Offline planning was performed using the daily treatment images registered with simulation computed tomography (CT) images. A total of 212 IMRT plans in conventional cohort and 292 VMAT plans in hypofractionated cohort were enrolled in the study. Dose distributions were recalculated on CBCT images registered with the planning CT scanner. Results: Compared with 7-field, step-and-shoot IMRT, VMAT plans resulted in improved planning target volume (PTV) D95% (7663.17 ± 69.57 cGy vs. 7789.17 ± 131.76 cGy, P V50 (P statistically significantly reduce the rectal V50, compared with 7-field, step-and-shoot IMRT (25.02 ± 5.54% vs. 27.43 ± 8.79%, P = 0.087). Conclusions: To deliver the hypofractionated radiotherapy in prostate cancer, VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent normal tissues comparing to 7-field, step-and-shoot IMRT. Daily online image-guidance and better management of bladder and rectum could make a more precise

  18. Prospective randomized trial to compare accelerated (six fractions a week radiotherapy against concurrent chemoradiotherapy (using conventional fractionation in locally advanced head and neck cancers

    Directory of Open Access Journals (Sweden)

    Manoj Gupta

    2015-01-01

    Full Text Available Background: Concurrent chemoradiation (CCRT is currently considered to be the standard of care in locally advanced head and neck cancer. The optimum radiotherapy schedule for best local control and acceptable toxicity is not yet clear. We aimed at shortening of treatment time by using accelerated radiation, thereby comparing the disease response, loco-regional tumor control and tolerability of accelerated radiation (six fractions per week against CCRT in locally advanced head and neck cancer. Materials and Methods: We conducted the prospective randomized study for a period of 2 years from June 2011 to May 2013 in 133 untreated patients of histologically confirmed squamous cell carcinoma of head and neck. Study group (66 patients received accelerated radiotherapy with 6 fractions per week (66Gy/33#/5½ weeks. Control group (67 patients received CCRT with 5 fractions per week radiation (66 Gy/33#/6½ weeks along with intravenous cisplatin 30 mg/m 2 weekly. Tumor control, survival, acute and late toxicities were assessed. Results: Median overall treatment time was 38 days and 45 days in the accelerated radiotherapy and concurrent chemoradiation arm, respectively. At a median follow up of 12 months, 41 patients (62.1% in the accelerated radiotherapy arm and 47 patients (70.1% in the CCRT arm were disease free (P = 0.402. Local disease control was comparable in both the arms. Acute toxicities were significantly higher in the CCRT arm as compared with accelerated radiotherapy arm. There was no difference in late toxicities between the two arms. Conclusion: We can achieve, same or near to the same local control, with lower toxicities with accelerated six fractions per week radiation compared with CCRT especially for Indian population.

  19. Hypofractionated stereotactic body radiotherapy (SBRT) for liver metastases. A retrospective analysis of 74 patients treated in the Klinikum rechts der Isar Munich; Die hypofraktionierte, stereotaktische Strahlentherapie von Lebermetastasen. Eine retrospektive Analyse von 74 Patienten des Klinikums rechts der Isar Muenchen

    Energy Technology Data Exchange (ETDEWEB)

    Heppt, Franz Johannes

    2013-06-12

    Purpose of this study was to evaluate the outcome of stereotactic body radiotherapy (SBRT) of liver metastases and prognostic factors for local control and overall survival. From 2000 to 2009 74 patients with 91 metastases were treated at the Department for Radiation Therapy and Oncology (TU Muenchen). With an observed local control rate of 75% after 1 year, SBRT proved as an effective local treatment option. Unfortunately, systemic tumor progression still dominates long term survival in many patients.

  20. Skin toxicity and cosmesis after hypofractionated whole breast irradiation for early breast cancer.

    Science.gov (United States)

    Saksornchai, Kitwadee; Rojpornpradit, Prayuth; Shotelersak, Kanjana; Lertbutsayanukul, Chawalit; Chakkabat, Chakkapong; Raiyawa, Tassapong

    2012-02-01

    To assess and compare the impact on skin reactions and cosmesis between hypofractionated whole breast and conventional irradiation for early breast cancer. Seventy-three patients with operable breast cancer (pT1-3pN0-1M0) who underwent breast-conserving surgery were assigned for irradiation to either conventional arm (50 Gy in 25 fractions) with a sequential electron boost of 15-16 Gy over five weeks or hypofractionated arm (43.2 Gy in 16 fractions) with a concomitant electron boost of 0.6 Gy over three weeks. At 3-week follow-up, skin toxicities in the hypofractionated arm were significantly worse than that seen in the conventional arm, while at 6-week follow-up, the percentages of skin toxicities in the conventional arm were higher After a median follow-up of six months, there was no significant difference in skin toxicities between the two treatment groups. In addition, there were no significant differences in the mean scores of cosmetic outcome for patients between two regimens. This hypofractionated radiotherapy regimen of 43.2 Gy in 16 fractions with a concomitant electron boost showed good results in terms of normal tissue effects and cosmesis. A long-term follow-up is needed to confirm these favorable results.

  1. Modern Hypofractionation Schedules for Tangential Whole Breast Irradiation Decrease the Fraction Size-corrected Dose to the Heart

    DEFF Research Database (Denmark)

    Appelt, Ane L; Vogelius, Ivan R; Bentzen, Søren M

    2013-01-01

    Aims: Hypofractionation of postoperative radiotherapy for breast cancer has been evaluated in a number of large randomised clinical trials, but concerns remain over the late cardiac toxicity. In this study, we examined the predictions of the linear quadratic model on the estimated fraction size......-corrected dose to the heart for four evidence-based hypofractionation regimens. Materials and methods: Dose plans for 60 left-sided breast cancer patients were analysed. All patients were planned with tangential fields for whole breast irradiation. Dose distributions were corrected to the equivalent dose in 2 Gy...... fractions (EQD(2)) using the linear quadratic model for five different fractionation schedules (50 Gy/25 fractions and four hypofractionation regimens) and for a range of alpha/beta. values (0-5 Gy). The mean EQD(2) to the heart (D-mean(EQD2)) and the volume receiving 40 Gy (V-40(Gy)EQD2), both...

  2. The Nano-X Linear Accelerator: A Compact and Economical Cancer Radiotherapy System Incorporating Patient Rotation.

    Science.gov (United States)

    Eslick, Enid M; Keall, Paul J

    2015-10-01

    Rapid technological improvements in radiotherapy delivery results in improved outcomes to patients, yet current commercial systems with these technologies on board are costly. The aim of this study was to develop a state-of-the-art cancer radiotherapy system that is economical and space efficient fitting with current world demands. The Nano-X system is a compact design that is light weight combining a patient rotation system with a vertical 6 MV fixed beam. In this paper, we present the Nano-X system design configuration, an estimate of the system dimensions and its potential impact on shielding cost reductions. We provide an assessment of implementing such a radiotherapy system clinically, its advantages and disadvantages compared to a compact conventional gantry rotating linac. The Nano-X system has several differentiating features from current radiotherapy systems, it is [1] compact and therefore can fit into small vaults, [2] light weight, and [3] engineering efficient, i.e., it rotates a relatively light component and the main treatment delivery components are not under rotation (e.g., DMLCs). All these features can have an impact on reducing the costs of the system. In terms of shielding requirements, leakage radiation was found to be the dominant contributor to the Nano-X vault and as such no primary shielding was necessary. For a low leakage design, the Nano-X vault footprint and concrete volume required is 17 m2 and 35 m3 respectively, compared to 54 m2 and 102 m3 for a conventional compact linac vault, resulting in decreased costs in shielding. Key issues to be investigated in future work are the possible patient comfort concerns associated with the patient rotation system, as well as the magnitude of deformation and subsequent adaptation requirements.

  3. 早期乳腺癌保乳术后大分割调强放疗美容效果的临床研究%Results of Clinical Studies on Hypofractionation Intensity-Modulated Radiotherapy in Patients with Early-Stage Breast Cancer after Breast-Conserving Surgery

    Institute of Scientific and Technical Information of China (English)

    吕春燕; 郝福荣; 刘杰; 姜迎宵; 马瑞忠; 王明臣

    2013-01-01

    目的:观察早期乳腺癌保乳术后大分割调强放疗( h-IMRT)的美容效果。方法收集潍坊市人民医院2009年2月~2013年1月67例女性早期乳腺癌保乳术后患者,根据患者意愿入组三维适形放疗(3DCRT)、常规分割调强放疗(IMRT)或h-IMRT组。3DCRT组:采用6MV-X线切线野照射,全乳腺50Gy/25次/5周,然后行瘤床区9/12 MeV电子线补量10 Gy/5 F/1周;IMRT组:采用逆向动态调强技术,全乳腺50 Gy/25次/5周,瘤床区用X线同步加量60Gy/25次/5周,或全乳腺放疗结束后行电子线补量(方式及剂量同3DCRT);h-IM-RT组:全乳腺42.5Gy/16F/22d,瘤床区同步加量48Gy/16F/22d。结果短期随访结果示,早期乳腺癌保乳术后患者大分割调强放疗组可以明显缩短放疗时间,未降低美容效果,未增加局部复发风险。结论大分割IMRT很有可能成为中国女性早期乳腺癌保乳术后安全有效的放疗模式。%Objective To observe short-term cosmetic outcome of hypofractionated intensity-modulated ra-diotherapy ( h-IMRT) in patients with early-stage breast cancer after breast-conserving surgery .Methods Sixty-seven women cases with early-stage breast cancer after breast-conserving were collected in Weifang People's Hospital from Feb-ruary 2009 to January 2013,and divided into three group:three-dimensional conformal radiotherapy (3DCRT),the con-ventional fractioned intensity modulated radiotherapy ( IMRT) ,and the hypofractionated intensity-modulated radiotherapy (h-IMRT) according to the patient's attention.For 3DCRT and IMRT group,the whole affected-side breast was delivered 5 days a week to a dose of 50 Gy in 25 fractions using 6 MV photons adopting tangential field irradiation or reverse dy-namic intensity modulated technology respectively , then tumor bed ( the lumpectomy site with a 1 ~2 cm margin or the breast scars with a 2~3cm margin) was boosted by 9/12MeV electron beam to a dose of 10Gy 5 days a

  4. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis

    DEFF Research Database (Denmark)

    Bourhis, J.; Overgaard, Jens; Audry, H.

    2006-01-01

    -specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction. FINDINGS: 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (International Union Against Cancer...

  5. The future of breast cancer radiotherapy: From one size fits all to taylor-made treatment; L'avenir de la radiotherapie du cancer du sein: de la taille unique au sur-mesure

    Energy Technology Data Exchange (ETDEWEB)

    Hennequin, C. [Service de cancerologie-radiotherapie, hopital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris (France); Azria, D. [Departement de cancerologie radiotherapie, CRLC Val-d' Aurelle-Paul-Lamarque, rue Croix-Verte, 34298 Montpellier cedex 5 (France); Universite de Montpellier I, 5, boulevard Henri-IV, CS 19044, 34967 Montpellier cedex 2 (France); Inserm U896, institut de recherche en cancerologie de Montpellier, CRLC Val-d' Aurelle-Paul-Lamarque, rue Croix-Verte, 34298 Montpellier cedex 5 (France)

    2011-10-15

    Various subgroups of breast tumours have been identified during the last 10 years according to the risk of local relapse. Prognostic factors for local relapse are age, surgical margins, tumour size, Her2 expression and hormonal receptors status. For tumours with a high risk of local relapse, an increased in boost dose or the addition of new drugs (trastuzumab, anti-angiogenics, PARP inhibitors) could be considered. For low risk tumours, hypo-fractionated, accelerated partial breast and intraoperative radiotherapy are being evaluated. The classical schedule (45-50 Gy to the whole gland followed by a boost dose of 16 Gy) is no longer the universal rule. Treatment individualization, according to clinical and biological characteristics of the tumour and - possibly - to the radiobiological profile of the patient, is likely to be the future of breast cancer radiotherapy. (authors)

  6. Technologies of image guidance and the development of advanced linear accelerator systems for radiotherapy.

    Science.gov (United States)

    Wu, Vincent W C; Law, Maria Y Y; Star-Lack, Josh; Cheung, Fion W K; Ling, C Clifton

    2011-01-01

    As advanced radiotherapy approaches for targeting the tumor and sparing the normal tissues have been developed, the image guidance of therapy has become essential to directing and confirming treatment accuracy. To approach these goals, image guidance devices now include kV on-board imagers, kV/MV cone-beam CT systems, CT-on-rails, and mobile and in-room radiographic/fluoroscopic systems. Nonionizing sources, such as ultrasound and optical systems, and electromagnetic devices have been introduced to monitor or track the patient and/or tumor positions during treatment. In addition, devices have been designed specifically for monitoring and/or controlling respiratory motion. Optimally, image-guided radiation therapy systems should possess 3 essential elements: (1) 3D imaging of soft tissues and tumors, (2) efficient acquisition and comparison of the 3D images, and (3) an efficacious process for clinically meaningful intervention. Understanding and using these tools effectively is central to current radiotherapy practice. The implementation and integration of these devices continue to carry practical challenges, which emphasize the need for further development of the technologies and their clinical applications.

  7. Role of the Technical Aspects of Hypofractionated Radiation Therapy Treatment of Prostate Cancer: A Review

    Energy Technology Data Exchange (ETDEWEB)

    Clemente, Stefania, E-mail: clemente_stefania@libero.it [Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata Rionero in Vulture, Potenza (Italy); Nigro, Roberta [Azienda Sanitaria Locale Rieti, Roma (Italy); Oliviero, Caterina [Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata Rionero in Vulture, Potenza (Italy); Marchioni, Chiara [Azienda Sanitaria Locale Rieti, Roma (Italy); Esposito, Marco [Azienda Sanitaria, Firenze (Italy); Giglioli, Francesca Romana [Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino (Italy); Mancosu, Pietro [Humanitas Clinical and Research Hospital, Rozzano, Milano (Italy); Marino, Carmelo [Humanitas Centro Catanese di Oncologia, Catania (Italy); Russo, Serenella [Azienda Sanitaria, Firenze (Italy); Stasi, Michele [Azienda Ospedaliera Ordine Mauriziano di Torino, Torino (Italy); Strigari, Lidia [Istituto Nazionale Tumori Regina Elena, Roma (Italy); Veronese, Ivan [Universita' degli Studi di Milano, Milano (Italy); Landoni, Valeria [Istituto Nazionale Tumori Regina Elena, Roma (Italy)

    2015-01-01

    The increasing use of moderate (<35 fractions) and extreme (<5 fractions) hypofractionated radiation therapy in prostate cancer is yielding favorable results, both in terms of maintained biochemical response and toxicity. Several hypofractionation (HF) schemes for the treatment of prostate cancer are available, although there is considerable variability in the techniques used to manage intra-/interfraction motion and deliver radiation doses. We performed a review of the published studies on HF regimens as a topic of interest for the Stereotactic Ablative Radiotherapy working group, which is part of the Italian Association of Medical Physics. Aspects of organ motion management (imaging for contouring, target volume definition, and rectum/bladder preparation) and treatment delivery (prostate localization, image guided radiation therapy strategy and frequency) were evaluated and categorized to assess outcome relative to disease control and toxicity. Despite the heterogeneity of the data, some interesting trends that emerged from the review might be useful in identifying an optimum HF strategy.

  8. Implementation of intraoperative radiotherapy in a linear accelerator Varian 21EX; Implementacao da radioterapia intraoperatoria em um acelerador linear VARIAN 21EX

    Energy Technology Data Exchange (ETDEWEB)

    Piriz, Gustavo H.; Lozano, Enrique; Banguero, Yolma; Varon, Carlos Fernando; Mancilla, Claudio S. [Instituto Nacional del Cancer, Santiago (Chile). Radioterapia; Parra, Cristian [Universidad de la Frontera, Temuco (Chile); Pacheco, P. [Universidad Nacional Mayor de San Marcos, Lima (Peru)

    2011-07-01

    The aim of this paper is to present the experience on intraoperative radiotherapy, which has as the reference center the network of radiotherapy in Chile. It is detailed the construction of a system of applicators with an easy coupling on a linear accelerator collimator. It is also detailed the cost and the measurements set up with their corresponding percentage depth dose and isodose curves. This technique was implemented in a Varian Clinac 21EX for beams with 6, 9 and 12 MeV electron energy. The coupling system provides a good dose distribution both laterally and in depth for different energies. This provides a good coverage of treatment planning volume. (author)

  9. Choosing Wisely? Patterns and Correlates of the Use of Hypofractionated Whole-Breast Radiation Therapy in the State of Michigan

    Energy Technology Data Exchange (ETDEWEB)

    Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [University of Michigan, Ann Arbor, Michigan (United States); Heimburger, David [Munson Medical Center, Traverse City, Michigan (United States); Walker, Eleanor M. [Henry Ford Hospital, Detroit, Michigan (United States); Grills, Inga S. [Beaumont Health System, Royal Oak, Michigan (United States); Boike, Thomas [McLaren Northern Michigan, Petoskey, Michigan (United States); Feng, Mary; Moran, Jean M.; Hayman, James; Pierce, Lori J. [University of Michigan, Ann Arbor, Michigan (United States)

    2014-12-01

    Purpose: Given evidence from randomized trials that have established the non-inferiority of more convenient and less costly courses of hypofractionated radiotherapy to the whole breast in selected breast cancer patients who receive lumpectomy, we sought to investigate the use of hypofractionated radiation therapy and factors associated with its use in a consortium of radiation oncology practices in Michigan. We sought to determine the extent to which variation in use occurs at the physician or practice level versus the extent to which use reflects individualization based on potentially relevant patient characteristics (such as habitus, age, chemotherapy receipt, or laterality). Methods and Materials: We evaluated associations between receipt of hypofractionated radiation therapy and various patient, provider, and practice characteristics in a multilevel model. Results: Of 1477 patients who received lumpectomy and whole-breast radiation therapy and were registered by the Michigan Radiation Oncology Quality Consortium (MROQC) from October 2011 to December 2013, 913 had T1-2, N0 breast cancer. Of these 913, 283 (31%) received hypofractionated radiation therapy. Among the 13 practices, hypofractionated radiation therapy use ranged from 2% to 80%. On multilevel analysis, 51% of the variation in the rate of hypofractionation was attributable to the practice level, 21% to the provider level, and 28% to the patient level. On multivariable analysis, hypofractionation was more likely in patients who were older (odds ratio [OR] 2.16 for age ≥50 years, P=.007), less likely in those with larger body habitus (OR 0.52 if separation between tangent entry and exit ≥25 cm, P=.002), and more likely without chemotherapy receipt (OR 3.82, P<.001). Hypofractionation use was not higher in the last 6 months analyzed: 79 of 252 (31%) from June 2013 to December 2013 and 204 of 661 (31%) from October 2011 to May 2013 (P=.9). Conclusions: Hypofractionated regimens of whole

  10. Laser-driven particle acceleration for radiobiology and radiotherapy: where we are and where we are going

    Science.gov (United States)

    Giulietti, Antonio

    2017-05-01

    Radiation therapy of tumors progresses continuously and so do devices, sharing a global market of about $ 4 billions, growing at an annual rate exceeding 5%. Most of the progress involves tumor targeting, multi-beam irradiation, reduction of damage on healthy tissues and critical organs, dose fractioning. This fast-evolving scenario is the moving benchmark for the progress of the laser-based accelerators towards clinical uses. As for electrons, both energy and dose requested by radiotherapy are available with plasma accelerators driven by lasers in the power range of tens of TW but several issues have still to be faced before getting a prototype device for clinical tests. They include capability of varying electron energy, stability of the process, reliability for medical users. On the other side hadron therapy, presently applied to a small fraction of cases but within an exponential growth, is a primary option for the future. With such a strong motivation, research on laser-based proton/ion acceleration has been supported in the last decade in order to get performances suitable to clinical standards. None of these performances has been achieved so far with laser techniques. In the meantime a rich crop of data have been obtained in radiobiological experiments performed with beams of particles produced with laser techniques. It is quite significant however that most of the experiments have been performed moving bio samples to laser labs, rather moving laser equipment to bio labs or clinical contexts. This give us the measure that laser community cannot so far provide practical devices usable by non-laser people.

  11. Continuous hyperfractionated accelerated radiotherapy with/without mitomycin C in head and neck cancer

    NARCIS (Netherlands)

    Dobrowsky, W; Naude, J; Widder, J; Dobrowsky, E; Millesi, W; Pavelka, R; Grasl, C; Reichel, M

    1998-01-01

    Purpose: To evaluate the effect of mitomycin C to an accelerated hyperfractionated radiation therapy. The aim was to test a very short schedule with/without mitomycin C (MMC) with conventional fractionation in histologically verified squamous cell carinoma of the head and neck region. Methods and Ma

  12. GPU-accelerated automatic identification of robust beam setups for proton and carbon-ion radiotherapy

    Science.gov (United States)

    Ammazzalorso, F.; Bednarz, T.; Jelen, U.

    2014-03-01

    We demonstrate acceleration on graphic processing units (GPU) of automatic identification of robust particle therapy beam setups, minimizing negative dosimetric effects of Bragg peak displacement caused by treatment-time patient positioning errors. Our particle therapy research toolkit, RobuR, was extended with OpenCL support and used to implement calculation on GPU of the Port Homogeneity Index, a metric scoring irradiation port robustness through analysis of tissue density patterns prior to dose optimization and computation. Results were benchmarked against an independent native CPU implementation. Numerical results were in agreement between the GPU implementation and native CPU implementation. For 10 skull base cases, the GPU-accelerated implementation was employed to select beam setups for proton and carbon ion treatment plans, which proved to be dosimetrically robust, when recomputed in presence of various simulated positioning errors. From the point of view of performance, average running time on the GPU decreased by at least one order of magnitude compared to the CPU, rendering the GPU-accelerated analysis a feasible step in a clinical treatment planning interactive session. In conclusion, selection of robust particle therapy beam setups can be effectively accelerated on a GPU and become an unintrusive part of the particle therapy treatment planning workflow. Additionally, the speed gain opens new usage scenarios, like interactive analysis manipulation (e.g. constraining of some setup) and re-execution. Finally, through OpenCL portable parallelism, the new implementation is suitable also for CPU-only use, taking advantage of multiple cores, and can potentially exploit types of accelerators other than GPUs.

  13. 三维适形低分割高剂量放射治疗非小细胞肺癌的临床探讨%Clinical research of three dimensional conformal hypofractionated hige dose radiotherapy(3DCRT) for non small cell lung cancer(NSCLC)

    Institute of Scientific and Technical Information of China (English)

    崔立春; 耿会生; 党升强; 王璇; 杨正浩; 杜建飞; 田春琴; 许世成

    2011-01-01

    目的:观察非小细胞肺癌行三维适形低分割高剂量放射治疗的疗效与并发症,探讨适合的分割模式和照射剂量.方法: 回顾性分析682例非小细胞肺癌,采用三维适形放射治疗, 90%-95%的剂量曲线覆盖PTV,单次分割剂量5Gy, 1次/日或隔日,3-5次/周,DT50-70Gy/10-14次, 中位照射剂量60Gy/12次,等效生物剂量88-90Gy.结果: 682例患者中,完全缓解(CR)87例(12.8%),部分缓解(PR)561例(82.2%),总有效率(CR+PR)为95%,其中III级以上放射性肺炎发生率5.2%(36/682 ),未出现明显的放射性食管炎.结论:非小细胞肺癌采用三维适形低分割高剂量放射治疗(5Gy/次,每周3-5次,中位照射剂量60Gy/12次),是相对安全的;而且局部控制率高,有较好的近期疗效,并发症低,值得推广使用.%Objective: To analyze the curative effects and side effects of three dimensional conformal hypofractionated high does radiotherapy( 3DCRT) for non small cell lung cancer( NSCLC) , to explore the fraction and the does in NSCLC treatment. Methods: To review and analyse the data of 682 NSCLC patients treated by 3DCRT, PTV was covered by the dose of 90% - 95 %  , the fraction dose was 5Gy. They were treated once a day or once two days , 3 - 5 times/week, DT 50 -70Gy/10 -14 times, the median does 60Gy/12F. Results : Of 682 NSCLC patients, complete remission in 87 cases and partial remission in 561 cases, the overall remission ( CR + PR) rate was 95%. Severe early radiation injuries were observed in 36 cases , radiation pneumonitis in grade Ⅲ, and no obvious rradiation esophagitis occurred. Conclusion : 3 DCRT could be used for NSCLC because it is safe , higher local control rate and lower side effects.

  14. Accelerated partial breast irradiation using 3D conformal radiotherapy: initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Gatti, M.; Madeddu, A.; Malinverni, G.; Delmastro, E.; Bona, C.; Gabriele, P. [IRCC-Radiotherapy, Candiolo, TO (Italy); Baiotto, B.; Stasi, M. [IRCC-Medical Physics, Candiolo, TO (Italy); Ponzone, R.; Siatis, D. [IRCC-Surgery, Candiolo, TO (Italy)

    2006-11-15

    Accelerated partial breast irradiation using 3D-C.R.T. is technically sophisticate but feasible and acute toxicity to date has been minimal. A C.T.V.-to-P.T.V. margin of 10 mm seems to provide coverage for analyzed patients. However, more patients and additional studies will be needed to validate the accuracy of this margin, and longer follow-up will be needed to assess acute and chronic toxicity, tumor control, and cosmetic results. (author)

  15. Fractionated stereotactic radiotherapy with linear accelerator for uveal melanoma - preliminary Vienna results

    Energy Technology Data Exchange (ETDEWEB)

    Zehetmayer, M.; Ruhswurm, I.; Georgopoulos, M. [Dept. of Ophthalmology, Vienna Univ. (Austria); Dieckmann, K.; Kren, G.; Poetter, R. [Dept. of Radiotherapy and Radiobiology, Vienna Univ (Austria); Kitz, K. [Dept. of Neurosurgery, Vienna Univ. (Austria)

    1999-06-01

    Between June 1997 and February 1998, 21 patients suffering from uveal melanomas have been treated with a sterotactic 6 MeV LINAC (Saturne 43 {sup trademark}, General Electric, France) in conjunction with a stereotactic frame system (BrainLAB {sup trademark}, Germany). Immobilization of the eye was ensured with an optical fixation system which was proven reliable. During radiotherapy, movements of the irradiated eye were controlled on a monitor and documented by video recording. All patients co-operated very well with the optical fixation system. In 1164 measurements, the median value of horizontal deviation of the diseased eye during treatment was 0.3 mm (range: 0 to 1.3 mm). Median vertical deviation was 0.2 mm (range: 0 to 1.2 mm). For all patients, mean tumor prominence before treatment was 6.0{+-}2.2 mm. In 20 patients, the total dose of 70 Gy (at 80%) was delivered in 5 fractions within 10 days. In one patient with a ciliary body tumor, the total dose of 70 Gy was divided into 7 fractions for better sparing of the anterior eye segment. Results: After a follow-up of at least 6 months, local tumor control was seen in all eyes. Mean tumor thickness reduction after 3, 6 and 9 months was 7%, 13% and 31%, respectively. Up to now, only mild subacute side-effects located in the anterior eye segment have been noticed. (orig.)

  16. Image guided, adaptive, accelerated, high dose brachytherapy as model for advanced small volume radiotherapy.

    Science.gov (United States)

    Haie-Meder, Christine; Siebert, Frank-André; Pötter, Richard

    2011-09-01

    Brachytherapy has consistently provided a very conformal radiation therapy modality. Over the last two decades this has been associated with significant improvements in imaging for brachytherapy applications (prostate, gynecology), resulting in many positive advances in treatment planning, application techniques and clinical outcome. This is emphasized by the increased use of brachytherapy in Europe with gynecology as continuous basis and prostate and breast as more recently growing fields. Image guidance enables exact knowledge of the applicator together with improved visualization of tumor and target volumes as well as of organs at risk providing the basis for very individualized 3D and 4D treatment planning. In this commentary the most important recent developments in prostate, gynecological and breast brachytherapy are reviewed, with a focus on European recent and current research aiming at the definition of areas for important future research. Moreover the positive impact of GEC-ESTRO recommendations and the highlights of brachytherapy physics are discussed what altogether presents a full overview of modern image guided brachytherapy. An overview is finally provided on past and current international brachytherapy publications focusing on "Radiotherapy and Oncology". These data show tremendous increase in almost all research areas over the last three decades strongly influenced recently by translational research in regard to imaging and technology. In order to provide high level clinical evidence for future brachytherapy practice the strong need for comprehensive prospective clinical research addressing brachytherapy issues is high-lighted. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  17. Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks). An alternative in the treatment of locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kubes, Jiri; Vondracek, Vladimir; Pala, Miloslav [Prague Univ., Prag (Czech Republic). Inst. of Radiation Oncology; Cvek, Jakub; Feltl, David [Faculty Hospital Ostrava (Czech Republic). Dept. of Oncology

    2011-10-15

    To present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer. A total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%. The median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13-45 days). The mean radiotherapy dose was 68.4 Gy (16-74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity {>=} grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%). Accelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.

  18. Accelerated split-course radiotherapy and concomitant cis-platinum and 5-fluorouracil chemotherapy with folinic acid enhancement in unresectable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wendt, T.G.; Wustrow, T.P.U.; Hartenstein, R.C.; Trott, K.R.

    1988-01-01

    In patients suffering from locally advanced, unresectable squamous cell carcinoma (SCC) of the base of the tongue, the floor of the mouth, the mobile part of the tongue, the tonsils, the hypopharynx and the larynx radiotherapy yields poor results, due to local failure rather than to distant metastases. Since toxicity of radiotherapy and cytotoxic chemotherapy do not overlap entirely efforts were made to achieve better results combining these two treatment modalities. Clinical trials on simultaneous radiotherapy/chemotherapy focussed on two cytotoxic agents: Cis-dichlorodiammineplatinum(II) (cis-DDP) and 5-flourouracil (5-FU). Another approach to overcome the radioresistance of large SCC adopts accelerated fractionation. The potential tumor doubling time of sqamous cell carcinomas is about four days, and thus repopulation of surviving clonogenic tumor cells during fractionated radiotherapy may be the cause of poor treatment results. In this pilot study a twice daily fractionated split-course radiotherapy is combined with simultaneous administration of cis-DDP and 5-FU with folinic acid (FA) enhancement.

  19. Monte Carlo Simulation of a Linear Accelerator and Electron Beam Parameters Used in Radiotherapy

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Bahreyni Toossi

    2009-06-01

    Full Text Available Introduction: In recent decades, several Monte Carlo codes have been introduced for research and medical applications. These methods provide both accurate and detailed calculation of particle transport from linear accelerators. The main drawback of Monte Carlo techniques is the extremely long computing time that is required in order to obtain a dose distribution with good statistical accuracy. Material and Methods: In this study, the MCNP-4C Monte Carlo code was used to simulate the electron beams generated by a Neptun 10 PC linear accelerator. The depth dose curves and related parameters to depth dose and beam profiles were calculated for 6, 8 and 10 MeV electron beams with different field sizes and these data were compared with the corresponding measured values. The actual dosimetry was performed by employing a Welhofer-Scanditronix dose scanning system, semiconductor detectors and ionization chambers. Results: The result showed good agreement (better than 2% between calculated and measured depth doses and lateral dose profiles for all energies in different field sizes. Also good agreements were achieved between calculated and measured related electron beam parameters such as E0, Rq, Rp and R50. Conclusion: The simulated model of the linac developed in this study is capable of computing electron beam data in a water phantom for different field sizes and the resulting data can be used to predict the dose distributions in other complex geometries.

  20. Comparative effectiveness research in radiation oncology: stereotactic radiosurgery, hypofractionation, and brachytherapy.

    Science.gov (United States)

    Aneja, Sanjay; Yu, James B

    2014-01-01

    Radiation oncology encompasses a diverse spectrum of treatment modalities, including stereotactic radiosurgery, hypofractionated radiotherapy, and brachytherapy. Though all these modalities generally aim to do the same thing-treat cancer with therapeutic doses of radiation while relatively sparing normal tissue from excessive toxicity, the general radiobiology and physics underlying each modality are distinct enough that their equivalence is not a given. Given the continued innovation in radiation oncology, the comparative effectiveness of these modalities is important to review. Given the broad scope of radiation oncology, this article focuses on the 3 most common sites requiring radiation treatment: breast, prostate, and lung cancer.

  1. TLD Intercomparison in accelerators for radiotherapy in three Latin american countries; Intercomparacion TLD en aceleradores para radioterapia en tres paises latinoamericanos

    Energy Technology Data Exchange (ETDEWEB)

    Gaona, E.; Azorin N, J.; Perez, M.A.; Picon, C.; Castellanos, E.; Plazas, M.C.; Murcia, G.; Archundia, L. [Depto. El Hombre y su Ambiente. Universidad Autonoma Metropolitana, Calz. Del Hueso 1100, 04960 Mexico D.F. (Mexico)

    1998-12-31

    In Radiotherapy one of the objectives is to establish and to give follow up to quality assurance programs which make sure that the doses administered to the patients with cancer are a high probability of a success in external radiation. Likewise, one of the present preoccupations of the United Nations Agencies as well as the International Atomic Energy Agency and the Pan-American Health Organization is the optimal employment of the radiations in the treatment of cancer patients since the administered dose in Radiotherapy suffers considerable variations by the lack of quality assurance programs. The use of Electron linear accelerators requires a program of quality assurance that includes expert personnel, equipment and adequate facilities. The more used methodology for the dosimetry calibration and characterization of X-ray beams and high energy electrons for radiotherapy use is using a ionization chamber dosemeter calibrated in a regional secondary standardization laboratory. However, to establish and give follow up to the quality assurance programs it is necessary the dosimetric intercomparison through TLD. In this study it was designed plastic phantoms with TLD crystals and it was made its characterization to realize an absorbed dose analysis in the crystals exposed at X-ray beams 6 MV and high energy electrons 10 and 12 MeV to standardize the dosimetric procedures and proceeding to realize an International Pilot intercomparison of absorbed doses in TLD crystals in three Latin American countries: Mexico, Peru and Colombia with the participation of accelerators of five different institutions. The found results show that the majority of the measured doses with TLD in the different accelerators were in the 0.95-1.05 range though it had two cases outside of this range. The use of the phantoms with TLD crystals shows that they are of excellent aid to make analysis of the doses administered to the patients and an intercomparison of results to standardize procedures at

  2. Short-course radiotherapy in elderly patients with glioblastoma. Feasibility and efficacy of results from a single centre

    Energy Technology Data Exchange (ETDEWEB)

    Fariselli, L.; Pinzi, V.; Milanesi, I.; Marchetti, M. [Neurological Carlo Besta Institute Foundation, Milan (Italy). Dept. of Neurosurgery; Silvani, A.; Salmaggi, A. [Neurological Carlo Besta Institute Foundation, Milan (Italy). Div. of Neurooncology; Farinotti, M. [Neurological Carlo Besta Institute Foundation, Milan (Italy). Epidemiology Unit

    2013-06-15

    Background: The incidence of glioblastoma (GBM) in the elderly population is currently increasing, with a peak seen between 65 and 84 years. The optimal treatment in terms of both efficacy and quality of life still remains a relevant and debated issue today. The purpose of our study was to evaluate the feasibility of short-course hypofractionated accelerated radiotherapy (HART) in GBM patients aged over 70 years and with a good Karnofsky performance score (KPS). Methods: A review of medical records at the 'Istituto Neurologico C. Besta' was undertaken; patients aged {>=} 70 years who had undergone adjuvant HART for GBM between January 2000 and January 2004 were included in the study. HART was administered to a total dose of 45 Gy, 2.5 Gy/fraction, in three daily fractions for three consecutive days/cycle fractions each, delivered in two cycles (split 15 days). Results: A total of 33 patients were evaluable for the current analysis. Median follow-up was 10 months. According to CTCAE (version 3.0) criteria, none of the patients developed radiation-induced neurological status deterioration or necrosis. KPS evaluation after HART was found to be stable in 73 % of patients, improved in 24 %, and worse in 3 %. The median overall survival time of the entire study population was 8 months (range 2-24). Conclusions: Our findings suggest that a hypofractionated accelerated schedule can be a safe and effective option in the treatment of GBM in the elderly. (orig.)

  3. Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Vuong Te

    2006-11-01

    Full Text Available Abstract Purpose Hypofractionated radiotherapy may overcome repopulation in rapidly proliferating tumors such as lung cancer. It is more convenient for the patients and reduces health care costs. This study reports our results on patients with medically inoperable, early stage, non-small cell lung cancer (NSCLC treated with hypofractionation. Materials and methods Stage T1-2N0 NSCLC patients were treated with hypofractionation alone, 52.5 Gy/15 fractions, in 3 weeks, with 3-dimensional conformal planning. T1-2N1 patients with the hilar lymphnode close to the primary tumor were also eligible for this treatment. We did not use any approach to reduce respiratory motion, but it was monitored in all patients. Elective nodal radiotherapy was not performed. Routine follow up included assessment for acute and late toxicity and radiological tumor response. Median follow up time was 29 months for the surviving patients. Results Thirty-two patients with a median age of 76 years, T1 = 15 and T2 = 17, were treated. Median planning target volume (PTV volume was 150cc and median V16 of both lungs was 13%. The most important finding of this study is that toxicity was minimal. Two patients had grade ≤ 2 acute pneumonitis and 3 had mild (grade 1 acute esophagitis. There was no late toxicity. Actuarial 1 and 2-year overall survival rates are 78% and 56%, cancer specific survival rates (CSS are 90% and 74%, and local relapse free survival rates are 93% and 76% respectively. Conclusion 3-D planning, involved field hypofractionation at a dose of 52.5 Gy in 15 daily fractions is safe, well tolerated and easy radiation treatment for medically inoperable lung cancer patients. It shortens by half the traditional treatment. Results compare favorably with previously published studies. Further studies are needed to compare similar technique with other treatments such as surgery and stereotactic radiotherapy.

  4. WE-F-304-00: Outcomes of Hypofractionated Treatments - Results of the WGSBRT

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model

  5. WE-F-304-03: Optic Nerve/Chiasm Hypofractionated SRS/SRT Dose Tolerance

    Energy Technology Data Exchange (ETDEWEB)

    Milano, M. [University of Rochester Medical Center (United States)

    2015-06-15

    Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model

  6. Accelerated gradient-based free form deformable registration for online adaptive radiotherapy

    Science.gov (United States)

    Yu, Gang; Liang, Yueqiang; Yang, Guanyu; Shu, Huazhong; Li, Baosheng; Yin, Yong; Li, Dengwang

    2015-04-01

    The registration of planning fan-beam computed tomography (FBCT) and daily cone-beam CT (CBCT) is a crucial step in adaptive radiation therapy. The current intensity-based registration algorithms, such as Demons, may fail when they are used to register FBCT and CBCT, because the CT numbers in CBCT cannot exactly correspond to the electron densities. In this paper, we investigated the effects of CBCT intensity inaccuracy on the registration accuracy and developed an accurate gradient-based free form deformation algorithm (GFFD). GFFD distinguishes itself from other free form deformable registration algorithms by (a) measuring the similarity using the 3D gradient vector fields to avoid the effect of inconsistent intensities between the two modalities; (b) accommodating image sampling anisotropy using the local polynomial approximation-intersection of confidence intervals (LPA-ICI) algorithm to ensure a smooth and continuous displacement field; and (c) introducing a ‘bi-directional’ force along with an adaptive force strength adjustment to accelerate the convergence process. It is expected that such a strategy can decrease the effect of the inconsistent intensities between the two modalities, thus improving the registration accuracy and robustness. Moreover, for clinical application, the algorithm was implemented by graphics processing units (GPU) through OpenCL framework. The registration time of the GFFD algorithm for each set of CT data ranges from 8 to 13 s. The applications of on-line adaptive image-guided radiation therapy, including auto-propagation of contours, aperture-optimization and dose volume histogram (DVH) in the course of radiation therapy were also studied by in-house-developed software.

  7. Hypofractionated radiation therapy for the treatment of feline facial squamous cell carcinoma; Hypofractionated radiation therapy for the treatment of feline facial squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Cunha, S.C.S.; Corgozinho, K.B.; Holguin, P.G.; Ferreira, A.M.R., E-mail: simonecsc@gmail.co [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil); Carvalho, L.A.V. [Coordenacao dos Programas de Pos-Graduacao de Engenharia (COPPE/UFRJ), Rio de Janeiro, RJ (Brazil); Canary, P.C.; Reisner, M. [Hospital Universitario Clementino Fraga Filho (HUCFF/UFRJ), Rio de Janeiro, RJ (Brazil); Pereira, A.N.; Souza, H.J.M. [Universidade Federal Rural do Rio de Janeiro (UFRRJ), Seropedica, RJ (Brazil)

    2010-07-01

    The efficacy of hypofractionated radiation protocol for feline facial squamous cell carcinoma was evaluated. Hypofractionated radiation therapy was applied to five cats showing single or multiple facial squamous cell carcinomas, in a total of ten histologically confirmed neoplastic lesions. Of the lesions, two were staged as T{sub 1}, four as T{sub 2}, two as T{sub 3}, and two as T{sub 4}. The animals were submitted to four radiation fractions from 7.6 to 10 grays each, with one week intervals. The equipment was a linear accelerator with electrons beam. The cats were evaluated weekly during the treatment and 30 and 60 days after the end of the radiation therapy. In this study, 40% of the lesions had complete remission, 40% partial remission, and 20% did not respond to the treatment. Response rates were lower as compared to other protocols previously used. However, hypofractionated radiation protocol was considered safe for feline facial squamous cell carcinoma. (author)

  8. Study of the characteristics of neutron monitor area applied to the evaluation of dose rates in a 15 MeV radiotherapy accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Candido M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Inst. de Fisica]. E-mail: candido_1998@yahoo.com; Patrao, Karla C.S.; Pereira, Walsan W.; Fonseca, Evaldo S.; Giannoni, Ricardo A. [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Lab. de Neutrons]. E-mails: karla@ird.gov.br; walsan@ird.gov.br; Batista, Delano V.S. [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil). Setor de Fisica Medica]. E-mail: delano@inca.gov.br

    2007-07-01

    Currently, in Radiotherapy, the use of linear accelerators is becoming each time more common. From Radiation Protection point of view, these instruments represent an advance in relation to the cobalt and caesium irradiators, mainly due to absence of the radioactive material. On the other hand, accelerators with the energies superior to 10 MeV produce contamination of the therapeutic beam with the presence of neutrons generated in the interaction of high-energy photons with high atomic number materials from the own irradiator. The present work carries through measurements in a linear accelerator of 15 MeV using three neutron area monitors for a comparison of the response of these instruments, evaluating its adequacy to this measurement. Characteristics of use and operation associates to parameters such as: monitor dead time, monitor gamma rejection, and calibration results are also analyzed in this study. (author)

  9. 大分割与常规分割3DCRT原发性肝癌合并门脉癌栓的临床观察%Clinical efficacy of conventionally fractionated versus hypofractionated three-dimensional conformal radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

    Institute of Scientific and Technical Information of China (English)

    芦东徽; 费振乐; 周俊平; 胡宗涛; 郝文胜

    2014-01-01

    Objective To observe the efficacy and adverse effects of conventionally fractionated (CF) versus hypofractionated (HF) three-dimensional conformal radiotherapy (3DCRT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis.Methods A retrospective analysis was performed on the clinical data of 65 patients with HCC suitable for 3DCRT from 2008 to 2012.These patients were randomly divided into HF group (n =32) and CF group (n =32).The HF group received 3DCRT at a total dose of 45-55 Gy (3-4 Gy/fraction,3-5 fractions/week),while the CF group at a total dose of 40-56 Gy (2 Gy/fraction,5 fractions/week).Results The follow-up rate was 100%.For the HF group and CF group,the short-term response rates were 72% vs.55% (P =0.034),the 1-year local control rates were 72% vs.55% (P=0.034),the 1-year overall survival rates were 59% vs.45% (P=0.042),and the numbers of individuals with grade 1-2 acute gastrointestinal reactions,deterioration of liver function,and radiation hepatitis were 14 vs.11,8 vs.8,and 1 vs.0,respectively (P =0.237).Conclusions HF 3DCRT is superior to CF 3DCRT in the treatment of HCC.%目的 观察大分割与常规分割3DCRT原发性肝癌合并门脉癌栓的疗效和不良反应.方法 回顾分析2008-2012年间对65例适合3DCRT的原发性肝癌患者资料,其中大分割组32例,常规分割组33例.大分割组3~4 Gy/次,3~5次/周,总剂量45 ~ 55 Gy,常规分割组2 Gy/次,5次/周,总剂量40 ~ 56 Gy.结果 随访率100%.大分割、常规分割3DCRT的近期有效率分别为72%、55% (P=0.034),1年局部控制率分别为72%、55%(P=0.034),1年OS分别为59%、45%(P=0.042),1~2级急性消化道反应分别为14、11例,肝功能下降分别为8、8例,放射性肝炎分别为1、0例(P=0.237).结论 大剂量分割3DCRT原发性肝癌比常规分割更具优势.

  10. Hypofractionation does not increase radiation pneumonitis risk with modern conformal radiation delivery techniques

    Energy Technology Data Exchange (ETDEWEB)

    Vogelius, Ivan S.; Westerly, David C.; Cannon, George M.; Bentzen, Soeren M. (Dept. of Human Oncology, Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States)), E-mail: bentzen@humonc.wisc.edu

    2010-10-15

    Purpose. To study the interaction between radiation dose distribution and hypofractionated radiotherapy with respect to the risk of radiation pneumonitis (RP) estimated from normal tissue complication probability (NTCP) models. Material and methods. Eighteen non-small cell lung cancer patients previously treated with helical tomotherapy were selected. For each patient a 3D-conformal plan (3D-CRT) plan was produced in addition to the delivered plan. The standard fractionation schedule was set to 60 Gy in 30 fractions. Iso-efficacy comparisons with hypofractionation were performed by changing the fractionation and the physical prescription dose while keeping the equivalent tumor dose in 2 Gy fractions constant. The risk of developing RP after radiotherapy was estimated using the Mean Equivalent Lung Dose in 2-Gy fractions (MELD2) NTCP model with alpha/beta=4 Gy for the residual lung. Overall treatment time was kept constant. Results. The mean risk of clinical RP after standard fractionation was 7.6% for Tomotherapy (range: 2.8-15.9%) and 9.2% for 3D-CRT (range 3.2-20.2%). Changing to 20 fractions, the Tomotherapy plans became slightly less toxic if the tumor alpha/beta ratio, (alpha/beta)T, was 7 Gy (mean RP risk 7.5%, range 2.8-16%) while the 3D-CRT plans became marginally more toxic (mean RP risk 9.8%, range 3.2-21%). If (alpha/beta)T was 13 Gy, the mean estimated risk of RP is 7.9% for Tomotherapy (range: 2.8-17%) and 10% for 3D-CRT (range 3.2-22%). Conclusion. Modern highly conformal dose distributions are radiobiologically more forgiving with respect to hypofractionation, even for a normal tissue endpoint where alpha/beta is lower than for the tumor in question.

  11. Should elderly patients with glioblastoma be proposed to radiotherapy?; Faut-il irradier les glioblastomes chez les patients ages?

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, S.; Taillibert, S.; Idbaih, A.; Simon, J.M.; Mazeron, J.J. [Groupe Hospitalier Pitie-Salpetriere, Service d' Oncologie Radiotherapique, Centre des Tumeurs, 75 -Paris (France)

    2008-12-15

    In glioblastoma multiform-patients, advanced age has been associated with poor prognosis and decreased tolerance to treatments. The optimal management, especially with irradiation, was not definitively determined in the eighth and ninth decades. The Association of French-speaking neuro-oncologists (Anocef) has recently conducted a randomized clinical trial comparing radiotherapy plus supportive care versus supportive care alone in such patients. Patients aged 70-years and older with newly diagnosed glioblastoma and a Karnofsky performance score of 70 or above were randomly assigned to receive focal irradiation in daily fraction of 1.8 Gy given five days per week for a total dose of 50 Gy plus supportive care or supportive care only. Radiotherapy resulted in a modest but significant improvement in overall survival without reducing quality of life or cognition. However, the optimal regimen of radiotherapy in this fragile population remains uncertain. Abbreviated course of radiotherapy (40 Gy in 15 fractions over 19 days) has been proposed. Analysis of preliminary results showed that efficacy and safety of this hypo-fractionated accelerated regimen compared favourably with those of classically fractionated treatments. Finally, the potential contribution of surgery and chemotherapy should be evaluated in prospective clinical trials. (authors)

  12. Hypofractionation in post-mastectomy breast cancer patients: seven-year follow-up.

    Science.gov (United States)

    Eldeeb, Hany; Awad, Iman; Elhanafy, Osman

    2012-12-01

    To compare three fractionation schedules in post-mastectomy patients treated with radiotherapy as regard acute and early late effects as well as local recurrence rates. One hundred and seven breast cancer patients treated with modified radical mastectomy and adjuvant radiotherapy±adjuvant systemic treatments between November 2001 and July 2004 were enrolled in this study. Patients were categorized into three groups. Group A (41 patients) received conventional fractionation 50 Gy over 25 fractions. Group B (36 patients) received other fractionation regimen 45 Gy over 17 fractions. Group C (30 patients) received 40 Gy over 15 fractions. The median follow-up period was 23 months. There has been no statistical significant difference in local control (P=0.88), pain (P=0.98), telangectasis (P=0.23), fibrosis (P=0.13), arm oedema (P=0.96) or pigmentation (P=0.80) between the three groups. GII-III Erythema was significantly higher in the two hypofractionation arms compared to the control arm (P=0.001). Although acute skin reactions were higher in the hypofractionated arms, there was no significant difference in the local recurrence rates or late radiation effects. A national randomized multicentre study is recommended to explore this further.

  13. Radiotherapy for craniopharyngioma.

    Science.gov (United States)

    Aggarwal, Ajay; Fersht, Naomi; Brada, Michael

    2013-03-01

    Radiotherapy remains the mainstay of multidisciplinary management of patients with incompletely resected and recurrent craniopharyngioma. Advances in imaging and radiotherapy technology offer new alternatives with the principal aim of improving the accuracy of treatment and reducing the volume of normal brain receiving significant radiation doses. We review the available technologies, their technical advantages and disadvantages and the published clinical results. Fractionated high precision conformal radiotherapy with image guidance remains the gold standard; the results of single fraction treatment are disappointing and hypofractionation should be used with caution as long term results are not available. There is insufficient data on the use of protons to assess the comparative efficacy and toxicity. The precision of treatment delivery needs to be coupled with experienced infrastructure and more intensive quality assurance to ensure best treatment outcome and this should be carried out within multidisciplinary teams experienced in the management of craniopharyngioma. The advantages of the combined skills and expertise of the team members may outweigh the largely undefined clinical gain from novel radiotherapy technologies.

  14. Hypofractionated external-beam radiation therapy (HEBRT versus conventional external-beam radiation (CEBRT in patients with localized prostate cancer: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Botrel TEA

    2013-03-01

    Full Text Available Tobias Engel Ayer Botrel,1 Otávio Clark,1 Antônio Carlos Lima Pompeo,2 Francisco Flávio Horta Bretas,2 Marcus Vinicius Sadi,2 Ubirajara Ferreira,2 Rodolfo Borges dos Reis21CoBEU and Evidencias, 2Comitê Brasileiro de Estudos em Uro-Oncologia – CoBEU, BrazilBackground: The purpose of this work was to conduct a systematic review and meta-analysis of all randomized controlled trials comparing the efficacy and side effect profile of hypofractionated versus conventional external-beam radiation therapy for prostate cancer.Methods: Several databases were searched, including Medline, EmBase, LiLACS, and Central. The endpoints were freedom from biochemical failure and side effects. We performed a meta-analysis of the published data. The results are expressed as the hazard ratio (HR or risk ratio (RR, with the corresponding 95% confidence interval (CI.Results: The final analysis included nine trials comprising 2702 patients. Freedom from biochemical failure was reported in only three studies and was similar in patients who received hypofractionated or conventional radiotherapy (fixed effect, HR 1.03, 95% CI 0.88–1.20; P = 0.75, with heterogeneity [χ2 = 15.32, df = 2 (P = 0.0005; I2 = 87%]. The incidence of acute adverse gastrointestinal events was higher in the hypofractionated group (fixed effect, RR 2.02, 95% CI 1.45–2.81; P < 0.0001. We also found moderate heterogeneity on this analysis [χ2 = 7.47, df = 5 (P = 0.19; I2 = 33%]. Acute genitourinary toxicity was similar among the groups (fixed effect, RR 1.19, 95% CI 0.95–1.49; P = 0.13, with moderate heterogeneity [χ2 = 5.83, df = 4 (P = 0.21; I2 = 31%]. The incidence of all late adverse events was the same in both groups (fixed effect, gastrointestinal toxicity, RR 1.17, 95% CI 0.79–1.72, P = 0.44; and acute genitourinary toxicity, RR 1.16, 95% CI 0.80–1.68, P = 0.44.Conclusion: Hypofractionated radiotherapy in localized prostate cancer was not superior to conventional radiotherapy and

  15. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: evaluation of the randomised DAHANCA 6&7 trial

    DEFF Research Database (Denmark)

    Lassen, Pernille; Eriksen, Jesper G; Krogdahl, Annelise

    2011-01-01

    demonstrated in the randomised DAHANCA 6&7 trial. We aimed to assess the influence of tumour HPV-status, expressed by p16, on the response to accelerated fractionated radiotherapy in HNSCC through evaluation of the DAHANCA 6&7 trial. MATERIALS AND METHODS: Immunohistochemical detection of HPV-associated p16......-expression was performed on FFPE-pre-treatment tumour-tissues from 794 patients enrolled in the DAHANCA 6&7 trial. The influence of tumour p16-status on loco-regional tumour control and survival as a function of fractionation schedule (5Fx/week vs 6Fx/week) was evaluated 5years after the completion...... of radiotherapy. RESULTS: The significant and independent prognostic value of tumour p16-positivity in HNSCC radiotherapy was confirmed, with adjusted hazard ratios (HR) of 0.58 [0.43-0.78], 0.47 [0.33-0.67] and 0.54 [0.42-0.68] for loco-regional control, disease-specific and overall survival, respectively...

  16. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: Evaluation of the randomised DAHANCA 6&7 trial

    DEFF Research Database (Denmark)

    Lassen, Pernille; Eriksen, Jesper Grau; Krogdahl, Annelise

    2011-01-01

    demonstrated in the randomised DAHANCA 6&7 trial. We aimed to assess the influence of tumour HPV-status, expressed by p16, on the response to accelerated fractionated radiotherapy in HNSCC through evaluation of the DAHANCA 6&7 trial. MATERIALS AND METHODS: Immunohistochemical detection of HPV-associated p16......-expression was performed on FFPE-pre-treatment tumour-tissues from 794 patients enrolled in the DAHANCA 6&7 trial. The influence of tumour p16-status on loco-regional tumour control and survival as a function of fractionation schedule (5Fx/week vs 6Fx/week) was evaluated 5years after the completion...... of radiotherapy. RESULTS: The significant and independent prognostic value of tumour p16-positivity in HNSCC radiotherapy was confirmed, with adjusted hazard ratios (HR) of 0.58 [0.43-0.78], 0.47 [0.33-0.67] and 0.54 [0.42-0.68] for loco-regional control, disease-specific and overall survival, respectively...

  17. Development of an ultrasmall C-band linear accelerator guide for a four-dimensional image-guided radiotherapy system with a gimbaled x-ray head.

    Science.gov (United States)

    Kamino, Yuichiro; Miura, Sadao; Kokubo, Masaki; Yamashita, Ichiro; Hirai, Etsuro; Hiraoka, Masahiro; Ishikawa, Junzo

    2007-05-01

    We are developing a four-dimensional image-guided radiotherapy system with a gimbaled x-ray head. It is capable of pursuing irradiation and delivering irradiation precisely with the help of an agile moving x-ray head on the gimbals. Requirements for the accelerator guide were established, system design was developed, and detailed design was conducted. An accelerator guide was manufactured and basic beam performance and leakage radiation from the accelerator guide were evaluated at a low pulse repetition rate. The accelerator guide including the electron gun is 38 cm long and weighs about 10 kg. The length of the accelerating structure is 24.4 cm. The accelerating structure is a standing wave type and is composed of the axial-coupled injector section and the side-coupled acceleration cavity section. The injector section is composed of one prebuncher cavity, one buncher cavity, one side-coupled half cavity, and two axial coupling cavities. The acceleration cavity section is composed of eight side-coupled nose reentrant cavities and eight coupling cavities. The electron gun is a diode-type gun with a cerium hexaboride (CeB6) direct heating cathode. The accelerator guide can be operated without any magnetic focusing device. Output beam current was 75 mA with a transmission efficiency of 58%, and the average energy was 5.24 MeV. Beam energy was distributed from 4.95 to 5.6 MeV. The beam profile, measured 88 mm from the beam output hole on the axis of the accelerator guide, was 0.7 mm X 0.9 mm full width at half maximum (FWHM) width. The beam loading line was 5.925 (MeV)-Ib (mA) X 0.00808 (MeV/mA), where Ib is output beam current. The maximum radiation leakage of the accelerator guide at 100 cm from the axis of the accelerator guide was calculated as 0.33 cGy/min at the rated x-ray output of 500 cGy/min from the measured value. This leakage requires no radiation shielding for the accelerator guide itself per IEC 60601-2-1.

  18. 大分割放疗联合替莫唑胺治疗大体积脑转移瘤的前瞻性临床研究%Efficacy of hypofractionated stereotactic radiotherapy combined with temozolomide for large brain metastases:a prospective clinical study

    Institute of Scientific and Technical Information of China (English)

    马玉超; 邓垒; 王文卿; 易俊林; 李晔雄; 肖建平; 毕楠; 刘峰; 刘笛; 赵瑞芝; 刘清峰; 张烨; 王凯

    2016-01-01

    目的:前瞻性Ⅱ期临床研究分析大分割放疗联合替莫唑胺( TMZ)治疗大体积脑转移瘤的疗效及安全性。方法2010—2015年共33例患者纳入研究,疗前、后中位KPS分别为70、80分,原发灶主要为NSCLC (58%)。脑转移瘤直径≥3 cm或体积≥6 cm3,放疗剂量52 Gy分13次或52.5 Gy分15次,同步TMZ 75 mg/m2/d,辅助TMZ 6周期(150 mg/m2,第1—5天,28天为1周期)。治疗中复查MRI,如瘤体积缩小≥20%则缩野。疗后2~3个月复查MRI评估疗效。结果总治疗病灶及大体积病灶数分别为95个及38个,>10 cm324例(63%),中位GTV 15.3 cm3(5.7~142.8 cm3)。22例(67%)实现疗中缩野,中位GTV缩小率为44%(21%~88%)。中位总剂量为59.5 Gy,同步和辅助TMZ完成率分别为100%和21%。全组客观反应率为97%,1年LC、颅内PFS、OS分别为97%、70%、62%,中位生存期15.3个月。主要不良反应为1—2级恶心、呕吐,1例出现3级肝功能损伤。结论大分割放疗联合TMZ治疗大体积脑转移瘤安全有效,50%以上患者可实现疗中缩野,缩短治疗时间,减少损伤。临床试验注册 ClinicalTrials.gov,注册号:NCT02654106。%Objective To analyze the efficacy and safety of hypofractionated stereotactic radiotherapy ( FSRT ) combined with temozolomide ( TMZ ) for large brain metastases ( BMs ) in a prospective phaseⅡclinical trial.Methods From 2010 to 2015, a total of 33 patients were enrolled as subjects.The median Karnofsky Performance Status scores before and after treatment were 70 and 80, respectively.The major primary tumor was non-small cell lung cancer (57.6%).The brain metastasis had a diameter of≥3 cm or a volume of ≥6 cm3 .The radiation dose was 52 Gy in 13 fractions or 52.2 Gy in 15 fractions.Patients received TMZ at a dose of 75 mg/m2 per day concurrently.The radiotherapy was followed by 6 cycles of adjuvant

  19. Extreme hypofractionation for early prostate cancer: Biology meets technology.

    Science.gov (United States)

    De Bari, Berardino; Arcangeli, Stefano; Ciardo, Delia; Mazzola, Rosario; Alongi, Filippo; Russi, Elvio G; Santoni, Riccardo; Magrini, Stefano M; Jereczek-Fossa, Barbara A

    2016-11-01

    The aim of this review is to present the available radiobiological, technical and clinical data about extreme hypofractionation in primary prostate cancer radiotherapy. The interest in this technique is based on the favourable radiobiological characteristics of prostate cancer and supported by advantageous logistic aspects deriving from short overall treatment time. The clinical validity of short-term treatment schedule is proven by a body of non-randomised studies, using both isocentric (LINAC-based) or non-isocentric (CyberKnife(®)-based) stereotactic body irradiation techniques. Twenty clinical studies, each enrolling more than 40 patients for a total of 1874 treated patients, were revised in terms of technological setting, toxicity, outcome and quality of life assessment. The implemented strategies for the tracking of the prostate and the sparing of the rectal wall have been investigated with particular attention. The urinary toxicity after prostate stereotactic body irradiation seems slightly more pronounced as compared to rectal adverse events, and this is more evident for late occurring events, but no worse as respect to conventional fractionation schemes. As far as the rate of severe acute toxicity is concerned, in all the available studies the treatment was globally well tolerated. While awaiting long-term data on efficacy and toxicity, the analysed studies suggest that the outcome profile of this approach, alongside the patient convenience and reduced costs, is promising. Forty-eight ongoing clinical trials are also presented as a preview of the expectation from the near future.

  20. Severe hypofractionation: Non-homogeneous tumour dose delivery can counteract tumour hypoxia

    Energy Technology Data Exchange (ETDEWEB)

    Ruggieri, Ruggero; Naccarato, Stefania (Medical Physics Dept., Inst. Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, FC (Italy)), E-mail: ruggieri.ruggero@gmail.com; Nahum, Alan E. (Physics Dept., Clatterbridge Centre for Oncology, Bebington CH63 4JY (United Kingdom))

    2010-11-15

    Background. The current rationale for severely hypofractionated schedules (3-5 fractions) used in stereotactic-body-radiotherapy (SBRT) of non-small-cell lung cancer (NSCLC) is the small size of the irradiated volumes. Being the dose prescribed to the 60-80% isodose line enclosing the PTV, a non-homogeneous tumour-dose-delivery results which might impact on tumour hypoxia. A comparison between homogeneous and SBRT-like non-homogeneous tumour-dose-delivery is then proposed here, using severe hypofractionation on large tumour volumes where both dose prescription strategies are applicable. Materials and methods. For iso-NTCP hypofractionated schedules (1f/d5d/w) with respect to standard fractionation (d=2Gy), computed from the individual DVHs for lungs, oesophagus, heart and spinal cord (Lyman-Kutcher-Burman NTCP-model), TCP values were calculated (a-averaged Poissonian-LQ model) for homogeneous and SBRT-like non-homogeneous plans both with and without tumour hypoxia. Two different estimates of the oxygen-enhancement-ratio (OER) in combination with two distinct assumptions on the kinetics of reoxygenation were considered. Homogeneous and SBRT-like non-homogeneous plans were finally compared in terms of therapeutic ratio (TR), as the product of TCP and the four (1-NTCPi) values. Results. For severe hypofractionation (3-5 fractions) and for any of the hypotheses on the kinetics of reoxygenation and the OER, there was a significant difference between the computed TRs with or without inclusion of tumour hypoxia (anova, p=0.01) for homogeneous tumour-dose-delivery, but no significant difference for the SBRT-like non-homogeneous one. Further, a significantly increased mean TR for the group of SBRT-like non-homogeneous plans resulted (t-test, p=0.05) with respect to the group with homogeneous target-dose-coverage. Conclusions. SBRT-like dose-boosting seems to counterbalance the loss of reoxygenation within a few fractions. For SBRT it then seems that, in addition to the high

  1. Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study

    Energy Technology Data Exchange (ETDEWEB)

    Cvek, J.; Skacelikova, E.; Otahal, B.; Halamka, M.; Feltl, D. [University Hospital Ostrava (Czech Republic). Dept. of Oncology; Kubes, J. [University Hospital Bulovka, Prague (Czech Republic). Dept. of Radiation Oncology; Kominek, P. [University Hospital Ostrava (Czech Republic). Dept. of Otolaryngology

    2012-08-15

    Background and purpose: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. Methods and materials: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV{sub tumor}) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV{sub uninvolved}) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. Results: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was {<=} 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. Conclusion: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

  2. Advances in conformal radiotherapy using Monte Carlo Code to design new IMRT and IORT accelerators and interpret CT numbers

    CERN Document Server

    Wysocka-Rabin, A

    2013-01-01

    The introductory chapter of this monograph, which follows this Preface, provides an overview of radiotherapy and treatment planning. The main chapters that follow describe in detail three significant aspects of radiotherapy on which the author has focused her research efforts. Chapter 2 presents studies the author worked on at the German National Cancer Institute (DKFZ) in Heidelberg. These studies applied the Monte Carlo technique to investigate the feasibility of performing Intensity Modulated Radiotherapy (IMRT) by scanning with a narrow photon beam. This approach represents an alternative to techniques that generate beam modulation by absorption, such as MLC, individually-manufactured compensators, and special tomotherapy modulators. The technical realization of this concept required investigation of the influence of various design parameters on the final small photon beam. The photon beam to be scanned should have a diameter of approximately 5 mm at Source Surface Distance (SSD) distance, and the penumbr...

  3. Image-guided radiotherapy by in-room CT- linear accelerator combination; Radiotherapie guidee par tomodensitometrie associee a l'accelerateur lineaire dans la salle de traitement

    Energy Technology Data Exchange (ETDEWEB)

    Crevoisiera, R. de; Lefkopoulos, D. [Institut Gustave-Roussy, Dept. de Radiotherapie, 94 - Villejuif (France); Kuban, D. [Texas Univ., M.D. Anderson Cancer Center, Dept. of Radiation Oncology, Houston, Texas (United States)

    2006-09-15

    Target localization has become increasingly important in the advent of IMRT, as treatment margins are reduced and target doses are increased with high-dose gradients outside this target volume. The in-room CT on rails-LINAC system allows CT imaging while the patient remains immobilized in the treatment position just prior to treatment. The anatomic inter- and intra-fractional variations can be therefore quantified during a course of treatment. The position of the tumour can be checked and corrected before the fraction. In case of modification of tumour shape, a re-planning of the treatment is also feasible. However, several issues remain: the integration with routine clinical treatment due to a lack of software tools, the frequency of imaging, and the cost-efficiency ratio. The clinical experience is yet very limited but CT-image-guided radiotherapy appears promising for prostate, brain and spinal tumours. (authors)

  4. The influence of epidermal growth factor receptor and tumor differentiation on the response to accelerated radiotherapy of squamous cell carcinomas of the head and neck in the randomized DAHANCA 6 and 7 study

    DEFF Research Database (Denmark)

    Eriksen, Jesper Grau; Steiniche, Torben; Overgaard, Jens

    2005-01-01

    to the repopulation taking place during radiotherapy. The aim of the current study was to address the influence of EGFr and histopathological differentiation when the overall treatment time of radiotherapy was moderately reduced. PATIENTS AND METHODS: Eight hundred and three patients with representative pretreatment...... tissue samples from the randomized DAHANCA 6 and 7 study of 5 vs. 6 fx/wk of radiotherapy. EGFr was visualized using immunohistochemistry and separated into high and low expression before correlation with clinical data. RESULTS: Tumors with high EGFr (84%) responded better to moderately accelerated...... radiotherapy, than carcinomas with low EGFr, using locoregional control as endpoint and a similar pattern was seen, stratifying by well/moderate vs. poor tumor differentiation. Therefore, a combined parameter was constructed showing a more prominent separation of response: tumors with high EGFr and well/moderate...

  5. Breast cancer radiotherapy: controversies and prospectives

    Institute of Scientific and Technical Information of China (English)

    YU Jin-ming; WANG Yong-sheng

    2008-01-01

    @@ Despite consensus on breast cancer radiotherapy, there are still some controversies over post-mastectomy radiotherapy (PMRT) in patients with 1-3 positive lymph nodes, accelerated partial breast irradiation (APBI), appropriate sequence of radiotherapy, chemotherapy and hormonal treatment, and radiotherapy after preoperative systemic therapy.

  6. Hypofractionated Irradiation Has Immune Stimulatory Potential and Induces a Timely Restricted Infiltration of Immune Cells in Colon Cancer Tumors

    Science.gov (United States)

    Frey, Benjamin; Rückert, Michael; Weber, Julia; Mayr, Xaver; Derer, Anja; Lotter, Michael; Bert, Christoph; Rödel, Franz; Fietkau, Rainer; Gaipl, Udo S.

    2017-01-01

    In addition to locally controlling the tumor, hypofractionated radiotherapy (RT) particularly aims to activate immune cells in the RT-modified microenvironment. Therefore, we examined whether hypofractionated RT can activate dendritic cells (DCs), induce immune cell infiltration in tumors, and how the chronology of immune cell migration into tumors occurs to gain knowledge for future definition of radiation breaks and inclusion of immunotherapy. Colorectal cancer treatments offer only limited survival benefit, and immunobiological principles for additional therapies need to be explored with preclinical models. The impact of hypofractionated RT on CT26 colon cancer tumor cell death, migration of DCs toward supernatants (SN) of tumor cells, and activation of DCs by SN were analyzed. The subcutaneous tumor of a BALB/c-CT26 mouse model was locally irradiated with 2 × 5 Gy, the tumor volume was monitored, and the infiltration of immune cells in the tumor was determined by flow cytometry daily. Hypofractionated RT induced a mixture of apoptotic and necrotic CT26 cells, which is known to be in particular immunogenic. DCs that migrated toward SN of CT26 cells particularly upregulated the activation markers CD80 and CD86 when in contact with SN of irradiated tumor cells. After hypofractionated RT, the tumor outgrowth was significantly retarded and in the irradiated tumors an increased infiltration of macrophages (CD11bhigh/F4-80+) and DCs (MHC-II+), but only between day 5 and 10 after the first irradiation, takes place. While CD4+ T cells migrated into non-irradiated and irradiated tumors, CD8+ T cells were only found in tumors that had been irradiated and they were highly increased at day 8 after the first irradiation. Myeloid-derived suppressor cells and regulatory T cells show regular turnover in irradiated and non-irradiated tumors. Tumor cell-specific anti-IgM antibodies were enhanced in the serum of animals with irradiated tumors. We conclude that

  7. Gradient of γ rays and β particles irradiation’s energy produced by accelerator and its use in radiotherapy of cancer diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kastrati, Labinot, E-mail: labinotkastrati82@gmail.com; Nafezi, Gazmend, E-mail: gazmend-nafezi@hotmail.com [Department of Physics, Faculty of Mathematical and Natural Sciences, University of Prishtina “HasanPrishtina”, Prishtina, Kosovo (Country Unknown); Shehi, Gëzim, E-mail: gezimshehi@yahoo.com [Department of Physics, Faculty of Mathematical and Natural Sciences, University of Tirana, Tirana (Albania)

    2016-03-25

    The Ionising irradiations used mostly in the treatment of tumoral diseases are: X, γ, β and e irradiations. The discussion will be about radiations, produced in accelerators, with photon energy 6 MV and 15 MV and electron energy from 5 MeV to 15 MeV. Due to the differences between γ and β radiations, their absorbtion in living tissues will be different. It is important to know, the absorption performance before and after the electronic equilibrium. For these purposes, we’ve use the function of dose gradient, for irradiations γ and β. It represents the velocity of dose change as a function of depth in tissue. From skin to maximum dose value, the increase of G-function is more accentuated for γ-rays than for β-particles, while after that the G-function decreasing is less sharp for γ-rays, while for β-particles, it is almost promptly. This fact allow us to use in radiotherapy, not only γ-rays but β-particles, too. The lasts, represents, a much more efficient tool, especially in terms of radiation protection, of health adjacent tissues and organs. Finally, we’ll to discus, about the advantages in terms of radiation protection of both, γ-rays and β-particles used in radiotherapy.

  8. Commissioning and quality assurance of the X-ray volume Imaging system of an image-guided radiotherapy capable linear accelerator

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2008-01-01

    Full Text Available An Image-Guided Radiotherapy-capable linear accelerator (Elekta Synergy was installed at our hospital, which is equipped with a kV x-ray volume imaging (XVI system and electronic portal imaging device (iViewGT. The objective of this presentation is to describe the results of commissioning measurements carried out on the XVI facility to verify the manufacturer′s specifications and also to evolve a QA schedule which can be used to test its performance routinely. The QA program consists of a series of tests (safety features, geometric accuracy, and image quality. These tests were found to be useful to assess the performance of the XVI system and also proved that XVI system is very suitable for image-guided high-precision radiation therapy.

  9. Acute Toxicity Profile and Compliance to Accelerated Radiotherapy Plus Carbogen and Nicotinamide for Clinical Stage T2-4 Laryngeal Cancer: Results of a Phase III Randomized Trial

    Energy Technology Data Exchange (ETDEWEB)

    Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Terhaard, Chris H. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Doornaert, Patricia A. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Bijl, Hendrik P. [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands); Ende, Piet van den [Department of Radiation Oncology, Maastricht University Medical Centre, Maastricht (Netherlands); Chin, Alim [Department of Clinical Oncology, Leiden University Medical Centre, Leiden (Netherlands); Pop, Lucas A.; Kaanders, Johannes H. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2012-02-01

    Purpose: To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. Methods and Materials: From April 2001 to February 2008, 345 patients with cT2-4 squamous cell laryngeal cancer were randomized to AR (n = 174) and ARCON (n = 171). Acute toxicity was scored weekly until Week 8 and every 2-4 weeks thereafter. Compliance to carbogen and nicotinamide was reported. Results: Between both treatment arms (AR vs. ARCON) no statistically significant difference was observed for incidence of acute skin reactions (moist desquamation: 56% vs. 58%, p = 0.80), acute mucosal reactions (confluent mucositis: 79% vs. 85%, p = 0.14), and symptoms related to acute mucositis (severe pain on swallowing: 53% vs. 58%, p = 0.37; nasogastric tube feeding: 28% vs. 28%, p = 0.98; narcotic medicines required: 58% vs. 58%, p = 0.97). There was a statistically significant difference in median duration of confluent mucositis in favor of AR (2.0 vs 3.0 weeks, p = 0.01). There was full compliance with carbogen breathing and nicotinamide in 86% and 80% of the patients, with discontinuation in 6% and 12%, respectively. Adjustment of antiemesis prophylaxis was needed in 42% of patients. Conclusion: With the exception of a slight increase in median duration of acute confluent mucositis, the present data reveal a similar acute toxicity profile between both regimens and a good compliance with ARCON for clinical stage T2-4 laryngeal cancers. Treatment outcome and late morbidity will determine the real therapeutic benefit.

  10. Acute toxicity profile and compliance to accelerated radiotherapy plus carbogen and nicotinamide for clinical stage T2-4 laryngeal cancer: results of a phase III randomized trial.

    Science.gov (United States)

    Janssens, Geert O; Terhaard, Chris H; Doornaert, Patricia A; Bijl, Hendrik P; van den Ende, Piet; Chin, Alim; Pop, Lucas A; Kaanders, Johannes H

    2012-02-01

    To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. From April 2001 to February 2008, 345 patients with cT2-4 squamous cell laryngeal cancer were randomized to AR (n = 174) and ARCON (n = 171). Acute toxicity was scored weekly until Week 8 and every 2-4 weeks thereafter. Compliance to carbogen and nicotinamide was reported. Between both treatment arms (AR vs. ARCON) no statistically significant difference was observed for incidence of acute skin reactions (moist desquamation: 56% vs. 58%, p = 0.80), acute mucosal reactions (confluent mucositis: 79% vs. 85%, p = 0.14), and symptoms related to acute mucositis (severe pain on swallowing: 53% vs. 58%, p = 0.37; nasogastric tube feeding: 28% vs. 28%, p = 0.98; narcotic medicines required: 58% vs. 58%, p = 0.97). There was a statistically significant difference in median duration of confluent mucositis in favor of AR (2.0 vs 3.0 weeks, p = 0.01). There was full compliance with carbogen breathing and nicotinamide in 86% and 80% of the patients, with discontinuation in 6% and 12%, respectively. Adjustment of antiemesis prophylaxis was needed in 42% of patients. With the exception of a slight increase in median duration of acute confluent mucositis, the present data reveal a similar acute toxicity profile between both regimens and a good compliance with ARCON for clinical stage T2-4 laryngeal cancers. Treatment outcome and late morbidity will determine the real therapeutic benefit. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. A Phase I Dose Escalation Study of Hypofractionated IMRT Field-in-Field Boost for Newly Diagnosed Glioblastoma Multiforme

    Energy Technology Data Exchange (ETDEWEB)

    Monjazeb, Arta M., E-mail: arta.monjazeb@ucdmc.ucdavis.edu [U.C. Davis School of Medicine, Department of Radiation Oncology, Sacramento, CA (United States); Ayala, Deandra; Jensen, Courtney [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Case, L. Douglas [Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Bourland, J. Daniel; Ellis, Thomas L. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); McMullen, Kevin P.; Chan, Michael D. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Tatter, Stephen B. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Lesser, Glen J. [Hematology Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Shaw, Edward G. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States)

    2012-02-01

    Objectives: To describe the results of a Phase I dose escalation trial for newly diagnosed glioblastoma multiforme (GBM) using a hypofractionated concurrent intensity-modulated radiotherapy (IMRT) boost. Methods: Twenty-one patients were enrolled between April 1999 and August 2003. Radiotherapy consisted of daily fractions of 1.8 Gy with a concurrent boost of 0.7 Gy (total 2.5 Gy daily) to a total dose of 70, 75, or 80 Gy. Concurrent chemotherapy was not permitted. Seven patients were enrolled at each dose and dose limiting toxicities were defined as irreversible Grade 3 or any Grade 4-5 acute neurotoxicity attributable to radiotherapy. Results: All patients experienced Grade 1 or 2 acute toxicities. Acutely, 8 patients experienced Grade 3 and 1 patient experienced Grade 3 and 4 toxicities. Of these, only two reversible cases of otitis media were attributable to radiotherapy. No dose-limiting toxicities were encountered. Only 2 patients experienced Grade 3 delayed toxicity and there was no delayed Grade 4 toxicity. Eleven patients requiring repeat resection or biopsy were found to have viable tumor and radiation changes with no cases of radionecrosis alone. Median overall and progression-free survival for this cohort were 13.6 and 6.5 months, respectively. One- and 2-year survival rates were 57% and 19%. At recurrence, 15 patients received chemotherapy, 9 underwent resection, and 5 received radiotherapy. Conclusions: Using a hypofractionated concurrent IMRT boost, we were able to safely treat patients to 80 Gy without any dose-limiting toxicity. Given that local failure still remains the predominant pattern for GBM patients, a trial of dose escalation with IMRT and temozolomide is warranted.

  12. Implementation of a linear mini accelerator for radiotherapy intraoperative; Puesta en marcha de un miniacelerador lineal para radioterapia intraoperatoria

    Energy Technology Data Exchange (ETDEWEB)

    Macias-Verde, D.; Yanez-Lopez, D.; Marti-Asenjo, J.; Sanchez-Carrascal, M.; Torres-Pozas, S.; Godoy-Cazorla, J. I.; Madan-Rodriguez, C.; Martin-Oliva, R.

    2013-07-01

    Has been defined the status initial reference of the lineal mini-accelerator Intrabeam PRS 500. The alternative worksheet in times of treatment provides an additional verification. The system is validated for clinical use. (Author)

  13. Procedure to measure the neutrons spectrum around a lineal accelerator for radiotherapy; Procedimiento para medir el espectro de los neutrones en torno a un acelerador lineal para radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Vega C, H. R.; Hernandez D, V. M.; Letechipia de L, C. [Universidad Autonoma de Zacatecas, Unidad Academica de Estudios Nucleares, Cipres No. 10, Fracc. La Penuela, 98060 Zacatecas (Mexico); Benites R, J. L. [Servicios de Salud de Nayarit, Centro Estatal de Cancerologia, Calzada de la Cruz 116 Sur, 63000 Tepic, Nayarit (Mexico); Salas L, M. A., E-mail: fermineutron@yahoo.com [Universidad Autonoma de Zacatecas, Unidad Academica de Agronomia, Apdo. Postal 336, 98000 Zacatecas (Mexico)

    2013-10-15

    An experimental procedure was developed, by means of Bonner spheres, to measure the neutrons spectrum around Linacs of medical use that only requires of a single shot of the accelerator; to this procedure we denominate Planetary or Isocentric method. One of the problems associated to the neutrons spectrum measurement in a radiotherapy room with lineal accelerator is because inside the room a mixed, intense and pulsed radiation field takes place affecting the detection systems based on active detector; this situation is solved using a passive detector. In the case of the Bonner spheres spectrometer the active detector has been substituted by activation detectors, trace detectors or thermoluminescent dosimeters. This spectrometer uses several spheres that are situated one at a time in the measurement point, this way to have the complete measurements group the accelerator should be operated, under the same conditions, so many times like spheres have the spectrometer, this activity can consume a long time and in occasions due to the work load of Linac to complicate the measurement process too. The procedure developed in this work consisted on to situate all the spectrometer spheres at the same time and to make the reading by means of a single shot, to be able to apply this procedure, is necessary that before the measurements two characteristics are evaluated: the cross-talking of the spheres and the symmetry conditions of the neutron field. This method has been applied to determine the photo-neutrons spectrum produced by a lineal accelerator of medical use Varian ix of 15 MV to 100 cm of the isocenter located to 5 cm of depth of a solid water mannequin of 30 x 30 x 15 cm. The spectrum was used to determine the total flow and the environmental dose equivalent. (Author)

  14. Adaptive hypofractionated gamma knife radiosurgery for a large brainstem metastasis

    Directory of Open Access Journals (Sweden)

    Georges Sinclair

    2016-01-01

    Conclusion: GK-based stereotactic adaptive hypofractionation proved to be effective to achieve tumor control while limiting local adverse reactions. This surgical modality should be considered when managing larger brain lesions in critical areas.

  15. Adaptive hypofractionated gamma knife radiosurgery for a large brainstem metastasis

    DEFF Research Database (Denmark)

    Sinclair, Georges; Bartek, Jiri; Martin, Heather

    2016-01-01

    BACKGROUND: To demonstrate how adaptive hypofractionated radiosurgery by gamma knife (GK) can be successfully utilized to treat a large brainstem metastasis - a novel approach to a challenging clinical situation. CASE DESCRIPTION: A 42-year-old woman, diagnosed with metastatic nonsmall cell lung...... adaptive hypofractionation proved to be effective to achieve tumor control while limiting local adverse reactions. This surgical modality should be considered when managing larger brain lesions in critical areas....

  16. Hypofractionation in non-small cell lung cancer (NSCLC): suggestions from modelling both acute and chronic hypoxia

    Energy Technology Data Exchange (ETDEWEB)

    Ruggieri, Ruggero [Department of Medical Physics, Az. Osp. Bianchi Melacrino Morelli, Via Melacrino, 89100 Reggio Calabria (Italy)

    2004-10-21

    Based on experimental estimates for acute and chronic tumour hypoxia, a speculative analysis of the therapeutic ratio dependence on the number of once-daily five-days-per-week fractions (n) for non-small cell lung cancer (NSCLC) radiotherapy is proposed. For this purpose an adapted formulation of the linear-quadratic model has been derived, including the effects of tumour repopulation, inter-tumour {alpha}-heterogeneity and oxygen enhancement ratio dependence on the dose per fraction. The relation between the curative dose D{sub 50}, assuring 50% tumour control probability, and n has been computed: for (n, D{sub 50}) fractionation schemes, the therapeutic ratios have been compared in terms of effective normalized total doses to the lungs (NTD{sup eff}{sub L}), estimated by a few supposed fractions of the normalized total dose to the tumour. Results suggest that D{sub 50} is dominated by chronic hypoxia for shortly hypofractionated treatments and by acute hypoxia for multifractionated treatments. Furthermore, the optimum number of fractions depends on the rapidity of the reoxygenation from chronically hypoxic cells, almost independently of the extent of both chronic and acute hypoxia. For NSCLC, both the reduction of n until about 20 fractions in hypofractionated dose-escalation trials, and the extension of extra-cranial stereotactic radiotherapy schedules to include at least 5-10 fractions, seem to be supported by this model.

  17. Determination of the neutron spectra in the treatment room of a linear accelerator for radiotherapy; Determinacion de los espectros de neutrones en la sala de tratamiento de un acelerador lineal para radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Vega C, H.R. [Universidad Autonoma de Zacatecas, Cuerpo Academico de Radiobiologia, A.P. 336, 98000 Zacatecas (Mexico); Barquero, R. [Hospital Universitario Rio Hortega, Valladolid (Spain); Mendez, R.; Iniguez, M.P. [Depto. de Fisica Teorica, Atomica, Molecular y Nuclear, Universidad de Valladolid, 47011 Valladolid (Spain)

    2003-07-01

    By means of a series of measures and Monte Carlo calculations the dosimetric characteristics of the photoneutrons have been determined that take place in volume to a linear accelerator of radiotherapy of 18 MV, LINAC, mark Siemens Mevatron model. The measures were carried out with thermoluminescent dosemeters TLD 600 and TLD 700 that were naked exposed and confined with cover of Cd and Sn, inside a sphere of paraffin and inside spheres Bonner. (Author)

  18. Photoneutron Flux Measurement via Neutron Activation Analysis in a Radiotherapy Bunker with an 18 MV Linear Accelerator

    Directory of Open Access Journals (Sweden)

    Çeçen Yiğit

    2017-01-01

    Full Text Available In cancer treatment, high energy X-rays are used which are produced by linear accelerators (LINACs. If the energy of these beams is over 8 MeV, photonuclear reactions occur between the bremsstrahlung photons and the metallic parts of the LINAC. As a result of these interactions, neutrons are also produced as secondary radiation products (γ,n which are called photoneutrons. The study aims to map the photoneutron flux distribution within the LINAC bunker via neutron activation analysis (NAA using indium-cadmium foils. Irradiations made at different gantry angles (0°, 90°, 180° and 270° with a total of 91 positions in the Philips SLI-25 linear accelerator treatment room and location-based distribution of thermal neutron flux was obtained. Gamma spectrum analysis was carried out with high purity germanium (HPGe detector. Results of the analysis showed that the maximum neutron flux in the room occurred at just above of the LINAC head (1.2x105 neutrons/cm2.s which is compatible with an americium-beryllium (Am-Be neutron source. There was a 90% decrease of flux at the walls and at the start of the maze with respect to the maximum neutron flux. And, just in front of the LINAC door, inside the room, neutron flux was measured less than 1% of the maximum.

  19. Be aware of neutrons outside short mazes from 10-MV linear accelerators X-rays in radiotherapy facilities.

    Science.gov (United States)

    Brockstedt, S; Holstein, H; Jakobsson, L; Tomaszewicz, A; Knöös, T

    2015-07-01

    During the radiation survey of a reinstalled 10-MV linear accelerator in an old radiation treatment facility, high dose rates of neutrons were observed. The area outside the maze entrance is used as a waiting room where patients, their relatives and staff other than those involved in the actual treatment can freely pass. High fluence rates of neutrons would cause an unnecessary high effective dose to the staff working in the vicinity of such a system, and it can be several orders higher than the doses received due to X-rays at the same location. However, the common knowledge appears to have been that the effect of neutrons at 10-MV X-ray linear accelerator facilities is negligible and shielding calculations models seldom mention neutrons for this operating energy level. Although data are scarce, reports regarding this phenomenon are now emerging. For the future, it is advocated that contributions from neutrons are considered already during the planning stage of new or modified facilities aimed for 10 MV and that estimated dose levels are verified.

  20. Radiation therapy for feline cutaneous squamous cell carcinoma using a hypofractionated protocol.

    Science.gov (United States)

    Cunha, Simone C S; Carvalho, Luis Alfredo V; Canary, Paulo Cesar; Reisner, Marcio; Corgozinho, Katia B; Souza, Heloisa J M; Ferreira, Ana Maria R

    2010-04-01

    The objective of this paper was to evaluate the efficacy of a hypofractionated radiation protocol for feline facial squamous cell carcinoma (SCC). Twenty-five histologically confirmed SCCs in 15 cats were treated with four fractions of 7.6-10Gy each, with 1 week intervals. The equipment used was a linear accelerator Clinac 2100 delivering electron beam of 4 or 6MeV, and a bolus of 5 or 10mm was used in all lesions. Of the lesions, 44% were staged as T4, 16% as T3, 8% as T2 and 32% as T1. Of the irradiated lesions, 40% had complete response, 12% had partial response and 48% had no response (NR) to the treatment. For T1 tumors, 62.5% had complete remission. Mean overall survival time was 224 days. Owners requested euthanasia of cats having NR to the treatment. Mean disease free time was 271 days. Side effects observed were skin erythema, epilation, ulceration and conjunctivitis, which were graded according to Veterinary Radiation Therapy Oncology Group (VRTOG) toxicity criteria. Response rates found in this study (52%) were lower when compared to other protocols, probably due to technique differences, such as fractionation schedule, bolus thickness and energy penetration depth. However, the hypofractionated radiation protocol was considered safe for feline facial SCC. Modifications of this protocol are being planned with the objective of improving the cure rates in the future.

  1. SU-E-T-190: First Integration of Steriotactic Radiotherapy Planning System Iplan with Elekta Linear Accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Biplab, S; Soumya, R; Paul, S; Jassal, K; Munshi, A; Giri, U; Kumar, V; Roy, S; Ganesh, T; Mohanti, B

    2014-06-01

    Purpose: For the first time in the world, BrainLAB has integrated its iPlan treatment planning system for clinical use with Elekta linear accelerator (Axesse with a Beam Modulator). The purpose of this study was to compare the calculated and measured doses with different chambers to establish the calculation accuracy of iPlan system. Methods: The iPlan has both Pencil beam (PB) and Monte Carlo (MC) calculation algorithms. Beam data include depth doses, profiles and output measurements for different field sizes. Collected data was verified by vendor and beam modelling was done. Further QA tests were carried out in our clinic. Dose calculation accuracy verified point, volumetric dose measurement using ion chambers of different volumes (0.01cc and 0.125cc). Planner dose verification was done using diode array. Plans were generated in iPlan and irradiated in Elekta Axesse linear accelerator. Results: Dose calculation accuracies verified using ion chamber for 6 and 10 MV beam were 3.5+/-0.33(PB), 1.7%+/-0.7(MC) and 3.9%+/-0.6(PB), 3.4%+/-0.6(MC) respectively. Using a pin point chamber, dose calculation accuracy for 6MV and 10MV was 3.8%+/-0.06(PB), 1.21%+/-0.2(MC) and 4.2%+/-0.6(PB), 3.1%+/-0.7(MC) respectively. The calculated planar dose distribution for 10.4×10.4 cm2 was verified using a diode array and the gamma analysis for 2%-2mm criteria yielded pass rates of 88 %(PB) and 98.8%(MC) respectively. 3mm-3% yields 100% passing for both MC and PB algorithm. Conclusion: Dose calculation accuracy was found to be within acceptable limits for MC for 6MV beam. PB for both beams and MC for 10 MV beam were found to be outside acceptable limits. The output measurements were done twice for conformation. The lower gamma matching was attributed to meager number of measured profiles (only two profiles for PB) and coarse measurement resolution for diagonal profile measurement (5mm). Based on these measurements we concluded that 6 MV MC algorithm is suitable for patient treatment.

  2. Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy. Five-year results of a prospective phase II clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Mozsa, Emoeke [National Institute of Oncology, Centre of Radiotherapy, Budapest (Hungary); Landesklinikum Wiener Neustadt, Department of Radiooncology and Radiotherapy, Wiener Neustadt (Austria); Meszaros, Norbert; Major, Tibor; Froehlich, Georgina; Stelczer, Gabor; Fodor, Janos; Polgar, Csaba [National Institute of Oncology, Centre of Radiotherapy, Budapest (Hungary); Sulyok, Zoltan [National Institute of Oncology, Centre of Surgery, Budapest (Hungary)

    2014-05-15

    The aim of this study was to report the 5-year results of accelerated partial breast irradiation (APBI) using external beam three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2011, 44 patients with low-risk, stage I-II breast cancer underwent breast-conserving surgery. Postoperative APBI was given by means of 3D-CRT using three to five non-coplanar fields. The total dose of APBI was 36.9 Gy (nine fractions of 4.1 Gy b.i.d.). The mean follow-up time was 58.2 months for surviving patients. Survival results, side effects, and cosmetic results were assessed. One (2.3 %) local recurrence was observed, for a 5-year actuarial rate of 3.7 %. Neither regional nor distant failure was observed. Two patients died of internal disease. The 5-year disease-free, cancer-specific, and overall survival rates were 96.3, 100, and 95.1 %, respectively. Acute side effects included grade 1 (G1) erythema in 75 %, G1 parenchymal induration in 46 %, and G1 pain in 46 % of patients. No G2 or higher acute side effect occurred. Late side effects included G1, G2, and G3 fibrosis in 44, 7, and 2 % of patients, respectively, G1 skin pigmentation in 12 %, and G1 pain in 2 %. Asymptomatic fat necrosis occurred in 14 %. Cosmetic results were rated excellent or good in 86 % of cases by the patients themselves and 84 % by the physicians. The 5-year local tumor control, toxicity profile, and cosmetic results of APBI delivered with external beam 3D-CRT are encouraging and comparable to other APBI series. (orig.) [German] Evaluation der 5-Jahres-Ergebnisse bezueglich Ueberleben, Tumorkontrolle, Nebenwirkungen und Kosmetik nach Teilbrustbestrahlung (APBI) mittels 3-D-konformaler, akzelerierter Radiotherapie (3D-CRT). Zwischen 2006 und 2011 wurden 44 Patienten mit Brustkrebs im Stadium I-II und niedrigem Risikoprofil brusterhaltend operiert. Die adjuvante, 3-D-konformale APBI wurde mittels 3-5 nonkoplanarer Feldern durchgefuehrt. Die Gesamtdosis betrug 36,9 Gy bei 9 -mal 4,1 Gy b.i.d.. Nach

  3. Short-course palliative radiotherapy for uterine cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hyun; Lee, Ju Hye; Ki, Yong Kan; Kim, Won Taek; Park, Dahl; Kim, Dong Won [Dept. of Radiation Oncology, Biomedical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Nam, Ji Ho; Jeon, Sang Ho [Dept. of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2013-12-15

    The purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer. Seventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions. The median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity. Short-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.

  4. Estimation of absorbed dose in clinical radiotherapy linear accelerator beams: Effect of ion chamber calibration and long-term stability.

    Science.gov (United States)

    Ravichandran, Ramamoorthy; Binukumar, Johnson Pichy; Davis, Cheriyathmanjiyil Antony

    2013-10-01

    The measured dose in water at reference point in phantom is a primary parameter for planning the treatment monitor units (MU); both in conventional and intensity modulated/image guided treatments. Traceability of dose accuracy therefore still depends mainly on the calibration factor of the ion chamber/dosimeter provided by the accredited Secondary Standard Dosimetry Laboratories (SSDLs), under International Atomic Energy Agency (IAEA) network of laboratories. The data related to Nd,water calibrations, thermoluminescent dosimetry (TLD) postal dose validation, inter-comparison of different dosimeter/electrometers, and validity of Nd,water calibrations obtained from different calibration laboratories were analyzed to find out the extent of accuracy achievable. Nd,w factors in Gray/Coulomb calibrated at IBA, GmBH, Germany showed a mean variation of about 0.2% increase per year in three Farmer chambers, in three subsequent calibrations. Another ion chamber calibrated in different accredited laboratory (PTW, Germany) showed consistent Nd,w for 9 years period. The Strontium-90 beta check source response indicated long-term stability of the ion chambers within 1% for three chambers. Results of IAEA postal TL "dose intercomparison" for three photon beams, 6 MV (two) and 15 MV (one), agreed well within our reported doses, with mean deviation of 0.03% (SD 0.87%) (n = 9). All the chamber/electrometer calibrated by a single SSDL realized absorbed doses in water within 0.13% standard deviations. However, about 1-2% differences in absorbed dose estimates observed when dosimeters calibrated from different calibration laboratories are compared in solid phantoms. Our data therefore imply that the dosimetry level maintained for clinical use of linear accelerator photon beams are within recommended levels of accuracy, and uncertainties are within reported values.

  5. Accelerated partial-breast irradiation vs conventional whole-breast radiotherapy in early breast cancer: A case-control study of disease control, cosmesis, and complications

    Directory of Open Access Journals (Sweden)

    Wadasadawala Tabassum

    2009-01-01

    Full Text Available Context: Accelerated partial-breast irradiation (APBI using various approaches is being increasingly employed for selected women with early breast cancer (EBC. Aims: To conduct a case-control study comparing disease control, cosmesis, and complications in patients with EBC undergoing APBI using multicatheter interstitial brachytherapy vs those receiving conventional whole breast radiotherapy (WBRT. Settings and Design: Women with EBC fulfilling the American Brachytherapy Society (ABS criteria were selected as ′cases′ if treated with APBI or as ′controls′ if offered WBRT during the period from May 2000 to December 2004. Materials and Methods: APBI patients were treated with high-dose-rate brachytherapy (HDR to a dose of 34 Gy/10#/6-8 days. WBRT was delivered to the whole breast to a dose of 45 Gy/25# followed by tumor bed boost, either with electrons (15 Gy/6# or interstitial brachytherapy (HDR 10 Gy/1#. Results: At the median follow-up of 43.05 months in APBI and 51.08 months in WBRT there was no difference in overall survival (OS, disease-free survival (DFS, late arm edema, and symptomatic fat necrosis between the two groups. However, APBI resulted in increase in mild breast fibrosis at the tumor bed. Telangiectasias were observed in three patients of the APBI group. The cosmetic outcome was significantly better in the APBI group as compared to the WBRT group (P = 0.003. Conclusions: This study revealed equivalent locoregional and distant disease control in the two groups. APBI offered better overall cosmetic outcome, though at the cost of a slight increase in mild breast fibrosis and telangiectasias.

  6. Accelerated hyperfractionated radiotherapy combined with induction and concomitant chemotherapy for inoperable non-small-cell lung cancer. Impact of total treatment time

    Energy Technology Data Exchange (ETDEWEB)

    Nyman, J.; Mercke, C. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Oncology; Bergman, B. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Respiratory Medicine

    1998-12-31

    Tumour cell proliferation during conventionally fractionated radiotherapy (RT) can negatively influence the treatment outcome in patients with unresectable non-small-cell lung cancer (NSCLC). Accelerated and hyperfractionated RT may therefore have an advantage over conventional RT. Moreover, earlier studies have suggested improved survival with addition of cisplatin-based chemotherapy (CT). We present here the results of combined treatment with induction and concomitant CT and accelerated hyperfractionated RT in a retrospective series of patients with advanced NSCLS. Between August 1990 and August 1995, 90 consecutive patients, aged 42-77 years (median 63 years), with locally advanced unresectable or medically inoperable NSCLC and good performance status were referred for treatment: stage: I 23%, IIIa 37%, IIIb 40%. Patient histologies included: squamous cell carcinoma 52%, adenocarcinoma 34% and large cell carcinoma 13%. The treatment consisted of two courses of CT (cisplatin 100 mg/m{sup 2} day 1 and etoposide 100 mg/m{sup 2} day 1-3 i.v.), the second course given concomitantly with RT. The total RT dose was 61.2-64.6 Gy, with two daily fractions of 1.7 Gy. A one-week interval was introduced after 40.8 Gy to reduce acute toxicity, making the total treatment time 4.5 weeks. Concerning toxicity, 33 patients had febrile neutropenia, 10 patients suffered from grade III oesophagitis and 7 patients had grade III pneumonitis. There were two possible treatment-related deaths, one due to myocardial infarction and the other due to a pneumocystis carinii infection. The 1-, 2- and 3-year overall survival rates were 72%, 46% and 34%, respectively; median survival was 21.3 months. Fifty-nine patients had progressive disease: 21 failed locoregionally, 29 had distant metastases and 9 patients had a combination of these. Pretreatment weight loss was the only prognostic factor found, except for stage. However, the results for stage IIIb were no different from those for stage IIIa

  7. High-dose radiation therapy alone by moderate hypofractionation for patients with thoracic esophageal squamous cell carcinoma.

    Science.gov (United States)

    Oh, Dongryul; Noh, Jae Myoung; Nam, Heerim; Lee, Hyebin; Kim, Tae Gyu; Ahn, Yong Chan

    2016-08-01

    We conducted retrospective analyses to investigate the clinical outcome of thoracic esophageal cancer patients who were treated with high-dose radiation therapy (RT) alone by moderate hypofractionation due to medical unfitness or refusal to receive either surgery or chemo-radiotherapy.Between May 2003 and April 2013, 70 patients were treated with high-dose RT alone with curative aim. The planned total RT dose was 60 Gy in daily 3.0 Gy per fraction. We evaluated the survival outcome, toxicities, and prognostic factors affecting patients' survival.At the time of analysis, 32 patients experienced disease progression. The 2-year overall survival (OS), cancer-specific survival (CSS) and local control (LC) rates were 52.1%, 57.8%, and 68.2%, respectively. Among them, 25 patients had superficial (cT1a-b) esophageal cancers, and the 2-year OS, CSS, and LC rates were 80.0%, 87.3%, and 81.6%, respectively. Multivariate analysis revealed that cT disease (P hypofractionation had led to reasonable clinical outcomes at acceptable toxicity risk in thoracic esophageal cancer patients who are medically unfit or refuse surgery or chemotherapy, especially for the patients having superficial lesion.

  8. A pilot study of intensity modulated radiation therapy with hypofractionated stereotactic body radiation therapy (SBRT) boost in the treatment of intermediate- to high-risk prostate cancer.

    Science.gov (United States)

    Oermann, Eric K; Slack, Rebecca S; Hanscom, Heather N; Lei, Sue; Suy, Simeng; Park, Hyeon U; Kim, Joy S; Sherer, Benjamin A; Collins, Brian T; Satinsky, Andrew N; Harter, K William; Batipps, Gerald P; Constantinople, Nicholas L; Dejter, Stephen W; Maxted, William C; Regan, James B; Pahira, John J; McGeagh, Kevin G; Jha, Reena C; Dawson, Nancy A; Dritschilo, Anatoly; Lynch, John H; Collins, Sean P

    2010-10-01

    Clinical data suggest that large radiation fractions are biologically superior to smaller fraction sizes in prostate cancer radiotherapy. The CyberKnife is an appealing delivery system for hypofractionated radiosurgery due to its ability to deliver highly conformal radiation and to track and adjust for prostate motion in real-time. We report our early experience using the CyberKnife to deliver a hypofractionated stereotactic body radiation therapy (SBRT) boost to patients with intermediate- to high-risk prostate cancer. Twenty-four patients were treated with hypofractionated SBRT and supplemental external radiation therapy plus or minus androgen deprivation therapy (ADT). Patients were treated with SBRT to a dose of 19.5 Gy in 3 fractions followed by intensity modulated radiation therapy (IMRT) to a dose of 50.4 Gy in 28 fractions. Quality of life data were collected with American Urological Association (AUA) symptom score and Expanded Prostate Cancer Index Composite (EPIC) questionnaires before and after treatment. PSA responses were monitored; acute urinary and rectal toxicities were assessed using Common Toxicity Criteria (CTC) v3. All 24 patients completed the planned treatment with an average follow-up of 9.3 months. For patients who did not receive ADT, the median pre-treatment PSA was 10.6 ng/ml and decreased in all patients to a median of 1.5 ng/ml by 6 months post-treatment. Acute effects associated with treatment included Grade 2 urinary and gastrointestinal toxicity but no patient experienced acute Grade 3 or greater toxicity. AUA and EPIC scores returned to baseline by six months post-treatment. Hypofractionated SBRT combined with IMRT offers radiobiological benefits of a large fraction boost for dose escalation and is a well tolerated treatment option for men with intermediate- to high-risk prostate cancer. Early results are encouraging with biochemical response and acceptable toxicity. These data provide a basis for the design of a phase II clinical

  9. Rapidly alternating combination of cisplatin-based chemotherapy and hyperfractionated accelerated radiotherapy in split course for Stage IIIA and Stage IIIB non-small cell lung cancer: results of a Phase I-II study by the GOTHA group

    Energy Technology Data Exchange (ETDEWEB)

    Alberto, P.; Mermillod, B. [Hopital Cantonal Geneve, Geneva (Switzerland); Mirimanoff, R.O.; Leyvraz, S.; Nagy-Mignotte, H.; Bolla, M.; Wellmann, D.; Moro, D.; Brambilla, E. [Hopital Cantonal Universitaire, Lausanne (Switzerland)

    1995-08-01

    The prognosis of stage III non-small cell lung cancer (NSCLC) can be improved by a combination of radiotherapy (RT) and chemotherapy (CT). In this study, the GOTHA group evaluated the feasibility, tolerance, tumour response, pattern of failure and effect on survival of a combination alternating accelerated hyperfractionated (AH) RT and CT in patients with tumour stage III NSCLC. Toxic effects were leucopenia, nausea and vomiting, mucositis, diarrhoea, alopecia and peripheral neuropathy. Alternating CT and AHRT, as used in this study, were well tolerated and allowed full dose delivery within less than 12 weeks. Initial response was not predictive of survival. The survival curve is encouraging and the 5 year survival is superior to the 5% generally observed with conventionally fractionated radiotherapy. (author).

  10. Stereotactic body radiotherapy for lung cancer: how much does it really cost?

    Science.gov (United States)

    Lievens, Yolande; Obyn, Caroline; Mertens, Anne-Sophie; Van Halewyck, Dries; Hulstaert, Frank

    2015-03-01

    Despite the lack of randomized evidence, stereotactic body radiotherapy (SBRT) is being accepted as superior to conventional radiotherapy for patients with T1-2N0 non-small-cell lung cancer in the periphery of the lung and unfit or unwilling to undergo surgery. To introduce SBRT in a system of coverage with evidence development, a correct financing had to be determined. A time-driven activity-based costing model for radiotherapy was developed. Resource cost calculation of all radiotherapy treatments, standard and innovative, was conducted in 10 Belgian radiotherapy centers in the second half of 2012. The average cost of lung SBRT across the 10 centers (6221&OV0556;) is in the range of the average costs of standard fractionated 3D-conformal radiotherapy (5919&OV0556;) and intensity-modulated radiotherapy (7379&OV0556;) for lung cancer. Hypofractionated 3D-conformal radiotherapy and intensity-modulated radiotherapy schemes are less costly (3993&OV0556; respectively 4730&OV0556;). The SBRT cost increases with the number of fractions and is highly dependent of personnel and equipment use. SBRT cost varies more by centre than conventional radiotherapy cost, reflecting different technologies, stages in the learning curve and a lack of clear guidance in this field. Time-driven activity-based costing of radiotherapy is feasible in a multicentre setup, resulting in real-life resource costs that can form the basis for correct reimbursement schemes, supporting an early yet controlled introduction of innovative radiotherapy techniques in clinical practice.

  11. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial.

    Science.gov (United States)

    Livi, Lorenzo; Meattini, Icro; Marrazzo, Livia; Simontacchi, Gabriele; Pallotta, Stefania; Saieva, Calogero; Paiar, Fabiola; Scotti, Vieri; De Luca Cardillo, Carla; Bastiani, Paolo; Orzalesi, Lorenzo; Casella, Donato; Sanchez, Luis; Nori, Jacopo; Fambrini, Massimiliano; Bianchi, Simonetta

    2015-03-01

    Accelerated partial breast irradiation (APBI) has been introduced as an alternative treatment method for selected patients with early stage breast cancer (BC). Intensity-modulated radiotherapy (IMRT) has the theoretical advantage of a further increase in dose conformity compared with three-dimensional techniques, with more normal tissue sparing. The aim of this randomised trial is to compare the local recurrence and survival of APBI using the IMRT technique after breast-conserving surgery to conventional whole-breast irradiation (WBI) in early stage BC. This study was performed at the University of Florence (Florence, Italy). Women aged more than 40years affected by early BC, with a maximum pathological tumour size of 25mm, were randomly assigned in a 1:1 ratio to receive either WBI or APBI using IMRT. Patients in the APBI arm received a total dose of 30 Gy to the tumour bed in five daily fractions. The WBI arm received 50Gy in 25 fractions, followed by a boost on the tumour bed of 10Gy in five fractions. The primary end-point was occurrence of ipsilateral breast tumour recurrences (IBTRs); the main analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT02104895. A total of 520 patients were randomised (260 to external WBI and 260 to APBI with IMRT) between March 2005 and June 2013. At a median follow-up of 5.0 years (Interquartile Range (IQR) 3.4-7.0), the IBTR rate was 1.5% (three cases) in the APBI group (95% confidence interval (CI) 0.1-3.0) and in the WBI group (three cases; 95% CI 0.0-2.8). No significant difference emerged between the two groups (log rank test p=0.86). We identified seven deaths in the WBI group and only one in the APBI group (p=0.057). The 5-year overall survival was 96.6% for the WBI group and 99.4% for the APBI group. The APBI group presented significantly better results considering acute (p=0.0001), late (p=0.004), and cosmetic outcome (p=0.045). To our knowledge, this is the first randomised

  12. Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity.

    Science.gov (United States)

    Guenzi, Marina; Blandino, Gladys; Vidili, Maria Giuseppina; Aloi, Deborah; Configliacco, Elena; Verzanini, Elisa; Tornari, Elena; Cavagnetto, Francesca; Corvò, Renzo

    2015-08-20

    The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity. From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34-83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59%), luminal-B 24 pts (24%), basal-like 10 pts (10%), Her-2 like 7 pts (7%). 82 pts (82%) received hormonal therapy, 9 pts (9%) neo-adjuvant chemotherapy, 81pts (81%) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation. Within a median follow-up of 50 months (range 19-82), 6 (6%) pts died, 1 pt (1%) had local progression disease, 2 pts (2%) developed distant metastasis and 1 subject (1%) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27%) presented lymphedema, but only 10 cases (10%) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis. Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related.

  13. Clinical oxygen enhancement ratio of tumors in carbon ion radiotherapy: the influence of local oxygenation changes

    DEFF Research Database (Denmark)

    Antonovic, Laura; Lindblom, Emely; Dasu, Alexandru

    2014-01-01

    The effect of carbon ion radiotherapy on hypoxic tumors has recently been questioned because of low linear energy transfer (LET) values in the spread-out Bragg peak (SOBP). The aim of this study was to investigate the role of hypoxia and local oxygenation changes (LOCs) in fractionated carbon ion...... level of tumor control probability is achievable with a large range of fractionation schedules for tumors with hypoxic subvolumes, but both hyperfractionation and hypofractionation should be pursued with caution....

  14. Recent Advances in Definitive Radiotherapy for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Michael Pinkawa

    2015-03-01

    Full Text Available Definitive radiation therapy is a well-recognised curative treatment option for localised prostate cancer. A suitable technique, dose, target volume, and the option of a combination with androgen deprivation therapy needs to be considered. An optimal standard external beam radiotherapy includes currently the intensity-modulated and image-guided radiotherapy techniques with total doses of ≥76-78 Gy in conventional fractionation. Data from several randomised studies increasingly support the rationale for hypofractionated radiotherapy. A simultaneous integrated boost with dose escalation focused on a computed tomography/positron emission tomography or magnetic resonance imaging/magnetic resonance spectroscopy detected malignant lesion is an option to increase tumour control with potentially no additional toxicity. The application of a spacer is a promising concept for optimal protection of the rectal wall.

  15. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. The 10-year results of a prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Budach, V.; Boehmer, D.; Badakhshi, H.; Jahn, U.; Stromberger, C. [Campus Virchow Klinikum, Charite Universitaetsmedizin Berlin, Department for Radiooncology, Clinic for Radiooncology, Berlin (Germany); Becker, E.T. [Charite Universitaetsmedizin, Department of Otorhinolaryngology, Berlin (Germany); Wernecke, K.D. [Sostana Statistics GmbH, Charite Universitaetsmedizin Berlin, Berlin (Germany)

    2014-03-15

    In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated. From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m{sup 2} on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m{sup 2}). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial. Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively. Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups. (orig.) [German] Untersuchung der Akuttoxizitaet und des Langzeitueberlebens einer hyperfraktioniert-akzelerierten simultanen Radiochemotherapie mit Cisplatin/5-Fluorouracil (5-FU) bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren. Von 2000 bis 2002 wurden 38 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region im Stadium III (5,3 %) und IV (94,7 %) eingeschlossen. Es erfolgte eine simultane hyperfraktionierte akzelerierte Radiochemotherapie mit 72 Gy in 15 Fraktionen a 2 Gy

  16. Performance characterization of siemens primus linear accelerator under small monitor unit and small segments for the implementation of step-and-shoot intensitymodulated radiotherapy

    Directory of Open Access Journals (Sweden)

    Reena P

    2006-01-01

    Full Text Available Implementation of step-and-shoot intensity-modulated radiotherapy (IMRT needs careful understanding of the accelerator start-up characteristic to ensure accurate and precise delivery of radiation dose to patient. The dosimetric characteristic of a Siemens Primus linear accelerator (LA which delivers 6 and 18 MV x-rays at the dose rate of 300 and 500 monitor unit (MU per minutes (min respectively was studied under the condition of small MU ranging from 1 to 100. Dose monitor linearity was studied at different dose calibration parameter (D1_C0 by measuring ionization at 10 cm depth in a solid water phantom using a 0.6 cc ionization chamber. Monitor unit stability was studied from different intensity modulated (IM groups comprising various combinations of MU per field and number of fields. Stability of beam flatness and symmetry was investigated under normal and IMRT mode for 20x20 cm2 field under small MU using a 2D Profiler kept isocentrically at 5 cm depth. Inter segment response was investigated form 1 to 10 MU by measuring the dose per MU from various IM groups, each consisting of four segments with inter-segment separation of 2 cm. In the range 1-4 MU, the dose linearity error was more than 5% (max -32% at 1 MU for 6 MV x-rays at factory calibrated D1_C0 value of 6000. The dose linearity error was reduced to -10.95% at 1 MU, within -3% for 2 and 3 MU and ±1% for MU ≥4 when the D1_C0 was subsequently tuned at 4500. For 18 MV x-rays, the dose linearity error at factory calibrated D1_C0 value of 4400 was within ±1% for MU ≥ 3 with maximum of -13.5 observed at 1 MU. For both the beam energies and MU/field ≥ 4, the stability of monitor unit tested for different IM groups was within ±1% of the dose from the normal treatment field. This variation increases to -2.6% for 6 MV and -2.7% for 18 MV x-rays for 2 MU/field. No significant variation was observed in the stability of beam profile measured from normal and IMRT mode. The beam flatness

  17. Quantitative analysis of results of quality control tests in linear accelerators used in radiotherapy; Analise quantitativa dos resultados de testes de controle de qualidade em aceleradores lineares usados em radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Passaro, Bruno M.; Rodrigues, Laura N. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Videira, Heber S., E-mail: bruno.passaro@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2013-04-15

    The aim of this study is to assess and analyze the stability of the calibration factor of three linear accelerators, as well as the other dosimetric parameters normally included in a program of quality control in radiotherapy. The average calibration factors of the accelerators for the period of approximately four years for the Clinac 600C and Clinac 6EX were (0.998±0.012) and (0.996±0.014), respectively. For the Clinac 2100CD 6 MV and 15 MV was (1.008±0.009) and (1.006±0.010), respectively, in a period of approximately four years. The data of the calibration factors were divided into four subgroups for a more detailed analysis of behavior over the years. Through statistical analysis of calibration factors, we found that for the 600C and Clinacs 2100CD, is an expected probability that more than 90% of cases the values are within acceptable ranges according to TG-142, while for the Clinac 6EX is expected around 85% since this had several exchanges of accelerator components. The values of TPR20,10 of three accelerators are practically constant and within acceptable limits according to the TG-142. It can be concluded that a detailed study of data from the calibration factor of the accelerators and TPR{sub 20},{sub 10} from a quantitative point of view, is extremely useful in a quality assurance program. (author)

  18. Quantification of intra-fraction motion in breast radiotherapy using supine magnetic resonance imaging

    NARCIS (Netherlands)

    van Heijst, Tristan C F; Philippens, Mariëlle E P; Charaghvandi, Ramona K; den Hartogh, Mariska D; Lagendijk, JJW; van den Bongard, H J G Desirée; van Asselen, B

    2016-01-01

    In early-stage breast-cancer patients, accelerated partial-breast irradiation techniques (APBI) and hypofractionation are increasingly implemented after breast-conserving surgery (BCS). For a safe and effective radiation therapy (RT), the influence of intra-fraction motion during dose delivery becom

  19. Radiation Therapy for Palliation of Sarcoma Metastases: A Unique and Uniform Hypofractionation Experience

    Directory of Open Access Journals (Sweden)

    Viacheslav Soyfer

    2010-01-01

    Full Text Available Radiotherapy (RT is our preferred modality for local palliation of metastatic soft tissue sarcoma (STS. A short and intense course of RT is usually needed for rapid palliation and local control of metastatic disease. Seventeen patients at a median age of 61 had symptomatic metastatic sarcoma and required rapid palliation. The symptoms related to the metastases were either pain or discomfort. All patients were treated by a short and intensive course of administration: 39 Gy were given in 13 fractions of 3 Gy/day, 5 times a week. Median follow-up period was 25 weeks. The treatment was well tolerated. Acute side effects included grade one skin toxicity. No wound complications were noted among those undergoing surgery. Late side effects included skin pigmentation and induration of irradiated soft tissues. Durable pain control was achieved in 12 out 15 cases treated for gross metastases. Tumor progression was seen in the 3 other cases within a period of two to nine months. Among 5 lesions which were irradiated as an adjunctive treatment following resection, no local recurrence was observed. The results of this series, although limited in size, point to the safety and feasibility of hypofractionated RT for palliation of musculoskeletal metastases from sarcoma

  20. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2011-11-15

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  1. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer

    DEFF Research Database (Denmark)

    Mortensen, Hanna Rahbek; Overgaard, Jens; Jensen, Kenneth;

    2013-01-01

    Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on informatio...

  2. Validation of the total dysphagia risk score (TDRS) in head and neck cancer patients in a conventional and a partially accelerated radiotherapy scheme

    NARCIS (Netherlands)

    Nevens, Daan; Deschuymer, Sarah; Langendijk, Johannes A.; Daisne, Jean -Francois; Duprez, Frederic; De Neve, Wilfried; Nuyts, Sandra

    Background and purpose: A risk model, the total dysphagia risk score (TDRS), was developed to predict which patients are most at risk to develop grade >= 2 dysphagia at 6 months following radiotherapy (RT) for head and neck cancer. The purpose of this study was to validate this model at 6 months and

  3. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer

    DEFF Research Database (Denmark)

    Mortensen, Hanna R; Overgaard, Jens; Jensen, Kenneth

    2013-01-01

    Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on information...

  4. Aggressive simultaneous radiochemotherapy with cisplatin and paclitaxel in combination with accelerated hyperfractionated radiotherapy in locally advanced head and neck tumors. Results of a phase I-II trial

    Energy Technology Data Exchange (ETDEWEB)

    Kuhnt, T.; Pigorsch, S.; Pelz, T.; Haensgen, G.; Dunst, J. [Dept. of Radiotherapy, Martin Luther Univ., Halle (Germany); Becker, A. [Dept. of Radiotherapy, Martin Luther Univ., Halle (Germany); Dept. of Radiotherapy, Municipial Hospital, Dessau (Germany); Bloching, M.; Passmann, M. [Dept. of Head and Neck Surgery, Martin Luther Univ., Halle (Germany); Lotterer, E. [Dept. of Internal Medicine I, Martin Luther Univ., Halle (Germany)

    2003-10-01

    We have tested a very aggressive combination protocol with cisplatin and escalated paclitaxel in combination with accelerated hyperfractionated radiotherapy to assess the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), overall toxicity, and response rate. Patients and Methods: The trial recruited 24 patients (21 males, three females, mean age 57 years) treated at our department from 1998 through 2001. Irradiation was administered in daily doses of 2 Gy up to 30 Gy followed by 1.4 Gy twice daily up to 70.6 Gy to the primary tumor and involved nodes and 51 Gy to the clinically negative regional nodes. The chemotherapy schedule included cisplatin in a fixed dose of 20 mg/m{sup 2} on days 1-5 and 29-33 and paclitaxel at increasing dose levels of 20, 25, 30 mg/m{sup 2} twice weekly over the whole treatment time. Patients were recruited in cohorts of three to six, and the MTD was reached if two out of six patients in one cohort developed DLT. DLT was defined as any grade 4 toxicity or any grade 3 toxicity requiring treatment interruption or unplanned hospitalization or any grade 3 neurotoxicity. We recruited mainly patients with large tumors for this protocol; all patients were stage IV, and the mean tumor volume (primary + metastases) amounted to 72 {+-} 61 cm{sup 3}. The mean follow-up was 30 months (range 4-39 months). Results: One early death (peritonitis and sepsis a t day 10) occurred, and 23 patients were evaluable for acute toxicity and response. The MTD of paclitaxel was reached at the third dose level (30 mg/m{sup 2} paclitaxel twice weekly). The DLT was severe mucositis grade 3 (n = 1) and skin erythema grade 4 (n = 2). After determining the MTD, another 14 patients were treated at the recommended dose level of paclitaxel with 25 mg/m{sup 2} twice weekly. In summary, 13/23 patients (57%) developed grade 3 and 10/23 (43%) grade 2 mucositis. Two patients (9%) had grade 4, five (22%) grade 3, and 16 (69%) grade 2 dermatitis. One patient died at day 30

  5. The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery

    Directory of Open Access Journals (Sweden)

    E. Lacarriere

    2013-12-01

    Full Text Available Objective The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. Patients and Methods Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. Results At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. Conclusions Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.

  6. Feasibility of preoperative hypo-fractionated volumetric modulated arc radiotherapy for malignant soft tissue tumor in rabbit extremity%兔肢体恶性软组织肿瘤术前大分割容积弧形调强放疗可行性研究

    Institute of Scientific and Technical Information of China (English)

    时广力; 刘艳; 王崇文; 白靖平; 杨爱梅

    2015-01-01

    目的 探讨应用兔肢体软组织肿瘤模型实施术前大分割容积弧形调强放疗(volumetric modulated arc radiotherapy,VMAT)的可行性.方法 成功构建30只兔VX2软组织肿瘤模型,2周后随机分为VMAT大分割放疗组10只(VMAT组)、常规分割调强放疗(intensity modulation radiated therapy,IMRT)放疗组10只(IMRT组)和对照组10只,给予的单次剂量分别为3 Gy、2 Gy和不采取任何处理.放疗结束后,3组行MRI扫描评估,并采用Envision法检测肿瘤组织Ki-67表达率.结果 VMAT组和IMRT组肿瘤体积[(21.11±2.36)、(23.56±3.21)cm3]和肿瘤组织Ki-67表达率[(49.67±2.34)%、(51.00±2.39)%]均小于对照组[(46.78±3.38)cm3,(68.22±5.21)%](P<0.01),VMAT组与IMRT组比较差异无统计学意义(P>0.05).结论 大分割VMAT在兔肢体恶性软组织肿瘤的术前放疗中可取得与常规分割IMRT相同疗效.

  7. Radiotherapy for diffuse brainstem glioma in children and young adults.

    Science.gov (United States)

    Hu, Xin; Fang, Yuan; Hui, Xuhui; Jv, Yan; You, Chao

    2016-06-27

    Interventions. We identified two RCTs that fulfilled our inclusion criteria. The two trials tested different comparisons.One multi-institutional RCT included 130 participants and compared hyperfractionated radiotherapy (six-week course with twice a day treatment of 117 cGy per fraction to a total dose of 7020 cGy) with conventional radiotherapy (six-week course with once a day treatment of 180 cGy per fraction to a total dose of 5400 cGy). The median time overall survival (OS) was 8.5 months in the conventional group and 8.0 months in the hyperfractionated group. We detected no clear evidence of effect on OS or event-free survival (EFS) in participants receiving hyperfractionated radiotherapy compared with conventional radiotherapy (OS: hazard ratio (HR) 1.07, 95% confidence interval (CI) 0.75 to 1.53; EFS: HR 1.26, 95% CI 0.83 to 1.90). Radiological response (risk ratio (RR) 0.94, 95% CI 0.54 to 1.63) and various types of toxicities were similar in the two groups. There was no information on other outcomes. According to the GRADE approach, we judged the quality of evidence to be low (i.e. further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate) for OS and EFS, and very low (i.e. we are very uncertain about the estimate) for radiological response and toxicities.The second RCT included 71 participants and compared hypofractionated radiotherapy (39 Gy in 13 fractions over 2.6 weeks, 3 Gy per fraction) with conventional radiotherapy (54 Gy in 30 fractions over six weeks, 1.8 Gy per fraction). This trial reported a median OS of 7.8 months for the hypofractionated group and 9.5 months for the conventional group. It reported a progression-free survival (PFS) of 6.3 months for the hypofractionated group and 7.3 months for the conventional group. We found no clear evidence of effect on OS (HR 1.03, 95% CI 0.53 to 2.01) or PFS (HR 1.19, 95% CI 0.63 to 2.22) in participants receiving hypofractionated

  8. Critical dose and toxicity index of organs at risk in radiotherapy: Analyzing the calculated effects of modified dose fractionation in non–small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pedicini, Piernicola, E-mail: ppiern@libero.it [Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture (Italy); Strigari, Lidia [Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome (Italy); Benassi, Marcello [Service of Medical Physics, Scientific Institute of Tumours of Romagna I.R.S.T., Meldola (Italy); Caivano, Rocchina [Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture (Italy); Fiorentino, Alba [U.O. of Radiotherapy, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy); Nappi, Antonio [U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy); Salvatore, Marco [U.O. of Nuclear Medicine, I.R.C.C.S. SDN Foundation, Naples (Italy); Storto, Giovanni [U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy)

    2014-04-01

    To increase the efficacy of radiotherapy for non–small cell lung cancer (NSCLC), many schemes of dose fractionation were assessed by a new “toxicity index” (I), which allows one to choose the fractionation schedules that produce less toxic treatments. Thirty-two patients affected by non resectable NSCLC were treated by standard 3-dimensional conformal radiotherapy (3DCRT) with a strategy of limited treated volume. Computed tomography datasets were employed to re plan by simultaneous integrated boost intensity-modulated radiotherapy (IMRT). The dose distributions from plans were used to test various schemes of dose fractionation, in 3DCRT as well as in IMRT, by transforming the dose-volume histogram (DVH) into a biological equivalent DVH (BDVH) and by varying the overall treatment time. The BDVHs were obtained through the toxicity index, which was defined for each of the organs at risk (OAR) by a linear quadratic model keeping an equivalent radiobiological effect on the target volume. The less toxic fractionation consisted in a severe/moderate hyper fractionation for the volume including the primary tumor and lymph nodes, followed by a hypofractionation for the reduced volume of the primary tumor. The 3DCRT and IMRT resulted, respectively, in 4.7% and 4.3% of dose sparing for the spinal cord, without significant changes for the combined-lungs toxicity (p < 0.001). Schedules with reduced overall treatment time (accelerated fractionations) led to a 12.5% dose sparing for the spinal cord (7.5% in IMRT), 8.3% dose sparing for V{sub 20} in the combined lungs (5.5% in IMRT), and also significant dose sparing for all the other OARs (p < 0.001). The toxicity index allows to choose fractionation schedules with reduced toxicity for all the OARs and equivalent radiobiological effect for the tumor in 3DCRT, as well as in IMRT, treatments of NSCLC.

  9. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies.

    Science.gov (United States)

    Adebahr, Sonja; Schimek-Jasch, Tanja; Nestle, Ursula; Brunner, Thomas B

    2016-08-01

    The oesophagus as a serial organ located in the central chest is frequent subject to "incidental" dose application in radiotherapy for several thoracic malignancies including oesophageal cancer itself. Especially due to the radiosensitive mucosa severe radiotherapy induced sequelae can occur, acute oesophagitis and strictures as late toxicity being the most frequent side-effects. In this review we focus on oesophageal side effects derived from treatment of gastrointestinal cancer and secondly provide an overview on oesophageal toxicity from conventional and stereotactic fractionated radiotherapy to the thoracic area in general. Available data on pathogenesis, frequency, onset, and severity of oesophageal side effects are summarized. Whereas for conventional radiotherapy the associations of applied doses to certain volumes of the oesophagus are well described, the tolerance dose to the mediastinal structures for hypofractionated therapy is unknown. The review provides available attempts to predict the risk of oesophageal side effects from dosimetric parameters of SBRT.

  10. Big Data Analytics for Prostate Radiotherapy.

    Science.gov (United States)

    Coates, James; Souhami, Luis; El Naqa, Issam

    2016-01-01

    Radiation therapy is a first-line treatment option for localized prostate cancer and radiation-induced normal tissue damage are often the main limiting factor for modern radiotherapy regimens. Conversely, under-dosing of target volumes in an attempt to spare adjacent healthy tissues limits the likelihood of achieving local, long-term control. Thus, the ability to generate personalized data-driven risk profiles for radiotherapy outcomes would provide valuable prognostic information to help guide both clinicians and patients alike. Big data applied to radiation oncology promises to deliver better understanding of outcomes by harvesting and integrating heterogeneous data types, including patient-specific clinical parameters, treatment-related dose-volume metrics, and biological risk factors. When taken together, such variables make up the basis for a multi-dimensional space (the "RadoncSpace") in which the presented modeling techniques search in order to identify significant predictors. Herein, we review outcome modeling and big data-mining techniques for both tumor control and radiotherapy-induced normal tissue effects. We apply many of the presented modeling approaches onto a cohort of hypofractionated prostate cancer patients taking into account different data types and a large heterogeneous mix of physical and biological parameters. Cross-validation techniques are also reviewed for the refinement of the proposed framework architecture and checking individual model performance. We conclude by considering advanced modeling techniques that borrow concepts from big data analytics, such as machine learning and artificial intelligence, before discussing the potential future impact of systems radiobiology approaches.

  11. MO-A-213AB-09: Hypofractionated Proton Therapy of the Prostate: The Impact of the Uncertainties in Dose Delivery and Alpha/Beta Ratio on Tumor Dose Escalation.

    Science.gov (United States)

    Wang, Yi; Trofimov, Alexei

    2012-06-01

    Hypofractionation is expected to improve therapeutic ratio for prostate radiotherapy, due to the relatively low alpha/beta ratio of the prostate tumor (∼1.2 to 2.0 Gy). However, the gain in tumor equivalent dose in 2-Gy fractions (EQD2) is accompanied by the increased uncertainty in delivered dose due to inter-fractional variations. The purpose of this study is to evaluate how this trade-off is affected by the uncertainty of the tumor alpha/beta. We used serial CT images acquired from two prostate cancer patients. Target and normal organs were contoured on the simulation and daily images. A 3D conformal proton plan was designed based on standard fractionation (78 Gy in 39 fractions) and renormalized for hypofractionation (between 5 and 28 fractions). The fraction size of the hypofractionated protocols was adjusted so as to maintain the maximum rectal dose at 78 Gy-EQD2 (alpha/beta = 3 Gy). The fractional dose, calculated on each daily CT, was mapped to the simulation geometry via deformable registration. The worst-case-scenario PTV dose for a hypofractionated protocol was estimated by summing the fractions (e.g., 28) with the lowest D97%. The target dose (e.g., D100%) was evaluated for alpha/beta of 1.2 to 2.0 Gy. The dose delivery uncertainty due to inter-fractional motion increased as the treatment became more hypofractionated. D100% was1.25, 1.46, 1.68 and 1.84 Gy, respectively. At alpha/beta of 2 Gy (1.2 Gy), D99% ranged from ∼79 (81) to 85 (98) Gy-EQD2 for treatments in 28 to 5 fractions. Below D97%, the target dose was predominantly determined by alpha/beta, and the motion impact was minimal. In prostate treatments, the impact of inter-fractional motion on tumor dose escalation is small for alpha/beta <2.0 Gy, and is of minimal concern to hypofractionated proton therapy. This study was supported by the Federal Share of program income earned by Massachusetts General Hospital on C06-CA059267, Proton Therapy Research and Treatment Center. © 2012 American

  12. Evaluation of a combined respiratory-gating system comprising the TrueBeam linear accelerator and a new real-time tumor-tracking radiotherapy system: a preliminary study.

    Science.gov (United States)

    Shiinoki, Takehiro; Kawamura, Shinji; Uehara, Takuya; Yuasa, Yuki; Fujimoto, Koya; Koike, Masahiro; Sera, Tatsuhiro; Emoto, Yuki; Hanazawa, Hideki; Shibuya, Keiko

    2016-07-08

    A combined system comprising the TrueBeam linear accelerator and a new real-time, tumor-tracking radiotherapy system, SyncTraX, was installed in our institution. The goals of this study were to assess the capability of SyncTraX in measuring the position of a fiducial marker using color fluoroscopic images, and to evaluate the dosimetric and geometric accuracy of respiratory-gated radiotherapy using this combined system for the simple geometry. For the fundamental evaluation of respiratory-gated radiotherapy using SyncTraX, the following were performed:1) determination of dosimetric and positional characteristics of sinusoidal patterns using a motor-driven base for several gating windows; 2) measurement of time delay using an oscilloscope; 3) positional verification of sinusoidal patterns and the pattern in the case of a lung cancer patient; 4) measurement of the half-value layer (HVL in mm AL), effective kVp, and air kerma, using a solid-state detector for each fluoroscopic condition, to determine the patient dose. The dose profile in a moving phantom with gated radiotherapy having a gating window ≤ 4 mm was in good agreement with that under static conditions for each photon beam. The total time delay between TrueBeam and SyncTraX was < 227 ms for each photon beam. The mean of the positional tracking error was < 0.4 mm for sinusoidal patterns and for the pattern in the case of a lung cancer patient. The air-kerma rates from one fluoroscopy direction were 1.93 ± 0.01, 2.86 ± 0.01, 3.92 ± 0.04, 5.28 ± 0.03, and 6.60 ± 0.05 mGy/min for 70, 80, 90, 100, and 110 kV X-ray beams at 80 mA, respectively. The combined system comprising TrueBeam and SyncTraX could track the motion of the fiducial marker and control radiation delivery with reasonable accuracy; therefore, this system provides significant dosimetric improvement. However, patient exposure dose from fluoroscopy was not clinically negligible.

  13. The case for hypofractionation of localized prostate cancer.

    Science.gov (United States)

    Wong, Winnifred M; Wallner, Kent E

    2013-01-01

    An optimal treatment regimen for localized prostate cancer (PCa) is yet to be determined. Increasing evidence reveals a lower α/β ratio for PCa with hypofractionated radiation therapy (HFRT) regimens introduced to exploit this change in therapeutic ratio. HFRT also results in shortened overall treatment times of 4 to 5 weeks, thus reducing staffing and machine burden, and, more importantly, patient stress. This review evaluates pretreatment characteristics, outcomes, and toxicity for 15 HFRT studies on localized PCa. HFRT results in comparable or better biochemical relapse-free survival and toxicity and is a viable option for localized PCa.

  14. Inter- and intrafractional dose uncertainty in hypofractionated Gamma Knife radiosurgery.

    Science.gov (United States)

    Kim, Taeho; Sheehan, Jason; Schlesinger, David

    2016-03-08

    The purpose of this study is to evaluate inter- and intrafractional dose variations resulting from head position deviations for patients treated with the Extend relocatable frame system utilized in hypofractionated Gamma Knife radiosurgery (GKRS). While previous reports characterized the residual setup and intrafraction uncertainties of the system, the dosimetric consequences have not been investigated. A digital gauge was used to measure the head position of 16 consecutive Extend patients (62 fractions) at the time of simulation, before each fraction, and immediately following each fraction. Vector interfraction (difference between simulation and prefraction positions) and intrafraction (difference between postfraction and prefraction positions) shifts in patient position were calculated. Planned dose distributions were shifted by the offset to determine the time-of-treatment dose. Variations in mean and maximum target and organ at risk (OAR) doses as a function of positional shift were evaluated. The mean vector interfraction shift was 0.64 mm (Standard Deviation (SD): 0.25 mm, maximum: 1.17 mm). The mean intrafraction shift was 0.39 mm (SD: 0.25 mm, maximum: 1.44 mm). The mean variation in mean target dose was 0.66% (SD: 1.15%, maximum: 5.77%) for inter-fraction shifts and 0.26% (SD: 0.34%, maximum: 1.85%) for intrafraction shifts. The mean variation in maximum dose to OARs was 7.15% (SD: 5.73%, maximum: 30.59%) for interfraction shifts and 4.07% (SD: 4.22%, maximum: 17.04%) for intrafraction shifts. Linear fitting of the mean variation in maximum dose to OARs as a function of position yielded dose deviations of 10.58%/mm for interfractional shifts and 7.69%/mm for intrafractional shifts. Positional uncertainties when per-forming hypofractionated Gamma Knife radiosurgery with the Extend system are small and comparable to frame-based uncertainties (< 1 mm). However, the steep dose gradient characteristics of GKRS mean that the dosimetric consequences of

  15. Adoption of Hypofractionated Whole-Breast Irradiation for Early-Stage Breast Cancer: A National Cancer Data Base Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Elyn H. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Mougalian, Sarah S. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Department of Medical Oncology, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Soulos, Pamela R. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Rutter, Charles E.; Evans, Suzanne B. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States); Haffty, Bruce G. [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Gross, Cary P. [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Yu, James B., E-mail: james.b.yu@yale.edu [Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)

    2014-12-01

    Purpose: To evaluate the relationship of patient, hospital, and cancer characteristics with the adoption of hypofractionation in a national sample of patients diagnosed with early-stage breast cancer. Methods and Materials: We performed a retrospective study of breast cancer patients in the National Cancer Data Base from 2004-2011 who were treated with radiation therapy and met eligibility criteria for hypofractionation. We used logistic regression to identify factors associated with receipt of hypofractionation (vs conventional fractionation). Results: We identified 13,271 women (11.7%) and 99,996 women (88.3%) with early-stage breast cancer who were treated with hypofractionation and conventional fractionation, respectively. The use of hypofractionation increased significantly, with 5.4% of patients receiving it in 2004 compared with 22.8% in 2011 (P<.001 for trend). Patients living ≥50 miles from the cancer reporting facility had increased odds of receiving hypofractionation (odds ratio 1.57 [95% confidence interval 1.44-1.72], P<.001). Adoption of hypofractionation was associated with treatment at an academic center (P<.001) and living in an area with high median income (P<.001). Hypofractionation was less likely to be used in patients with high-risk disease, such as increased tumor size (P<.001) or poorly differentiated histologic grade (P<.001). Conclusions: The use of hypofractionation is rising and is associated with increased travel distance and treatment at an academic center. Further adoption of hypofractionation may be tempered by both clinical and nonclinical concerns.

  16. Modeling of α/β for late rectal toxicity from a randomized phase II study: conventional versus hypofractionated scheme for localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Arcangeli Giorgio

    2009-08-01

    Full Text Available Abstract Background Recently, the use of hypo-fractionated treatment schemes for the prostate cancer has been encouraged due to the fact that α/β ratio for prostate cancer should be low. However a major concern on the use of hypofractionation is the late rectal toxicity, it is important to be able to predict the risk of toxicity for alternative treatment schemes, with the best accuracy. The main purpose of this study is to evaluate the response of rectum wall to changes in fractionation and to quantify the α/β ratio for late rectal toxicity Methods 162 patients with localized prostate cancer, treated with conformal radiotherapy, were enrolled in a phase II randomized trial. The patients were randomly assigned to 80 Gy in 40 fractions over 8 weeks (arm A or 62 Gy in 20 fractions over 5 weeks (arm B. The median follow-up was 30 months. The late rectal toxicity was evaluated using the Radiation Therapy Oncology Group (RTOG scale. It was assumed ≥ Grade 2 (G2 toxicity incidence as primary end point. Fit of toxicity incidence by the Lyman-Burman-Kutcher (LKB model was performed. Results The crude incidence of late rectal toxicity ≥ G2 was 14% and 12% for the standard arm and the hypofractionated arm, respectively. The crude incidence of late rectal toxicity ≥ G2 was 14.0% and 12.3% for the arm A and B, respectively. For the arm A, volumes receiving ≥ 50 Gy (V50 and 70 Gy (V70 were 38.3 ± 7.5% and 23.4 ± 5.5%; for arm B, V38 and V54 were 40.9 ± 6.8% and 24.5 ± 4.4%. An α/β ratio for late rectal toxicity very close to 3 Gy was found. Conclusion The ≥ G2 late toxicities in both arms were comparable, indicating the feasibility of hypofractionated regimes in prostate cancer. An α/β ratio for late rectal toxicity very close to 3 Gy was found.

  17. Hypofractionated helical tomotherapy (75 Gy at 2.5 Gy per fraction for localized prostate cancer: long-term analysis of gastrointestinal and genitourinary toxicity

    Directory of Open Access Journals (Sweden)

    Kong M

    2014-04-01

    toxicities, constraining the rectum maximum dose to less than 76.5 Gy, rectum V70 to less than 2.8%, bladder V40 to less than 17.3%, bladder V50 to less than 10.2%, bladder V70 to less than 2.8%, and bladder V75 to less than 1.0% would be necessary.Keywords: prostate cancer, helical tomotherapy, hypofractionated radiotherapy, radiation toxicity, predictive factor

  18. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fehlauer, F.; Tribius, S.; Alberti, W.; Rades, D. [Dept. of Radiation Oncology, Univ. Medical Clinic Hamburg-Eppendorf, Hamburg (Germany)

    2005-10-01

    Background and purpose: breast irradiation after lumpectomy is an integral component of breast-conserving therapy (BCT). As the prognosis is general good following BCT, late morbidity and cosmesis are important. The present study compares two different radiation schedules with respect to these two endpoints. Patients and methods: 129 breast cancer patients (pT1-2 pN0-1 cM0) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule (2.5 Gy to 55 Gy, 4 x /week, n = 65) or with a conventional fractionation schedule (28 days, 2.0 Gy to 55 Gy, 5 x /week, n = 64), both without additional boost. The equivalent dose of 2-Gy fractions (EQD2) was 55 Gy and 62 Gy, respectively. Late toxicity, assessed according to the LENT-SOMA criteria, and cosmetic outcome, graded on a 5-point scale, were evaluated after a median of 86 months (range 72-94 months) in tumor-free breast cancer patients. Results: LENT-SOMA grade 2/3 toxicity (2.5 Gy vs. 2.0 Gy): breast pain (18% vs. 11%; p = 0.3), fibrosis (57% vs. 16%; p < 0.001), telangiectasia (22% vs. 3%; p = 0.002), atrophy (31% vs. 3%; p < 0.001). Medication to breast pain was taken by 8% versus 9% of patients. Cosmesis was very good/good/acceptable in 75% versus 93% (2.5 Gy vs. 2.0 Gy; p = 0.006). Conclusion: late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy (2.5 Gy to 55 Gy). However, morbidity was not associated with major implications on daily life. (orig.)

  19. Hypofractionation with no boost after breast conservation in early-stage breast cancer patients.

    Science.gov (United States)

    Arcadipane, Francesca; Franco, Pierfrancesco; De Colle, Chiara; Rondi, Nadia; Di Muzio, Jacopo; Pelle, Emanuela; Martini, Stefania; Ala, Ada; Airoldi, Mario; Donadio, Michela; De Sanctis, Corrado; Castellano, Isabella; Ragona, Riccardo; Ricardi, Umberto

    2016-10-01

    The aim of this study was to evaluate local control, survival and toxicity profile of a consecutive cohort of early-stage breast cancer (EBC) patients treated with adjuvant hypofractionated radiotherapy (HF) with no boost delivered to the lumpectomy cavity, after breast-conserving surgery (BCS). Between 2005 and 2015, a total of 493 women affected with EBC were treated with HF (46 Gy/20 fractions or 40.05 Gy/15 fractions) to the whole breast without boost to tumor bed, because of age and/or favorable tumor characteristics. The primary endpoint was 5-year actuarial local control (LC); secondary endpoints included survival, toxicity profile and cosmesis. Median follow-up was 57 months (range 6-124). Actuarial 5-year overall, cancer-specific, disease-free survival and LC were 96.3, 98.9, 97.8 and 98.6 %, respectively. On multivariate analysis, tumor stage (T1 vs. T2) and hormonal status (positive vs. negative estrogen receptors) were significantly correlated with LC. Only 2 % of patients experienced ≥G3 acute skin toxicity. Late toxicity was mild with only 1 case of G3 fibrosis. Most of the patients (95 %) had good-excellent cosmetic results. HF to the whole breast with no boost delivered to the tumor bed is a safe and effective option for a population of low-risk breast cancer patients after BCS, with excellent 5-year LC, mild toxicity profile and promising cosmetic outcome. A subgroup of patients with larger tumors and/or with no estrogen receptor expression may potentially benefit from treatment intensification with a boost dose to the lumpectomy cavity.

  20. Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Ju Andrew W

    2013-01-01

    Full Text Available Abstract Background Hypofractionated stereotactic body radiation therapy (SBRT has been advanced as monotherapy for low-risk prostate cancer. We examined the dose distributions and early clinical outcomes using this modality for the treatment of intermediate-risk prostate cancer. Methods Forty-one sequential hormone-naïve intermediate-risk prostate cancer patients received 35–36.25 Gy of CyberKnife-delivered SBRT in 5 fractions. Radiation dose distributions were analyzed for coverage of potential microscopic ECE by measuring the distance from the prostatic capsule to the 33 Gy isodose line. PSA levels, toxicities, and quality of life (QOL measures were assessed at baseline and follow-up. Results All patients completed treatment with a mean coverage by the 33 Gy isodose line extending >5 mm beyond the prostatic capsule in all directions except posteriorly. Clinical responses were documented by a mean PSA decrease from 7.67 ng/mL pretreatment to 0.64 ng/mL at the median follow-up of 21 months. Forty patients remain free from biochemical progression. No Grade 3 or 4 toxicities were observed. Mean EPIC urinary irritation/obstruction and bowel QOL scores exhibited a transient decline post-treatment with a subsequent return to baseline. No significant change in sexual QOL was observed. Conclusions In this intermediate-risk patient population, an adequate radiation dose was delivered to areas of expected microscopic ECE in the majority of patients. Although prospective studies are needed to confirm long-term tumor control and toxicity, the short-term PSA response, biochemical relapse-free survival rate, and QOL in this interim analysis are comparable to results reported for prostate brachytherapy or external beam radiotherapy. Trial registration The Georgetown Institutional Review Board has approved this retrospective study (IRB 2009–510.

  1. Hypofractionated radiation therapy of oral melanoma in five cats.

    Science.gov (United States)

    Farrelly, John; Denman, David L; Hohenhaus, Ann E; Patnaik, Amiya K; Bergman, Philip J

    2004-01-01

    Five cats with melanoma involving the oral cavity were treated with hypofractionated radiation therapy (RT). Cobalt photons were used to administer three fractions of 8.0 Gray (Gy) for a total dose of 24 Gy. Four cats received radiation on days 0, 7, and 21 and one cat received radiation on days 0, 7, and 13. One of the cats received additional irradiation following the initial treatment course. Two cats received chemotherapy. Their age ranged from 11 to 15 years with a median age of 12 years. Three cats had a response to radiation, including one complete response and two partial responses. All five cats were euthanized due to progression of disease, with one cat having evidence of metastatic disease at the time of euthanasia. The median survival time for the five cats was 146 days (range 66-224 days) from the start of RT. The results of this study suggest that oral melanoma in cats may be responsive to hypofractionated RT, but response does not seem to be durable.

  2. Accelerated high-dose radiotherapy alone or combined with either concomitant or sequential chemotherapy; treatments of choice in patients with Non-Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Pieters Bradley R

    2007-07-01

    Full Text Available Abstract Background Results of high-dose chemo-radiotherapy (CRT, using the treatment schedules of EORTC study 08972/22973 or radiotherapy (RT alone were analyzed among all patients (pts with Non Small Cell Lung Cancer (NSCLC treated with curative intent in our department from 1995–2004. Material Included are 131 pts with medically inoperable or with irresectable NSCLC (TNM stage I:15 pts, IIB:15 pts, IIIA:57 pts, IIIB:43 pts, X:1 pt. Treatment Group I: Concomitant CRT: 66 Gy/2.75 Gy/24 fractions (fx/33 days combined with daily administration of cisplatin 6 mg/m2: 56 pts (standard. Group II: Sequential CRT: two courses of a 21-day schedule of chemotherapy (gemcitabin 1250 mg/m2 d1, cisplatin 75 mg/m2 d2 followed by 66 Gy/2.75 Gy/24 fx/33 days without daily cisplatin: 26 pts. Group III: RT: 66 Gy/2.75 Gy/24 fx/33 days or 60 Gy/3 Gy/20 fx/26 days: 49 pts. Results The 1, 2, and 5 year actuarial overall survival (OS were 46%, 24%, and 15%, respectively. At multivariate analysis the only factor with a significantly positive influence on OS was treatment with chemo-radiation (P = 0.024 (1-, 2-, and 5-yr OS 56%, 30% and 22% respectively. The incidence of local recurrence was 36%, the incidence of distant metastases 46%. Late complications grade 3 were seen in 21 pts and grade 4 in 4 patients. One patient had a lethal complication (oesophageal. For 32 patients insufficient data were available to assess late complications. Conclusion In this study we were able to reproduce the results of EORTC trial 08972/22973 in a non-selected patient population outside of the setting of a randomised trial. Radiotherapy (66 Gy/24 fx/33 days combined with either concomitant daily low dose cisplatin or with two neo-adjuvant courses of gemcitabin and cisplatin are effective treatments for patients with locally advanced Non-Small Cell Lung Cancer. The concomitant schedule is also suitable for elderly people with co-morbidity.

  3. Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Adkison, Jarrod B.; McHaffie, Derek R.; Bentzen, Soren M.; Patel, Rakesh R.; Khuntia, Deepak [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Petereit, Daniel G. [Department of Radiation Oncology, John T. Vucurevich Regional Cancer Care Institute, Rapid City Regional Hospital, Rapid City, SD (United States); Hong, Theodore S.; Tome, Wolfgang [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Ritter, Mark A., E-mail: ritter@humonc.wisc.edu [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States)

    2012-01-01

    Purpose: Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5 Vulgar-Fraction-One-Half weeks. Methods and Materials: Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. Results: The median follow-up time was 25.4 months (range, 4.2-57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose-volume descriptors correlated with GU toxicity, and only the volume of bowel receiving {>=}30 Gy correlated with early GI toxicity (p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 {+-} 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. Conclusions: Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose

  4. Preliminary Experience in Treatment of Papillary and Macular Retinoblastoma: Evaluation of Local Control and Local Complications After Treatment With Linear Accelerator-Based Stereotactic Radiotherapy With Micromultileaf Collimator as Second-Line or Salvage Treatment After Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Pica, Alessia, E-mail: Alessia.Pica@chuv.ch [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Moeckli, Raphael [University Institute for Radiation Physics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Balmer, Aubin [Department of Radiation Oncology, Jules Gonin Eye Hospital, Lausanne (Switzerland); Beck-Popovic, Maja [Unit of Pediatric Oncology, University of Lausanne, Lausanne (Switzerland); Chollet-Rivier, Madeleine [Department of Anesthesiology, University of Lausanne, Lausanne (Switzerland); Do, Huu-Phuoc [University Institute for Radiation Physics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Weber, Damien C. [Department of Radiation Oncology, Geneva University Hospital, University of Geneva, Geneva (Switzerland); Munier, Francis L. [Department of Radiation Oncology, Jules Gonin Eye Hospital, Lausanne (Switzerland)

    2011-12-01

    Purpose: To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator. Methods and Materials: Between 2004 and 2008, 11 children (15 eyes) with macular and/or papillary retinoblastoma were treated with SRT. The mean age was 19 months (range, 2-111). Of the 15 eyes, 7, 6, and 2 were classified as International Classification of Intraocular Retinoblastoma Group B, C, and E, respectively. The delivered dose of SRT was 50.4 Gy in 28 fractions using a dedicated micromultileaf collimator linear accelerator. Results: The median follow-up was 20 months (range, 13-39). Local control was achieved in 13 eyes (87%). The actuarial 1- and 2-year local control rates were both 82%. SRT was well tolerated. Late adverse events were reported in 4 patients. Of the 4 patients, 2 had developed focal microangiopathy 20 months after SRT; 1 had developed a transient recurrence of retinal detachment; and 1 had developed bilateral cataracts. No optic neuropathy was observed. Conclusions: Linear accelerator-based SRT for papillary and/or macular retinoblastoma in children resulted in excellent tumor control rates with acceptable toxicity. Additional research regarding SRT and its intrinsic organ-at-risk sparing capability is justified in the framework of prospective trials.

  5. 肺癌超分割同步放化疗致急性放射性食管炎的研究%Research on Hyperfractionated Accelerated Radiotherapy-induced Acute Radiation Esophagitis in Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    蓝柳; 杨春旭; 莫玉珍; 苏毅; 宁四海

    2011-01-01

    目的 观察超分割同步放化疗治疗局部晚期非小细胞肺癌(NSCLC)患者放射性食管炎的发生情况,评价其安全性,探讨超分割放疗导致放射性食管炎损伤的有效预测指标.方法 初治NSCLC 48例,采用超分割同步放化疗24例,放疗剂量:56.0~64.4 Gy/40~46次,1.4 Gy/次,2次/d;常规分割同步放化疗24例,放疗剂量:60.0~66 Gy/30~33次,2.0 Gy/次,1次/d.两组均接受依托泊苷+顺铂(EP)方案同步化疗.采用RTOG标准评价急性放射性食管炎发生情况,分析急性放射性食管炎的相关临床及物理因素.结果 48例患者均完成治疗计划.超分割组≥2级和≥3急性放射性食管炎发生率高于对照组(P<0.05).急性放射性食管炎最早在第10天发生,累计剂量为22.4 Gy,在疗程的第17天后其发生率明显上升.超分割组中食管LETT30、LETT35、V35与≥2级急性放射性食管炎显著相关(P<0.01).结论 超分割同步放化疗治疗NSCLC急性放射性食管炎的发生率及严重程度较常规分割同步放化疗明显增加,并且发生时间早;食管LETT30、LETT35、V35和周累计剂量是预测超分割同步放化疗致急性放射性食管炎的可靠指标.%Objective To observed the incidence of acute radiation esophagitis and analyze the factors as predictors of acute radiotherapy-induced acute radiation esophagitis for locally advanced non-small cell lung cancer( LA-NSCLC )patients treated with 3DCRT were reviewed. To analyze the efficacy and safety of hyperfractionated accelerated radiotherapy for the treatment of lung cancer and assess effective indexes in those patient. Methods Forty eight patients with LA-NSCLC were allocated to treatment group( 24 cases ), treated with hyperfractionated accelerated radiotherapy.Radiotherapy was delivered at 1. 4 Gy/fraction ,56. 0 - 64. 4 Gy/40 - 45 fractions , twice a day. The control group( 24 cases )treated with conventional fractionation , with delivered at 2 Gy fraction , 60. 0

  6. Radiotherapy; Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Wannenmacher, M. [Heidelberg Univ., Mannheim (Germany). Abt. fuer Klinische Radiologie; Debus, J. [Univ. Heidelberg (Germany). Abt. Radioonkologie und Strahlentherapie; Wenz, F. (eds.) [Universitaetsklinikum Mannheim (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2006-07-01

    The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy.

  7. Technical and functional considerations of the portable electron accelerator, mobetron, for intraoperative radiotherapy; Consideraciones tecnicas y funcionales del acelerador de electrones portatil, mobetron, para radioterapia intraoperatoria

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Cases, F. J.; Javier de Luis, F.; Herranz Gonzalez, M.; Canon Rodriguez, R.; Munoz Miguelanez, T.; Aakki, L.; Azinovic Gamo, I.; Brugarolas Masllorens, A.

    2013-07-01

    This work reveals the peculiarities which must be taken into account for the clinical use of this type of accelerators, regarding its operational stability and describe the problems that arise in the logistics work, both from the point of view of the physical dosimetry and radiation protection. (Author)

  8. Partial breast radiotherapy with simple teletherapy techniques

    Energy Technology Data Exchange (ETDEWEB)

    Fekete, Gábor; Újhidy, Dóra; Együd, Zsófia; Kiscsatári, Laura; Marosi, Gusztáv; Kahán, Zsuzsanna; Varga, Zoltán, E-mail: varga.zoltan@med.u-szeged.hu

    2015-01-01

    A prospective pilot study of partial breast irradiation (PBI) with conventional vs hypofractionated schedules was set out. The study aimed to determine efficacy, acute and late side effects, and the preference of photon vs electron irradiation based on individual features. Patients were enrolled according to internationally accepted guidelines on PBI. Conformal radiotherapy plans were generated with both photon and electron beams, and the preferred technique based on dose homogeneity and the radiation exposure of healthy tissues was applied. For electron dose verification, a special phantom was constructed. Patients were randomized for fractionation schedules of 25 × 2 vs 13 × 3 Gy. Skin and breast changes were registered at the time of and ≥1 year after the completion of radiotherapy. Dose homogeneity was better with photons. If the tumor bed was located in the inner quadrants, electron beam gave superior results regarding conformity and sparing of organ at risk (OAR). If the tumor was situated in the lateral quadrants, conformity was better with photons. A depth of the tumor bed ≥3.0 cm predicted the superiority of photon irradiation (odds ratio [OR] = 23.6, 95% CI: 5.2 to 107.5, p < 0.001) with >90% sensitivity and specificity. After a median follow-up of 39 months, among 72 irradiated cases, 1 local relapse out of the tumor bed was detected. Acute radiodermatitis of grade I to II, hyperpigmentation, and telangiectasia developed ≥1 year after radiotherapy, exclusively after electron beam radiotherapy. The choice of electrons or photons for PBI should be based on tumor bed location; the used methods are efficient and feasible.

  9. Partial breast radiotherapy with simple teletherapy techniques.

    Science.gov (United States)

    Fekete, Gábor; Újhidy, Dóra; Együd, Zsófia; Kiscsatári, Laura; Marosi, Gusztáv; Kahán, Zsuzsanna; Varga, Zoltán

    2015-01-01

    A prospective pilot study of partial breast irradiation (PBI) with conventional vs hypofractionated schedules was set out. The study aimed to determine efficacy, acute and late side effects, and the preference of photon vs electron irradiation based on individual features. Patients were enrolled according to internationally accepted guidelines on PBI. Conformal radiotherapy plans were generated with both photon and electron beams, and the preferred technique based on dose homogeneity and the radiation exposure of healthy tissues was applied. For electron dose verification, a special phantom was constructed. Patients were randomized for fractionation schedules of 25 × 2 vs 13 × 3Gy. Skin and breast changes were registered at the time of and ≥1 year after the completion of radiotherapy. Dose homogeneity was better with photons. If the tumor bed was located in the inner quadrants, electron beam gave superior results regarding conformity and sparing of organ at risk (OAR). If the tumor was situated in the lateral quadrants, conformity was better with photons. A depth of the tumor bed ≥3.0cm predicted the superiority of photon irradiation (odds ratio [OR] = 23.6, 95% CI: 5.2 to 107.5, p 90% sensitivity and specificity. After a median follow-up of 39 months, among 72 irradiated cases, 1 local relapse out of the tumor bed was detected. Acute radiodermatitis of grade I to II, hyperpigmentation, and telangiectasia developed ≥1 year after radiotherapy, exclusively after electron beam radiotherapy. The choice of electrons or photons for PBI should be based on tumor bed location; the used methods are efficient and feasible.

  10. A New Therapeutic Paradigm for Breast Cancer Exploiting Low Dose Estrogen-Induced Apoptosis

    Science.gov (United States)

    2014-08-01

    recurrence, disease-free survival, and overall survival.93 The START trial has assessed accelerated hypofractionated whole-breast irradiation and...does a dose of 50 Gy in a standard 5-week schedule. This fi nding supports hypofractionation as a safe and eff ective approach, but long-term...The START trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trail A of radiotherapy hypofractionation for treatment of early

  11. Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

    Energy Technology Data Exchange (ETDEWEB)

    Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Thompson, Reid F.; Chen Yu; Bernstein, Karen; Kabarriti, Rafi; Skinner, William [Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States); Chen, Chin C. [Department of Radiation Oncology, Columbia University Medical Center, New York, New York (United States); Landau, Evan; Miller, Ekeni; Spierer, Marnee; Hong, Linda; Kalnicki, Shalom [Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States)

    2012-11-15

    Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm{sub 3}) (n=97) and small-breasted patients (chest wall separation <25 cm and PTV <1500 cm{sub 3}) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable

  12. Determination of radiation levels by neutrons in an accelerator for radiotherapy; Determinacion de niveles de radiacion por neutrones en un acelerador para radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Paredes G, L.; Salazar B, M.A. [Instituto Nacional de Investigaciones Nucleares, Apdo. Postal 18-1027, 11801 Mexico D.F. (Mexico); Genis S, R. [Fundacion Clinica Medica Sur, Puente de Piedra 150, Col. Torriello Guerra, Tlalpan 14050, Mexico D.F. (Mexico)

    1998-12-31

    It was determined the radiation levels by neutrons due to photonuclear reactions ({gamma}, n) which occur in the target, levelling filter, collimators and the small pillow blinding of a medical accelerator Varian Clinac 2100C of 18 MeV, using thermoluminescent dosemeters UD-802AS and US-809AS. The experimental values were presented for the patient level, inside and outside of the radiation field, as well as for the small pillow. (Author)

  13. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. Results from the DAHANCA 18 phase II study

    DEFF Research Database (Denmark)

    Bentzen, Jens; Toustrup, Kasper; Eriksen, Jesper Grau

    2015-01-01

    with stage III or IV HNSCC of the larynx, oropharynx, hypopharynx, or oral cavity where included between January 2007 and December 2010. The prescribed radiotherapy (RT) dose was 66-68 Gy in 2 Gy fractions, 6 F/W. The hypoxic radiosensitiser nimorazole was given orally at a dose of 1200 mg/m(2) before each......, and 149 patients (66%) received the full dose of nimorazole. The five-year actuarial LRC, EFS and OS rates were 80%, 67% and 72%, respectively. The LRC rates according to site were: oropharynx: 88%, larynx: 77%, hypopharynx 72% and oral cavity 49%, respectively. HPV/p16 staining was obtained in 141...... of the 150 oropharyngeal cancers. Of these, 112 (79%) were p16 pos and 29 (21%) were p16 neg. LRC for the p16 neg oropharyngeal cancers was poorer than for the p16 pos (74% vs. 91%; p = 0.02). Tube feeding during treatment was necessary for 146 (64%) patients. At 12 months this number was reduced to 6...

  14. Exploiting Gene Expression Kinetics in Conventional Radiotherapy, Hyperfractionation, and Hypofractionation for Targeted Therapy.

    Science.gov (United States)

    Makinde, Adeola Y; Eke, Iris; Aryankalayil, Molykutty J; Ahmed, Mansoor M; Coleman, C Norman

    2016-10-01

    The dramatic changes in the technological delivery of radiation therapy, the repertoire of molecular targets for which pathway inhibitors are available, and the cellular and immunologic responses that can alter long-term clinical outcome provide a potentially unique role for using the radiation-inducible changes as therapeutic targets. Various mathematical models of dose and fractionation are extraordinarily useful in guiding treatment regimens. However, although the model may fit the clinical outcome, a deeper understanding of the molecular and cellular effect of the individual dose size and the adaptation to repeated exposure, called multifraction (MF) adaptation, may provide new therapeutic targets for use in combined modality treatments using radiochemotherapy and radioimmunotherapy. We discuss the potential of using different radiation doses and MF adaptation for targeting transcription factors, immune and inflammatory response, and cell "stemness." Given the complex genetic composition of tumors before treatment and their adaptation to drug treatment, innovative combinations using both the pretreatment molecular data and also the MF-adaptive response to radiation may provide an important role for focused radiation therapy as an integral part of precision medicine and immunotherapy.

  15. Normal tissue toxicity after small field hypofractionated stereotactic body radiation

    Directory of Open Access Journals (Sweden)

    Constine Louis S

    2008-10-01

    Full Text Available Abstract Stereotactic body radiation (SBRT is an emerging tool in radiation oncology in which the targeting accuracy is improved via the detection and processing of a three-dimensional coordinate system that is aligned to the target. With improved targeting accuracy, SBRT allows for the minimization of normal tissue volume exposed to high radiation dose as well as the escalation of fractional dose delivery. The goal of SBRT is to minimize toxicity while maximizing tumor control. This review will discuss the basic principles of SBRT, the radiobiology of hypofractionated radiation and the outcome from published clinical trials of SBRT, with a focus on late toxicity after SBRT. While clinical data has shown SBRT to be safe in most circumstances, more data is needed to refine the ideal dose-volume metrics.

  16. Normal tissue toxicity after small field hypofractionated stereotactic body radiation

    Science.gov (United States)

    Milano, Michael T; Constine, Louis S; Okunieff, Paul

    2008-01-01

    Stereotactic body radiation (SBRT) is an emerging tool in radiation oncology in which the targeting accuracy is improved via the detection and processing of a three-dimensional coordinate system that is aligned to the target. With improved targeting accuracy, SBRT allows for the minimization of normal tissue volume exposed to high radiation dose as well as the escalation of fractional dose delivery. The goal of SBRT is to minimize toxicity while maximizing tumor control. This review will discuss the basic principles of SBRT, the radiobiology of hypofractionated radiation and the outcome from published clinical trials of SBRT, with a focus on late toxicity after SBRT. While clinical data has shown SBRT to be safe in most circumstances, more data is needed to refine the ideal dose-volume metrics. PMID:18976463

  17. Adoption of Hypofractionated Radiation Therapy for Breast Cancer After Publication of Randomized Trials

    Energy Technology Data Exchange (ETDEWEB)

    Jagsi, Reshma, E-mail: rjagsi@med.umich.edu [Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan (United States); Falchook, Aaron D.; Hendrix, Laura H. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Curry, Heather [Radiation Oncology, Eviti, Inc, Philadelphia, Pennsylvania (United States); Chen, Ronald C. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States)

    2014-12-01

    Purpose: Large randomized trials have established the noninferiority of shorter courses of “hypofractionated” radiation therapy (RT) to the whole breast compared to conventional courses using smaller daily doses in the adjuvant treatment of selected breast cancer patients undergoing lumpectomy. Hypofractionation is more convenient and less costly. Therefore, we sought to determine uptake of hypofractionated breast RT over time. Methods and Materials: In the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database, we identified 16,096 women with node-negative breast cancer and 4269 with ductal carcinoma in situ (DCIS) who received lumpectomy followed by more than 12 fractions of RT between 2004 and 2010. Based on Medicare claims, we determined the number of RT treatments given and grouped patients into those receiving hypofractionation (13-24) or those receiving conventional fractionation (≥25). We also determined RT technique (intensity modulated RT or not) using Medicare claims. We evaluated patterns and correlates of hypofractionation receipt using bivariate and multivariable analyses. Results: Hypofractionation use was similar in patients with DCIS and those with invasive disease. Overall, the use of hypofractionation increased from 3.8% in 2006 to 5.4% in 2007, to 9.4% in 2008, and to 13.6% in 2009 and 2010. Multivariable analysis showed increased use of hypofractionation in recent years and in patients with older age, smaller tumors, increased comorbidity, higher regional education, and Western SEER regions. However, even in patients over the age of 80, the hypofractionation rate in 2009 to 2010 was only 25%. Use of intensity modulated RT (IMRT) also increased over time (from 9.4% in 2004 to 22.7% in 2009-2010) and did not vary significantly between patients receiving hypofractionation and those receiving traditional fractionation. Conclusions: Hypofractionation use increased among low-risk older US breast cancer patients with

  18. Biological and medical research with accelerated heavy ions at the Bevalac, 1974--1977. [Planning for use for radiotherapy and as radiation source for diagnostic radiography

    Energy Technology Data Exchange (ETDEWEB)

    Elam, S. (ed.)

    1977-04-01

    The Bevalac, a versatile high-energy heavy-ion accelerator complex, has been in operation for less than two years. A major purpose for which the Bevalac was constructed was to explore the possibility of heavy-ion teams for therapy for certain forms of cancer. Significant progress has been made in this direction. The National Cancer Institute has recognized the advantages that these and other accelerated particles offer, and heavy ions have been included in a long-term plan for particle therapy that will assess by means of controlled therapeutic tests the value of various modalities. Since accelerated heavy ions became available, the possibility of other contributions, not planned, became apparent. We are developig a new diagnostic method known as heavy-ion radiography that has greatly increased sensitivity for soft-tissue detail and that may become a powerful tool for localizing early tumors and metastases. We have discovered that radioactive beams are formed from fragmentation of stable deflected beams. Use of these autoradioactive beams is just beginning; however, we know that these beams will be helpful in localizing the region in the body where therapy is being delivered. In addition, it has been demonstrated that instant implantation of the radioactive beam allows direct measurements of blood perfusion rates in inaccessible parts of the body, and such a technique may become a new tool for the study of fast hot atom reactions in biochemistry, tracer biology and nuclear medicine. The Bevalac will also be useful for the continuation of previously developed methods for the control of acromegaly, Cushing's disease and, on a research basis, advanced diabetes mellitus with vascular disease. The ability to make small bloodless lesions in the brain and elsewhere with heavy-ion beams has great potential for nervous-system studies and perhaps later for radioneurosurgery.

  19. Commissioning and quality assurance of the X-ray volume Imaging system of an image-guided radiotherapy capable linear accelerator

    Science.gov (United States)

    Muralidhar, K. R.; Murthy, P. Narayana; Kumar, Rajneesh

    2008-01-01

    An Image-Guided Radiotherapy–capable linear accelerator (Elekta Synergy) was installed at our hospital, which is equipped with a kV x-ray volume imaging (XVI) system and electronic portal imaging device (iViewGT). The objective of this presentation is to describe the results of commissioning measurements carried out on the XVI facility to verify the manufacturer's specifications and also to evolve a QA schedule which can be used to test its performance routinely. The QA program consists of a series of tests (safety features, geometric accuracy, and image quality). These tests were found to be useful to assess the performance of the XVI system and also proved that XVI system is very suitable for image-guided high-precision radiation therapy. PMID:19893694

  20. Role of Principal Component Analysis in Predicting Toxicity in Prostate Cancer Patients Treated With Hypofractionated Intensity-Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Vesprini, Danny [Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Sia, Michael [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Lockwood, Gina [Department of Clinical Study Co-ordination and Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Moseley, Douglas; Rosewall, Tara; Bayley, Andrew; Bristow, Robert; Chung, Peter; Menard, Cynthia; Milosevic, Michael; Warde, Padraig [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Catton, Charles, E-mail: charles.catton@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2011-11-15

    Purpose: To determine if principal component analysis (PCA) and standard parameters of rectal and bladder wall dose-volume histograms (DVHs) of prostate cancer patients treated with hypofractionated image-guided intensity-modulated radiotherapy (hypo-IMRT) can predict acute and late gastrointestinal (GI) toxicity. Methods and Materials: One hundred twenty-one patients underwent hypo-IMRT at 3 Gy/fraction, 5 days/week to either 60 Gy or 66 Gy, with daily online image guidance. Acute and late GI and genitourinary (GU) toxicity were recorded weekly during treatment and at each follow-up. All Radiation Therapy Oncology Group (RTOG) criteria toxicity scores were dichotomized as <2 and {>=}2. Standard dosimetric parameters and the first five to six principal components (PCs) of bladder and rectal wall DVHs were tested for association with the dichotomized toxicity outcomes, using logistic regression. Results: Median follow-up of all patients was 47 months (60 Gy cohort= 52 months; 66 Gy cohort= 31 months). The incidence rates of {>=}2 acute GI and GU toxicity were 14% and 29%, respectively, with no Grade {>=}3 acute GU toxicity. Late GI and GU toxicity scores {>=}2 were 16% and 15%, respectively. There was a significant difference in late GI toxicity {>=}2 when comparing the 66 Gy to the 60 Gy cohort (38% vs. 8%, respectively, p = 0.0003). The first PC of the rectal DVH was associated with late GI toxicity (odds ratio [OR], 6.91; p < 0.001), though it was not significantly stronger than standard DVH parameters such as Dmax (OR, 6.9; p < 0.001) or percentage of the organ receiving a 50% dose (V50) (OR, 5.95; p = 0 .001). Conclusions: Hypofractionated treatment with 60 Gy in 3 Gy fractions is well tolerated. There is a steep dose response curve between 60 Gy and 66 Gy for RTOG Grade {>=}2 GI effects with the dose constraints employed. Although PCA can predict late GI toxicity for patients treated with hypo-IMRT for prostate cancer, it provides no additional information

  1. Big Data Analytics for Prostate Radiotherapy

    Science.gov (United States)

    Coates, James; Souhami, Luis; El Naqa, Issam

    2016-01-01

    Radiation therapy is a first-line treatment option for localized prostate cancer and radiation-induced normal tissue damage are often the main limiting factor for modern radiotherapy regimens. Conversely, under-dosing of target volumes in an attempt to spare adjacent healthy tissues limits the likelihood of achieving local, long-term control. Thus, the ability to generate personalized data-driven risk profiles for radiotherapy outcomes would provide valuable prognostic information to help guide both clinicians and patients alike. Big data applied to radiation oncology promises to deliver better understanding of outcomes by harvesting and integrating heterogeneous data types, including patient-specific clinical parameters, treatment-related dose–volume metrics, and biological risk factors. When taken together, such variables make up the basis for a multi-dimensional space (the “RadoncSpace”) in which the presented modeling techniques search in order to identify significant predictors. Herein, we review outcome modeling and big data-mining techniques for both tumor control and radiotherapy-induced normal tissue effects. We apply many of the presented modeling approaches onto a cohort of hypofractionated prostate cancer patients taking into account different data types and a large heterogeneous mix of physical and biological parameters. Cross-validation techniques are also reviewed for the refinement of the proposed framework architecture and checking individual model performance. We conclude by considering advanced modeling techniques that borrow concepts from big data analytics, such as machine learning and artificial intelligence, before discussing the potential future impact of systems radiobiology approaches. PMID:27379211

  2. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    Energy Technology Data Exchange (ETDEWEB)

    Geinitz, Hans [Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Dept. of Radiation Oncology; Linz Univ. (Austria). Medical Faculty; Roach, Mack III [California Univ., San Francisco, CA (United States). Dept. of Radiation Oncology; Van As, Nicholas (ed.) [The Institute of Cancer Research, Sutton Surrey (United Kingdom)

    2015-04-01

    Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

  3. Integrating a MRI scanner with a 6 MV radiotherapy accelerator: dose increase at tissue-air interfaces in a lateral magnetic field due to returning electrons

    Energy Technology Data Exchange (ETDEWEB)

    Raaijmakers, A J E; Raaymakers, B W; Lagendijk, J J W [Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht (Netherlands)

    2005-04-07

    In the framework of the development of the integration of a MRI-scanner with a linear accelerator, the influence of a lateral, magnetic field on the dose distribution has to be determined. Dose increase is expected at tissue-air boundaries, due to the electron return effect (ERE): electrons entering air will describe a circular path and return into the phantom causing extra dose deposition. Using IMRT with many beam directions, this exit dose will not constitute a problem. Dose levels behind air cavities will decrease because of the absence of electrons crossing the cavity. The ERE has been demonstrated both by simulation and experiment. Monte Carlo simulations are performed with GEANT4, irradiating a water-air-water phantom in a lateral magnetic field. Also an air tube in water has been simulated, resulting in slightly twisted regions of dose increase and decrease. Experimental demonstration is achieved by film measurement in a perspex-air-perspex phantom in an electromagnet. Although the ERE causes dose increase before air cavities, relatively flat dose profiles can be obtained for the investigated cases using opposite beam configurations. More research will be necessary whether this holds for more realistic geometries with the use of IMRT and whether the ERE can be turned to our advantage when treating small tumour sites at air cavities.

  4. Phase II Trial of Hypofractionated IMRT With Temozolomide for Patients With Newly Diagnosed Glioblastoma Multiforme

    Energy Technology Data Exchange (ETDEWEB)

    Reddy, Krishna [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Damek, Denise [Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado (United States); Gaspar, Laurie E. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Ney, Douglas [Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado (United States); Waziri, Allen; Lillehei, Kevin [Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado (United States); Stuhr, Kelly; Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Chen Changhu, E-mail: changhu.chen@ucdenver.edu [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States)

    2012-11-01

    Purpose: To report toxicity and overall survival (OS) in patients with newly diagnosed glioblastoma multiforme (GBM) treated with hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent and adjuvant temozolomide (TMZ). Methods and Materials: Patients with newly diagnosed GBM after biopsy or resection and with adequate performance status and organ or bone marrow function were eligible for this study. Patients received postoperative hypo-IMRT to the surgical cavity and residual tumor seen on T1-weighted brain MRI with a 5-mm margin to a total dose of 60 Gy in 10 fractions (6 Gy/fraction) and to the T2 abnormality on T2-weighted MRI with 5-mm margin to 30 Gy in 10 fractions (3 Gy/fraction). Concurrent TMZ was given at 75 mg/m{sup 2}/day for 28 consecutive days. Adjuvant TMZ was given at 150 to 200 mg/m{sup 2}/day for 5 days every 28 days. Toxicities were defined using Common Terminology Criteria for Adverse Events version 3.0. Results: Twenty-four patients were treated, consisting of 14 men, 10 women; a median age of 60.5 years old (range, 27-77 years); and a median Karnofsky performance score of 80 (range, 60-90). All patients received hypo-IMRT and concurrent TMZ according to protocol, except for 2 patients who received only 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 6.5 (range, 0-14).With a median follow-up of 14.8 months (range, 2.7-34.2 months) for all patients and a minimum follow-up of 20.6 months for living patients, no instances of grade 3 or higher nonhematologic toxicity were observed. The median OS was 16.6 months (range, 4.1-35.9 months). Six patients underwent repeated surgery for suspected tumor recurrence; necrosis was found in 50% to 100% of the resected specimens. Conclusion: In selected GBM patients, 60 Gy hypo-IMRT delivered in 6-Gy fractions over 2 weeks with concurrent and adjuvant TMZ is safe. OS in this small cohort of patients was comparable to that treated with current standard of care

  5. Postmastectomy radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shikama, Naoto; Koguchi, Masahiko; Sasaki, Shigeru; Kaneko, Tomoki; Shinoda, Atsunori; Nishikawa, Atsushi [Shinshu Univ., Matsumoto, Nagano (Japan). School of Medicine

    2000-10-01

    Since there have been few reports on postmastectomy radiotherapy having a high evidence level in Japan, the significance of postoperative radiotherapy and the irradiation techniques were reviewed based on reports from Western countries. Authors focused on the indications for postoperative irradiation, irradiation methods (irradiation sites, irradiation techniques; prosthetics, methods of irradiating the chest wall and lymph nodes, timing of irradiation), and complications, and discuss them. The factors thought to be adaptable to postmastectomy radiotherapy have been listed. Axillary lymph node metastasis and the size of the primary focus are thought to be important factors in locoregional recurrence. The chest wall and the supraclavicular lymph nodes are the usual sites of irradiation after mastectomy. The irradiation method consists of tangential irradiation of the chest wall and single-field irradiation of the supraclavicular lymph nodes, with 46-50 Gy in fractional doses of 1.8-2 Gy x 5/w is administered for 4.5-5.5 weeks. The timing of irradiation in the West is generally after chemotherapy. Adverse radiation effects include ischemic heart disease, pneumonitis, arm edema, rib fractures, and brachial plexus paralysis. The frequency of these complications is increased by the combined use of chemotherapy or surgery. The breast cancer cure rate in Japan is generally better than in the West. It remains to be determined whether the clinical data from Europe and America are applicable to the treatment of breast cancer in Japan. To address this issue, a clinical investigation should be performed in Japan with close cooperation between surgeons, physicians, pathologists, and radiotherapists. (K.H.)

  6. Radiotherapy of prostate cancer; Strahlentherapie des Prostatakarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Krause, S.; Herfarth, K. [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany)

    2011-11-15

    With the development of modern radiation techniques, such as intensity-modulated radiotherapy (IMRT), a dose escalation in the definitive radiotherapy of prostate cancer and a consecutive improvement in biochemical recurrence-free survival (BFS) could be achieved. Among others, investigators at the Memorial Sloan-Kettering Cancer Center (MSKCC) saw 5-year BFS rates of up to 98%. A further gain in effectiveness and safety is expected of hypofractionation schedules, as suggested by data published by Kupelian et al., who saw a low 5-year rate of grade {>=}2 rectal side-effects of 4.5%. However, randomized studies are just beginning to mature. Patients with intermediate or high-risk tumors should receive neoadjuvant (NHT) and adjuvant (AHT) androgen deprivation. Bolla et al. could show an increase in 5-year overall survival from 62-78%. The inclusion of the whole pelvis in the treatment field (WPRT) is still controversial. The RTOG 94-13 study showed a significant advantage in disease-free survival after 60 months but long-term data did not yield significant differences between WPRT and irradiation of the prostate alone. The German Society of Urology strongly recommends adjuvant radiotherapy of the prostate bed for pT3 N0 tumors with positive margins. In a pT3 N0 R0 or pT2 N0 R+ situation, adjuvant radiotherapy should at least be considered. So far, no randomized data on NHT and AHT have been published, so androgen deprivation remains an individual decision in the postoperative setting. In a retrospective analysis Spiotto et al. reported a positive effect for adjuvant WPRT and biochemical control. This article summarizes the essential publications on definitive and adjuvant radiotherapy and discusses the additional use of androgen deprivation and WPRT. (orig.) [German] Die Entwicklung der intensitaetsmodulierten Radiotherapie (IMRT) ermoeglichte in den letzten Jahren eine Dosiseskalation bei der primaeren Radiotherapie des Prostatakarzinoms und damit eine Verbesserung

  7. Dosimetry for electron Intra-Operative RadioTherapy: Comparison of output factors obtained through alanine/EPR pellets, ionization chamber and Monte Carlo-GEANT4 simulations for IORT mobile dedicate accelerator

    Science.gov (United States)

    Marrale, Maurizio; Longo, Anna; Russo, Giorgio; Casarino, Carlo; Candiano, Giuliana; Gallo, Salvatore; Carlino, Antonio; Brai, Maria

    2015-09-01

    In this work a comparison between the response of alanine and Markus ionization chamber was carried out for measurements of the output factors (OF) of electron beams produced by a linear accelerator used for Intra-Operative Radiation Therapy (IORT). Output factors (OF) for conventional high-energy electron beams are normally measured using ionization chamber according to international dosimetry protocols. However, the electron beams used in IORT have characteristics of dose per pulse, energy spectrum and angular distribution quite different from beams usually used in external radiotherapy, so the direct application of international dosimetry protocols may introduce additional uncertainties in dosimetric determinations. The high dose per pulse could lead to an inaccuracy in dose measurements with ionization chamber, due to overestimation of ks recombination factor. Furthermore, the electron fields obtained with IORT-dedicated applicators have a wider energy spectrum and a wider angular distribution than the conventional fields, due to the presence of electrons scattered by the applicator's wall. For this reason, a dosimetry system should be characterized by a minimum dependence from the beam energy and from angle of incidence of electrons. This become particularly critical for small and bevelled applicators. All of these reasons lead to investigate the use of detectors different from the ionization chamber for measuring the OFs. Furthermore, the complete characterization of the radiation field could be accomplished also by the use of Monte Carlo simulations which allows to obtain detailed information on dose distributions. In this work we compare the output factors obtained by means of alanine dosimeters and Markus ionization chamber. The comparison is completed by the Monte Carlo calculations of OFs determined through the use of the Geant4 application "iort _ therapy" . The results are characterized by a good agreement of response of alanine pellets and Markus

  8. Simplified geometric model for the calculation of neutron yield in an accelerator of 18 MV for radiotherapy; Modelo geometrico simplificado para el calculo del rendimiento de neutrones en un acelerador de 18 MV para radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Paredes G, L.C.; Balcazar G, M. [ININ, 52750 La Marquesa, Estado de Mexico (Mexico); Francois L, J.L. [FI-UNAM, 04510 Mexico D.F. (Mexico); Azorin N, J. [UAM-I, 09340 Mexico D.F. (Mexico)

    2008-07-01

    The results of the neutrons yield in different components of the bolster of an accelerator Varian Clinac 2100C of 18 MV for radiotherapy are presented, which contribute to the radiation of flight of neutrons in the patient and bolster planes. For the calculation of the neutrons yield, a simplified geometric model of spherical cell for the armor-plating of the bolster with Pb and W was used. Its were considered different materials for the Bremsstrahlung production and of neutrons produced through the photonuclear reactions and of electro disintegration, in function of the initial energy of the electron. The theoretical result of the total yield of neutrons is of 1.17x10{sup -3} n/e, considering to the choke in position of closed, in the patient plane with a distance source-surface of 100 cm; of which 15.73% corresponds to the target, 58.72% to the primary collimator, 4.53% to the levelled filter of Fe, 4.87% to the levelled filter of Ta and 16.15% to the closed choke. For an initial energy of the electrons of 18 MeV, a half energy of the neutrons of 2 MeV was obtained. The calculated values for radiation of experimental neutrons flight are inferior to the maxima limit specified in the NCRP-102 and IEC-60601-201.Ed.2.0 reports. The absorbed dose of neutrons determined through the measurements with TLD dosemeters in the isocenter to 100 cm of the target when the choke is closed one, is approximately 3 times greater that the calculated for armor-plating of W and 1.9 times greater than an armor-plating of Pb. (Author)

  9. The radiosurgery fractionation quandary: single fraction or hypofractionation?

    Science.gov (United States)

    Kirkpatrick, John P; Soltys, Scott G; Lo, Simon S; Beal, Kathryn; Shrieve, Dennis C; Brown, Paul D

    2017-04-01

    Stereotactic radiosurgery (SRS), typically administered in a single session, is widely employed to safely, efficiently, and effectively treat small intracranial lesions. However, for large lesions or those in close proximity to critical structures, it can be difficult to obtain an acceptable balance of tumor control while avoiding damage to normal tissue when single-fraction SRS is utilized. Treating a lesion in 2 to 5 fractions of SRS (termed "hypofractionated SRS" [HF-SRS]) potentially provides the ability to treat a lesion with a total dose of radiation that provides both adequate tumor control and acceptable toxicity. Indeed, studies of HF-SRS in large brain metastases, vestibular schwannomas, meningiomas, and gliomas suggest that a superior balance of tumor control and toxicity is observed compared with single-fraction SRS. Nonetheless, a great deal of effort remains to understand radiobiologic mechanisms for HF-SRS driving the dose-volume response relationship for tumors and normal tissues and to utilize this fundamental knowledge and the results of clinic studies to optimize HF-SRS. In particular, the application of HF-SRS in the setting of immunomodulatory cancer therapies offers special challenges and opportunities.

  10. MO-G-BRF-06: Radiotherapy and Prompt Oxygen Dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Kissick, M; Campos, D; Adamson, E; Niles, D; Torres, A; L, Che Fru; Kimple, R; Fain, S; Kogel, A van der [University of Wisconsin - Madison, Madison, WI (United States); Jacques, S [Oregon Health ' Science University, Portland, OR (United States)

    2014-06-15

    Purpose: Adaptive radiotherapy requires a knowledge of the changing local tumor oxygen concentrations for times on the order of the treatment time, a time scale far shorter than cell death and proliferation. This knowledge will be needed to guide hypofractionated radiotherapy. Methods: A diffuse optical probe system was developed to spatially average over the whole interior of athymic Sprague Dawley nude mouse xenografts of human head and neck cancers. The blood volume and hemoglobin saturation was measured in real time. The quantities were measured with spectral fitting before and after 10 Gy of radiation is applied. An MRI BOLD scan is acquired before and after 10 Gy that measures regional changes in R2* which is inversely proportional to oxygen availability. Simulations were performed to fit the blood oxygen dynamics and infer changes in hypoxia within the tumor. Results: The optical probe measured nearly constant blood volume and a significant drop in hemoglobin saturation of about 30% after 10 Gy over the time scale of less than 30 minutes. The averaged R2* within the tumor volume increased by 15% after the 10 Gy dose, which is consistent with the optical results. The simulations and experiments support likely dynamic metabolic changes and/or fast vasoconstrictive signals are occurring that change the oxygen concentrations significantly, but not cell death or proliferation. Conclusion: Significant oxygen changes were observed to occur within 30 minutes, coinciding with the treatment time scale. This dynamic is very important for patient specific adaptive therapy. For hypofractionated therapy, the local instantaneous oxygen content is likely the most important variable to control. The invention of a bedside device for the purpose of measuring the instantaneous response to large radiation doses would be an important step to future improvements in outcome.

  11. Four and five dimensional radiotherapy with reference to prostate cancer - definitions, state of the art and further directions - an overview

    Energy Technology Data Exchange (ETDEWEB)

    Lennernaes, Bo (Dept. of Oncology, Sahlgrenska Hospital and Academy, Univ. of Gothenburg, Gothenburg (Sweden)), e-mail: bo.lennernas@telia.com; Castellanos, Enrique; Nilsson, Sten; Levitt, Seymour (Dept. of Oncology/Pathology, Karolinska Univ. Hospital and Institutet, Stockholm (Sweden))

    2011-06-15

    Radiotherapy (RT) always requires a compromise between tumor control and normal tissue side-effects. Technical innovation in radiation therapy (RT), such as three dimensional RT, is now established. Concerning prostate cancer (PC), it is reasonable to assume that RT of PC will increase in the future. The combination of small margins, a movable target (prostate), few fractions and high doses will probably demand dynamically positioning systems and in real time. This is called four dimensional radiotherapy (4DRT). Moreover, biological factors must be included in new treatments such as hypofractionation schedules. This new era is called five dimensional radiotherapy, 5DRT. In this paper we discuss new concepts in RT in respect to PC

  12. IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies : A Case Series

    Directory of Open Access Journals (Sweden)

    Sana D Karam

    2014-10-01

    Full Text Available Patients with high risk salivary gland malignancies are at increased risk of local failure. We present our institutional experience with dose escalation using hypofractionated Stereotactic Body Radiotherapy (SBRT in a subset of this rare disease. Over the course of 9 years, 10 patients presenting with skull base invasion, gross disease with one or more adverse features, or those treated with adjuvant radiation with three or more pathologic features were treated with intensity modulated radiation therapy followed by hypofractionated SBRT boost. Patients presented with variable tumor histologies, and in all but one, the tumors were classified as poorly differentiated high grade. Four patients had gross disease, 3 had gross residual disease, 3 had skull base invasion, and 2 patients had rapidly recurrent disease (≤ 6 months that had been previously treated with surgical resection. The median Stereotactic Radiosurgery boost dose was 17.5 Gy (range 10-30 Gy given in a median of 5 fractions (range 3-6 fractions for a total median cumulative dose of 81.2 Gy (range 73.2-95.6 Gy. The majority of the patients received platinum based concurrent chemotherapy with their radiation. At a median follow-up of 32 months (range 12-120 for all patients and 43 months for surviving patients (range 12-120, actuarial 3-year locoregional control, distant control, progression free survival, and overall survival were 88%, 81%, 68%, and 79%, respectively. Only one patient failed locally and two failed distantly. Serious late toxicity included graft ulceration in 1 patient and osteoradionecrosis in another patient, both of which underwent surgical reconstruction. Six patients developed fibrosis. In a subset of patients with salivary gland malignancies with skull base invasion, gross disease, or those treated adjuvantly with three or more adverse pathologic features, hypofractionated SBRT boost to Intensity Modulated Radiotherapy yields good local control rates and

  13. DEGRO practical guidelines: radiotherapy of breast cancer II. Radiotherapy of non-invasive neoplasia of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Souchon, R. [University Hospital Tuebingen, Klinik fuer Radioonkologie, Tuebingen (Germany); Sautter-Bihl, M.L. [Municipal Hospital Karlsruhe, Karlsruhe (Germany); Sedlmayer, F. [LKH Salzburg, Paracelsus Medical University Hospital, Salzburg (Austria); Budach, W. [University Hospital Duesseldorf, Duesseldorf (Germany); Dunst, J. [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Fietkau, R.; Sauer, R. [University Hospital Erlangen, Erlangen (Germany); Harms, W. [St. Clara Hospital, Basel (Switzerland); Wenz, F. [University Hospital Mannheim, Mannheim (Germany); Haase, W.

    2014-01-15

    . Randomized clinical trials and a huge number of mostly observational studies have unanimously demonstrated that RT significantly reduces recurrence risks of ipsilateral DCIS as well as invasive breast cancer independent of patient age in all subgroups. The recommended total dose is 50 Gy administered as whole breast irradiation (WBI) in single fractions of 1.8 or 2.0 Gy given on 5 days weekly. Retrospective data indicate a possible beneficial effect of an additional tumor bed boost for younger patients. Prospective clinical trials of different dose-volume concepts (hypofractionation, accelerated partial breast irradiation, boost radiotherapy) are still ongoing. Postoperative radiotherapy permits breast conservation for the majority of women by halving local recurrence as well as reducing progression rates into invasive cancer. New data confirmed this effect in all patient subsets - even in low risk subgroups (LoE 1a). (orig.) [German] Aktualisierung und Ergaenzung der 2007 von der DEGRO-Expertengruppe Mammakarzinom publizierten Leitlinie zur Radiotherapie (RT) des Mammakarzinoms. Aufgrund der zunehmenden klinischen Relevanz nicht-invasiver epithelialer Neoplasien der Brust wurde diesen in der aktuellen Version ein eigenes Kapitel gewidmet. Schwerpunkte der hier vorgelegten Empfehlungen sind - in Ergaenzung zu den S3-Leitlinien der Deutschen Krebsgesellschaft von 2012 - die Indikation und Technik der postoperativen RT nach brusterhaltender Operation. Die DEGRO-Expertengruppe fuehrte eine Literaturrecherche aktueller klinisch kontrollierter Studien, systematischer Reviews und Metaanalysen, orientiert an den Kriterien der evidenzbasierten Medizin, im Hinblick auf neue Aspekte gegenueber 2005 und 2007 durch. Die Recherche umfasst die Zeitspanne 2008 bis September 2012 und erstreckte sich auf in PubMed und Guidelines International Network (G-I-N) gelisteten Publikationen. Suchbegriffe waren ''non invasive breast cancer'', ''ductal carcinoma in situ

  14. Radiotherapy and "new" drugs-new side effects?

    Directory of Open Access Journals (Sweden)

    Niyazi Maximilian

    2011-12-01

    Full Text Available Abstract Background and purpose Targeted drugs have augmented the cancer treatment armamentarium. Based on the molecular specificity, it was initially believed that these drugs had significantly less side effects. However, currently it is accepted that all of these agents have their specific side effects. Based on the given multimodal approach, special emphasis has to be placed on putative interactions of conventional cytostatic drugs, targeted agents and other modalities. The interaction of targeted drugs with radiation harbours special risks, since the awareness for interactions and even synergistic toxicities is lacking. At present, only limited is data available regarding combinations of targeted drugs and radiotherapy. This review gives an overview on the current knowledge on such combined treatments. Materials and methods Using the following MESH headings and combinations of these terms pubmed database was searched: Radiotherapy AND cetuximab/trastuzumab/panitumumab/nimotuzumab, bevacizumab, sunitinib/sorafenib/lapatinib/gefitinib/erlotinib/sirolimus, thalidomide/lenalidomide as well as erythropoietin. For citation crosscheck the ISI web of science database was used employing the same search terms. Results Several classes of targeted substances may be distinguished: Small molecules including kinase inhibitors and specific inhibitors, antibodies, and anti-angiogenic agents. Combination of these agents with radiotherapy may lead to specific toxicities or negatively influence the efficacy of RT. Though there is only little information on the interaction of molecular targeted radiation and radiotherapy in clinical settings, several critical incidents are reported. Conclusions The addition of molecular targeted drugs to conventional radiotherapy outside of approved regimens or clinical trials warrants a careful consideration especially when used in conjunction in hypo-fractionated regimens. Clinical trials are urgently needed in order to

  15. Biological dose representation for carbon-ion radiotherapy of unconventional fractionation

    Science.gov (United States)

    Kanematsu, Nobuyuki; Inaniwa, Taku

    2017-02-01

    In carbon-ion radiotherapy, single-beam delivery each day in alternate directions has been common practice for efficient operation, taking advantage of the Bragg peak and the relative biological effectiveness (RBE) for uniform dose conformation to a tumor. Treatments are usually fractionated and treatment plans are evaluated with the total RBE-weighted dose; however, this is of limited relevance to the biological effect. In this study, we reformulate the biologically effective dose (BED) to normalize the dose-fractionation and cell-repopulation effects as well as the RBE of treating radiation, based on inactivation of a reference cell line by a reference carbon-ion radiation. The BED distribution virtually represents the biological effect of a treatment regardless of radiation modality or fractionation scheme. We applied the BED formulation to simplistic model treatments and to a preclinical survey for hypofractionation based on an actual prostate cancer treatment with carbon ions. The proposed formulation was demonstrated to be practical and to give theoretical implications. For a prostate cancer treatment in 12 fractions, the distributions of BED and of RBE-weighted dose were very similar. With hypofractionation, while the RBE-weighted dose distribution varied significantly, the BED distribution was nearly invariant, implying that carbon-ion radiotherapy would be effectively insensitive to fractionation. However, treatment evaluation with such a simplistic biological dose is intrinsically limited and must be complemented in practice by clinical experience and biological experiments.

  16. Technical Note: Introduction of variance component analysis to setup error analysis in radiotherapy.

    Science.gov (United States)

    Matsuo, Yukinori; Nakamura, Mitsuhiro; Mizowaki, Takashi; Hiraoka, Masahiro

    2016-09-01

    The purpose of this technical note is to introduce variance component analysis to the estimation of systematic and random components in setup error of radiotherapy. Balanced data according to the one-factor random effect model were assumed. Analysis-of-variance (anova)-based computation was applied to estimate the values and their confidence intervals (CIs) for systematic and random errors and the population mean of setup errors. The conventional method overestimates systematic error, especially in hypofractionated settings. The CI for systematic error becomes much wider than that for random error. The anova-based estimation can be extended to a multifactor model considering multiple causes of setup errors (e.g., interpatient, interfraction, and intrafraction). Variance component analysis may lead to novel applications to setup error analysis in radiotherapy.

  17. The Role of Hypofractionated Radiation Therapy with Photons, Protons and Heavy Ions for Treating Extracranial Lesions

    Directory of Open Access Journals (Sweden)

    Aaron Michael Laine

    2016-01-01

    Full Text Available Traditionally, the ability to deliver large doses of ionizing radiation to a tumor has been limited by radiation induced toxicity to normal surrounding tissues. This was the initial impetus for the development of conventionally fractionated radiation therapy, where large volumes of healthy tissue received radiation and were allowed the time to repair the radiation damage. However, advances in radiation delivery techniques and image guidance have allowed for more ablative doses of radiation to be delivered in a very accurate, conformal and safe manner with shortened fractionation schemes. Hypofractionated regimens with photons have already transformed how certain tumor types are treated with radiation therapy. Additionally, hypofractionation is able to deliver a complete course of ablative radiation therapy over a shorter period of time compared to conventional fractionation regimens making treatment more convenient to the patient and potentially more cost-effective. Recently there has been an increased interest in proton therapy because of the potential further improvement in dose distributions achievable due to their unique physical characteristics. Furthermore, with heavier ions the dose conformality is increased and in addition there is potentially a higher biological effectiveness compared to protons and photons. Due to the properties mentioned above, charged particle therapy has already become an attractive modality to further investigate the role of hypofractionation in the treatment of various tumors. This review will discuss the rationale and evolution of hypofractionated radiation therapy, the reported clinical success with initially photon and then charged particle modalities, and further potential implementation into treatment regimens going forward.

  18. Hypofractionated IMRT of the Prostate Bed After Radical Prostatectomy: Acute Toxicity in the PRIAMOS-1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Katayama, Sonja, E-mail: sonja.katayama@med.uni-heidelberg.de [Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg (Germany); Striecker, Thorbjoern; Kessel, Kerstin [Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg (Germany); Sterzing, Florian [Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg (Germany); Department of Radiation Oncology, German Cancer Research Center, Im Neuenheimer Feld, Heidelberg (Germany); Habl, Gregor [Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg (Germany); Edler, Lutz [Department of Biostatistics, German Cancer Research Center, Im Neuenheimer Feld, Heidelberg (Germany); Debus, Juergen [Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg (Germany); Department of Radiation Oncology, German Cancer Research Center, Im Neuenheimer Feld, Heidelberg (Germany); Herfarth, Klaus [Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg (Germany)

    2014-11-15

    Purpose: Hypofractionated radiation therapy as primary treatment for prostate cancer is currently being investigated in large phase 3 trials. However, there are few data on postoperative hypofractionation. The Radiation therapy for the Prostate Bed With or Without the Pelvic Lymph Nodes (PRIAMOS 1) trial was initiated as a prospective phase 2 trial to assess treatment safety and toxicity of a hypofractionated intensity modulated radiation therapy (IMRT) of the prostate bed. Methods and Materials: From February to September 2012, 40 patients with indications for adjuvant or salvage radiation therapy were enrolled. One patient dropped out before treatment. Patients received 54 Gy in 18 fractions to the prostate bed with IMRT and daily image guidance. Gastrointestinal (GI) and genitourinary (GU) toxicities (according to National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0) were recorded weekly during treatment and 10 weeks after radiation therapy. Results: Overall acute toxicity was favorable, with no recorded adverse events grade ≥3. Acute GI toxicity rates were 56.4% (grade 1) and 17.9% (grade 2). Acute GU toxicity was recorded in 35.9% of patients (maximum grade 1). Urinary stress incontinence was not influenced by radiation therapy. The incidence of grade 1 urinary urge incontinence increased from 2.6% before to 23.1% 10 weeks after therapy, but grade 2 urge incontinence remained unchanged. Conclusions: Postoperative hypofractionated IMRT of the prostate bed is tolerated well, with no severe acute side effects.

  19. Comparison of dose distribution between hypofractionated IMRT and SRT plans in lung tumor%IMRT和SRT大分割治疗肺部肿瘤的剂量分布研究

    Institute of Scientific and Technical Information of China (English)

    吴凤; 肖建平; 张可; 姜雪松; 宋一昕; 张红志; 李晔雄

    2009-01-01

    Objective To compare the characteristics of dose distribution between hypofractionated intensity modulated radiotherapy (IMRT) and hypofractionated stereotactic radiotherapy (SRT) plans in lung tumor and to select an optimal clinical approach. Methods SRT plans were designed for 16 patients with lung tumors who had received IMRT between April 2007 and April 2008. The dose distribution of target volume and normal tissues, conformal index (CI) and heteregenous index (HI) were analyzed using the dose-volume histogram (DVH) for the IMRT and SRT plans. Results The mean dose and equivalent uni-form dose of planning target volume (PTV) in IMRT were similar to those in SRT. SRT had significantly better CI and HI than IMRT (t = 2.77, P 0.05 ). The lung V20 of IMRT and SRT was 6.9% ± 2.1% and 4.2%± 1.9%, respectively ( t = 3.30, P 0.05),均一化剂量分别为6366.7 cGy和6246.8 cGy(t=-1.18,P>0.05),CI平均值分别为0.78和0.57(t=2.77,P0.05),全肺V20分别为6.9%±2.1%和4.2%±1.9%(t=3.30,P<0.01).IMRT和SRT计划的心脏和脊髓平均受照剂量无差别.结论 PTV最大径<4.7 cm、靶体积<57 cm3、靶区呈圆形或类圆形时,SRT靶区剂量与大分割IMRT接近并可满足临床要求;SRT计划正常肺组织受照剂量低于大分割IMRT计划.

  20. Radiotherapy for breast cancer and pacemaker; Radiotherapie pour un cancer du sein et stimulateur cardiaque

    Energy Technology Data Exchange (ETDEWEB)

    Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M. [Oncologie-radiotherapie, institut Curie, 26, rue d' Ulm, 75005 Paris (France); Kirov, K.M.; Esteve, M. [Departement d' anesthesie-reanimation-douleur, institut Curie, 75005 Paris (France)

    2011-06-15

    Purpose. - Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic Irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. Patients and methods. - From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. Results. - Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. Conclusion. - The multidisciplinary work with position change of the pacemaker

  1. Tratamento hipofracionado de radioterapia em felinos portadores de carcinoma epidermóide facial Hypofractionated radiation therapy for the treatment of feline facial squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    S.C.S. Cunha

    2010-10-01

    Full Text Available Avaliou-se a eficácia do protocolo radioterápico hipofracionado no tratamento de felinos portadores de carcinoma epidermóide facial. Um protocolo hipofracionado de radioterapia foi aplicado em cinco gatos portadores de um ou mais carcinomas epidermóides faciais, em um total de 10 lesões neoplásicas, confirmadas por meio de análise histológica. Duas lesões foram classificadas como T1, quatro como T2, duas como T3 e duas como T4. Os animais foram submetidos a quatro frações radioterápicas de 7,6 a 10gy, com intervalo de uma semana entre elas, utilizando-se um acelerador linear com feixe de elétrons. O acompanhamento dos animais foi realizado semanalmente durante o tratamento e aos 30 e 60 dias após o término da radioterapia. Neste estudo, 40% das lesões resultaram em remissão completa, 40% em remissão parcial e 20% não apresentaram resposta ao tratamento. A taxa de resposta encontrada nessa pesquisa foi baixa, porém o protocolo de hipofracionamento radioterápico foi seguro para gatos com carcinoma epidermóide facial e resultou em efeitos colaterais leves/moderadosThe efficacy of hypofractionated radiation protocol for feline facial squamous cell carcinoma was evaluated. Hypofractionated radiation therapy was applied to five cats showing single or multiple facial squamous cell carcinomas, in a total of ten histologically confirmed neoplastic lesions. Of the lesions, two were staged as T1, four as T2, two as T3, and two as T4. The animals were submitted to four radiation fractions from 7.6 to 10 grays each, with one week intervals. The equipment was a linear accelerator with electrons beam. The cats were evaluated weekly during the treatment and 30 and 60 days after the end of the radiation therapy. In this study, 40% of the lesions had complete remission, 40% partial remission, and 20% did not respond to the treatment. Response rates were lower as compared to other protocols previously used. However, hypofractionated radiation

  2. Stereotactic multiple are radiotherapy. IV--Haemangioblastoma.

    Science.gov (United States)

    Chakraborti, P R; Chakrabarti, K B; Doughty, D; Plowman, P N

    1997-04-01

    Our initial experience in the treatment of haemangioblastoma using conventional external beam radiotherapy and stereotactic radiotherapy (radiosurgery), by the linear accelerator method, is reported. Six haemangioblastomas in five patients were treated with a mean follow-up of 40 months (range 14-60). Five haemangioblastomas in four patients were treated with stereotactic radiotherapy, where four showed complete radiological response and the fifth was static. Neurological symptoms and signs improved in those patients. The sixth haemangioblastoma was situated close to the pituitary and optic chiasm, and was treated with conventionally fractionated external beam radiotherapy. The lesion showed partial response. No complications were noted in this patient group. This series complements and extends the relatively sparse published literature demonstrating that radiotherapy is an effective option for treating haemangioblastomas. Radiosurgery often lends itself particularly well to these discrete lesions allowing highly focused treatment. For patients with multiple and metachronous cerebellar haemangioblastomas as part of the von Hipple-Lindau syndrome, the data support a policy of conventionally fractionated external beam radiotherapy to the whole cerebellum of 50-55 Gy followed, after a period of time, by radiosurgery to persisting lesions (patients 3 and 4).

  3. Radiotherapy for Hodgkin lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Specht, Lena [Rigshospitalet Copenhagen Univ. (Denmark). Depts. of Oncology and Haematology; Yahalom, Joachim (eds.) [Memorial Sloan-Kettering Cancer, New York, NY (United States). Dept. of Radiation Oncology

    2011-07-01

    This book deals in detail with all aspects of the best practice in modern radiotherapy for Hodgkin lymphoma. It provides the background and rationale for the inclusion of radiotherapy in today's combined-modality approach, including special clinical situations such as Hodgkin lymphoma in children, in the pregnant patient, and in the elderly. Radiotherapy planning using state-of-the-art imaging, target definition, planning software, and treatment equipment is expounded in detail. Acute and long-term side effects of radiotherapy are analyzed, and the implications for modern radiotherapy approaches in Hodgkin lymphomas are explained. (orig.)

  4. Extracranial stereotactic radiotherapy: evaluation of PTV coverage and dose conformity.

    Science.gov (United States)

    Hädinger, Ulrich; Thiele, Wibke; Wulf, Jörn

    2002-01-01

    During the past few years the concept of cranial stereotactic radiotherapy has been successfully extended to extracranial tumoral targets. In our department, hypofractionated treatment of tumours in lung, liver, abdomen, and pelvis is performed in the Stereotactic Body Frame (ELEKTA Instrument AB) since 1997. We present the evaluation of 63 consecutively treated targets (22 lung, 21 liver, 20 abdomen/pelvis) in 58 patients with respect to dose coverage of the planning target volume (PTV) as well as conformity of the dose distribution. The mean PTV coverage was found to be 96.3% +/- 2.3% (lung), 95.0% +/- 4.5% (liver), and 92.1% +/- 5.2% (abdomen/pelvis). For the so-called conformation number we obtained values of 0.73 +/- 0.09 (lung), 0.77 +/- 0.10 (liver), and 0.70 +/- 0.08 (abdomen/pelvis). The results show that highly conformal treatment techniques can be applied also in extracranial stereotactic radiotherapy. This is primarily due to the relatively simple geometrical shape of most of the targets. Especially lung and liver targets turned out to be approximately spherically/cylindrically shaped, so that the dose distribution can be easily tailored by rotational fields.

  5. Stereotactic Radiotherapy for Adrenal Gland Metastases: University of Florence Experience

    Energy Technology Data Exchange (ETDEWEB)

    Casamassima, Franco, E-mail: f.casamassima@dfc.unifi.it [Clinical Radiobiological Institute, University of Florence, Florence (Italy); Livi, Lorenzo [Department of Radiation-Oncology, University of Florence, Florence (Italy); Masciullo, Stefano; Menichelli, Claudia; Masi, Laura [Clinical Radiobiological Institute, University of Florence, Florence (Italy); Meattini, Icro [Department of Radiation-Oncology, University of Florence, Florence (Italy); Bonucci, Ivano [Clinical Radiobiological Institute, University of Florence, Florence (Italy); Agresti, Benedetta; Simontacchi, Gabriele [Department of Radiation-Oncology, University of Florence, Florence (Italy); Doro, Raffaela [Clinical Radiobiological Institute, University of Florence, Florence (Italy)

    2012-02-01

    Purpose: To evaluate a retrospective single-institution outcome after hypofractionated stereotactic body radiotherapy (SBRT) for adrenal metastases. Methods and Materials: Between February 2002 and December 2009, we treated 48 patients with SBRT for adrenal metastases. The median age of the patient population was 62.7 years (range, 43-77 years). In the majority of patients, the prescription dose was 36 Gy in 3 fractions (70% isodose, 17.14 Gy per fraction at the isocenter). Eight patients were treated with single-fraction stereotactic radiosurgery and forty patients with multi-fraction stereotactic radiotherapy. Results: Overall, the series of patients was followed up for a median of 16.2 months (range, 3-63 months). At the time of analysis, 20 patients were alive and 28 patients were dead. The 1- and 2-year actuarial overall survival rates were 39.7% and 14.5%, respectively. We recorded 48 distant failures and 2 local failures, with a median interval to local failure of 4.9 months. The actuarial 1-year disease control rate was 9%; the actuarial 1- and 2-year local control rate was 90%. Conclusion: Our retrospective study indicated that SBRT for the treatment of adrenal metastases represents a safe and effective option with a control rate of 90% at 2 years.

  6. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sedlmayer, F. [Paracelsus Medical Univ. Hospital, Salzburg (Austria). Dept. of Radiotherapy and Radiation Oncology; Sautter-Bihl, M.L. [Staedtisches Klinium Karlsruhe (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Budach, W. [University Hospital Duesseldorf (Germany)] [and others

    2013-10-15

    research lies in partial breast irradiation strategies as well as WBI hypofractionation schedules. The potential of both in replacing normofractionated WBI has not yet been finally clarified. Conclusion: After breast conserving surgery, no subgroup even in low risk patients has yet been identified for whom radiotherapy can be safely omitted without compromising local control and, hence, cancer-specific survival. In most patients, this translates into an overall survival benefit. (orig.)

  7. POTENTIAL APPLICATIONS OF IMAGE-GUIDED RADIOTHERAPY FOR RADIATION DOSE ESCALATION IN PATIENTS WITH EARLY STAGE HIGH-RISK PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    Nam Phong Nguyen

    2015-02-01

    Full Text Available Patients with early stage high-risk prostate cancer (PSA >20, Gleason score >7 are at high risk of recurrence following prostate cancer irradiation. Radiation dose escalation to the prostate may improve biochemical free survival for these patients. However, high rectal and bladder dose with conventional three-dimensional conformal radiotherapy (3D-CRT may lead to excessive gastrointestinal and genitourinary toxicity. Image-guided radiotherapy (IGRT, by virtue of combining the steep dose gradient of intensity-modulated radiotherapy (IMRT and daily pretreatment imaging, may allow for radiation dose escalation and decreased treatment morbidity. Reduced treatment time is feasible with hypofractionated IGRT and it may improve patient quality of life.

  8. Four and five dimensional radiotherapy with reference to prostate cancer--definitions, state of the art and further directions--an overview.

    Science.gov (United States)

    Lennernäs, Bo; Castellanos, Enrique; Nilsson, Sten; Levitt, Seymour

    2011-06-01

    Radiotherapy (RT) always requires a compromise between tumor control and normal tissue side-effects. Technical innovation in radiation therapy (RT), such as three dimensional RT, is now established. Concerning prostate cancer (PC), it is reasonable to assume that RT of PC will increase in the future. The combination of small margins, a movable target (prostate), few fractions and high doses will probably demand dynamically positioning systems and in real time. This is called four dimensional radiotherapy (4DRT). Moreover, biological factors must be included in new treatments such as hypofractionation schedules. This new era is called five dimensional radiotherapy, 5DRT. In this paper we discuss new concepts in RT in respect to PC.

  9. Pelvic nodal dose escalation with prostate hypofractionation using conformal avoidance defined (H-CAD) intensity modulated radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S.; Tome, Wolfgang A.; Jaradat, Hazim; Raisbeck, Bridget M.; Ritter, Mark A. [Univ. of Wisconsin Medical School, Madison, WI (United States). Dept. of Human Oncology

    2006-09-15

    The management of prostate cancer patients with a significant risk of pelvic lymph node involvement is controversial. Both whole pelvis radiotherapy and dose escalation to the prostate have been linked to improved outcome in such patients, but it is unclear whether conventional whole pelvis doses of only 45-50 Gy are optimal for ultimate nodal control. The purpose of this study is to examine the dosimetric and clinical feasibility of combining prostate dose escalation via hypofractionation with conformal avoidance-based IMRT (H-CAD) dose escalation to the pelvic lymph nodes. One conformal avoidance and one conventional plan were generated for each of eight patients. Conformal avoidance-based IMRT plans were generated that specifically excluded bowel, rectum, and bladder. The prostate and lower seminal vesicles (PTV 70) were planned to receive 70 Gy in 2.5 Gy/fraction while the pelvic lymph nodes (PTV 56) were to concurrently receive 56 Gy in 2 Gy/fraction. The volume of small bowel receiving >45 Gy was restricted to 300 ml or less. These conformal avoidance plans were delivered using helical tomotherapy or LINAC-based IMRT with daily imaging localization. All patients received neoadjuvant and concurrent androgen deprivation with a planned total of two years. The conventional, sequential plans created for comparison purposes for all patients consisted of a conventional 4-field pelvic box prescribed to 50.4 Gy (1.8 Gy/fraction) followed by an IMRT boost to the prostate of 25.2 Gy (1.8 Gy/fraction) yielding a final prostate dose of 75.6 Gy. For all plans, the prescription dose was to cover the target structure. Equivalent uniform dose (EUD) analyses were performed on all targets and dose-volume histograms (DVH) were displayed in terms of both physical and normalized total dose (NTD), i.e. dose in 2 Gy fraction equivalents. H-CAD IMRT plans were created for and delivered to all eight patients. Analysis of the H-CAD plans demonstrates prescription dose coverage of >95

  10. Advances in treatment techniques: stereotactic body radiation therapy and the spread of hypofractionation.

    Science.gov (United States)

    Kavanagh, Brian D; Miften, Moyed; Rabinovitch, Rachel A

    2011-01-01

    Radiation therapy (RT) is an essential component of the management of many cancers. Traditionally, a course of external bream RT often involved daily treatments for a duration of 6 weeks or longer in some instances. Now, however, emerging clinical evidence indicates that, for some common cancers, the total length of treatment can be substantially shortened, offering convenience to patients and opportunities for resource utilization efficiencies. This trend toward so-called hypofractionated RT has been supported by hypothesis-driven clinical research guided by a combination of radiobiological and clinical insights and technological enhancements. The present review presents the rationale behind and current status of hypofractionation for prostate, breast, and medically inoperable early stage lung cancer.

  11. Radiotherapy for T1a glottic cancer: the influence of smoking cessation and fractionation schedule of radiotherapy.

    Science.gov (United States)

    Al-Mamgani, Abrahim; van Rooij, Peter H; Mehilal, Robert; Verduijn, Gerda M; Tans, Lisa; Kwa, Stefan L S

    2014-01-01

    The objective of the presented study is to report on retrospectively collected data on long-term outcome and toxicity and prospective assessment of quality of life (QoL) and Voice-Handicap Index (VHI) of patients with T1a glottic cancer treated with radiotherapy. Between 1985 and 2011, 549 patients were treated. Endpoints were local control (LC), toxicity, QoL and VHI. After a median follow-up of 93 months, the actuarial rates of LC were 91, and 90 % at 5- and 10-years, respectively. Continuing smoking (p VHI improved significantly from 34 at baseline to 21 at 24 months. Patients who continued smoking had significantly worse VHI. In conclusion, excellent outcome with good QoL and VHI were reported. Patients who continued smoking after radiotherapy had significantly poor LC and worse VHI. The current study emphasizes the importance of smoking cessation and the non-inferiority of hypofractionated schemes in terms of outcome and VHI. At our institution, phase II study is going to evaluate the role of single vocal cord irradiation with high fraction dose.

  12. Low Incidence of Fatigue after Hypofractionated Stereotactic Body Radiation Therapy for Localized Prostate Cancer

    OpenAIRE

    Dash, Chiranjeev; Demas, Kristina; Uhm, Sunghae; Hanscom, Heather N; Kim, Joy S; Suy, Simeng; Davis, Kimberly M.; Sween, Jennifer; Collins, Sean; Lucile L Adams-Campbell

    2012-01-01

    Background: Fatigue is a common side effect of conventional prostate cancer radiation therapy. The increased delivery precision necessitated by the high dose per fraction of stereotactic body radiation therapy (SBRT) offers the potential of reduce target volumes and hence the exposure of normal tissues to high radiation doses. Herein, we examine the level of fatigue associated with SBRT treatment. Methods: Forty patients with localized prostate cancer treated with hypofractionated SBRT, and a...

  13. Low Incidence of Fatigue after Hypofractionated Stereotactic Body Radiation Therapy (SBRT) for Localized Prostate Cancer

    OpenAIRE

    Chiranjeev eDash; Kristina eDemas; Sunghae eUhm; Hanscom, Heather N; Kim, Joy S; Simeng eSuy; Davis, Kimberly M.; Jennifer eSween; Sean eCollins; Lucile L Adams-Campbell

    2012-01-01

    Background: Fatigue is a common side-effect of conventional prostate cancer radiation therapy. The increased delivery precision necessitated by the high dose per fraction of stereotactic body radiation therapy (SBRT) offers the potential of reduce target volumes and hence the exposure of normal tissues to high radiation doses. Herein, we examine the level of fatigue associated with SBRT treatment.Methods: Forty patients with localized prostate cancer treated with hypofractionated SBRT, an...

  14. Hypofractionation for breast cancer: lessons learned from our neighbors to the north and across the pond.

    Science.gov (United States)

    Eblan, Michael J; Vanderwalde, Noam A; Zeman, Elaine M; Jones, Ellen

    2014-06-01

    Adjuvant whole breast irradiation was established within the standard of care for breast-conserving therapy in the early 1980s, following the results of major randomized trials comparing mastectomy vs breast-conserving surgery and radiation. Since that time, techniques and treatment strategies have evolved, but one major thread that carries forward is the need to balance cost, efficacy, complications, and convenience. Fortunately, data from randomized trials conducted in Canada and Great Britain provide a solid framework for the consideration of hypofractionated radiation in the treatment of breast cancer. In this review we discuss the rationale and underlying radiobiologic concepts for hypofractionation, and review the clinical trials and American Society for Radiation Oncology (ASTRO) guidelines supporting this approach. We also review the practical considerations for treatment planning, including dosimetric criteria and how to approach treatment of the node-positive patient. In the current era of healthcare reform and cost awareness, thoughtful utilization of hypofractionation may offer considerable savings to individual patients and the healthcare system--without compromising clinical outcomes or quality of life.

  15. Histopathologic effects of hypofractionated robotic radiation therapy on malignant and benign prostate tissue.

    Science.gov (United States)

    Suy, Simeng; Oermann, Eric; Hanscom, Heather; Lei, Sue; Vahdat, Saloomeh; Yu, Xia; Park, Hyeon U; Chen, Viola; Collins, Brian T; McGeagh, Kevin; Dawson, Nancy; Jha, Reena; Azumi, Norio; Dritschilo, Anatoly; Lynch, John; Collins, Sean P

    2010-12-01

    We describe the first histopathologic analysis of prostatic tissue following hypofractionated robotic radiation therapy. A 66 year-old man presented with stage II, low risk adenocarcinoma of the prostate and underwent elective conformal hypofractionated radiation therapy. His pretreatment evaluation revealed T1c adenocarcinoma, Gleason's grade 3 + 3 = 6 and a prostate specific antigen (PSA) level of 4.87 ng/ml. Hypofractionated radiation therapy (37.5 Gy in five daily fractions of 7.5 Gy) was completed on an Internal Review Board approved protocol. One year later, he developed progressive urinary retention. Transurethral prostatic resection was performed to alleviate obstructive symptoms. Bilobar hypertrophy was observed without evidence of stricture. Histolopathologic analyses of resected prostate tissues revealed changes consistent with radiation treatment, including cellular changes, inflammation, glandular atrophy and hyperplasia. There was no evidence of residual cancer, fibrosis or necrosis. The patient's postoperative course was uneventful with post-treatment PSA of 0.5 ng/ml and residual grade 1 stress incontinence.

  16. Hypofractionation with simultaneous integrated boost for early breast cancer. Results of the German multicenter phase II trial (ARO-2010-01)

    Energy Technology Data Exchange (ETDEWEB)

    Dellas, Kathrin [University of Kiel, Department of Radiooncology, Kiel (Germany); University of Luebeck, Department of Radiooncology, Luebeck (Germany); Vonthein, Reinhard; Ziegler, Andreas [Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck (Germany); University of Luebeck, Center for Clinical Trials, Luebeck (Germany); Zimmer, Joerg [Private Practice of Radiooncology, Dresden (Germany); Dinges, Stefan [Klinikum Lueneburg, Department of Radiooncology, Lueneburg (Germany); Boicev, Alexander D. [Klinikum Zwickau, Department of Radiooncology, Zwickau (Germany); Andreas, Peter [Krankenhaus Buchholz, Department of Radiooncology, Buchholz (Germany); Fischer, Dorothea [University of Luebeck, Department of Gynecology, Luebeck (Germany); Winkler, Cornelia [TU Munich, Department of Radiooncology, Munich (Germany); Dunst, Juergen [University of Kiel, Department of Radiooncology, Kiel (Germany); University of Luebeck, Department of Radiooncology, Luebeck (Germany); University of Copenhagen, Copenhagen (Denmark); Collaboration: Study Group, ARO

    2014-07-15

    To evaluate the feasibility of hypofractionation with SIB in all settings in Germany to prepare a multicenter treatment comparison. Eligible patients had histopathologically confirmed breast cancer operated by BCS. Patients received WBI 40.0 Gy in 16 fractions of 2.5 Gy. A SIB with 0.5 Gy per fraction was administered to the tumor bed, thereby giving 48.0 Gy in 16 fractions to the boost-PTV sparing heart, LAD, lung, contralateral breast. The primary study objective was feasibility, administration of specified dose in 16 fractions within 22-29 days with adherence to certain dose constraints (heart; LAD; contralateral breast); secondary endpoints were toxicity, QoL. 151 patients were recruited from 7 institutions between 07/11-10/12. 10 patients met exclusion criteria prior to irradiation. All but two patients (99 %) received the prescribed dose in the PTVs. Adherence to dose constraints and time limits was achieved in 89 % (95 % CI 82 % to 93 %). 11 AE were reported in 10 patients; five related to concurrent endocrine therapy. Two of the AEs were related to radiotherapy: grade 3 hot flushes in two cases. QoL remained unchanged. Hypofractionation with a SIB is feasible and was well tolerated in this study. (orig.) [German] Die ARO-2010-01-Studie pruefte die Durchfuehrbarkeit einer hypofraktionierten Bestrahlung mit simultan-integriertem Boost (SIB) in unterschiedlichen Versorgungseinrichtungen zur Vorbereitung einer multizentrischen Vergleichsstudie. In die Studie rekrutiert wurden Patientinnen mit histopathologisch gesichertem Mammakarzinom nach brusterhaltender Operation. Bestrahlt wurde die Brust mit 40,0 Gy in 16 Fraktionen a 2,5 Gy Einzeldosis; zusaetzlich wurde bei jeder Fraktion ein simultan- integrierter Boost mit 0,5 Gy appliziert, so dass im Boost-PTV (Planungszielvolumen) eine Dosis von 48 Gy in 16 Fraktionen erreicht wurde. Das primaere Zielkriterium war die Durchfuehrbarkeit, definiert als Verabreichung von 48 Gy GD in 16 Fraktionen in mindestens 22 d

  17. Quality-of-life outcomes in high-risk prostate cancer patients treated with helical tomotherapy in a hypofractionated radiation schedule with long-term androgen suppression

    Science.gov (United States)

    Pervez, N.; Krauze, A.V.; Yee, D.; Parliament, M.; Mihai, A.; Ghosh, S.; Joseph, K.; Murtha, A.; Amanie, J.; Kamal, M.; Pearcey, R.

    2012-01-01

    Purpose We examined the impact of hypofractionated radiation therapy and androgen suppression therapy (ast) on quality of life (qol) in high-risk prostate cancer patients. Methods Between March 2005 and March 2007, 60 patients with high-risk prostate cancer were enrolled in a prospective phase ii study. All patients received 68 Gy (2.72 Gy per fraction) to the prostate gland and 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes in 25 fractions over 5 weeks. Of the 60 patients, 58 received ast. The University of California–Los Angeles Prostate Cancer Index questionnaire was used to prospectively measure qol at baseline (month 0) and at 1, 6, 12, 18, 24, 30, and 36 months after radiation treatment. The generalized estimating equation approach was used to compare the qol scores at 1, 6, 12, 18, 24, 30, and 36 months with those at baseline. Results We observed a significant decrease in qol items related to bowel and sexual function. Several qol items related to bowel function were significantly adversely affected at both 1 and 6 months, with improvement toward 6 months. Although decreased qol scores persisted beyond the 6-month mark, they began to re-approach baseline at the 18- to 24-month mark. Most sexual function items were significantly adversely affected at both 1 and 6 months, but the effects were not considered to be a problem by most patients. A complete return to baseline was not observed for either bowel or sexual function. Urinary function items remained largely unaffected, with overall urinary function being the only item adversely affected at 6 months, but not at 1 month. Urinary function returned to baseline and remained unimpaired from 18 months onwards. Conclusions In our study population, who received hypofractionated radiation delivered using dynamic intensity-modulated radiotherapy with inclusion of the pelvic lymph nodes, and 2–3 years of ast prescription, qol with respect to bowel and sexual function was significantly affected; qol with

  18. Radiotherapy of esthesioneuroblastoma. Radiotherapie beim Aesthesioneuroblastom

    Energy Technology Data Exchange (ETDEWEB)

    Strnad, V. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik); Grabenbauer, G.G. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik); Dunst, J. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik); Sauer, R. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik)

    1994-02-01

    From 1985 through 1990, twelve patients with estehesioneuroblastoma have been treated at the Department of Radiotherapy at the University of Erlangen. Two had Kadish stage A, one stage B, and nine stage C. There were seven males and five females with a mean age of 43 years. Eleven patients had combined trancranial-transbasal surgery prior to radiotherapy (five R0-, four R1-, and two patients R2-resections) and one received radiotherapy only. The dose was 12 to 60 Gy (mean 54 Gy) in 1.8 Gy to 2 Gy per fraction. 8/12 patients (67%) were locally controlled. One had progressive disease during radiotherapy after partial resection and died. Three had local recurrences, one in-field and two marginal. One patient with a local recurrence developed cervical lymph node metastases, and one locally controlled patient developed bone metastases but is alive eight years after chemotherapy plus radiotherapy for metastatic disease. The five-year-overall and recurrence-free survival was 72% and 55%, respectively. (orig./MG)

  19. Targeted tumor radiotherapy

    Directory of Open Access Journals (Sweden)

    Unak Perihan

    2002-01-01

    Full Text Available Targeted tumor radiotherapy is selectively delivery of curative doses of radiation to malignant sites. The aim of the targeted tumor radiotherapy is to use the radionuclides which have high LET particle emissions conjugated to appropriate carrier molecules. The radionuclides are selectively collected by tumor cells, depositing lethal doses to tumor cells while no admission occur to normal cells. In theory, targeted radiotherapy has several advantages over conventional radiotherapy since it allows a high radiation dose to be administered without causing normal tissue toxicity, although there are some limitations in the availability of appropriate targeting agents and in the calculations of administered doses. Therefore, for routine clinical applications more progress is still needed. In this article, the potential use of targeted tumor radiotherapy is briefly reviewed. More general aspects and considerations, such as potential radionuclides, mechanisms of tumor targeting was also outlined.

  20. Current status and potential perspectives in classical radiotherapy technology

    Directory of Open Access Journals (Sweden)

    Dabić-Stanković Kata M.

    2004-01-01

    Full Text Available Introduction and potentials of classical radiotherapy After purchase of radiotherapy equipment in 2003, classic radiation therapy in Serbia will reach the highest world level. In order to define the highest standards in radiation technology, we analyzed the current status and potential perspectives of radiation therapy. Technological levels of radiotherapy in developed countries An analysis of present situation in the USA, assumed as the most developed in the world, was done. Available data, collected in the last 3 years (equipment assortment, therapy modalities, workload and manpower for 284 radiotherapy centers, out of potential 2050, were analyzed. Results were presented as crude percentage and mached to point current status. Results of analysis and discussion The analysis showed that CLINAC accelerators are the most popular (82.7%, as well as, ADAC (43.7% and Focus (CMS (27.4% systems for therapy planning. Movement towards virtual simulation is evident (59.3%, although classic ”simulation” is not fully eliminated from the radiotherapy chain. The most popular brachytherapy afterloader is Microselectron HDR (71%. About 64.4% centers use IMPAC communication/verification/record system that seems more open than Varis. All centers practice modern radiotherapy modalities and techniques (CFRT, IMRT, SRS/SRT, TBI, IORT, IVBHRT, HDR BHRT, etc.. CT and MRI availability is out of question, but PET is available in 3% of centers, however this percentage is rapidly growing. Up to 350 new patients per year are treated by one accelerator (about 35 pts. a day. Centers are relatively small and utilize 2-3 accelerators on average. Average FTE staffing norm is 4 radiation oncologists, 2-3 medical radiotherapy physicists, about 3 certified medical dosimetrists and about 6 radiotherapy technologists. Technological aspects and conclusion In the past 5 years relative stagnation in classic radiotherapy has been observed. In spite of substantial investments in

  1. A New Cancer Radiotherapy System Using Multi Robotic Manipulators

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Ho; Lee, Nam Ho; Lee, Byung Chul; Jeung, Kyung Min; Lee, Seong Uk; Bae, Yeong Geol; Na, Hyun Seok [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-10-15

    The CyberKnife system is state-of-the-art cancer treatment equipment that combines an image tracking technique, artificial intelligence software, robot technology, accelerator technology, and treatment simulation technology. The current CyberKnife System has significant shortcomings. The biggest problem is that it takes a longer time to treat a tumor. A long treatment time gives stress to patients. Furthermore it makes the patients uncomfortable with radiation and thus it is difficult to measure the exact radiation dose rate to the tumor in the processing. Linear accelerators for radiation treatment are dependent on imports, and demand high maintenance cost. This also makes the treatment cost higher and prevents the popularization of radiation. To solve the disadvantages of the existing CyberKnife, a radiation treatment robot system applied to several articulated robots is suggested. Essential element techniques for new radiotherapy robot system are investigated and some problems of similar existing systems are analyzed. This paper presents a general configuration of a new radiation robot treatment system including with a quantitative goal of the requirement techniques. This paper described a new radiotherapy robot system to track the tumor using multiple articulated robots in real time. The existing CyberKnife system using a single robot arm has disadvantages of a long radiotherapy time, high medical fee, and inaccurate measurement of the radiotherapy dose. So a new radiotherapy robot system for tumors has been proposed to solve the above problems of conventional CyberKnife systems. Necessary technologies to configure new the radiotherapy robot system have been identified. Quantitative targets of each technology have been established. Multiple robot arms are adopted to decrease the radiotherapy time. The results of this research are provided as a requisite technology for a domestic radiotherapy system and are expected to be the foundation of new technology. The

  2. Review on heavy ion radiotherapy facilities and related ion sources (invited)

    NARCIS (Netherlands)

    Kitagawa, A.; Fujita, T.; Muramatsu, M.; Biri, S.; Drentje, A. G.

    Heavy ion radiotherapy awakens worldwide interest recently. The clinical results obtained by the Heavy Ion Medical Accelerator in Chiba at the National Institute of Radiological Sciences in Japan have clearly demonstrated the advantages of carbon ion radiotherapy. Presently, there are four

  3. Stromal-epithelial dynamics in response to fractionated radiotherapy

    Science.gov (United States)

    Qayyum, Muqeem Abdul

    Radiotherapy is central to the management of a number of human cancers, either as an adjuvant or primary treatment modality. The principal objective in irradiating tumors is to permanently inhibit their proliferative ability. More than half of all malignancies are primarily treated with radiation, but the heterotypic nature of tumor cells greatly complicates their response to radiotherapy. The need for reliable parameters to predict tumor and normal tissue response to radiation is therefore a prime concern of clinical oncology. Post-operative radiotherapy has commonly been used for early stage breast cancer to treat residual disease. There is continued debate as to what might be the proper dose per fraction as well as the total dose of radiation that needs to be prescribed to prevent disease recurrence. Countries outside the US have adopted increased dose fractionation (i.e., hypofractionation) schemes for early stage breast cancer as a standard of practice; however there is a lack of confidence in these approaches in the United States. The tumor microenvironment plays a significant role in regulating the progression of carcinomas, although the mechanisms are not entirely clear. The primary objective of this work was to characterize, through mechanobiological and radiobiological modeling, a test bed for radiotherapy fractionation techniques assessment. Our goal is to understand how the tumor microenvironment responds to dose fractionation schemes for Breast Conserving Therapy (BCT). Although carcinomas are the major concern for oncology, in this project, the goal is to understand how the stromal microenvironment influences behavior of the cancer cell populations. By classifying 3-D cellular co-cultures as having a reactive or quiescent stroma using the mechanobiology profile (culture stiffness,cellular activation, differentiation, and proliferation) we aim to differentiate the effectiveness of various fractionation schemes. The benefits of understanding heterotypic

  4. Evolving Paradigm of Radiotherapy for High-Risk Prostate Cancer: Current Consensus and Continuing Controversies

    Directory of Open Access Journals (Sweden)

    Aditya Juloori

    2016-01-01

    Full Text Available High-risk prostate cancer is an aggressive form of the disease with an increased risk of distant metastasis and subsequent mortality. Multiple randomized trials have established that the combination of radiation therapy and long-term androgen deprivation therapy improves overall survival compared to either treatment alone. Standard of care for men with high-risk prostate cancer in the modern setting is dose-escalated radiotherapy along with 2-3 years of androgen deprivation therapy (ADT. There are research efforts directed towards assessing the efficacy of shorter ADT duration. Current research has been focused on assessing hypofractionated and stereotactic body radiation therapy (SBRT techniques. Ongoing randomized trials will help assess the utility of pelvic lymph node irradiation. Research is also focused on multimodality therapy with addition of a brachytherapy boost to external beam radiation to help improve outcomes in men with high-risk prostate cancer.

  5. Whole-Pelvic Nodal Radiation Therapy in the Context of Hypofractionation for High-Risk Prostate Cancer Patients: A Step Forward

    Energy Technology Data Exchange (ETDEWEB)

    Kaidar-Person, Orit [Division of Oncology, Rambam Health Care Campus, Haifa (Israel); Roach, Mack [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Créhange, Gilles, E-mail: gcrehange@cgfl.fr [Department of Radiation Oncology, Georges-François Leclerc Cancer Center, Dijon (France)

    2013-07-15

    Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer.

  6. Whole-pelvic nodal radiation therapy in the context of hypofractionation for high-risk prostate cancer patients: a step forward.

    Science.gov (United States)

    Kaidar-Person, Orit; Roach, Mack; Créhange, Gilles

    2013-07-15

    Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer.

  7. [Recent developments in radiotherapy of hepatocellular carcinoma].

    Science.gov (United States)

    Seong, Jinsil

    2004-12-01

    With the accumulation of clinical experiences, the efficacy of radiotherapy has been recognized in management scheme for HCC. While hepatologists are beginning to show less reluctance for applying radiotherapy to the treatment of HCC, it is necessary that the hepatologists be informed of the rapid developments in technical strategy for radiation oncology. Recent advances in several technologies have opened a new era in radiation oncology. Modern imaging technologies can provide a 3-dimensional model of patient's anatomy, and this allows radiation oncologists to identify accurate tumor volumes as well as the tumors' relationship with the adjacent normal tissues. Moreover, the development of the computer-controlled multileaf collimator systems now enables physicians to perform precise beam shaping and to modulate the radiation dose distribution. A combination of these systems, 3-DCRT, is rapidly replacing the more conventional 2-D radiotherapy. 3-DCRT has evolved into a more sophisticated technology, intensity modulated radiotherapy (IMRT). In IMRT, with the powerful computer-aided optimization process, the radiation dose can be delivered to the target using highly complex isodose profiles. This new technology has been further developed into IGRT, which combines the CT-images scanning system and radiation equipments into one hardware package, and this system is currently ready for clinical application. In parallel with the radiation technologies described above, the strategy of stereotactic radiation has evolved from the conventional linear accelerator-based system to a gammaknife, and more recently, to a cyberknife. These systems are primarily based on the concept of radiosurgery. Currently, various radiation technologies have been adopted for the radiotherapy of HCC. In this article, each strategy will be discussed as well as the indications for radiotherapy and the radiation-related complications.

  8. Dose rate measurement due to activation of the head of a linear accelerator used in radiotherapy; Medida de tasa de dosis debido a la activacion del cabezal de un acelerador lineal utilizado en radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Ruiz-Zorrilla, J.; Minambres Moro, A.; Fernandez Leton, P.; Martinez Gomez, L. C.; Gillaranz Moreno, R.; Castro Novais, J.; Zucca Aparicio, D.; Perez Moreno, J. M.

    2011-07-01

    Electron accelerators which produce photon energies greater than 8 MV dose rates can present after irradiation due to the emission of neutrons and consequent formation of products of activation, the aim of this study is to measure the variation in the rate of dose over time produced by an accelerator of 25 MV and try to locate any of the isotopes produced and conservatively estimate the dose received by workers.

  9. Prostate Hypofractionated Radiation Therapy With Injection of Hyaluronic Acid: Acute Toxicities in a Phase 2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Chapet, Olivier, E-mail: olivier.chapet@chu-lyon.fr [Department of Radiation Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite (France); EMR3738, Université Lyon 1, Lyon (France); Decullier, Evelyne; Bin, Sylvie [Pole Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon (France); Université Lyon 1, Lyon (France); EA SIS, Université de Lyon, Lyon (France); Faix, Antoine [Department of Urology, Clinique Beausoleil, Montpellier (France); Ruffion, Alain [Université Lyon 1, Lyon (France); Department of Urology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite (France); Jalade, Patrice [Department of Medical Physics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite (France); Fenoglietto, Pascal [Department of Radiation Oncology and Physics, Institut du Cancer de Montpellier, Montpellier (France); Udrescu, Corina; Enachescu, Ciprian [Department of Radiation Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite (France); Azria, David [Department of Radiation Oncology and Physics, Institut du Cancer de Montpellier, Montpellier (France)

    2015-03-15

    Purpose: Hypofractionated radiation therapy (RT) in prostate cancer can be developed only if the risk of rectal toxicity is controlled. In a multicenter phase 2 trial, hypofractionated irradiation was combined with an injection of hyaluronic acid (HA) to preserve the rectal wall. Tolerance of the injection and acute toxicity rates are reported. Methods and Materials: The study was designed to assess late grade 2 toxicity rates. The results described here correspond to the secondary objectives. Acute toxicity was defined as occurring during RT or within 3 months after RT and graded according to the Common Terminology Criteria for Adverse Events version 4.0. HA tolerance was evaluated with a visual analog scale during the injection and 30 minutes after injection and then by use of the Common Terminology Criteria at each visit. Results: From 2010 to 2012, 36 patients with low-risk to intermediate-risk prostate cancer were included. The HA injection induced a mean pain score of 4.6/10 ± 2.3. Thirty minutes after the injection, 2 patients still reported pain (2/10 and 3/10), which persisted after the intervention. Thirty-three patients experienced at least 1 acute genitourinary toxicity and 20 patients at least 1 acute gastrointestinal toxicity. Grade 2 toxicities were reported for 19 patients with urinary obstruction, frequency, or both and for 1 patient with proctitis. No grade 3 or 4 toxicities were reported. At the 3-month visit, 4 patients described grade 2 obstruction or frequency, and no patients had any grade 2 gastrointestinal toxicities. Conclusions: The injection of HA makes it possible to deliver hypofractionated irradiation over 4 weeks with a dose per fraction of > 3 Gy, with limited acute rectal toxicity.

  10. Long-term Cardiac Mortality After Hypofractionated Radiation Therapy in Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tjessem, Kristin Holm, E-mail: krtjes@ous-hf.no [Department of Oncology, Oslo University Hospital, National Resource Centre for Late Effects after Cancer Treatment, Oslo (Norway); Johansen, Safora [Department of Oncology, Oslo University Hospital-Radium Hospital, and Division of Radiotherapy/Radiography, College of Oslo and Akershus, Faculty of Health, Oslo (Norway); Malinen, Eirik [Department of Medical Physics, Oslo University Hospital, Oslo (Norway); Reinertsen, Kristin V. [Department of Oncology, Oslo University Hospital, National Resource Centre for Late Effects after Cancer Treatment, Oslo (Norway); Danielsen, Turi [Department of Medical Physics, Oslo University Hospital, Oslo (Norway); Fosså, Sophie D.; Fosså, Alexander [Department of Oncology, Oslo University Hospital, National Resource Centre for Late Effects after Cancer Treatment, Oslo (Norway)

    2013-10-01

    Purpose: To explore very-long-term mortality from ischemic heart disease (IHD) after locoregional radiation therapy of breast cancer (BC) in relation to degree of hypofractionation and other treatment variables. Methods and Materials: Two hypofractionated regimens used for locoregional radiation therapy for BC from 1975 to 1991 were considered. Patients received 4.3 Gy × 2/week (10 fractions; target dose 43 Gy; n=1107) or 2.5 Gy × 5/week (20 fractions; target dose 50 Gy; n=459). To estimate cardiac doses, radiation fields were reconstructed in a planning system. Time to death from IHD was the endpoint, comparing the groups with each other and with age-matched, cancer-free control individuals, modeled with the Cox proportional hazards model. Results: Patients given 4.3 Gy × 10 had an increased risk of dying of IHD compared with both the 2.5 Gy group (hazard ratio [HR] = 2.37; 95% confidence interval [CI]: 1.06-5.32; P=.036) and the control group (HR = 1.59; 95% CI: 1.13-2.23; P=.008). Photon beams for parasternal fields gave an increased risk of dying of IHD compared with electron beams (HR = 2.56; 95% CI: 1.12-5.84; P=.025). Multivariate analysis gave an increased risk for the 4.3-Gy versus 2.5-Gy regimen with borderline significance (HR = 2.90; 95% CI: 0.97-8.79; P=.057) but not for parasternal irradiation. Conclusions: The degree of hypofractionation and parasternal photon beams contributed to increased cardiac mortality in this patient cohort. Differences emerged after 12 to 15 years, indicating the need of more studies with observation time of 2 decades.

  11. Hypofractionated proton therapy for prostate cancer: Dose delivery uncertainty due to interfractional motion

    Science.gov (United States)

    Wang, Yi; Efstathiou, Jason A.; Lu, Hsiao-Ming; Sharp, Gregory C.; Trofimov, Alexei

    2013-01-01

    Purpose: The α-to-β (α/β) ratio for prostate tumor is likely lower than that for the surrounding normal organs, such as rectum and bladder (∼3 Gy). As a result, hypofractionation is expected to improve the therapeutic ratio in prostate radiation therapy. However, with the use of fewer, larger fractions, the accuracy of treatment dose delivery becomes more influenced by the physical uncertainties resulting from motion and radiobiological uncertainties in the α/β ratio of the prostate tumor. The purpose of this study is to evaluate the impact of interfractional motion on treatment dose delivery within the likely range of the tumor α/β ratio. Methods: Serial CT images acquired at simulation and daily treatment for three prostate patients were studied retrospectively. A conventional 3D-conformal proton plan was created for each patient, delivering 25 fractions of 2 Gy to ITV1 (internal target volume, expanded from the prostate and clinically involved seminal vesicles) followed by 14 fractions to ITV2 (expanded from the prostate). The plans were renormalized for a series of hypofractionated protocols of between five and 28 fractions. The fractional doses were computed on daily CT and were mapped onto simulation CT using deformable registration. In each course, the doses from the fractions with the lowest D97% of the ITV2 were summed to approximate the lower limit (worst case) of target coverage. The uncertainty in dose and coverage was estimated as the deviation of the worst case from the nominal plan. Results: For treatments in 28 to five fractions, the uncertainty arising from interfractional motion ranged from ∼1% to 4% for V100% and ∼2% to 6% for D100% of the ITV2. The uncertainties in V95% and D95% were both minimal ( 2.5 Gy, assuming the worst case for interfractional motion. Conclusions: In hypofractionated proton therapy for prostate cancer, the dosimetric uncertainties due to interfractional motion were minimal for the ITV2 coverage at 95% isodose

  12. [The security system of SIEMENS digital linear accelerator].

    Science.gov (United States)

    Wang, Jianping

    2013-03-01

    The security system plays an important role to protect the safety of patients and equipment in radiotherapy. The principle and structure of three kinds of security system of the Siemens digital linear accelerator were analyzed with some examples.

  13. Prostate Radiotherapy in the Era of Advanced Imaging and Precision Medicine

    Directory of Open Access Journals (Sweden)

    Caleb R. Dulaney

    2016-01-01

    Full Text Available Tremendous technological advancements in prostate radiotherapy have decreased treatment toxicity and improved clinical outcomes for men with prostate cancer. While these advances have allowed for significant treatment volume reduction and whole-organ dose escalation, further improvement in prostate radiotherapy has been limited by classic techniques for diagnosis and risk stratification. Developments in prostate imaging, image-guided targeted biopsy, next-generation gene expression profiling, and targeted molecular therapies now provide information to stratify patients and select treatments based on tumor biology. Image-guided targeted biopsy improves detection of clinically significant cases of prostate cancer and provides important information about the biological behavior of intraprostatic lesions which can further guide treatment decisions. We review the evolution of prostate magnetic resonance imaging (MRI and MRI-ultrasound fusion-guided prostate biopsy. Recent advancements in radiation therapy including dose escalation, moderate and extreme hypofractionation, partial prostate radiation therapy, and finally dose escalation by simultaneous integrated boost are discussed. We also review next-generation sequencing and discuss developments in targeted molecular therapies. Last, we review ongoing clinical trials and future treatment paradigms that integrate targeted biopsy, molecular profiling and therapy, and prostate radiotherapy.

  14. Medical applications of accelerators

    CERN Document Server

    Rossi, Sandro

    1998-01-01

    At Present, about five thousands accelerators are devoted to biomedical applications. They are mainly used in radiotherapy, research and medical radioisotopes production. In this framework oncological hadron-therapy deserves particular attention since it represents a field in rapid evolution thanks to the joint efforts of laboratories with long experiences in particle physics. It is the case of CERN where the design of an optimised synchrotron for medical applications has been pursued. These lectures present these activities with particular attention to the new developments which are scientifically interesting and/or economically promising.

  15. Factors influencing conformity index in radiotherapy for non-small cell lung cancer.

    LENUS (Irish Health Repository)

    Brennan, Sinead M

    2010-01-01

    The radiotherapy conformity index (CI) is a useful tool to quantitatively assess the quality of radiotherapy treatment plans, and represents the relationship between isodose distributions and target volume. A conformity index of unity implies high planning target volume (PTV) coverage and minimal unnecessary irradiation of surrounding tissues. We performed this analysis to describe the CI for lung cancer 3-dimensional conformal radiotherapy (3DCRT) and to identify clinical and technical determinants of CI, as it is not known which factors are associated with good quality 3D conformal radiotherapy treatment planning. Radiotherapy treatment plans from a database of 52 patients with inoperable Stage 1 to 3b lung cancer, on a hypofractionated 3DCRT trial were evaluated. A CI was calculated for all plans using the definition of the ICRU 62:CI = (TV\\/PTV), which is the quotient of the treated volume (TV) and the PTV. Data on patient, tumor, and planning variables, which could influence CI, were recorded and analyzed. Mean CI was 2.01 (range = 1.06-3.8). On univariate analysis, PTV (p = 0.023), number of beams (p = 0.036), medial vs. lateral tumor location (p = 0.016), and increasing tumor stage (p = 0.041) were associated with improved conformity. On multiple regression analysis, factors found to be associated with CI included central vs. peripheral tumor location (p = 0.041) and PTV size (p = 0.058). The term 3DCRT is used routinely in the literature, without any indication of the degree of conformality. We recommend routine reporting of conformity indices. Conformity indices may be affected by both planning variables and tumor factors.

  16. Factors influencing conformity index in radiotherapy for non-small cell lung cancer.

    Science.gov (United States)

    Brennan, Sinead M; Thirion, Pierre; Buckney, Steve; Shea, Carmel O; Armstrong, John

    2010-01-01

    The radiotherapy conformity index (CI) is a useful tool to quantitatively assess the quality of radiotherapy treatment plans, and represents the relationship between isodose distributions and target volume. A conformity index of unity implies high planning target volume (PTV) coverage and minimal unnecessary irradiation of surrounding tissues. We performed this analysis to describe the CI for lung cancer 3-dimensional conformal radiotherapy (3DCRT) and to identify clinical and technical determinants of CI, as it is not known which factors are associated with good quality 3D conformal radiotherapy treatment planning. Radiotherapy treatment plans from a database of 52 patients with inoperable Stage 1 to 3b lung cancer, on a hypofractionated 3DCRT trial were evaluated. A CI was calculated for all plans using the definition of the ICRU 62:CI = (TV/PTV), which is the quotient of the treated volume (TV) and the PTV. Data on patient, tumor, and planning variables, which could influence CI, were recorded and analyzed. Mean CI was 2.01 (range = 1.06-3.8). On univariate analysis, PTV (p = 0.023), number of beams (p = 0.036), medial vs. lateral tumor location (p = 0.016), and increasing tumor stage (p = 0.041) were associated with improved conformity. On multiple regression analysis, factors found to be associated with CI included central vs. peripheral tumor location (p = 0.041) and PTV size (p = 0.058). The term 3DCRT is used routinely in the literature, without any indication of the degree of conformality. We recommend routine reporting of conformity indices. Conformity indices may be affected by both planning variables and tumor factors.

  17. The influence of simultaneous integrated boost, hypofractionation and oncoplastic surgery on cosmetic outcome and PROMs after breast conserving therapy

    NARCIS (Netherlands)

    Lansu, J.T.; Essers, M.; Voogd, A.C.; Luiten, E.J.; Buijs, C.; Groenendaal, N.; Poortmans, P.M.P.

    2015-01-01

    INTRODUCTION: We retrospectively investigated the possible influence of a simultaneous integrated boost (SIB), hypofractionation and oncoplastic surgery on cosmetic outcome in 125 patients with stage I-II breast cancer treated with breast conserving therapy (BCT). PATIENTS AND METHODS: The boost was

  18. Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis

    NARCIS (Netherlands)

    Janssens, G.O.R.J.; Jansen, M.H.; Lauwers, S.J.; Nowak, P.J.; Oldenburger, F.R.; Bouffet, E.; Saran, F.; Kamphuis-van Ulzen, K.; Lindert, E.J. van; Schieving, J.H.; Boterberg, T.; Kaspers, G.J.L.; Span, P.N.; Kaanders, J.H.A.M.; Gidding, C.E.M.; Hargrave, D.

    2013-01-01

    PURPOSE: Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy give

  19. Hypofractionated radiation therapy versus conventional radiation therapy in prostate cancer: A systematic review of its safety and efficacy.

    Science.gov (United States)

    Sánchez-Gómez, L M; Polo-deSantos, M; Rodríguez-Melcón, J I; Angulo, J C; Luengo-Matos, S

    2015-01-01

    New therapeutic alternatives can improve the safety and efficacy of prostate cancer treatment. To assess whether hypofractionated radiation therapy results in better safety and efficacy in the treatment of prostate cancer. Systematic review of the literature through searches on PubMed, Cochrane Library, CRD, ClinicalTrials and EuroScan, collecting indicators of safety and efficacy. We included 2 systematic reviews and a clinical trial. In terms of efficacy, there is considerable heterogeneity among the studies, and no conclusive results were found concerning the superiority of the hypofractionated option over the normal fractionated option. In terms of safety, there were no significant differences in the onset of acute genitourinary complications between the 2 treatments. However, one of the reviews found more acute gastrointestinal complications in patients treated with hypofractionated radiation therapy. There were no significant differences in long-term complications based on the type of radiation therapy used, although the studies did have limitations. To date, there are no conclusive results that show that hypofractionated radiation therapy is more effective or safer than normal fractionated radiation therapy in the treatment of localized prostate cancer. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Experimental radiotherapy and clinical radiobiology. Vol. 20. Proceedings; Experimentelle Strahlentherapie und Klinische Strahlenbiologie. Bd. 20. Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, Michael; Dahm-Daphi, Jochen; Dikomey, Ekkehard; Petersen, Cordula; Rodemannn, Hans-Peter; Zips, Daniel (eds.)

    2011-07-01

    The proceedings include contributions on the following issues: laser driven proton accelerators on the way for radiotherapy, radiobiological evaluation of new radiations; molecular factors of radiation response; biological targeting; EGFR epidermal growth factor receptor/targeting - combined internal and external irradiation, radiobiology of normal tissues; dose-volume histograms for the radiotherapy: curves without radiobiological relevance or important information for the therapy planning; HPV (human papilloma virus) and radiation sensitivity of HNSCC (head and neck squamous cell carcinomas): evidence, radiobiological mechanism, clinical consequences and perspectives; mechanisms of action and intertumoral heterogeneity of response to EGFR inhibition in radiotherapy of solid tumors; evaluation of biomarkers for radiotherapy.

  1. Planning a Radiotherapy Department.

    Science.gov (United States)

    van der Merwe, D

    2017-02-01

    The master planning of new radiotherapy facilities requires the input and engagement of a range of highly specialised professionals, both in the construction and health sector. Although radiation protection and safety aspects of radiotherapy services are universal, low and middle income countries are often presented with unique challenges that also need to be considered, e.g. competing needs within the health sector, lack of financial and human resources, environmental factors like poor provision of transport or electrical power, inadequate regulatory infrastructure, etc. Efforts to establish, upgrade or expand radiotherapy services should therefore not only focus on the technology that is appropriate and sustainable, but also be mindful of the need for quality, safety and optimal utilisation of technology. The workflow in a radiotherapy department can be facilitated by strategic placement of the main functional areas into the concept design. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  2. Outcome Evaluation of Oligometastatic Patients Treated with Surgical Resection Followed by Hypofractionated Stereotactic Radiosurgery (HSRS) on the Tumor Bed, for Single, Large Brain Metastases

    Science.gov (United States)

    Pessina, Federico; Navarria, Pierina; Cozzi, Luca; Ascolese, Anna Maria; Maggi, Giulia; Riva, Marco; Masci, Giovanna; D’Agostino, Giuseppe; Finocchiaro, Giovanna; Santoro, Armando; Bello, Lorenzo; Scorsetti, Marta

    2016-01-01

    Purpose The aim of this study was to evaluate the benefit of a combined treatment, surgery followed by adjuvant hypofractionated stereotactic radiosurgery (HSRS) on the tumor bed, in oligometastatic patients with single, large brain metastasis (BM). Methods and Materials Fom January 2011 to March 2015, 69 patients underwent complete surgical resection followed by HSRS with a total dose of 30Gy in 3 daily fractions. Clinical outcome was evaluated by neurological examination and MRI 2 months after radiotherapy and then every 3 months. Local progression was defined as radiographic increase of the enhancing abnormality in the irradiated volume, and brain distant progression as the presence of new brain metastases or leptomeningeal enhancement outside the irradiated volume. Surgical morbidity and radiation-therapy toxicity, local control (LC), brain distant progression (BDP), and overall survival (OS) were evaluated. Results The median preoperative volume and maximum diameter of BM was 18.5cm3 (range 4.1–64.2cm3) and 3.6cm (range 2.1-5-4cm); the median CTV was 29.0cm3 (range 4.1–203.1cm3) and median PTV was 55.2cm3 (range 17.2–282.9cm3). The median follow-up time was 24 months (range 4–33 months). The 1-and 2-year LC in site of treatment was 100%; the median, 1-and 2-year BDP was 11.9 months, 19.6% and 33.0%; the median, 1-and 2-year OS was 24 months (range 4–33 months), 91.3% and 73.0%. No severe postoperative morbidity or radiation therapy toxicity occurred in our series. Conclusions Multimodal approach, surgery followed by HSRS, can be an effective treatment option for selected patients with single, large brain metastases from different solid tumors. PMID:27348860

  3. Nanoparticle-guided radiotherapy

    DEFF Research Database (Denmark)

    2012-01-01

    The present invention relates to a method and nano-sized particles for image guided radiotherapy (IGRT) of a target tissue. More specifically, the invention relates to nano-sized particles comprising X-ray-imaging contrast agents in solid form with the ability to block x-rays, allowing for simult...... for simultaneous or integrated external beam radiotherapy and imaging, e.g., using computed tomography (CT)....

  4. On the importance of prompt oxygen changes for hypofractionated radiation treatments

    Science.gov (United States)

    Kissick, Michael; Campos, David; van der Kogel, Albert; Kimple, Randall

    2013-10-01

    This discussion is motivated by observations of prompt oxygen changes occurring prior to a significant number of cancer cells dying (permanently stopping their metabolic activity) from therapeutic agents like large doses of ionizing radiation. Such changes must be from changes in the vasculature that supplies the tissue or from the metabolic changes in the tissue itself. An adapted linear-quadratic treatment is used to estimate the cell survival variation magnitudes from repair and reoxygenation from a two-fraction treatment in which the second fraction would happen prior to significant cell death from the first fraction, in the large fraction limit. It is clear the effects of oxygen changes are likely to be the most significant factor for hypofractionation because of large radiation doses. It is a larger effect than repair. Optimal dose timing should be determined by the peak oxygen timing. A call is made to prioritize near real time measurements of oxygen dynamics in tumors undergoing hypofractionated treatments in order to make these treatments adaptable and patient-specific.

  5. Hypo-fractionated radiation, magnetic nanoparticle hyperthermia and a viral immunotherapy treatment of spontaneous canine cancer

    Science.gov (United States)

    Hoopes, P. Jack; Moodie, Karen L.; Petryk, Alicia A.; Petryk, James D.; Sechrist, Shawntel; Gladstone, David J.; Steinmetz, Nicole F.; Veliz, Frank A.; Bursey, Alicea A.; Wagner, Robert J.; Rajan, Ashish; Dugat, Danielle; Crary-Burney, Margaret; Fiering, Steven N.

    2017-02-01

    It has recently been shown that cancer treatments such as radiation and hyperthermia, which have conventionally been viewed to have modest immune based anti-cancer effects, may, if used appropriately stimulate a significant and potentially effective local and systemic anti-cancer immune effect (abscopal effect) and improved prognosis. Using eight spontaneous canine cancers (2 oral melanoma, 3 oral amelioblastomas and 1 carcinomas), we have shown that hypofractionated radiation (6 x 6 Gy) and/or magnetic nanoparticle hyperthermia (2 X 43°C / 45 minutes) and/or an immunogenic virus-like nanoparticle (VLP, 2 x 200 μg) are capable of delivering a highly effective cancer treatment that includes an immunogenic component. Two tumors received all three therapeutic modalities, one tumor received radiation and hyperthermia, two tumors received radiation and VLP, and three tumors received only mNP hyperthermia. The treatment regimen is conducted over a 14-day period. All patients tolerated the treatments without complication and have had local and distant tumor responses that significantly exceed responses observed following conventional therapy (surgery and/or radiation). The results suggest that both hypofractionated radiation and hyperthermia have effective immune responses that are enhanced by the intratumoral VLP treatment. Molecular data from these tumors suggest Heat Shock Protein (HSP) 70/90, calreticulin and CD47 are targets that can be exploited to enhance the local and systemic (abscopal effect) immune potential of radiation and hyperthermia cancer treatment.

  6. Stereotactic radiotherapy of meningiomas. Symptomatology, acute and late toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Henzel, M.; Gross, M.W.; Failing, T.; Strassmann, G.; Engenhart-Cabillic, R. [Dept. of Radiation Oncology, Univ. of Gisssen (Germany); Dept. of Radiation Oncology, Marburg Univ. (Germany); Hamm, K.; Surber, G.; Kleinert, G. [Dept. of Stereotactic Neurosurgery and Radiosurgery, Helios Klinikum Erfurt (Germany)

    2006-07-15

    Background and purpose: stereotactic radiosurgery (SRS) is well established in the treatment of skull base meningiomas, but this therapy approach is limited to small tumors only. The fractionated stereotactic radiotherapy (SRT) offers an alternative treatment option. This study aims at local control, symptomatology, and toxicity. Patients and methods: between 1997-2003, 224 patients were treated with SRT (n= 183), hypofractionated SRT (n = 30), and SRS (n = 11). 95/224 were treated with SRT/SRS alone. 129/224 patients underwent previous operations. Freedom from progression and overall survival, toxicity, and symptomatology were evaluated systematically. Additionally, tumor volume (TV) shrinkage was analyzed three-dimensionally within the planning system. Results: the median follow-up was 36 months (range, 12-100 months). Overall survival and freedom from progression for 5 years were 92.9% and 96.9%. Quantitative TV reduction was 26.2% and 30.3% 12 and 18 months after SRT/SRS (p < 0.0001). 95.9% of the patients improved their symptoms or were stable. Clinically significant acute toxicity (CTC III ) was rarely seen (2.5%). Clinically significant late morbidity (III -IV ) or new cranial nerve palsies did not occur. Conclusion: SRT offers an additional treatment option of high efficacy with only few side effects. In the case of large tumor size (> 4 ml) and adjacent critical structures (< 2 mm), SRT is highly recommended. (orig.)

  7. Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Jansen, Marc H. [Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam (Netherlands); Lauwers, Selmer J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Nowak, Peter J. [Department of Radiation Oncology, Erasmus Medical Centre, Rotterdam (Netherlands); Oldenburger, Foppe R. [Department of Radiation Oncology, Academic Medical Centre, Amsterdam (Netherlands); Bouffet, Eric [Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto (Canada); Saran, Frank [Department of Pediatric Oncology, The Royal Marsden NHS Foundation Trust, Sutton (United Kingdom); Kamphuis-van Ulzen, Karin [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Lindert, Erik J. van [Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Schieving, Jolanda H. [Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Boterberg, Tom [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium); Kaspers, Gertjan J. [Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam (Netherlands); Span, Paul N.; Kaanders, Johannes H. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Gidding, Corrie E. [Department of Pediatric Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Hargrave, Darren [Department of Oncology, Great Ormond Street Hospital, London (United Kingdom)

    2013-02-01

    Purpose: Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy given over 3 to 4 weeks. A 1:1 matched-cohort analysis with conventional radiation therapy was performed to assess response and survival. Methods and Materials: Twenty-seven children, aged 3 to 14, were treated according to 1 of 2 hypofractionation regimens over 3 to 4 weeks (39/3 Gy, n=16 or 44.8/2.8 Gy, n=11). All patients had symptoms for {<=}3 months, {>=}2 signs of the neurologic triad (cranial nerve deficit, ataxia, long tract signs), and characteristic features of DIPG on magnetic resonance imaging. Twenty-seven patients fulfilling the same diagnostic criteria and receiving at least 50/1.8 to 2.0 Gy were eligible for the matched-cohort analysis. Results: With hypofractionation radiation therapy, the overall survival at 6, 9, and 12 months was 74%, 44%, and 22%, respectively. Progression-free survival at 3, 6, and 9 months was 77%, 43%, and 12%, respectively. Temporary discontinuation of steroids was observed in 21 of 27 (78%) patients. No significant difference in median overall survival (9.0 vs 9.4 months; P=.84) and time to progression (5.0 vs 7.6 months; P=.24) was observed between hypofractionation vs conventional radiation therapy, respectively. Conclusions: For patients with newly diagnosed DIPG, a hypofractionation regimen, given over 3 to 4 weeks, offers equal overall survival with less treatment burden compared with a conventional regimen of 6 weeks.

  8. Saliva in relation to dental erosion before and after radiotherapy

    DEFF Research Database (Denmark)

    Jensdottir, Thorbjorg; von Buchwald, Christian; Nauntofte, Birgitte

    2013-01-01

    Abstract Objective. Low saliva flow and abnormal saliva composition are common conditions after radiotherapy for oral cavity and pharyngeal cancer. Both conditions increase the susceptibility to dental caries and erosion, which may be further accelerated by changes in food preferences. The aim of...

  9. Radiobiological evaluation of the radiation dose as used in high-precision radiotherapy: effect of prolonged delivery time and applicability of the linear-quadratic model.

    Science.gov (United States)

    Shibamoto, Yuta; Otsuka, Shinya; Iwata, Hiromitsu; Sugie, Chikao; Ogino, Hiroyuki; Tomita, Natsuo

    2012-01-01

    Since the dose delivery pattern in high-precision radiotherapy is different from that in conventional radiation, radiobiological assessment of the physical dose used in stereotactic irradiation and intensity-modulated radiotherapy has become necessary. In these treatments, the daily dose is usually given intermittently over a time longer than that used in conventional radiotherapy. During prolonged radiation delivery, sublethal damage repair takes place, leading to the decreased effect of radiation. This phenomenon is almost universarily observed in vitro. In in vivo tumors, however, this decrease in effect can be counterbalanced by rapid reoxygenation, which has been demonstrated in a laboratory study. Studies on reoxygenation in human tumors are warranted to better evaluate the influence of prolonged radiation delivery. Another issue related to radiosurgery and hypofractionated stereotactic radiotherapy is the mathematical model for dose evaluation and conversion. Many clinicians use the linear-quadratic (LQ) model and biologically effective dose (BED) to estimate the effects of various radiation schedules, but it has been suggested that the LQ model is not applicable to high doses per fraction. Recent experimental studies verified the inadequacy of the LQ model in converting hypofractionated doses into single doses. The LQ model overestimates the effect of high fractional doses of radiation. BED is particularly incorrect when it is used for tumor responses in vivo, since it does not take reoxygenation into account. For normal tissue responses, improved models have been proposed, but, for in vivo tumor responses, the currently available models are not satisfactory, and better ones should be proposed in future studies.

  10. Intraoperative radiotherapy in the theatre room with electron beams: technical and dosimetric description of Sordina LIAC accelerator; Radioterapia intraoperatoria en quirofano con haces de electrones: descripcion tecnica y dosimetrica del acelerador dedicado Sordina LIAC

    Energy Technology Data Exchange (ETDEWEB)

    Sendon del Rio, J. R.; Ayala Lazaro, R.; Gomez Cores, S.; Garcia Hernandez, M. J.; Polo Cezon, R.; Jimenez Rojas, R.; Lopez Bote, M. A.

    2015-05-01

    n this work we show our experience during the commissioning of a mobile electron-beam accelerator dedicated to intraoperative radiation therapy in the theatre room. The linac is a Sordina LIAC 12 MeV model with a hard-docking applicator system. We describe the linac, the measurement methods and the specific dosimetry. The dosimetric behavior is also discussed. Differences with other applicator systems can be explained from the particular head design of the linac. (Author)

  11. Comparison of Radiation-Induced Normal Lung Tissue Density Changes for Patients From Multiple Institutions Receiving Conventional or Hypofractionated Treatments

    Energy Technology Data Exchange (ETDEWEB)

    Diot, Quentin, E-mail: quentin.diot@ucdenver.edu [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Bentzen, Soren M. [Division of Biostatistics and Bioinformatics, University of Maryland Greenbaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (United States); Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Lawrence, Michael V. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Miften, Moyed [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Palma, David A. [London Regional Cancer Program, London, Ontario (Canada)

    2014-07-01

    Purpose: To quantitatively assess changes in computed tomography (CT)–defined normal lung tissue density after conventional and hypofractionated radiation therapy (RT). Methods and Materials: The pre-RT and post-RT CT scans from 118 and 111 patients receiving conventional and hypofractionated RT, respectively, at 3 institutions were registered to each other and to the 3-dimensional dose distribution to quantify dose-dependent changes in normal lung tissue density. Dose-response curves (DRC) for groups of patients receiving conventional and hypofractionated RT were generated for each institution, and the frequency of density changes >80 Hounsfield Units (HU) was modeled depending on the fractionation type using a Probit model for different follow-up times. Results: For the pooled data from all institutions, there were significant differences in the DRC between the conventional and hypofractionated groups; the respective doses resulting in 50% complication risk (TD{sub 50}) were 62 Gy (95% confidence interval [CI] 57-67) versus 36 Gy (CI 33-39) at <6 months, 48 Gy (CI 46-51) versus 31 Gy (CI 28-33) at 6-12 months, and 47 Gy (CI 45-49) versus 35 Gy (32-37) at >12 months. The corresponding m values (slope of the DRC) were 0.52 (CI 0.46-0.59) versus 0.31 (CI 0.28-0.34) at <6 months, 0.46 (CI 0.42-0.51) versus 0.30 (CI 0.26-0.34) at 6-12 months, and 0.45 (CI 0.42-0.50) versus 0.31 (CI 0.27-0.35) at >12 months (P<.05 for all comparisons). Conclusion: Compared with conventional fractionation, hypofractionation has a lower TD{sub 50} and m value, both suggesting an increased degree of normal tissue density sensitivity with hypofractionation.

  12. Radiotherapy for the medulloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Gose, Kyuhei; Imajo, Yoshinari; Imanaka, Kazufumi (Kobe Univ. (Japan). School of Medicine)

    1983-08-01

    Eighteen patients with medulloblastoma, treated between 1972 and 1981, at Kobe University School of Medicine, were retrospectively studied. Of those completing post operative irradiation,