Predictive value of bcl-2 immunoreactivity in prostate cancer patients treated with radiotherapy

International Nuclear Information System (INIS)

Bylund, A.; Widmark, A.; Stattin, P.; Bergh, A.

1998-01-01

Background and purpose: Recent experimental evidence suggests that overexpression of bcl-2, a protein functioning by blocking apoptosis, may influence the treatment outcome in human tumours, including prostate cancer. To test the clinical implications of this hypothesis, tumours from patients with prostate cancer treated with external beam radiotherapy were investigated for bcl-2 immunoreactivity (IR) and correlated with prognosis and treatment outcome. Materials and methods: Bcl-2 IR was evaluated in archival tumour specimens obtained through transurethral resection from 42 patients with localized prostate cancer (T0-T4, N0 and M0). Bcl-2 IR expression was related to stage, grade and cancer-specific survival. Specimens were obtained prior to administrating routine radiotherapy for all patients. Results: Bcl-2 IR was present in 19/42 (45%) tumours. The bcl-2-positive patients had a significantly longer cancer-specific survival than the bcl-2-negative patients (10.3 versus 3.4 years, P<0.04). At follow-up (7-19 years), nine patients were still alive, 26 patients had died of prostate cancer and seven patients had died of other causes. Conclusions: This study indicates that pre-treatment bcl-2 overexpression is related to a favourable outcome in prostate cancer treated with radiotherapy. Low bcl-2 along with a high stage may be a predictor of poor prognosis and these patients might benefit from additional treatment. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

The role of neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy

International Nuclear Information System (INIS)

Peters, Lester J.; Weber, Randal S.; Morrison, William H.; Byers, Robert M.; Garden, Adam S.; Goepfert, Helmuth

1996-01-01

Purpose: The role of neck surgery in node- positive patients whose primary tumours are treated by definitive radiotherapy is controversial. A planned neck dissection following radiotherapy is frequently recommended regardless of response of the neck nodes to treatment. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. Materials and Methods: The analysis is based on all 100 patients treated using the concomitant boost protocol described below who presented between 1984 and 1993 with primary squamous cell carcinomas of the oropharynx and clinically positive cervical lymphadenopathy. There were 73 males and 27 females with a median age of 59. Primary disease site was base of tongue 39, tonsil 40, soft palate 14 and pharyngeal wall 7. Nodal stages were N1: 35, N2: 51 and N3: 15. Nodal size varied from 1 - 9 cm with a median of 3 cm. Radiotherapy consisted of 54 Gy in 30 fractions over 6 weeks to large fields with a boost to gross disease of 18 Gy in 12 fractions being delivered as a second daily fraction during the last 2.4 weeks of treatment. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while the remaining 13 underwent neck dissection for presumed residual disease. Twenty-five patients had either node excision (8) or neck dissection (17) prior to radiotherapy. Results: There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who were operated for presumed residual disease (pathologically negative in 7) and 5 in the 25 patients who had initial neck surgery. Of the 62 patients who had a complete response to radiotherapy, the two year probability of neck control was 87% if the initial nodal size was ≤ 3 cm versus 85% for nodes > 3 cm. However the likelihood of

Preliminary result in patients with primary hepatoma treated by stereotactic radiotherapy

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Kang, Ki Mun; Choi, Ihl Bohng; Kim, In Ah; Choi, Byung Ock; Kang, Young Nam; Han, Sung Tae; Chung, Gyu Won [College of Medicine, Catholic Univ., Seoul (Korea, Republic of); Chai, Gyu Young [College of Medicine, Gyeongsang National Univ., Chinju (Korea, Republic of)

2001-03-01

It is not common to evaluate the response of the fractionated stereotactic radiotherapy (SRT) to primary hepatoma as compared with conventional radiotherapy. The purpose of the study was to take the preliminary result on the clinical trial of primary hepatoma by SRT. From July 1999 to March 2000, thirty three patients were hospitalized in the St. Mary's Hospital, and treated with SRT for extracranial tumors. Among them, 13 patients were diagnosed to primary hepatoma and then applied by frameless SRT using 6 MV linac accelerator. There were 12 male and 1 female patients. They had the age of 44-66 year old (median: 59) and the tumor size of 10-825 cc (median: 185 cc). SRT was given to them 3-5 fractions a week (5 Gy/fraction, 90% isodose line) for 2-3 weeks. Median dose of SRT was 50 Gy and the range was 30-50 Gy. Follow-up period ranged from 3 months to 13 months with median of 8 months. After treating SRT to thirteen patients with primary hepatoma, the response of the tumor was examined by abdominal CT: they are classified by 1 complete regression (7.7%), 7 partial regression (53.8%), 4 minimal regression (30.8%), 1 stable disease (7.7%). The positive responses more than partial remission were 8 patients (61.5%) after the treatment. The level of serum alpha-fetoprotein (AFP) after the treatment as compared with pretreatment had been 92.3% decreased. There was no severe complication except dyspepsia 84.6%, mild nausea 69.2%, transient decreased of hepatic function 15.4% and fever 7.7%. SRT to the patients with primary hepatoma was potentially suggested to become the safe and more effective tool than the conventional radiotherapy even though there were relatively short duration of follow-up and small numbers to be tested.

Outcome analysis of 300 prostate cancer patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy

International Nuclear Information System (INIS)

Higgins, Geoffrey S.; McLaren, Duncan B.; Kerr, Gillian R.; Elliott, Tony; Howard, Grahame

2006-01-01

Purpose: Neoadjuvant androgen deprivation and radical radiotherapy is an established treatment for localized prostate carcinoma. This study sought to analyze the outcomes of patients treated with relatively low-dose hypofractionated radiotherapy. Methods and Materials: Three hundred patients with T1-T3 prostate cancer were treated between 1996 and 2001. Patients were prescribed 3 months of neoadjuvant androgen deprivation before receiving 5250 cGy in 20 fractions. Patients' case notes and the oncology database were used to retrospectively assess outcomes. Median follow-up was 58 months. Results: Patients presented with prostate cancer with poorer prognostic indicators than that reported in other series. At 5 years, the actuarial cause-specific survival rate was 83.2% and the prostate-specific antigen (PSA) relapse rate was 57.3%. Metastatic disease had developed in 23.4% of patients. PSA relapse continued to occur 5 years from treatment in all prognostic groups. Independent prognostic factors for relapse included treatment near the start of the study period, neoadjuvant oral anti-androgen monotherapy rather than neoadjuvant luteinizing hormone releasing hormone therapy, and diagnosis through transurethral resection of the prostate rather than transrectal ultrasound. Conclusion: This is the largest reported series of patients treated with neoadjuvant androgen deprivation and hypofractionated radiotherapy in the United Kingdom. Neoadjuvant hormonal therapy did not appear to adequately compensate for the relatively low effective radiation dose used

Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance.

Science.gov (United States)

Sveistrup, Joen; af Rosenschöld, Per Munck; Deasy, Joseph O; Oh, Jung Hun; Pommer, Tobias; Petersen, Peter Meidahl; Engelholm, Svend Aage

2014-02-04

Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1-2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5-7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT. The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction.

Brain abnormalities on MRI in non-functioning pituitary adenoma patients treated with or without postoperative radiotherapy

NARCIS (Netherlands)

Sattler, Margriet G. A.; Meiners, Linda C.; Sluiter, Wim J.; van den Berg, Gerrit; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; van den Bergh, Alphons C. M.; van Beek, Andre P.

Background and purpose: To assess and compare brain abnormalities on Magnetic Resonance Imaging (MRI) in non-functioning pituitary macro-adenoma (NFA) patients treated with or without postoperative radiotherapy (RT). Material and methods: In 86 NFA patients, treated between 1987 and 2008 at the

Acute toxicity in prostate cancer patients treated with and without image-guided radiotherapy

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Williams Scott

2011-10-01

Full Text Available Abstract Background Image-guided radiotherapy (IGRT increases the accuracy of treatment delivery through daily target localisation. We report on toxicity symptoms experienced during radiotherapy treatment, with and without IGRT in prostate cancer patients treated radically. Methods Between 2006 and 2009, acute toxicity data for ten symptoms were collected prospectively onto standardized assessment forms. Toxicity was scored during radiotherapy, according to the Common Terminology Criteria Adverse Events V3.0, for 275 prostate cancer patients before and after the implementation of a fiducial marker IGRT program and dose escalation from 74Gy in 37 fractions, to 78Gy in 39 fractions. Margins and planning constraints were maintained the same during the study period. The symptoms scored were urinary frequency, cystitis, bladder spasm, urinary incontinence, urinary retention, diarrhoea, haemorrhoids, proctitis, anal skin discomfort and fatigue. Analysis was conducted for the maximum grade of toxicity and the median number of days from the onset of that toxicity to the end of treatment. Results In the IGRT group, 14228 toxicity scores were analysed from 249 patients. In the non-IGRT group, 1893 toxicity scores were analysed from 26 patients. Urinary frequency ≥G3 affected 23% and 7% in the non-IGRT and IGRT group respectively (p = 0.0188. Diarrhoea ≥G2 affected 15% and 3% of patients in the non-IGRT and IGRT groups (p = 0.0174. Fatigue ≥G2 affected 23% and 8% of patients in the non-IGRT and IGRT groups (p = 0.0271. The median number of days with a toxicity was higher for ≥G2 (p = 0.0179 and ≥G3 frequency (p = 0.0027, ≥G2 diarrhoea (p = 0.0033 and ≥G2 fatigue (p = 0.0088 in the non-IGRT group compared to the IGRT group. Other toxicities were not of significant statistical difference. Conclusions In this study, prostate cancer patients treated radically with IGRT had less severe urinary frequency, diarrhoea and fatigue during treatment

Chronic fatigue in cancer patients treated with radiotherapy

International Nuclear Information System (INIS)

Rucinska, M.; Wojtukiewicz, M.Z.; Tokajuk, P.

2004-01-01

Fatigue is one of the most prevalent and profound symptoms related to both malignancy and anti-neoplastic treatment. It is being reported in 60% to 80% of cancer patients. We review the correlation between the cancer-related fatigue syndrome and radiotherapy. In patients undergoing radiotherapy, fatigue is often cumulative and may reach its peak during the last weeks of treatment. The presence of fatigue prior to therapy initiation is the most important predictive factor of the occurrence of radiotherapy-related cancer fatigue syndrome. Occasionally, fatigue persists for a prolonged period of months and even years beyond radiotherapy. Anemia may be one of major causative factors responsible for the development of the cancer-related fatigue syndrome. Fatigue has an enormous physical, mental, emotional, and economic impact on cancer patients, their families and care-providers. The treatment of radiation-related fatigue remains unknown. The initial approach should cover efforts aimed at the correction of potential etiologies, especially anemia. Education concerning fatigue greatly benefits some patients. It seems that exercise may be beneficial in relieving fatigue, bearing in mind that the exercise program for cancer patients should be initiated gradually and significantly individualized. (author)

Invasive bladder cancer treated by radical external radiotherapy

International Nuclear Information System (INIS)

Corcoran, M.O.; Thomas, D.M.; Lim, A.; Berry, R.J.; Milroy, E.J.G.

1985-01-01

Fifty-three consecutive unselected patients with invasive bladder cancer, Stage T2 to T3, treated by radical radiotherapy have been reviewed. Cystectomy was reserved for patients with significant worsening of disease during treatment, histologically confirmed persistent or recurrent invasive tumour after treatment, or patients with intolerable symptoms due to radiation cystitis. In 64% of our patients a favourable tumour response to radiotherapy was seen, while a further 31% showed disease progression either during or on completion of radiotherapy. Cystectomy was performed on 22% of patients, mainly for radiation cystitis, and was not associated with a significant operative mortality rate. The crude 5-year survival rate was 42%. We conclude that radical radiotherapy is as effective as other forms of treatment for invasive bladder cancer, but that there remains a need to identify those bladder tumours destined to respond poorly to radiotherapy at an earlier stage. (author)

The role of radiotherapy in the management of extrahepatic bile duct cancer: an analysis of 145 consecutive patients treated with intraluminal and/or external beam radiotherapy

International Nuclear Information System (INIS)

Kamada, Tadashi; Saitou, Hiroya; Takamura, Akio; Nojima, Takayuki; Okushiba, Shun-Ichi

1996-01-01

Purpose: To determine the feasibility of high dose radiotherapy and to evaluate its role in the management of extrahepatic bile duct (EHBD) cancer. Methods and Materials: Between 1983 and 1991, 145 consecutive patients with EHBD cancer were treated by low dose rate intraluminal 192 Ir irradiation (ILRT) either alone or in combination with external beam radiotherapy (EBRT). Among the primarily irradiated, 77 patients unsuitable for surgical resection, 54 were enrolled in radical radiotherapy, and 23 received palliative radiotherapy. Fifty-nine received postoperative radiotherapy, and the remaining 9 preoperative radiotherapy. The mean radiation dose was 67.8 Gy, ranging from 10 to 135 Gy. Intraluminal 192 Ir irradiation was indicated in 103 patients, and 85 of them were combined with EBRT. Expandable metallic biliary endoprosthesis (EMBE) was used in 32 primarily irradiated patients (31 radical and 1 palliative radiotherapy) after the completion of radiotherapy. Results: The 1-, 3-, and 5-year actuarial survival rates for all 145 patients were 55%, 18%, and 10%, for the 54 patients treated by radical radiotherapy (mean 83.1 Gy), 56%, 13%, and 6% [median survival time (MST) 12.4 months], and for the 59 patients receiving postoperative radiotherapy (mean 61.6 Gy), 73%, 31%, and 18% (MST 21.5 months), respectively. Expandable metallic biliary endoprosthesis was useful for the early establishment of an internal bile passage in radically irradiated patients and MST of 14.9 months in these 31 patients was significantly longer than that of 9.3 months in the remaining 23 patients without EMBE placement (p < 0.05). Eighteen patients whose surgical margins were positive in the hepatic side bile duct(s) showed significantly better survival compared with 15 patients whose surgical margins were positive in the adjacent structure(s) (44% vs. 0% survival at 3 years, p < 0.001). No survival benefit was obtained in patients given palliative or preoperative radiotherapy

Usefulness of pulmonary scintigraphy in primary lung cancer patients treated by radiotherapy

International Nuclear Information System (INIS)

Mitomo, Osamu

1994-01-01

To assess the pulmonary function of lung cancer patients treated by radiotherapy, we tried qualitative and semiquantitative analysis of pulmonary scintigrams using 133 Xe and 99m Tc-MAA. Individual scores for ventilation, perfusion and the ventilation-perfusion ratio of tumor-bearing lungs were calculated on the basis of healthy control cases in order to analyze whether, and to what degree, the tumor-bearing lung was functionally impaired. The score was proportional to the severity of impairment, and when the ventilation and perfusion of tumor-bearing lungs had a score of one or greater than one, the tumor-bearing lung was functionally defined as an 'impaired lung'. Impaired lungs were demonstrated in 68% of tumor-bearing lungs. Hilar and left hilar-type cancers, clinically more advanced cancers, patients whose tumors were confirmed by bronchofiberscopy, small-cell and epidermoid cancers, etc., had higher rates of impairment and more severe impairment. Many patients with impaired lungs had a worse prognosis, but patients in whom scintigraphy showed improvement after radiotherapy had a better prognosis. It can be concluded that pulmonary scintigraphy scoring is capable of semiquantitatively indicating the degree of pulmonary impairment and is useful in deciding on a radiotherapeutic plan and predicting the outcome in pre- and post-radiotherapy lung cancer patients. (author)

Outcomes in 24 selected patients with stage IVB cervical cancer and excellent performance status treated with radiotherapy and chemotherapy

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Zighelboim, Israel; Taylor, Nicholas P.; Powell, Matthew A.; Gibb, Randall K.; Rader, Janet S.; Mutch, David G.; Grigsby, Perry W.

2006-01-01

We sought to review outcomes in patients with stage IVB carcinoma of the cervix treated with irradiation in combination with chemotherapy. We report outcomes of 24 consecutive patients with good performance status treated from 1998 to 2005. Most of these patients underwent concurrent irradiation with platinum-based chemotherapy. Some patients received subsequent systemic chemotherapy. All patients underwent external beam radiotherapy; 7 patients (29%) had additional high-dose-rate and 12 (50%) low-dose-rate brachytherapy. Two patients (8%) received an intensity modulated radiation therapy (IMRT) boost instead of brachytherapy. The mean dose to point A was variable (73.9±19.2 Gy). Twenty patients (83%) received radio-sensitizing platinum-based chemotherapy, and the remaining had radiotherapy alone. Seven patients (29%) had further combination chemotherapy. Therapy was well tolerated. The overall survival was 44% at 36 months and 22% at 5 years. Patients with stage IVB cervical cancer have mostly been treated with palliative intent. With the advent of concurrent chemoradiation, we have treated many of these cases with aggressive combination therapy. In this series, the use of radiotherapy and multiagent chemotherapy in patients with stage IVB cervical carcinoma and good performance status was well tolerated and resulted in higher survival rates than previously reported. (author)

Radiotherapy in digestive tumours in elderly patients; Radiotherapie dans les tumeurs digestives chez le patient age

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Guillerme, F.; Clavier, J.B.; Nehme-Schuster, H.; Schumacher, C.; Noel, G. [Centre de lutte contre le cancer Paul-Strauss, Strasbourg (France)

2011-10-15

The authors comment the taking into care of a digestive cancer in the case of elderly patient. These patients are treated by radiotherapy, operative radiotherapy with concomitant chemotherapy, or pre-operative radiotherapy, depending on the age, on the cancer type, with an adaptation of the total dose or with a hypo-fractionation of the treatment. Short communication

Patterns of failure in children with medulloblastoma treated with 3D conformal radiotherapy

International Nuclear Information System (INIS)

Skowronska-Gardas, Anna; Chojnacka, Marzanna; Morawska-Kaczynska, Marzena; Perek, Danuta; Perek-Polnik, Marta

2007-01-01

Background and purpose: Craniospinal irradiation for medulloblastoma is one of the most complex techniques employed in radiotherapy. Many reports stress the impact of irradiation quality on survival in these patients. Our report presents the outcome and patterns of failure for 95 patients treated with 3D conformal radiotherapy (3D-CRT). Materials and methods: From 1998 to 2003, 95 children with medulloblastoma received 3D conformal radiotherapy. All of them were previously treated with surgery and chemotherapy. The brain and upper spinal cord were treated with two lateral 6 MV photon fields. In four patients, the cribriform plate was irradiated by the additional field. For primary tumour bed we applied two or three photon beams. Spinal cord was irradiated either with 18-20 MeV electron fields or with a mixed beam. Results: With a median follow-up of 48 months, 32/95 patients suffered a multifocal (21) or isolated (11) recurrence. We evaluated every primary site of failure. In all patients, the recurrence appeared within the isodose level of 95-100%. Conclusions: Patterns of failure in medulloblastoma patients treated with 3D conformal radiotherapy indicated that the relapse was mainly associated with poor response to pre-irradiation chemotherapy. We believe that 3D conformal radiotherapy allows avoiding failures, related to radiotherapy uncertainties

Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance

International Nuclear Information System (INIS)

Sveistrup, Joen; Rosenschöld, Per Munck af; Deasy, Joseph O; Oh, Jung Hun; Pommer, Tobias; Petersen, Peter Meidahl; Engelholm, Svend Aage

2014-01-01

Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1–2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5–7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p < 0.001). For GU toxicity the numbers were 41.8% and 29.7%, respectively (p = 0.011). On multivariate analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p < 0.001, HR = 11.59 [CI: 6.67-20.14]). 3DCRT was also associated with an increased risk of developing GU toxicity compared to IG-IMRT. The 3-year actuarial biochemical progression-free survival probability was 86.0% for 3DCRT and 90.3% for IG-IMRT (p = 0.386). On multivariate analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT. The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction

Occult carcinoma discovered after simple hysterectomy treated with postoperative radiotherapy

International Nuclear Information System (INIS)

Crane, Christopher H.; Schneider, Bernard F.

1999-01-01

Purpose: Treatment of patients with occult carcinoma of the cervix discovered after simple hysterectomy is controversial. The purpose of this review is to examine our results with postoperative radiotherapy and to compare them to similar reports and to reports of treatment with radical parametrectomy. Methods and Materials: Between November 1979 and April:, 18 patients were treated with radiotherapy at the University of Virginia for invasive carcinoma of the cervix discovered after simple hysterectomy. Simple hysterectomy was performed in all 18 patients for a variety of indications. After surgery gross residual carcinoma remained in four patients; and microscopic disease was present at the surgical margins in two patients. The remaining patients had no evidence of residual disease. All 18 patients had postoperative radiotherapy with or without brachytherapy. The endpoints for this study were local control, survival, and treatment-related toxicity. Actuarial rates were calculated using the Life method. Results: Median follow-up for all 18 patients was 42 months (range 2-202 months). Both the 5 and the 10-year actuarial local control rates were 88%. Five and 10-year actuarial overall survival rates were both 93%. Two patients had both local and distant cancer recurrences. There were no recurrences among the six patients treated with external beam alone. The remaining patients are all alive without evidence of disease, including two patients who had gross residual disease after surgery, and one patient with both microscopic positive margin and a positive lymph node (the only patient to undergo lymph node sampling). There was no severe acute morbidity and only one patient had severe late morbidity. Conclusions: Invasive carcinoma found after simple hysterectomy may be treated safely and effectively with postoperative radiotherapy. Patients with known residual disease following surgery do poorly with either radiotherapy or reoperation, but treatment with radiotherapy

Effect of Whole Pelvic Radiotherapy for Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy and Long-Term Androgen Deprivation Therapy

International Nuclear Information System (INIS)

Mantini, Giovanna; Tagliaferri, Luca; Mattiucci, Gian Carlo; Balducci, Mario; Frascino, Vincenzo; Dinapoli, Nicola; Di Gesù, Cinzia; Ippolito, Edy; Morganti, Alessio G.; Cellini, Numa

2011-01-01

Purpose: To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT). Methods and materials: Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score ≥7 and/or prostate-specific antigen level ≥20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT). Results: A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12–38). With a median follow-up of 52 months (range, 20–150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p = NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p = .03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p = NS). Conclusions: Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.

Outcome of 289 locally advanced non-small cell lung cancer treated with radiotherapy alone and radiotherapy combined with chemotherapy

International Nuclear Information System (INIS)

Ou Guangfei; Wang Lvhua; Zhang Hongxing; Chen Dongfu; Xiao Zefen; Feng Qinfu; Zhou Zongmei; Lv Jima; Liang Jun; Wang Mei; Yin Weibo

2007-01-01

Objective: To retrospectively analyze the outcome of locally advanced non-small cell lung cancer patients treated with radiotherapy and chemoradiotherapy. Methods: 289 patients who were treated either by radiotherapy alone (168 patients) or radiotherapy plus chemotherapy (121 patients) from Dec. 1999 to Dec. 2002 were entered into the database for analysis. Pathological types: squamous cancer (152), adenocarcinoma(74), squamoadenocarcinoma(2) and other types (2). 24 showed cancer unclassificable and 35 were diagnosed without pathological proof. Stages: 74 had III A and 215 III B stage disease. Among the 121 patients treated with combined modality, 24 were treated with concurrent chemoradiotherapy, 78 radiotherapy after chemotherapy(C + R), and 19 radiotherapy followed by chemotherapy(R + C). In patients treated by concurrent chemoradiotherapy or C + R, 38 received consolidation chemotherapy after induction treatment. Results: The 1-, 3-, 5-year overall survival, and the median survival were: 45% , 16% , 8%, and 16.2 months for all patients; 57%, 27%, 11%, and 21.7 months for stage IIIA; 41%, 12%, 7%, and 15.3 months for IIIB. By logrank test, clinical stage, KPS performance, tumor volume, hemoglobin level before treatment, consolidation chemotherapy, radiation dose, and response to treatment showed statistically dramatic impact on overall survival. The overall survival rate and median survival time were slightly higher in the combined group than in the radiotherapy alone group, but the difference is statistically insignificant. In Cox multivariable regression, stage and consolidation chemotherapy were independent prognostic factors; KPS performance, radiation dose, and response to treatment were at the margin of statistical significance. Esophagitis and pneumonitis of Grade II or higher were 24% and 8%, respectively. Failure sites included in the thorax(41%), outside of thorax(48%), and both in and outside the thorax(11%). There was no difference between the

Factors influencing the treatment outcome for patients with T2N0 glottic carcinoma treated by definitive radiotherapy

International Nuclear Information System (INIS)

Fukuda, Ichiro; Kanehira, Chihiro; Kobayashi, Masao; Aoki, Manabu; Takagi, Sayako; Shirahama, Jun; Honda, Chikara

2007-01-01

The purpose of this study was to determine the prognostic factors affecting local outcomes for patients with T2N0 glottic carcinoma treated by definitive radiotherapy. A total of 48 patients with T2N0 squamous cell carcinoma treated by definitive radiotherapy between 1992 and 2005 were studied. Cumulative probability of overall survival, cause-specific survival, local control and larynx-preserving were calculated according the Kaplan-Meier method, and the prognostic significance of patient's age, number of subsites involved, impaired cord mobility, anterior commisure involved, total dose and overall treatment time were analyzed using the log-rank test in univariate analysis and Cox regression in multivariate analysis. Follow-up ranged from 13 to 141 months (median, 62 months). Five-year survivals were: overall, 95.3%; cause-specific, 97.9% and five years rates were local control, 61.4%; larynx-preserving, 76.4%. Multivariate analyses of the six parameters showed that overall treatment time significantly influenced the probability of local control, and impaired mobility and overall treatment time affected the probability of larynx-preserving. Our study showed that longer overall treatment time significantly worsened the percentage of local control and larynx-preserving for patients with T2N0 glottic carcinoma treated with definitive radiotherapy. Therefore, we suggest treating, the patients in a shorter treatment course. (author)

The evaluation of results and complications of radiotherapy in children treated for orbital rhabdomyosarcoma

International Nuclear Information System (INIS)

Skowronska-Gardas, A.; Pedziwiatr, K.; Chojnacka, M.

2002-01-01

To analyse treatment results and late complications of radiotherapy in children treated for orbital rhabdomyosarcoma. Between the years 1980 and 2000 34 children (median age 7 yrs. range: 1-15) with orbital RMS, were treated in the 1st Department of the MCCMCC in Warsaw. All but two of the patients received induction chemotherapy; 3 children were treated after ablative surgery (exenteration); 6 children were irradiated due to recurrence after chemotherapy. All the children were treated with megavoltage radiotherapy from a Co-60 unit or linear accelerator. We applied individual lens and lacrimal apparatus shielding in 16 patients. Five children, treated between 1996-2000, received conformal radiotherapy, with CT and 3-D treatment planning system.To obtain information about late side effects, we developed a questionnaire, including questions about the status of the affected eye, appearance of the orbit and facial structures.Thirty one patients (91%) are still living (between 24 and 264 months - median 138 mos) after completion of radiotherapy and 28 (82%) with no recurrence. In six patients treated due to recurrent tumour OS and DFS was 80% and 60%, respectively. Late complications were evaluated in 24 patients. We observed lacrimal duct stenosis in 33%, cataract in 29%, enophtalmos in 20% of patients. Retinopathy developed in 2 children, glaucoma in 2 pts, and facial asymmetry in 3 pts. In one case enucleation of blind eye was performed. Thirteen children have preserved adequate vision in the treated eye. In children treated with conformal radiotherapy we did not observe any late complications. Radiotherapy in orbital RMS allows to obtain good local control and excellent survival rate. Late complications could be limited with the application of individual treatment planning and conformal radiotherapy. (author)

Characteristics of female patients with primary lung cancer treated with radiotherapy

International Nuclear Information System (INIS)

Shiojima, Kazumi; Hayakawa, Kazushige; Nakayama, Yuko; Saito, Yoshihiro; Mitomo, Osamu; Katano, Susumu; Mitsuhashi, Norio; Niibe, Hideo

1993-01-01

From 1976 to 1985, 402 patients with primary lung cancer were treated with radiotherapy at our hospital. There were 75 female patients who formed the basis of our analysis. Comparing the characteristics of female and male patients, the predominant characteristics of the female patients were as follows; 1) larger proportion of the patients with adenocarcinoma, 2) higher percentage of stage 4 patients, 3) lower average age, 4) better performance status (PS), 5) lower frequency of lethal complications, and 6) higher frequency of more than two admissions. The prognosis of female patients was better than that of males. The favorable characteristics of female patients for prognosis, were lower average age, better PS, and lower frequency of lethal complications. A higher frequency of admission to hospital might be a favorable characteristics for female patients to extend survival in patients with recurrence disease. (author)

Cytokine levels as biomarkers of radiation fibrosis in patients treated with breast radiotherapy

International Nuclear Information System (INIS)

Westbury, Charlotte B; Yarnold, John R; Haviland, Joanne; Davies, Sue; Gothard, Lone; Abdi, Bahja Ahmed; Sydenham, Mark; Bowen, Jo; Stratton, Richard; Short, Susan C

2014-01-01

Radiation fibrosis is not easily measurable although clinical scores have been developed for this purpose. Biomarkers present an alternative more objective approach to quantification, and estimation in blood provides accessible samples. We investigated if blood cytokines could be used to measure established fibrosis in patients who have undergone radiotherapy for breast cancer. We studied two cohorts treated by breast-conserving surgery and radiotherapy in the UK START Trial A, one with breast fibrosis (cases) and one with no or minimal fibrosis (controls). Two candidate cytokines, plasma connective tissue growth factor (CTGF) and serum interleukin-6 (IL6) were estimated by ELISA. Comparisons between cases and controls used the t-test or Mann–Whitney test and associations between blood concentration and clinical factors were assessed using the Spearman rank correlation coefficient. Seventy patients were included (26 cases, 44 controls). Mean time since radiotherapy was 9.9 years (range 8.3-12.0). No statistically significant differences between cases and controls in serum IL6 (median (IQR) 0.84 pg/ml (0.57-1.14), 0.75 pg/ml (0.41-1.43) respectively) or plasma CTGF (331.4 pg/ml (234.8-602.9), 334.5 pg/ml (270.0-452.8) were identified. There were no significant associations between blood cytokine concentration and age, fibrosis severity, breast size or time since radiotherapy. No significant difference in IL6 or CTGF concentrations was detected between patients with breast fibrosis and controls with minimal or no fibrosis

Analysis of oral cancer treated by preoperative radiotherapy

International Nuclear Information System (INIS)

Hosokawa, Yoichiro; Kaneko, Masayuki; Yasuda, Motoaki

1997-01-01

Fifty-eight patients with squamous cell carcinoma of the oral region, treated by preoperative radiotherapy between January 1988 and December 1993, were reviewed to evaluate the relation between prognosis and pathological findings after preoperative radiotherapy. All patients underwent external radiotherapy of up to 40 Gy in 16 fractions (2.5 Gy a day, 4 fractions a week) before surgery, and the average term from the end of preoperative radiotherapy to surgery were 27.3 days. According to pathological findings during surgery, the patients were divided into a radiation effective group and a radiation noneffective group. There was a significant difference in the survival rates of the two groups, but there was no difference in local control rates. After surgery, regional lymph node metastasis and distant metastasis were more common in the radiation noneffective group than in the radiation effective group. It was considered that regional lymph node metastasis after treatment in the noneffective group is the determining factor in the progress. (author)

Organ Preservation Using Contact Radiotherapy for Early Rectal Cancer: Outcomes of Patients Treated at a Single Centre in the UK.

Science.gov (United States)

Dhadda, A S; Martin, A; Killeen, S; Hunter, I A

2017-03-01

Contact radiotherapy for early rectal cancer uses 50 kV X-rays to treat rectal cancers under direct vision. We present data of a series of patients treated at a single centre with prospective follow-up and functional assessment. All patients were treated at the Queen's Centre for Oncology, Hull, UK between September 2011 and October 2015. Patients received a biopsy, magnetic resonance imaging (MRI) of the liver/pelvis, computed tomography of the chest and endorectal ultrasound. Patients were deemed to be either unfit for radical surgery or refused it due to the need for a permanent stoma. Follow-up consisted of 3 monthly flexible sigmoidoscopy and MRI of the liver/pelvis and 12 monthly computed tomography of the chest. In total, 42 patients were treated with contact radiotherapy ± external beam chemo/radiotherapy without any primary surgical excision. The median age was 78 years (range 50-94 years). Local recurrence-free survival was 88%, disease-free survival was 86% and overall survival was 88% with a median follow-up of 24 months (range 5-54 months). The median time to recurrence was 12 months (range 4-14 months). The estimated 30 day surgical mortality for this cohort with radical surgery was 12%. Mortality from the contact radiotherapy procedure was 0%. Functional outcomes as investigated by the Low Anterior Resection Syndrome (LARS) score were good, with 65% having no LARS. Contact radiotherapy for early rectal cancer is a safe, well-tolerated outpatient procedure, allowing organ preservation, with excellent oncological and functional outcomes. For elderly co-morbid patients with suitable rectal cancers this should be considered as a standard of care. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Assessment of long-term quality of life of esophageal carcinoma patients treated with continuous accelerated hyperfractionated and late-course accelerated hyperfractionated radiotherapy

International Nuclear Information System (INIS)

Wang Yang; He Shaoqin; Shi Xuehui; Jiang Kaida; Yao Weiqiang; Wang Ying

2002-01-01

Objective: To compare the long-term quality of life in esophageal carcinoma patients treated with continuous accelerated hyperfractionated (CAHF) and late-course accelerated hyperfractionated (LCAF) radiotherapy. Methods: Subjective and Objective Management Analysis (SOMA) scale, Symptom Checklist 90 (SCL-90) and Life Satisfaction Index A (LSIA) questionnaire were mailed to the long survivors in both CAHF and LCAF groups to assess the long-term quality of life including symptoms, psychological status and life satisfaction. Results: There was no significant difference between the two groups in the score of quality of life such as late radiation reaction, SCL-90 and LSI-A. Conclusions: 1. It is reasonable to assess the quality of life with these scales for esophageal carcinoma patients treated with radiotherapy, 2. Preliminary results demonstrate that there is no significant difference in long-term quality of life between the CAHF and LCAF radiotherapy groups, 3. Methods of evaluating the long-term quality of life for esophageal carcinoma patients treated with radiotherapy needs further investigation, preferably involving more patients and setting on control arm

Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

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Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

2012-02-01

Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

International Nuclear Information System (INIS)

Clavel, Sébastien; Nguyen, David H.A.; Fortin, Bernard; Després, Philippe; Khaouam, Nader; Donath, David; Soulières, Denis; Guertin, Louis; Nguyen-Tan, Phuc Felix

2012-01-01

Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

The pitfalls of treating anorectal conditions after radiotherapy for prostate cancer.

LENUS (Irish Health Repository)

Thornhill, J A

2012-03-01

We present a salutary lesson learned from three cases with significant complications that followed anorectal intervention in the presence of radiation proctitis due to prior radiotherapy for adenocarcinoma of the prostate. After apparent routine rubber band ligation for painful haemorrhoids, one patient developed a colo-cutaneous fistula. Following laser coagulation for radiation proctitis, one patient required a pelvic exenteration for a fistula, while another developed a rectal stenosis. Those diagnosing and treating colonic conditions should be mindful of the increased prevalence of patients who have had radiotherapy for prostate cancer and the potential for complications in treating these patients.

Diagnosis and treatment of fatigue and depression in the patient treated with radiotherapy

International Nuclear Information System (INIS)

Greenberg, Donna B.; Piper, Barbara F.

1995-01-01

The purpose of this course is to clarify the diagnosis of when the diagnosis of major depressive disorder is appropriate for the cancer patient treated with radiotherapy. Specific anxiety syndromes and confounding differential diagnoses will be considered. We will consider the relationship between depression and anxiety and the symptom of radiation-induced fatigue. The review will also include the psychopharmacology of common antidepressants and antianxiety agents

Neuropsychological evaluation of patients with inoperable non-small cell lung cancer treated with combination chemotherapy or radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Kaasa, S; Olsnes, B T; Mastekaasa, A

1988-01-01

Neuropsychological tests were used to evaluate possible central nervous system dysfunction in patients treated with chemotherapy. Ninety-five patients with non-small cell lung cancer limited disease were randomized to either radiotherapy (2.8 Gyx15) or combination chemotherapy with cisplatin and etoposide. In order to evaluate cognitive functions three neuropsychological tests were applied: Trail Making, Benton Visual Retention Test and Verbal Learning. Changes in the patients' test scores before and after treatment were compared. The chemotherapy patients showed reduced performance on some of the neuropsychological tests compared to the radiotherapy group. This indicates a treatment related effect on the central nervous system, possibly caused by the combination chemotherapy.

Neuropsychological evaluation of patients with inoperable non-small cell lung cancer treated with combination chemotherapy or radiotherapy

International Nuclear Information System (INIS)

Kaasa, S.; Olsnes, B.T.; Mastekaasa, A.

1988-01-01

Neuropsychological tests were used to evaluate possible central nervous system dysfunction in patients treated with chemotherapy. Ninety-five patients with non-small cell lung cancer limited disease were randomized to either radiotherapy (2.8 Gyx15) or combination chemotherapy with cisplatin and etoposide. In order to evaluate cognitive functions three neuropsychological tests were applied: Trail Making, Benton Visual Retention Test and Verbal Learning. Changes in the patients' test scores before and after treatment were compared. The chemotherapy patients showed reduced performance on some of the neuropsychological tests compared to the radiotherapy group. This indicates a treatment related effect on the central nervous system, possibly caused by the combination chemotherapy. (orig.)

Immunological factors correlated in radiation effect in cancer patients treated by radiotherapy alone or radiotherapy with combined chemotherapy

International Nuclear Information System (INIS)

Kimura, Shuji

1981-01-01

Local immunological factors are thought to be parenchymal reaction of normal and tumor tissues. Those were studied by morphological changes of angiographic findings and histological methods which included photomicroscopic, electromicroscopic and enzymic-histochemical studies. It was demonstrated that the effect of radiotherapy depended on not only local blood supply but also parenchymal reaction of the host. Especially, the parenchymal reaction at 2000 or 3000 rad irradiation was regarded as nonspecific tissue repair as well as immunological protective reactions brought about by enhancement of the tumor antigenicity. It was proved that T-cell system played a main role in this parenchymal reaction. Changes of systemic immunological factors were studied in 17 laryngeal cancer and 80 lung cancer patients treated by radiotherapy alone or radiotherapy with combined chemotherapy. Due to the fact that damages of the host before treatment were not so serious and integral dose given to the patients was a little in cases of laryngeal cancer immunological parameters such as absolute lymphocyte counts, PHA and PPD skin test activities, lymphocyte blastoid transformation with PHA, PWM and Con A, did not show significant change. However, as for lung cancer treated by large integral dose irradiation combined with chemotherapy, immunological parameters were depressed in inverse proportion to the dose of irradiation and chemotherapeutic agents. Moreover T-cell subsets (early E-rosette forming cells, IgG Fc-receptor positive cells), lymphocyte sub-populations, ADCC activity, serum immunoglobulins, and serum protein were also investigated in cases of lung cancer. We have evaluated the immunological parameters in relation to the therapeutic effect. As a result, it was suggested that several parameters should be needed to forecast the prognosis. (author)

Hypothyroidism in patients treated with radiotherapy for head and neck carcinoma: standardised long-term follow-up study.

Science.gov (United States)

Alba, J R; Basterra, J; Ferrer, J C; Santonja, F; Zapater, E

2016-05-01

Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients. Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma. Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology). Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).

Second Malignanat Solid Neoplasms in Children Treated with Radiotherapy-Report of Two Cases and Review of Literature

International Nuclear Information System (INIS)

Chung, Eun Ji; Suh, Chang Ok; Kim, Gwi Eon; Lyu, Chuhl Joo; Kim, Byung Soo

1995-01-01

Radiotherapy and chemotherapy can effectively control cancer but can also cause new second cancers to develop as long-term complications especially in childhood cancer. We experienced two patients with second malignant solid neoplasm who had been treated with radiation and chemotherapy for childhood cancers. One female patients with rhabdomyosarcoma of the right popliteal fossa was treated with radiotherapy at total dose of 54 Gy. Three years and seven months later, osteosarcoma developed in the field of radiation therapy. The other male patient with non-Hodgkin's lymphoma of the small bowel was treated with radiotherapy and leiomyosarcoma developed in the field of radiotherapy 18 years later. We reviewed the literature of the second malignant neoplasm in children in respect of risk factors. The risk for a second primary cancer following radiotherapy or chemotherapy emphasizes the need for life long follow-up of patients receiving such treatments. Particularly patients treated for childhood cancers

TGFB1 Single Nucleotide Polymorphisms Are Associated With Adverse Quality of Life in Prostate Cancer Patients Treated With Radiotherapy

International Nuclear Information System (INIS)

Peters, Christopher A.; Stock, Richard G.; Cesaretti, Jamie A.; Atencio, David P.; Peters, Sheila B.A.; Burri, Ryan J.; Stone, Nelson N.; Ostrer, Harry; Rosenstein, Barry S.

2008-01-01

Purpose: To investigate whether the presence of single nucleotide polymorphisms (SNPs) located within TGFB1 might be predictive for the development of adverse quality-of-life outcomes in prostate cancer patients treated with radiotherapy. Methods and Materials: A total of 141 prostate cancer patients treated with radiotherapy were screened for SNPs in TGFB1 using DNA sequencing. Three quality-of-life outcomes were investigated: (1) prospective decline in erectile function, (2) urinary quality of life, and (3) rectal bleeding. Median follow-up was 51.3 months (range, 12-138 months; SD, 24.4 months). Results: Those patients who possessed either the T/T genotype at position -509, the C/C genotype at position 869 (pro/pro, codon 10) or the G/C genotype at position 915 (arg/pro, codon 25) were significantly associated with the development of a decline in erectile function compared with those who did not have these genotypes: 56% (9 of 16) vs. 24% (11 of 45) (p = 0.02). In addition, patients with the -509 T/T genotype had a significantly increased risk of developing late rectal bleeding compared with those who had either the C/T or C/C genotype at this position: 55% (6 of 11) vs. 26% (34 of 130) (p = 0.05). Conclusions: Possession of certain TGFB1 genotypes is associated with the development of both erectile dysfunction and late rectal bleeding in patients treated with radiotherapy for prostate cancer. Therefore, identification of patients harboring these genotypes may represent a means to predict which men are most likely to suffer from poor quality-of-life outcomes after radiotherapy for prostate cancer

Outcome and late complications of radiotherapy in patients with unicentric Castleman disease

International Nuclear Information System (INIS)

Neuhof, Dirk; Debus, Juergen

2006-01-01

Castleman disease is a rare lymphoproliferative disorder. Surgery is considered standard therapy for the unicentric type. However, case reports have documented favorable responses to radiotherapy. The aim of this study was to analyse the clinical outcomes of five patients with unicentric Castleman disease treated with radiotherapy between 1991 and 2005. Mediastinal lymph nodes were the most common site of disease (four patients). Three patients were treated with radiotherapy alone, two patients with surgery and radiotherapy. Patients were treated with radiotherapy doses ranging from 40 Gy to 50 Gy. The median follow-up was 12 months (range, 3-175 months). During follow-up only one patient had progressive disease and died of Castleman disease. At the time of last follow-up two patients were in complete remission, one patient in partial remission, and one patient had stable disease. One patient showed serious acute and late toxicities. At the end of radiotherapy a paraneoplastic pemphigus vulgaris occurred, and eight to 11 months after radiotherapy a stenosis of the esophagus, of the left bronchus, and of the trachea due to scars. The study shows that unicentric Castleman disease is successfully treated with radiotherapy. However, for detection of possible complications as pemphigus vulgaris or stenosis of the esophagus or trachea an accurate follow-up is necessary

Factors Influencing Neurocognitive Outcomes in Young Patients With Benign and Low-Grade Brain Tumors Treated With Stereotactic Conformal Radiotherapy

International Nuclear Information System (INIS)

Jalali, Rakesh; Mallick, Indranil; Dutta, Debnarayan

2010-01-01

Purpose: To present the effect of radiotherapy doses to different volumes of normal structures on neurocognitive outcomes in young patients with benign and low-grade brain tumors treated prospectively with stereotactic conformal radiotherapy (SCRT). Methods and Materials: Twenty-eight patients (median age, 13 years) with residual/progressive brain tumors (10 craniopharyngioma, 8 cerebellar astrocytoma, 6 optic pathway glioma and 4 cerebral low-grade glioma) were treated with SCRT to a dose of 54 Gy in 30 fractions over 6 weeks. Prospective neuropsychological assessments were done at baseline before RT and at subsequent follow-up examinations. The change in intelligence quotient (IQ) scores was correlated with various factors, including dose-volume to normal structures. Results: Although the overall mean full-scale IQ (FSIQ) at baseline before RT remained unchanged at 2-year follow-up after SCRT, one third of patients did show a >10% decline in FSIQ as compared with baseline. Logistic regression analysis demonstrated that patients aged 10% drop in FSIQ than older patients (53% vs. 10%, p = 0.03). Dosimetric comparison in patients showing a >10% decline vs. patients showing a 43.2 Gy to >13% of volume of the left temporal lobe were the ones to show a significant drop in FSIQ (p = 0.048). Radiotherapy doses to other normal structures, including supratentorial brain, right temporal lobe, and frontal lobes, did not reveal any significant correlation. Conclusion: Our prospectively collected dosimetric data show younger age and radiotherapy doses to left temporal lobe to be predictors of neurocognitive decline, and may well be used as possible dose constraints for high-precision radiotherapy planning.

Clinical Outcome in Posthysterectomy Cervical Cancer Patients Treated With Concurrent Cisplatin and Intensity-Modulated Pelvic Radiotherapy: Comparison With Conventional Radiotherapy

International Nuclear Information System (INIS)

Chen, M.-F.; Tseng, C.-J.; Tseng, C.-C.; Kuo, Y.-C.; Yu, C.-Y.; Chen, W.-C.

2007-01-01

Purpose: To assess local control and acute and chronic toxicity with intensity-modulated radiation therapy (IMRT) as adjuvant treatment of cervical cancer. Methods and Materials: Between April 2002 and February 2006, 68 patients at high risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy. Adjuvant chemotherapy consisted of cisplatin (50 mg/m 2 ) for six cycles every week. Thirty-three patients received adjuvant radiotherapy by IMRT. Before the IMRT series was initiated, 35 other patients underwent conventional four-field radiotherapy (Box-RT). The two groups did not differ significantly in respect of clinicopathologic and treatment factors. Results: IMRT provided compatible local tumor control compared with Box-RT. The actuarial 1-year locoregional control for patients in the IMRT and Box-RT groups was 93% and 94%, respectively. IMRT was well tolerated, with significant reduction in acute gastrointestinal (GI) and genitourinary (GU) toxicities compared with the Box-RT group (GI 36 vs. 80%, p = 0.00012; GU 30 vs. 60%, p = 0.022). Furthermore, the IMRT group had lower rates of chronic GI and GU toxicities than the Box-RT patients (GI 6 vs. 34%, p = 0.002; GU 9 vs. 23%, p = 0.231). Conclusion: Our results suggest that IMRT significantly improved the tolerance to adjuvant chemoradiotherapy with compatible locoregional control compared with conventional Box-RT. However, longer follow-up and more patients are needed to confirm the benefits of IMRT

Long term outcome of adolescent and adult patients with pineal parenchymal tumors treated with fractionated radiotherapy between 1982 and 2003 -- a single institution's experience

International Nuclear Information System (INIS)

Stoiber, Eva Maria; Schaible, Benjamin; Herfarth, Klaus; Schulz-Ertner, Daniela; Huber, Peter E; Debus, Jürgen; Oertel, Susanne

2010-01-01

To evaluate the effectivity of fractionated radiotherapy in adolescent and adult patients with pineal parenchymal tumors (PPT). Between 1982 and 2003, 14 patients with PPTs were treated with fractionated radiotherapy. 4 patients had a pineocytoma (PC), one a PPT with intermediate differentiation (PPTID) and 9 patients a pineoblastoma (PB), 2 of which were recurrences. All patients underwent radiotherapy on the primary tumor site with a median total dose of 54 Gy. In 9 patients with primary PB treatment included whole brain irradiation (3 patients) or irradiation of the craniospinal axis (6 patients) with a median total dose of 35 Gy. Median follow-up was 123 months in the PC patients and 109 months in the patients with primary PB. 7 patients were free from relapse at the end of follow-up. One PC patient died from spinal seeding. Among 5 PB patients treated with radiotherapy without chemotherapy, 3 developed local or spinal tumor recurrence. Both patients treated for PB recurrences died. The patient with PPTID is free of disease 7 years after radiotherapy. Local radiotherapy seems to be effective in patients with PC and some PPTIDs. Diagnosis and treatment of patients with more aggressive variants of PPTIDs as well as treatment of PB needs to be further improved, since local and spinal failure even despite craniospinal irradiation (CSI) is common. As PPT are very rare tumors, treatment within multi-institutional trials remains necessary

Prognostic significance of the PC10 index for patients with stage II and III oesophageal cancer treated with radiotherapy

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Sugahara, Shinji; Irie, Toshiyuki; Nozawa, Kumiko; Nakajima, Kotaro [Hitachi General Hospital, Ibaraki (Japan). Dept. of Radiology; Ohara, Kiyoshi; Itai, Yuji [Tsukuba Univ., Ibaraki (Japan). Dept. of Radiology; Takahashi, Atsushi [Hitachi General Hospital, Ibaraki (Japan). Dept. of Pathology; Watanabe, Teruo [Tsukuba Univ., Ibaraki (Japan). Dept. of Pathology; Tanaka, Naomi [Tsukuba Univ., Ibaraki (Japan). Dept. of Internal Medicine

1999-07-01

The monoclonal antibody PC10 is used for immunohistochemical staining of the proliferating cell nuclear antigen (PCNA). The percentage of PC10-positive cancer cells is defined as the PC10 index. We evaluated the relationship between the PC10 index in pretreatment endoscopic biopsies and the prognoses of 47 patients with Stage II-III oesophageal squamous cell carcinoma treated with radiotherapy. The patients with a PC10 index >40% had significantly poorer prognoses than the other patients (p=0.0007). Proportional hazards model analysis indicated that only the PC10 index was a prognostic factor (p=0.0009). The patient group of complete responders showed significantly lower PC10 indices compared to patients with a partial response or no change (p=0.049). The PC10 index can be a good predictive indicator of the prognosis in patients with Stage II-III oesophageal cancer treated with radiotherapy. (orig.)

Anaplastic thyroid carcinoma: 91 patients treated by surgery and radiotherapy

International Nuclear Information System (INIS)

Junor, E.J.; Paul, J.; Reed, N.S.

1992-01-01

Ninety-one patients with histologically proven anaplastic carcinoma of the thyroid were referred to the Beatson Oncology Centre between 1961 and 1986. The female:male ratio was 2.4:1 and the median age at presentation was 70 (range 38-92) years. All patients had a thyroid mass at presentation and the most common symptoms were dyspnoea, dyspnagia and dysphonia. Five patients had a total thyroidectomy and 28 partial thyroidectomy. Ninety five per cent of patients received external beam radiotherapy. Results show dyspnoea to be the only symptom strongly influencing survival. Total or partial thyroidectomy is associated with increased survival. This association is most marked for patients presenting without dyspnoea. Eighty per cent of patients responded to radiotherapy. (Author)

Anaplastic thyroid carcinoma: 91 patients treated by surgery and radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Junor, E.J.; Paul, J.; Reed, N.S. (Beatson Oncology Centre, Glasgow (United Kingdom))

1992-04-01

Ninety-one patients with histologically proven anaplastic carcinoma of the thyroid were referred to the Beatson Oncology Centre between 1961 and 1986. The female:male ratio was 2.4:1 and the median age at presentation was 70 (range 38-92) years. All patients had a thyroid mass at presentation and the most common symptoms were dyspnoea, dyspnagia and dysphonia. Five patients had a total thyroidectomy and 28 partial thyroidectomy. Ninety five per cent of patients received external beam radiotherapy. Results show dyspnoea to be the only symptom strongly influencing survival. Total or partial thyroidectomy is associated with increased survival. This association is most marked for patients presenting without dyspnoea. Eighty per cent of patients responded to radiotherapy. (Author).

Tendency of quality of life in patients with nasopharyngeal carcinoma treated with conventional radiotherapy

International Nuclear Information System (INIS)

Xiao Weiwei; Lu Taixiang; Li Jiaxin; Liu Qing; Zhao Chong; Han Fei; Wang Hanyu

2010-01-01

Objective: To investigate the tendency of quality of life in patients with nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy. Methods: Quality of life in NPC patients was assessed using FACT-H and N and NPC-QOL Patients were divided into nine groups according to the treatment period :before treatment group, 0 -20 Gy group, 20 -50 Gy group, > 50 Gy group, 0 -6 months after treatment group, 6 - 12 mouths group, 1 -2 years group, 2 -3 years group and 3 -5 years group. Scores of FACT-H and N and NPC-QOL were compared between the either two groups. Results: 450 NPC patients were assessed. The total score of FACT-H and N decreased during the treatment and then increased six months after the treatment. The tendencies of physical and functional well-being were similar. The social/family and emotional well-being did not change significantly along with the treatment but the scores of head and neck well-being and NPC-QOL decreased obviously. Xerotomia was aggravated from the initiation of treatment and became the most severe at 6 - 12 months after treatment. 50% - 60% of the patients with disease-free reported severe xerotomia at 3 -5 years after radiotherapy. Incidence of severe trismus increased up to 14% at 3 -5 years after treatment. Conclusions: Quality of life of NPC patients with conventional radiotherapy deteriorates during the treatment period, but recovers to the normal level six months after the treatment. Xerotomia and trismus can affect the quality of life of NPC patients. (authors)

Clinical outcome and cosmetics in breast cancer patients treated with conservative surgery and radiotherapy

International Nuclear Information System (INIS)

Li Rongqing; Jin Yening; Wang Yajie

2005-01-01

Objective: To evaluate the effectiveness and the cosmetics result of radiotherapy after conservative surgery for early breast cancer. Methods: Altogether 109 patients were treated by post-operative whole-breast irradiation and a tumor bed boost from May, 1995 to December, 2002. Among them 79 cases received a brachytherapy boost ( 192 Ir HDR implant Nucletron ) of 10-12 Gy(DB) by single plan of implantation with 1.5 cm between the needles for T1 and double plan for T2-4 tumors, and 30 cases received an electron beam boost with 15 Gy. External beam irradiation was applied to the whole breast with 45-52 Gy(mean 48.6 Gy) in 25 fractions over 5 weeks followed or concurrently with chemotherapy (CMF or CEF) and hormonotherapy. The cosmetic result was scored by a doctor and patients via questionnaire. Results: The median follow-up time was 52 months. The actuarial 5-year overall survival rate was 93.8% using Kaplan-Meier method and the within breast recurrence rate was 6.5%. No radiation- induced ulcer in the breast occurred except acute inflammation of skin around the pinholes in 5 patients. Cosmetic results were scored to be good by patients and the doctor (81% and 87%, respectively) for 75 followed-up cases, and good cosmetic rate was reported by the doctor for 82% (39/48) of the cases treated with brachytherapy boost and 85.2%(23/27) for those treated with external beam boost. There was no difference in cosmetic results between these two groups(P>0.05). Conclusion: In patients at high risk for local recurrence, tumor-bed boost with brachytherapy or electron beam carried out after limited surgery and external radiotherapy can provide satisfactory local control without morbidity. Cosmetic result may not be influenced by the boost technique. (authors)

Urinary incontinence in prostate cancer patients treated with external beam radiotherapy

International Nuclear Information System (INIS)

Liu, Mitchell; Pickles, Tom; Berthelet, Eric; Agranovich, Alexander; Kwan, Winkle; Tyldesley, Scott; McKenzie, Michael; Keyes, Mira; Morris, James; Pai, Howard

2005-01-01

Background and purpose: To describe the incidence of urinary incontinence among prostate cancer patients treated with external beam radiotherapy (RT) and to investigate associated risk factors. Patients and methods: One thousand and hundred ninety-two patients with ≥24 months follow-up were the subjects of this series. All patients received between 50 and 72 Gy in 20-37 fractions (median 66 Gy/33). Post-RT urinary incontinence was scored by direct patient interviewing according to the modified RTOG/SOMA scale: Grade 1-occasional use of incontinence pads, Grade 2-intermittent use of incontinence pads, Grade 3-persistent use of incontinence pads, and Grade 4-permanent catheter. Risk-factors investigated were: age, diabetes, TURP prior to RT, elapsed time from TURP to RT, clinical stage, RT dose and presence of Grade ≥2 acute GU and GI toxicity. Non-parametric, actuarial univariate (Kaplan-Meier) and multivariate tests (MVA, Cox regression) were performed. Results: Median follow-up for the group is 52 months (24-109). Thirty-four patients (2.9%) had incontinence prior to RT, which was more common in TURP patients (7.8% vs 1.6% P<0.001). These are excluded from further analysis. Fifty-seven patients (4.9%) developed Grade 1 incontinence, 7 (0.6%) Grade 2, and 7 (0.6%) Grade 3. There was no Grade 4 incontinence. Actuarial rates for Grade ≥1 and ≥2 incontinence at 5 years are 7 and 1.7%, respectively. Risk factors on MVA associated with the development of Grade 1 or worse incontinence are pre-RT TURP (5-year rates 10% vs 6%, P=0.026), presence of Grade ≥2 acute GU toxicity (5-year rates 11% vs 5%, P=0.002). Age, diabetes, clinical stage, elapsed time from TURP to RT, RT dose or fraction size, acute GI toxicity were not significant. Patients who underwent post-RT TURP or dilatation for obstructive symptoms (4.3%), were more likely to develop Grade 2-3 incontinence (5-year rate 8 vs 1.5%, P=0.0015). Conclusions: Grade 2 or greater urinary incontinence is rare

Every second cancer patient receives radiotherapy

International Nuclear Information System (INIS)

Ojala, A.

1996-01-01

Radiotherapy to treat cancer was given for the first time exactly one hundred years ago. Today, radiotherapy and surgery are the two main modes of treating cancer. One in two cancer patients receives radiotherapy at some point during the course of treatment for the disease. Radiotherapy is applied most commonly in cases where surgery is not possible. Moreover, these two modes of treatment are often used together to supplement each other. About half of new cancer cases detected today can be ordered. The estimate given by the EU for cancers cured is 45 per cent, which is divided between the various treatment modes as follows: surgery 22 %, radiotherapy 12 %, surgery plus radiotherapy 6 %, and drug therapy 6 %. In addition to curative treatment, radiotherapy plays a crucial role in palliative treatment, i.e. treatment that alleviates symptoms. The sensitivity of malignant tumours to radiotherapy varies over a wide range; the same is true for healthy tissues. Radiotherapy can only be used to cure a tumour that is more sensitive to radiation than the surrounding healthy tissue. The tumour must also be sufficiently small in size and limited to a relatively small area. (orig.)

Outcome of patients with localized prostate cancer treated by radiotherapy after confirming the absence of lymph node invasion

International Nuclear Information System (INIS)

Suzuki, Noriyuki; Shimbo, Masaki; Amiya, Yoshiyasu; Tomioka, Susumu; Shima, Takayuki; Murakami, Shino; Nakatsu, Hiroomi; Oota, Sayako; Shimazaki, Jun

2010-01-01

Management of lymph nodes in radiotherapy for prostate cancer is an issue for curative intent. To find the influence of lymph nodes, patients with T1-T3 prostate cancer and surgically confirmed negative nodes were treated with radiotherapy. After lymphadenectomy, 118 patients received photon beam radiotherapy with 66 Gy to the prostate. No adjuvant treatment was performed until biochemical failure. After failure, hormone therapy was administered. Follow-up period was 57 months (mean). Biochemical failure occurred in 47 patients. Few failures were observed in patients with low (24%) and intermediate risks (14%). In contrast, 64% of high-risk patients experienced failure, 97% of whom showed until 36 months. Most patients with failure responded well to hormone therapy. After 15 months (mean), a second biochemical failure occurred in 21% of patients who had the first failure, most of them were high risk. Factors involving failure were high initial and nadir prostate-specific antigen, advanced stage, short prostate-specific antigen-doubling time and duration between radiation and first failure. Failure showed an insufficient reduction in prostate-specific antigen after radiotherapy. Factor for second failure was prostate-specific antigen-doubling time at first failure. Half of high-risk patients experienced biochemical failure, indicating one of the causes involves factors other than lymph nodes. Low-, intermediate- and the other half of high-risk patients did not need to take immediate hormone therapy after radiotherapy. After failure, delayed hormone therapy was effective. Prostate-specific antigen parameters were predictive factors for further outcome. (author)

PSA Density as a prognostic factor in prostate cancer patients treated with radiotherapy

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Lankford, Scott; Pollack, Alan; Zagars, Gunar K

1995-07-01

Purpose/Objective: The pretreatment serum prostate specific antigen level (PSAL) is the most significant predictor of biochemical failure in patients treated with definitive radiotherapy. While one report indicates that PSA density (PSAD) is an important prognostic factor for patients treated with radiotherapy, another claims that it adds nothing to that seen with PSAL. We describe here a comparative analysis of the prognostic value of PSAL and PSAD using the endpoints of local control (LC), freedom from distant metastasis (FFDM), freedom from biochemical failure (FFBF), and freedom from any failure (FFAF, biochemical and/or clinical failure). Materials and Methods: There were 353 patients who between 1987-1993 were treated for regionally localized adenocarcinoma of the prostate and in whom PSAL and pretreatment prostate volume by ultrasound were available. External beam radiotherapy was administered to 334 patients using a four field box with high energy photons to {<=}70 Gy in 35 fractions. The remainder received between 76-78 Gy using conformal radiotherapy. The mean and median doses were 66.8 Gy and 66.0 Gy. Median follow-up for those living was 27 mo. The mean PSAL was 12.0 ng/ml with a median of 9.3 ng/ml. The PSAL was divided into 4 groups that we have described previously as correlating strongly with LC, FFBF, and FFAF; there were 64 patients with a PSA of {<=}4, 133 with >4 and {<=}10, 107 with >10 and {<=}20, and 49 with >20 ng/ml. PSAD was calculated by dividing the PSAL by the pretreatment prostate volume (in cc). The PSAD was divided into 4 groups based on the frequency distribution, which was not normally distributed. The subdivisions were 110 patients with a PSAD of {<=}0.2, 113 with {<=}0.2 and {<=}0.4, 87 with >0.4 and {<=}0.8, and 43 with >0.8. Patient breakdown by Stage was 106 with T1, 130 with T2, and 117 with T3/T4 disease. Patient breakdown by Gleason score was 76 patients with tumor scores of 2-4, 151 with scores of 5 or 6, 83 with a score

Clinical Outcomes for Patients with Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiotherapy or Radical Prostatectomy: A Multi-institutional Comparative Analysis.

Science.gov (United States)

Kishan, Amar U; Shaikh, Talha; Wang, Pin-Chieh; Reiter, Robert E; Said, Jonathan; Raghavan, Govind; Nickols, Nicholas G; Aronson, William J; Sadeghi, Ahmad; Kamrava, Mitchell; Demanes, David Jeffrey; Steinberg, Michael L; Horwitz, Eric M; Kupelian, Patrick A; King, Christopher R

2017-05-01

The long natural history of prostate cancer (CaP) limits comparisons of efficacy between radical prostatectomy (RP) and external beam radiotherapy (EBRT), since patients treated years ago received treatments considered suboptimal by modern standards (particularly with regards to androgen deprivation therapy [ADT] and radiotherapy dose-escalation]. Gleason score (GS) 9-10 CaP is particularly aggressive, and clinically-relevant endpoints occur early, facilitating meaningful comparisons. To compare outcomes of patients with GS 9-10 CaP following EBRT, extremely-dose escalated radiotherapy (as exemplified by EBRT+brachytherapy [EBRT+BT]), and RP. Retrospective analysis of 487 patients with biopsy GS 9-10 CaP treated between 2000 and 2013 (230 with EBRT, 87 with EBRT+BT, and 170 with RP). Most radiotherapy patients received ADT and dose-escalated radiotherapy. Kaplan-Meier analysis and multivariate Cox regression estimated and compared 5-yr and 10-yr rates of distant metastasis-free survival, cancer-specific survival (CSS), and overall survival (OS). The median follow-up was 4.6 yr. Local salvage and systemic salvage were performed more frequently in RP patients (49.0% and 30.1%) when compared with either EBRT patients (0.9% and 19.7%) or EBRT+BT patients (1.2% and 16.1%, pRadiotherapy and RP provide equivalent CSS and OS. Extremely dose-escalated radiotherapy with ADT in particular offers improved systemic control when compared with either EBRT or RP. These data suggest that extremely dose-escalated radiotherapy with ADT might be the optimal upfront treatment for patients with biopsy GS 9-10 CaP. While some prostate cancers are slow-growing requiring many years, sometimes decades, of follow-up in order to compare between radiation and surgery, high-risk and very aggressive cancers follow a much shorter time course allowing such comparisons to be made and updated as treatments, especially radiation, rapidly evolve. We showed that radiation-based treatments and surgery

Dose-volume histogram analysis as predictor of radiation pneumonitis in primary lung cancer patients treated with radiotherapy

International Nuclear Information System (INIS)

Fay, Michael; Tan, Alex; Fisher, Richard; Mac Manus, Michael; Wirth, Andrew; Ball, David

2005-01-01

Purpose: To determine the relationship between various parameters derived from lung dose-volume histogram analysis and the risk of symptomatic radiation pneumonitis (RP) in patients undergoing radical radiotherapy for primary lung cancer. Methods and Materials: The records of 156 patients with lung cancer who had been treated with radical radiotherapy (≥45 Gy) and for whom dose-volume histogram data were available were reviewed. The incidence of symptomatic RP was correlated with a variety of parameters derived from the dose-volume histogram data, including the volume of lung receiving 10 Gy (V 10 ) through 50 Gy (V 50 ) and the mean lung dose (MLD). Results: The rate of RP at 6 months was 15% (95% confidence interval 9-22%). On univariate analysis, only V 30 (p = 0.036) and MLD (p = 0.043) were statistically significantly related to RP. V 30 correlated highly positively with MLD (r = 0.96, p 30 and MLD can be used to predict the risk of RP in lung cancer patients undergoing radical radiotherapy

Intensity-Modulated Radiotherapy Triggers Onset of Bullous Pemphigoid in a Patient with Advanced Melanoma Treated with Nivolumab

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Kayo Tanita

2018-02-01

Full Text Available Since the efficacy of ipilimumab on nivolumab-resistant advanced melanoma is extremely low, additional supportive therapy for anti-PD-1 antibody therapy-resistant advanced melanoma is needed. Although several supportive therapies that enhance the antitumor immune response of anti-PD-1 antibodies have already been reported, unexpected immune-related adverse events were detected at the same time. In this report, we describe a patient with advanced melanoma treated with nivolumab followed by intensity-modulated radiotherapy, which might have triggered bullous pemphigoid (BP. Although several cases of BP developing in anti-PD-1 antibody-treated patients have already been reported, in this report, we shed light on the possible pathogenesis of BP developing in a patient treated with nivolumab through M2 macrophages.

Fanconi's anemia and clinical radiosensitivity. Report on two adult patients with locally advanced solid tumors treated by radiotherapy

International Nuclear Information System (INIS)

Bremer, M.; Karstens, J.H.; Schindler, D.; Gross, M.; Doerk, T.; Morlot, S.

2003-01-01

Background: Patients with Fanconi's anemia (FA) may exhibit an increased clinical radiosensitivity of various degree, although detailed clinical data are scarce. We report on two cases to underline the possible challenges in the radiotherapy of FA patients. Case Report and Results: Two 24- and 32-year-old male patients with FA were treated by definitive radiotherapy for locally advanced squamous cell head and neck cancers. In the first patient, long-term tumor control could be achieved after delivery of 67 Gy with a - in part - hyperfractionated split-course treatment regimen and, concurrently, one course of carboplatin followed by salvage neck dissection. Acute toxicity was marked, but no severe treatment-related late effects occurred. 5 years later, additional radiotherapy was administered due to a second (squamous cell carcinoma of the anus) and third (squamous cell carcinoma of the head and neck) primary, which the patient succumbed to. By contrast, the second patient experienced fatal acute hematologic toxicity after delivery of only 8 Gy of hyperfractionated radiotherapy. While the diagnosis FA could be based on flow cytometric analysis of a lymphocyte culture in the second patient, the diagnosis in the first patient had to be confirmed by hypersensitivity to mitomycin of a fibroblast cell line due to complete somatic lymphohematopoietic mosaicism. In this patient, phenotype complementation and molecular genetic analysis revealed a pathogenic mutation in the FANCA gene. The first patient has not been considered to have FA until he presented with his second tumor. Conclusion: FA has to be considered in patients presenting at young age with squamous cell carcinoma of the head and neck or anus. The diagnosis FA is of immediate importance for guiding the optimal choice of treatment. Radiotherapy or even radiochemotherapy seems to be feasible and effective in individual cases. (orig.)

Patient assessed symptoms are poor predictors of objective findings. Results from a cross sectional study in patients treated with radiotherapy for pharyngeal cancer

DEFF Research Database (Denmark)

Jensen, Kenneth; Lambertsen, Karin; Torkov, Peter

2007-01-01

Introduction. The aim of the study was to assess the value of the EORTC questionnaires C30 and H&N35, as an instrument for the study of side effects. Patients and methods. We invited all recurrence free patients, treated with radical radiotherapy for pharyngeal cancer between 1998 and 2002 at our...

Radiotherapy in patients with connective tissue diseases.

Science.gov (United States)

Giaj-Levra, Niccolò; Sciascia, Savino; Fiorentino, Alba; Fersino, Sergio; Mazzola, Rosario; Ricchetti, Francesco; Roccatello, Dario; Alongi, Filippo

2016-03-01

The decision to offer radiotherapy in patients with connective tissue diseases continues to be challenging. Radiotherapy might trigger the onset of connective tissue diseases by increasing the expression of self-antigens, diminishing regulatory T-cell activity, and activating effectors of innate immunity (dendritic cells) through Toll-like receptor-dependent mechanisms, all of which could potentially lead to breaks of immune tolerance. This potential risk has raised some debate among radiation oncologists about whether patients with connective tissue diseases can tolerate radiation as well as people without connective tissue diseases. Because the number of patients with cancer and connective tissue diseases needing radiotherapy will probably increase due to improvements in medical treatment and longer life expectancy, the issue of interactions between radiotherapy and connective tissue diseases needs to be clearer. In this Review, we discuss available data and evidence for patients with connective tissue diseases treated with radiotherapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma

International Nuclear Information System (INIS)

Zoubek, J.; McGuire, E.J.; Noll, F.; DeLancey, J.O.

1989-01-01

Urinary tract complications apparently resulting from radiation therapy for carcinoma of the cervix can occur as long as 30 years after cessation of such treatment. Patients generally present with urinary incontinence and often are treated by standard operative methods that usually are unsuccessful. Incontinence is related to bladder fibrosis, urethral nonfunction and vesicovaginal fistuLa formation, and may be accompanied by bilateral ureteral obstruction. Of 11 patients with late complications of radiotherapy 4 had upper tract deterioration, 4 had vesicovaginal fistulas, 5 had an incompetent urethra aNd 9 had a fibrotic, noncompliant areflexive bladder. Treatment was aimed at providing adequate low pressure storage capacity and consisted of augmentation cystoplasty in 5 patients, repair of the fistula in 4 and correction of urethral dysfunction in 5. Women who complain of incontinence and/or irritable bladder symptoms with a history of radiotherapy for cervical carcinoma should be evaluated for fistuLa formation, urethral incompetence, and detrusor areflexia and fibrosis before treatment is done

Oropharyngeal carcinoma treated with radiotherapy: a 30-year experience

International Nuclear Information System (INIS)

Fein, Douglas A.; Lee, W. Robert; Amos, Warren R.; Hinerman, Russell W.; Parsons, James T.; Mendenhall, William M.; Stringer, Scott P.; Cassisi, Nicholas J.; Million, Rodney R.

1996-01-01

Purpose: This study was done to determine the outcome in patients with oropharyngeal carcinoma treated at the University of Florida with radiotherapy alone to the primary site, for comparison with reported results of other types of treatment. Methods and Materials: Of a consecutive cohort of 785 patients with biopsy-proven, previously untreated, invasive squamous cell carcinoma of the oropharynx, this report is based on the 490 patients who had continuous-course irradiation with curative intent at the University of Florida between October 1964 and January 1991. All patients had a minimum 2-year follow-up. Forty-eight percent had Stage T3 or T4 disease, and 64% had clinically apparent neck node metastases. The median radiation dose was 68 Gy for once-a-day treatment and 76.8 Gy for twice-a-day treatment. Patients with advanced neck node disease had planned neck dissection(s) after radiotherapy. Results: The overall local control rate after radiotherapy alone was 73%. The ultimate local control rate (including surgical salvage) was 78%. At 5 years, the probability of control of neck disease was 85%; control above the clavicles, 67%; absolute survival, 44%; cause-specific survival, 77%; distant metastasis (as the first or only site of failure), 11%. Thirteen patients (2.6%) experienced severe treatment complications. Conclusion: Radiotherapy results in tumor control and survival rates comparable with rates achieved with combined irradiation and surgery, with less morbidity

Radiotherapy-induced cerebral abnormalities in patients with low-grade glioma

NARCIS (Netherlands)

Postma, TJ; Klein, M; Verstappen, CCP; Bromberg, JEC; Swennen, M; Langendijk, JA; Taphoorn, MJB; Scheltens, P; Slotman, BJ; van der Ploeg, HM; Aaronson, NK; Heimans, JJ

2002-01-01

Abnormalities on CT or MRI and neuropsychological performance in patients with low-grade glioma, with (n = 23) or without (n = 16) prior cerebral radiotherapy, were evaluated. Cerebral atrophy was observed in 14 of 23 patients (61%) treated with prior radiotherapy, and in 1 of 16 patients (6%)

Radiotherapy for prostatic cancer in patients aged 75 or older

International Nuclear Information System (INIS)

Hisada, Tomohiro; Kataoka, Masaaki; Mogami, Hiroshi; Inoue, Takeshi; Uemura, Masahiko; Sumiyoshi, Yoshiteru; Nagao, Shuji

2000-01-01

Thirty-eight patients with prostatic cancer treated with radiotherapy giving a mean dose of 60.7 Gy between 1992 and 1997 at Shikoku Cancer Center Hospital were reviewed and the treatment outcomes were investigated retrospectively. About two-third of the patients were treated with radiation by linear accelerator with 40 to 46 Gy to the whole pelvis and with 20 to 26 Gy boost to the prostate area and the other one-third were treated only to the prostate area. For almost patients, external beam radiotherapy in combination with endocrine therapy was used. The median duration of follow-up was 36 months. Overall 5-year survival and 5-year relapse-free survival rate were 65.8%, and 88.9%, respectively. Severe rectal late morbidity (over grade 3) according to RTOG grading system were seen in one (2.6%). Although the number of cases was rather small and the follow-up duration was rather short, conventional external beam radiotherapy in combination with endocrine therapy may contribute to the survival benefit of patients with prostatic cancer in aged 75 or older. Radiotherapy for elderly prostatic cancer patients should be treated with an effort to decrease the late morbidity and not to deteriorate the QOL of the patients, because many patients were died of other causes than cancer. (author)

Radiotherapy for local progression in patients with hormone-refractory prostate cancer

International Nuclear Information System (INIS)

Furuya, Yuzo; Akakura, Koichiro; Akimoto, Susumu; Ichikawa, Tomohiko; Ito, Haruo

1999-01-01

The aim of the present study was to investigate the effect of radiotherapy on the local progression of hormone-refractory prostate cancer. From 1986 to 1995, 38 patients were diagnosed with local progression without distant progression after hormonal therapy at Chiba University Hospital. Eleven cases were treated with irradiation for local progression. External beam irradiation was delivered to the prostate at a dose of 50-66.6 Gy. In patients treated with radiotherapy, the duration from initial treatment to local recurrence was 6-80 months (mean±SD: 33.9±22.9 months). The follow-up period after irradiation was 7-64 months (mean±SD: 25.4±18.8 months). Three and 5 year cause-specific survival rates from radiotherapy were 46.2 and 23.1%, respectively. Radiotherapy had a marked effect on symptoms associated with local progression and no patients suffered from the symptoms after the radiotherapy. Complications of radiotherapy were limited. In patients with hormone refractory local progression without distant progression, low morbidity, low mortality radiotherapy offers a variable therapy to other palliative treatments because radiotherapy is able to control local symptoms for a long period of time. (author)

Thyroid disorders in patients treated with radiotherapy for head-and-neck cancer: A retrospective analysis of seventy-three patients

International Nuclear Information System (INIS)

Alterio, Daniela; Jereczek-Fossa, Barbara Alicja; Franchi, Benedetta; D'Onofrio, Alberto Sc.D.; Piazzi, Valeria; Rondi, Elena; Ciocca, Mario; Gibelli, Bianca; Grosso, Enrica; Tradati, Nicoletta; Mariani, Luigi; Boboc, Genoveva Ionela; Orecchia, Roberto

2007-01-01

Purpose: To evaluate the incidence of thyroid disorders and dose distribution to the thyroid in patients treated with radiotherapy for head-and-neck carcinomas. Methods and Materials: A retrospective evaluation of data from 73 patients treated for head-and-neck cancers in our department was performed. Thyroid function was evaluated mainly by the measurement of thyrotropin (thyroid stimulating hormone [TSH]). A retrospective analysis of treatment plans was performed for 57 patients. Percentages of thyroid glandular volume absorbing 10, 30, and 50 Gy (V10, V30, and V50 respectively) were considered for statistical analysis. Results: A majority of patients (61%) had a normal thyroid function whereas 19 patients (26%) had hypothyroidism. Mean thyroid volume was 30.39 cc. Point 3 (located at isthmus) absorbed lower doses compared with other points (p < 0.0001). Median values of V10, V30, and V50 were 92% (range, 57-100%), 75% (range, 28.5-100%), and 35% (range, 3-83%) respectively. Gender was associated with toxicity (presence of any kind of thyroid disorders) (p < 0.05), with females displaying higher levels of TSHr (relative TSH = patient's value/maximum value of the laboratory range) (p = 0.0005) and smaller thyroid volume (p 0.0012) compared with male population. TSHr values were associated with thyroid volume, and the presence of midline shielding block in the anterior field was associated with relative free thyroxine (FT4r = patient's value/maximum value of the laboratory range) values. Conclusions: Gender and thyroid volume seem to play an important role in the occurrence of thyroid toxicity, but further studies on dose-effect relationship for radiotherapy-induced thyroid toxicity are needed

Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment

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Tanaka, Hidekazu; Yamaguchi, Takahiro; Hachiya, Kae; Okada, Sunaho; Kitahara, Masashi; Matsuyama, Katsuya; Matsuo, Masayuki [Gifu University, Gifu (Japan)

2017-03-15

Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.

Treatment results and prognostic analysis of 47 patients with urethral transitional cell carcinoma treated with post-operative adjuvant radiotherapy

International Nuclear Information System (INIS)

He Ke; Hou Xiaorong; Shen Jie; Lian Xin; Sun Shuai; Zhang Fuquan

2010-01-01

Objective: To evaluate treatment results and prognostic factors of 47 patients with primary urethral transitional cell carcinoma treated with post-operative adjuvant radiotherapy. Methods: From October 1998 to October 2008, 47 patients with primary urethral transitional cell carcinoma received postoperative adjuvant radiotherapy. Thirty-one patients had stage T 3 /T 4 disease, 7 had lymph node metastasis. Thirty-nine patients had G3 tumor, 13 had stump-positive. The median radiotherapy dose was 60 Gy (36-64 Gy). 81% patients (38/47) were treated with regional irradiation. Results: The median follow-up time was 21 months (6 -88 months). The follow-up rate was 92%. The median overall survival time was 35 months (5 -88 months). The 2-and 5-year overall survival rates were 57% and 49%, respectively. In univariate analysis, the median overall survival time was better in patients with stage T 1 or T 2 compared with stage T 3 or T 4 tumor (42 months vs. 19 months, χ 2 =7.28, P=0.007), with age of ≤65 years compared with >65 years (28 mouths vs 18 months,χ 2 =8.23, P =0.004). There was no significant difference in the long term survival in patients with non-radical surgery compared with radical mastectomy (21 months vs. 20 months, χ 2 = 0.90, P = 0.344). In multivariate analysis, the stage T 3 or T 4 (χ 2 = 7.89, P =0.005), >65 years old (χ 2 = 4.85, P = 0.028), renal pelvis involvement (χ 2 = 5.65, P = 0.018), and tumor located in the mid or inferior segment (χ 2 =6.08,P =0.014) were factors associated with poorer prognosis. Conclusions: Postoperative adjuvant radiotherapy can improve the efficacy of patients with locally advanced urethral transitional cell carcinoma. Advanced T stage and > 65 years age are associated with poorer prognosis. (authors)

Radiation therapy technology innovations applied to the treatment of head and neck patients: - Clinical results of Intensity Modulated Radiotherapy (IMRT), - Contribution of Image Guided Radiotherapy (IGRT) in the management of head and neck patients treated with IMRT

International Nuclear Information System (INIS)

Graff-Cailleaud, Pierre

2011-01-01

Numerous and exciting technological innovations were recently developed in radiotherapy. We aimed to assess benefits in two specific fields. 1) Clinical results of Intensity Modulated Radiotherapy (IMRT) applied to the treatment of Head and Neck (H and N) patients. The first study was a long-term mono-centric prospective registration of all H and N patients treated with IMRT in our institution. Locoregional control was excellent and toxicities limited. Recurrences were in-field. Dosimetric recommendations (parotids mean dose) were established. The second study assessed the impact of IMRT on health-related quality of life for H and N patients through a multicentric matched-pair comparison with conventional radiotherapy. Outstanding benefits were observed particularly in the fields of salivary dysfunction and oral discomfort. 2) Contribution of Image Guided Radiotherapy (IGRT) in the management of H and N patients treated with IMRT. The first study was a monitoring of delivered dose, using 3D dose recalculation from Megavoltage Cone-Beam CT (CBCT), as a quality assurance measure of a panel of H and N IMRT patients aligned with IGRT. Dosimetric consequences of anatomical changes were assessed. Contribution of color-coded MVCBCT dose-difference maps was studied. The aim of the second study was to quantify the inherent relative mobility between anatomic regions of the H and N area and to assess the dosimetric impact of several different matching procedures. Recommendations for the use of CBCT images in a daily practice were established. (author) [fr

Comparative Survival in Patients With Postresection Recurrent Versus Newly Diagnosed Non-Small-Cell Lung Cancer Treated With Radiotherapy

International Nuclear Information System (INIS)

Cai Xuwei; Xu Luying; Wang Li; Hayman, James A.; Chang, Andrew C.; Pickens, Allan; Cease, Kemp B.; Orringer, Mark B.; Kong, F.-M.

2010-01-01

Purpose: To compare the survival of postresection recurrent vs. newly diagnosed non-small-cell lung cancer (NSCLC) patients treated with radiotherapy or chemoradiotherapy. Methods and Materials: The study population consisted of 661 consecutive patients with NSCLC registered in the radiation oncology databases at two medical centers in the United States between 1992 and 2004. Of the 661 patients, 54 had postresection recurrent NSCLC and 607 had newly diagnosed NSCLC. Kaplan-Meier and Cox regression models were used for the survival analyses. Results: The distribution of relevant clinical factors between these two groups was similar. The median survival time and 5-year overall survival rates were 19.8 months (95% confidence interval [CI], 13.9-25.7) and 14.8% (95% confidence interval, 5.4-24.2%) vs. 12.2 months (95% CI, 10.8-13.6) and 11.0% (95% CI, 8.5-13.5%) for recurrent vs. newly diagnosed patients, respectively (p = .037). For Stage I-III patients, no significant difference was observed in the 5-year overall survival (p = .297) or progression-free survival (p = .935) between recurrent and newly diagnosed patients. For the 46 patients with Stage I-III recurrent disease, multivariate analysis showed that chemotherapy was a significant prognostic factor for 5-year progression-free survival (hazard ratio, 0.45; 95% CI, 0.224-0.914; p = .027). Conclusion: Our institutional data have shown that patients with postresection recurrent NSCLC achieved survival comparable to that of newly diagnosed NSCLC patients when they were both treated with radiotherapy or chemoradiotherapy. These findings suggest that patients with postresection recurrent NSCLC should be treated as aggressively as those with newly diagnosed disease.

Risk stratification of patients with advanced squamous cell carcinoma of cervix treated by radiotherapy alone

International Nuclear Information System (INIS)

Hong, J.-H.; Tsai, C.-S.; Lai, C.-H.; Chang, T.-C.; Wang, C.-C.; Chou, H.-H.; Lee, Steve P.; Lee, C.-C.; Tang, Simon G.; Hsueh Swei

2005-01-01

Purpose: To identify prognostic factors for local and distant relapse and perform risk stratification for patients with advanced cervical cancer treated with radiotherapy (RT) alone. Methods and Materials: A total of 1031 patients with Stage IB-IVA squamous cell carcinoma of the cervix treated with full-course RT but without any chemotherapy were included for analysis. Of these, 311 patients with nonbulky Stage IB-IIA disease were designated the reference group and the other 720 patients were the study group. The associations of stage, squamous cell carcinoma antigen (SCC-ag) level, hemoglobin level, age, cell differentiation, and pelvic lymph node status with treatment failure were evaluated. The independent prognostic factors were identified by multivariate analysis. The study group was further stratified into subgroups using combinations of these risk factors. Results: In the study group, independent risk factors for local relapse were advanced stage and age 2, and positive pelvic lymph nodes. The 5-year distant relapse-free survival rate was 83% for patients with bulky Stage IB-IIA and IIB disease, SCC-ag level 2, and positive lymph nodes. Conclusion: The risk of treatment failure in advanced-stage cervical cancer patients treated by RT alone can be more precisely predicted by risk stratification. A certain subgroup of patients had better control than the others. The benefit of treating these relatively low-risk patients with additional treatment such as concurrent chemotherapy should be further evaluated in prospective studies or meta-analyses

Electronic database of patients in radiotherapy: Amedatos

International Nuclear Information System (INIS)

Perez Guevara, Adrian; Rodriguez Zayas, Michael; Gonzalez Perez, Yelina; Sola Rodriguez, Yeline; Reyes Gonzalez, Tommy; Caballero, Roberto

2009-01-01

Registration and monitoring of patients in the departments of radiotherapy in our country are taken manually, which is difficult when very large number of patients and treatment units in service. Due to these problems in the Department of Radiotherapy 'Hospital Hermanos Ameijeiras' AMEDATOS program was designed in Microsoft Excel. The main program relates different books, macros are used to improve visualization and facilitate the management of data on different sheets (dosimetry, Team, Daily Record, Record monitoring, patient data, dosimetry data, not treated and four sheets of Report). (Author)

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

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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 [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.

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

International Nuclear Information System (INIS)

Dunavoelgyi, Roman; Dieckmann, Karin; Gleiss, Andreas; Sacu, Stefan; Kircher, Karl; Georgopoulos, Michael; Georg, Dietmar; Zehetmayer, Martin; Poetter, Richard

2012-01-01

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.

Radiotherapy treatment results of bladder cancer: study of 458 patients

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Vara Santos, J.; Torre Tomas, A. de la; Romero Fernandez, J.; Regueiro Otero, C.; Clavo Varas, B.; Magallan Sebastian, R.; Valcarcel Sancho, F.; Polo Tolosana, E.; Aragon de la Cruz, G.

1994-01-01

Between 1964 to 1990, 458 patients diagnosed of bladder cancer have been treated with radical radiotherapy in our department. The 5-years and 10-years actuarial survival rates were 37% and 27% respectively. The 5-years and 10-years actuarial local control rates, evaluated in 404 patients, were 41% and 38%. In regard to survival, T stage (p=0.013), advanced intravesical extension or multicentrity (p>0.0001), and squamous differentiation (p<0.0001), reached statistical significance as adverse prognostic factors. In 248 patients, with invasive transitional carcinoma, radical radiotherapy alone was used. In this group of patients, T stage (p=0.006) and advanced intravesical extension or multicentrity (p=0.0002) were adverse prognostic factors for survival. Our results suggest that radical radiotherapy must be considered and alternative to surgery in management of bladder cancer. On the basis of prognostic factors evidenced in this series a subgroup of patients with low probability of survival when treated with exclusive radiotherapy are defined. This patients must be included in clinical research protocols. (Author) 44 refs

Fanconi's anemia and clinical radiosensitivity. Report on two adult patients with locally advanced solid tumors treated by radiotherapy

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Bremer, M.; Karstens, J.H. [Hannover Medical School, Hannover (Germany). Dept. of Radiation Oncology; Schindler, D.; Gross, M. [Univ. Wuerzburg (Germany). Inst. of Human Genetics; Doerk, T. [Hannover Medical School, Hannover (Germany). Dept. of Obstetrics and Gynecology; Morlot, S. [Hannover Medical School, Hannover (Germany). Inst. of Human Genetics

2003-11-01

Background: Patients with Fanconi's anemia (FA) may exhibit an increased clinical radiosensitivity of various degree, although detailed clinical data are scarce. We report on two cases to underline the possible challenges in the radiotherapy of FA patients. Case Report and Results: Two 24- and 32-year-old male patients with FA were treated by definitive radiotherapy for locally advanced squamous cell head and neck cancers. In the first patient, long-term tumor control could be achieved after delivery of 67 Gy with a - in part - hyperfractionated split-course treatment regimen and, concurrently, one course of carboplatin followed by salvage neck dissection. Acute toxicity was marked, but no severe treatment-related late effects occurred. 5 years later, additional radiotherapy was administered due to a second (squamous cell carcinoma of the anus) and third (squamous cell carcinoma of the head and neck) primary, which the patient succumbed to. By contrast, the second patient experienced fatal acute hematologic toxicity after delivery of only 8 Gy of hyperfractionated radiotherapy. While the diagnosis FA could be based on flow cytometric analysis of a lymphocyte culture in the second patient, the diagnosis in the first patient had to be confirmed by hypersensitivity to mitomycin of a fibroblast cell line due to complete somatic lymphohematopoietic mosaicism. In this patient, phenotype complementation and molecular genetic analysis revealed a pathogenic mutation in the FANCA gene. The first patient has not been considered to have FA until he presented with his second tumor. Conclusion: FA has to be considered in patients presenting at young age with squamous cell carcinoma of the head and neck or anus. The diagnosis FA is of immediate importance for guiding the optimal choice of treatment. Radiotherapy or even radiochemotherapy seems to be feasible and effective in individual cases. (orig.)

Late toxicity and biochemical control in 554 prostate cancer patients treated with and without dose escalated image guided radiotherapy

International Nuclear Information System (INIS)

Kok, David; Gill, Suki; Bressel, Mathias; Byrne, Keelan; Kron, Tomas; Fox, Chris; Duchesne, Gillian; Tai, Keen Hun; Foroudi, Farshad

2013-01-01

Background and purpose: To compare rates of late gastrointestinal toxicity, late genitourinary toxicity and biochemical failure between patients treated for prostate cancer with implanted fiducial marker image guided radiotherapy (FMIGRT), and those treated without FMIGRT. Methods and materials: We performed a single institution retrospective study comparing all 311 patients who received 74 Gy without fiducial markers in 2006 versus all 243 patients who received our updated regimen of 78 Gy with FMIGRT in 2008. Patient records were reviewed 27 months after completing radiotherapy. Biochemical failure was defined using the Phoenix definition. Details of late gastrointestinal and genitourinary toxicities were graded according to CTCAEv4. Moderate/severe toxicity was defined as a grade 2 or higher toxicity. Cumulative incidence and prevalence curves for moderate/severe toxicity were constructed and compared using multistate modeling while biochemical failure free survival was compared using the log rank test. A Cox regression model was developed to correct for confounding factors. Results: Median follow-up time for both groups was 22 months. The hazard ratio for moderate/severe late gastrointestinal toxicity in the non-FMIGRT group was 3.66 [95% CI (1.63–8.23), p = 0.003] compared to patients in the FMIGRT group. There was no difference in the hazard ratio of moderate/severe late genitourinary toxicity between the two groups (0.44 [95% CI (0.19–1.00)]), but patients treated with FMIGRT did have a quicker recovery from their genitourinary toxicities HR = 0.24 [95% CI (0.10–0.59)]. We were unable to detect any differences in biochemical failure free survival between the cohorts HR = 0.60 [95% CI (0.30–1.20), p = 0.143]. Conclusion: Despite dose escalation, the use of FMIGRT in radical radiotherapy for prostate cancer significantly reduces the incidence of gastrointestinal toxicity and the duration of late genitourinary toxicity when compared to conventional non

Association of genetic variants in VEGF-A with clinical recurrence in prostate cancer patients treated with definitive radiotherapy

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Langsenlehner, T.; Thurner, E.M.; Kapp, K.S. [Medical University of Graz, Department of Therapeutic Radiology and Oncology, Graz (Austria); Renner, W. [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz (Austria); Gerger, A. [Medical University of Graz, Division of Oncology, Department of Internal Medicine, Graz (Austria); Langsenlehner, U. [GKK Outpatient Department, Division of Internal Medicine, Graz (Austria)

2014-04-15

Vascular endothelial growth factor-A (VEGF-A), a key regulator of tumor-induced angiogenesis, is critical for tumor growth and metastasization. The goal of the present study was to evaluate the prognostic value of VEGF single nucleotide polymorphisms (SNPs) and haplotypes for clinical recurrence after definitive radiotherapy for prostate cancer. The association of seven VEGF-A polymorphisms and their haplotypes with clinical recurrence (defined as the occurrence of local recurrence and/or distant metastases) in 496 prostate cancer patients treated with definitive radiotherapy were investigated. Genotypes were determined by 5'-nuclease (TaqMan) assays; haplotypes were analyzed using the Haploview program. Within a median follow-up time of 80 months, 44 patients (9%) developed clinical recurrences. Haplotype analysis showed two separate blocks of high-linkage disequilibrium, formed by five polymorphisms (-2578C > A, -2489C > T, -1498C > T, -634G > C, -7C > T) upstream of the coding sequence (CCCCC, ATTGC, CCCGC, ATTGT) and two polymorphisms (936C > T, 1612G > A) downstream of the coding sequence (CA, CG, TG). Carriers of at least 1 copy of the ATTGC haplotype were at higher risk of recurrence (hazard ratio [HR] 3.83; 95%CI 1.48-9.90, p=0.006); for carriers of 2 copies, the HR was 4.85 (95%CI 1.72-13.6; p=0.003). In multivariate analysis, patients harboring at least one copy of the ATTGC haplotype remained at increased risk of recurrence (HR 3.63, 95%CI 1.38-9.55, p=0.009); in patients carrying 2 copies, the HR was 4.72 (95%CI 1.64-13.6, p=0.004). Our findings indicate that the VEGF-A ATTGC haplotype may predict clinical recurrence in prostate cancer patients treated with radiotherapy. (orig.)

Treating all fields in every radiotherapy session? - Questioning the old dogma (or, pelvis radiotherapy: speculations on fractioning)

International Nuclear Information System (INIS)

Faria, S.L.; Ferrigno, R.; Osti, N.

1995-01-01

Twenty years ago Wilson and Hall published paper on the advisability of treating all fields at each radiotherapy session. That was based on the widely accepted method for calculating the biological effect of fractionated treatment in terms of a single quantity: the concept of a nominal standard dose (NSD). It was the beginning of an old dogma in radiation oncology: treating all fields every day. The basis megavoltage units of treatment in Brazil are cobalt and low energy linacs. The country is poor and it is not rare to have patients waiting lines. Due to that situation since five years ago we have been treating pelvic tumors with four fields (box technique) but irradiating only two fields per day. After treating hundreds of patients this way we have found no increased late complications, particularly subcutaneous tissue fibrosis. Previous data showed that TDE factors equal or lower than 90 were not related to any kind of fibrosis. treating pelvic tumors with the box technique but irradiating only two fields per day gives TDF values little greater than doing all four fields per day, but still lower than 90. That may explain why we have found no fibrosis. The impression is that not to treat all fields at each radiotherapy session may be possible with no increased rate of late complications. (author). 10 refs, 3 tabs, 2 figs

Long-term results of radiotherapy for 104 patients with Graves' orbitopathy

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Qu Baolin; Yang Dong; Feng Linchun; Luo Zhiyuan

2008-01-01

Objective: To evaluate the long-term outcome and the sequelae of Graves' orbitopathy treated with radiotherapy, and to specify the prognostic factors. Methods: From 1979 to 1999, 104 patients with progressive Graves' orbitopathy were treated with conventional orbital radiotherapy. Post globe and pituitary irradiation of 25-35 Gy was given to 56 patients, which was followed by a boost of 15-20 Gy to the pituitary. Follow-up time was 7.5 - 25.0 years. The result of radiotherapy was analyzed. Results: Overall response rate was 71.1%. The response rate of patients with soft-tissue infiltration, corneal involvement, proptosis, sight loss and extraocular muscle dysfunction was 88.4%, 75.1%, 55.6%, 68.8% and 64.4%, respectively. Twelve patients (11.5%) developed cataracts 2.5-18.3 years (median 11.2 years) after irradiation. One patient developed left-eye retinopathy 3.2 years after irradiation. No patient developed secondary tumor within the irradiation field. Conclusions: Orbital radiotherapy for progressive Graves' orbitopathy, being effective and safe, can control the disease progression and improve the symptoms. The side effect of radiotherapy is fewer than other treatment modalities. (authors)

Blood tests and prognosis in bladder carcinomas treated with definitive radiotherapy

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Hannisdal, E.; Fossa, S.D.; Host, H.

1993-01-01

The value of some commonly recorded blood tests as prognostic factors in patients with bladder carcinomas treated with definitive radiotherapy has been assessed. This study included 202 consecutive patients (T2, n=46; T3, n=82 and T4, n=74) treated during the period 1980-1987. The median total dose received was 56 Gy [50-67] and the median cumulative radiation effect was 1750 reu (radiation effect unit) (1515-1823). The blood tests examined in survival analyses were erythrocyte sedimentation rate (ESR), hemoglobin (Hb), leucocyte and thrombocyte count, alkaline phosphatase (ALP), γ-glutamyltransferase (GT), lactate dehydrogenase (LD), creatinine and albumin. In the univariate survival analyses six blood tests were significant prognostic factors (ESR, albumin, creatinine, Hb, ALP and GT). In the multivariate analysis of all 202 patients, the following five variables were significantly associated with shorter survival: T4 tumors, ESR > 30 mm/h, albumin 400 U/I and age >75 years. Our conclusion is that several commonly recorded blood tests are powerful prognostic factors in bladder cancer treated with definitive radiotherapy. These tests can replace other more expensive laboratory investigations used for prognostication. (author). figs. tabs

Carcinomas of the Paranasal Sinuses and Nasal Cavity Treated With Radiotherapy at a Single Institution Over Five Decades: Are We Making Improvement?

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Chen, Allen M.; Daly, Megan E.; Bucci, M. Kara; Xia Ping; Akazawa, Clayton C.; Quivey, Jeanne M.; Weinberg, Vivian; Garcia, Joaquin; Lee, Nancy Y.; Kaplan, Michael J.; El-Sayed, Ivan; Eisele, David W.; Fu, Karen K.; Phillips, Theodore L.

2007-01-01

Purpose: To compare clinical outcomes of patients with carcinomas of the paranasal sinuses and nasal cavity according to decade of radiation treatment. Methods and Materials: Between 1960 and 2005, 127 patients with sinonasal carcinoma underwent radiotherapy with planning and delivery techniques available at the time of treatment. Fifty-nine patients were treated by conventional radiotherapy; 45 patients by three-dimensional conformal radiotherapy; and 23 patients by intensity-modulated radiotherapy. Eighty-two patients (65%) were treated with radiotherapy after gross total tumor resection. Nineteen patients (15%) received chemotherapy. The most common histology was squamous cell carcinoma (83 patients). Results: The 5-year estimates of overall survival, local control, and disease-free survival for the entire patient population were 52%, 62%, and 54%, respectively. There were no significant differences in any of these endpoints with respect to decade of treatment or radiotherapy technique (p > 0.05, for all). The 5-year overall survival rate for patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s was 46%, 56%, 51%, 53%, and 49%, respectively (p = 0.23). The observed incidence of severe (Grade 3 or 4) late toxicity was 53%, 45%, 39%, 28%, and 16% among patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s, respectively (p = 0.01). Conclusion: Although we did not detect improvements in disease control or overall survival for patients treated over time, the incidence of complications has significantly declined, thereby resulting in an improved therapeutic ratio for patients with carcinomas of the paranasal sinuses and nasal cavity

Quality of life of patients with laryngeal cancer treated with radiotherapy

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Ikeda, Hajime; Sawai, Yuka; Inoue, Toshihiko; Matayoshi, Yoshinobu; Murayama, Shigeyuki; Kozuka, Takahiro.

1995-01-01

Radiotherapy (RT) is considered as the best treatment for early laryngeal cancer in terms of survival and preservation of voice. Quality of life (QOL) must also be assessed after new treatments, such as laser treatment or laryngomicrosurgery. The QOL after RT was assessed in 61 patients (57 men and 4 women) with histologically proven laryngeal or hypopharyngeal cancer (glottis T1-2, 48 : supraglottis 11 : hypopharynx, 2). Cobalt-60 gamma rays were emitted via lateral opposed portals that included the glottis/larynx area. The delivered dose was 53 to 70 Gy/23 to 35 Fr (median, 60 Gy/30 Fr). Assessment was done by interview of physicians at periodic follow-up examinations of patients. The census period was June to December 1990. Patients' ages ranged from 37 to 82 years (median, 62 years) at treatment and 38 to 88 years (median, 68 years) at QOL assessment. Most patients enjoyed the similar daily activities and job status as before. Thirty-seven of 61 patients felt occasional hoarseness after RT, and 21 refrained from loud speech. All patients could use the telephone easily, except for one patient who had severe hearing loss. Many patients stopped smoking cigarettes, but most drank as before RT. There were no significant differences in lifestyle quality between less than and more than 5 years after RT. This QOL assessment is applicable to patients with laryngeal cancer. One half of patients treated by RT have symptoms compatible with chronic laryngitis. This study confirms that RT yields good QOL and voice quality for patients with laryngeal cancer. (author)

Radiotherapy for superficial esophageal cancer of poor risk patients

International Nuclear Information System (INIS)

Kagami, Yoshikazu; Ikeda, Hiroshi; Murayama, Shigeyuki; Yamaguchi, Hajime; Tachimori, Yuji; Kato, Hoichi; Watanabe, Hiroshi; Tokuue, Kouichi; Sumi, Minako; Kawashima, Mitsuhiko; Imai, Atsushi; Nakayama, Shuji

1997-01-01

Purpose/Objective: The reported incidence of superficial esophageal cancer (SEC) has steadily increased in Japan as result of endoscopic examination has been become common. In Japan, treatment of SEC is endoscopical mucosal resection (EMR) for mucosal cancer or esophagectomy with 3 fields lymph nodes resection for submucosal cancer. Radiotherapy is little place for the management of SEC. Because of some reasons, we treated patients with SEC by radiotherapy alternative to surgery. Purpose of this report is to evaluate efficacy of radiotherapy for SEC. Methods and Materials: Between 1989 to 1996, eighteen patients with SEC were treated with radiotherapy at our hospital. Reasons of radiotherapy that was chosen as the primary methods of treatment were refusal of surgery in one patient, poor medical condition in 4 patients and double primary cancer in 13 patients (head and neck: 11, simultaneously: 11). No patients had indication of EMR. Diagnosis was made by endoscopy and radiography. Some patients were examined with endoscopic ultrasound. Two patients (11.1%) had tumor limited to the mucosa and 16 patients (88.9%) had tumor invaded the submucosa. Seven of these tumors (38.9%) were multicentric. All patients had squamous cell carcinoma. There were 17 male patients and one female patient. The age range was 49 years to 87 years with a median of 62 years. Stage of all patients was T1N0M0 according to UICC staging system. Ten patients underwent external radiotherapy (Ex) (50 Gy - 66 Gy) alone and 8 patients did both Ex and intracavitary radiotherapy (IC) (30-60 Gy of Ex with 5-15 Gy of IC). No patients received chemotherapy. Duration of follow-up was 6 months to 96 months with a median of 30 months. Results: The overall survival rate was 55.9% in 3-year and 14% in 5-year, and the cause-specific 5-year survival rate was 100%. Causes of death were malignant tumor other than esophageal cancer in 4 patients, intercurrent disease other than malignant tumor in 3 patients and no

External beam radiotherapy for rectal adenocarcinoma

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Taylor, R.E.; Kerr, G.R.; Arnott, S.J.

1987-01-01

A series of 243 patients with adenocarcinoma of the rectum treated with radiotherapy is presented. Radiotherapy was combined with 5-fluorouracil, or given alone. Seventy-four patients were treated with radical external beam radiotherapy for recurrent or inoperable rectal adenocarcinoma. One hundred and forty-five patients with advanced pelvic tumours or metastases were treated with palliative pelvic radiotherapy. Twenty-four patients with small-volume residual pelvic tumour or who were felt to be at high risk of pelvic recurrence following radical resection received postoperative radiotherapy. Complete tumour regression was seen in 38% of radically treated patients, and 24% of palliatively treated patients. Partial regression was observed in 56% of radically treated patients, and 58% of palliatively treated patients. Long-term local tumour control was more commonly observed for small tumours (< 5 cm diameter). Fifty-eight % of patients treated with postoperative radiotherapy remained free of local recurrence. Survival was significantly better with small tumours. The addition of 5FU did not appear to improve survival or tumour control. (author)

Protocol updated for the treatment of patients in radiotherapy with implanted cardiac devices

International Nuclear Information System (INIS)

Martin Martin, G.; Bermudez Luna, R.; Rodriguez Rodriguez, C.; Lopez Fernandez, A.; Rodriguez Perez, A.; Sotoca Ruiz, A.

2013-01-01

Radiotherapy treatment can be safely performed in patients with pacemakers or implanted defibrillators, however, it is very important to ensure that the patient receives the minimum dose possible in your heart device. Is considered essential good coordination with the cardiology service before, during and after radiotherapy treatment for the patient safety. Finally we present a protocol updated to treat these patients in radiotherapy. (Author)

Post-radiation mucocele in two patients treated for nasopharyngeal cancer; Mucocele apres radiotherapie chez deux patients traites pour cancer du nasopharynx

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Mnejja, M.; Hammami, B.; Achour, I.; Chakroun, A.; Charfeddine, I.; Ghorbel, A. [Service ORL et chirurgie cervico-faciale, CHU Habib-Bourguiba, 3029 Sfax (Tunisia); Frikha, M. [Service de carcinologie, CHU Habib-Bourguiba, 3029 Sfax (Tunisia); Daoud, J. [Service de radiotherapie, CHU Habib-Bourguiba, 3029 Sfax (Tunisia)

2011-06-15

A 30-year-old woman, with a history of nasopharyngeal carcinoma, which was treated by radiotherapy nine years previously, presented with occasional diplopia and recent headaches. A nasopharyngeal biopsy showed no recurrence. The imaging revealed a sphenoidal sinus mucocele. Endoscopic marsupialization of the mucocele allowed clinical improvement. A 56-year-old woman presented, five years after radiotherapy for nasopharyngeal carcinoma, with a fronto-orbital mass. CT-scan revealed a fronto-ethmoidal mucocele. Nasopharyngeal biopsy showed tumour recurrence. Marsupialization of mucocele was performed. Recurrence of the carcinoma was treated by radiotherapy and chemotherapy. Sphenoidal sinus mucocele developing after radiotherapy for nasopharyngeal carcinoma has rarely been reported. CT scan and MRI are useful tools in making the diagnosis. Biopsy is required to diagnose recurrence or associated radio-induced tumor. Endoscopic approach gives good results. (authors)

Primary lung sarcoma treated with stereotactic ablative radiotherapy: a case report

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Yeo SG

2017-07-01

Full Text Available Seung-Gu Yeo Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea Abstract: Primary lung sarcoma (PLS is an extremely rare, very aggressive malignancy. Surgical removal is considered the treatment of choice, and patients who have been given conventional radiotherapy have had inferior outcomes. This study is the first describing a case of PLS treated with stereotactic ablative radiotherapy (SABR, which precisely targets a small tumor with a markedly higher biologically effective dose than conventional radiotherapy. The patient was an 82-year-old man who was diagnosed with primary lung leiomyosarcoma based on radiology, pathology, and immunohistochemical examinations. The PLS was located in the right lower lobe and measured 2.5 cm. No regional nodal or distant organ metastasis was observed. He was inoperable medically. The SABR was performed using volumetric modulated arc therapy and a dose of 56 Gy in four fractions. Follow-up computed tomography 2 months after SABR revealed a complete tumor response. The toxicity was limited to mild respiratory symptoms. The patient is alive and has had no evidence of disease for 2 years. This study suggests that SABR can be a safe and effective treatment option for PLS. Keywords: primary lung sarcoma, leiomyosarcoma, stereotactic ablative radiotherapy, stereotactic body radiotherapy, radiation therapy, sarcoma 

[Thermoplastic mask in radiotherapy: a source of anxiety for the patient?].

Science.gov (United States)

Arino, C; Stadelmaier, N; Dupin, C; Kantor, G; Henriques de Figueiredo, B

2014-12-01

The thermoplastic mask often used to immobilize patients in radiotherapy can cause varying levels of stress and anxiety. This study aimed at evaluating the anxiety related to the use of radiotherapy masks and the coping strategies adopted by patients. Nineteen patients treated with radiotherapy mask for head and neck cancer, a brain tumour or a lymphoma, were met twice by a psychologist, either after the making of the mask and the first course of radiotherapy, or in the middle and at the end of treatment. Thirty-four semi-structured interviews were treated using a thematic content analysis and 13 patients answered to anxiety (STAI-YB) and coping (WCC) scales. The STAI-YB anxiety scores related to wearing the masks were low during the radiotherapy treatment period, and were confirmed by the remarks of patients recorded during the semi-structured interviews. Most patients had a positive perception of the mask, and considered it as a friend or protection. Twelve out of the 13 patients admitting to anxiety benefited from problem focused coping strategies. Thermoplastic mask-related anxiety is low and possibly lies in the positive representation patients have about the mask. The explanations provided by health professionals on the radiotherapy mask possibly have a very positive effect on this perception. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Case report: renovascular hypertension following radiotherapy and chemotherapy treated by transluminal angioplasty

International Nuclear Information System (INIS)

Minton, M.J.; McIvor, J.; Cappuccio, F.P.; MacGregor, G.A.; Newlands, E.S.

1986-01-01

A man aged 33 with poorly controlled hypertension who had been treated with radiotherapy and combination chemotherapy for testicular teratoma 8 years earlier was found on arteriography to have 75% stenosis of the left renal artery and occlusion of the right renal artery. The stenosis was dilated by transluminal angioplasty and the hypertension adequately controlled. Patients who develop high blood pressure after abdominal radiotherapy with or without chemotherapy should be investigated for renal artery stenosis. (author)

Radiotherapy alone for elderly patients with stage III non-small cell lung cancer

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Nakano, Kikuo; Hiramoto, Takehiko; Kanehara, Masasi; Doi, Mihoko; Furonaka, Osamu; Miyazu, Yuka; Hada, Yosihiro

1999-01-01

We undertook a retrospective study of elderly patients with stage III non-small cell lung cancer who had been treated solely with radiotherapy during the period 1986 to 1995. Our study was designed to assess the influence of age on survival and malnutrition in patients aged 75 years or older (elderly group) and patients aged 74 years or younger (younger group). Radiotherapy alone resulted in a median survival period of 11.5 months in the younger group and 6.3 months in the elderly group (p=0.0043). With the Cox multivariate model, good performance status, age less than 75 years, and good response were significant favorable independent predictors. Furthermore, the elderly group patients more frequently died of respiratory infections and had lower prognostic nutritional indexes than the younger group patients before and after radiotherapy. These findings suggested elderly patients with stage III non-small cell lung cancer who had been treated with radiotherapy alone had a poor prognosis and that malnutrition caused by radiotherapy was a factor contributing to the risk of death from respiratory infection in such patients. (author)

Evaluation of QOL in cancer patients treated with radiation therapy

International Nuclear Information System (INIS)

Takahashi, Takeo; Machida, Kikuo; Honda, Norinari; Hosono, Makoto; Murata, Osamu; Osada, Hisato; Omichi, Masahide

2002-01-01

Evaluation of quality of life (QOL) in cancer patients is an important theme. However, we do not have an established method to assess QOL in cancer patients during radiotherapy in Japan. We evaluated both the changes of QOL and the factors affecting QOL in radiotherapy patients. Three hundred fifty-five cancer patients, who filled in a questionnaire at the beginning, middle, and end of radiotherapy between 1998 and 2001, were studied. We used The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD)'' devised by Kurihara et al, the Ministry of Health and Welfare. The QOL Questionnaire had five categories: physical activity, physical condition, mental state, social interaction, and face scale. The total score, sum of the score of five categories, were established synthetically (maximum score is 110). The mean of total QOL scores were 75.8, 77.6, and 78.2 at the beginning, middle, and end of radiotherapy respectively. Patients with symptoms related to cancer had apparent improvement of QOL score. Patients receiving chemotherapy had a decreased QOL score at the end of radiotherapy. The score of physical condition was reduced improvement. It was suggested that radiotherapy could be performed without losing QOL of cancer patients, including older patients. However, patients receiving chemotherapy and those with head and neck cancer may lose their QOL, therefore, we should treat such patients carefully. (author)

Definitive treatment of anal canal carcinoma with radiotherapy: Adverse impact of a pre-radiation resection. A retrospective study of 57 patients treated with curative intent

International Nuclear Information System (INIS)

Coquard, R.; Cenni, J.C.; Artru, P.; Lledo, G.; Chalabreysse, P.; Queneau, P.E.; Taieb, S.; Alessio, A.

2009-01-01

Purpose To describe retrospectively the overall survival, the cancer specific survival and the tumor control in an homogeneous series of patients with epidermoid carcinoma of the anal canal treated with definitive radiotherapy; to assess the impact of brachytherapy, chemotherapy and pre-radiotherapy resection on the risk of recurrence. Patients and methods From 1997 to 2007, 57 patients (pts) presenting with an epidermoid carcinoma of the anal canal (T1: 14, T2: 33, T3-4: 10, N0: 31, N1: 19, N2: 3, N3: 4, M0: 57) were treated with definitive radiotherapy by the same radiation oncologist. The treatment included an external beam irradiation (E.B.R.T.) given to the posterior pelvis (45 Gy/25 fractions) and, six weeks later, a boost delivered with interstitial brachytherapy (37/57) or external beam irradiation (20/57). Twelve pts had undergone a surgical resection of the tumour before radiotherapy. A belly board was used for E.B.R.T. in 13 pts. A concurrent platinum based chemotherapy was done in 42 pts. The mean follow-up was 57 months. Results The overall survival rate at 5 years was 89% with a cause specific survival of 96%. Five patients recurred (5-year rate: 12%: four had local relapse (5-year rate: 8%), four had groin recurrence, and distant metastases were seen in two. In univariate analysis, the risk of relapse was higher in patients who had undergone a pre-radiation excision (p = 0.018), in those who did not receive chemotherapy (p = 0.076) and in those who were irradiated on a belly board (p = 0.049). In multivariate analysis, a pre-radiotherapy resection (p = 0.084) had an inverse impact on the tumour control reaching the level of statistical significance and the use of a belly board was of marginal influence (p = 0.13). Conclusion Radiotherapy and chemo radiation with cisplatin-based chemotherapy cure a vast majority of patients with epidermoid carcinoma of the anal canal. Therapeutic factors that may interfere with the definition of the target volume and

Reduction of pituitary-tumour size in patients with prolactinomas and acromegaly treated with bromocriptine with or without radiotherapy

International Nuclear Information System (INIS)

Wass, J.A.H.; Moult, P.J.A.; Thorner, M.O.; Dacie, J.E.; Charlesworth, M.; Jones, A.E.; Besser, G.M.

1979-01-01

69 patients with prolactin-secreting or growth-hormone-secreting pituitary tumours were treated with bromocriptine with or without pituitary irradiation and followed up for 6 months to 6 1/2 years. Of 26 patients with prolactinomas, 11 had external pituitary irradiation in addition to bromocriptine. There was evidence of shrinkage of the pituitary tumour (either a reduction in fossa size or loss of visual-field defects) in 6 of these patients (23%), 3 of whom had been treated with bromocriptine alone. Of 43 acromegalic patients, 30 received external pituitary irradiation. 8 (19%) showed evidence of shrinkage of the pituitary tumour, including 2 who had received no radiotherapy. 1 patient treated with bromocriptine alone showed striking reduction in the size of his suprasella extension, as assessed by serial computed-tomography scans over 11 months. At the same time his visual-field defects resolved and his deficient corticotrophin and thyrotrophin reserves returned to normal. Bromocriptine can reduce the size of both prolactin-secreting and growth-hormone-secreting pituitary tumours, and this is of potential importance in their management. (author)

Mean esophageal radiation dose is predictive of the grade of acute esophagitis in lung cancer patients treated with concurrent radiotherapy and chemotherapy

International Nuclear Information System (INIS)

Ozgen, A.; Hayran, M.; Kahraman, F.

2012-01-01

The intention of this research was to define the predictive factors for acute esophagitis (AE) in lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy. The data for 72 lung cancer patients treated with concurrent chemoradiotherapy between 2008 and 2010 were prospectively evaluated. Mean lung dose, mean dose of esophagus, volume of esophagus irradiated and percentage of esophagus volume treated were analysed according to esophagitis grades. The mean esophageal dose was associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P<0.001). However, the mean lung dose and the volume of esophagus irradiated were not associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P=0.50 and P=0.41, respectively). The mean radiation dose received by the esophagus was found to be highly correlated with the duration of Grade 2 esophagitis (Spearman test, r=0.82, P<0.001). The mean dose of esophagus ≥28 Gy showed statistical significance with respect to AE Grade 2 or worse (receiver operating characteristic curve analysis, 95% confidence interval (CI), 0.929-1.014). In conclusion, the mean esophageal dose was significantly associated with a risk of esophageal toxicity in patients with lung cancer treated with concurrent radiotherapy and chemotherapy. (author)

Survival in patients with brain metastases treated with radiotherapy holoencefalica at the National Institute of Cancerology

International Nuclear Information System (INIS)

Ospino, Rosalba; Cendales, Ricardo; Tria, Jaime

2009-01-01

Objective: To describe the overall survival among patients with brain metastases treated with whole brain radiation therapy at the Instituto Nacional de Cancerologia (INC) during 2004-2006. Methods: A survival study was conducted. All patients with brain metastases treated with whole brain radiotherapy were included. Frequencies, central tendency, and dispersion measures were used to describe discrete and continuous variables. Survival analysis was performed by the Kaplan-Meyer method. Results: 109 patients were included and the vital status was updated in 85 patients (80%). The median follow-up time was 2.76 months. 78 deaths were observed; the median survival time was 5.2 months and the cumulated one-year overall survival 25.5%. Karnofsky index, extra-cranial metastases, type of lesion, and recursive partitioning analysis (RPA) were significant prognostic factors. The overall median survival for recursive partitioning analysis class I was 7.2 months; class II 6.9 months; class III 1.8 months. Conclusion: Overall survival INC are similar than previous international series for RPA class I and III, while it was better in RPA class II.

Improvement of swallowing function in patients with esophageal cancer treated by radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Sugahara, Shinji; Nakajima, Kotaro; Nozawa, Kumiko [Hitachi Ltd., Ibaraki (Japan). Hitachi General Hospital; Ohara, Kiyoshi; Yoshioka, Hiroshi; Tatsuzaki, Hideo; Tanaka, Naomi; Fukao, Katashi; Itai, Yuji

1996-12-01

This study investigated the impact of radiotherapy on swallowing function in 152 patients with esophageal cancer. Swallowing function was retrospectively assessed in these patients using a swallowing-function scoring system. Total tumor dose ranged from 22.5 Gy in 14 fractions to 104.4 Gy in 50 fractions. Improvement in dysphagia was noted in 62.3% of these patients, with a median time to improvement of 6 weeks. Improvement rate of patients irradiated with 20.0 to 34.9 Gy, 35.0 to 59.9 Gy and 60.0 Gy or more was 23.1%, 58.3% and 71.6%, respectively. Patients with T1-3 showed, a greater improvement rate than patients with T4 cancer (72.2% versus 54.1%). On multivariate analysis, the initial score, total dose and T factor correlated with improvements in swallowing function. Our results suggest that 35.0 Gy or more is necessary to improve swallowing function. The median duration in which patients could swallow soft or solid foods, was 8 months in patients receiving 60.0 Gy or more and 2 months in patients receiving 50.0 to 59.9 Gy, respectively. There was a significant difference between these periods (p<0.01). Regarding duration of palliation, median duration for patients receiving 60.0 Gy or more was 30 weeks, while it was 22 weeks for patients treated with lesser doses (p=0.053). We recommend 60.0 Gy or more as the optimal dosage for improving dysphagia. (author)

Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): Long-term results in 106 patients treated in a single institution

International Nuclear Information System (INIS)

Combs, Stephanie E.; Volk, Sigrid; Schulz-Ertner, Daniela; Huber, Peter E.; Thilmann, Christoph; Debus, Juergen

2005-01-01

Purpose: To assess the long-term outcome and toxicity of fractionated stereotactic radiotherapy for acoustic neuromas in 106 patients treated in a single institution. Patients and Methods: Between October 1989 and January 2004, fractionated stereotactic radiotherapy (FSRT) was performed in 106 patients with acoustic neuroma (AN). The median total dose applied was 57.6 Gy in median single fractions of 1.8 Gy in five fractions per week. The median irradiated tumor volume was 3.9 mL (range, 2.7-30.7 mL). The median follow-up time was 48.5 months (range, 3-172 months). Results: Fractionated stereotactic radiotherapy was well tolerated in all patients. Actuarial local tumor control rates at 3- and 5- years after FSRT were 94.3% and 93%, respectively. Actuarial useful hearing preservation was 94% at 5 years. The presence of neurofibromatosis (NF-2) significantly adversely influenced hearing preservation in patients that presented with useful hearing at the initiation of RT (p = 0.00062). Actuarial hearing preservation without the diagnosis of NF-2 was 98%. In cases with NF-2, the hearing preservation rate was 64%. Cranial nerve toxicity other than hearing impairment was rare. The rate of radiation induced toxicity to the trigeminal and facial nerve was 3.4% and 2.3%, respectively. Conclusion: Fractionated stereotactic radiotherapy is safe and efficacious for the treatment of AN, with mild toxicity with regard to hearing loss and cranial nerve function. FSRT might be considered as an equieffective treatment modality compared to neurosurgery and therefore represents an interesting alternative therapy for patients with AN

Factors influencing the parotid function in nasopharyngeal carcinoma treated with parotid-sparing radiotherapy

International Nuclear Information System (INIS)

Liu Wenshan; Lee Jongkang; Su Maochang; Lee, S.P.; Chen Ginden; Lee Hongshen; Lee Huei

2006-01-01

The background of this study was to evaluate the factors influencing post-irradiation parotid gland function in nasopharyngeal cancer treated with parotid-sparing radiotherapy. This study consisted of 45 patients with nasopharyngeal cancer treated with radiotherapy including 3D conformal radiotherapy, intensity-modulated radiotherapy and high-dose-rate brachytherapy. The mean follow-up time was 37.5 months (range: 15-50 months). Objective parotid gland function was assessed by series sialoscintigraphy pre-irradiation and post-irradiation at 1, 6, 12 and 18 months. Subjective salivary function was recorded by the LENT/SOMA system. Wilcoxon signed-rank test was used to compare the secretion ratio (SR) of parotid gland before and after treatment. Mann-Whitney rank-sum test was used to determine the factors influencing the post-irradiated SR. Chi-square test was used to compare the correlation between subjective grading of xerostomia and objective grading of parotid glands. There was a significant difference between the pre-irradiation and post-irradiation parotid gland's SR at 1 (0.30 versus 0.01, P 0.05) and 18 months (0.30 versus 0.18, P>0.05). There was significant correlation between subjective and objective salivary function (P=0.024) at 12 months after radiotherapy. The factor that impacted the preservation of parotid function was mean dose to the parotid gland >38.0 Gy (P<0.05). Our results demonstrated that parotid function could recover 1 year after treatment with parotid-sparing radiotherapy in patients with nasopharyngeal cancer. The most important factor that influenced parotid function was the mean dose to the parotid gland. (author)

Clinical outcome in 520 consecutive Danish rectal cancer patients treated with short course preoperative radiotherapy

DEFF Research Database (Denmark)

Jensen, L H; Altaf, R; Harling, H

2010-01-01

AIM: The purpose of this study was to analyse the results of preoperative short course radiotherapy in a consecutive, national cohort of patients with rectal cancer. METHODS: Through a validated, prospective national database we identified 520 Danish patients who presented with high-risk mobile...... tumours in the lower two thirds of the rectum and were referred for preoperative radiotherapy with 5 x 5 Gy. The inclusion period was 56 months. Radiotherapy data was retrospectively collected. RESULTS: Of the 520 patients, 514 completed radiotherapy and 506 had surgery. Surgery was considered curative...... in 439 patients. The 3-year local recurrence rate was 4.0% (95% CI 2.5-6.5%) and the distant recurrence rate at 3 years was 18.7% (95% CI 15.4-22.5%). The 5-year disease free survival rate was 40.2% (95% CI 27.0-53.1%) and overall survival 50.4% (95% CI 36.1-63.1%). Most tumours (61%) were classified...

Clinical evaluation on cardiac enlargement in patients with esophageal cancer treated by radiotherapy with or without chemotherapy

Energy Technology Data Exchange (ETDEWEB)

Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine

2002-09-01

Recent literature on chemoradiotherapy for esophageal cancer report the comparable survival results as surgery, and suggest the importance of management for the late adverse effect of chemoradiotherapy. The aim of this study is to investigate the incidence and risk factors of cardiomegaly after chemoradiotherapy using low dose continuous infusion of 5FU/CDDP+5FU for esophageal cancer. Fifty-one patients with stage I-IVA esophageal cancer who were treated by radiotherapy with more than 50 Gy with or without chemotherapy and followed up for more than 6 months were analyzed. Sixteen patients were treated by radiation alone and 35 patients were treated by chemoradiotherapy. A change of CTR (cardio-thoracic ratio) was defined as the difference between CTR in the pre-treatment X-ray film and CTR in the post-treatment X-ray film with maximum cardiac silhouette. A change of CTR by more than 10% was defined as ''significant cardiomegaly''. In this study cardiac area-dose'', which is the sum of the products of cardiac area within every radiation field and its target dose, was calculated in each patient as a radiation parameter. Significant cardiomegaly was noted in 1 patient (6%) in the radiation alone group, in 8 patients (23%) in the chemoradiotherapy group and in 9 patients (18%) in the total population. In cases with more than 0.4 m{sup 2}{center_dot}Gy in cardiac area-dose, CTR elevation was significantly higher than in cases with less than 0.4m{sup 2}{center_dot}Gy. More than moderate pleural effusion was noted in 5 patients (10%). Chronic pericardial effusion and subsequent cardiac tamponade was considered to be one of the contributing factors for pleural effusion, because increases of pleural effusion coincided with CTR elevations in 3 cases. In addition, the fact that no case had right-sided unilateral pleural effusion suggested the direct effect of radiation to the pleura. Significant cardiomegaly was seen in 18% of 51 patients with

Human papilloma virus and survival of oropharyngeal cancer patients treated with surgery and adjuvant radiotherapy.

Science.gov (United States)

Broglie, Martina A; Soltermann, Alex; Haile, Sarah R; Huber, Gerhard F; Stoeckli, Sandro J

2015-07-01

Impact of p16 protein, a surrogate marker for human papilloma virus induced cancer, p53 and EGFR as well as clinical factors on survival in a patient cohort with oropharyngeal squamous cell carcinoma (OPSCC) treated by surgical resection and adjuvant radiotherapy (RT) ± concomitant chemotherapy (CT). This is a retrospective analysis of patient's charts and tumor tissue. 57 patients were consecutively included and their tumor tissue assembled on a tissue microarray following immunohistochemical analysis. Survival times were estimated by means of Kaplan-Meier analysis. The importance of clinical and immunohistochemical factors for outcome was estimated by cox proportional hazard models. With 88% 5-year overall survival, 91% 5-year disease-specific survival and 91% 5-year disease-free survival, respectively, we found excellent survival rates in this surgically treated patient cohort of mainly advanced OPSCC (93% AJCC stage III or IV). The only factors positively influencing survival were p16 overexpression as well as p53 negativity and even more pronounced the combination of those biomarkers. Survival analysis of patients classified into three risk categories according to an algorithm based on p16, smoking, T- and N-category revealed a low, intermediate and high-risk group with significant survival differences between the low and the high-risk group. Patients with OPSCC can be successfully treated by surgery and adjuvant RT ± CT with a clear survival benefit of p16 positive, p53 negative patients. We recommend considering a combination of immunohistochemical (p16, p53) and clinical factors (smoking, T- and N-category) for risk stratification.

Persistence of unstable and stable chromosome aberrations in lymphocytes of cancer patients treated with radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Di Giorgio, M.; Vallerga, M.B.; Taja, M.R. [Autoridad Regulatoria Nuclear, Buenos Aires (Argentina); Sardi, M. [Hospital Italiano - Mevaterapia, Buenos Aires (Argentina)

2006-07-01

Background: Radiation-induced DNA damage in human lymphocytes has equal probability of producing both stable or unstable chromosome aberrations (C.A.). Reports of its in vivo persistence show considerable variations. The quantification of unstable C.A. (dicentrics) in peripheral blood lymphocytes (P.B.L.) is the most reliable biological method for estimating whole-body doses of recent overexposures to ionizing radiation. Given that during the division of T cell precursors, proliferative death of cells containing dicentrics reduces the number of such lymphocytes in peripheral blood, dicentric methodology should be modified to account for past exposures. Micronuclei (M.N.) in cytokinesis-blocked human P.B.L. are well established bio markers for assessing radiation damage in vivo. However, persistence of radiation induced M.N. is limited. Unlike dicentrics and M.N., stable C.A. (translocations) identified at present by the FISH technique, seem to be an adequate indicator for the dosimetric evaluation of past exposures, since translocations are not selected against during mitotic division in the haematopoietic stem cells compartment. Nevertheless, for partial -body exposures with high dose there is some evidence that the decline with time of dicentrics causes some reduction in the yield of translocations. Purpose: To assess the persistence along time of dicentrics, M.N. and translocations in lymphocytes of cancer patients after radiotherapy in order to model changes in C.A. frequencies with partial-body exposures. Materials and methods: 22 cancer patients with different tumor sites, treated with radiotherapy, were evaluated through dicentric chromosome, M.N. and FISH techniques with a follow-up time of up to 90 months after the end of radiotherapy. Regression analysis were performed: 1) for dicentric and for M.N. frequencies in relation to time after the end of radiotherapy and total tumor dose; 2) for the percentage of uns table cells in relation to time after the end

Dental needs in Brazilian patients subjected to head and neck radiotherapy.

Science.gov (United States)

Rosales, Ana Carolina de Mesquita Netto; Esteves, Sérgio Carlos Barros; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Márcio Ajudarte

2009-01-01

In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.

Dental needs in Brazilian patients subjected to head and neck radiotherapy

International Nuclear Information System (INIS)

Rosales, Ana Carolina de Mesquita Netto; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Marcio Ajudarte

2009-01-01

In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients. (author)

Development of electronic clinical path for patients with H and N cancer treated with carbon ion radiotherapy

International Nuclear Information System (INIS)

Ebisutani, Asuka; Okabe, Satsuki; Murakami, Masao; Kagawa, Kazufumi; Hishikawa, Yoshio

2005-01-01

The purpose of this study was to develop an electronic clinical path for patients with head and neck (H and N) tumor treated with carbon ion radiotherapy (RT) focusing on acute reactions of the oral mucosa and the skin. Between January and July, 2002, fifteen patients with H and N tumor had been treated with carbon ion radiotherapy including oral cavity in the RT fields. Acute reactions of the oral mucosa and the skin were analyzed together with face scales (FS) that is an indicator of quality of life obtained daily from patients during RT courses. Medical interventions including prescription for mucositis or dermatitis, nursing care, and changes of meal were also analyzed. Average period of being in hospital was 42.6±3.6 days and that of radiation was 27.0±1.9 days. Radiation mucositis appeared 5 days (10.8 GyE) after start of carbon ion RT, reached a maximum reaction at 20 days (Grade 1: 7%, Grade 2: 33%, Grade 3: 60%), and recovered less than Grade 1 at 44 days on average. Radiation dermatitis also appeared 8 days (18 GyE), reached a maximum at 33 days (Grade 1: 47%, Grade 2: 40%, Grade 3: 13%), and recovered less than Grade 1 at 51 days on average. Changes of FS showed deterioration 23 days after start of therapy. At the latter half of RT courses, mucositis, FS, and dermatitis reached a maximum in that order. Through analyses of the time-score plots, the change of FS seemed corresponding to that of dermatitis. The required medical interventions were change of meal in 10, analgesics in 8, and gargles in 15 patients. Based on these results, we established a clinical path as a trial piece. We confirmed that there was a specific pattern in ups and downs of acute reactions of the oral mucosa and the skin during a RT course. We concluded that a clinical path is useful for patients with H and N cancer treated with carbon ion RT. (author)

Anti-emetic effect of granisetron in patients undergoing cranial and craniospinal radiotherapy

International Nuclear Information System (INIS)

Yamasaki, Fumiyuki; Watanabe, Yosuke; Nosaka, Ryo

2014-01-01

Approximately 30-59% of patients undergoing cranial or craniospinal radiotherapy experience nausea and/or vomiting. Here, we evaluated the effectiveness of granisetron for controlling emesis in patients treated with cranial or craniospinal radiotherapy. Between December 2011 and January 2013, 34 patients (19 males, 15 females; age range, 3-80 years) received cranial or craniospinal radiotherapy at our department. All but one male patient, who developed meningitis during the irradiation period were enrolled in this retrospective study. Patients who experienced irradiation-induced vomiting (grade 1) or nausea (grade 2) were treated with granisetron as a rescue anti-emetic. Episodes were graded as no vomiting, no nausea, no anti-emetic; no vomiting, nausea, no anti-emetic; no vomiting, nausea with anti-emetic; and vomiting. Of the 9 patients who underwent whole-brain or whole neural-axis irradiation, 5 (55.6%) experienced grade 2 nausea or vomiting. Two of 6 patients (33.3%) treated with whole ventricle irradiation experienced grade 2 nausea or vomiting. Three of 18 patients (16.7%) who underwent local-field irradiation experienced grade 2 nausea or vomiting. Patients who underwent wide-field irradiation experienced nausea, vomiting, and anorexia (p<0.05). Complete response (no vomiting, no additional rescue anti-emetic, and no nausea) was observed in 5 of 9 patients treated with granisetron. Four of 9 patients (44.4%) treated with granisetron experienced constipation (grade 1 or 2); its administration had no major adverse effects in our study population. Rescue therapy with granisetron is safe and effective to treat nausea and vomiting in patients subjected to cranial or craniospinal irradiation. (author)

Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

International Nuclear Information System (INIS)

Kirova, Youlia M.; Menard, Jean; Chargari, Cyrus; Mazal, Alejandro; Kirov, Krassen

2012-01-01

To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

Energy Technology Data Exchange (ETDEWEB)

Kirova, Youlia M., E-mail: youlia.kirova@curie.net [Department of Radiation Oncology, Institut Curie, Paris (France); Menard, Jean; Chargari, Cyrus; Mazal, Alejandro [Department of Radiation Oncology, Institut Curie, Paris (France); Kirov, Krassen [Department of Anesthesiology and Reanimation, Institut Curie, Paris (France)

2012-07-01

To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

Autopsy findings in carcinoma of the esophagus treated with radiotherapy

International Nuclear Information System (INIS)

Hishikawa, Yoshio; Kamikonya, Norihiko; Tanaka, Shinichi; Miura, Takashi

1988-01-01

Forty autopsied patients with esophageal carcinoma (35 treated with radiotherapy and 5 with conservative treatment) were analyzed by multiple regression analysis. Local recurrence significantly differed with the treatment method. The lowest rate of local recurrence was observed in the patients treated with high-dose-rate intracavitary irradiation following external irradiation. Mediastinal lymph node metastasis was significantly related to the extent of the primary tumor (T) and the lowest rate of metastasis was seen in the patients with T1. Abdominal lymph node metastasis was significantly related to both the disease stage and treatment method. The lowest rate of metastasis was noted in stage 1 patients, whereas, the rate was high in the patients with high-dose-rate intracavitary irradiation following external irradiation. Distant metastasis was significantly related to disease stage, with stage 1 patients showing the lowest rate of metastasis. Prognosis was significantly related to the treatment method. The average of survival was highest in the patients treated with high-dose-rate intracavitary irradiation following external irradiation. (author)

[Anti-emetic effect of granisetron in patients undergoing cranial and craniospinal radiotherapy].

Science.gov (United States)

Yamasaki, Fumiyuki; Watanabe, Yosuke; Nosaka, Ryo; Kenjo, Masahiro; Nakamura, Kazuhiro; Takayasu, Takeshi; Saito, Taiichi; Tominaga, Atsushi; Sugiyama, Kazuhiko; Kurisu, Kaoru

2014-01-01

Approximately 30-59% of patients undergoing cranial or craniospinal radiotherapy experience nausea and/or vomiting. Here, we evaluated the effectiveness of granisetron for controlling emesis in patients treated with cranial or craniospinal radiotherapy. Between December 2011 and January 2013, 34 patients(19 males, 15 females;age range, 3-80 years)received cranial or craniospinal radiotherapy at our department. All but one male patient, who developed meningitis during the irradiation period were enrolled in this retrospective study. Patients who experienced irradiation-induced vomiting(grade 1)or nausea(grade 2)were treated with granisetron as a rescue anti-emetic. Episodes were graded as(1)no vomiting, no nausea, no anti-emetic;(2)no vomiting, nausea, no anti-emetic;(3)no vomiting, nausea with anti-emetic;and(4)vomiting. Of the 9 patients who underwent whole-brain or whole neural-axis irradiation, 5(55.6%)experienced grade 2 nausea or vomiting. Two of 6 patients(33.3%)treated with whole ventricle irradiation experienced grade 2 nausea or vomiting. Three of 18 patients(16.7%)who underwent local-field irradiation experienced grade 2 nausea or vomiting. Patients who underwent wide-field irradiation experienced nausea, vomiting, and anorexia(pgranisetron. Four of 9 patients(44.4%)treated with granisetron experienced constipation(grade 1 or 2);its administration had no major adverse effects in our study population. Rescue therapy with granisetron is safe and effective to treat nausea and vomiting in patients subjected to cranial or craniospinal irradiation.

Immunoreactivity examination of patients with testicular tumours treated with radiotherapy

International Nuclear Information System (INIS)

Stefanits, Klara; Kuhn, Endre; Csere, Tibor

1985-01-01

Results of the immunoreactivity study of 72 patients receiving radiotherapy are presented. Tuberculin and DNCB (2,4 dinitrochlorobenzol) reactivity tests were performed before, during and 3 years after the radiation therapy and at the time when metastases appeared. The number of positive reactions decreased slightly in both tuberculin and DNCB groups, though not significantly. Metastatic patients showed a significant decrease of reactivity against DNCB as compared with the results obtained before the treatment. In 5,6% of patients herpes zoster was registered. No other infections occured. It was found that immunosuppression caused by the radiation treatment does not influence the later fate of patients with testicular tumours. (author)

Therapeutic Results of Radiotherapy in Rectal Carcinoma -Comparison of Sandwich Technique Radiotherapy with Postoperative Radiotherapy

International Nuclear Information System (INIS)

Huh, Gil Cha; Suh, Hyun Suk; Lee, Hyuk Sang; Kim, Re Hwe; Kim, Chul Soo; Kim, Hong Yong; Kim, Sung Rok

1996-01-01

Purpose : To evaluate the potential advantage for 'sandwich' technique radiotherapy compared to postoperative radiotherapy in respectable rectal cancer. Between January 1989 and May 1994, 60 patients with respectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital.Fifty one patients were available for analysis : 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with postoperative radiotherapy. In sandwich technique radiotherapy(RT), patients were treated with preoperative RT 1500 cGy/5fx followed by immediate curative resection. Patients staged as Astler-Coller B2, C were considered for postoperative RT with 2500-4500 cGy. In postoperative RT, total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-6 weeks was delivered. Patients were followed for median period of 25 months. Results : The overall 5-year survival rates for sandwich technique RT group and postoperative RT group were 60% and 71%, respectively(p>0.05). The 5-year disease free survival rates for each group were 63%. There was no difference in local failure rate between two groups(11% versus 7%). Incidence of distant metastasis was 11%(2/20) in the sandwich technique RT group and 20%(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. Conclusion : The sandwich technique radiotherapy group shows local recurrence and survival similar to those of postoperative RT alone group but reduced distant metastasis compared to postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT

Association between adjuvant regional radiotherapy and cognitive function in breast cancer patients treated with conservation therapy

International Nuclear Information System (INIS)

Shibayama, Osamu; Yoshiuchi, Kazuhiro; Inagaki, Masatoshi; Matsuoka, Yutaka; Yoshikawa, Eisho; Sugawara, Yuriko; Akechi, Tatsuo; Wada, Noriaki; Imoto, Shigeru; Murakami, Koji; Ogawa, Asao; Akabayashi, Akira; Uchitomi, Yosuke

2014-01-01

Although protracted cognitive impairment has been reported to occur after radiotherapy even when such therapy is not directed to brain areas, the mechanism remains unclear. This study investigated whether breast cancer patients exposed to local radiotherapy showed lower cognitive function mediated by higher plasma interleukin (IL)-6 levels than those unexposed. We performed the Wechsler Memory Scale-Revised (WMS-R) and measured plasma IL-6 levels for 105 breast cancer surgical patients within 1 year after the initial therapy. The group differences in each of the indices of WMS-R were investigated between cancer patients exposed to adjuvant regional radiotherapy (n = 51) and those unexposed (n = 54) using analysis of covariance. We further investigated a mediation effect by plasma IL-6 levels on the relationship between radiotherapy and the indices of WMS-R using the bootstrapping method. The radiotherapy group showed significantly lower Immediate Verbal Memory Index and Delayed Recall Index (P = 0.001, P = 0.008, respectively). Radiotherapy exerted an indirect effect on the lower Delayed Recall Index of WMS-R through elevation of plasma IL-6 levels (bootstrap 95% confidence interval = −2.6626 to −0.0402). This study showed that breast cancer patients exposed to adjuvant regional radiotherapy in conservation therapy might have cognitive impairment even several months after their treatment. The relationship between the therapy and the cognitive impairment could be partially mediated by elevation of plasma IL-6 levels

10-year epidemiological profile changes for cervical and endometrial cancer patients treated by radiotherapy in the Pernambuco state, Brazil

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Cantinha, Rebeca S.; Santos, Mariana L.O.; Franca, Elvis J.; Pessoa, Juanna G.; Melo, Ana M.M.A.; Amancio, Francisco F.

2014-01-01

Cancer is a worldwide public health problem, its prevention and control are included within 16 strategic objectives of the Brazilian Ministry of Health for the period 2011-2015. Cervical cancer is the fourth most common tumor in the female population, being new 15,590 cases estimated for 2014 according to the Brazilian National Cancer Institute (INCA). Pernambuco is the fifth state with the highest number of cases of cervical cancer and the seventh in cases of endometrial ones, both estimative for 2014. The understanding of the epidemiological profile of these pathologies corroborates strategies for prevention, control and treatment. As Pernambuco has implemented the radiotherapy for cancer treatment since 1998-1999, this work encompassed the comparison of the 1998-1999 epidemiological profile of patients treated by radiotherapy for cervical and endometrial cancer in the State of Pernambuco, Brazil, with 2008-2009 profile - ten years after. Medical record of 490 patients treated at the Center of Radiotherapy of Pernambuco (CERAPE) were compiled according to the patient origin, the affected uterus region, the staging of disease, the type and cell differentiation of the tumor, the age group, and, finally, the realization of hysterectomy as part of the treatment. More than 90% of the patients were affected by cervical cancer in the two investigated periods. For the interval of 1998-1999 the proportion of patients submitted to hysterectomy was quite higher compared to those after ten years. The results also showed a change in the origin of the patients, in which, in 1999, most of the patients were from the capital and the metropolitan area, while, after ten years, patients were mostly from the interior of the State. There was a predominance of squamous cell type tumors in both periods evaluated. For the 1998-1999 interval, tumors were stage 2, moderately differentiated type. Differently, the tumors were mostly stage 3, not differentiated type, for the 2008-2009 period

10-year epidemiological profile changes for cervical and endometrial cancer patients treated by radiotherapy in the Pernambuco state, Brazil

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Cantinha, Rebeca S.; Santos, Mariana L.O.; Franca, Elvis J., E-mail: ejfranca@yahoo.com.br, E-mail: marianasantos_ufpe@hotmail.com, E-mail: rebecanuclear@gmail.com [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil); Pessoa, Juanna G.; Melo, Ana M.M.A.; Amancio, Francisco F., E-mail: amdemelo@hotmail.com, E-mail: amanciobike@gmail.com, E-mail: juannapessoa@gmail.com, E-mail: marianasantos_ufpe@hotmail.com [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Departamento de Biofisica e Radiobiologia; Oliveira Neto, Aristides M.; Melo, Jonathan A., E-mail: aristidesoliveira466@hotmail.com, E-mail: jonathan@truenet.com.br [Centro de Radioterapia de Pernambuco (CERAPE), Santo Amaro, PE (Brazil)

2014-07-01

Cancer is a worldwide public health problem, its prevention and control are included within 16 strategic objectives of the Brazilian Ministry of Health for the period 2011-2015. Cervical cancer is the fourth most common tumor in the female population, being new 15,590 cases estimated for 2014 according to the Brazilian National Cancer Institute (INCA). Pernambuco is the fifth state with the highest number of cases of cervical cancer and the seventh in cases of endometrial ones, both estimative for 2014. The understanding of the epidemiological profile of these pathologies corroborates strategies for prevention, control and treatment. As Pernambuco has implemented the radiotherapy for cancer treatment since 1998-1999, this work encompassed the comparison of the 1998-1999 epidemiological profile of patients treated by radiotherapy for cervical and endometrial cancer in the State of Pernambuco, Brazil, with 2008-2009 profile - ten years after. Medical record of 490 patients treated at the Center of Radiotherapy of Pernambuco (CERAPE) were compiled according to the patient origin, the affected uterus region, the staging of disease, the type and cell differentiation of the tumor, the age group, and, finally, the realization of hysterectomy as part of the treatment. More than 90% of the patients were affected by cervical cancer in the two investigated periods. For the interval of 1998-1999 the proportion of patients submitted to hysterectomy was quite higher compared to those after ten years. The results also showed a change in the origin of the patients, in which, in 1999, most of the patients were from the capital and the metropolitan area, while, after ten years, patients were mostly from the interior of the State. There was a predominance of squamous cell type tumors in both periods evaluated. For the 1998-1999 interval, tumors were stage 2, moderately differentiated type. Differently, the tumors were mostly stage 3, not differentiated type, for the 2008-2009 period

Results of radiotherapy for brain metastases in old-aged patients

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Nieder, C.; Niewald, M.; Schnabel, K.

1995-01-01

To evaluate which patients older tahn 70 years will benefit by radiotherapy for their brain metastases the data of 35 patients in this age-group who were treated between 1983 and 1994 were retrospectivley analyzed. All patients were previously untreated and received a whole-brain irradiation and concomitantly corticosteroids. The median total dose was 30 Gy (fractionation: 10 times 3 Gy in 2 weeks). Six patients each received lower or higher total doses with 50.4 Gy at maximum. Six patients failed to complete their prescribed treatment (17%). The median survival of all patients who completed their radiotherapy course was 67 days only. Patients with extracerebral metastases had a median survival of 31 days. Survival was not dependent on total dose of radiotherapy. In 56% of all cases the general condition of the patients improved or remained stable at a high level. Karnofsky-performance status was the most important prognostic factor. Advanced age is an unfavourable prognostic factor. Only patients in good general condition without extracerebral metastases had survival times which justify radiotherapy for their brain metastases. (orig./MG) [de

Assessment of quality of life in patients treated with accelerated radiotherapy for laryngeal and hypopharyngeal carcinomas.

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Allal, A S; Dulguerov, P; Bieri, S; Lehmann, W; Kurtz, J M

2000-05-01

This study was conducted to evaluate quality of life (QOL) and functional outcome in patients with carcinomas of the larynx and hypopharynx treated with accelerated radiotherapy (RT). Between January 1991 and September 1996, 21 patients treated with accelerated concomitant boost RT schedule (69.9 Gy in 5. 5 weeks) for laryngeal (n = 10) or hypopharyngeal (n = 11) carcinomas and who remained free of disease at 1-year minimum follow-up were evaluated. The functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and general QOL by the European Organization for Research and Treatment of Cancer Core QOL questionnaire (EORTC QLQ-C30). The median length of follow-up was 37 months (range, 13 to 75). The PSSHN scores were 89, 84, and 86, respectively, for eating in public, understandability of speech and normalcy of diet (100 = normal function). Significantly lower scores for understandability of speech were observed in patients with advanced and laryngeal carcinomas. Normalcy of diet was affected negatively by the severity of xerostomia. All mean functional scale scores of the EORTC QLQ-C30 module were 20% to 25% below the higher score. Most of these scale scores were significantly affected by the severity of xerostomia. Patients treated with concomitant boost RT for laryngeal and hypopharyngeal carcinomas appear to have similar QOL and functional outcome to those reported for patients treated with conventional or hyperfractionated RT. As expected, many QOL scales were affected by the severity of xero- stomia.

Nutritional status of patients treated with radiotherapy as determined by subjective global assessment

International Nuclear Information System (INIS)

Koom, Woong Sub; Keum, Ki Chang; Ahn, Seung Do

2012-01-01

The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). The mean age of patients in this study was 59.4 ± 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss 5% (OR, 2.299). SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.

Nutritional status of patients treated with radiotherapy as determined by subjective global assessment

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Koom, Woong Sub; Keum, Ki Chang [Dept. of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Ahn, Seung Do [Dept. of Radiation Oncology, Asan Medical Center, Seoul (Korea, Republic of); and others

2012-09-15

The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). The mean age of patients in this study was 59.4 {+-} 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss 5% (OR, 2.299). SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.

Improved survival and complete response rates in patients with advanced melanoma treated with concurrent ipilimumab and radiotherapy versus ipilimumab alone.

Science.gov (United States)

Koller, Kristian M; Mackley, Heath B; Liu, Jason; Wagner, Henry; Talamo, Giampaolo; Schell, Todd D; Pameijer, Colette; Neves, Rogerio I; Anderson, Bryan; Kokolus, Kathleen M; Mallon, Carol A; Drabick, Joseph J

2017-01-02

There is a growing body of evidence supporting the synergistic roles of radiotherapy and immunotherapy in the treatment of malignancy. Published case studies of the abscopal effect have been reported with the use of ipilimumab and radiotherapy in metastatic melanoma, but evidence supporting the routine use of this combination of therapy is limited. We conducted a retrospective analysis to evaluate patients treated with ipilimumab for advanced melanoma at a single institution from May 2011 to June 2015. Patients were grouped into those who had received concurrent radiotherapy while on ipilimumab (Ipi-RT), and those who did not. We then evaluated the treatment response following completion of ipilimumab. A total of 101 patients received ipilimumab in the prespecified time frame. 70 received Ipi-RT and 31 received ipilimumab without concurrent radiotherapy. Median overall survival (OS) was significantly increased in the concurrent Ipi-RT arm at 19 months vs. 10 months for ipilimumab alone (p = 0.01). Median progression free survival (PFS) was marginally increased in the Ipi-RT group compare with the ipilimumab alone group (5 months vs. 3 months, p = 0.20). Rates of complete response (CR) were significantly increased in the Ipi-RT group vs. ipilimumab alone (25.7% vs. 6.5%; p = 0.04), and rates of overall response (OR) in the groups were 37.1% vs. 19.4% (p = 0.11). No increase in toxicities was observed in the Ipi-RT group compare with ipilimumab alone. Prospective trials are needed to further clarify the role of radiotherapy with ipilimumab, but these encouraging preliminary observations suggest that this combination can induce more durable responses to immunotherapy.

Prognostic Value of Cavernous Sinus Invasion in Patients with Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiotherapy.

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Jun-Fang Liao

Full Text Available To investigate the prognostic value of cavernoussinus invasion (CSI in patients with nasopharyngeal carcinoma (NPC treated with intensity-modulated radiotherapy (IMRT.Retrospective review of data from 1,087 patients with biopsy-proven, non-metastatic NPC. All patients were diagnosed using magnetic resonance imaging (MRI scans and received IMRT as the primary treatment.The incidence of cavernoussinus invasion in this cohort was 12.1%. In univariate analysis, 5-year overall survival (OS (70.6% vs. 88.5%, P < 0.001 and distant metastasis-free survival (DMFS (71.4% vs. 87.7%, P < 0.001, but not locoregional relapse-free survival (LRFS (93.9% vs. 93.7%, P = 0.341, were significantly different between patients with and without cavernoussinus invasion. In the T4 subgroup, the 5-year OS, DMFS, and LRFS of patients with and without cavernoussinus extension were 70.6% vs. 81.9% (P = 0.011, 71.4% vs. 84.1% (P = 0.011, and 91.2% vs. 89.7% (P = 0.501, respectively. In multivariate analysis, cavernoussinus invasion was an independent prognostic factor for poorer OS (HR = 1.782; P = 0.013 and DMFS (HR = 1.771; P = 0.016, but not LRFS (HR = 0.632; P = 0.294. In patients with lymph node metastasis, the DMFS rates of patients with and without cavernoussinus invasion were significantly different (P < 0.001. Preliminaryanalysis indicated that neoadjuvant chemotherapy led to better DMFS and OS in patients with cavernoussinus invasion than concurrent chemotherapy or radiotherapy alone; however, the differences were not significant.In the IMRT era, cavernoussinus invasion remains a prognostic factor for poor DMFS and OS in NPC, even in patients with T4 disease.

Second cancers in children treated with modern radiotherapy techniques

International Nuclear Information System (INIS)

Schneider, Uwe; Lomax, Antony; Timmermann, Beate

2008-01-01

Background and Purpose: The scattered radiation from the treatment volume might be more significant for children than for adults and, as a consequence, modern radiotherapy treatment techniques such as IMRT and passive proton therapy could potentially increase the number of secondary cancers. In this report, secondary cancer risk resulting from new treatment technologies was estimated for an adult prostate patient and a child. Material and methods: The organ equivalent dose (OED) concept with a linear-exponential, a plateau and a linear dose-response curve was applied to dose distributions of an adult prostate patient and a child with a rhabdomyosarcoma of the prostate. Conformal radiotherapy, IMRT with 6 MV photons and proton therapy were planned. OED (cancer risk) was estimated for the whole body, the rectum and the bladder. In addition, relative cumulative risk was calculated. Results: Secondary cancer risk in the adult is not more than 15% it increased when IMRT or passive proton therapy was compared to conventional treatment planning. In the child, risk remains practically constant or was even reduced for proton therapy. The cumulative risk in the child relative to that in the adult can be as large as 10-15. Conclusions: By a comparison between an adult patient and a child treated for a disease of the prostate, it was shown that modern radiotherapy techniques such as IMRT and proton therapy (active and passive) do not increase the risk for secondary cancers

The expression of epidermal growth factor receptor results in a worse prognosis for patients with rectal cancer treated with preoperative radiotherapy: a multicenter, retrospective analysis

International Nuclear Information System (INIS)

Giralt, Jordi; Heras, Manuel de las; Cerezo, Laura; Eraso, Aranzazu; Hermosilla, Edurado; Velez, Dolores; Lujan, Juan; Espin, Eloi; Rossello, Jose; Majo, Joaquin; Benavente, Sergi; Armengol, Manel; Torres, I. de

2005-01-01

Background and purpose: Expression of epidermal growth factor receptor (EGFR) is observed in 50-70% of colorectal carcinoma and is associated with poor prognosis. The aim of this study was to determine the prognostic value of EGFR status before radiotherapy in a group of patients with locally advanced rectal cancer treated with preoperative radiotherapy. Patients and methods: Eighty-seven patients were studied retrospectively. Treatment consisted of pelvic radiotherapy, in 50 patients with concomitant chemotherapy and surgical resection. Immunohistochemistry for EGFR was determined at the preradiation biopsy and in the resected specimens. Immunohistochemical analysis for EGFR expression was evaluated according to extension and staining intensity. We defined positive staining (EGFR positive), when extension was 5% or more. Results: A total of 52 of 87 tumors showed EGFR positive status at biopsy (60%) and EGFR expression was associated neither with clinical tumor stage nor with clinical nodal stage. EGFR positive expression was linked to a lack of pathologic complete response to preoperative radiotherapy (P=0.006). Disease-free survival was lower among patients with EGFR positive status before radiotherapy (P=0.003). In a multivariate analysis EGFR expression at biopsy was a statistically significant predictor of disease-free survival, RR=2.88 (1.1-7.8), P=0.036. Conclusions: EGFR is expressed in a significant number of rectal tumors. EGFR-positive expression before radiotherapy is an indicator for poor response and low disease-free survival

Nasopharyngeal Carcinoma Treated with Precision-Oriented Radiation Therapy Techniques Including Intensity-Modulated Radiotherapy: Preliminary Results

Directory of Open Access Journals (Sweden)

Wen-Shan Liu

2004-02-01

Full Text Available This paper reports preliminary results with intensity-modulated radiotherapy (IMRT in nasopharyngeal carcinoma (NPC. Between August 2000 and May 2001, we treated 19 patients with NPC using IMRT. Twelve patients had stage I-II disease and seven had stage III-IV disease. Six patients received 9.0-19.8 Gy three-dimensional conformal radiotherapy (3D-CRT before IMRT and 18 patients received a brachytherapy boost after IMRT. The mean follow-up time was 13.0 months. All patients with stage II-IV disease except one received two cycles of chemoradiotherapy with cisplatin and 5-fluorouracil (5-FU during radiotherapy, followed by two to four cycles of chemotherapy after radiotherapy. Tumor response was assessed using clinical examination and computerized tomography or magnetic resonance imaging. The mean doses administered to the gross tumor volume and clinical tumor volume were 70.9 Gy and 63.2 Gy, respectively. The mean doses administered to the right and left parotid glands were 38.1 Gy and 38.6 Gy, respectively. All 19 patients had a complete response of primary and lymph node disease. Grade III mucositis developed during chemoradiotherapy in 15 patients (79%. In addition, clinical grade I xerostomia was recorded in nine patients, grade II in nine, and grade III in one. This study demonstrated that 3D-CRT, IMRT, intracavitary brachytherapy, and chemotherapy are effective and safe methods to treat NPC. Although IMRT treatment spared parotid gland function, its efficacy may be significantly influenced by disease stage and location of the neck lymph nodes. More cases and a longer follow-up to assess survival and complications are planned.

Development and validation of a scoring system for late anorectal side-effects in patients treated with radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Petersen, Stine Elleberg; Bentzen, Lise; Emmertsen, Katrine J.; Laurberg, Søren; Lundby, Lilli; Høyer, Morten

2014-01-01

Purpose: To develop and validate a scoring system for evaluation of long term anorectal dysfunction following radiotherapy for prostate cancer. Materials and methods: Patients treated for prostate cancer with radiotherapy filled in questionnaires on anorectal function and quality of life. Items for the condensed anorectal dysfunction score (RT-ARD) were identified and weighted by binomial regression analysis. The score was tested in a separate patient material by receiver operating characteristic (ROC) analysis and correlations to quality of life domains. Results: A total of 309 patients participated in the study. The items selected were “incontinence for solid stool”, “ability to defer defecation”, “unproductive call to stool”, “clustering of stool”, and “mucus in stool.” Patients were grouped into three categories according to the RT-ARD score; 0–8 (no RT-ARD), 9–23 (minor RT-ARD), 24–45 (major RT-ARD). ROC analyses revealed high sensitivity (91%) and specificity (85%) for major RT-ARD. The prediction model demonstrated a perfect fit in 60%, moderate fit in 36% and no fit in 4%. There was good correlation between the RT-ARD score and quality of life. Conclusions: The RT-ARD score is a validated and simple instrument for evaluation of anorectal dysfunction following radiotherapy for prostate cancer, and the RT-ARD score correlates to the patient’s quality of life

Delayed rectal and urinary symptomatology in patients treated for prostate cancer by radiotherapy with or without short term neo-adjuvant androgen deprivation

International Nuclear Information System (INIS)

Christie, David; Denham, James; Steigler, Allison; Lamb, David; Turner, Sandra; Mameghan, Hedy; Joseph, David; Matthews, John; Franklin, Ian; Atkinson, Chris; North, John; Poulsen, Michael; Spry, Nigel A.; Tai, Keen-Hun; Wynne, Chris; Duchesne, Gillian; Kovacev, Olga; Francis, Lynne; Kramar, Andrew; D'Este, Cate; Bill, Dana

2005-01-01

Background and purpose: To identify contributing factors to delayed rectal and urinary symptoms in a randomised trial comparing different durations of maximal androgen deprivation (MAD), given prior to radiotherapy, for locally advanced prostate cancer. Patients and methods: Between 1996 and 2000, 818 patients with stages T2b,c, 3 and 4 prostate cancer were entered into a trial comparing 0, 3 and 6 months of MAD prior to and during radiotherapy. Their delayed normal tissue effects were recorded by their treating doctors using standardised scales and by the patients using a self-assessment questionnaire regularly. Time to occurrence and prevalence data were analysed. Results: Rectal and urinary symptom levels were observed to vary markedly over time in at least 80% of patients, with some indicating lasting resolution of symptoms. Prevalence rates were found to be substantially lower than actuarial probability rates. Baseline symptom levels and greatest acute symptom levels were both very powerful predictors. Obstructive lower urinary tract symptoms were noted to improve during the first 4 years after radiotherapy in approximately 60% of cases in each treatment arm. However, the treatment arm itself was not shown to influence these improvements in other univariate or multivariate analyses. MAD was shown to reduce both time to occurrence and prevalence of delayed proctopathic symptoms, but this effect was confirmed statistically in the 3 month treatment arm only. Multivariate models indicated that higher levels of haemoglobin prior to any treatment may in some way protect against delayed proctopathic symptoms. Conclusions: Prevalence data provide more clinically meaningful estimates of risk of delayed effects in normal tissues where assessment relies substantially on reported symptom levels. In these tissues consideration of the impact of baseline symptom levels and pathologies, and greatest acute symptom levels in analyses of delayed effects appears mandatory

Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment

International Nuclear Information System (INIS)

Yoshida, Ken; Takenaka, Tadashi; Tanaka, Eiichi; Kuriyama, Keiko; Yoshida, Mineo; Yamazaki, Hideya; Nishimura, Tsunehiko; Kotsuma, Tadayuki; Fujita, Yuka; Masuda, Norikazu

2010-01-01

To evaluate radiation dermatitis objectively in patients with breast cancer who had undergone post-operative radiotherapy after breast-conserving surgery. Skin color (L * , a * , and b * values) and moisture analyses were performed for both breasts (before, after, 1 month, 6 months, and 1 year after radiotherapy) to examine irradiated and non-irradiated skin divided into four quadrants in 118 patients. These patients underwent breast conservative surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost irradiation (10 Gy/5 fractions). L * , a * , and moisture values were changed by irradiation and maximized at completion or 1 month after radiotherapy. One year after radiotherapy, the skin color had returned to the range observed prior to radiotherapy. However, moisture did not return to previous values even 1 year after treatment. The lateral upper side (quadrant C) showed greater changes than other quadrants in the L * value (darker) at the end of radiotherapy. The Common Toxicity Criteria version 3 scores were found to correlate well with a * and L * values at the completion and 1 month after radiotherapy. Boost radiotherapy intensified reddish and darker color changes at the completion of radiotherapy, while chemotherapy did not intensify the skin reaction caused by radiotherapy. Moisture impairment as a result of irradiation lasts longer than color alterations. Objective assessments are useful for analyzing radiation dermatitis. (orig.)

Long-term effects in children treated with radiotherapy for head and neck rhabdomyosarcoma

International Nuclear Information System (INIS)

Paulino, Arnold C.; Simon, James H.; Zhen Weining; Wen, B.-C.

2000-01-01

Purpose: To examine the long-term effects of treatment in children receiving radiotherapy for head and neck rhabdomyosarcoma. Methods: From 1967 to 1994, a total of 30 children with head and neck rhabdomyosarcoma received megavoltage radiotherapy at one institution. Seventeen patients (57%) have survived and have at least a 5-year follow-up. There were 11 males and 6 females, with a median age of 5.7 years (range 2.2-11.6) at the time of radiotherapy. Tumor location was orbit in 6 patients, infratemporal fossa in 4, paranasal sinuses in 2, and supraglottic larynx in 2; the nasopharynx, pterygopalatine fossa, and parotid gland were sites for the remaining children. All but 2 patients had tumors of embryonal histology. The Intergroup Rhabdomyosarcoma Study (IRS) Group was I in 2, II in 3, and III in 11 children; 1 patient had a recurrent tumor after surgery alone. Radiotherapy volume was the primary tumor or tumor bed in 13, tumor and whole brain in 3, and tumor and craniospinal axis in 1. Median radiotherapy dose to the primary site was 5,040 cGy (range 4,140-6,500) and to the whole brain was 3,000 cGy. All but 1 were treated with 150-200-cGy fractions; 1 patient received 250-cGy fractions for a tumor in the larynx. Chemotherapy was vincristine (V), actinomycin-D (A), and cyclophosphamide (C) in 10 patients, VAC + adriamycin in 2, VA in 1, VA + ifosfamide in 1, VC + adriamycin in 1, and none in 2. One patient had salvage chemotherapy consisting of cisplatin and etoposide. Median follow-up time was 20 years (range 7.5-33). Results: Late effects of treatment were seen in all patients and included facial growth retardation in 11, neuroendocrine dysfunction in 9, visual/orbital problems in 9, dental abnormalities in 7, hearing loss in 6, and hypothyroidism in 3. Intellectual and academic delays were documented in 3 patients who had received whole brain radiotherapy. While neuroendocrine, thyroid, dental, and cognitive sequelae were primarily attributed to radiotherapy

Patterns of Radiotherapy Practice for Patients With Cervical Cancer (1999-2001): Patterns of Care Study in Japan

International Nuclear Information System (INIS)

Toita, Takafumi; Kodaira, Takeshi; Shinoda, Atsunori; Uno, Takashi; Akino, Yuichi; Mitsumori, Michihide; Teshima, Teruki

2008-01-01

Purpose: To describe the patterns of definitive radiotherapy practice for patients with uterine cervical cancer from 1999 to 2001 in Japan. Methods and Materials: The Japanese Patterns of Care Study (JPCS) working group conducted a third extramural audit survey of 68 institutions and collected specific information on 324 cervical cancer patients treated with definitive radiotherapy. Results: Almost all patients (96%) were treated with whole pelvic radiotherapy using opposing anteroposterior fields (87%). A midline block was used in 70% of the patients. Intracavitary brachytherapy (ICBT) was applied in 82% of cases. Most patients (89%) were treated with high-dose rate (HDR) ICBT. Calculation of doses to organs at risk (ICRU 38) was performed for rectum in 25% of cases and for bladder in 18% of cases. Only 3% of patients were given intravenous conscious sedation during ICBT applicator insertions. The median total biologically effective dose at point A (EBRT+ICBT) was 74 Gy 10 in cases treated with HDR-ICBT. There was no significant difference in total biologically effective dose between stages. The median overall treatment time was 47 days. Concurrent chemoradiation was applied in 17% of patients. Conclusions: This study describes the general patterns of radiotherapy practice for uterine cervical cancer in Japan. Although methods of external radiotherapy seemed to be appropriate, there was room for improvement in ICBT practice, such as pretreatment. A substantial difference in total radiotherapy dose between Japan and the United States was observed

The brachytherapy vaginal cuff boost in patients with cervix cancer IB1-IB2 that have been treated with surgery plus pelvic radiotherapy in ION SOLCA, Guayaquil Ecuador from November 1 to October 2002

International Nuclear Information System (INIS)

Gamboa, Eugenia; Falquez, Roberto

2003-01-01

To determine if the additional vaginal cuff irradiation is necessary or not in patients with cervix cancer, stages IB 1- IB 2, that has been treated previously with radical hysterectomies and pelvic radiotherapy, to get better local control and global survival versus presence of complications. We studied 54 patients from Radiation Oncology Department of ION SOLCA Guayaquil Ecuador, with cervix cancer stages IB1 - IB2, that have been treated with surgery plus pelvic radiotherapy plus or not brachytherapy. They have been divides into two arms, group one included surgery plus Rx T (radiotherapy) plus BxT (Brachytherapy), and group two included those patients with surgery plus external RxT alone. We studied, aged, histologic type, surgery type, doses and techniques of teletherapy and brachytherapy and we analyzed the presence of complications. Conclusions: The brachytherapy vaginal cuff boost in patients with cervix cancer IB1-IB2 that have been treated with surgery plus pelvic radiotherapy is not useful to get better local control and global survival in some patients carefully chosen without desfavorable factors, because this therapy represent and increase in the complication. (The author)

Radiotherapy for cancer patients aged 85 or older

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Kan, Tomoko; Kodani, Kazuhiko; Michimoto, Koichi; Ogawa, Toshihide

2009-01-01

The purpose of this study was to investigate the clinical efficacy and problems of radiotherapy for cancer patients aged 85 or older. Fifty-three patients (26 men, 27 women) who underwent radiotherapy were analyzed retrospectively. Median age was 87 years (range; 85-99). Treatment policy was classified into curative, semi-curative (treatment field or total dose were limited due to performance status) and palliative therapy. Head-and-neck, bladder and skin cancer were the most common primary disease. The treatment was deemed curative in 27%, semi-curative in 13%, and palliative in 49%. Total dose of semi-curative therapy was almost same compared with curative therapy. The rate of treatment completion and effectiveness were not significantly different in curative therapy and semi-curative therapy. We should consider to reduce the field size to gross target volume, but to treat with substantial dose to make radiotherapy safe and effective. We must be aware that elderly patients have basically low tolerability. (author)

Clinical outcomes in patients treated with radiotherapy after surgery for cervical cancer

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Yang, Kyung Mi; Park, Won; Huh, Seung Jae; Bae, Duk Soo; Kim, Byoung Gie; Lee, Jeong Won [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2017-03-15

The purpose of this study was to analyze clinical outcomes from cervical cancer and stratify patients into risk groups for prognostic factors for early-stage disease. We retrospectively reviewed patients with stage IB or IIA cervical cancer treated with adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) following primary surgery at Samsung Medical Center from 2001 to 2011. Adjuvant RT was added for patients with intermediate-risk factors, and adjuvant CCRT was performed on high-risk patients after surgery. We reviewed 247 patients—149 in the high-risk group and 98 in intermediate-risk group. The median follow-up was 62 months. Loco-regional failure (LRF) alone occurred in 7 patients (2.8%), distant metastasis alone in 37 patients (15.0%) and LRF with DM in 4 patients (1.6%). The 5-year disease-free survival (DFS) and overall survival (OS) rates for both groups were 79.7% and 87.6%, respectively. In the high-risk group, the 5-year DFS and OS probabilities were 72.5% and 81.9%, respectively. Histologic type, pathologic tumor size, and the number of pelvic lymph node (PLN) metastasis were significant prognostic factors for DFS and OS. We suggest a scoring system (0–3) using these prognostic factors to predict poor prognosis in high-risk patients. Using this system, patients with higher scores have higher recurrence and lower survival rates. In the high-risk cervical-cancer group who received primary surgery and adjuvant CCRT, non-squamous type, large tumor size and the number of PLN metastasis were significant prognostic factors, and the number of these factors was associated with survival rates.

Prognostic value of p53 in patients with muscle-invasive bladder cancer treated with preoperative radiotherapy

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Wu, Catherine S; Pollack, Alan; Czerniak, Bogdan A; Chyle, Valerian; Zagars, Gunar K; Dinney, Colin P; Benedict, William F

1995-07-01

Purpose/Objective: The overexpression of mutated and/or wild type p53 has been associated with poorer prognosis in patients with bladder cancer. However, most studies have involved a mixed patient population, including those with superficial and muscle-invasive disease, and some patients treated with adjuvant chemotherapy. In this study we examine the prognostic significance of p53 detected immunohistochemically in a cohort of patients with muscle-invasive transitional cell carcinoma of the bladder treated relatively uniformly with preoperative radiotherapy 4-6 weeks prior to radical cystectomy. Materials and Methods: Of 301 patients treated with preoperative radiotherapy (50 Gy in 25 fractions over 5 weeks) for muscle-invasive bladder cancer between 1960-1983, adequate material for immunohistochemical analysis of p53 was obtained in 107. Formalin-fixed paraffin-embedded archival tissue was stained using monoclonal anti-p53 antibody D01 (Oncogene Science, Manhasset, NY). The immunostaining of p53 was considered positive if greater than 20% of the tumor nuclei were stained. There were 82 men and 25 women with a mean age of 61 yr and no patient received neoadjuvant or adjuvant chemotherapy. All patients were without distant metastasis prior to treatment initiation. The median follow-up for those living (n=32) was 88 mo. The number of patients by clinical stage was 48 for T2, 30 for T3a, and 29 for T3b. Results: Overall, 46% of the patients were p53 positive, with 42% in Stage T2, 57% in Stage T3a, and 41% in Stage T3b. The distributions of potential patient prognostic factors by p53 positivity were investigated and the only association was with lymphatic-vascular invasion (p=0.04, chi-square). No correlation was seen between p53 staining and pathologic complete response (seen in 47%), clinical-to-pathologic downstaging (seen in 69%), clinical stage, tumor grade, tumor morphology, tumor number, tumor size, gender, patient age, pretreatment hemoglobin levels, BUN

A Single-Institutional Experience of 15 Years of Treating T3 Laryngeal Cancer With Primary Radiotherapy, With or Without Chemotherapy

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Al-Mamgani, Abrahim; Tans, Lisa; Rooij, Peter van; Levendag, Peter C.

2012-01-01

Purpose: To retrospectively analyze the outcomes, toxicity, quality of life, and voice quality of patients with T3 laryngeal cancer treated with radiotherapy and to identify subgroups of patients in whom the addition of chemotherapy to radiotherapy is necessary. Methods and Materials: Between March 1996 and November 2009, 170 consecutive patients with T3 tumor were treated with (chemo)radiotherapy. Endpoints of the study were local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), late toxicity, quality of life, and voice handicap index. Results: After a median follow-up time of 32 months (range, 7–172), the 3-year actuarial rates of LC, LRC, DFS, and OS were 73%, 70%, 64%, and 61%, respectively, and the 5-year figures were 68%, 65%, 60%, and 49%, respectively. At last follow-up, 84 patients (49.5%) were still alive, 65 of them (77.3%) without local progression. Laryngectomy was performed in 16 patients, leaving 49 patients with anatomic organ preservation, corresponding to an actuarial laryngectomy-free survival of 58.3% at 3 years. The figures for patients treated with chemoradiotherapy and radiotherapy alone were 76.8% and 53.5%, respectively (p = 0.001). Chemoradiotherapy was the only significant predictor for LC on multivariate analysis. The overall 5-year cumulative incidence of late Grade ≥2 toxicity was 28.2%. Chemoradiotherapy, compared with radiotherapy alone, resulted in slight increase in late toxicity and slight deterioration of quality of life and voice-handicap-index scores. However, the differences were statistically not significant. Conclusion: The addition of chemotherapy to radiotherapy in T3 laryngeal cancer significantly improved LC and laryngectomy-free survival without statistically significant increases in late toxicity or deterioration of quality of life or voice handicap index.

Thalassaemic osteoarthropathy treated with radiotherapy

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Davies, A.N.

1993-01-01

Patients with beta thalassaemia may develop a specific osteoarthropathy involving the feet. A number of different treatments for this condition have been tried, including rest, analgesia and hypertransfusion. We report a case of a patient with thalassaemic osteoarthropathy who responded to radiotherapy after failing conventional treatment. (author)

Prognostic significance of several histological features in intermediate and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy

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Narayan, K.; Bernshaw, D.; Quinn, M.; Allen, D.; Rejeki, V.; Herschtal, A.; Jobling, T.

2009-01-01

Full text: The purpose of the present study was to explore the prognostic significance of several histological features with respect to lymph node metastasis, failure-free survival (FeS), and overall survival (Os) in intermediate and high-risk endometrial cancer patients treated with curative intent. One hundred and eighty patients with endometrial cancer were treated with hysterectomy with or without lymphadenectomy and received external beam radiotherapy (EBRT). The mean follow-up period was 4.25 years (range 0.44-10.45 years). In multifactor analysis, fractional myometrial invasion (MI) (P = 0.047), histology (P < 0.001) and lymph-vascular space invasion (LVSI) (P = 0.025) were significant predictors for FFS when nodal status was not included. When lymph node status was known, histology (P - 0.007) and LVSI (P = 0.014) remained significant factors for FFS. For OS, histology (P < 0.001) and fractional MI (P = 0.004) were the significant factors. Lymph node status could be predicted by tumour grading (P = 0.016) and absolute MI (P 0.002). Histology type and the presence of LVSI were the most important prognostic factors in high-risk endometrial cancer patients treated by surgery and postoperative radiotherapy. Absolute MI and tumour grading were useful predictors of nodal spread.

Influence of boost technique (external beam radiotherapy or brachytherapy) on the outcome of patients with carcinoma of the base of the tongue

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Regueiro, C.A.; Millan, I.; Torre, A. de la; Valcarcel, F.J.; Magallon, R.; Fernandez, E.; Aragon, G.

1995-01-01

We reviewed 90 patients with squamous cell carcinoma of the base of the tongue. Fifty-three patients were treated with external beam radiotherapy alone (3 T1, 11 T2, 21 T3, and 18 T4 tumors) and thirty-seven patients were treated with external beam radiotherapy plus brachytherapy boost (4 T1, 15 T2, 11 T3, and 7 T4 tumors). For patients with T1, T2 and T3 primaries, the actuarial 3-year local relapse-free survival was 42% following external beam radiotherapy alone and 67% following external beam radiotherapy plus brachytherapy (p<0.05). The actuarial 3-year cause specific survival for these T-stages was 37% for patients treated with external beam radiotherapy alone and 53% for patients treated with external beam radiotherapy plus brachytherapy (p=0.1). In the Cox multivariate analyses restricted patients with T1, T2 and T3 staged tumors, treatment modality was the only predictor for local control but no influence on specific survival was found. The trend towards significant differences in specific survival found in the univariate comparison of both treatment modalities was probably due to the significantly higher number of N-positive patients treated with external beam radiotherapy alone. When all stages were included in the Cox analysis, low hemoglobin level, invasion of deep muscle, number of palpable nodes, and history of weight loss significantly influenced the outcome. Soft tissue necrosis occurred more frequently in patients treated with external beam radiotherapy plus brachytherapy (33% vs. 10%, p=0.52). (orig.)

Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer. Outcome analysis and comparison with a 3D-treated patient cohort

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Combs, S.E.; Habermehl, D.; Kessel, K.; Brecht, I. [Univ. Hospital of Heidelberg (Germany). Dept. of Radiation Oncology; Bergmann, F.; Schirmacher, P. [Univ. Hospital of Heidelberg (Germany). Dept. of Pathology; Werner, J.; Buechler, M.W. [Univ. Hospital of Heidelberg (Germany). Dept. of Surgery; Jaeger, D. [National Center for Tumor Diseases (NCT), Heidelberg (Germany); Debus, J. [Univ. Hospital of Heidelberg (Germany). Dept. of Radiation Oncology; Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany). Clinical Cooperation Unit Radiation Oncology

2013-09-15

Background: To evaluate outcome after intensity modulated radiotherapy (IMRT) compared to 3D conformal radiotherapy (3D-RT) as neoadjuvant treatment in patients with locally advanced pancreatic cancer (LAPC). Materials and methods: In total, 57 patients with LAPC were treated with IMRT and chemotherapy. A median total dose of 45 Gy to the PTV {sub baseplan} and 54 Gy to the PTV {sub boost} in single doses of 1.8 Gy for the PTV {sub baseplan} and median single doses of 2.2 Gy in the PTV {sub boost} were applied. Outcomes were evaluated and compared to a large cohort of patients treated with 3D-RT. Results: Overall treatment was well tolerated in all patients and IMRT could be completed without interruptions. Median overall survival was 11 months (range 5-37.5 months). Actuarial overall survival at 12 and 24 months was 36 % and 8 %, respectively. A significant impact on overall survival could only be observed for a decrease in CA 19-9 during treatment, patients with less pre-treatment CA 19-9 than the median, as well as weight loss during treatment. Local progression-free survival was 79 % after 6 months, 39 % after 12 months, and 13 % after 24 months. No factors significantly influencing local progression-free survival could be identified. There was no difference in overall and progression-free survival between 3D-RT and IMRT. Secondary resectability was similar in both groups (26 % vs. 28 %). Toxicity was comparable and consisted mainly of hematological toxicity due to chemotherapy. Conclusion: IMRT leads to a comparable outcome compared to 3D-RT in patients with LAPC. In the future, the improved dose distribution, as well as advances in image-guided radiotherapy (IGRT) techniques, may improve the use of IMRT in local dose escalation strategies to potentially improve outcome. (orig.)

Potency following high-dose three-dimensional conformal radiotherapy and the impact of prior major urologic surgical procedures in patients treated for prostate cancer

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Chinn, Daniel M.; Holland, John; Crownover, Richard L.; Roach, Mack

1995-01-01

Purpose: To assess the impact of high-dose three-dimensional conformal radiotherapy (3DCRT) on potency in patients treated for clinically localized prostate cancer and to identify factors that might predict the outcome of sexual function following treatment. Methods and Materials: One hundred twenty-four consecutive patients treated with 3DCRT for localized prostate cancer at UCSF between 1991-1993 were included in this retrospective analysis. Patient responses were obtained from a mailed questionnaire, telephone interviews, or departmental records. Median follow-up was 21 months. Results: Sixty patients reported having sexual function prior to 3DCRT, including 47 who were fully potent and 13 who were marginally potent. Of the remaining 64 patients, 45 were impotent, 7 were on hormones, 1 was status-postorchiectomy, and 11 were not evaluable. Following 3DCRT, 37 of 60 patients (62%) retained sexual function sufficient for intercourse. Of those with sexual function before irradiation, 33 of 47 (70%) of patients fully potent and 4 of 13 (31%) of patients marginally potent maintained function sufficient for intercourse (p < 0.01). Potency was retained in 6 of 15 (40%) patients with a history of a major urologic surgical procedure (MUSP) and in 31 of 45 (69%) with no history of a MUSP (p < 0.04). Transurethral resection of the prostate was the MUSP in eight of these patients, with four (50%) maintaining sexual function. Conclusions: Patients who receive definitive 3DCRT for localized prostate cancer appear to maintain potency similar to patients treated with conventional radiotherapy. However, patients who are marginally potent at presentation or who have a history of a MUSP appear to be at increased risk of impotence following 3DCRT

A Novel Dose Constraint to Reduce Xerostomia in Head-and-Neck Cancer Patients Treated With Intensity-Modulated Radiotherapy

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Strigari, Lidia; Benassi, Marcello; Arcangeli, Giorgio; Bruzzaniti, Vicente; Giovinazzo, Giuseppe; Marucci, Laura

2010-01-01

Purpose: To investigate the predictors of incidence and duration of xerostomia (XT) based on parotid glands (PG), submandibular glands (SMG), and both glands taken as a whole organ (TG) in head-and-neck cancer patients treated with intensity-modulated radiotherapy. Methods and Materials: A prospective study was initiated in May 2003. Sixty-three head-and-neck patients (44 with nasopharynx cancer) were included in the analysis. Using the dose-volume histogram the PG, SMG, and TG mean doses were calculated. Unstimulated and stimulated salivary flow were measured and XT-related questionnaires were compiled before and at 3, 6, 12, 18, and 24 months after radiotherapy. Salivary gland toxicity was evaluated using the Radiation Therapy Oncology Group scale, and Grade ≥3 toxicity was used as the endpoint. The XT incidence was investigated according to descriptive statistics and univariate and multivariate analysis. The Bonferroni method was used for multiple comparison adjustment. Results: After a reduced flow at 3 months after radiotherapy, recovery of salivary flow was observed over time. Primary site and salivary gland mean doses and volumes were identified in univariate analysis as prognostic factors. Multivariate analysis confirmed that TG mean dose (p = 0.00066) and pretreatment stimulated salivary flow (p = 0.00420) are independent factors for predicting XT. Conclusion: The TG mean dose correlates with XT as assessed by Radiation Therapy Oncology Group criteria, salivary output, and XT-related questionnaires. Our results suggest that TG mean dose is a candidate dose constraint for reducing XT, requiring considerably more validation in non-nasopharyngeal cancer patients.

Ewing sarcoma in adults treated with modern radiotherapy techniques

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Casey, Dana L.; Meyers, Paul A.; Alektiar, Kaled M.; Magnan, Heather; Healey, John H.; Boland, Patrick J.; Wolden, Suzanne L.

2014-01-01

Background and purpose: To evaluate local control and survival outcomes in adults with Ewing sarcoma (ES) treated with radiotherapy (RT). Material and methods: Retrospective review of all 109 patients age ⩾18 treated for ES with RT to the primary site at Memorial Sloan Kettering Cancer Center between 1990 and 2011. RT was used as the definitive local control modality in 44% of patients, preoperatively for 6%, and postoperatively for 50%. Results: Median age at diagnosis was 27 years (range, 18–67). The 5-year local failure (LF) was 18%. Differences in LF were not identified when evaluated by modality of local control (RT versus combined surgery and RT), RT dose, fractionation, and RT technique. However, margin status at time of resection significantly predicted LF. The 5-year event-free survival and overall survival rates were 44% and 66% for patients with localized disease, compared with 16% and 26% for metastatic disease (p = 0.0005 and 0.0002). Tumor size, histopathologic response to chemotherapy, and treatment on or according to a protocol were also significantly associated with survival. Conclusions: This series of adults treated with modern chemotherapy and RT had prognostic factors and outcomes similar to adolescents with ES. All adults with ES should be treated with an aggressive, multidisciplinary approach

Radiotherapy for gynecologic cancer in nonagenarian patients: a framework for new paradigms.

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Méry, Benoîte; Ndong, Sylvie Mengue; Guy, Jean-Baptiste; Assouline, Avi; Falk, Alexander T; Valeille, Anaïs; Trone, Jane-Chloé; Rivoirard, Romain; Auberdiac, Pierre; Vallard, Alexis; Espenel, Sophie; Moriceau, Guillaume; Collard, Olivier; Bosacki, Claire; Jacquin, Jean-Philippe; de Laroche, Guy; Fournel, Pierre; Chargari, Cyrus; Magné, Nicolas

2016-05-09

No consensus exists regarding the role of radiotherapy in the management of gynecologic cancer in nonagenarian patients. We retrospectively reviewed the outcomes of 19 consecutive nonagenarian patients with gynecologic cancer (6 endometrial cancers, 6 cervical cancers, 4 vulvar cancers, and 3 vaginal cancers) who were treated with radiotherapy. Radiotherapy was performed mainly in a palliative setting (n = 12; 63.2%), with a median dose of 45 Gy (range, 6-76 Gy). Infrequent major acute or late toxicities were reported. Among 19 patients, 9 (47.4%) experienced tumor progression, 5 (26.3%) experienced complete response, 2 (10.5%) experienced stable disease and/or partial response. At last follow-up, 12 patients (63.2%) had died; most deaths (n = 9) occurred because of the cancer. These results suggest that radiotherapy is feasible in the treatment of nonagenarian patients with gynecologic cancer.

Radiotherapy in poor risk patients with stage I cancer of the endometrium: results of not giving external beam radiotherapy.

Science.gov (United States)

DeCruze, B; Guthrie, D

1999-01-01

Poor prognosis (poorly differentiated and/or deep myometrial invasion) Stage I endometrial cancer can have a relapse rate as high as 50%. Traditionally, most clinical oncologists treat these patients with external beam radiotherapy after surgery but there is no evidence to show that this improves survival. The retrospective study looks at the results of not giving external beam radiotherapy in 25 consecutive patients and compares the results with a group of 13 consecutive patients who did have such treatment. The two groups were comparable with regard to age, degree of differentiation and degree of invasion. Survival was comparable in the two groups. There is no evidence of any obvious decrease in survival from withholding external beam radiotherapy, but this was not a prospective randomized controlled trial. This study illustrates that it is essential that the Medical Research Council ASTEC trial should be supported because this will determine the true place of external beam radiotherapy in such patients.

Effect of vitamin E on protein bound carbohydrate complexes in radiation treated oral squamous cell carcinoma patients

International Nuclear Information System (INIS)

Chitra, S.; Shyamala Devi, C.S.

2008-01-01

Serum glycoproteins were evaluated in oral squamous cell carcinoma patients treated with radiotherapy and also the effect of vitamin E was studied. Cell surface glycoconjugates are important parameters in the detection of malignancy. Thus, the objective of the present study is to evaluate the efficacy of vitamin E on glycoproteins in oral cavity cancer patients treated with radiotherapy. The study includes 26 age and sex matched normal healthy individuals and 26 patients with squamous cell carcinoma of oral cavity. These patients were divided into two groups, one for radiotherapy alone (at a dosage of 6000 cGy in five fractions per week for a period of six weeks) and the other for radiotherapy plus vitamin E supplementation (at a dosage of 400 IU/day of vitamin E) for the entire period of radiotherapy. Levels of hexose, hexosamine, fucose and sialic acid were increased in oral squamous cell carcinoma patients and a significant decrease was observed in radiation treated patients when compared to control. The levels of glycoconjugates were significantly decreased in radiation treated patients supplemented with vitamin E. This measurement may be useful in assessing disease progression and identifying patients resistant to therapy and a possible role of vitamin E on reduction in glycoconjugate levels of radiation treated oral squamous cell carcinoma patients. (author)

Radiotherapy for cancer patients aged 80 and older: a study of effectiveness and side effects

International Nuclear Information System (INIS)

Zachariah, Babu; Balducci, Lodovico; Venkattaramanabalaji, G.V.; Casey, Linda; Greenberg, Harvey M.; Del Regato, Juan A.

1997-01-01

Purpose: To profile cancer patients aged 80 and older undergoing radiotherapy and to study the tumor response and side effects of therapy. Methods and Materials: We retrospectively analyzed the records of patients aged 80 and older who received radiation therapy at James A. Haley Veterans Hospital and H. Lee Moffitt Cancer Center between 1988 and 1995. A total of 203 patients aged 80-94 received radiotherapy during this period. Treatment sites included head and neck [50], breast [16], chest [37], pelvis [53], and miscellaneous [39]. Age, treatment site, field size, total dose, response to treatment, treatment interruptions, incidence and severity of weight loss, myelosuppression, diarrhea, mucositis, dermatitis, and follow-up status are assessed using our departmental records and hospital tumor registry. Results: Of 191 patients evaluated, 179 (94%) completed the treatment without serious complications. A total of 195 sites were irradiated. Twelve patients (6%) required interruption of the treatment. Therapeutic responses were seen in 86 out of 112 patients (77%) treated with curative intent (with 67% complete response) and in 67 out of 83 patients (81%) treated with palliative intent. The causes of treatment interruptions included weight loss from diarrhea, dysphagia, and progressive disease. Treatment interruptions were more likely in patients treated with large treatment fields. In patients treated for upper aero-digestive tract cancer, Grade 3 and 4 mucositis was noted in 20 and 2% of patients, respectively. Grade 1 and 2 enteritis was noted in 43% of patients treated for pelvic malignancies. Grade 3 dermatitis was noted only in 2% of patients. Conclusion: Radiotherapy is highly effective and well tolerated by the oldest old. Age is not a contraindication to aggressive radiotherapy

Low-dose radiotherapy as treatment for benign lymphoepitelial lesion in HIV-patients

International Nuclear Information System (INIS)

Gonzalez Patino, E.; Lopez Vazquez, M.D.; Cascallar Caneda, L.; Antinez Lopez, J.; Victoria Fernandez, C.; Salvador Garrido, N.; Ares Banobre, M.; Porto vazquez, M.C.

1995-01-01

Standard treatments for benign lymphoepitelial lesion of the parotid gland in patients infected with the human immunodeficiency virus (HIV) are unsatisfactory. Recently, low-dose radiotherapy has been proposed as a noninvasive treatment option. We describe a case of bilateral benign lymphoepitelial lesion parotid gland in a HIV-positive paint, treated by radiotherapy. Low-dose radiotherapy, appears as a alternative in the treatment for benign lymphoepitelial lesion in HIV-patients, and preliminary evaluations have indicated that this treatment is effective from both the clinical and cosmetic points of view

Neoadjuvant androgen deprivation and long-term results for patients with intermediate- and high-risk prostate cancer treated with high-dose rate brachytherapy and external beam radiotherapy

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Pellizzon, Antonio Cassio Assis; Fogaroli, Ricardo Cesar; Silva, Maria Leticia Gobo; Castro, Douglas Guedes; Maia, Maria Conte

2010-01-01

Purpose: to evaluate the influence of neoadjuvant androgen deprivation (NAAD) and report the long term biochemical control rates according to the Phoenix Consensus Conference, and prognostic factors of intermediate- (IR) and high-risk (HR) prostate cancer treated with external beam radiotherapy and high-dose-rate brachytherapy (HDR-BT). Methods and materials: between March, 1997 and June, 2005, 184 patients considered IR or HR were treated with localized radiotherapy and HDR-BT at the Department of Radiation Oncology, Hospital A.C. Camargo, Sao Paulo, Brazil. Patient's age, Gleason score, clinical stage, initial PSA value, risk group for biochemical failure, presence of NAAD, doses of radiotherapy and HDR-BT were evaluated. Results: median age and follow-up were 70 years old (range, 47-83) and 74.5 months (range, 24-123 months), respectively. Patients considered IR were 91 (49.4%) and HR 93 (50.6%). Ninety-nine (53.8%) patients had no NAAD. The overall survival at 5 years was 93.6%. The 5-year actuarial biochemical control rates for all patients, IR and HR were 83.4%, 86.2% and 78.8%, respectively, p0.076. On univariate analysis the prognostic factors related to better biochemical control were Gleason score 45 Gy (p= 0.011) and HDR-BT dose > 20 Gy (p< 0.001). On multivariate analysis no statistical significant predictive factor related to biochemical control was found. Conclusions: the role of NAAD for IR and HR prostate cancer is still to be defined. HDR-BT combined to external radiotherapy is a successful form of treatment for these patients, with our results comparable to published data. (author)

Preliminary analysis of the risk factors for radiation pneumonitis in patients with non- small-cell lung cancer treated with concurrent erlotinib and thoracic radiotherapy

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Zhuang H

2014-05-01

Full Text Available Hongqing Zhuang,* Hailing Hou,* Zhiyong Yuan, Jun Wang, Qingsong Pang, Lujun Zhao, Ping WangDepartment of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People's Republic of China*These authors contributed equally to this workPurpose: The aim of this study was to investigate radiation pneumonitis and its associated risk factors in patients with non-small-cell lung cancer treated with concurrent erlotinib and thoracic radiotherapy.Materials and methods: We conducted an analysis of patients with nonoperable stage IIIA–IV non-small-cell lung cancer who were treated with concurrent thoracic radiotherapy and erlotinib (ClinicalTrials.gov identifier: NCT00973310. The Common Terminology Criteria for Adverse Events version 3.0 grading system was applied to evaluate the incidence of radiation pneumonitis. The lung dosimetric parameters were recorded in accordance with the treatment plan, and the study endpoint was radiation pneumonitis at grade 2 or more.Results: Among the 24 selected clinical cases, nine were identified with radiation pneumonitis of grade 2 or above (37.5%. This included four cases with grade 2 (16.7%, two cases with grade 3 (8.3%, and three cases with grade 5 (12.5%. The results showed that the planning target volume was a significant factor affecting the incidence of radiation pneumonitis. All lung dosimetric parameters exhibited statistically significant differences between patients with pneumonitis and patients without pneumonitis. The receiver operating characteristic (ROC curve analysis showed that all lung dosimetric parameters were useful in predicting the incidence of radiation pneumonitis. In addition, the threshold values of V5, V10, V15, V20, V30, and mean lung dose were >4%, >29%, >27%, >22%, >17% and >1,027 cGy, respectively.Conclusion: Special attention

Assessment of thyroid function in patients with laryngeal carcinoma treated surgically and with radiotherapy

International Nuclear Information System (INIS)

Skoneczny, J.; Kulczynski, B.; Sowinski, J.

1975-01-01

In 40 patients with laryngeal carcinoma after total laryngectomy and radiotherapy the triiodotyronine binding index, total thyroxine level, serum free thyroxine index were determined before, during and after treatment. At the same time thyroid iodine uptake was determined by the routine method. Surgical treatment as well as radiotherapy caused lowering of thyroid functions. These changes had a high tendency for return to normal values, not earlier, however, than 6 months after treatment. The authors stress that endocrine thyroid disturbances may have an important influence on delay of psychic rehabilitation and speech training in laryngectomized patients. (author)

Socioeconomic characteristics of patients with squamous cell carcinoma of the uterine cervix treated with radiotherapy in the 1992 to 1994 patterns of care study

International Nuclear Information System (INIS)

Katz, Angela; Eifel, Patricia J.; Moughan, Jennifer; Owen, Jean B.; Mahon, Irene; Hanks, Gerald E.

2000-01-01

Purpose: To describe the relationship between socioeconomic variables and the treatment of patients with radiotherapy for cervix cancer. Methods and Materials: Sixty-two institutions were randomly selected from a list of all radiotherapy facilities in the United States. From these we randomly selected and reviewed 471 cases of squamous cell carcinoma treated during 1992 to 1994. To create an additional minority-rich sample, we randomly selected 215 additional cases from 17 randomly selected institutions that admitted > 40% minority patients. The median household income of each patient's neighborhood was determined by matching her zip code to data from the 1990 United States Census. Results: Patients who lived in low-income neighborhoods, who had only Medicaid coverage, or who were treated at large academic or minority-rich institutions tended to have a poorer initial performance status, higher-stage or bulky central disease, and a lower pretreatment hemoglobin level. Ability to complete treatment did not correlate with ethnicity or income. However, noncompliant patients tended to be treated at minority-rich institutions and were more often ≤ 40 or > 60 years old. Patients who completed definitive treatment were more likely to have had ≤ 1 low-dose-rate intracavitary implants if they were black, came from a low-income neighborhood, were covered by Medicaid or Medicare only, or were treated at a minority-rich institution. Patients who were treated in academic institutions received higher mean radiation doses to Point A (83.8 Gy) than those treated in research- or non-research-participating facilities (79.4 and 80.9 Gy, respectively; p = 0.002). Patients who received their radiation therapy in facilities that treated an average of ≤ 3 patients per year also received lower mean doses to Point A (79.1 vs. 83.0 Gy; p = 0.001). Conclusion: The treatment received by patients who belonged to minority groups, came from low-income neighborhoods, or were treated in large

Patients and radiotherapy

International Nuclear Information System (INIS)

Eardley, A.

1986-01-01

The results of interviews with thirty discharged patients who had undergone radical radiotherapy for cancer of the head and neck are presented. Patients were asked whether their side-effects had got worse or had stayed the same, what effect their side effects had had on eating and drinking and whether they had felt depressed during this period. Measures which could be taken to improve patients' experiences of radiotherapy are discussed. (U.K.)

Side Effects of Adjuvant Radiotherapy in Patients With Testicular Seminoma Stage I

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Gamulin, M.; Grgic, M.

2011-01-01

In the present study the side effects of adjuvant radiotherapy of testicular seminoma stage I patients were followed up in the period between 13 to 84 months (median 28 months). The most frequent side effects in these patients during radiotherapy were gastrointestinal problems (nausea/vomiting), psychologic and cognitive problems and minor sexual problems. The reported side effects were treated by antimmimetics and anxiolytics. After radiotherapy, the side effects persisted in 6 % of patients but therapy was needed only in few. Healthy children were born to 76 % of patients in the age group 18 - 39 years after radiotherapy. The present study shows that adjuvant irradiation of paraaortal lymph nodes with total a dose of 24 Gy in 16 daily fractions in testicular seminoma patients causes acceptable side effects with acceptable quality of life and fertility, however in conditions of individual approach and family consulting. (author)

The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy

International Nuclear Information System (INIS)

Park, Won; Huh, Seung-Jae; Yang, Jung-Hyun

2008-01-01

The objective of this study was to analyze the implication of abnormal hot spots in the irradiated field of patients treated with mastectomy followed by radiotherapy for breast cancer. We reviewed 1842 consecutive bone scans performed on 292 patients treated with a modified radical mastectomy and followed by radiotherapy. If abnormal hot spots at the irradiated sites were detected in the bone scans, we evaluated further studies to determine whether bone metastases were present. Radiation was given using 4 or 6 MV X-rays at a dosage of 50.4 Gy during 5.5 weeks with a dosage per fraction of 1.8 Gy. The follow-up period was 25-136 months (median 57 months). Sixty patients (20.6%) developed bone metastasis. Solitary rib metastases were identified in four patients; all were detected outside of the irradiated field. Of 232 patients who did not develop bone metastases, hot spots in the irradiated field were detected in 30 patients (12.9%). A simple rib facture at the site of a hot spot was demonstrated in four patients. The cumulative incidence of hot spots at 5 years was 12.9%. The cumulative incidence of hot spots was more common in postmenopausal women, patients who were less than 60 kg, patients who received adjuvant hormonal therapy and patients who had radiation that included the supraclavicular area. We confirmed that the hot spots within the irradiated fields might be benign, especially in patients who were postmenopause, had a low body weight, received adjuvant hormonal therapy and who had radiation that included the supraclavicular area. (author)

Effect of radiotherapy on immunity function of cancer patients receiving radiotherapy

International Nuclear Information System (INIS)

Li Xinli; Zhu Shentao; Xu Jiuhong

2003-01-01

Objective: In order to observe the effect of radiotherapy on immunity function of cancer patients receiving radiotherapy. Methods: Cellular immunity is determined by APAAP; Humoral immunity is determined by transmission method. Results: The items of cellular immunity is lower than the control after radiotherapy. These items decrease continually. The difference between before and after radiotherapy has statistic significance. Of all Humoral immunity items, IgA, IgM decreased after radiotherapy and the difference has statistic significance. Conclusions: Radiotherapy can damage patients' immunity function

Effect of Increased Radiotoxicity on Survival of Patients with Non-small Cell Lung Cancer Treated with Curatively Intended Radiotherapy.

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Holgersson, Georg; Bergström, Stefan; Liv, Per; Nilsson, Jonas; Edlund, Per; Blomberg, Carl; Nyman, Jan; Friesland, Signe; Ekman, Simon; Asklund, Thomas; Henriksson, Roger; Bergqvist, Michael

2015-10-01

To elucidate the impact of different forms of radiation toxicities (esophagitis, radiation pneumonitis, mucositis and hoarseness), on the survival of patients treated with curatively intended radiotherapy for non-small cell lung cancer (NSCLC). Data were individually collected retrospectively for all patients diagnosed with NSCLC subjected to curatively intended radiotherapy (≥50 Gy) in Sweden during the time period 1990 to 2000. Esophagitis was the only radiation-induced toxicity with an impact on survival (hazard ratio=0.83, p=0.016). However, in a multivariate model, with clinical- and treatment-related factors taken into consideration, the impact of esophagitis on survival was no longer statistically significant (hazard ratio=0.88, p=0.17). The effect on survival seen in univariate analysis may be related to higher radiation dose and to the higher prevalence of chemotherapy in this group. The results do not suggest that the toxicities examined have any detrimental effect on overall survival. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Influence of radiotherapy on node-positive prostate cancer treated with androgen ablation

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Sands, M Elizabeth; Pollack, Alan; Zagars, Gunar K

1995-01-01

Purpose: Patients with node-positive prostate cancer that is regionally localized (T1-4, N1-3, M0) have a relatively poor prognosis when a single-treatment modality such as radical surgery, definitive radiotherapy, or androgen ablation is used. While promising results using radical surgery and androgen ablation have been reported, there are no data to support an analogous approach using local radiotherapy and androgen ablation. In this retrospective review, the outcome after local radiotherapy and early androgen ablation (XRT/HORM) was compared to early androgen ablation alone (HORM). Methods and Materials: Between 1984 and 1992 there were 181 patients treated with HORM and 27 patients treated with XRT/HORM at the University of Texas M. D. Anderson Cancer Center. The nodal status of all patients was established pathologically by lymph node dissection, which was terminated after frozen section confirmation of involvement. In the majority of cases androgen ablation was by orchiectomy. The median dose to the prostate in XRT/HORM group was 66 Gy. The median follow-up was 45 months; 49 months for the HORM group and 25 months for the XRT/HORM group. Results: The distribution of prognostic factors between the HORM and XRT/HORM groups was similar, with the exception of tumor grade. There was a significantly larger proportion of high grade tumors in the HORM group. In terms of actuarial disease outcome, at 4 years the results of patients in the HORM group were significantly worse, including a rising prostate specific antigen (PSA) of 53%, any disease progression of 32%, a rising PSA or disease progression of 55%, and local progression of 22%. None of the patients in the XRT/HORM group failed biochemically or clinically. To determine the impact of grade on these findings, the analyses were repeated, using only those with grade 2 tumors. A similar pattern was evidenced with significantly worse actuarial outcome at 4 years for the HORM group using the endpoints of a rising PSA

Postoperative radiotherapy for stage I/II seminoma: results for 212 patients

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Bauman, Glenn S.; Venkatesan, Varagur M.; Ago, C. Tetteh; Radwan, John S.; Dar, A. Rashid; Winquist, Eric W.

1998-01-01

Purpose: A retrospective review of patients with Stage I and II seminoma treated at a regional cancer center was performed to assess the long term efficacy and toxicity associated with post operative radiotherapy. Methods and Materials: Between 1950 and 1995, 212 patients seen at the London Regional Cancer Centre received adjuvant radiotherapy following orchiectomy for Stage I (169) and II (43) seminoma. Median follow-up for the group was 7.5 years. Results: Progression free, cause specific, and overall survival were 95%, 98%, and 95% at 5 years, and 94%, 98%, and 94% at 10 years respectively. An increased risk of failure was noted among patients with bulky Stage II disease. No other prognostic factors for relapse were identified. Late toxicity was uncommon with only 12/212 (6%) developing any late GI toxicity potentially attributable to radiotherapy. The incidence of second malignancies (excluding second testicular tumors) was 6/212 (actuarial:1%, 1%, 6% at 5,10,15 years respectively). There was a trend toward increased acute complications for patients treated with larger volumes of radiation. No prognostic factors associated with increased risk of late toxicity or second malignancy were identified, likely a consequence of the small number of these events. Conclusion: Survival and toxicity were comparable to that reported in the literature. Post-operative radiotherapy remains a safe and efficacious adjuvant treatment for Stage I and early Stage II seminoma

Hypofractionated stereotactic body radiotherapy (SBRT) for liver metastases. A retrospective analysis of 74 patients treated in the Klinikum rechts der Isar Munich

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Heppt, Franz Johannes

2013-01-01

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.

Chemotherapy response as a prognosticator for survival in patients with limited squamous cell lung cancer treated with combined chemotherapy and radiotherapy

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Eagan, R.T.; Fleming, T.R.; Lee, R.E.; Ingle, J.N.; Frytak, S.; Creagan, E.T.

1980-01-01

Twenty-two patients with limited unresectable squamous cell lung cancer were treated with 6 courses of combination chemotherapy consisting of cyclophosphamide, adriamycin, cisplatin, and bleomycin (CAP-Bleo) and short-course thoracic irradiation started after the first 4 weeks of chemotherapy. Of 20 patients with visible tumor who were treated with 4 weeks of chemotherapy alone, 10 (50%) had a tumor regression in that 4 week period and 10 did not. Those patients with tumor regression had significantly better progression free and overall survivals than did patients with no chemotherapy regressions (medians of 258 days vs. 136 days and 356 days vs. 150 days respectively). The original bleomycin dose had to be reduced by 50% primarily because of excessive radiation esophagitis that has not been reported with use of either the CAP regimen or bleomycin along in conjunction with thoracic irradiation. An initial chemotherapy regression seems to be a good prognosticator for progression-free and overall survival in patients with limited squamous cell lung cancer treated with combined chemotherapy and radiotherapy

Analysis of cervical cancer cells treated with radiotherapy or arterial infusion chemotherapy

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Izutu, Toshihiko; Nishiya, Iwao

1995-01-01

The present study was designed to analyze cervical cancer cells treated with radiotherapy or intraarterial infusion of CDDP using image analysis. Total nuclear extinction (TE), 5 N-exceeding rate (5 NER) and nuclear area (NA) gradually increased following irradiation, in cervical cancer cases. TE and 5 NER increased markedly following radiotherapy in good response cases. TE, 5 NER and NA were not-changed following irradiation in poor response cases. 5 NER, in good prognostic cases was higher than in poor prognostic cases, significantly among cervical cancer cases treated with radiotherapy. 5 NER and NA increased dramatically in good response cases treated with intraarterial infusion of CDDP. (author)

Intensity-Modulated Radiotherapy Reduces Gastrointestinal Toxicity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

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Sharma, Navesh K.; Li Tianyu; Chen, David Y.; Pollack, Alan; Horwitz, Eric M.; Buyyounouski, Mark K.

2011-01-01

Purpose: Androgen deprivation therapy (AD) has been shown to increase late Grade 2 or greater rectal toxicity when used concurrently with three-dimensional conformal radiotherapy (3D-CRT). Intensity-modulated radiotherapy (IMRT) has the potential to reduce toxicity by limiting the radiation dose received by the bowel and bladder. The present study compared the genitourinary and gastrointestinal (GI) toxicity in men treated with 3D-CRT+AD vs. IMRT+AD. Methods and Materials: Between July 1992 and July 2004, 293 men underwent 3D-CRT (n = 170) or IMRT (n = 123) with concurrent AD (<6 months, n = 123; ≥6 months, n = 170). The median radiation dose was 76 Gy for 3D-CRT (International Commission on Radiation Units and Measurements) and 76 Gy for IMRT (95% to the planning target volume). Toxicity was assessed by a patient symptom questionnaire that was completed at each visit and recorded using a Fox Chase Modified Late Effects Normal Tissue Task radiation morbidity scale. Results: The mean follow-up was 86 months (standard deviation, 29.3) for the 3D-CRT group and 40 months (standard deviation, 9.7) for the IMRT group. Acute GI toxicity (odds ratio, 4; 95% confidence interval, 1.6-11.7; p = .005) was significantly greater with 3D-CRT than with IMRT and was independent of the AD duration (i.e., <6 vs. ≥6 months). The interval to the development of late GI toxicity was significantly longer in the IMRT group. The 5-year Kaplan-Meier estimate for Grade 2 or greater GI toxicity was 20% for 3D-CRT and 8% for IMRT (p = .01). On multivariate analysis, Grade 2 or greater late GI toxicity (hazard ratio, 2.1; 95% confidence interval, 1.1-4.3; p = .04) was more prevalent in the 3D-CRT patients. Conclusion: Compared with 3D-CRT, IMRT significantly decreased the acute and late GI toxicity in patients treated with AD.

Analysis of 5 year survival of esophageal cancer treated by radiotherapy

International Nuclear Information System (INIS)

Takegawa, Yoshihiro; Ohgushi, Ikuyo; Hiraki, Yoshio; Honke, Yoshifumi; Matsuki, Tsutomu; Yokoyama, Takashi; Yoshida, Mineo.

1987-01-01

Since 1984, a total of 1,419 patients with carcinoma of the esophagus were treated at the Department of Radiology of 17 hospitals in Chugoku-Shikoku province. The five year survival rate was 7.3 % (42/578 cases). Thirty-nine out of the forty-two cases were analyzed according to the tumor extent, localization and types of the X-ray findings. In addition, 95 patients (67 had been reported in other journals and 28 in this report) who have survived more than 5 years after radical radiotherapy were analyzed. (author)

Effect of stereotactic body radiotherapy versus intensity-modulated radiotherapy in primary liver cancer patients with secondary malignant tumor of vertebra

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SUN Jing

2016-06-01

Full Text Available ObjectiveTo investigate the effect of stereotactic body radiotherapy (SBRT versus intensity-modulated radiotherapy (IMRT in primary liver cancer (PLC patients with secondary malignant tumor of vertebra. MethodsA total of 49 PLC patients with secondary metastatic tumor of vertebra, who were treated in our hospital from December 2011 to January 2014, were enrolled and divided into group A (20 patients treated with SBRT and group B (29 patients treated with IMRT. The prescribed dose was 35 Gy in 5 fractions in group A and 35 Gy in 10 fractions in group B. The time to pain relief, imaging findings, and survival analysis were used to evaluate pain-relieving effect, the condition of lesions, and survival time. The t-test was used to compare continuous data between groups, and the chi-square test was used to compare categorical data between groups. The K-M method was used to plot survival curves for both groups, and the log-rank test was used for survival difference analysis. ResultsThe proportion of patients who achieved complete or partial remission and stable disease shown by radiological examination after radiotherapy showed no significant difference between group A and group B (P=0.873. The pain relief rate also showed no significant difference between group A and group B (P=0.908. The time of pain relief showed a significant difference between group A and group B (t=-3.353, P＜0.01. The overall survival showed no significant difference between the two groups (P=0.346. ConclusionRadiotherapy has a definite therapeutic effect in PLC patients with secondary malignant tumor of vertebra. SBRT and IMRT have similar pain-relieving effects. However, with the same prescribed dose, SBRT has a short time to pain relief and does not lead to serious intolerable acute or late toxic and side effects in surrounding fast-response tissues.

Hormonal balance of breast cancer patients treated by various radiotherapy schemes

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Lozinskaya, I.N.; Yakimova, T.P.

1993-01-01

Examination of patients with breast cancer has shown a relationship between disease stage, on the one hand, and thyroid function depression, carcinoembryonic antigen and somatotropin levels, on the other. High levels of carcinoembrionic antigen are conducive to depression of immune stromal reactions in the tumor and unfavorably tell on five-year survival. Radiotherapy leads to nonuniversal changes in the hormonal system, related to cancer stage

The radiotherapy affects the cognitive processes; La radiotherapie affecte la cognition

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Anon

2009-10-15

Researchers from the medical center of the free university of Amsterdam report that the radiotherapy can hinder the cognitive functions of patients affected by cerebral tumors treated after a surgery. Even low dose radiation could contribute in their opinion, to the progressive cognitive decline of patients suffering of low grade gliomas, the most commune cerebral tumor. To get these conclusions, 65 patients, whom half of them received a radiotherapy, had a neurological and psychological evaluation twelve years after their treatment. Results: 53% of patients treated by radiotherapy present disorders of attention, memory, execution and speed of information treatment against 27% of these ones that received an only surgery. The researchers conclude to the necessity to take into account this risk in the choice of treatment, or even to avoid radiotherapy in this precise case. (N.C.)

Safty and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors

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Zhai Yirui; Feng Qinfu; Li Minghui

2010-01-01

Objective: To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors. Methods: From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy, including 14 patients with breast cancer,19 with pancreatic cancer, 3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors. Fifteen patients were with recurrent tumors. The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy. In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively. The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0). Results: The median duration of surgery was 190 minutes. Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxaemia, all of which were treated conservatively. The median hospitalization time and time to take out stitches was 12 and 13 days, respectively. And the in-hospital mortality was 4% (2/52). Twenty-four patients suffered post-operative adverse events, including 3 postoperative infections. With a median follow-up time of 183 days, 20% of patients suffered from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache. Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively. None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy. Conclusions: Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone. (authors)

Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

International Nuclear Information System (INIS)

Min, Sun Young; Lee, Seung Ju; Shin, Kyung Hwan; Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won; Kim, Tae Hyun; Kang, Han-Sung; Cho, Kwan Ho

2011-01-01

Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

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Min, Sun Young [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Surgery, Kyung Hee University, Seoul (Korea, Republic of); Lee, Seung Ju [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Shin, Kyung Hwan, E-mail: radiat@ncc.re.kr [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Tae Hyun [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kang, Han-Sung [Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Cho, Kwan Ho [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

2011-12-01

Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

Overexpression of synuclein-γ predicts lack of benefit from radiotherapy for breast cancer patients

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Min, Li; Zhang, Cheng; Ma, Ruolan; Li, Xiaofan; Yuan, Hua; Li, Yihao; Chen, Ruxuan; Liu, Caiyun; Guo, Jianping; Qu, Like; Shou, Chengchao

2016-01-01

Although radiotherapy following mastectomy was demonstrated to reduce the recurring risk and improve the prognosis of patients with breast cancer, it is also notorious for comprehensive side effects, hence only a selected group of patients can benefit. Therefore, the screening of molecular markers capable of predicting the efficacy of radiotherapy is essential. We have established a cohort of 454 breast cancer cases and selected 238 patients with indications for postoperative radiotherapy. Synuclein-γ (SNCG) protein levels were assessed by immunohistochemistry, and SNCG status was retrospectively correlated with clinical features and survival in patients treated or not treated with radiotherapy. Gene Set Enrichment Analysis (GSEA) and survival analysis for online datasets were also performed for further validation. Among patients that received radiotherapy (82/238), those demonstrating positive SNCG expression had a 55.0 month shorter median overall survival (OS) in comparison to those demonstrating negative SNCG expression (78.4 vs. 133.4 months, log rank χ 2 = 16.13; p < 0.001). Among the patients that received no radiotherapy (156/238), SNCG status was not correlated with OS (log rank χ 2 = 2.40; p = 0.121). A COX proportional hazard analysis confirmed SNCG as an independent predictor of OS, only for patients who have received radiotherapy. Similar results were also obtained for distant metastasis-free survival (DMFS). A GSEA analysis indicated that SNCG was strongly associated with genes related to a radiation stress response. A survival analysis was performed with online databases consisting of breast cancer, lung cancer, and glioblastoma and further confirmed SNCG’s significance in predicting the survival of patients that have received radiotherapy. A positive SNCG may serve as a potential marker to identify breast cancer patients who are less likely to benefit from radiotherapy and may also be extended to other types of cancer. However, the role of SNCG

Wound healing morbidity in STS patients treated with preoperative radiotherapy in relation to in vitro skin fibroblast radiosensitivity, proliferative capacity and TGF-β activity

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Akudugu, John M.; Bell, Robert S.; Catton, Charles; Davis, Aileen M.; Griffin, Anthony M.; O'Sullivan, Brian; Waldron, John N.; Ferguson, Peter C.; Wunder, Jay S.; Hill, Richard P.

2006-01-01

Background and purpose: In a recent study, we demonstrated that the ability of dermal fibroblasts, obtained from soft tissue sarcoma (STS) patients, to undergo initial division in vitro following radiation exposure correlated with the development of wound healing morbidity in the patients following their treatment with preoperative radiotherapy. Transforming growth factor beta (TGF-β) is thought to play an important role in fibroblast proliferation and radiosensitivity both of which may impact on wound healing. Thus, in this study we examined the interrelationship between TGF-β activity, radiosensitivity and proliferation of cultured fibroblasts and the wound healing response of STS patients after preoperative radiotherapy to provide a validation cohort for our previous study and to investigate mechanisms. Patients and methods: Skin fibroblasts were established from skin biopsies of 46 STS patients. The treatment group consisted of 28 patients who received preoperative radiotherapy. Eighteen patients constituted a control group who were either irradiated postoperatively or did not receive radiation treatment. Fibroblast cultures were subjected to the colony forming and cytokinesis-blocked binucleation assays (low dose rate: ∼0.02 Gy/min) and TGF-β assays (high dose-rate: ∼1.06 Gy/min) following γ-irradiation. Fibroblast radiosensitivity and initial proliferative ability were represented by the surviving fraction at 2.4 Gy (SF 2.4 ) and binucleation index (BNI), respectively. Active and total TGF-β levels in fibroblast cultures were determined using a biological assay. Wound healing complication (WHC), defined as the requirement for further surgery or prolonged deep wound packing, was the clinical endpoint examined. Results: Of the 28 patients treated with preoperative radiotherapy, 8 (29%) had wound healing difficulties. Fibroblasts from patients who developed WHC showed a trend to retain a significantly higher initial proliferative ability after

Outcomes of Patients With Non-Hodgkin's Lymphoma Treated With Bexxar With or Without External-Beam Radiotherapy

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Smith, Kristy; Byer, Gracie; Morris, Christopher G.; Kirwan, Jessica M.; Lightsey, Judith; Mendenhall, Nancy P.; Hoppe, Bradford S.; Lynch, James; Olivier, Kenneth

2012-01-01

Purpose: To compare the efficacy and toxicity of external-beam radiotherapy (EBRT) to sites of bulky lymphadenopathy in patients with chemotherapy-refractory low-grade non-Hodgkin’s lymphoma (NHL) immediately before receiving Bexxar (tositumomab and 131 I) vs. in patients receiving Bexxar alone for nonbulky disease. Methods and Materials: Nineteen patients with chemotherapy-refractory NHL were treated with Bexxar at our institution (University of Florida, Gainesville, FL) from 2005 to 2008. Seventeen patients had Grade 1–2 follicular lymphoma. Ten patients received a median of 20 Gy in 10 fractions to the areas of clinical involvement, immediately followed by Bexxar (EBRT + Bexxar); 9 patients received Bexxar alone. The median tumor sizes before EBRT + Bexxar and Bexxar alone were 4.8 cm and 3.3 cm, respectively. All 5 patients with a tumor diameter >5 cm were treated with EBRT + Bexxar. A univariate analysis of prognostic factors for progression-free survival (PFS) was performed. Results: The median follow-up was 2.3 years for all patients and 3.1 years for 12 patients alive at last follow-up. Of all patients, 79% had a partial or complete response; 4 of the 8 responders in the EBRT + Bexxar group achieved a durable response of over 2 years, including 3 of the 5 with tumors >5 cm. Three of 9 patients treated with Bexxar alone achieved a durable response over 2 years. Actuarial estimates of 3-year overall survival and PFS for EBRT + Bexxar and Bexxar alone were 69% and 38% and 62% and 33%, respectively. The median time to recurrence after EBRT + Bexxar and Bexxar alone was 9 months. Having fewer than 4 involved lymph-node regions was associated with superior PFS at 3 years (63% vs. 18%). There was no Grade 4 or 5 complications. Conclusions: Adding EBRT immediately before Bexxar produced PFS equivalent to that with Bexxar alone, despite bulkier disease. Hematologic toxicity was not worsened. EBRT combined with Bexxar adds a safe and effective therapeutic

Prognostic value of the Glasgow Prognostic Score for glioblastoma multiforme patients treated with radiotherapy and temozolomide.

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Topkan, Erkan; Selek, Ugur; Ozdemir, Yurday; Yildirim, Berna A; Guler, Ozan C; Ciner, Fuat; Mertsoylu, Huseyin; Tufan, Kadir

2018-04-25

To evaluate the prognostic value of the Glasgow Prognostic Score (GPS), the combination of C-reactive protein (CRP) and albumin, in glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (GPS). Data of newly diagnosed GBM patients treated with partial brain RT and concurrent and adjuvant TMZ were retrospectively analyzed. The patients were grouped into three according to the GPS criteria: GPS-0: CRP L and albumin > 35 g/L; GPS-1: CRP L and albumin L or CRP > 10 mg/L and albumin > 35 g/L; and GPS-2: CRP > 10 mg/L and albumin L. Primary end-point was the association between the GPS groups and the overall survival (OS) outcomes. A total of 142 patients were analyzed (median age: 58 years, 66.2% male). There were 64 (45.1%), 40 (28.2%), and 38 (26.7%) patients in GPS-0, GPS-1, and GPS-2 groups, respectively. At median 15.7 months follow-up, the respective median and 5-year OS rates for the whole cohort were 16.2 months (95% CI 12.7-19.7) and 9.5%. In multivariate analyses GPS grouping emerged independently associated with the median OS (P GPS grouping and the RTOG RPA classification were found to be strongly correlated in prognostic stratification of GBM patients (correlation coefficient: 0.42; P GPS appeared to be useful in prognostic stratification of GBM patients into three groups with significantly different survival durations resembling the RTOG RPA classification.

What information should patients be given before radiotherapy?

International Nuclear Information System (INIS)

Bergerot, Ph.

2009-01-01

Following a number of accidents at radiotherapy units, at Epinal and Toulouse hospitals in particular, and the problems encountered in the summer 2008, mainly caused by a shortage of radiation physicians and probably due to legislation that bears little relation to reality, a national radiotherapy monitoring committee was set up on 15 December 2008 in the presence of Roselyne Bachelot-Narquin, France's Minister for Health and Sport. A first progress report was submitted to the Minister in May 2009. Twelve members sit on this national monitoring committee, including a CISS representative and a person that has received radiotherapy treatment. This demonstrates the seriousness and the commitment required of users on this issue. Radiotherapy, one of the main treatments for cancer, is a loco-regional treatment that uses radiation capable of destroying cancer cells. It can be used on its own, or before, during or after another treatment method (surgery or a medical treatment such as chemotherapy, for example). The decision to treat a patient by means of radiotherapy is based on the opinions of health care professionals discussed at a multidisciplinary team meeting, the minutes of which are sent to the various doctors involved. The radiotherapy treatment prescribed (the technique, total radiation dose, length of the treatment, number of sessions, etc.) is adapted to the individual situation of each patient. It is designed to be as effective as possible in light of the tumour pathology, while protecting neighbouring organs as far as is possible. (author)

Correlation factor analysis between radiation pneumonitis and chemo-radiotherapy in breast cancer patients

International Nuclear Information System (INIS)

Li Huiping; Wang Junjie; Ma Liwen; Zhang Shulan; Deng Huijing; Jia Tingzhen

2004-01-01

Objective: To investigate the relationship between radiotherapy-induced lung injury and chemotherapy agents as well as other factors. Methods: A total of 85 breast cancer patients received radiotherapy with sequential or concurrent chemotherapy after surgery were analysed for radiation dose, chemotherapy schedule, age, and lung disease history. Results: Five patients had clinical symptoms of radiation pneumonitis, one of them was necessary to treat and 16 patients developed radiological changes (18.8%). Close relationship was noted between incidence of radiation pneumonitis and radiation dose, timing and drugs used in chemotherapy and lung disease history. Conclusion: High irradiation dose, concurrent chemotherapy, and lung disease history can increase the rate of radiotherapy-induced pulmonary injury in breast cancer patients. (authors)

Transoral laser resection or radiotherapy? Patient choice in the treatment of early laryngeal cancer: a prospective observational cohort study.

Science.gov (United States)

Zahoor, T; Dawson, R; Sen, M; Makura, Z

2017-06-01

The choices made by patients offered treatment for early laryngeal cancer with radiotherapy or transoral laser resection were reviewed. A prospective review was conducted of all patients diagnosed and treated for early laryngeal carcinoma from December 2002 to September 2009 at the Leeds Teaching Hospitals NHS Trust. A total of 209 patients with tumour stage T1 or T2 laryngeal cancer were treated; each new patient suitable for radiotherapy or transoral laser resection was seen jointly by the clinical (radiation) oncologist and head and neck surgeon, and offered the choice of treatment. Of the patients, 47.4 per cent were given a choice between radiotherapy and transoral laser resection; 51.2 per cent were advised to have radiotherapy, and there were no records for the remaining 1.4 per cent. From those given the choice, 59.6 per cent chose transoral laser resection (p < 0.02 (t-test)) and 35.4 per cent chose radiotherapy. When given the choice, a statistically significant majority of patients choose transoral laser resection rather than radiotherapy.

Radio-induced malignancies after breast cancer postoperative radiotherapy in patients with Li-Fraumeni syndrome

International Nuclear Information System (INIS)

Heymann, Steve; Bourgier, Céline; Delaloge, Suzette; Rahal, Arslane; Caron, Olivier; Frebourg, Thierry; Barreau, Lise; Pachet, Corinne; Mathieu, Marie-Christine; Marsiglia, Hugo

2010-01-01

There are no specific recommendations for the management of breast cancer patients with germ-line p53 mutations, an exceptional genetic condition, particularly regarding postoperative radiotherapy. Preclinical data suggested that p53 mutations conferred enhanced radiosensitivity in vitro and in vivo and the few clinical observations showed that Li-Fraumeni families were at a higher risk of secondary radio-induced malignancies. We reviewed a cohort of patients with germ-line p53 mutations who had been treated for breast cancer as the first tumor event. We assessed their outcome and the incidence of secondary radio-induced malignancies. Among 47 documented Li-Fraumeni families treated from 1997 to 2007 at the Institut Gustave Roussy, 8 patients had been diagnosed with breast cancer as the first tumor event. Three patients had undergone conservative breast surgery followed by postoperative radiotherapy and five patients had undergone a mastectomy (3 with postoperative radiotherapy). Thus, 6/8 patients had received postoperative radiotherapy. Median follow-up was 6 years. Median age at the diagnosis of the primary breast cancer was 30 years. The histological characteristics were as follows: intraductal carcinoma in situ (n = 3), invasive ductal carcinoma (n = 4) and a phyllodes tumor (n = 1). Among the 6 patients who had received adjuvant radiotherapy, the following events had occurred: 3 ipsilateral breast recurrences, 3 contralateral breast cancers, 2 radio-induced cancers, and 3 new primaries (1 of which was an in-field thyroid cancer with atypical histology). In contrast, only one event had occurred (a contralateral breast cancer) among patients who had not received radiation therapy. These observations could argue in favor of bilateral mastectomy and the avoidance of radiotherapy

Cytogenetic effects induced by radiotherapy of cancer patients

International Nuclear Information System (INIS)

Ekhtiar, A.; Al-Achkar, W.

2008-03-01

Ionizing radiation plays a key role in the treatment of many neoplasias. But it is well known that ionizing radiation induce wide specter of DNA damages, including SSBs, DSBs, base damage, and DNA-protein cross links. As a consequence, a second tumor may be developed after the primary tumor therapy. Attempts have been made to evaluate the genotoxicity of ionizing radiation in patients undergoing radiotherapy. In the present work, the cytogenetic damage present in peripheral blood lymphocytes of patients (29 donors) treated with fractionated partial-body radiation therapy for Head-and-neck cancer patient was followed before, during and at the end of treatment by means of the cytokinesis-block micronucleus assay. These patients had no previous chemotherapy or radiotherapy. Our results indicate that the level of spontaneous cytogenetic damage in cancer patients and smokers control (3 donors) were higher than in healthy non smoking controls (3 donor). During and after treatment, increased of micronucleus cells frequencies were observed with increasing treatment doses.(author)

Stereotactic radiotherapy for patients with metallic implants on vertebral body: A dosimetric comparison

OpenAIRE

Guzle Adas, Yasemin; Yazici, Omer; Kekilli, Esra; Kiran, Ferat

2018-01-01

Objective: Metallic implants have impacts on dose distribution of radiotherapy. Our purpose is evaluating impact of metallic implants with different dose calculation algorithms on dose distribution. Material and Methods: Two patients with metallic implants on vertebral body were included in this study. They were treated with stereotactic radiotherapy. The data of the patients were retrospectively re-calculated with different TPSs and calculation algorithms. Ray-Tracing (Ry-Tc), Mont...

Asymmetry of disciform scarring in bilateral disease when one eye is treated with radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Hart, P.M.; Archer, D.B.; Chakravarthy, U. [Queen`s Univ., Belfast, Northern Ireland (United Kingdom)

1995-06-01

A previous study has shown that in age-related macular degeneration a high degree of concordance of disciform scar size occurs in the two eyes of any one patient. In a study of 35 patients with choroidal neovascular membrane who were treated with low dose ionising radiation to the macula of the affected eye, 11 were found to have bilateral disease. The visual outcome and scar size and morphology in the two eyes of each of these patients were compared. This study has provided evidence in support of reduced scarring and maintenance of better central visual function in radiotherapy treated eyes when compared with untreated fellow eyes. (author).

Asymmetry of disciform scarring in bilateral disease when one eye is treated with radiotherapy

International Nuclear Information System (INIS)

Hart, P.M.; Archer, D.B.; Chakravarthy, U.

1995-01-01

A previous study has shown that in age-related macular degeneration a high degree of concordance of disciform scar size occurs in the two eyes of any one patient. In a study of 35 patients with choroidal neovascular membrane who were treated with low dose ionising radiation to the macula of the affected eye, 11 were found to have bilateral disease. The visual outcome and scar size and morphology in the two eyes of each of these patients were compared. This study has provided evidence in support of reduced scarring and maintenance of better central visual function in radiotherapy treated eyes when compared with untreated fellow eyes. (author)

Long-term Treatment Response and Patient Outcomes for Vestibular Schwannoma Patients Treated with Hypofractionated Stereotactic Radiotherapy

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Mira A. Patel

2017-09-01

Full Text Available PurposeThe aim of this study is to evaluate long-term treatment outcome and toxicities among vestibular schwannoma (VS patients treated with hypofractionated stereotactic radiotherapy (HSRT.Methods383 patients with unilateral VS treated with HSRT (25 Gy, five fractions between 1995 and 2007 were retrospectively reviewed. Treatment failure was defined as requiring salvage microsurgery. Posttreatment new/progressive clinical symptoms or increases in baseline tumor volume (BTV due to treatment effect or progression were noted. Symptom outcomes were reported as baseline and posttreatment ± improvement, respectively. Symptoms were grouped by cranial nerve (CN VII or CNVIII. Audiometry was assessed baseline and posttreatment hearing. Patients were grouped as having greater than serviceable hearing [Gardner Robertson (GR score 1–2] or less than non-serviceable hearing (GR score 3–5 by audiometry.ResultsMedian follow-up was 72.0 months. Nine (2.3% experienced treatment failure. At last follow-up, 74 (19.3% had new/progressive symptoms and were categorized as radiologic non-responders, whereas 300 (78.3% had no tumor progression and were grouped as radiologic responders. Average pretreatment BTV for treatment failures, radiologic non-responders, and radiologic responders was 2.11, 0.44, and 1.87 cm3, respectively. Pretreatment CNVII and CNVIII symptoms were present in 9.4 and 93.4% of patients, respectively. Eight (24% with pre-HSRT CNVII and 37 (10% with pre-HSRT CNVIII symptoms recovered CN function post-HSRT. Thirty-five (9% and 36 (9.4% experienced new CNVII and CNVIII deficit, respectively, after HSRT. Of these, 20 (57% and 18 (50% recovered CNVII and CNVIII function, respectively, after HSRT. Evaluable audiograms were available in 199 patients. At baseline and at last follow-up, 65.8 and 36.2% had serviceable hearing, respectively. Fifty-one percent had preservation of serviceable hearing at last follow-up.ConclusionTreatment of VS

Leukemia in patients following radiotherapy for malignant neoplasms in the pelvic region

Energy Technology Data Exchange (ETDEWEB)

Murohashi, Ikuo

1985-01-01

A prospective study of 1572 women treated with radiotherapy for cervical (1478 women) and ovarian cancer (95 women) was done. Patients had been followed clinically and especially by blood tests between 1961 and 1981, comprising 8990 women-years (WY). Following radiotherapy, 5 patients developed non-lymphocytic leukemia (2 acute myeloblastic leukemia (AML), 1 acute monocytic leukemia (AMoL), and 2 chronic myeloid leukemia (CML)). Based on rates for the general population, 0.45 case would be expected, and, therefore, the relative risk was 11.2. The average mean marrow dose for all our subjects was calculated to be 11.77 rad, the risk of radiation-induced leukemia was 0.43 excess case per year per one million women exposed to 1 rad of radiation to the bone marrow. Four patients with cervical cancer who developed leukemia were in a high-dose-rate group treated with both a linear accelerator (Linac) and remote afterloading system (RALS), and 1 patient with ovarian cancer who developed leukemia was treated with a Linac alone. This is the first report of a statistically significant increased risk of leukemia for patients treated with large doses of radiation for malignant neoplasms in the pelvic region. (author).

Leukemia in patients following radiotherapy for malignant neoplasms in the pelvic region

International Nuclear Information System (INIS)

Murohashi, Ikuo

1985-01-01

A prospective study of 1572 women treated with radiotherapy for cervical (1478 women) and ovarian cancer (95 women) was done. Patients had been followed clinically and especially by blood tests between 1961 and 1981, comprising 8990 women-years (WY). Following radiotherapy, 5 patients developed non-lymphocytic leukemia [2 acute myeloblastic leukemia (AML), 1 acute monocytic leukemia (AMoL), and 2 chronic myeloid leukemia (CML)]. Based on rates for the general population, 0.45 case would be expected, and, therefore, the relative risk was 11.2. The average mean marrow dose for all our subjects was calculated to be 11.77 rad, the risk of radiation-induced leukemia was 0.43 excess case per year per one million women exposed to 1 rad of radiation to the bone marrow. Four patients with cervical cancer who developed leukemia were in a high-dose-rate group treated with both a linear accelerator (Linac) and remote afterloading system (RALS), and 1 patient with ovarian cancer who developed leukemia was treated with a Linac alone. This is the first report of a statistically significant increased risk of leukemia for patients treated with large doses of radiation for malignant neoplasms in the pelvic region. (author)

Survival After Palliative Radiotherapy in Patients with Breast Cancer and Bone-only Metastases.

Science.gov (United States)

Nieder, Carsten; Dalhaug, Astrid; Pawinski, Adam; Mannsåker, Bård; Haukland, Ellinor

Patients with bone-only metastases survive longer than patients with widespread visceral disease. We analyzed the prognostic impact of different baseline parameters, such as abnormal blood tests and receptor status in patients who received local radiotherapy, in addition to contemporary systemic treatment, according to national guidelines. Retrospective uni- and multivariate analyses of 57 consecutive female patients treated in the time period 2007-2014 (median follow-up=29 months). The median age was 59 years and the median time interval from the initial diagnosis of breast cancer was 57 months. The median survival was 23 months from radiotherapy and 32 months from initial diagnosis of metastatic disease. Five-year survival rates were 13 and 21%, respectively. Survival after radiotherapy was significantly longer in patients who were prescribed higher radiation doses; 29 months after ≥30 Gy and 10 months after radiotherapy improves survival in patients with bone-only disease suitable for local therapy. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Prophylactic Breast Bud Radiotherapy for Patients Taking Bicalutamide: Should This Still Be Practised for Patients with Prostate Cancer?

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R. Lewis

2012-01-01

Full Text Available Prophylactic breast bud radiotherapy is used to prevent gynaecomastia and mastalgia in patients with prostate cancer who are being treated with antiandrogen and oestrogen therapy. Here a case is presented of a patient who developed soft-tissue sarcoma of the breast subsequent to breast bud radiotherapy prior to bicalutamide hormone treatment. Bicalutamide is often prescribed for younger men in the adjuvant setting or as monotherapy for locally advanced disease. The data regarding the efficacy of prophylactic breast bud radiotherapy is reviewed, and it is proposed that alternative therapies should be considered such as tamoxifen.

Analysis for prognostic factors of radiotherapy for esophageal squamous cell carcinoma

International Nuclear Information System (INIS)

Nakano, Takashi; Ito, Jun; Ito, Ichiro; Yamanaka, Mikio; Suto, Hisao; Mitsuhashi, Norio; Niibe, Hideo

1984-01-01

Two hundred and fifty patients with squamous cell carcinoma of the esophagus were treated at our department from 1969 to 1981 with radiotherapy involving radiation alone and pre-and/or post-operative radiotherapy. For 167 patients receiving radiotherapy alone, 144 were inoperable cases and only 60 patients could be radically treated. The others were palliative treated patients because of the locally advanced state or distant metastases or severe complications. For 83 patients receiving pre-and/or post-operative radiotherapy, 62 were radically treated. Results of radiotherapy were analyzed to elucidate factors responsible for these prognosis. Relative 5 years survival rates for radically treated patients were 26% in radiotherapy alone and 20% in pre-and/or post-operative radiotherapy respectively. In radiotherapy alone, quite a good prognoses could be obtained in the patients with tumors less than 5cm at radiografical finding (42% for 5 yrs), with tumors located in Ei, Ea esophagus (40%), with tumors of serrative and tumorous X-P types (48%, 43%, respectively) and with good radiation response at the end of radiotherapy (54%). From the analysis of 12 patients surviving more than 5 years from onset of treatment, not only tumor size less than 5cm but also radiation response was major factor responsible for the prognosis. It might be important to treat patients precisely according to their own clinical characteristics and considering tumor host relationship. (author)

Secondary acute non lymphoid leukemia in patients treated for non Hodgkin's lymphoma

International Nuclear Information System (INIS)

Cimino, G.; Anselma, A.; Cartoni, C.

1987-01-01

The present study was undertaken to evaluate the frequency, characteristics and actual risk of secondary acute non lymphoid leukemia (s-ANLL) in 141 patients treated for non Hodgkin's lymphoma with different modalities. One hundred and twenty-four patients received chemotherapy according to PROVECIP protocol (9). Of these, 15 also received as induction treatment a local nodal irradiation and 33 an extended field radiotherapy. Seventeen out of 141 were treated by total body irradiation. Of these, 15 relapsed and received salvage chemotherapy. Sixteen of the 124 patients trated with PROVECIP also underwent different chemotherapeutic programs as salvage treatment. Of the entire population studied, 2 patients significantly affected the occurrence of s-ANLL, since both leukemias occurred in patients treated with total body irradiation, given alone or followed by chemotherapy. The actuarial risk at 8 years was 5.24% in the whole group, whereas it greatly increased in the group of patients treated with total body irradiation (24%). Conversely, no risk was found in the group treated with PROVECIP, alone, with additional chemotherapy, or with associated local or extended field radiotherapy

Radiotherapy for malignancy in patients with scleroderma: The Mayo Clinic experience

International Nuclear Information System (INIS)

Gold, Douglas G.; Miller, Robert C.; Petersen, Ivy A.; Osborn, Thomas G.

2007-01-01

Purpose: To determine the frequency of acute and chronic adverse effects in patients with scleroderma who receive radiotherapy for treatment of cancer. Methods and Materials: Records were reviewed of 20 patients with scleroderma who received radiotherapy. Acute and chronic toxic effects attributable to radiotherapy were analyzed, and freedom from radiation-related toxicity was calculated. Results: Of the 20 patients, 15 had acute toxic effects, with Grade 3 or higher toxicity for 3 patients. Seven patients had self-limited Grade 1 or 2 radiation dermatitis, and no patient had Grade 3 or higher radiation dermatitis. Thirteen patients had chronic toxic effects, with Grade 3 or higher chronic toxicity for 3 patients. The median estimated time to any grade chronic toxicity was 0.4 years, and the median estimated time to Grade 3 or higher chronic toxicity has not been reached. Conclusions: The results suggest that although some patients with scleroderma treated with radiation experience considerable toxic effects, the occurrence of Grade 3 or higher toxicity may be less than previously anticipated

The importance of haemoglobin level and effect of transfusion in HNSCC patients treated with radiotherapy - Results from the randomized DAHANCA 5 study

International Nuclear Information System (INIS)

Hoff, Camilla Molich; Hansen, Hanne Sand; Overgaard, Marie; Grau, Cai; Johansen, Jorgen; Bentzen, Jens; Overgaard, Jens

2011-01-01

Background and purpose: Patients with head and neck squamous cell carcinoma (HNSCC) and a low level of haemoglobin (Hb) often have a poor response to radiation which may be related to hypoxia induced radioresistance. The aim of the study was to evaluate the prognostic significance of low Hb level and its modification by transfusion in HNSCC patients treated with radiotherapy. The study was performed as a subrandomization in the DAHANCA 5 trial. Material and methods: Patients were randomized to treatment with the hypoxic radiosensitizer nimorazole or placebo, and in addition, patients with 'low' pre-irradiation Hb values (females < 13 g/dL; males < 14.5 g/dL) were subrandomized to plus or minus transfusion. Transfusion was given with packed red blood cells with the aim to achieve a Hb level in the 'high' value range. Results: A total of 414 patients were included, 243 patients had high Hb levels and 171 patients had low Hb levels. Of the low Hb patients, 82 were randomized to receive transfusion and 89 not to receive transfusion. The treatment arms were well balanced. In the majority of patients, transfusion resulted in increased Hb levels although this tended to decline throughout treatment. Patients with high Hb levels had a significantly better probability of locoregional control, disease-specific survival and overall survival compared to 'low Hb no transfusion' patients. In the low Hb group, transfusion did not improve the outcome in locoregional control, disease-specific survival or overall survival. In multivariate analyses, T and N classifications were significant for all outcome measures, whereas there was no significant influence of transfusion or Hb level on endpoints. Conclusion: The univariate prognostic significance of high Hb level was demonstrated in patients with HNSCC treated with radiotherapy; however, transfusion prior to and during treatment did not improve the outcome in patients with low Hb values.

Verification of the Patient Positioning in the Bellyboard Pelvic Radiotherapy

International Nuclear Information System (INIS)

Kasabasic, M.; Faj, D.; Smilovic Radojcic, D.; Svabic, M.; Ivkovic, A.; Jurkovic, S.

2008-01-01

The size and shape of the treatment fields applied in radiotherapy account for uncertainties in the daily set-up of the patients during the treatment. We investigated the accuracy of daily patient positioning in the bellyboard pelvic radiotherapy in order to find out the magnitude of the patients movement during the treatment. Translational as well as rotational movements of the patients are explored. Film portal imaging is used in order to find patient positioning error during the treatment of the pelvic region. Patients are treated in the prone position using the bellyboard positioning device. Thirty six patients are included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisition was completed in 85 percent and systematic and random positioning errors in 453 images are analyzed. (author)

Collagen Type III Metabolism Evaluation in Patients with Malignant Head and Neck Cancer Treated with Radiotherapy

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Klaudia Mazurek

2018-01-01

Full Text Available Ionizing radiation affects the metabolism of key proteins of extracellular matrix including type III collagen, an important component of human skin. The aim of the work is an analysis of the impact of radical and palliative radiotherapy on collagen type III synthesis in patients with head and neck cancer. The test group consisted of 56 males with histopathologically confirmed head and neck cancer, for whom radiotherapy was applied as a form of radical or palliative treatment. The level of procollagen III aminoterminal propeptide (PIIINP, which is a marker of collagen type III synthesis, was determined in blood serum before radiotherapy, immediately following radiotherapy, and 3 months after it was finished. As a result of radical radiotherapy a statistically significant decrease of PIIINP levels in serum (p<0.0001 was observed, both immediately after the radiotherapy and 3 months after the end of the treatment. Also the palliative radiotherapy caused a significant decrease of PIIINP right after the treatment (p=0.0052, as well as during the examination performed 3 months later (p=0.0004. The achieved results suggest that PIIINP can be used as a marker helpful in assessing radiation damage to connective tissue.

The contribution of radiotherapy in the adult patients with a medulloblastoma: a long mono-institutional experience

International Nuclear Information System (INIS)

Bari, B. de; Balducci, M.; Manfrida, S.; Chiesa, S.; Frascino, V.; Valentini, V.; Anile, C.

2009-01-01

The medulloblastoma is rare among adults (1% of primitive cerebral tumors). currently, the surgery constitutes the initial therapy approach, followed by the radiotherapy. This summary presents the update of a retrospective analysis in a population of adult patients (>18 years) suffering of a medulloblastoma presented in 2006 at the national congress of the Italian association of oncological radiotherapy. It confirms the efficiency of radiotherapy to treat the adult patients suffering of a medulloblastoma. (N.C.)

Radiotherapy-induced emesis. An overview

International Nuclear Information System (INIS)

Feyer, P.; Buchali, A.; Hinkelbein, M.; Budach, V.; Zimmermann, J.S.; Titlbach, O.J.

1998-01-01

Background: A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life. Methods: International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced. Results: Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exist high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%. Conclusions: Studies with total body irradiation, fractionated treatment and high-dose single exposures have cleary demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic

Radiotherapy for laryngeal cancer in patients under 50 years old

International Nuclear Information System (INIS)

Shimizu, Wakako; Ogino, Takashi; Ebihara, Satoshi; Ikeda, Hiroshi.

1995-01-01

Fifty-nine cases of laryngeal cancer treated by radiotherapy at the National Cancer Center Hospital between 1962 and 1990 were analyzed retrospectively. All the patients were less than 50 years old. The median total dose of the radiation delivered to the primary tumor site was 70 Gy. The overall 5-yr survival rate and 5-yr local control rate were 88% and 72%, respectively. Five (8.5%) of the 59 patients developed late recurrence more than five yr after initial treatment, but subsequent salvage operations were successful for disease control; three patients had T1 glottic cancer, one had T2-3 glottic cancer and one had T3N1 supraglottic cancer. Since the local control rate and the 5-yr survival rate after radiotherapy are satisfactory, radiotherapy, which allows both functional and esthetic conservation, has an important role in the treatment of laryngeal cancer in adults under 50 yr of age. (author)

Prognostic factors in non-Hodgkin lymphoma stage I treated with radiotherapy

International Nuclear Information System (INIS)

Hagberg, H.; Pettersson, U.; Glimelius, B.; Sundstroem, C.

1989-01-01

The results of treatment in 175 consecutive patients with non-Hodgkin lymphoma (NHL) clinical stage I treated between 1969 and 1984 were analysed according to different pretreatment prognostic variables. Treatment consisted of radiotherapy in 166 of the 175 patients. The estimated 5 and 10-year disease-free survival rates (DFS) were 63% and 60% and the survival rates at 5 and 10 years 82% and 76% respectively. Lymphomas arising from gut-associated lymphoid tissue, i.e. Waldeyer's ring, the thyroid and the gastrointestinal tract had a more favourable clinical course (10-year projected DFS 83%) than nodal (50%) and other extranodal lymphomas. Although the number of patients with other extranodal sites was small, sites such as testis, nasal cavity, paranasal sinus and extradural space seemed to have a high relapse rate. Unfavourable clinical courses were also observed among nodal high-grade NHL if the lymph nodes were larger than 5 cm in diameter. Chemotherapy before radiotherapy may be recommended in NHL subgroups with a high relapse rate and which today are potentially curable with chemotherapy, i.e. high-grade NHL. This study indicates that large nodal lymphomas and some extranodal sites belong to this group. (orig.)

Prognostic factors in non-Hodgkin lymphoma stage I treated with radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Hagberg, H.; Pettersson, U.; Glimelius, B.; Sundstroem, C.

1989-01-01

The results of treatment in 175 consecutive patients with non-Hodgkin lymphoma (NHL) clinical stage I treated between 1969 and 1984 were analysed according to different pretreatment prognostic variables. Treatment consisted of radiotherapy in 166 of the 175 patients. The estimated 5 and 10-year disease-free survival rates (DFS) were 63% and 60% and the survival rates at 5 and 10 years 82% and 76% respectively. Lymphomas arising from gut-associated lymphoid tissue, i.e. Waldeyer's ring, the thyroid and the gastrointestinal tract had a more favourable clinical course (10-year projected DFS 83%) than nodal (50%) and other extranodal lymphomas. Although the number of patients with other extranodal sites was small, sites such as testis, nasal cavity, paranasal sinus and extradural space seemed to have a high relapse rate. Unfavourable clinical courses were also observed among nodal high-grade NHL if the lymph nodes were larger than 5 cm in diameter. Chemotherapy before radiotherapy may be recommended in NHL subgroups with a high relapse rate and which today are potentially curable with chemotherapy, i.e. high-grade NHL. This study indicates that large nodal lymphomas and some extranodal sites belong to this group. (orig.).

Radiological response and clinical outcome in patients with femoral bone metastases after radiotherapy

International Nuclear Information System (INIS)

Harada, Hideyuki; Katagiri, Hirohisa; Kamata, Minoru

2010-01-01

We evaluated the radiological response and clinical outcome in patients with femoral bone metastases after radiotherapy. 102 consecutive patients with femoral metastases without pathological fracture were treated by surgery or radiotherapy between 2002 and 2005. Twelve of them initially treated with surgery were excluded from this study. The remaining 90 patients with 102 lesions underwent radiation therapy as the initial treatment. Twelve patients who died within 30 days by disease progression and 6 who were lost to follow-up were excluded. The remaining 72 patients with 84 lesions including 43 impending fractures were enrolled in this analysis. Radiological changes were categorized into complete response, partial response, no change, and progressive disease based on plain radiograph findings. Pain relief was reviewed for 77 painful lesions. The median radiation dose was 30 Gy. No re-irradiation was performed. 35 lesions (42%) achieved radiological responses median 3 months after radiotherapy. Pain relief was obtained in 36 of 77 lesions (47%). There was no significant correlation between radiological response and pain relief (P=0.166). Eleven lesions eventually required surgery and considered as treatment failure. The treatment failure rate in the radiological progressive disease (PD) group (8/19, 42%) was significantly higher than that in the non-PD group (3/65, 5%) (P<0.001). Among 43 impending fracture lesions, 15 lesions (36%) experienced radiological response and 35 lesions (81%) required no surgical interventions. Our data suggest that radiotherapy can enable metastatic bone healing and avoid surgery in many lesions. However, radiological PD lesions often require surgery after radiotherapy. (author)

Results of radiotherapy with and without chemotherapy for esophageal cancer

International Nuclear Information System (INIS)

Hada, Yoshihiro

1986-01-01

From 1975 to 1983, a total of 51 cases of esophageal cancer with T2 ∼ T3 in TNM classification, were treated by radiotherapy alone or combined chemotherapy. All 51 patients received total dose of 60 ∼ 70 GY for 6 ∼ 8 weeks and 20 out of 51 were treated by radiotherapy plus chemotherapy (5FU or UFT and/or bleomycin or pepleomycin). The 2-year-survival rate was slightly better in patients treated by radiotherapy plus chemotherapy than in patients treated by radiotherapy alone, but this difference was not significant. (author)

Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

International Nuclear Information System (INIS)

Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

2010-01-01

Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines

DEFF Research Database (Denmark)

Girinsky, Theodore; van der Maazen, Richard; Specht, Lena

2006-01-01

are designed to irradiate the initially involved lymph nodes exclusively and to encompass their initial volume. In some cases, radiation fields are slightly modified to avoid unnecessary irradiation of muscles or organs at risk. CONCLUSIONS: The concept of involved-node radiotherapy (INRT) described here......BACKGROUND AND PURPOSE: To describe new concepts for radiation fields in patients with early stage Hodgkin lymphoma treated with a combined modality. PATIENTS AND MATERIALS: Patients receiving combined modality therapy with at least 2 or 3 cycles of chemotherapy prior to radiotherapy. Pre...

Setup accuracy of stereoscopic X-ray positioning with automated correction for rotational errors in patients treated with conformal arc radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Soete, Guy; Verellen, Dirk; Tournel, Koen; Storme, Guy

2006-01-01

We evaluated setup accuracy of NovalisBody stereoscopic X-ray positioning with automated correction for rotational errors with the Robotics Tilt Module in patients treated with conformal arc radiotherapy for prostate cancer. The correction of rotational errors was shown to reduce random and systematic errors in all directions. (NovalisBody TM and Robotics Tilt Module TM are products of BrainLAB A.G., Heimstetten, Germany)

Radiotherapy for carcinoma of the esophagus in aged patients

International Nuclear Information System (INIS)

Nomoto, Satoshi; Imada, Hajime; Yamashita, Shigeru; Terashima, Hiromi; Nakata, Hajime; Itoh, Hideaki; Ohsato, Keiichi; Okamura, Takeshi

1995-01-01

One hundred and fifty-four patients with esophageal carcinoma were treated with either irradiation alone or irradiation combined with surgery at the University of Occupational and Environmental Health Hospital between January 1980 and February 1992. The number of patients 75 years old and older was 25. In patients 74 years old and younger, the overall five-year survival rate by Kaplan-Meier method was 24.5%. The survival rate was best in the patients who were treated by a combination of irradiation and surgery. In patients 75 years old and older, the one-year survival rate was 59%, and the three-year rate was 20%. Aged patients had a tendency to be worse in performance status, and there was no correlation between treatment modality and survival time. We conclude that radiotherapy is useful for treating esophageal cancer in aged patients particularly when maintenance of the quality of life is considered. (author)

Normalization of serum testosterone levels in patients treated with neoadjuvant hormonal therapy and three-dimensional conformal radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Padula, Gilbert D.A.; Zelefsky, Michael J.; Venkatraman, Ennapadam S.; Fuks, Zvi; Lee, Henry J.; Natale, Linda; Leibel, Steven A.

2002-01-01

Purpose: To determine the expected time to serum testosterone normalization after short-course neoadjuvant androgen deprivation therapy (NAAD) and three-dimensional conformal radiotherapy for patients with localized prostate cancer and to identify pretreatment predictors that correlated with the time to testosterone normalization. Methods: Between 1993 and 1999, 88 patients with localized prostate cancer, treated with NAAD and external beam radiotherapy, were prospectively monitored after treatment with sequential testosterone levels. NAAD was administered before and during the entire course of radiotherapy and discontinued at the end of treatment. The median duration of NAAD was 6 months. The actuarial rate of serum testosterone normalization from the end of treatment was evaluated, and the presence or absence of androgen deprivation-related symptoms was correlated with serum testosterone levels. Symptoms assessed included weight gain, loss of libido, breast tenderness, breast enlargement, hot flashes, and fatigue. Results: Serum testosterone levels returned to the normal range in 57 (65%) of the 88 patients and failed to normalize in 31 patients (35%). The median time to normalization was 18.3 months. The actuarial rate of normalization at 3, 6, 12, and 24 months was 10%, 26%, 38%, and 59%, respectively. In a multivariate analysis, a pretreatment testosterone level in the lower range of normal was the only variable that predicted for delayed testosterone normalization after NAAD (p=0.00047). Among 45 patients with information concerning androgen deprivation-related symptoms recorded 1 year after cessation of NAAD, 24 (53%) had normalized testosterone levels, but in 21 patients (47%), the levels had not yet returned to normal. At 1 year, only 1 (4%) of 24 patients whose testosterone level had returned to normal experienced NAAD-related symptoms compared with 14 (67%) of 21 patients who did not have normal testosterone levels (p<0.001). Conclusion: Testosterone

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

International Nuclear Information System (INIS)

Stiebel-Kalish, Hadas; Reich, Ehud; Gal, Lior; Rappaport, Zvi Harry; Nissim, Ouzi; Pfeffer, Raphael; Spiegelmann, Roberto

2012-01-01

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.

Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial.

Science.gov (United States)

Breugom, A J; van Gijn, W; Muller, E W; Berglund, Å; van den Broek, C B M; Fokstuen, T; Gelderblom, H; Kapiteijn, E; Leer, J W H; Marijnen, C A M; Martijn, H; Meershoek-Klein Kranenbarg, E; Nagtegaal, I D; Påhlman, L; Punt, C J A; Putter, H; Roodvoets, A G H; Rutten, H J T; Steup, W H; Glimelius, B; van de Velde, C J H

2015-04-01

The discussion on the role of adjuvant chemotherapy for rectal cancer patients treated according to current guidelines is still ongoing. A multicentre, randomized phase III trial, PROCTOR-SCRIPT, was conducted to compare adjuvant chemotherapy with observation for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision (TME). The PROCTOR-SCRIPT trial recruited patients from 52 hospitals. Patients with histologically proven stage II or III rectal adenocarcinoma were randomly assigned (1:1) to observation or adjuvant chemotherapy after preoperative (chemo)radiotherapy and TME. Radiotherapy consisted of 5 × 5 Gy. Chemoradiotherapy consisted of 25 × 1.8-2 Gy combined with 5-FU-based chemotherapy. Adjuvant chemotherapy consisted of 5-FU/LV (PROCTOR) or eight courses capecitabine (SCRIPT). Randomization was based on permuted blocks of six, stratified according to centre, residual tumour, time between last irradiation and surgery, and preoperative treatment. The primary end point was overall survival. Of 470 enrolled patients, 437 were eligible. The trial closed prematurely because of slow patient accrual. Patients were randomly assigned to observation (n = 221) or adjuvant chemotherapy (n = 216). After a median follow-up of 5.0 years, 5-year overall survival was 79.2% in the observation group and 80.4% in the chemotherapy group [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.62-1.39; P = 0.73]. The HR for disease-free survival was 0.80 (95% CI 0.60-1.07; P = 0.13). Five-year cumulative incidence for locoregional recurrences was 7.8% in both groups. Five-year cumulative incidence for distant recurrences was 38.5% and 34.7%, respectively (P = 0.39). The PROCTOR-SCRIPT trial could not demonstrate a significant benefit of adjuvant chemotherapy with fluoropyrimidine monotherapy after preoperative (chemo)radiotherapy and TME on overall survival, disease-free survival, and recurrence rate. However, this trial did not complete

Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma – A prospective study

International Nuclear Information System (INIS)

Molich Hoff, Camilla; Grau, Cai; Overgaard, Jens

2012-01-01

Background: Head and neck cancer patients with high hemoglobin respond better to irradiation compared to patients with low hemoglobin possibly due to hypoxia induced radioresistance. The hemoglobin level is, however, a crude indicator of the amount of oxygen available to the tissue and may be influenced by a number of factors, smoking being of potential importance. The aim of the present study was to examine the effect of smoking on available oxygen to tumors and the effect on outcome in head and neck cancer patients treated with radiotherapy in a prospective study. Materials and methods: A total of 232 consecutive patients with squamous cell carcinoma of the larynx, pharynx and oral cavity completed questionnaires on smoking habits prior to treatment. Venous blood samples were collected before and/or during treatment to determine the hemoglobin and carboxyhemoglobin level. Patients were treated with primary curative radiotherapy 62–68 Gy, 2 Gy/fx, 5 fx/week. Results: All but 12 patients had a history of smoking, 35 were long term quitters, 23 recent quitters, 54 moderate smokers and 108 heavy smokers (>1 pack/day). There was no relationship between total hemoglobin and carboxyhemoglobin, but effective hemoglobin and carboxyhemoglobin were linearly correlated. The amount of carboxyhemoglobin increased with increasing smoking status. Actuarial 5-year univariate analysis showed that heavy smokers had a significantly reduced probability of loco-regional control (44% vs. 65%, p = 0.001), disease-specific (56% vs. 77%, p = 0.003) and overall survival (39% vs. 66%, p = 0.0004) compared to non-smoking patients. Multivariate analyses showed that patients characterized as non-smokers, with low T and N classifications and high hemoglobin level had the best outcome measurements. A rise in carboxyhemoglobin significantly decreased the probability of loco-regional control and each additional pack year increased the risk of death. Smokers and former smokers develop secondary

Radiotherapy Alone With Curative Intent in Patients With Stage I Extranodal Nasal-Type NK/T-Cell Lymphoma

International Nuclear Information System (INIS)

Li Yexiong; Wang Hua; Jin Jing; Wang Weihu; Liu Qingfeng; Song Yongwen; Wang Zhaoyang; Qi Shunan; Wang Shulian; Liu Yueping; Liu Xinfan; Yu Zihao

2012-01-01

Purpose: This study aims to evaluate the outcome and pattern of failure in a large cohort of patients with Stage I NK/T-cell lymphoma of the upper aerodigestive tract treated with radiotherapy alone. Methods and Materials: The pathological diagnosis was confirmed using standard criteria. All patients were treated with high-dose extended-field radiotherapy alone. The median dose was 50 Gy. The primary tumor was located in the nasal cavity (n = 80), Waldeyer ring (n = 5), or oral cavity (n = 2). Results: The overall response to radiotherapy was achieved in 85 of 87 (97.7%) patients, with a complete response rate of 95.4% and a partial response rate of 2.3%. The 5-year overall survival, progression-free survival, and local control rates for all patients were 80%, 69%, and 93%, respectively. Twenty patients (23%) had disease progression or relapse. Of these, 15 patients (17%) developed systemic extranodal disseminations, whereas only 4 (5%) patients had local relapse and 4 (5%) patients had lymph node relapse. Conclusions: Our study suggests that high-dose extended-field radiotherapy alone is a curative therapy and shows favorable clinical outcome in patients with Stage I disease. With the high possibility of local control and primary failure of systemic dissemination, the integration of optimal radiotherapy with more effective systematic therapy is warranted to bring additional improvement to the outcome for these patients.

Long-term results of radiotherapy for pituitary adenomas. Evaluation of tumor control and hypopituitarism after radiotherapy

International Nuclear Information System (INIS)

Tsuchida, Emiko; Sakai, Kunio; Matsumoto, Yasuo; Sugita, Tadashi; Sasamoto, Ryuta

1999-01-01

To evaluate the results of conventional radiotherapy for pituitary adenomas assessed with computed tomography (CT) or magnetic resonance imaging (MRI). Endpoints include tumor control, normalization of hormone levels in functioning adenomas, and hypopituitarism after radiotherapy as an adverse effect. Forty-two patients were treated with radiotherapy from 1982 to 1995 at Niigata University Hospital. Forty patients were irradiated after surgery because of residual adenomas in 33 patients and tumor regrowth in 7 patients. One patient was treated with radiotherapy alone, and the remaining 1 patient was treated with preoperative radiotherapy. Tumor size and extension were evaluated using CT or MRI, and all tumors were macroadenomas. They consisted of 18 non-functioning and 24 functioning adenomas (growth hormone (GH)-secreting: 11, prolactinomas: 7, concomitant GH and prolactin (PRL)-secreting: 5, gonadotropin-secreting: 1). Treatment was given in 200 cGy daily fraction size and a total dose of 50 Gy was given to most patients. Sixteen patients with GH- and/or PRL-secreting adenomas received bromocriptine. Tumor progression was determined by increase in tumor size as shown by CT or MRI. Hypopituitarism after radiotherapy was evaluated using the functions of corticotropin (ACTH), thyrotropin (TSH), and gonadotropin. Median follow-up time from the end of radiotherapy was 103 months. Tumor progression occurred in 2 out of 42 patients and 10-year progression-free rate for all patients was 93.7%. Normalization of GH levels was obtained in 12 of 16 GH-secreting adenomas with a mean time of 27 months after radiotherapy, and 9 of 12 PRL-secreting adenomas achieved normalization of PRL levels with a mean time of 34 months. One gonadotropin-secreting adenoma achieved normalization of gonadotropin level at 21 months after radiotherapy. The incidence of hypopituitarism after radiotherapy increased with time, and cumulative risk of deficiencies of ACTH, TSH, and gonadotropin at 10

An investigation of anxiety about radiotherapy deploying the radiotherapy categorical anxiety scale

International Nuclear Information System (INIS)

Shimotsu, Sakie; Karasawa, Kumiko; Ito, Kana; Saito, Anneyuko I.; Izawa, Hiromi; Kawase, Eri; Horikawa, Naoshi

2010-01-01

Radiotherapy is one of the major methods for treating cancer, but many patients undergoing radiotherapy have deep concerns about receiving radiation treatment. This problem is not generally appreciated and has not been adequately studied. The objective of this investigation was to empirically investigate the anxieties that cancer patients feel towards radiotherapy by using questionnaires to classify and quantitatively measure their concerns. A preliminary interview to develop a questionnaire was carried out with 48 patients receiving radiotherapy to discover their anxieties about on-going treatments. Subsequently, a main study was performed using a questionnaire with 185 patients to classify their types of anxiety and to ascertain the reliability and validity of the responses. Confirmatory factor analysis was then carried out with a 17-item Radiotherapy Categorical Anxiety Scale. Three anxiety factors were abstracted by factor analysis: adverse effects of radiotherapy, environment of radiotherapy, and treatment effects of radiotherapy. Reliability, content validity, and concurrent validity were obtained. The adequacy of the three-factor model of anxiety concerning radiotherapy was confirmed. A 17-item Radiotherapy Categorical Anxiety Scale was formulated to quantitatively measure the specific types of anxiety among cancer patients receiving radiotherapy. (author)

The future demand for and structural problems of Japanese Radiotherapy

International Nuclear Information System (INIS)

Imai, Atsushi; Inoue, Toshihiko; Teshima, Teruki; Ohno, Yuko; Yamashita, Takashi; Mitsuhashi, Norio; Hiraoka, Masahiro; Sumi, Minako

2001-01-01

Recently, as the number of elderly people in Japan is growing, so is the number of new cancer cases. The number of patients treated with radiotherapy is therefore also on the increase, so that it is important to estimate the future demand for radiotherapy and to make preparations for it. All the surveys were conducted for 106 facilities selected randomly out of 556 radiotherapy facilities in Japan. To obtain trends in the number of new cancer patients treated with radiotherapy in Japan, we conducted a survey with a self-administered mail questionnaire designed to obtain the number of new patients treated with radiotherapy for each year of the past decade (1990-99). The future number of new patients treated with radiotherapy was estimated from the data thus obtained. To investigate structural problems of Japanese radiotherapy, surveys about the number of treatment machines and full-time equivalent (FTE) radiation oncologists were conducted according to data from the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) structure survey and the Patterns of Care Study (PCS). We also compared the structure of Japanese radiotherapy with that in the USA. The number of patients treated with radiotherapy has increased for every institutional stratum, with an overall increase of 1.4-fold over the past 10 years in Japan. It is estimated that the number of cancer patients treated with radiotherapy will reach 190000 in 2015. In Japanese non-academic institutions, less than one FTE radiation oncologist has been managing many of these patients. In both equipment and manpower, academic institutions exceed non-academic institutions. The future demand for Japanese radiotherapy will grow substantially, so that it is of vital importance to prepare for it. Specifically, the number of FTE radiation oncologists must be increased. (author)

Patient costs associated with external beam radiotherapy treatment for localized prostate cancer: the benefits of hypofractionated over conventionally fractionated radiotherapy.

Science.gov (United States)

Sethukavalan, Perakaa; Cheung, Patrick; Tang, Colin I; Quon, Harvey; Morton, Gerard; Nam, Robert; Loblaw, Andrew

2012-04-01

To estimate the out-of-pocket costs for patients undergoing external beam radiotherapy (EBRT) for prostate cancer and calculate the patient-related savings of being treated with a 5-fraction versus a standard 39-fraction approach. Seventy patients accrued to the pHART3 (n = 84) study were analyzed for out-of-pocket patient costs as a result of undergoing treatment. All costs are in Canadian dollars. Using the postal code of the patient's residence, the distance between the hospital and patient home was found using Google Maps. The Canada Revenue Agency automobile allowance rate was then applied to determine the cost per kilometer driven. The average cost of travel from the hospital and pHART3 patient's residence was $246 per person after five trips. In a standard fractionation regimen, pHART3 patients would have incurred an average cost of $1921 after 39 visits. The patients receiving hypofractionated radiotherapy would have paid an average of $38 in parking while those receiving conventional treatment would have paid $293. The difference in out-of-pocket costs for the patients receiving a standard versus hypofractionated treatment was $1930. Medium term prospective data shows that hypofractionated radiotherapy is an effective treatment method for localized prostate cancer. Compared to standard EBRT, hypofractionated radiotherapy requires significantly fewer visits. Due to the long distance patients may have to travel to the cancer center and the expense of parking, the short course treatment saves each patient an average of $1900. A randomized study of standard versus hypofractionated accelerated radiotherapy should be conducted to confirm a favorable efficacy and tolerability profile of the shorter fractionation scheme.

Hypothyroidism after radiotherapy for head and neck cancer patients

International Nuclear Information System (INIS)

Ozawa, Hiroyuki; Saito, Hideyuki; Inagaki, Kouji; Mizutari, Kunio

2004-01-01

We report two cases of hypothyroidism with clinical symptoms that occurred after radiotherapy for cancer of the head and neck. The first patient underwent total laryngectomy without thyroidectomy for laryngeal cancer and partial gastrectomy for gastric cancer. Radiation of the neck was carried out postoperatively. Two years later, he developed chest pain and pericardial effusion was detected, leading to a diagnosis of myxedema due to hypothyroidism. The second patient received radiotherapy alone for laryngeal carcinoma. Two months later, a low serum sodium concentration and anemia were detected, both of which proved difficult to correct. The cause of these changes was found subsequently to be hypothyroidism. From the experience of these 2 cases, we measured thyroid function in 37 patients who had received neck radiation for head and neck cancers at our hospital over the past 10 years. In 13 of the 37 patients (35%), hypothyroidism was observed. The prevalence of hypothyroidism was higher in the 13 patients treated with both radiation and surgery, with 6 (46%) showing this condition, compared with 7 of the 24 patients (29%) who received radiation alone. The risk factor responsible for hypothyroidism was not evident from statistical analysis of these cases. We consider that thyroid function should be evaluated periodically in patients who have received neck radiotherapy, as it is often difficult to diagnose hypothyroidism from clinical symptoms. (author)

Radiotherapy with concurrent or sequential temozolomide in elderly patients with glioblastoma multiforme

International Nuclear Information System (INIS)

Hashem, Sameh A.; Salem, Ahmed; Al-Rashdan, Abdulla

2012-01-01

The objective of this article was to evaluate therapeutic outcomes of elderly patients with glioblastoma multiforme (GBM) treated by surgery followed by combined modality therapy and compare achievable outcomes to those of a younger age population. Seventy-eight adult patients with histologically confirmed grade IV astrocytoma were treated at King Hussein Cancer Center (Amman, Jordan) between September 2004 and December 2008. Records were retrospectively reviewed and included 55 males and 23 females between 19 and 78 years of age (median age 50 years). This case series included 20 patients aged 60 years or older. All patients underwent craniotomy followed radiotherapy and concurrent or sequential temozolomide. The follow-up ranged from 1 to 56 months (median 9.4 months). The median survival for the whole cohort was 13.8 months. The median survival for patients less than 60 years was 14.3 months and for patients 60 years or older was 12.3 months (P = 0.19). Among elderly patients, radical surgical resection (P = 0.002), concurrent delivery of chemoradiation (0.041) and radiotherapy dose ≥5400 cGy (P = 0.0001) conferred statistically significant improvements in overall survival. Management of GBM in elderly patients should include maximal surgical resection followed by radiotherapy and temozolomide whenever medically feasible. Outcomes comparable to those obtained in younger age groups can be expected. Our results indicate that concurrent chemoradiation is superior to sequential chemoradiation in these patients.

Carbon-ion radiotherapy for marginal lymph node recurrences of cervical cancer after definitive radiotherapy: a case report

International Nuclear Information System (INIS)

Tamaki, Tomoaki; Nakano, Takashi; Ohno, Tatsuya; Kiyohara, Hiroki; Noda, Shin-ei; Ohkubo, Yu; Ando, Ken; Wakatsuki, Masaru; Kato, Shingo; Kamada, Tadashi

2013-01-01

Recurrences of cervical cancer after definitive radiotherapy often occur at common iliac or para-aortic lymph nodes as marginal lymph node recurrences. Patients with these recurrences have a chance of long-term survival by optimal re-treatment with radiotherapy. However, the re-irradiation often overlaps the initial and the secondary radiotherapy fields and can result in increased normal tissue toxicities in the bowels or the stomach. Carbon-ion radiotherapy, a form of particle beam radiotherapy using accelerated carbon ions, offers more conformal and sharp dose distribution than X-ray radiotherapy. Therefore, this approach enables the delivery of high radiation doses to the target while sparing its surrounding normal tissues. Marginal lymph node recurrences in common iliac lymph nodes after radiotherapy were treated successfully by carbon-ion radiotherapy in two patients. These two patients were initially treated with a combination of external beam radiotherapy and intracavitary and interstitial brachytherapy. However, the diseases recurred in the lymph nodes near the border of the initial radiotherapy fields after 22 months and 23 months. Because re-irradiation with X-ray radiotherapy may deliver high doses to a section of the bowels, carbon-ion radiotherapy was selected to treat the lymph node recurrences. A total dose of 48 Gy (RBE) in 12 fractions over 3 weeks was given to the lymph node recurrences, and the tumors disappeared completely with no severe acute toxicities. The two patients showed no evidence of disease for 75 months and 63 months after the initial radiotherapy and for 50 months and 37 months after the carbon-ion radiotherapy, respectively. No severe late adverse effects are observed in these patients. The two presented cases suggest that the highly conformal dose distribution of carbon-ion radiotherapy may be beneficial in the treatment of marginal lymph node recurrences after radiotherapy. In addition, the higher biological effect of carbon

Oral Health and Experiences of Oral Care in Radiotherapy Patients ...

African Journals Online (AJOL)

Background: In spite of careful planning and modern techniques, radiotherapy inevitably involves side-effects due to exposure of surrounding normal tissues. Patients treated for head and neck cancer who experience oral symptoms do not always consider these symptoms to be related to their disease or its treatment.

Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy

International Nuclear Information System (INIS)

Riaz, Nadeem; Afaq, Asim; Akin, Oguz; Pei Xin; Kollmeier, Marisa A.; Cox, Brett; Hricak, Hedvig; Zelefsky, Michael J.

2012-01-01

Purpose: To investigate the utility of endorectal coil magenetic resonance imaging (eMRI) in predicting biochemical relapse in prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Methods and Materials: Between 2000 and 2008, 279 men with intermediate- or high-risk prostate cancer underwent eMRI of their prostate before receiving brachytherapy and supplemental intensity-modulated radiotherapy. Endorectal coil MRI was performed before treatment and retrospectively reviewed by two radiologists experienced in genitourinary MRI. Image-based variables, including tumor diameter, location, number of sextants involved, and the presence of extracapsular extension (ECE), were incorporated with other established clinical variables to predict biochemical control outcomes. The median follow-up was 49 months (range, 1–13 years). Results: The 5-year biochemical relapse-free survival for the cohort was 92%. Clinical findings predicting recurrence on univariate analysis included Gleason score (hazard ratio [HR] 3.6, p = 0.001), PSA (HR 1.04, p = 0.005), and National Comprehensive Cancer Network risk group (HR 4.1, p = 0.002). Clinical T stage and the use of androgen deprivation therapy were not correlated with biochemical failure. Imaging findings on univariate analysis associated with relapse included ECE on MRI (HR 3.79, p = 0.003), tumor size (HR 2.58, p = 0.04), and T stage (HR 1.71, p = 0.004). On multivariate analysis incorporating both clinical and imaging findings, only ECE on MRI and Gleason score were independent predictors of recurrence. Conclusions: Pretreatment eMRI findings predict for biochemical recurrence in intermediate- and high-risk prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Gleason score and the presence of ECE on MRI were the only significant predictors of biochemical relapse in this group of patients.

Sparing of contralateral major salivary glands has a significant effect on oral health in patients treated with radical radiotherapy of head and neck tumors

International Nuclear Information System (INIS)

Beer, K.T.; Greiner, R.H.; Zehnder, D.; Lussi, A.

2002-01-01

Background: Has a conscious exclusion of the contralateral major salivary glands (parotid, submandibular, and sublingual glands) a significant impact on the milieu of the oral cavity (saliva flow, pH, buffer capacity, and colonisation with Streptococcus mutans) in patients with ENT tumors receiving radical radiotherapy? Patients and Methods: 20 consecutive consentient patients with ENT tumors were evaluated once before, weekly during, and 6 weeks after the end of treatment in regard to saliva flow, pH, buffer capacity, and colonisation with Streptococcus mutans. In 13 patients the major salivary glands on both sides were included in the treated volume, in seven patients the treatment portals excluded consciously the contralateral major salivary glands. Results: The stimulated saliva flow decreases already during the 1st week of radiotherapy, the decrease follows the dose exponentially; the saliva flow is further reduced in the weeks after the end of treatment. The effect is less pronounced in patients with sparing of contralateral major salivary glands. The majority of patients with unilateral sparing of the major salivary glands retain the baseline value of buffer capacity, whereas buffer capacity of all patients with inclusion of all major salivary glands is markedly reduced with 20 Gy already, without signs of recovery when treatment has stopped. With unilateral salivary gland sparing the pH always remains basic, in bilaterally irradiated patients the pH changes from a mean of 7.3 to 5.8 during treatment. The colonisation with Streptococcus mutans varies little in both groups during the radiotherapy; after the end of therapy, it is higher in bilaterally irradiated patients. Conclusions: The conscious arrangement of irradiation portals in order to spare contralateral major salivary glands in patients with radical radiotherapy of ENT tumors has a significant influence on the oral environment: the stimulated saliva flow is higher, the buffer capacity retains the

Lumboaortic radiotherapy in patients with cervical cancer. Experience of the National Cancer Institute

International Nuclear Information System (INIS)

Santini B, Alejandro; Becerra S, Sergio; Gayan G, Patricio; Carcamo I, Marcela; Bianchi G, Benjamin

2010-01-01

Background: Uterine cancer is still a prevalent disease in Chile. Is common to treat patients with tumors in stages IIB and IIIB where the risk of pelvic and paraortic limph node involvement is very high. Its treatment is radio-chemotherapy. Objective: To present a retrospective analysis of patients that suffered cervix-uterine cancer who were treated with radiotherapy including the aortic-lumbar area. Methods: From the revision of patients who were treated of cervix-uterine cancer between the years 1995 and 2007, 39 were treated including aortic-lumbar chains. Evolution and toxicity were analyzed. Two radiotherapy techniques were used. The first one, during the nineties, included two parallel previous and later and opposed fields, and a second technique, currently used, where pelvis and paraortic are radiated at the same time through four lateral (AP-PA) fields. Results: The dosimeter analysis of both techniques shows that there is a higher volume of radiated normal tissue with the two fields techniques, mainly in the small bowel. On the other hand, the toxicity was significantly different being today's technique less toxic and showing low gastrointestinal

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.

Radiotherapy in Prostate Cancer Patients With Pelvic Lymphocele After Surgery: Clinical and Dosimetric Data of 30 Patients.

Science.gov (United States)

Jereczek-Fossa, Barbara Alicja; Colangione, Sarah Pia; Fodor, Cristiana; Russo, Stefania; Cambria, Raffaella; Zerini, Dario; Bonora, Maria; Cecconi, Agnese; Vischioni, Barbara; Vavassori, Andrea; Matei, Deliu Victor; Bottero, Danilo; Brescia, Antonio; Musi, Gennaro; Mazzoleni, Federica; Orsi, Franco; Bonomo, Guido; De Cobelli, Ottavio; Orecchia, Roberto

2015-08-01

The purpose of the study was to evaluate the feasibility of irradiation after prostatectomy in the presence of asymptomatic pelvic lymphocele. The inclusion criteria for this study were: (1) patients referred for postoperative (adjuvant or salvage) intensity modulated radiotherapy (IMRT; 66-69 Gy in 30 fractions); (2) detection of postoperative pelvic lymphocele at the simulation computed tomography [CT] scan; (3) no clinical symptoms; and (4) written informed consent. Radiotherapy toxicity and occurrence of symptoms or complications of lymphocele were analyzed. Dosimetric data (IMRT plans) and the modification of lymphocele volume during radiotherapy (cone beam CT [CBCT] scan) were evaluated. Between January 2011 and July 2013, in 30 of 308 patients (10%) treated with radiotherapy after prostatectomy, pelvic lymphocele was detected on the simulation CT. The median lymphocele volume was 47 cm(3) (range, 6-467.3 cm(3)). Lymphocele was not included in planning target volume (PTV) in 8 cases (27%). Maximum dose to lymphocele was 57 Gy (range, 5.7-73.3 Gy). Radiotherapy was well tolerated. In all but 2 patients, lymphoceles remained asymptomatic. Lymphocele drainage-because of symptom occurrence-had to be performed in 2 patients during IMRT and in one patient, 7 weeks after IMRT. CBCT at the end of IMRT showed reduction in lymphocele volume and position compared with the initial data (median reduction of 37%), more pronounced in lymphoceles included in PTV. Radiotherapy after prostatectomy in the presence of pelvic asymptomatic lymphocele is feasible with acceptable acute and late toxicity. The volume of lymphoceles decreased during radiotherapy and this phenomenon might require intermediate radiotherapy plan evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

The situation of radiotherapy in 2011

International Nuclear Information System (INIS)

2012-06-01

Published within the frame of the French 2009-2013 cancer plan, this report proposes an analysis of the situation of radiotherapy in France. More particularly, it analyses the French offer in terms of radiotherapy treatments and the French position in Europe. A second part analyses equipment (accelerators and other equipment) and techniques aimed at radiotherapy treatment preparation and delivery. The following techniques are addressed: three-dimensional conformational, intensity modulation, intracranial and extracranial stereotactic, image-guided, total body irradiation, hadron-therapy, and peri-operative radiotherapy. The last parts analyse the activity of radiotherapy centres in terms of treated patients, of patient age structure, of sessions and preparations, and of treated pathologies, the medical and paramedical personnel in charge of radiotherapy, and financial and cost aspects

Second primary cancers after adjuvant radiotherapy in early breast cancer patients: A national population based study under the Danish Breast Cancer Cooperative Group (DBCG)

International Nuclear Information System (INIS)

Grantzau, Trine; Mellemkjær, Lene; Overgaard, Jens

2013-01-01

Background and purpose: To analyze the long-term risk of second primary solid non-breast cancer in a national population-based cohort of 46,176 patients treated for early breast cancer between 1982 and 2007. Patients and methods: All patients studied were treated according to the national guidelines of the Danish Breast Cancer Cooperative Group. The risk of second primary cancers was estimated by Standardised incidence ratios (SIRs) and multivariate Cox regression models were used to estimate adjusted hazard ratios (HR) among irradiated women compared to non-irradiated. All irradiated patients were treated on linear accelerators. Second cancers were a priori categorized into two groups; radiotherapy-associated- (oesophagus, lung, heart/mediastinum, pleura, bones, and connective tissue) and non-radiotherapy-associated sites (all other cancers). Results: 2358 second cancers had occurred during the follow-up. For the radiotherapy-associated sites the HR among irradiated women was 1.34 (95% CI 1.11–1.61) with significantly increased HRs for the time periods of 10–14 years (HR 1.55; 95% CI 1.08–2.24) and ⩾15 years after treatment (HR 1.79; 95% CI 1.14–2.81). There was no increased risk for the non-radiotherapy-associated sites (HR 1.04; 95% CI 0.94–1.1). The estimated attributable risk related to radiotherapy for the radiotherapy-associated sites translates into one radiation-induced second cancer in every 200 women treated with radiotherapy. Conclusions: Radiotherapy treated breast cancer patients have a small but significantly excess risk of second cancers

Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy

DEFF Research Database (Denmark)

Wirth, A; Gospodarowicz, M; Aleman, B M P

2013-01-01

We evaluated the long-term results of radiotherapy for patients with gastric marginal zone lymphoma (GMZL).......We evaluated the long-term results of radiotherapy for patients with gastric marginal zone lymphoma (GMZL)....

External beam radiotherapy dose response characteristics of 1127 men with prostate cancer treated in the PSA era

International Nuclear Information System (INIS)

Pollack, Alan; Smith, Lewis G.; Eschenbach, Andrew C. von

2000-01-01

Purpose: To characterize the relationship of radiotherapy dose to prostate cancer patient outcome, with an emphasis on the influence of pretreatment prognostic variables. Methods and Materials: The 1127 Stage T1-T4 prostate cancer patients examined were treated consecutively with definitive external beam radiotherapy at the University of Texas-M.D. Anderson Cancer Center from 1987 to 1997. All had a pretreatment prostate-specific antigen (PSA) level. Treatment failure was defined as two consecutive PSA elevations on follow-up. There were 994 patients treated with a four-field box throughout to 60-70 Gy after a small reduction at 46 Gy and 161 treated with a six-field conformal boost after 46 Gy to 74-78 Gy. No patient received neoadjuvant or adjuvant androgen ablation. Median follow-up was 51.8 months. Results: Patients were divided into three radiotherapy dose groups consisting of ≤67 Gy (n = 500), >67-77 Gy (n = 495), and >77 Gy (n = 132). Relative to other prognostic factors, there were fewer patients treated to the highest dose level with a pretreatment PSA (PSAB) ≤4 or >20 ng/ml, Stage T3/T4 disease, or a Gleason score of 2-6. Actuarial 4-year freedom from biochemical failure (bNED) rates for the entire cohort were 54%, 71%, and 77% (p 67-77 Gy was associated with improved bNED rates for all PSAB (≤10 and >10), stage (T1/T2 and T3/T4), and Gleason score (2-6 and 7-10) subgroups tested. In contrast, the only prognostic group that benefited from raising dose from >67-77 Gy to >77 Gy was patients with a PSAB >10 ng/ml; although trends were noted for Stage T1/T2 and Gleason 2-6 patients. Patients with the combined features of a PSAB >10 ng/ml and Stage T1/T2 disease had 4-year bNED rates of 61% and 93% at the intermediate- and high-dose levels. A strongly significant linear association between dose (60-78 Gy) and 4-year actuarial bNED was demonstrated for patients with these intermediate-risk features. Conclusion: Prostate cancer dose response to external

Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer. A population-based analysis

International Nuclear Information System (INIS)

Abdollah, F.; Schmitges, J.; Sun, M.

2012-01-01

The objectives of this study were to compare the mortality outcomes of radical prostatectomy and radiotherapy as treatment modalities for patients with localized prostate cancer. Our cohort consisted of 68 665 patients with localized prostate cancer, treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancer-specific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline Charlson Comorbidity Index and age. For patients treated with radical prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson Comorbidity Index of ≥2. Rates were 2.1 versus 5.0% in patients aged 65-69 years, 2.8 versus 5.5% in patients aged 70-74 years, and 2.9 versus 7.6% in patients aged 75-80 years (all P<0.001). At multivariable analyses, radiotherapy was associated with less favorable cancer-specific mortality in all categories (all P<0.001). Patients treated with radical prostatectomy fare substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories. (author)

FADD Expression as a Prognosticator in Early-Stage Glottic Squamous Cell Carcinoma of the Larynx Treated Primarily With Radiotherapy

International Nuclear Information System (INIS)

Schrijvers, Michiel L.; Pattje, Wouter J.; Slagter-Menkema, Lorian; Mastik, Mirjam F.; Gibcus, Johan H.; Langendijk, Johannes A.; Wal, Jacqueline E. van der; Laan, Bernard F.A.M. vn der; Schuuring, E.

2012-01-01

Purpose: We recently reported on the identification of the Fas-associated death domain (FADD) as a possible driver of the chromosome 11q13 amplicon and the association between increased FADD expression and disease-specific survival in advanced-stage laryngeal carcinoma. The aim of this study was to examine whether expression of FADD and its Ser194-phosphorylated isoform (pFADD) predicts local control in patients with early-stage glottic carcinoma primarily treated with radiotherapy only. Methods and Materials: Immunohistochemical staining for FADD and pFADD was performed on pretreatment biopsy specimens of 92 patients with T1–T2 glottic squamous cell carcinoma primarily treated with radiotherapy between 1996 and 2005. Cox regression analysis was used to correlate expression levels with local control. Results: High levels of pFADD were associated with significantly better local control (hazard ratio, 2.40; 95% confidence interval, 1.04–5.55; p = 0.040). FADD overexpression showed a trend toward better local control (hazard ratio, 3.656; 95% confidence interval, 0.853–15.663; p = 0.081). Multivariate Cox regression analysis showed that high pFADD expression was the best predictor of local control after radiotherapy. Conclusions: This study showed that expression of phosphorylated FADD is a new prognostic biomarker for better local control after radiotherapy in patients with early-stage glottic carcinomas.

Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial

NARCIS (Netherlands)

Nout, Remi A.; van de Poll-Franse, Lonneke V.; Lybeert, Marnix L. M.; Warlam-Rodenhuis, Carla C.; Jobsen, Jan J.; Mens, Jan Willem M.; Lutgens, Ludy C. H. W.; Pras, Betty; van Putten, Wim L. J.; Creutzberg, Carien L.

2011-01-01

Purpose To determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial. Patients and Methods Between 1990 and

Autopsy findings in surgical-radiotherapeutically treated bladder carcinoma - conclusions for optimization of radiotherapy

International Nuclear Information System (INIS)

Fueller, J.; Kob, D.; Fritzsche, V.

1989-01-01

Autopsy findings in patients with bladder carcinoma, treated by combined operation and radiotherapy, revealed tendencies of tumor spread as well as complications and late effects of radiotherapy. In 24.5% of the cases tumor tissue was found within the bladder and in 30.5% within the minor pelvis. Metastases were found in 24.1% in iliac lymph nodes, in 21.3% in abdominal lymph nodes. Liver, lungs, bones, and kidneys are main organs for hematological metastasizing. Little or undifferentiated carcinomas and squamous cell carcinomas showed a greater tendency to metastasize than highly and medium-differentiated ureteral carcinomas. The least radiotherapeutical complications and late effects were found in a fractionation with daily 1.5 Gy and a total dose of 60 Gy. (author)

Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report.

Science.gov (United States)

Giannelli, Flavio; Chiola, Ilaria; Belgioia, Liliana; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

2017-12-01

Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 - PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D 90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report

Directory of Open Access Journals (Sweden)

Flavio Giannelli

2017-12-01

Full Text Available Hidradenocarcinoma (HC is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB, followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 – PTV1, 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node, and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes. Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1, and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2. D90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

Radiotherapy is Not Associated With Reduced Quality of Life and Cognitive Function in Patients Treated for Nonfunctioning Pituitary Adenoma

International Nuclear Information System (INIS)

Beek, Andre P. van; Bergh, Alphons C.M. van den; Berg, Linda M. van den; Berg, Gerrit van den; Keers, Joost C.; Langendijk, Johannes A.; Wolffenbuttel, Bruce H.R.

2007-01-01

Purpose: To assess the influence of different treatment modalities on long-term health-related quality of life (HR-QoL) and cognitive problems among patients who had been treated for nonfunctioning pituitary adenoma (NFA). Methods and Materials: Eighty-one patients (49 men and 32 women, aged 55 ± 10 years) with a minimal follow-up period of 1 year after treatment for NFA participated in this cross-sectional study. Sixty-two patients were initially treated by transsphenoidal surgery and 19 by craniotomy. Subsequently, 45 of these 81 subjects (56%) received additional radiotherapy (RT) after surgery because of a tumor remnant or regrowth. All subjects filled in standardized questionnaires measuring HR-QoL, depression, fatigue, and cognitive problems. Results: Patients who underwent additional RT more frequently underwent a craniotomy and were younger at surgery, but not at entering this study. They also used more hormonal substitution. Most HR-QoL domains showed a similar score in patients who underwent RT when compared with patients who did not receive RT. However, vitality and physical functioning proved to be better in RT subjects, and RT subjects also had better scores for depression and physical and mental fatigue (all p < 0.05). Some aspects of HR-QoL of patients who have been successfully treated for NFA are reduced compared with the normal population, but this was much more pronounced in the group that did not receive RT. In multivariate analysis, RT remained significantly associated with improved HR-QoL. No differences in cognitive function scores were observed. Conclusion: Postoperative RT in patients with NFA is not associated with reduced quality of life or cognition when compared with surgery alone

High-dose radiotherapy alone for patients with T4-stage laryngeal cancer

Energy Technology Data Exchange (ETDEWEB)

Mucha-Malecka, A. [Maria Sklodowska-Curie Memorial Institute, Krakow (Poland). Dept. of Radiation Oncology; Skladowski, K. [Maria Sklodowska-Curie Memorial Institute, Gliwice (Poland). Dept. of Radiation Oncology

2013-08-15

Background and purpose: The purpose of this retrospective study was to report on the efficacy of radiotherapy alone in patients with T4-stage laryngeal cancer and to establish the prognostic value of (a) the size and location of the extralaryngeal tumor extensions and (b) of emergency tracheostomy. Patients and methods: A group of 114 patients were treated with definitive radiotherapy between 1990 and 1996. The piriform recess was involved in 37 cases (33 %), the base of the tongue and glosso-epiglottic vallecula in 34 cases (30 %), and the hypopharyngeal wall in 10 cases (9 %). In 16 cases (14 %), emergency tracheostomy was performed before radiotherapy. The mean total dose was 68 Gy (range, 60-77.6 Gy). The mean treatment time was 49 days (range, 42-74 days). Results: Actuarial 3-year local control (LC) was noted in 42 % of patients, disease-free survival (DFS) in 35 %, and overall survival (OS) in 40 %. The best prognosis was for the lesion suspected of cartilage infiltration: 56 % 3-year LC. The worst results were noted in the cases with massive infiltrations spreading from the larynx through the hypopharynx: 13 % 3-year LC. Emergency tracheostomy before radiotherapy was significantly connected with the worst treatment results (p = 0.000): 3-year LC in patients with tracheostomy was 0 % vs. 48 % in patients without tracheostomy. Conclusion: Conventional radiotherapy of T4 laryngeal cancer is a method of treatment with limited effectiveness. The efficacy of radiotherapy is dependent on the location and extent of extralaryngeal infiltrations. Emergency tracheostomy is a prognostic factor connected with the worst prognosis. (orig.)

High-dose radiotherapy alone for patients with T4-stage laryngeal cancer

International Nuclear Information System (INIS)

Mucha-Malecka, A.; Skladowski, K.

2013-01-01

Background and purpose: The purpose of this retrospective study was to report on the efficacy of radiotherapy alone in patients with T4-stage laryngeal cancer and to establish the prognostic value of (a) the size and location of the extralaryngeal tumor extensions and (b) of emergency tracheostomy. Patients and methods: A group of 114 patients were treated with definitive radiotherapy between 1990 and 1996. The piriform recess was involved in 37 cases (33 %), the base of the tongue and glosso-epiglottic vallecula in 34 cases (30 %), and the hypopharyngeal wall in 10 cases (9 %). In 16 cases (14 %), emergency tracheostomy was performed before radiotherapy. The mean total dose was 68 Gy (range, 60-77.6 Gy). The mean treatment time was 49 days (range, 42-74 days). Results: Actuarial 3-year local control (LC) was noted in 42 % of patients, disease-free survival (DFS) in 35 %, and overall survival (OS) in 40 %. The best prognosis was for the lesion suspected of cartilage infiltration: 56 % 3-year LC. The worst results were noted in the cases with massive infiltrations spreading from the larynx through the hypopharynx: 13 % 3-year LC. Emergency tracheostomy before radiotherapy was significantly connected with the worst treatment results (p = 0.000): 3-year LC in patients with tracheostomy was 0 % vs. 48 % in patients without tracheostomy. Conclusion: Conventional radiotherapy of T4 laryngeal cancer is a method of treatment with limited effectiveness. The efficacy of radiotherapy is dependent on the location and extent of extralaryngeal infiltrations. Emergency tracheostomy is a prognostic factor connected with the worst prognosis. (orig.)

Role of fractionated radiotherapy in patients with hemangioma of the cavernous sinus

International Nuclear Information System (INIS)

Park, Sun Min; Yoon, Sang Min; Lee, Su Min; Park, Jin Hong; Song, Si Yeol; Lee, Sang Wook; Ahn, Seung Do; Kim, Jong Hoon; Choi, Eun Kyung

2017-01-01

We performed this retrospective study to investigate the outcomes of patients with hemangioma of the cavernous sinus after fractionated radiotherapy. We analyzed 10 patients with hemangioma of the cavernous sinus who were treated with conventional radiotherapy between January 2000 and December 2016. The median patient age was 54 years (range, 31–65 years), and 8 patients (80.0%) were female. The mean hemangioma volume was 34.1 cm"3 (range, 6.8–83.2 cm"3), and fractionated radiation was administered to a total dose of 50–54 Gy with a daily dose of 2 Gy. The median follow-up period was 6.8 years (range, 2.2–8.8 years). At last follow-up, the volume of the tumor had decreased in all patients. The average tumor volume reduction rate from the initial volume was 72.9% (range, 18.9–95.3%). All 10 of the cranial neuropathies observed before radiation therapy had improved, with complete symptomatic remission in 9 cases (90%) and partial remission in 1 case (10%). No new acute neurologic impairments were reported after radiotherapy. One probable compressive optic neuropathy was observed at 1 year after radiotherapy. Fractionated radiotherapy achieves both symptomatic and radiologic improvements. It is a well-tolerated treatment modality for hemangiomas of the cavernous sinus

Role of fractionated radiotherapy in patients with hemangioma of the cavernous sinus

Energy Technology Data Exchange (ETDEWEB)

Park, Sun Min; Yoon, Sang Min; Lee, Su Min; Park, Jin Hong; Song, Si Yeol; Lee, Sang Wook; Ahn, Seung Do; Kim, Jong Hoon; Choi, Eun Kyung [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2017-09-15

We performed this retrospective study to investigate the outcomes of patients with hemangioma of the cavernous sinus after fractionated radiotherapy. We analyzed 10 patients with hemangioma of the cavernous sinus who were treated with conventional radiotherapy between January 2000 and December 2016. The median patient age was 54 years (range, 31–65 years), and 8 patients (80.0%) were female. The mean hemangioma volume was 34.1 cm{sup 3} (range, 6.8–83.2 cm{sup 3}), and fractionated radiation was administered to a total dose of 50–54 Gy with a daily dose of 2 Gy. The median follow-up period was 6.8 years (range, 2.2–8.8 years). At last follow-up, the volume of the tumor had decreased in all patients. The average tumor volume reduction rate from the initial volume was 72.9% (range, 18.9–95.3%). All 10 of the cranial neuropathies observed before radiation therapy had improved, with complete symptomatic remission in 9 cases (90%) and partial remission in 1 case (10%). No new acute neurologic impairments were reported after radiotherapy. One probable compressive optic neuropathy was observed at 1 year after radiotherapy. Fractionated radiotherapy achieves both symptomatic and radiologic improvements. It is a well-tolerated treatment modality for hemangiomas of the cavernous sinus.

External Beam Radiotherapy for Prostate Cancer Patients on Anticoagulation Therapy: How Significant is the Bleeding Toxicity?

International Nuclear Information System (INIS)

Choe, Kevin S.; Jani, Ashesh B.; Liauw, Stanley L.

2010-01-01

Purpose: To characterize the bleeding toxicity associated with external beam radiotherapy for prostate cancer patients receiving anticoagulation (AC) therapy. Methods and Materials: The study cohort consisted of 568 patients with adenocarcinoma of the prostate who were treated with definitive external beam radiotherapy. Of these men, 79 were receiving AC therapy with either warfarin or clopidogrel. All patients were treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Bleeding complications were recorded during treatment and subsequent follow-up visits. Results: With a median follow-up of 48 months, the 4-year actuarial risk of Grade 3 or worse bleeding toxicity was 15.5% for those receiving AC therapy compared with 3.6% among those not receiving AC (p < .0001). On multivariate analysis, AC therapy was the only significant factor associated with Grade 3 or worse bleeding (p < .0001). For patients taking AC therapy, the crude rate of bleeding was 39.2%. Multivariate analysis within the AC group demonstrated that a higher radiotherapy dose (p = .0408), intensity-modulated radiotherapy (p = 0.0136), and previous transurethral resection of the prostate (p = .0001) were associated with Grade 2 or worse bleeding toxicity. Androgen deprivation therapy was protective against bleeding, with borderline significance (p = 0.0599). Dose-volume histogram analysis revealed that Grade 3 or worse bleeding was minimized if the percentage of the rectum receiving ≥70 Gy was <10% or the rectum receiving ≥50 Gy was <50%. Conclusion: Patients taking AC therapy have a substantial risk of bleeding toxicity from external beam radiotherapy. In this setting, dose escalation or intensity-modulated radiotherapy should be used judiciously. With adherence to strict dose-volume histogram criteria and minimizing hotspots, the risk of severe bleeding might be reduced.

Tetracaine oral gel in patients treated with radiotherapy for head-and-neck cancer: Final results of a phase II study

International Nuclear Information System (INIS)

Alterio, Daniela; Jereczek-Fossa, Barbara Alicja; Zuccotti, Gabriele Fulvio Phar; Leon, Maria Elena; Omodeo Sale, Emanuela Phar; Pasetti, Marcella; Modena, Tiziana Phar; Perugini, Paola; Mariani, Luigi; Orecchia, Roberto

2006-01-01

Purpose: We performed a phase II study to assess feasibility, pain relief, and toxicity of a tetracaine-based oral gel in the treatment of radiotherapy (RT)-induced mucositis. Methods and Materials: Fifty patients treated with RT for head-and-neck cancer with clinical evidence of acute oral mucositis of grade ≥2 were scheduled to receive the tetracaine gel. A questionnaire evaluating the effect of the gel was given to all subjects. Results: In 38 patients (79.2%), a reduction in oral cavity pain was reported. Thirty-four patients (82.9%) reported no side effect. Seventy-one percent of patients had no difficulties in gel application. Unpleasant taste of the gel and interference with food taste were noticed in 5 (12%) and 16 patients (39%), respectively. Planned RT course was interrupted less frequently in patients who reported benefit from gel application than in patients who did not (p = 0.014). None of the patients who experienced pain relief needed a nasogastric tube, opposite to the patients who did not report any benefit from gel application (p = 0.001). Conclusion: Tetracaine oral gel administration seemed feasible and safe while reducing RT-induced mucositis-related oral pain in a sizeable proportion of treated head-and-neck cancer patients. A trial designed to compare efficacy of this gel vs. standard treatment is warranted

Audiological findings in patients treated with radio- and concomitant chemotherapy for head and neck tumors

International Nuclear Information System (INIS)

Dell'Aringa, Ana Helena B; Isaac, Myrian L; Arruda, Gustavo V; Esteves, Maria Carolina BN; Dell'Aringa, Alfredo Rafael; Júnior, José Luis S; Rodrigues, Alexandre F

2009-01-01

To evaluate the functionality of the auditory system in patients who underwent radiotherapy and chemotherapy treatment with cisplatin to treat head and neck tumors. Case series with planned data collection. From May 2007 to May 2008 by the Department of Otorhinolaryngology and the Department of Oncology/Radiotherapy at Faculdade de Medicina de Marília. Audiological evaluation (Pure Tone Audiometry (air and bone conduction), Speech Audiometry, Tympanometry, Acoustic Reflex testing and Distortion Product Otoacoustic Emissions) was performed in 17 patients diagnosed with head and neck neoplasia and treated with chemotherapy, using cisplatin, and radiotherapy. 12 left ears (70.5%) and 11 right ears (64.7%) presented bilateral decreased hearing soon after the treatment for the frequency 1 kHz (mild auditory damage) and for the frequency 8 kHz (more significant auditory damage). Patients with head and neck cancer submitted to the conventional radiotherapy treatment, combined with the chemotherapy with cisplatin, presented a high incidence of decreased hearing by the end of treatment. Strong evidence was observed linking auditory alteration to the amount of radiotherapy treatment

The role of dentistry other than oral care in patients undergoing radiotherapy for head and neck cancer

Directory of Open Access Journals (Sweden)

Hidenobu Matsuzaki

2017-05-01

Full Text Available The usefulness of dental approaches, such as oral management, has gained recognition among patients treated for head and neck cancer. In particular, oral management plays a very important role before, during, and after treatment in patients undergoing radiotherapy, chemotherapy, or a combination of both. However, specialized dentistry knowledge and techniques that are useful for patients undergoing radiotherapy for head and neck cancer have yet to be reported. Therefore, in this review article, our aim is to introduce dental approaches in radiotherapy for patients with head and neck cancer that have been developed and are currently being used at our institute.

The volume effect in radiation-related late small bowel complications. Results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma

International Nuclear Information System (INIS)

Letschert, J.G.J.; Lebesque, J.V.; Aleman, B.M.P.; Bartelink, H.; Bosset, J.F.; Horiot, J.C.; Cionini, L.; Hamers, J.P.; Leer, J.W.H.; van Glabbele, M.

1994-01-01

The purpose of this study was to quantify the correlation between irradiated small bowel volume and late occurring small bowel complications. Methods: Small bowel volumes in the high-dose region were measured using orthogonal barium films for 203 patients treated for rectal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EORTC multicentric study. Results: The 5-year estimate of lat pelvic small bowel obstruction requiring surgery was 11%. No correlation between the irradiated small bowel volume and obstruction was detected. The actuarial 5-year estimate of chronic diarrhea varied from 31% in patients with irradiated small bowel volumes below 77 cm 3 to 42% in patients with volumes over 328 cm 3 . This correlation was significant in the univariate and multivariate analysis (p=0.025). The type of rectal surgery significantly influenced the incidence of chronic diarrhea and malabsorption, the actuarial 5-year estimate being 49% and 26% after low anterior resection and abdominoperineal resection, respectively (p=0.04). Conclusions: This study demonstrated that there is a volume-effect in radiation-induced diarrhea atr a dose of 50 Gy in 25 fractions. No volume-effect for small bowel obstruction was detected at this dose-level in pelvic postoperative radiotherapy. A review of the literature data on small bowel obstruction indicates that the volume effect at this dose level can only be demonstrated in patients who were treated with extended field radiotherapy (estimated small bowel volume 800 cm 3 ) after intra-abdominal surgery. (author). 22 refs., 5 tabs

The effects of sequential versus concurrent chemotherapy and radiotherapy on survival and toxicity in patients with newly diagnosed high-grade astrocytoma

International Nuclear Information System (INIS)

Kleinberg, Lawrence; Grossman, Stuart A.; Piantadosi, Steven; Zeltzman, Michel; Wharam, Moody

1999-01-01

Purpose: To determine the effects of sequential versus concurrent administration of cranial radiotherapy and cisplatin/carmustine (BCNU) chemotherapy on survival and toxicity in newly diagnosed high-grade astrocytomas. Methods and Materials: From 1988 to 1996, 101 patients were treated on 2 therapeutic protocols for malignant glioma that used the identical chemotherapy regimen but differed in the timing of cranial radiotherapy. The eligibility criteria for the 2 protocols were identical. In the first protocol (1988-1991, 52 patients), cisplatin 120 mg/BCNU 120 mg i.v. over 72 h, was given for 3 monthly cycles prior to cranial radiotherapy. After a response rate of 42%, with a median survival of 13 months was achieved with this sequential regimen, a successor protocol (1992-1996, 49 patients) was developed in which cranial radiotherapy began concurrently with the start of the identical chemotherapy regimen. Chemotherapy was delayed but not discontinued if prolonged grade III/IV hematologic toxicity was experienced, but protocol therapy was discontinued if disease progression or thromboembolic events occurred. Survival outcome and hematologic toxicity were compared for the patients treated on these protocols. Results: Seventy-seven percent of sequentially-treated patients and 68% of concurrently-treated patients completed all planned therapy. Kaplan-Meier survival was similar to concurrent or sequential administration of chemotherapy and radiotherapy (median 12.8 months vs. 13.8 months, respectively). Hematologic toxicity was significantly less in sequentially- versus concurrently-treated patients, with median nadir per cycle (2.9 vs. 1.8 x 10 3 /mm 3 ) (p < 0.001), and incidence of grade 3/4 leukopenia 40% versus 77% (p = 0.002). There was also an increase in platelet transfusion requirements in concurrently-treated patients, but no significant worsening of anemia. We postulate that the worsened leukopenia results from the effects of concurrent radiotherapy on

Stress associated gene expression in blood cells is related to outcome in radiotherapy treated head and neck cancer patients

International Nuclear Information System (INIS)

Bøhn, Siv K; Blomhoff, Rune; Russnes, Kjell M; Sakhi, Amrit K; Thoresen, Magne; Holden, Marit; Moskaug, JanØ; Myhrstad, Mari C; Olstad, Ole K; Smeland, Sigbjørn

2012-01-01

We previously observed that a radiotherapy-induced biochemical response in plasma was associated with favourable outcome in head and neck squamous carcinoma cancer (HNSCC) patients. The aim of the present study was to compare stress associated blood cell gene expression between two sub-groups of HNSCC patients with different biochemical responses to radiotherapy. Out of 87 patients (histologically verified), 10 biochemical ‘responders’ having a high relative increase in plasma oxidative damage and a concomitant decrease in plasma antioxidants during radiotherapy and 10 ‘poor-responders’ were selected for gene-expression analysis and compared using gene set enrichment analysis. There was a significant induction of stress-relevant gene-sets in the responders following radiotherapy compared to the poor-responders. The relevance of the involvement of similar stress associated gene expression for HNSCC cancer and radioresistance was verified using two publicly available data sets of 42 HNSCC cases and 14 controls (GEO GSE6791), and radiation resistant and radiation sensitive HNSCC xenografts (E-GEOD-9716). Radiotherapy induces a systemic stress response, as revealed by induction of stress relevant gene expression in blood cells, which is associated to favourable outcome in a cohort of 87 HNSCC patients. Whether these changes in gene expression reflects a systemic effect or are biomarkers of the tumour micro-environmental status needs further study. Raw data are available at ArrayExpress under accession number E-MEXP-2460

The efficacy of radiotherapy for 59 patients with vertebral hemangioma

International Nuclear Information System (INIS)

Qian Liting; Liu Xinfan; Li Yexiong; Yu Zihao; Yin Weibo

2004-01-01

Objective: To investigate the indication, total dose and efficacy of radiotherapy for vertebral hemangiomas. Methods: Between 1967 and 2000, 59 patients (36 female, 23 male) with vertebral hemangioma were treated with deep X-ray, electron beam, 60 Co or 6-8MV X-ray with a total dose ranging from 28 to 90 Gy and a median of 40 Gy. Results: Of the 54 evaluable cases, the overall response rate was 87.0%. The response rates were 90.2% and 83.3%, respectively, for patients treated with 34-40 Gy and more than 40 Gy (χ 2 =0.41, P=0.608). Among the 9 patients with paraplegic patients, 4 achieved complete response, 4 partial response, and only one showed no response to the treatment. Conclusions: Radiotherapy is effective and safe for symptomatic vertebral hemangioma, on condition of a suitable total dose range of 30 to 40 Gy. Patients with asymptomatic or minor symptomatic lesion should be watched and followed rather than giving immediate treatment. Radiation therapy shows slow and delayed improvement in vertebral hemangioma and the symptoms are gradually relieved or disappear in three months to seven years with a median interval of 1.5 years, even though diagnostic images show no or only minor changes after treatment

Radiotherapy for cutaneous cancers with xeroderma pigmentosum; Radiotherapie des cancers cutanes au cours du xeroderma pigmentosum

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Ben Salah, H.; Bahri, M.; Turki, H.; Abdelmoula, M.; Frikha, M.; Daoud, J. [Service de radiotherapie, CHU Habib-Bourguiba, route Majida-Bouleila, 3029 Sfax (Tunisia)

2011-08-15

Purpose. - To analyze the therapeutic results of cutaneous cancers on xeroderma pigmentosum through a series of 15 patients treated by radiotherapy. Patients and methods. - Between 1993 and 2006, 15 patients with xeroderma pigmentosum and having cutaneous cancers were treated in the Radiotherapy Department of university hospital Habib-Bourguiba of Sfax in Tunisia. Seventy-three percent of the cases occurred in male patients and the mean age of appearance of the first tumour was 18.2 years. Tumour histology was squamous cell carcinoma in 74% of the cases. The total number of cutaneous tumours was 84. Ten patients had a surgical resection. Four patients did not respond to chemotherapy. The modality of irradiation was decided according to the size, thickness and localization of the tumour. The dose of radiotherapy was 60 Gy or equivalent with classic irradiation. Results. - The total number of lesions treated with radiotherapy was 64. Forty-three lesions were treated with contact-therapy, ten with brachytherapy and 11 with cobalt-therapy. The following acute complications were observed: cutaneous infection (53.3% of patients), radio-epithelitis (80% of patients) and necroses (33.3% of patients). Evaluation after treatment showed a clinical complete remission in 73% of the cases. Late effects were noted in seven cases: telangiectasia and cutaneous atrophy. A recurrence in the irradiated zone was observed in one case. A nodal metastasis was observed in two cases. Another patient presented lung metastases. After a median follow up of 37.2 months, four patients died, seven are alive with cutaneous cancer and four are alive with complete remission. Conclusion. - Radiotherapy is a possible and effective therapeutic alternative. Dose and methods are not defined for xeroderma pigmentosum. (authors)

Radiotherapy Plus Transarterial Chemoembolization for Hepatocellular Carcinoma Invading the Portal Vein: Long-Term Patient Outcomes

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Yoon, Sang Min [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lim, Young-Suk [Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Won, Hyung Jin [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Jong Hoon, E-mail: jhkim2@amc.seoul.kr [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Kang Mo; Lee, Han Chu; Chung, Young-Hwa; Lee, Yung Sang [Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lee, Sung Gyu [Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Park, Jin-hong [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Suh, Dong Jin [Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2012-04-01

Purpose: We have evaluated the clinical outcomes of patients after transarterial chemoembolization (TACE) and 3-dimensional conformal radiotherapy for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods and Materials: A registry database of 412 patients treated with TACE and three-dimensional conformal radiotherapy for HCC with PVTT between August 2002 and August 2008 were analyzed retrospectively. The radiotherapy volume included the PVTT, with a 2- to 3-cm margin to cover adjacent HCC. Intrahepatic primary HCC was managed by TACE before or after radiotherapy. Results: Median patient age was 52 years old, and 88.1% of patients were male. Main or bilateral PVTT was observed in 200 (48.5%) patients. Median radiation dose was 40 Gy (range, 21-60 Gy) delivered in 2- to 5-Gy fractions. We found that 3.6% of patients achieved a complete response and that 24.3% of patients achieved a partial response. The response and progression-free rates of PVTT were 39.6% and 85.6%, respectively. Median patient survival was 10.6 months, and the 1- and 2-year survival rates were 42.5% and 22.8%, respectively. Significant independent variables associated with overall survival included advanced tumor stage, alpha-fetoprotein level, degree of PVTT, and response to radiotherapy. Forty-one patients (10.0%) showed grade 3-4 hepatic toxicity during or 3 months after completion of radiotherapy. Grades 2-3 gastroduodenal complications were observed in 15 patients (3.6%). Conclusions: Radiotherapy is a safe and effective treatment for PVTT in patients with HCC. These results suggested that the combination of TACE and radiotherapy is a treatment option for relieving and/or stabilizing PVTT in patients with advanced HCC.

Parotid gland-sparing 3-dimensional conformal radiotherapy results in less severe dry mouth in nasopharyngeal cancer patients: A dosimetric and clinical comparison with conventional radiotherapy

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Jen, Y.-M.; Shih Rompin; Lin, Y.-S.; Su, W.-F.; Ku, C.-H.; Chang, C.-S.; Shueng, P.-W.; Hwang, J.-M.; Liu, D.-W.; Chao, H.-L.; Lin, H.-Y.; Chang, L.-P.; Shum, W.-Y.; Lin, C.-S.

2005-01-01

Background and purpose: This study examined the efficacy of parotid gland sparing of three-dimensional conformal radiotherapy (3DCRT) compared with conventional radiotherapy for NPC patients. Both the dose given to the parotids and clinical assessment of dry mouth were conducted. Materials and methods: Dry mouth was assessed for 108 patients treated with conventional technique and 72 treated with 3DCRT. Dose analysis was performed in 48 patients of the 3DCRT group. A dose of 70 Gy was given to the midplane in conventional radiotherapy and to 90% isodose volume in 3DCRT. Prognostic factors affecting the severity of dry mouth were analyzed using Generalized Estimating Equation (GEE). Results: In the 3DCRT group about 50% of the patients' parotid glands received less than 25 Gy. Parallel analysis of dry mouth shows a significant decrease in the incidence of severe xerostomia after 3DCRT. The proportion of patients without dry mouth was also significantly higher in the 3DCRT group than the conventional group at 1-3 years after completion of radiotherapy. Although 3DCRT delivered a higher dose to the tumor, it spared the parotid gland significantly better than the conventional treatment. Late toxicities were mostly similar between the 2 groups while local control in T4 patients and survival were improved for 3DCRT. Conclusion: Dosimetrically and clinically 3DCRT is better than conventional technique regarding parotid gland protection

Long-Term Outcome and Patterns of Failure in Primary Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiotherapy

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Hashimoto, Naoki [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan); Sasaki, Ryohei, E-mail: rsasaki@med.kobe-u.ac.jp [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan); Nishimura, Hideki; Yoshida, Kenji; Miyawaki, Daisuke; Nakayama, Masao; Uehara, Kazuyuki; Okamoto, Yoshiaki; Ejima, Yasuo [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan); Azumi, Atsushi [Division of Ophthalmology, Kobe University Graduate School of Medicine, Hyogo (Japan); Matsui, Toshimitsu [Division of Hematology, Kobe University Graduate School of Medicine, Hyogo (Japan); Sugimura, Kazuro [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan)

2012-03-15

Purpose: To evaluate the long-term treatment outcome and disease behavior of primary ocular adnexal MALT (mucosa-associated lymphoid tissue) lymphoma (POAML) after treatment with radiotherapy. Methods and Materials: Seventy-eight patients (42 male, 36 female) diagnosed with stage I POAML between 1991 and 2010 at Kobe University Hospital were included. The median age was 60 years (range, 22-85 years). The median radiation dose administered was 30.6 Gy. Rituximab-based targeted therapy and/or chemotherapy was performed in 20 patients (25.6%). Local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Results: The median follow-up duration was 66 months. Major tumor sites were conjunctiva in 37 patients (47.4%), orbita in 29 (37.2%), and lacrimal glands in 12 (15.4%). The 5- and 10-year OS rates were 98.1% and 95.3%, respectively. The 5- and 10-year LC rates were both 100%, and the 5- and 10-year RFS rates were 88.5% and 75.9%, respectively. Patients treated with a combination of radiotherapy and targeted therapy and/or chemotherapy had a trend for a better RFS compared with those treated with radiotherapy alone (p = 0.114). None developed greater than Grade 2 acute morbidity. There were 14 patients who experienced Grade 2 morbidities (cataract: 14; retinal disorders: 7; dry eye: 3), 23 patients who had Grade 3 morbidities (cataract: 23; dry eye: 1), and 1 patient who had Grade 4 glaucoma. Conclusions: Radiotherapy for POAML was shown to be highly effective and safe for LC and OS on the basis of long-term observation. The absence of systemic relapse in patients with combined-modality treatment suggests that lower doses of radiation combined with targeted therapy may be worth further study.

Long-Term Outcome and Patterns of Failure in Primary Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiotherapy

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Hashimoto, Naoki; Sasaki, Ryohei; Nishimura, Hideki; Yoshida, Kenji; Miyawaki, Daisuke; Nakayama, Masao; Uehara, Kazuyuki; Okamoto, Yoshiaki; Ejima, Yasuo; Azumi, Atsushi; Matsui, Toshimitsu; Sugimura, Kazuro

2012-01-01

Purpose: To evaluate the long-term treatment outcome and disease behavior of primary ocular adnexal MALT (mucosa-associated lymphoid tissue) lymphoma (POAML) after treatment with radiotherapy. Methods and Materials: Seventy-eight patients (42 male, 36 female) diagnosed with stage I POAML between 1991 and 2010 at Kobe University Hospital were included. The median age was 60 years (range, 22–85 years). The median radiation dose administered was 30.6 Gy. Rituximab-based targeted therapy and/or chemotherapy was performed in 20 patients (25.6%). Local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Results: The median follow-up duration was 66 months. Major tumor sites were conjunctiva in 37 patients (47.4%), orbita in 29 (37.2%), and lacrimal glands in 12 (15.4%). The 5- and 10-year OS rates were 98.1% and 95.3%, respectively. The 5- and 10-year LC rates were both 100%, and the 5- and 10-year RFS rates were 88.5% and 75.9%, respectively. Patients treated with a combination of radiotherapy and targeted therapy and/or chemotherapy had a trend for a better RFS compared with those treated with radiotherapy alone (p = 0.114). None developed greater than Grade 2 acute morbidity. There were 14 patients who experienced Grade 2 morbidities (cataract: 14; retinal disorders: 7; dry eye: 3), 23 patients who had Grade 3 morbidities (cataract: 23; dry eye: 1), and 1 patient who had Grade 4 glaucoma. Conclusions: Radiotherapy for POAML was shown to be highly effective and safe for LC and OS on the basis of long-term observation. The absence of systemic relapse in patients with combined-modality treatment suggests that lower doses of radiation combined with targeted therapy may be worth further study.

Emotional state of patients in radiotherapy and how they deal with their disorder

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Voigtmann, Kristina [Dept. of Psychosomatics and Psychotherapy, Univ. Hospital Carl Gustav Carus, Technical Univ. of Dresden (Germany); Neurology Dept., Hospital and Clinic for Internal Medicine, NAEL - Norra Aelvsborg Laenssjukhus, Trollhaettan (Sweden); Koellner, Volker [Dept. of Psychoanalysis, Psychotherapy, and Psychosomatic Medicine, Saarland Univ. Hospital, Homburg/Saar (Germany); Dept. of Psychosomatic Medicine, Mediclin Bliestal Clinic, Blieskastel (Germany); Einsle, Franziska; Joraschky, Peter [Dept. of Psychosomatics and Psychotherapy, Univ. Hospital Carl Gustav Carus, Technical Univ. of Dresden (Germany); Alheit, Horst; Herrmann, Thomas [Dept. of Radiotherapy and Radiation Oncology, Univ. Hospital Carl Gustav Carus, Technical Univ. of Dresden (Germany)

2010-04-15

Purpose: The aim of the study was to record patients' symptoms of anxiety, depression and post-traumatic stress, as well as their subjective experience of illness, with different forms of radiotherapy and for different indications. The question is to be answered of whether more invasive techniques such as stereotactic radiotherapy involve greater stress or whether the psychological stress instead tends to be caused by the underlying disorder itself. Patients and methods: Questionnaires were given to 240 patients after conventional radiotherapy for a malignant underlying disorder, to 80 with a benign disorder, and to 67 patients following stereotactic radiotherapy. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to measure anxiety and depression; the Post-Traumatic Symptom Scale (PTSS-10) was used to measure symptoms related to post-traumatic stress disorder (PTSD), and there were questions about patients' subjective experience of radiotherapy. Results: 28% of all patients scored in the pathologic or borderline anxiety range; 26% were in the pathologic or borderline depression range. 22% of patients were above the diagnostic cutoff for the PTSS-10. No differences were evident between the three groups in terms of anxiety and stress-related symptoms. Women were significantly (p = 0.001) more severely affected by symptoms of PTSD and anxiety than men. No gender differences could be proven in terms of depression. In the HADS-D, patients with a benign underlying disorder had significantly (p < 0.05) lower depression values than the two other groups studied. Conclusion: Patients who had undergone stereotactic radiotherapy did not demonstrate higher values for anxiety, depression or PTS symptoms than patients treated with conventional radiotherapy. From the results submitted here it cannot be assumed that this form of treatment leads to an increased incidence of traumatic stress or even post-traumatic stress disorder (PTSD). All

Emotional state of patients in radiotherapy and how they deal with their disorder

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Voigtmann, Kristina; Koellner, Volker; Einsle, Franziska; Joraschky, Peter; Alheit, Horst; Herrmann, Thomas

2010-01-01

Purpose: The aim of the study was to record patients' symptoms of anxiety, depression and post-traumatic stress, as well as their subjective experience of illness, with different forms of radiotherapy and for different indications. The question is to be answered of whether more invasive techniques such as stereotactic radiotherapy involve greater stress or whether the psychological stress instead tends to be caused by the underlying disorder itself. Patients and methods: Questionnaires were given to 240 patients after conventional radiotherapy for a malignant underlying disorder, to 80 with a benign disorder, and to 67 patients following stereotactic radiotherapy. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to measure anxiety and depression; the Post-Traumatic Symptom Scale (PTSS-10) was used to measure symptoms related to post-traumatic stress disorder (PTSD), and there were questions about patients' subjective experience of radiotherapy. Results: 28% of all patients scored in the pathologic or borderline anxiety range; 26% were in the pathologic or borderline depression range. 22% of patients were above the diagnostic cutoff for the PTSS-10. No differences were evident between the three groups in terms of anxiety and stress-related symptoms. Women were significantly (p = 0.001) more severely affected by symptoms of PTSD and anxiety than men. No gender differences could be proven in terms of depression. In the HADS-D, patients with a benign underlying disorder had significantly (p < 0.05) lower depression values than the two other groups studied. Conclusion: Patients who had undergone stereotactic radiotherapy did not demonstrate higher values for anxiety, depression or PTS symptoms than patients treated with conventional radiotherapy. From the results submitted here it cannot be assumed that this form of treatment leads to an increased incidence of traumatic stress or even post-traumatic stress disorder (PTSD). All in all, it

Radiotherapy for breast cancer and pacemaker; Radiotherapie pour un cancer du sein et stimulateur cardiaque

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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

Nasopharyngeal carcinoma treated by radical radiotherapy alone: Ten-year experience of a single institution

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Yi Junlin; Gao Li; Huang Xiaodong; Li Suyan; Luo Jinwei; Cai Weiming; Xiao Jianping; Xu Guozhen

2006-01-01

Purpose: To report on our experience in the treatment of nasopharyngeal carcinoma (NPC) by radical radiotherapy alone in our institution during the last decade. Methods and Materials: From January 1990 to May 1999, 905 NPC patients were treated and were studied retrospectively. Radical radiotherapy was given to this cohort by conventional technique in a routine dose of 70-72 Gy to the primary tumor and metastatic lymph nodes. In case of residual primary lesion, a boost dose of 8-24 Gy was delivered by either 192 Ir afterloading brachytherapy, fractionated stereotactic radiotherapy, conformal radiotherapy, or small external-beam fields. Results: The 5-year and 10-year local-regional control, overall survival, and disease-free survival rates were 81.7% and 76.7%, 76.1% and 66.5%, 58.4% and 52.1%, respectively. In case of residual primary lesions after a dose of 70-72 Gy of conventional external-beam radiotherapy (EBRT), an additional boost was able to achieve a local control of 80.8%, similar to that obtained with primary lesions that completely disappeared at 70-72 Gy (82.6%, p = 0.892). Conclusions: The treatment results of radical EBRT followed by a boost dose to the residual primary tumor for nasopharyngeal carcinoma in our institution are promising

Daily-diary evaluated side-effects of conformal versus conventional prostatic cancer radiotherapy technique

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Widmark, A.; Fransson, P.; Franzen, L.; Littbrand, B.; Henriksson, R.

1997-01-01

Conventional 4-field box radiotherapy technique induces high morbidity for patients with localized prostatic cancer. Using a patient daily diary, the present study compared side-effects after conventional radiotherapy with conformal radiotherapy for prostate cancer. Fifty-eight patients treated with the conventional technique (with or without sucralfate) were compared with 72 patients treated with conformal technique. The patient groups were compared with an age-matched control population. Patients treated with conformal technique were also evaluated regarding acute and late urinary problems. Results showed that patients treated with conformal technique reported significantly fewer side-effects as compared with conventional technique. Patients treated with sucralfate also showed slightly decreased intestinal morbidity in comparison to non-sucralfate group. Acute and late morbidity evaluated by the patients was decreased after conformal radiotherapy as compared with the conventional technique. Sucralfate may be of value if conformal radiotherapy is used for dose escalation in prostatic cancer patients. (orig.)

Patterns of Failure and Treatment-Related Toxicity in Advanced Cervical Cancer Patients Treated Using Extended Field Radiotherapy With Curative Intent

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Rajasooriyar, Chrishanthi; Van Dyk, Sylvia; Bernshaw, David; Kondalsamy-Chennakesavan, Srinivas; Barkati, Maroie; Narayan, Kailash

2011-01-01

Purpose: The purpose of this study was to evaluate the patterns of failure and overall survival (OS) and disease-free survival (DFS) rates in cervical cancer patients who had metastatic disease in common iliac or para-aortic lymph nodes and were treated with curative intent, using extended field radiotherapy (EFRT). Methods and Materials: This was a retrospective study involving 39 patients treated from January 1996 to June 2007, using EFRT with concurrent chemotherapy and intracavitary brachytherapy. EFRT consisted of 45 Gy in 1.8-Gy fractions. Radiation to involved nodes was boosted to a total dose of 50.4 to 54 Gy. Primary tumor radiation was boosted to a dose of 80 Gy using brachytherapy. Results: Overall, 30 patients (77%) have relapsed. The 5-year OS rate was 26% (95% confidence interval [CI], 11-44). The 5-year DFS rate was 19.4% (95% CI, 8-35). Only 3 patients (7.5%) experienced treatment failure exclusively within the treatment field, and 2 patients underwent salvage treatment. Grade 3 to 4 acute bone marrow and gastrointestinal toxicities were observed in 10 (26%) and 7 (18%) patients, respectively. Conclusions: Concurrent chemotherapy and EFRT treatment was well tolerated. Most patients showed failure at multiple sites and outside the treatment field. Only 3/39 patients had failures exclusively within the treatment field, and 2 underwent salvage treatment.

Normalization of prostate specific antigen in patients treated with intensity modulated radiotherapy for clinically localized prostate cancer

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Schmitz Matthew D

2010-09-01

Full Text Available Abstract Background The purpose of this study was to determine the expected time to prostate specific antigen (PSA normalization with or without neoadjuvant androgen deprivation (NAAD therapy after treatment with intensity modulated radiotherapy (IMRT for patients with clinically localized prostate cancer. Methods A retrospective cohort research design was used. A total of 133 patients with clinical stage T1c to T3b prostate cancer (2002 AJCC staging treated in a community setting between January 2002 and July 2005 were reviewed for time to PSA normalization using 1 ng/mL and 2 ng/mL as criteria. All patients received IMRT as part of their management. Times to PSA normalization were calculated using the Kaplan-Meier method. Significance was assessed at p Results Fifty-six of the 133 patients received NAAD (42.1%. Thirty-one patients (23.8% received radiation to a limited pelvic field followed by an IMRT boost, while 99 patients received IMRT alone (76.2%. The times to serum PSA normalization 0.05, and 303 ± 24 and 405 ± 46 days, respectively, for PSA Conclusions Use of NAAD in conjunction with IMRT leads to a significantly shortened time to normalization of serum PSA

Chemotherapy and radiotherapy for elderly head and neck cancer patients

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Fujii, Masato

2012-01-01

Among head and neck cancers, cases affecting elderly people are increasing. Radical treatment is sometimes difficult in advanced cases of elderly patients. With progressive cancer, because radical surgery is often difficult, radiotherapy is chosen and may be used together with chemotherapy when overall status is good. However, according to the meta-analysis of Pignon et al., the chemoradiotherapy for elderly patients 71 years old or older, the hazard ratio becomes approximately 0.95, and there is little chemotherapy combined effect. In terms of 5-year survival rate, chemotherapy combined effect is -0.7%. Chemotherapy effect in elderly patients is not clear in past clinical trials. We examined 50 cases 75 years or older treated mainly by radiotherapy at Tokyo Medical Center between February, 2003 and August, 2011. In all, 21 of the 50 patients died, including four who died due to other cancers, while pneumonia accounted for five other deaths. These results suggested that various complications are often present and multiple primary cancers often occur in elderly people. With chemotherapy for elderly people, the effect of radiotherapy treatment and quality of life of the patients should be considered fully based on characteristics of elderly people, and a treatment plan devised accordingly. It is also necessary to undertake care after treatment. (author)

Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

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Al-Mamgani, Abrahim, E-mail: a.al-mamgani@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Rooij, Peter van [Department of Biostatistics, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Verduijn, Gerda M. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Meeuwis, Cees A. [Department of Otorhinolaryngology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

2012-09-01

Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4-172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade {>=}2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in

Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

International Nuclear Information System (INIS)

Al-Mamgani, Abrahim; Rooij, Peter van; Verduijn, Gerda M.; Meeuwis, Cees A.; Levendag, Peter C.

2012-01-01

Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4–172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade ≥2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in

A case of remnant pancreatic cancer after pancreatoduodenectomy successfully treated using chemotherapy and carbon-ion radiotherapy

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Yamamoto, Tatsuhito; Tokunou, Kazuhisa; Yamamoto, Hisato; Kamei, Ryoji; Kitamura, Yoshinori; Ando, Seiichiro

2016-01-01

We report a case of remnant pancreatic cancer after pancreatoduodenectomy that was successfully treated using chemotherapy and carbon-ion radiotherapy. A 68-year-old woman received SSPPD for pancreatic head cancer. Gemcitabine (GEM) was administered for a year as postoperative chemotherapy. One year 8 months after surgery, abdominal CT showed a 20 mm solid mass in the stump of the remnant pancreas and dilation of the distal pancreatic duct. FDG-PET revealed a solitary tumor without any recurrence. We diagnosed the patient with a solitary recurrence of pancreatic cancer. Chemotherapy (GEM) and carbon-ion radiotherapy were performed. After treatment, the lesion was not detected on CT or FDG-PET. Chemotherapy (GEM) and carbon-ion radiotherapy for locally advanced pancreatic cancer seems to be effective and there might result in a survival benefit. (author)

Radical radiotherapy treatment (EBRT + HDR-ICRT of carcinoma of the uterine cervix: Outcome in patients treated at a rural center in India

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Jain Vandana

2007-01-01

Full Text Available Aim: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT and high-dose-rate (HDR intracavitary radiotherapy (ICRT. Materials and Methods: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. Results: There were 7 (3.27%, 88 (41.1%, 101 (47.1%, and 18 (8.4% patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months. The overall treatment time (OTT ranged from 52 to 73 days (median 61 days. The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97% cases with local residual disease, 35 (16.3% developed local recurrence/distant metastases, 17 (7.9% developed distant metastases, and 9 (4.2% had local recurrence as well. Discussion and Conclusion: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.

Psychological and physical distress of cancer patients during radiotherapy

International Nuclear Information System (INIS)

Koenig, A.

2001-05-01

Purpose: patients undergoing radiotherapy have physical and psychological symptoms related to the underlying disease and the treatment. In order to give the best possible support to the patients, more knowledge about the amount and the changing of distress in the course of radiotherapy is of essentially importance. Methods: The distress was measured in a consecutive sample of cancer patients (n=82) undergoing radiotherapy. Each patient was given the EORTC-QLQ-C30, the HADS and a special questionnaire which ascertain radiotherapy-specific items before starting the radiotherapy, at the onset of radiotherapy, in the third week of radiotherapy and 3 weeks after the end of radiotherapy. Results: within the first week of treatment the psychological distress of the patients is increasing; 98.8 % of the patients are 'moderate distressed', 46 % 'severe distressed'. General physical symptoms seem not to be affected by the radiotherapy, there is no changing. The distress caused by the organization of the radiotherapy is decreasing, while therapy-related symptoms are increasing in the course of radiotherapy. Even after the end of the therapy these symptoms keep on causing distress, sometimes in a higher amount than before. A correlation between sex, sort of cancer and curative or palliative treatment and the amount of distress was found. Conclusion: the results stress the importance of adequate emotional support for patients undergoing radiotherapy especially in the first week of treatment and after the treatment. There is a need for the development of a valid radiotherapy - questionnaire in order to be able to measure the distress of these patients. (author)

Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 Patients treated with a prospective margin-directed policy

International Nuclear Information System (INIS)

Livi, Lorenzo; Meattini, Icro; Franceschini, Davide; Saieva, Calogero; Meacci, Fiammetta; Marrazzo, Livia; Gerlain, Elena; Desideri, Isacco; Scotti, Vieri; Nori, Jacopo; Sanchez, Luis Jose; Orzalesi, Lorenzo; Bonomo, Pierluigi; Greto, Daniela; Bianchi, Simonetta; Biti, Giampaolo

2013-01-01

Purpose: To investigate the outcome of invasive early breast cancer patients that underwent breast-conserving surgery and adjuvant radiotherapy (RT), treated with a prospective margin-directed institutional policy for RT boost dose, based on final margins status (FMS). Methods and materials: A total of 2093 patients were treated between 2000 and 2008. 10 Gy boost was prescribed in case of FMS > 5 mm; 16 Gy boost with FMS between 2 and 5 mm; 20 Gy boost in case of FMS 5 mm. At multivariate analysis, higher nuclear grade (p = 0.045), triple negative subtype (p = 0.036) and higher T-stage (p = 0.02) resulted as the independent predictors of LR occurrence. Conclusions: Our experience showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype

Peroperative radiotherapy in the treatment of cancer of the pancreas

International Nuclear Information System (INIS)

Huguier, M.; Schlienger, M.; Houry, S.; Charron, R.

1987-01-01

7 patients presenting with unresected (6 cases) or resected (1 case) cancer of the pancreas were treated peroperatively by radiotherapy. Tumors were treated with 15 to 20 Gy delivered by a particle accelerator. There were no post-operative complications. Three patients who were experiencing pain before radiotherapy no longer had pain after radiotherapy and this effect was maintained. Five patients died during the follow-up period after 5 to 10 months. Two patients are still alive after 4 and 9 months follow-up. This experience with peroperative radiotherapy should be continued [fr

The radiotherapy affects the cognitive processes

International Nuclear Information System (INIS)

Anon.

2009-01-01

Researchers from the medical center of the free university of Amsterdam report that the radiotherapy can hinder the cognitive functions of patients affected by cerebral tumors treated after a surgery. Even low dose radiation could contribute in their opinion, to the progressive cognitive decline of patients suffering of low grade gliomas, the most commune cerebral tumor. To get these conclusions, 65 patients, whom half of them received a radiotherapy, had a neurological and psychological evaluation twelve years after their treatment. Results: 53% of patients treated by radiotherapy present disorders of attention, memory, execution and speed of information treatment against 27% of these ones that received an only surgery. The researchers conclude to the necessity to take into account this risk in the choice of treatment, or even to avoid radiotherapy in this precise case. (N.C.)

Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N. [University Hospital Muenster (Germany). Dept. of Radiotherapy and Radiooncology

2002-05-01

Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

International Nuclear Information System (INIS)

Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N.

2002-01-01

Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients

DEFF Research Database (Denmark)

Persson, Oscar; Bartek, Jiri; Shalom, Netanel Ben

2017-01-01

OBJECTIVE: Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) ... to patients treated with fractionated stereotactic radiotherapy. RESULTS: No randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were...... included in the systematic review. Loss of tumor control necessitating a new VS-targeted intervention was found in an average of 5.0% of the patients treated with SRS and in 4.8% treated with FSRT. Mean deterioration ratio for patients with serviceable hearing before treatment was 49% for SRS and 45...

Normalization of prostate specific antigen in patients treated with intensity modulated radiotherapy for clinically localized prostate cancer

International Nuclear Information System (INIS)

Schmitz, Matthew D; Padula, Gilbert DA; Chun, Patrick Y; Davis, Alan T

2010-01-01

The purpose of this study was to determine the expected time to prostate specific antigen (PSA) normalization with or without neoadjuvant androgen deprivation (NAAD) therapy after treatment with intensity modulated radiotherapy (IMRT) for patients with clinically localized prostate cancer. A retrospective cohort research design was used. A total of 133 patients with clinical stage T1c to T3b prostate cancer (2002 AJCC staging) treated in a community setting between January 2002 and July 2005 were reviewed for time to PSA normalization using 1 ng/mL and 2 ng/mL as criteria. All patients received IMRT as part of their management. Times to PSA normalization were calculated using the Kaplan-Meier method. Significance was assessed at p < 0.05. Fifty-six of the 133 patients received NAAD (42.1%). Thirty-one patients (23.8%) received radiation to a limited pelvic field followed by an IMRT boost, while 99 patients received IMRT alone (76.2%). The times to serum PSA normalization < 2 ng/mL when treated with or without NAAD were 298 ± 24 and 302 ± 33 days (mean ± SEM), respectively (p > 0.05), and 303 ± 24 and 405 ± 46 days, respectively, for PSA < 1 ng/mL (p < 0.05). Stage T1 and T2 tumors had significantly increased time to PSA normalization < 1 ng/mL in comparison to Stage T3 tumors. Also, higher Gleason scores were significantly correlated with a faster time to PSA normalization < 1 ng/mL. Use of NAAD in conjunction with IMRT leads to a significantly shortened time to normalization of serum PSA < 1 ng/mL in patients with clinically localized prostate cancer

Quality indicators for prostate radiotherapy: are patients disadvantaged by receiving treatment in a 'generalist' centre?

Science.gov (United States)

Freeman, Amanda R; Roos, Daniel E; Kim, Laurence

2015-04-01

The purpose of this retrospective review was to evaluate concordance with evidence-based quality indicator guidelines for prostate cancer patients treated radically in a 'generalist' (as distinct from 'sub-specialist') centre. We were concerned that the quality of treatment may be lower in a generalist centre. If so, the findings could have relevance for many radiotherapy departments that treat prostate cancer. Two hundred fifteen consecutive patients received external beam radiotherapy (EBRT) and/or brachytherapy between 1.10.11 and 30.9.12. Treatment was deemed to be in line with evidence-based guidelines if the dose was: (i) 73.8-81 Gy at 1.8-2.0 Gy/fraction for EBRT alone (eviQ guidelines); (ii) 40-50 Gy (EBRT) for EBRT plus high-dose rate (HDR) brachytherapy boost (National Comprehensive Cancer Network (NCCN) guidelines); and (iii) 145 Gy for low dose rate (LDR) I-125 monotherapy (NCCN). Additionally, EBRT beam energy should be ≥6 MV using three-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT), and high-risk patients should receive neo-adjuvant androgen-deprivation therapy (ADT) (eviQ/NCCN). Treatment of pelvic nodes was also assessed. One hundred four high-risk, 84 intermediate-risk and 27 low-risk patients (NCCN criteria) were managed by eight of nine radiation oncologists. Concordance with guideline doses was confirmed in: (i) 125 of 136 patients (92%) treated with EBRT alone; (ii) 32 of 34 patients (94%) treated with EBRT + HDR BRT boost; and (iii) 45 of 45 patients (100%) treated with LDR BRT alone. All EBRT patients were treated with ≥6 MV beams using 3D-CRT (78%) or IMRT (22%). 84%, 21% and 0% of high-risk, intermediate-risk and low-risk patients received ADT, respectively. Overall treatment modality choice (including ADT use and duration where assessable) was concordant with guidelines for 176/207 (85%) of patients. The vast majority of patients were treated concordant with evidence-based guidelines suggesting that

Protection of patient In radiotherapy

International Nuclear Information System (INIS)

Deiyi, P.

2013-04-01

The purpose of this project is to clarify some aspects about protection of patient in radiotherapy. Therefore, some basic information about how the use of ionizing radiation in medicine has brought tremendous health benefits to the population globally, the requirement of radiation protection (Justification of practices, Dose limitation and Optimization of protection), and the deterministic and stochastic effects of radiation are presented. The aim of radiotherapy is to use ionizing radiation to cure diseases or make the symptoms of a disease less severe. Also presented are layout of a radiotherapy facility (controlled areas, supervised areas, mazes, door and interlocks, patient observation and communication, and warning sign and lights), radionuclides commonly used for radiation therapy and their main emissions, equipment and devices used in radiotherapy, aspect of protection of patient in radiotherapy such as: leakage test, source on/off, emergency buttons, radiation oncology team, treatment planning, room monitoring, equipment or for protection and Cobalt-60 unit stuck source. The advantages of brachytherapy, leakage from the treatment head and radiation incidents resulting from incorrect dose calibration are discussed. The importance of minimization dose exposure, by considering the basic principles of: time, distance and shielding are also stated. These principles prevent deterministic effects and limit stochastic effects of radiation. (author)

The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas.

LENUS (Irish Health Repository)

O'Sullivan, Eoin P

2009-11-01

Transsphenoidal surgery is indicated for patients with nonfunctioning pituitary adenomas (NFPAs) causing compressive symptoms. Previous studies attempting to define the rate of recurrence\\/regrowth of surgically treated but radiation-naïve NFPAs were somewhat limited by selection bias and\\/or small numbers and\\/or lack of consistency of findings between studies. A better understanding of the natural history of this condition could allow stratification of recurrence risk and inform future management. We aimed to define the natural history of a large, mainly unselected cohort with surgically treated, radiotherapy (RT)-naïve NFPAs and to try to identify predictors of recurrence\\/regrowth.

Radiotherapy for pituitary adenoma: long-term outcome and sequelae

International Nuclear Information System (INIS)

McCord, Mark W.; Buatti, John M.; Fennell, Eileen M.; Mendenhall, William M.; Marcus, Robert B.; Rhoton, Albert L.; Grant, Maria B.; Friedman, William A.

1997-01-01

Purpose: To review outcome and treatment sequelae in patients treated with external beam radiotherapy for pituitary adenomas. Methods and Materials: One hundred forty-one patients with pituitary adenomas received radiotherapy at the University of Florida and had 2-year minimum potential follow-up. One hundred twenty-one had newly diagnosed adenomas, and 20 had recurrent tumors. Newly diagnosed tumors were treated with surgery and radiotherapy (n = 98) or radiotherapy alone (n = 23). Patients with recurrent tumors received salvage treatment with surgery and radiotherapy (n = 10) or radiotherapy alone (n = 10). The impact of age, sex, presenting symptoms, tumor extent, surgery type, degree of resection, hormonal activity, primary or salvage therapy, and radiotherapy dose on tumor control was analyzed. Tumor control is defined by the absence of radiographic progression and stable or decreased hormone level (in hormonally active tumors) after treatment. Effect of therapy on vision, hormonal function, neurocognitive function, life satisfaction, and affective symptoms were examined. A Likert categorical scale survey was used for assessment of neurocognitive, life satisfaction, and affective symptom status. Survey results from the radiotherapy patients were compared with a control group treated with transsphenoidal surgery alone. Multivariate analysis used the forward step-wise sequence of chi squares for the log rank test. Results: At 10 years, tumor control for the surgery and radiotherapy group (S + RT) was 95% and not statistically different (p = 0.58) than for patients treated with radiotherapy alone (RT) (90%). Patients with prolactin- and ACTH-secreting tumors had significantly worse tumor control, as did patients treated for recurrent tumors. Multivariate analysis for tumor control revealed that only young age was predictive of worse outcome (p = 0.0354). Visual function was either unaffected or improved in most patients, although four patients developed visual

Survey on nursing of breast cancer patients treated with radiotherapy following to breast-conserving surgery. Actual states and problems for nursing care by certified nurses in breast cancer nursing

International Nuclear Information System (INIS)

Kobayashi, Mariko; Higuchi, Yuki; Hirose, Kiyomi; Nakanishi, Yoko; Ichikawa, Kayo; Horikoshi, Masataka; Futawatari, Tamae

2011-01-01

The purpose of the present study is to elucidate the actual states and problems of nursing care provided by certified nurses in breast cancer patients treated with radiotherapy following to breast-conserving surgery. The survey was conducted by a postal anonymous questionnaire. Participants were drawn from the list of certified nurses on the website of Japanese Nursing Association. The questionnaires consisted of multiple choice questions regarding the contents of care performed before, during and after radiotherapy, and free questionnaire on the related problems. The rate of valid replies was 41.2% (40 out of 97 subjects). Before radiotherapy, the accomplishing rate exceeded 70% in about half of all nursing cares. The accomplishing rates were 30 to 50% in about 90% of all cares and 40 to 60% in all cares during and after radiotherapy, respectively. Problems were classified into three categories high-quality practice of radiotherapy nursing, establishment of continuing care system and improvement of cooperation. It is recommended to achieve high quality radiotherapy nursing by certified nurses, the establishment of continuing care system and the improvement of cooperation in order to improve nursing care during and after radiotherapy. (author)

Quality of life following endoscopic resection or radio-therapy for early glottic cancer

International Nuclear Information System (INIS)

Bahannan, Abdulrahman A.; Zabrodsky, M.; Chovanec, M.; Cerny, L.; Lohynska, R.

2007-01-01

To compare post treatment quality of life (QoL) of patients treated by radiotherapy or endoscopic transoral endolaryngeal surgery using two quality of life scoring tools. From May 1998 to July 2005, 48 patients (11 women and 37 men) with early glottic cancer were treated with curative radiotherapy (18 patients) or laser cordectomy (30 patients), and retrospectively evaluated using QoL questionnaires; European Organization for Research and Treatment of Cancer (EORTC) - EORTC-QoL Core Questionnaire (QLQ-C30 version 2.0) and organ specific EORTC - QLQ, Head and Neck Module (QLQ-H and N35) at the University Hospital Motol, Czech Republic. Mean follow-up was 24 months. Only patients in complete remission were enrolled in the study. The overall score calculated separately for both questionnaires was not statistically different between both groups. Statistically significant differences were found only in specific group of questions focusing on saliva production (p=0.034) and sexuality performance (p=0.002). The majority of cases treated with cordectomy were Tis lesions. In the radiotherapy group, T1 lesions predominated (p=0.0001). Patients treated with radiotherapy were significantly older than those treated with cordectomy (p=0.027), which could explain the worsened score in sexuality questions. There were no significant differences found between genders allocated either to cordectomy or radiotherapy group. The overall QoL did not differ between patients treated with cordectomy or radiotherapy, despite the fact that patients treated with radiotherapy had more advanced disease and were older. There was significantly worse saliva and sexuality question score in the radiotherapy group. (author)

Radiotherapy With or Without Surgery for Patients With Idiopathic Sclerosing Orbital Inflammation Refractory or Intolerant to Steroid Therapy

International Nuclear Information System (INIS)

Lee, Jong Hoon; Kim, Yeon-Sil; Yang, Suk Woo; Cho, Won-Kyung; Lee, Sang Nam; Lee, Kyung Ji; Ryu, Mi-Ryeong; Jang, Hong Seok

2012-01-01

Purpose: To evaluate the outcomes of patients with idiopathic sclerosing orbital inflammation (ISOI) treated with radiotherapy with or without surgery. Methods and Materials: We retrospectively reviewed 22 patients with histopathologically confirmed ISOI who had been refractory or intolerant to steroid therapy and treated with radiation with or without surgery. The radiation dose ranged from 20 to 40 Gy (median, 20 Gy) at 2 Gy per fraction. Presenting signs and treatment outcomes were assessed. Results: Proptosis was the most common sign at presentation, seen in 19 (86.3%) patients, followed by restriction of extraocular movements in 10 (45.4%) patients. Response to radiotherapy was complete in 15 (68.1%) patients, partial in 3 (13.6%) patients, and none in 4 (18.2%) patients. At the median follow-up of 34 months, 14 (63.6%) patients had progression-free state of symptoms and signs, with the progression-free duration ranging from 3 to 75 months (median, 41.5 months), whereas 8 (36.4%) patients had recurrent or persistent disease although they had received radiotherapy. Of the 14 progression-free patients, 6 underwent a bimodality treatment of debulking surgery of ocular disease and radiotherapy. They had had no recurrent disease. Cataract was the most common late complications, and 2 patients experienced a Grade 3 cataract. Conclusion: Our study suggests that for patients with ISOI who are refractory or intolerant to steroid therapy, 20 Gy of radiotherapy appears to be effective for the control of disease with acceptable complications, especially when it is combined with surgery.

Early post-treatment pseudo-progression amongst glioblastoma multiforme patients treated with radiotherapy and temozolomide: a retrospective analysis

International Nuclear Information System (INIS)

Gunjur, Ashray; Lau, Eddie; Taouk, Yamna; Ryan, Gail

2011-01-01

To evaluate the incidence and impact of early post-chemoradiation (cRT) 'pseudoprogression' (PsPD) amongst glioblastoma multiforme (GBM) patients treated with the current standard of care – 60 Gy conformal radiotherapy with concurrent low-dose temozolomide, followed by six cycles of high-dose temozolomide (the 'Stupp protocol'). Clinical notes and radiology reports for GBM patients treated as per the Stupp protocol were reviewed. PsPD was defined as apparent radiological progression on the first post-cRT scan, with further imaging within 3 months being stable or improving, while true early progression (ePD) was confirmed by continued progression in the subsequent 3 months following the first post-cRT scan. Of the 68 patients evaluated, 14 (21%) and 27 (40%) experienced PsPD and ePD, respectively; 3/14 (21%) patients experiencing PsPD and 14/27(52%), ePD were symptomatic for progression on first post-cRT follow-up (P = 0.096 for difference). Median survival for patients with ePD, PsPD and neither were 10.4, 27.4 and 13.0 months, respectively (P = 0.003 for ePD vs. PsPD, P = 0.19 for neither vs. PsPD groups). These data confirm a significant incidence of PsPD in post-cRT GBM patients, associated with improved median survival compared with those with neither ePD nor PsPD (not statistically significant). It appears likely that PsPD actually represents tumour response, conflicting with the traditional notion that increase in lesion size on contrast-enhanced imaging represents disease progression. Early post-cRT imaging should thus be interpreted with caution. Accompanying clinical symptoms are more commonly associated with ePD, but do not reliably distinguish PsPD from ePD.

Cell Cycle Inhibitors and Outcome after Radiotherapy in Bladder Cancer Patients

International Nuclear Information System (INIS)

Roetterud, Ranveig; Pettersen, Erik O.; Berner, Aasmund; Holm, Ruth; Olsen, Dag Rune; Fossaa, Sophie D.

2002-01-01

The aim of this study was to correlate the expression of cell cycle inhibitors with outcome of patients with muscle-invasive bladder cancer treated with preoperative radiotherapy (46 Gy/4-5 weeks or 20 Gy/1 week) and cystectomy. Patients with pT3b (n=42) or pT0 (n=17) were included in the study. Expression of p16INK4a and p27KIP1 was assessed immunohistochemically in pre-radiotherapy biopsies and cystectomy specimens. Previously reported results of p21CIP1 expression were also included. No difference in pretreatment protein expression was found between patients with pT0 and pT3b. Expression of p21CIP1 and p27KIP1 was lower in cystectomy specimens than in pretreatment biopsies. None of the proteins showed significant impact on survival when analysed separately. However, patients with tumours showing > 50% expression of p16INK4a, p21CIP1, or p27KIP1 displayed poorer cancer-specific survival rates compared with the remaining patients (p=0.025). This effect was more pronounced in patients receiving 46 Gy than in those receiving 20 Gy. In conclusion, low expression of cell cycle inhibitors is related to favourable survival after precystectomy radiotherapy

Second malignancy in patients treated for Hodgkin's disease

International Nuclear Information System (INIS)

Baccarani, M; Bosi, A.; Papa, G.

1980-01-01

Six hundred and thirteen consecutive patients with Hodgkin's disease (HD), with a follow-up of two to ten years, were reviewed with the aim of establishing the type and frequency of second malignancies. Acute non-lymphoid leukemia developed in 2 of 152 patients treated by chemotherapy (CHT), and in 5 of 344 patients treated by CHT and radiotherapy (RT). Leukemia developed 12 to 83 months after diagnosis of HD, was always preceded by a preleukemic phase (3 to 25 months), and was always fatal (after 1 to 12 months). The karyotype of leukemic cells was studied in 4 of 7 patients and was always abnormal. Solid tumors developed in 1 of 152 patients treated by CHT, and in 4 of 344 patients treated by CHT and RT. The tumors appeared 10 to 63 months after diagnosis of HD and killed all 5 patients after 10 to 16 months. For patients treated by CHT, the actuarial frequency of leukemia and other tumors seven years after diagnosis of HD was 2.0% and 1.26%, respectively. For patients treated by CHT and RT, the figures were 2.04% and 2.26%, respectively. Second malignancies were not recorded among 117 patients treated by RT alone. These data are consistent with a relationship of acute leukemia to therapy for HD

Radiotherapy for breast cancer and pacemaker

International Nuclear Information System (INIS)

Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M.; Kirov, K.M.; Esteve, M.

2011-01-01

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 before

Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy Alone

Energy Technology Data Exchange (ETDEWEB)

Su Shengfa [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China); Department of Oncology, GuiYang Medical College Hospital, Guiyang, Guizhou (China); Han Fei; Zhao Chong; Chen Chunyan; Xiao Weiwei; Li Jiaxin [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China); Lu Taixiang, E-mail: ssf2010@sina.cn [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China)

2012-01-01

Purpose: Reports of intensity-modulated radiotherapy (IMRT) for early-stage nasopharyngeal carcinoma (NPC) have been limited. The present study evaluated the long-term survival outcomes and toxicity of early-stage NPC patients treated with IMRT alone. Methods and Materials: Between February 2001 and January 2008, 198 early-stage (T1-T2bN0-N1M0) NPC patients had undergone IMRT alone. The data from these patients were retrospectively analyzed. The patients were treated to 68 Gy at 2.27 Gy/fraction prescribed to the planning target volume of the primary nasopharygeal gross tumor volume. The Radiation Therapy Oncology Group scoring system was used to assess the toxicity. Results: At a median follow-up of 50.9 months (range, 12-104), the 5-year estimated disease-specific survival, local recurrence-free survival, and distant metastasis-free survival rate was 97.3%, 97.7%, and 97.8%, respectively. The 5-year local recurrence-free survival rate was 100% for those with Stage T1 and T2a and 94.2% for those with Stage T2b lesions (p = 0.252). The 5-year distant metastasis-free survival rate for Stage T1N0, T2N0, T1N1, and T2N1 patients was 100%, 98.8%, 100%, and 93.8%, respectively (p = .073). All local recurrence occurred in patients with T2b lesions. Five patients developed distant metastasis. Of these 5 patients, 4 had had Stage T2bN1 disease and 1 had had Stage T2bN0 disease with retropharyngeal lymph node involvement. The most common acute toxicities were mainly Grade 1 or 2. At 24 months after IMRT, no Grade 3 or 4 xerostomia had developed, and 62 (96.9%) of 64 evaluated patients were free of trismus; only 2 patients (3.1%) had Grade 1 trismus. Radiation encephalopathy and cranial nerve injury were not observed. Conclusions: IMRT alone for Stage T1N0, T2N0, T1N1, and T2N1 yielded satisfactory survival outcomes with acceptable toxicity, and no differences were found in survival outcomes among these four subgroups. Patients with Stage T2b lesions might have relatively

Radiological protection of the radiotherapy patient?

International Nuclear Information System (INIS)

Waligorski, M.P.R.; Lesiak, J.

2001-01-01

We propose that the system and concepts of radiation protection should not be used with reference to radiotherapy patients. We justify this on conceptual grounds. The patient undergoing radiotherapy procedures, as prescribed by the medical practitioner, is protected by the quality assurance system legally required for medical exposures. (author)

The evaluation of the degree of impairment of pulmonary perfusion in lung cancer patients treated by radiotherapy by the quantification of nonuniform distribution of lung perfusion scintigraphy SPECT

International Nuclear Information System (INIS)

Mitomo, Osamu; Tsunoda, Takashi; Kuwabara, Hidemasa

2004-01-01

By means of quantifying the nonuniform distribution of pulmonary perfusion in Lung Perfusion Scintigraphy SPECT (single photon emission tomography), which is called ''SPECT'' for short, we evaluated the degree of functional impairment of pulmonary perfusion in non-operated lung cancer patients treated by the radiotherapy. Sixty-eight patients with non-operated lung cancer treated with radiotherapy, and who either received or did not receive chemotherapy, from February, 1996 to August, 2002, were examined using SPECT within 6 weeks prior to, or within 2 weeks following radiotherapy. This group was called ''irradiated lung cancer patients''. Twenty-six patients, who were called ''follow-up irradiated lung cancer patients'', were reexamined within four weeks after radiotherapy. On the other hand, 323 patients without lung cancer, who were subdivided into four groups; pulmonary, cardiac, cardio-pulmonary, and non-cardiopulmonary. The SPECT was examined in the supine position after infusing Tc-99m-MAA, 185 MBq in a bolus, mainly into an antecubital vein with the patient's arm elevated. From reconstructed SPECT images, the volume of lung as a whole calculated at 10% of thresholds was assumed to be the ''Baseline Lung Perfusion Volume'' (BPV), and the functional volume rates were calculated in 10% threshold widths from 10% to 100% of the threshold. Assuming the total absolute differences in functional volume rate between each subject and the control to be the distribution index of the lung as a whole (D index), we quantified the degree of nonuniform distribution of the lung as a whole in each subject. In the same way, the distribution index of the left or right lung respectively was calculated as D l or D r index assuming the volume of left or right lung were calculated at 10% of the threshold as left or right BPV and calculating the functional volume rates of each lung in 10% threshold widths from 10% to 100% of the threshold. The D index of irradiated lung cancer

Predictors of pulmonary toxicity in limited stage small cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy: CALGB 30904.

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Salama, Joseph K; Pang, Herbert; Bogart, Jeffrey A; Blackstock, A William; Urbanic, James J; Hogson, Lydia; Crawford, Jeffrey; Vokes, Everett E

2013-12-01

Standard therapy for limited stage small cell lung cancer (L-SCLC) is concurrent chemotherapy and radiotherapy followed by prophylactic cranial radiotherapy. Predictors of post chemoradiotherapy pulmonary toxicity in limited stage (LS) small cell lung cancer (SCLC) patients are not well defined. Current guidelines are derived from non-small cell lung cancer regimens, and do not account for the unique biology of this disease. Therefore, we analyzed patients on three consecutive CALGB LS-SCLC trials treated with concurrent chemotherapy and daily high dose radiotherapy (70 Gy) to determine patient and treatment related factors predicting for post-treatment pulmonary toxicity. Patients treated on CALGB protocols 39808, 30002, 30206 investigating two cycles of chemotherapy followed by concurrent chemotherapy and 70 Gy daily thoracic radiation therapy were pooled. Patient, tumor, and treatment related factors were evaluated to determine predictors of grade 3–5 pulmonary toxicities after concurrent chemoradiotherapy. 100 patients were included. No patient experienced grade 4–5 post-treatment pulmonary toxicity. Patients who experienced post-treatment pulmonary toxicity were more likely to be older (median age 69 vs 60, p = 0.09) and have smaller total lung volumes (2565 cc vs 3530 cc, p = 0.05).). Furthermore,exposure of larger volumes of lung to lower (median V5 = 70%, p = 0.09, median V10 = 63%, p = 0.07), inter-mediate (median V20 = 50, p = 0.04) and high (median V60 = 25%, p = 0.01) doses of radiation were all associated with post-treatment grade 3 pulmonary toxicity, as was a larger mean lung radiation dose(median 31 Gy) p = 0.019. Post-treatment pulmonary toxicity following the completion of 2 cycles of chemotherapy followed by concurrent chemotherapy and high dose daily radiation therapy was uncommon. Care should be taken to minimize mean lung radiation exposure, as well as volumes of low, intermediate and high doses of radiation.

Reporting Late Rectal Toxicity in Prostate Cancer Patients Treated With Curative Radiation Treatment

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Faria, Sergio L.; Souhami, Luis; Joshua, Bosede; Vuong, Te; Freeman, Carolyn R.

2008-01-01

Purpose: Long-term rectal toxicity is a concern for patients with prostate cancer treated with curative radiation. However, comparing results of late toxicity may not be straightforward. This article reviews the complexity of reporting long-term side effects by using data for patients treated in our institution with hypofractionated irradiation. Methods and Materials: Seventy-two patients with localized prostate cancer treated with hypofractionated radiotherapy alone to a dose of 66 Gy in 22 fractions were prospectively assessed for late rectal toxicity according to the Common Toxicity Criteria, Version 3, scoring system. Ninety percent of patients had more than 24 months of follow-up. Results are compared with data published in the literature. Results: We found an actuarial incidence of Grade 2 or higher late rectal toxicity of 27% at 30 months and a crude incidence of Grade 2 or higher late rectal toxicity of 18%. This was mostly severe toxicity documented during follow-up. The incidence of Grade 3 rectal toxicity at the last visit was 3% compared with 13% documented at any time during follow-up. Conclusion: Comparison of late toxicity after radiotherapy in patients with prostate cancer must be undertaken with caution because many factors need to be taken into consideration. Because accurate assessment of late toxicity in the evaluation of long-term outcome after radiotherapy in patients with localized prostate cancer is essential, there is a need to develop by consensus guidelines for assessing and reporting late toxicity in this group of patients

Prognostic value of pretreatment factors in patients with locally advanced carcinoma of the uterine cervix treated by radiotherapy alone

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Pedersen, D.; Soegaard, H.; Overgaard, J.; Bentzen, S.M.

1995-01-01

The prognostic effect of pretreatment patient- and tumor characteristics, and the influence of radiotherapy schedule on local control, distant metastases, and crude survival were analyzed in 424 consecutive patients with FIGO stage IIB (n = 137), IIIA (n = 10), IIIB (n = 211) and IVA (n = 66) cancer of the uterine cervix. All patients were given radiotherapy alone. From 1974 and through 1977, the external and intracavitary combined radiotherapy was given continuously in 4 to 6 weeks. From 1978 and through 1983, the treatment policy was changed to split-course radiotherapy by introducing planned pauses, resulting in an overall treatment time of 10 to 12 weeks. The results were estimated by univariate actuarial- and Cox multivariate regression analyses. Multivariate analysis showed that significant adverse variables for local control were large lateral tumor diameter, young age, low hemoglobin at time of admission, many prognancies, split-course strategy, and high FIGO stage. Risk of metastases increased with decreasing hemoglobin, increasing malignancy grade and split-course treatment. Poor survival probability were related to large lateral tumor diameter, high malignancy grade and FIGO stage, low hemoglobin, split-course therapy, and adeno/adenosquamous tumor type. (orig.)

Radiotherapy for esthesioneuroblastoma: is elective nodal irradiation warranted in the multimodality treatment approach?

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Noh, O Kyu; Lee, Sang-wook; Yoon, Sang Min; Kim, Sung Bae; Kim, Sang Yoon; Kim, Chang Jin; Jo, Kyung Ja; Choi, Eun Kyung; Song, Si Yeol; Kim, Jong Hoon; Ahn, Seung Do

2011-02-01

The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy. Copyright © 2011 Elsevier Inc. All rights reserved.

Radiotherapy for Esthesioneuroblastoma: Is Elective Nodal Irradiation Warranted in the Multimodality Treatment Approach?

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Noh, O Kyu; Lee, Sang-wook; Yoon, Sang Min; Kim, Sung Bae; Kim, Sang Yoon; Kim, Chang Jin; Jo, Kyung Ja; Choi, Eun Kyung; Song, Si Yeol; Kim, Jong Hoon; Ahn, Seung Do

2011-01-01

Purpose: The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. Methods and Materials: Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. Results: Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. Conclusions: ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy.

Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective.

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Mortimer, Joshua W; McLachlan, Craig S; Hansen, Carmen J; Assareh, Hassan; Last, Andrew; McKay, Michael J; Shakespeare, Thomas P

2016-02-01

The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration. Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences. Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy. Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. © 2015 The Royal Australian and New Zealand College of Radiologists.

Comparative analyses of the effect of radiotherapy and chemotherapy or chemotherapy alone on patients' electrocardiogram

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Liang Li; Zhang Shulan; Zhang Zhaohui; Wang Junjie; Jia Tingzhen

2005-01-01

Objective: To investigate the change of breast cancer patients' electrocardiogram during combined radiotherapy and chemotherapy or chemotherapy alone for the sake of predicting the cardiotoxicity of combined radiotherapy and chemotherapy. Methods: From January, 1998 to June, 2004, 47 postoperative breast cancer patients were enrolled. Among them 29 patients received chemotherapy combined with radiotherapy (combinative group), and 18 patients received chemotherapy alone (non combinative group). The changes of electrocardiogram were observed and correlation factors were analyzed. Results: Abnormal electrocardiograms were noted in 11 (37.9%) and 2 patients (11.1%) of the combinative group and the non-combinative group respectively(z=-1.977, P=0.048). In the combinative group, heart events were significantly increased in patients above 60 years old (z=- 2.094 P=0.036). The changes of electrocardiogram were not significantly correlative with hypertension history, tumor site, dose of radiotherapy or chemotherapeutic drugs. But the incidence of abnormal electrocardiogram was higher in patients with a hypertension history than in those without it (54.5% vs 27.8%). Conclusion: The abnormalities of electrocardiogram were are more frequent in patients treated with both radiotherapy combined with chemotherapy. Our results suggest that breast cancer patients should be regularly reexamined with electrocardiography during therapy, especially whose age was those have a hypertension history and above 60 years old. (authors)

Outcome of wide local excision in dermatofibrosarcoma protuberans and use of radiotherapy for margin-positive disease

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Raashid Hamid

2013-01-01

Full Text Available Purpose: Wide local excision (WLE is the preferred treatment of dermatofibrosarcoma protuberans (DFSP. The aim is to achieve negtive margins. We followed the impact of radiotherapy used postoperatively for both margin-negative and margin-positive DFSP tumors. Materials and Methods: Outcome of treatment of 36 patients of DFSP treated at our hospital was assessed. Thirty patients received radiotherapy postoperatively and six patients received radiotherapy alone. The maximum dimension of the lesion was 15 cm 2 . Patients were followed up for varying periods of time for any recurrence. Results: 10-year actuarial local control rate was determined. Local control was realized in six patients who were treated with radiotherapy alone. 30 patients were treated by radiotherapy and surgery. Out of these 30 patients, there were 6 local failures (failure rate 10%. Actuarial control rate was 82%. The failures were among patients who had positive margins. Conclusion: Radiotherapy is effective, and it decreases the recurrence rate in the treatment of DFSP. It is especially helpful in margin-positive disease. This appears true for patients treated with radiotherapy alone or radiotherapy used postoperatively.

Normal tissue complication models for clinically relevant acute esophagitis (≥ grade 2) in patients treated with dose differentiated accelerated radiotherapy (DART-bid)

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Zehentmayr, Franz; Söhn, Matthias; Exeli, Ann-Katrin; Wurstbauer, Karl; Tröller, Almut; Deutschmann, Heinz; Fastner, Gerd; Fussl, Christoph; Steininger, Philipp; Kranzinger, Manfred; Belka, Claus; Studnicka, Michael; Sedlmayer, Felix

2015-01-01

One of the primary dose-limiting toxicities during thoracic irradiation is acute esophagitis (AE). The aim of this study is to investigate dosimetric and clinical predictors for AE grade ≥ 2 in patients treated with accelerated radiotherapy for locally advanced non-small cell lung cancer (NSCLC). 66 NSCLC patients were included in the present analysis: 4 stage II, 44 stage IIIA and 18 stage IIIB. All patients received induction chemotherapy followed by dose differentiated accelerated radiotherapy (DART-bid). Depending on size (mean of three perpendicular diameters) tumors were binned in four dose groups: <2.5 cm 73.8 Gy, 2.5–4.5 cm 79.2 Gy, 4.5–6 cm 84.6 Gy, >6 cm 90 Gy. Patients were treated in 3D target splitting technique. In order to estimate the normal tissue complication probability (NTCP), two Lyman models and the cutoff-logistic regression model were fitted to the data with AE ≥ grade 2 as statistical endpoint. Inter-model comparison was performed with the corrected Akaike information criterion (AIC c ), which calculates the model’s quality of fit (likelihood value) in relation to its complexity (i.e. number of variables in the model) corrected by the number of patients in the dataset. Toxicity was documented prospectively according to RTOG. The median follow up was 686 days (range 84–2921 days), 23/66 patients (35 %) experienced AE ≥ grade 2. The actuarial local control rates were 72.6 % and 59.4 % at 2 and 3 years, regional control was 91 % at both time points. The Lyman-MED model (D50 = 32.8 Gy, m = 0.48) and the cutoff dose model (D c = 38 Gy) provide the most efficient fit to the current dataset. On multivariate analysis V38 (volume of the esophagus that receives 38 Gy or above, 95 %-CI 28.2–57.3) was the most significant predictor of AE ≥ grade 2 (HR = 1.05, CI 1.01–1.09, p = 0.007). Following high-dose accelerated radiotherapy the rate of AE ≥ grade 2 is slightly lower than reported for concomitant radio-chemotherapy with the

The effects of radiotherapy and surgery on the sexual function of women treated for cervical cancer

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Flay, Linda D.; Matthews, John H.L.

1995-01-01

Purpose: This study investigated the short- and medium-term effects of pelvic radiotherapy and surgery on the sexual function of women treated for cervical cancer. Methods and Materials: Sixteen women with Stages I, II, or III disease referred for radiotherapy treatment were assessed. Six had undergone prior hysterectomy. The women were assessed with questionnaires prior to radiotherapy, at completion of radiotherapy, and at 6 weeks and 14 weeks after radiotherapy treatment. The clinical findings at routine follow-up were noted. Results: The study showed significant changes in sexual activity and satisfaction as a result of treatment. This was due to a number of physical and psychological factors. The level of sexual activity was lowest at completion of radiotherapy treatment. A feeling of vaginal shortening was the most frequent reason and was more common in women who were treated with surgery and radiotherapy. Dyspareunia, bleeding, and concern of bleeding and/or recurrence were all significant factors. Conclusions: The questionnaires were an effective way of assessing women's sexual function. Radiotherapy caused sexual dysfunction in one-half of women. Combined treatment with radiotherapy and surgery results in a higher risk than radiotherapy alone. Women with cervical cancer and undergoing radiotherapy treatment require considerable counseling and support

Sparing of contralateral major salivary glands has a significant effect on oral health in patients treated with radical radiotherapy of head and neck tumors

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Beer, K.T.; Greiner, R.H. [Klinik fuer Radio-Onkologie, Univ. Bern, Inselspital (Switzerland); Zehnder, D.; Lussi, A. [Klinik fuer Zahnerhaltung, Kinder- und Praeventivmedizin, Univ. Bern, Inselspital (Switzerland)

2002-12-01

Background: Has a conscious exclusion of the contralateral major salivary glands (parotid, submandibular, and sublingual glands) a significant impact on the milieu of the oral cavity (saliva flow, pH, buffer capacity, and colonisation with Streptococcus mutans) in patients with ENT tumors receiving radical radiotherapy? Patients and Methods: 20 consecutive consentient patients with ENT tumors were evaluated once before, weekly during, and 6 weeks after the end of treatment in regard to saliva flow, pH, buffer capacity, and colonisation with Streptococcus mutans. In 13 patients the major salivary glands on both sides were included in the treated volume, in seven patients the treatment portals excluded consciously the contralateral major salivary glands. Results: The stimulated saliva flow decreases already during the 1st week of radiotherapy, the decrease follows the dose exponentially; the saliva flow is further reduced in the weeks after the end of treatment. The effect is less pronounced in patients with sparing of contralateral major salivary glands. The majority of patients with unilateral sparing of the major salivary glands retain the baseline value of buffer capacity, whereas buffer capacity of all patients with inclusion of all major salivary glands is markedly reduced with 20 Gy already, without signs of recovery when treatment has stopped. With unilateral salivary gland sparing the pH always remains basic, in bilaterally irradiated patients the pH changes from a mean of 7.3 to 5.8 during treatment. The colonisation with Streptococcus mutans varies little in both groups during the radiotherapy; after the end of therapy, it is higher in bilaterally irradiated patients. Conclusions: The conscious arrangement of irradiation portals in order to spare contralateral major salivary glands in patients with radical radiotherapy of ENT tumors has a significant influence on the oral environment: the stimulated saliva flow is higher, the buffer capacity retains the

Radiotherapy for cutaneous cancers with xeroderma pigmentosum

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Ben Salah, H.; Bahri, M.; Turki, H.; Abdelmoula, M.; Frikha, M.; Daoud, J.

2011-01-01

Purpose. - To analyze the therapeutic results of cutaneous cancers on xeroderma pigmentosum through a series of 15 patients treated by radiotherapy. Patients and methods. - Between 1993 and 2006, 15 patients with xeroderma pigmentosum and having cutaneous cancers were treated in the Radiotherapy Department of university hospital Habib-Bourguiba of Sfax in Tunisia. Seventy-three percent of the cases occurred in male patients and the mean age of appearance of the first tumour was 18.2 years. Tumour histology was squamous cell carcinoma in 74% of the cases. The total number of cutaneous tumours was 84. Ten patients had a surgical resection. Four patients did not respond to chemotherapy. The modality of irradiation was decided according to the size, thickness and localization of the tumour. The dose of radiotherapy was 60 Gy or equivalent with classic irradiation. Results. - The total number of lesions treated with radiotherapy was 64. Forty-three lesions were treated with contact-therapy, ten with brachytherapy and 11 with cobalt-therapy. The following acute complications were observed: cutaneous infection (53.3% of patients), radio-epithelitis (80% of patients) and necroses (33.3% of patients). Evaluation after treatment showed a clinical complete remission in 73% of the cases. Late effects were noted in seven cases: telangiectasia and cutaneous atrophy. A recurrence in the irradiated zone was observed in one case. A nodal metastasis was observed in two cases. Another patient presented lung metastases. After a median follow up of 37.2 months, four patients died, seven are alive with cutaneous cancer and four are alive with complete remission. Conclusion. - Radiotherapy is a possible and effective therapeutic alternative. Dose and methods are not defined for xeroderma pigmentosum. (authors)

Design and implementation of a system for treating paediatric patients with stereotactically-guided conformal radiotherapy.

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Adams, E J; Suter, B L; Warrington, A P; Black, P; Saran, F; Brada, M

2001-09-01

Stereotactically-guided conformal radiotherapy (SCRT) allows the delivery of highly conformal dose distributions to localised brain tumours. This is of particular importance for children, whose often excellent long-term prognosis should be accompanied by low toxicity. The commercial immobilisation system in use at our hospital for adults was felt to be too heavy for children, and precluded the use of anaesthesia, which is sometimes required for paediatric patients. This paper therefore describes the design and implementation of a system for treating children with SCRT. This system needed to be well tolerated by patients, with good access for treating typical childhood malignancies. A lightweight frame was developed for immobilisation, with a shell-based alternative for patients requiring general anaesthetic. Procedures were set up to introduce the patients to the frame system in order to maximise patient co-operation and comfort. Film measurements were made to assess the impact of the frame on transmission and surface dose. The reproducibility of the systems was assessed using electronic portal images. Both frame and shell systems are in clinical use. The frame weighs 0.6 kg and is well tolerated. It has a transmission of 92-96%, and fields which pass through it deliver surface doses of 58-82% of the dose at d(max), compared to 18% when no frame is present. However, the frame is constructed to maximise the availability of unobstructed beam directions. Reproducibility measurements for the frame showed a mean random error of 1.0+/-0.2mm in two dimensions (2D) and 1.4+/-0.7 mm in 3D. The mean systematic error in 3D was 2.2mm, and 90% of all overall 3D errors were less than 3.4mm. For the shell system, the mean 2D random error was 1.5+/-0.2mm. Two well-tolerated immobilisation devices have been developed for fractionated SCRT treatment of paediatric patients. A lightweight frame system gives a wide range of possible unobstructed beam directions, although beams that