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Sample records for resection radiation therapy

  1. Role of radiation therapy in patients with resectable pancreatic cancer.

    Science.gov (United States)

    Palta, Manisha; Willett, Christopher; Czito, Brian

    2011-07-01

    The 5-year overall survival of patients with pancreatic cancer is approximately 5%, with potentially resectable disease representing the curable minority. Although surgical resection remains the cornerstone of treatment, local and distant failure rates are high after complete resection, and debate continues as to the appropriate adjuvant therapy. Many oncologists advocate for adjuvant chemotherapy alone, given that high rates of systemic metastases are the primary cause of patient mortality. Others, however, view locoregional failure as a significant contributor to morbidity and mortality, thereby justifying the use of adjuvant chemoradiation. As in other gastrointestinal malignancies, neoadjuvant chemoradiotherapy offers potential advantages in resectable patients, and clinical investigation of this approach has shown promising results; however, phase III data are lacking. Further therapeutic advances and prospective trials are needed to better define the optimal role of adjuvant and neoadjuvant treatment in patients with resectable pancreatic cancer.

  2. Result of radiation therapy for non-resectable lung cancer

    International Nuclear Information System (INIS)

    Kataoka, Masaaki; Kawamura, Masashi; Kimura, Makoto; Mogami, Hiroshi; Kimura, Yoshiko; Hamamoto, Ken

    1988-01-01

    A total of 122 patients with non-resectable lung cancer, comprising 98 with non-small cell lung cancer (NSCLC) and 24 with small cell lung cancer (SCLC), who were treated from November 1976 through December 1985 with definitive radiation therapy (RT), were retrospectively analyzed for the outcome of RT. Overall, the 5-year survival rate was 6 %: it was 8 % for SCLC and 4 % for NSCLC. For NSCLC, survival was significantly better in stages I-III patients than stage IV patients (p < 0.01), although it was independent of histology, the combination of chemotherapy, and fractionation schedule. Local recurrence and distant metastasis were found to be the cause of death in 42 % and 13 %, respectively, in the stages I-II NSCLC group; and in 19 % and 52 %, respectively, in the SCLC group. The SCLC patients tended to have better survival when given chemotherapy before RT. Ten patients surviving for three years or more were characterized by having early stage of NSCLC, less than 100 cm of irradiated field, and a total dose of 60 Gy or more. Twelve patients (10 %) had severe radiation pneumonitis that resulted in death. Acute and fetal pneumonitis tended to be frequent when chemotherapy was combined with RT. (Namekawa, K.)

  3. Adjuvant postoperative radiation therapy for resectable rectal cancer

    International Nuclear Information System (INIS)

    Minsky, B.D.; Cohen, A.M.; Enker, W.E.; Kelsen, D.; Kemeny, N.; Sigurdson, E.

    1991-01-01

    Following potentially curative surgery for resectable adenocarcinoma of the rectum, the incidence of local failure is 15% to 35% in stages T 3 N 0 and T 1 N 1-2 and 45% to 65% in stages T 4 N 0 , T 3 N 1-2 , and T 4 N 1-2 . In order to determine the impact of pelvic radiation therapy±chemotherapy on local failure and survival, we present a prospective analysis of our results of 25 patients treated with this approach. The median follow-up was 30 months (range: 10 to 48 months). For the total patients group the 3-year actuarial survival was 74%. In order to more accurately analyze the patterns of failure, actuarial calculations were performed. The actuarial incidence of local failure as a component of failure was 17%. For patients with node positive disesse (T 1-4 N 1-2 ), the overall survival was 80%, and the actuarial incidence of local failure as a component of failure was 15%. Complications were acceptable and the incidence of small bowel obstruction requiring surgery was 8%. (author)

  4. Selective use of adjuvant radiation therapy in resectable colorectal adenocarcinoma

    International Nuclear Information System (INIS)

    Cohen, A.M.; Gunderson, L.L.; Welch, C.E.

    1981-01-01

    Colorectal cancer recurs within the operative field in 10-20 per cent of patients undergoing potentially curative surgery. In certain subgroups, the recurrence rate is 20-50 per cent. There are some data to suggest either preoperative or postoperative radiation therapy as an adjuvant to potentially curative surgery can reduce the local operative failure rate. However, since radiation therapy has significant side effects, patient selection to maximize the therapeutic ratio is important. This report defines the criteria at the Massachusetts General Hospital for selection of patients with colorectal cancer for adjuvant radiation therapy, defines radiation therapy-surgery sequencing alternatives used, and describes techniques to reduce radiation side effects. Over a period of three and a half years, 196 patients received adjuvant radiation therapy: 51 patients received either moderate or low dose preoperative radiation therapy to rectal or rectosigmoid cancers, and 161 patients received postoperative radiation therapy to the pelvis or extrapelvic colonic tumor-lymph node beds. Some patients who received low-dose preoperative radiation therapy also received moderate-dose postoperative radiation therapy. We prefer moderate-dose postoperative radiation therapy as the approach most likely to decrease the local recurrence rate with minimal interference with surgical procedures and late small-bowel complications. Patients who received postoperative radiation therapy were those without distant metastases, whose primary tumor pathology revealed macroscopic or extensive microscopic transmural tumor penetration into extraperitoneal tissues. Careful case selection, multiple field techniques, the use of reperitonealization, omental flaps, and retroversion of the uterus into the pelvis were combined with postoperative small-bowel x-rays, bladder distention, and lateral portals to minimize radiation damage to normal structures

  5. Salvage radiation therapy for residual superficial esophageal cancer after endoscopic mucosal resection

    International Nuclear Information System (INIS)

    Nemoto, Kenji; Takai, Kenji; Ogawa, Yoshihiro; Sakayauchi, Toru; Sugawara, Toshiyuki; Jingu, Ken-ichi; Wada, Hitoshi; Takai, Yoshihiro; Yamada, Shogo

    2005-01-01

    Purpose: To analyze the outcomes of radiation therapy for patients with residual superficial esophageal cancer (rSEC) after endoscopic mucosal resection (EMR). Methods and Materials: From May 1996 to October 2002, a total of 30 rSEC patients without lymph node metastasis received radiation therapy at Tohoku University Hospital and associated hospitals. The time interval from EMR to start of radiation therapy ranged from 9 to 73 days (median interval, 40 days). Radiation doses ranged from 60 Gy to 70 Gy (mean dose, 66 Gy). Chemotherapy was used in 9 of 30 patients (30%). Results: The 2-year, 3-year, and 5-year overall survival rates and cause-specific survival rates were 91%, 82%, and 51%, respectively, and 95%, 85%, and 73%, respectively. The 2-year, 3-year, and 5-year local control rates for mucosal cancer were 91%, 91%, and 91%, respectively, and those for submucosal cancer were 89%, 89%, and 47%, respectively. These differences in survival rates for patients with two types of cancer were not statistically significant. Local recurrence and lymph node recurrence were more frequent in patients with submucosal cancer than in patients with mucosal cancer (p = 0.38 and p 0.08, respectively). Esophageal stenosis that required balloon dilatation developed in 3 of the 30 patients, and radiation pneumonitis that required steroid therapy developed in 1 patient. Conclusions: Radiation therapy is useful for preventing local recurrence after incomplete EMR

  6. Postoperative Radiation Therapy in Resected N2 Stage Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Lee, Chang Geol

    1993-01-01

    A total of forty patients with resected N2 stage non-small cell lung cancer treated with postoperative adjuvant radiation therapy between Jan. 1975 and Dec. 1990 at the Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center were retrospectively analysed to evaluate whether postoperative radiation therapy improves survival. Patterns of failure and prognostic factors affecting survival were also analysed. The 5 year overall and disease free survival rate were 26.3%, 27.3% and median survival 23.5 months. The 5 year survival rates by T-stage were T1 66.7%, T2 25.6% and T3 12.5%. Loco-regional failure rate was 14.3% and distant metastasis rate was 42.9% and both 2.9%. Statistically significant factor affecting distant failure rate was number of positive lymph nodes(>= 4). This retrospective study suggests that postoperative radiation therapy in resected N2 stage non-small cell lung cancer can reduce loco-regional recurrence and may improve survival rate as compared with other studies which were treated by surgery alone. Further study of systemic control is also needed due to high rate of distant metastasis

  7. Radiation therapy rather than prior surgery reduces extent of resection during endonasal endoscopic reoperation for craniopharyngioma.

    Science.gov (United States)

    Younus, Iyan; Forbes, Jonathan A; Ordóñez-Rubiano, Edgar G; Avendano-Pradel, Rafael; La Corte, Emanuele; Anand, Vijay K; Schwartz, Theodore H

    2018-07-01

    Radiation therapy is often advocated for residual or recurrent craniopharyngioma following surgical resection to prevent local recurrence. However, radiation therapy is not always effective and may render tumors more difficult to remove. If this is the case, patients may benefit more from reoperation if gross total resection can be achieved. Nevertheless, there is little data on the impact of radiation on reoperations for craniopharyngioma. In this study, we sought to analyze whether a history of previous radiation therapy (RT) affected extent of resection in patients with recurrent craniopharyngiomas subsequently treated with reoperation via endoscopic endonasal approach (EEA). The authors reviewed a prospectively acquired database of EEA reoperations of craniopharyngiomas over 13 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior author. The operations were separated into two groups based on whether the patient had surgery alone (group A) or surgery and RT (group B) prior to recurrence. A total of 24 patients (16 male, 8 female) who underwent surgery for recurrent craniopharyngioma were identified. The average time to recurrence was 7.64 ± 4.34 months (range 3-16 months) for group A and 16.62 ± 12.1 months (range 6-45 months) for group B (p < 0.05). The average tumor size at recurrence was smaller in group A (1.85 ± 0.72 cm; range 0.5-3.2) than group B (2.59 ± 0.91 cm; range 1.5-4.6; p = 0.00017). Gross total resection (GTR) was achieved in 91% (10/11) of patients in group A and 54% (7/13) of patients in group B (p = 0.047). There was a near significant trend for higher average Karnofsky performance status (KPS) score at last follow-up for group A (83 ± 10.6) compared with group B (70 ± 16.3, p = 0.056). While RT for residual or recurrent craniopharyngioma may delay time to recurrence, ability to achieve GTR with additional surgery is reduced. In the case of

  8. The influence of intraoperative radiation therapy (IORT) on outcome of surgically resectable adenocarcinoma of the pancreas

    International Nuclear Information System (INIS)

    Ono, Mark K.; Ahmad, Neelofur; Huq, M. Saiful; Vernick, Jerome; Rosato, Francis E.

    1996-01-01

    Purpose/Objective: Surgical resection offers an opportunity for long term survival for patients with cancer of the pancreas. Unfavorable pathologic prognostic factors following resection of these lesions include positive surgical margins and positive lymph nodes. The purpose of this study was to analyze the influence of IORT on survival of completely resected adenocarcinomas of the pancreas in patients with these poor pathologic features. Materials and Methods: From 1988 to 1994, 391 newly diagnosed patients with carcinoma of the pancreas were seen at Thomas Jefferson University Hospital. Pre-operative work-up identified 166 patients with clinically localized disease. These patients were evaluated by the Department of Radiation Oncology for possible treatment with IORT. These patients underwent exploratory laparotomy and 26 had a complete surgical resection (i.e. Whipple procedure or total pancreatectomy) and received IORT. Mean patient age was 66 ± 2 years (range: 43-80) with 15 male and 11 female patients. All patients had histologically proven adenocarcinoma of the pancreas. IORT was delivered to the surgical tumor bed and regional lymph nodes with a median dose of 15.0 Gy (range: 10.0-20.0 Gy). Technique, field size, and energy of the electron radiation beam varied with the clinical situation and were determined by the radiation oncologist. All 26 patients received post-operative external beam radiation therapy (EBRT) with concurrent weekly 5-FU chemotherapy. Follow-up times ranged from one to 84 months (median: 15 months). Actuarial survival rates were calculated by the Life-Table Method. Patient outcome was evaluated with respect to surgical margin and pathological lymph node status. Results: The overall actuarial 2-year survival rate was 44%. The overall median survival time (MST) was 19 months. At pathological review, five of the 26 patients (19%) were found to have positive surgical margins, four of whom also had involved lymph nodes. Thus, only one

  9. Hyperfractionated radiation therapy for incompletely resected supratentorial low-grade glioma. A phase II study

    International Nuclear Information System (INIS)

    Jeremic, B.; Milicic, B.; Stojanovic, M.; Nikolic, N.; Dagovic, A.; Shibamoto, Y.; Grujicic, D.

    1998-01-01

    Background and purpose: In order to investigate the feasibility, toxicity and antitumor efficacy of hyperfractionated radiation therapy, 37 adult patients with incompletely resected supratentorial low-grade glioma were entered into a phase II study. Materials and methods: The radiation therapy dose was 55 Gy in 50 fractions in 25 treatment days over 5 weeks to the tumor plus a 2-cm margin, with an additional 17.6 Gy given in 16 fractions in 8 treatment days over 1.5 weeks to the tumor plus a 1-cm margin, using 1.1 Gy b.i.d. fractionation with a 6 h interfraction interval. The total tumor dose was 72.6 Gy in 66 fractions in 33 treatment days over 6.5 weeks. Results: The median survival time (MST) for all 37 patients has not yet been attained, while 5- and 7-year survival rates were 75% and 69%, respectively. The median time to tumor progression (MTP) has also not yet been attained, while 5- and 7-year progression-free survival (PFS) rates were both 70%. There was no difference in survival or PFS regarding histology, although patients with oligodendroglioma and mixed glioma had similar survival, both being higher than that of ordinary astrocytoma. On univariate analysis of potential prognostic factors, age, Karnofsky performance status (KPS), neurologic status and extent of surgery were found to influence survival. The toxicity of HFX RT was generally assessed as mild to moderate. Conclusion: HFX RT is feasible with mild to moderate toxicity. Further studies are warranted with more patients and longer follow-up before testing it against standard fractionation RT in this patient population. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  10. The role of radiation therapy after incomplete resection of penile cancer

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    Langsenlehner, T.; Mayer, R.; Prettenhofer, U.; Kapp, K.S. [Dept. of Therapeutic Radiology and Oncology, Medical Univ. of Graz (Austria); Quehenberger, F. [Inst. for Medical Informatics, Statistics and Documentation, Medical Univ. of Graz (Austria); Langsenlehner, U. [Div. of Oncology, Dept. of Internal Medicine, Medical Univ. of Graz (Austria); Pummer, K. [Dept. of Urology, Medical Univ. of Graz (Austria)

    2008-07-15

    Purpose: to retrospectively assess the outcome in patients treated with adjuvant radiotherapy for penile cancer. Patients and methods: between 1987 and 2006, 24 patients (median age, 62.7 years; range, 35.5-90.4 years) with squamous cell carcinoma of the penis (T1, n = 10; T2, n = 11; T3, n = 3) received megavoltage external radiotherapy (n = 22) or {sup 192}Ir high-dose-rate brachytherapy (n = 2) following total penectomy (n = 7), partial penectomy (n = 10), or local excision (n = 7); lymphadenectomy was performed in eight patients. In 14 patients, radiotherapy was delivered after incomplete tumor resection, and in 20 patients the planning target volume included the regional lymph nodes. Median total dose of external radiotherapy was 56 Gy/1.8-2 Gy (range, 50-60 Gy). Brachytherapy was given with a total dose of 45 Gy/3 Gy. Results: during a median follow-up of 58.4 months, penile or perineal recurrence was found in four patients giving a 5-year local control rate of 74.8%. Regional failure occurred in two patients. 5-year metastases-free survival and progression-free survival rates were 86.7% and 64.5%, respectively. Four patients died due to tumor progression. The actuarial 5-year cause-specific and overall survival rates were 84.3 and 56.6%, respectively. Conclusion: radiation therapy is a successful method of treatment for penile cancer in terms of local control and organ preservation after microscopically incomplete surgery. Radiotherapy of the regional lymph nodes might also be effective in preventing regional recurrence and can be considered in case of high-risk features and following excision of extensive lymph node involvement. (orig.)

  11. Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers

    International Nuclear Information System (INIS)

    Gemignani, Mary L.; Alektiar, Kaled M.; Leitao, Mario; Mychalczak, Boris; Chi, Dennis; Venkatraman, Ennapadam; Barakat, Richard R.; Curtin, John P.

    2001-01-01

    Objective: To determine the outcome for patients with recurrent gynecologic tumors treated with radical resection and combined high-dose intraoperative radiation therapy (HDR-IORT). Methods and Materials: Between November 1993 and June 1998, 17 patients with recurrent gynecologic malignancies underwent radical surgical resection and high-dose-rate brachytherapy. The mean age of the study group was 49 years (range 28-72 years). The site of the primary tumor was the cervix in 9 (53%) patients, the uterus in 7 (41%) patients, and the vagina in 1 (6%) patient. The treatment for the primary disease was surgery with or without adjuvant radiation in 14 (82%) patients and definitive radiation in 3 (18%) patients. The current surgery consisted of exenterative surgery in 10 (59%) patients and tumor resection in 7 (41%) patients. Complete gross resection was achieved in 13 (76%) patients. The mean HDR-IORT dose was 14 Gy (range 12-15). Additional radiation in the form of permanent Iodine-125 implant was given to 3 of 4 patients with gross residual disease. The median peripheral dose was 140 Gy. Results: With a median follow-up of 20 months (range 3-65 months), the 3-year actuarial local control (LC) rate was 67%. In patients with complete gross resection, the 3-year LC rate was 83%, compared to 25% in patients with gross residual disease, p<0.01. The 3-year distant metastasis disease-free and overall survival rates were 54% and 54%, respectively. The complications were as follows: gastrointestinal obstruction, 4 (24%); wound complications, 4 (24%); abscesses, 3 (18%); peripheral neuropathy, 3 (18%); rectovaginal fistula, 2 (12%); and ureteral obstruction, 2 (12%). Conclusion: Radical surgical resection and combined IORT for patients with recurrent gynecologic tumors seems to provide a reasonable local-control rate in patients who have failed prior surgery and/or definitive radiation. Patient selection is very important, however, as only those patients with complete gross

  12. External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Long-term outcome

    International Nuclear Information System (INIS)

    Sole, C.V.; Calvo, F.A.; Lozano, M.A.; Gonzalez-Sansegundo, C.; Gonzalez-Bayon, L.; Alvarez, A.; Lizarraga, S.; Garcia-Sabrido, J.L.

    2014-01-01

    The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC). From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10-15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Median follow-up time for the entire cohort of patients was 42 months (range 2-169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates. External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment. (orig.)

  13. External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Long-term outcome

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    Sole, C.V. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Instituto de Radiomedicina, Service of Radiation Oncology, Santiago (Chile); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Calvo, F.A. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Lozano, M.A.; Gonzalez-Sansegundo, C. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Gonzalez-Bayon, L. [Hospital General Universitario Gregorio Maranon, Service of General Surgery, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Alvarez, A. [Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Lizarraga, S. [Hospital General Universitario Gregorio Maranon, Department of Gynecology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Garcia-Sabrido, J.L. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of General Surgery, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Gynecology, Madrid (Spain)

    2014-02-15

    The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC). From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10-15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Median follow-up time for the entire cohort of patients was 42 months (range 2-169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates. External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment. (orig.)

  14. Patterns of failure after resection of non-small-cell lung cancer: Implications for postoperative radiation therapy volumes

    International Nuclear Information System (INIS)

    Kelsey, Chris R.; Light, Kim L.C.; Marks, Lawrence B.

    2006-01-01

    Purpose: To analyze local-regional patterns of failure after surgical resection of non-small-cell lung cancer (NSCLC). Methods and Materials: This retrospective analysis included 61 patients who underwent resection of NSCLC at Duke University Medical Center. Inclusion into the study required the following: margin-negative resection, no neoadjuvant/adjuvant radiation therapy (RT), first recurrence involving a local-regional site, and imaging studies available for review. Sites of intrathoracic disease recurrence were documented. Diagrams were constructed that illustrated sites of failure on the basis of lobe of primary tumor. Failure rates were compared by application of a two-tailed Fisher's exact test. Results: All patients had CT imaging for review, and 54% also had PET imaging. The median number of local-regional recurrent sites was two (range, 1-6). For all patients, the most common site of failure was the bronchial stump/staple line (44%), which was present more often in those who had a wedge resection than in those who had a more radical procedure (79% vs. 34%, p = 0.005). Patients with initial nodal involvement (pN1-2) were not more likely to have involvement of the mediastinum than were patients with pN0 disease (64% vs. 72%, p = 0.72), but were more likely to have involvement of the supraclavicular fossa (27% vs. 4%, p = 0.04). Mediastinal involvement, without overt evidence of hilar involvement, occurred in 59% of patients. Left-sided tumors tended to involve the contralateral mediastinum more frequently than did right-sided tumors. Patterns of failure after resection are diagrammed and follow a fairly predictable pattern on the basis of involved lobe. Conclusions: These data may help clinicians construct postoperative RT volumes that are smaller than ones traditionally utilized, which may improve the therapeutic ratio

  15. Intraoperative Radiation Therapy Reduces Local Recurrence Rates in Patients With Microscopically Involved Circumferential Resection Margins After Resection of Locally Advanced Rectal Cancer

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    Alberda, Wijnand J.; Verhoef, Cornelis [Department of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Nuyttens, Joost J. [Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Meerten, Esther van [Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Rothbarth, Joost [Department of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Wilt, Johannes H.W. de [Department of Surgery, Division of Surgical Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Burger, Jacobus W.A., E-mail: j.burger@erasmusmc.nl [Department of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)

    2014-04-01

    Purpose: Intraoperative radiation therapy (IORT) is advocated by some for patients with locally advanced rectal cancer (LARC) who have involved or narrow circumferential resection margins (CRM) after rectal surgery. This study evaluates the potentially beneficial effect of IORT on local control. Methods and Materials: All surgically treated patients with LARC treated in a tertiary referral center between 1996 and 2012 were analyzed retrospectively. The outcome in patients treated with IORT with a clear but narrow CRM (≤2 mm) or a microscopically involved CRM was compared with the outcome in patients who were not treated with IORT. Results: A total of 409 patients underwent resection of LARC, and 95 patients (23%) had a CRM ≤ 2 mm. Four patients were excluded from further analysis because of a macroscopically involved resection margin. In 43 patients with clear but narrow CRMs, there was no difference in the cumulative 5-year local recurrence-free survival of patients treated with (n=21) or without (n=22) IORT (70% vs 79%, P=.63). In 48 patients with a microscopically involved CRM, there was a significant difference in the cumulative 5-year local recurrence-free survival in favor of the patients treated with IORT (n=31) compared with patients treated without IORT (n=17) (84 vs 41%, P=.01). Multivariable analysis confirmed that IORT was independently associated with a decreased local recurrence rate (hazard ratio 0.24, 95% confidence interval 0.07-0.86). There was no significant difference in complication rate of patients treated with or without IORT (65% vs 52%, P=.18) Conclusion: The current study suggests that IORT reduces local recurrence rates in patients with LARC with a microscopically involved CRM.

  16. Stereotactic Body Radiation Therapy for Locally Advanced and Borderline Resectable Pancreatic Cancer Is Effective and Well Tolerated

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    Chuong, Michael D. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Springett, Gregory M. [Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Freilich, Jessica M.; Park, Catherine K. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Weber, Jill M. [Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Mellon, Eric A. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Hodul, Pamela J.; Malafa, Mokenge P.; Meredith, Kenneth L. [Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Hoffe, Sarah E. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Shridhar, Ravi, E-mail: ravi.shridhar@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States)

    2013-07-01

    Purpose: Stereotactic body radiation therapy (SBRT) provides high rates of local control (LC) and margin-negative (R0) resections for locally advanced pancreatic cancer (LAPC) and borderline resectable pancreatic cancer (BRPC), respectively, with minimal toxicity. Methods and Materials: A single-institution retrospective review was performed for patients with nonmetastatic pancreatic cancer treated with induction chemotherapy followed by SBRT. SBRT was delivered over 5 consecutive fractions using a dose painting technique including 7-10 Gy/fraction to the region of vessel abutment or encasement and 5-6 Gy/fraction to the remainder of the tumor. Restaging scans were performed at 4 weeks, and resectable patients were considered for resection. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Results: Seventy-three patients were evaluated, with a median follow-up time of 10.5 months. Median doses of 35 Gy and 25 Gy were delivered to the region of vessel involvement and the remainder of the tumor, respectively. Thirty-two BRPC patients (56.1%) underwent surgery, with 31 undergoing an R0 resection (96.9%). The median OS, 1-year OS, median PFS, and 1-year PFS for BRPC versus LAPC patients was 16.4 months versus 15 months, 72.2% versus 68.1%, 9.7 versus 9.8 months, and 42.8% versus 41%, respectively (all P>.10). BRPC patients who underwent R0 resection had improved median OS (19.3 vs 12.3 months; P=.03), 1-year OS (84.2% vs 58.3%; P=.03), and 1-year PFS (56.5% vs 25.0%; P<.0001), respectively, compared with all nonsurgical patients. The 1-year LC in nonsurgical patients was 81%. We did not observe acute grade ≥3 toxicity, and late grade ≥3 toxicity was minimal (5.3%). Conclusions: SBRT safely facilitates margin-negative resection in patients with BRPC pancreatic cancer while maintaining a high rate of LC in unresectable patients. These data support the expanded implementation of SBRT for pancreatic cancer.

  17. Radiation therapy of non-resected epidermoid carcinoma of the esophagus

    International Nuclear Information System (INIS)

    Matsudaira, Naoya

    1989-01-01

    During the period between January 1972 and March 1987, 72 patients with locoregional or extensive epidermoid carcinomas of the esophagus were treated with radiation. Patients were subdivided into three groups ; 17 patients who received a radiation dose of more than 50 Gy to locoregional carcinomas (curative group), 44 patients who received more than 50 Gy to extensive carcinomas (non-curative group) and 11 patients who received less than 50 Gy to locoregional or extensive carcinomas (palliative group). Both local control and survival rates were excellent and highest in the curative group, followed by the non-curative and palliative groups, respectively. Survival rates at 1, 2, 3, and 5 years were, 50.0, 31.3, 25.0 and 18.8% in the curative group; 23.3, 7.0, 2.4% and no survivors at 4 years in the non-curative group; and 11.1% and no survivors at 2 years in the palliative group, respectively. The median survival periods were 290, 170 and 149 days in the curative, non-curative and palliative group, respectively. Assuming the survival of patients beyond 2 years to be the excellent result of radiation therapy of carcinoma of the esophagus, the favorable factors were determined to be as follows. Stage I or II carcinomas, a tumor length of less than 5 cm, complete tumor response to radiation (CR), duration of symptoms of more than 6 months, and radiation dose of more than 71 Gy. (author)

  18. Intraoperative Radiation Therapy in Resected Pancreatic Carcinoma: Long-Term Analysis

    International Nuclear Information System (INIS)

    Valentini, Vincenzo; Morganti, Alessio G.; Macchia, Gabriella; Mantini, Giovanna; Mattiucci, Gian C.; Brizi, M. Gabriella; Alfieri, Sergio; Bossola, Maurizio; Pacelli, Fabio; Sofo, Luigi; Doglietto, Giovanbattista; Cellini, Numa

    2008-01-01

    Purpose: The combination of external radiotherapy (RT) plus intraoperative radiotherapy (IORT) in patients with pancreatic cancer is still debated. This study presents long-term results (minimum follow-up, 102 months) for 26 patients undergoing integrated adjuvant RT (external RT + IORT). Methods and Materials: From 1990 to 1995, a total of 17 patients with pancreatic cancer underwent IORT (10 Gy) and postoperative external RT (50.4 Gy). Preoperative 'flash' RT was included for the last 9 patients. The liver and pancreatic head received 5 Gy (two 2.5-Gy fractions) the day before surgery. In the subsequent period (1996-1998), 9 patients underwent preoperative concomitant chemoradiation (39.6 Gy) with 5-fluorouracil, IORT (10 Gy), and adjuvant chemotherapy. Results: Preoperative chemoradiation was completed in all patients, whereas postoperative therapy was completed in 13 of 17 patients. All 26 patients underwent pancreatectomy (25 R0 and one R1 resections). One patient died of postoperative complications (3.8%) not related to IORT. The 9 patients undergoing concomitant chemoradiation were candidates for adjuvant chemotherapy; however, only 4 of 9 underwent adjuvant chemotherapy. At last follow-up, 4 patients (15.4%) were alive and disease free. Disease recurrence was documented in 20 patients (76.9%). Sixteen patients (61.5%) showed distant metastasis, and 5 patients (19.2%) showed local recurrence. The incidence of local recurrence in R0 patients was 4 of 25 (16.0%). The overall 5-year survival rate was 15.4%. There was significant correlation with overall survival of tumor diameter (p = 0.019). Conclusions: The incidence of local recurrence in this long follow-up series (19.2%) was definitely less than that reported in other studies of adjuvant RT (∼50%), suggesting a positive impact on local control of integrated adjuvant RT (IORT + external RT)

  19. Clinical phase I/II trial to investigate neoadjuvant intensity-modulated short term radiation therapy (5 × 5 gy) and intraoperative radiation therapy (15 gy) in patients with primarily resectable pancreatic cancer - NEOPANC

    International Nuclear Information System (INIS)

    Roeder, Falk; Debus, Juergen; Huber, Peter E; Werner, Jens; Timke, Carmen; Saleh-Ebrahimi, Ladan; Schneider, Lutz; Hackert, Thilo; Hartwig, Werner; Kopp-Schneider, Annette; Hensley, Frank W; Buechler, Markus W

    2012-01-01

    The current standard treatment, at least in Europe, for patients with primarily resectable tumors, consists of surgery followed by adjuvant chemotherapy. But even in this prognostic favourable group, long term survival is disappointing because of high local and distant failure rates. Postoperative chemoradiation has shown improved local control and overalls survival compared to surgery alone but the value of additional radiation has been questioned in case of adjuvant chemotherapy. However, there remains a strong rationale for the addition of radiation therapy considering the high rates of microscopically incomplete resections after surgery. As postoperative administration of radiation therapy has some general disadvantages, neoadjuvant and intraoperative approaches theoretically offer benefits in terms of dose escalation, reduction of toxicity and patients comfort especially if hypofractionated regimens with highly conformal techniques like intensity-modulated radiation therapy are considered. The NEOPANC trial is a prospective, one armed, single center phase I/II study investigating a combination of neoadjuvant short course intensity-modulated radiation therapy (5 × 5 Gy) in combination with surgery and intraoperative radiation therapy (15 Gy), followed by adjuvant chemotherapy according to the german treatment guidelines, in patients with primarily resectable pancreatic cancer. The aim of accrual is 46 patients. The primary objectives of the NEOPANC trial are to evaluate the general feasibility of this approach and the local recurrence rate after one year. Secondary endpoints are progression-free survival, overall survival, acute and late toxicity, postoperative morbidity and mortality and quality of life. http://www.clinicaltrials.gov/ct2/show/NCT01372735

  20. Patterns of failure after complete resection of thoracic esophageal squamous cell carcinoma: implications for postoperative radiation therapy volumes

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    Zhang Wencheng; Wang Qifeng; Xiao Zefen; Yang Longhai; Liu Xiangyang

    2012-01-01

    Objective: To analyze intrathoracic or extrathoracic recurrence pattern after surgical resection of thoracic esophageal squamous cell carcinoma (TESCC) and its help for further modify and improvement on the target of postoperative radiation therapy. Methods: One hundred and ninety-five patients who had undergone resection of TESCC at the Cancer Hospital, Chinese Academy of Medical Sciences enrolled from April 1999 to July 2007. Sites of failure on different primary location of esophageal cancer were documented. Results: Patients with upper or middle thoracic esophageal cancer had higher proportion of intrathoracic recurrence. Patients with lower thoracic esophageal cancer had more intrathoracic recurrence and abdominal lymph node metastatic recurrence. Histological lymph node status has nothing to do with intrathoracic recurrence, supraclavicular lymph node (SLN) metastasis or distant metastasis (χ 2 =1.58, 0.06, 0.04, P =0.134, 0.467, 0.489, respectively), whereas the chance of abdominal lymph node metastases in N positive patients was significantly higher than that in N 0 patients (28.7%: 10.6%, χ 2 =9.94, P =0.001), and so did in middle thoracic esophageal cancer (20.0%: 5.6%, χ 2 =5.67, P =0.015). Anatomic recurrence rate of patients with proximal resection margin no more than 3 cm was significantly higher compared to those more than 3 cm (25.0%: 11.3%, χ 2 =5.65, P=0.019). Conclusions: Mediastinum is the most common recurrence site.According to recurrence site, the following radiation targets are recommended: when tumor was located at the upper or middle thoracic esophagus with negative N status, the mediastinum, the tumor bed and the supraclavicular region should be included as postoperative RT target; when tumor was located at the middle thoracic esophagus with positive N or located at the lower thoracic esophagus, the abdominal lymph node should be added.If the proximal resection margin was no more than 3 cm, the anastomotic-stoma should be included

  1. Gemcitabine-Based Combination Chemotherapy Followed by Radiation With Capecitabine as Adjuvant Therapy for Resected Pancreas Cancer

    International Nuclear Information System (INIS)

    Desai, Sameer; Ben-Josef, Edgar; Griffith, Kent A.; Simeone, Diane; Greenson, Joel K.; Francis, Isaac R.; Hampton, Janet; Colletti, Lisa; Chang, Alfred E.; Lawrence, Theodore S.; Zalupski, Mark M.

    2009-01-01

    Purpose: To report outcomes for patients with resected pancreas cancer treated with an adjuvant regimen consisting of gemcitabine-based combination chemotherapy followed by capecitabine and radiation. Patients and Methods: We performed a retrospective review of a series of patients treated at a single institution with a common postoperative adjuvant program. Between January 2002 and August 2006, 43 resected pancreas cancer patients were offered treatment consisting of 4, 21-day cycles of gemcitabine 1 g/m 2 intravenously over 30 min on Days 1 and 8, with either cisplatin 35 mg/m 2 intravenously on Days 1 and 8 or capecitabine 1500 mg/m 2 orally in divided doses on Days 1-14. After completion of combination chemotherapy, patients received a course of radiotherapy (54 Gy) with concurrent capecitabine (1330 mg/m 2 orally in divided doses) day 1 to treatment completion. Results: Forty-one patients were treated. Median progression-free survival for the entire group was 21.7 months (95% confidence interval 13.9-34.5 months), and median overall survival was 45.9 months. In multivariate analysis a postoperative CA 19-9 level of ≥180 U/mL predicted relapse and death. Toxicity was mild, with only two hospitalizations during adjuvant therapy. Conclusions: A postoperative adjuvant program using combination chemotherapy with gemcitabine and either cisplatin or capecitabine followed by radiotherapy with capecitabine is tolerable and efficacious and should be considered for Phase III testing in this group of patients.

  2. Adjuvant Radiation Therapy Improves Local Control After Surgical Resection in Patients With Localized Adrenocortical Carcinoma

    International Nuclear Information System (INIS)

    Sabolch, Aaron; Else, Tobias; Griffith, Kent A.; Ben-Josef, Edgar; Williams, Andrew; Miller, Barbra S.; Worden, Francis; Hammer, Gary D.; Jolly, Shruti

    2015-01-01

    Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone. Methods and Materials: We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane. Results: From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group. Conclusions: Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed

  3. Adjuvant Radiation Therapy Improves Local Control After Surgical Resection in Patients With Localized Adrenocortical Carcinoma

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    Sabolch, Aaron [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Else, Tobias [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Griffith, Kent A. [Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mchigan (United States); Ben-Josef, Edgar [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Williams, Andrew [University of Michigan Medical School, Ann Arbor, Mchigan (United States); Miller, Barbra S. [Division of Endocrine Surgery, Department of General Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Worden, Francis [Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Hammer, Gary D. [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Jolly, Shruti, E-mail: shrutij@med.umich.edu [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States)

    2015-06-01

    Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone. Methods and Materials: We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane. Results: From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group. Conclusions: Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed.

  4. Radiation Therapy for Control of Soft-Tissue Sarcomas Resected With Positive Margins

    International Nuclear Information System (INIS)

    DeLaney, Thomas F.; Kepka, Lucyna; Goldberg, Saveli I.; Hornicek, Francis J.; Gebhardt, Mark C.; Yoon, Sam S.; Springfield, Dempsey S.; Raskin, Kevin A.; Harmon, David C.; Kirsch, David G.; Mankin, Henry J.; Rosenberg, Andrew E.; Nielsen, G. Petur; Suit, Herman D.

    2007-01-01

    Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM. Methods and Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated by univariate (log-rank) and multivariate analysis of prognostic and treatment factors. Results: At 5 years, actuarial LC, DFS, and OS rates were: 76%, 46.7%, and 65.2%, respectively. LC was highest with extremity lesions (p 64 Gy (p 64 Gy had higher 5-year LC, DFS, and OS rates of 85%, 52.1%, and 67.8% vs. 66.1%, 41.8%, and 62.9% if ≤64 Gy, p 50), also significantly influenced OS. By multivariate analysis, the best predictors of LC were site (extremity vs. other), p 64 vs. ≤64 Gy), p 64 Gy, superficial location, and extremity site are associated with improved LC. OS is worse in patients with tumors with lesions >5 cm, grossly positive margins, and after local failure

  5. Splenomegaly and tumor marker response following selective internal radiation therapy for non-resectable liver metastases from neuroendocrine tumor

    International Nuclear Information System (INIS)

    Shehata, M.; Yan, K.; Itoh, Seiji; King, J.; Glenn, D.; Quinn, R.; Morris, D.L.

    2009-01-01

    The aim of this study was to investigate changes in spleen size, the level of chromogranin A as a tumor marker, and the relationship between these two parameters before and 3 months after selective internal radiation therapy (SIRT) for non-resectable liver metastases from neuroendocrine tumor (NET). Our first serious adverse event with this relatively new treatment is also discussed. A retrospective review of a prospective database identified patients with non-resectable liver metastases from NET who underwent SIRT between 2003 and 2007. Patients who underwent CT scans before and 3 months after treatment were included. The patients were divided into two groups: those with and without a 20% or more increase in splenic volume on the CT scans. The percentages of patients showing a tumor marker response in the two groups were then compared. Fourteen patients were included in the present analysis. A tumor marker response was seen in 6 of 7 patients (85.7%) who showed an increase in splenic volume of >20%, and in 3 of 7 patients (42.9%) without an increase in splenic volume (p=0.266). There was one death as a result of oesophageal variceal bleeding due to portal hypertension at 9 months after treatment. Splenic enlargement after SIRT may be associated with tumor marker response, although this could not be confirmed statistically in this study due to the small number of patients. Long-term splenomegaly and portal hypertension may be important complications of SIRT. This issue needs to be investigated further using a larger number of patients and longer follow-up. (author)

  6. Implications for high-precision dose radiation therapy planning or limited surgical resection after percutaneous computed tomography-guided lung nodule biopsy using a tract sealant

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    Patricia M. de Groot, MD

    2018-04-01

    Full Text Available Purpose: Precision radiation therapy such as stereotactic body radiation therapy and limited resection are being used more frequently to treat intrathoracic malignancies. Effective local control requires precise radiation target delineation or complete resection. Lung biopsy tracts (LBT on computed tomography (CT scans after the use of tract sealants can mimic malignant tract seeding (MTS and it is unclear whether these LBTs should be included in the calculated tumor volume or resected. This study evaluates the incidence, appearance, evolution, and malignant seeding of LBTs. Methods and materials: A total of 406 lung biopsies were performed in oncology patients using a tract sealant over 19 months. Of these patients, 326 had follow-up CT scans and were included in the study group. Four thoracic radiologists retrospectively analyzed the imaging, and a pathologist examined 10 resected LBTs. Results: A total of 234 of 326 biopsies (72%, including primary lung cancer [n = 98]; metastases [n = 81]; benign [n = 50]; and nondiagnostic [n = 5] showed an LBT on CT. LBTs were identified on imaging 0 to 3 months after biopsy. LBTs were typically straight or serpiginous with a thickness of 2 to 5 mm. Most LBTs were unchanged (92% or decreased (6.3% over time. An increase in LBT thickness/nodularity that was suspicious for MTS occurred in 4 of 234 biopsies (1.7%. MTS only occurred after biopsy of metastases from extrathoracic malignancies, and none occurred in patients with lung cancer. Conclusions: LBTs are common on CT after lung biopsy using a tract sealant. MTS is uncommon and only occurred in patients with extrathoracic malignancies. No MTS was found in patients with primary lung cancer. Accordingly, potential alteration in planned therapy should be considered only in patients with LBTs and extrathoracic malignancies being considered for stereotactic body radiation therapy or wedge resection.

  7. Radiation therapy

    International Nuclear Information System (INIS)

    Matsuura, Keiichi; Miyoshi, Makoto; Jinguu, Ken-ichi

    1982-01-01

    Of the cases of lung cancer in which radiation therapy was given between 1961 and November 1981, 399 cases for which histological type was confirmed, and irradiated as follows were reviewed. The cases of squamous cell carcinoma and adenocarcinoma irradiated with more than 5,000 rad or more, those of undifferentiated carcinoma irradiated with 3,000 rad or more, and those irradiated pre- and post-operatively with 3,000 rad or more. The actual 5 year survival rate for stages I, II, III and IV were 29.6, 9.3, 7.5 and 1.9% respectively, and the survival rate tended to be better for adenocarcinoma than squamous cell carcinoma at stages I, II and III, but not different at stage IV. There was no difference between large cell, small cell and squamous cell carcinomas. Irradiation with 200 rad every other day or 150 rad daily was better than that with 200 rad, and daily irradiation with 150 rad was used since 1976. The therapy of stage III small cell carcinoma at the age of up to 80 years was improved with the combination of anticancer agents, maintenance therapy and immunotherapy, but these combined therapies were not significantly effective for the cancers with other histological types or at other stages. Although there was no significant difference in statistics for resectable cases, clinically, the results were experienced to be better after resection, and surgery was done in combination as much as possible. (Kaihara, S.)

  8. Daily Tracking of Glioblastoma Resection Cavity, Cerebral Edema, and Tumor Volume with MRI-Guided Radiation Therapy.

    Science.gov (United States)

    Mehta, Shahil; Gajjar, Shefali R; Padgett, Kyle R; Asher, David; Stoyanova, Radka; Ford, John C; Mellon, Eric A

    2018-03-19

    Radiation therapy (RT) plays a critical role in the treatment of glioblastoma. Studies of brain imaging during RT for glioblastoma have demonstrated changes in the brain during RT. However, frequent or daily utilization of standalone magnetic resonance imaging (MRI) scans during RT have limited feasibility. The recent release of the tri-cobalt-60 MRI-guided RT (MR-IGRT) device (ViewRay MRIdian, Cleveland, OH) allows for daily brain MRI for the RT setup. Daily MRI of three postoperative patients undergoing RT and temozolomide for glioblastoma over a six-week course allowed for the identification of changes to the cavity, edema, and visible tumor on a daily basis. The volumes and dimensions of the resection cavities, edema, and T2-hyperintense tumor were measured. A general trend of daily decreases in cavity measurements was observed in all patients. For the one patient with edema, a trend of daily increases followed by a trend of daily decreases were observed. These results suggest that daily MRI could be used for onboard resimulation and adaptive RT for future fluctuations in the sizes of brain tumors, cavities, or cystic components. This could improve tumor targeting and reduce RT of healthy brain tissue.

  9. Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer

    International Nuclear Information System (INIS)

    Kwon, Jung Hyun; Bae, Si Hyun; Kim, Ji Yoon; Choi, Byung Ock; Jang, Hong Seok; Jang, Jeong Won; Choi, Jong Young; Yoon, Seung Kew; Chung, Kyu Won

    2010-01-01

    We evaluated the long-term effect of stereotactic body radiation therapy (SBRT) for primary small hepatocellular carcinoma (HCC) ineligible for local therapy or surgery. Forty-two HCC patients with tumors ≤ 100 cc and ineligible for local ablation therapy or surgical resection were treated with SBRT: 30-39 Gy with a prescription isodose range of 70-85% (median 80%) was delivered daily in three fractions. Median tumor volume was 15.4 cc (3.0-81.8) and median follow-up duration 28.7 months (8.4-49.1). Complete response (CR) for the in-field lesion was initially achieved in 59.6% and partial response (PR) in 26.2% of patients. Hepatic out-of-field progression occurred in 18 patients (42.9%) and distant metastasis developed in 12 (28.6%) patients. Overall in-field CR and overall CR were achieved in 59.6% and 33.3%, respectively. Overall 1-year and 3-year survival rates were 92.9% and 58.6%, respectively. In-field progression-free survival at 1 and 3 years was 72.0% and 67.5%, respectively. Patients with smaller tumor had better in-field progression-free survival and overall survival rates (<32 cc vs. ≥32 cc, P < 0.05). No major toxicity was encountered but one patient died with extrahepatic metastasis and radiation-induced hepatic failure. SBRT is a promising noninvasive-treatment for small HCC that is ineligible for local treatment or surgical resection

  10. Outcome of patients with local recurrent gynecologic malignancies after resection combined with intraoperative electron radiation therapy (IOERT)

    International Nuclear Information System (INIS)

    Arians, Nathalie; Foerster, Robert; Rom, Joachim; Uhl, Matthias; Roeder, Falk; Debus, Jürgen; Lindel, Katja

    2016-01-01

    Treatment of recurrent gynecologic cancer is a challenging issue. Aim of the study was to investigate clinical features and outcomes of patients with recurrent gynecologic malignancies who underwent resection including IOERT (intraoperative electron radiation therapy) with regard to clinical outcome and potential predictive factors or subgroups that benefit most from this radical treatment regime. A total of 36 patients with recurrent gynecologic malignancies (cervical (n = 18), endometrial (n = 12) or vulvar cancer (n = 6)) were retrospectively identified through hospital databases in accordance with institutional ethical policies. Patient characteristics and outcomes were assessed. Survival data was analyzed using the Kaplan-Meier-method and log-rank-test, categorical variables were analyzed with chi-square-method. For the entire cohort 1-/2-/5-year Overall Survival (OS) was 65.3 %/36.2 %/21.7 %. Patients with endometrial, cervical, and vulvar carcinoma had a 1-/2-/5-year OS of 83.3 %/62.5 %/50 %, 44.5 %/25.4 %/6.4 %, and 83.3 %/16.7 %/16.7 %, respectively. Patients with endometrial carcinoma showed a significantly better OS (p = 0.038). 1-/2-/5-year Local Progression-free Survival (LPFS) for the entire cohort was 44.1 %/28 %/21 % with 76.2 %/61 %/40.6 % for endometrial, 17.2 %/0 %/0 % for cervical, and 40 %/20 %/20 % for vulvar cancer, respectively. Patients with endometrial cancer showed a significantly (p = 0.017) and older patients a trend (p = 0.059) for a better LPFS. 1-/2-/5-year Distant Progression-free Survival (DPFS) for the entire cohort was 53.1 %/46.5 %/38.7 % with 74.1 %/74.1 %/74.1 % for endometrial, 36.7 %/36.7 %/0 % for cervical, and 60 %/30 %/30 % for vulvar cancer, respectively. There was a significantly better DPFS for older patients (p = 0.015) and a trend for a better DPFS for patients with endometrial carcinoma (p = 0.075). The radical procedure of resection combined with IOERT seems to be a valid curative treatment option for patients with

  11. Prognostic factors derived from recursive partition analysis (RPA) of radiation therapy oncology group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases

    International Nuclear Information System (INIS)

    Agboola, Olusegun; Benoit, Brien; Cross, Peter; Silva, Vasco da; Esche, Bernd; Lesiuk, Howard; Gonsalves, Carol

    1998-01-01

    Purpose: (a) To identify the prognostic factors that determine survival after surgical resection and irradiation of tumors metastatic to brain. (b) To determine if the prognostic factors used in the recursive partition analysis (RPA) of brain metastases cases from Radiation Therapy Oncology Group (RTOG) studies into three distinct survival classes is applicable to surgically resected and irradiated patients. Method: The medical records of 125 patients who had surgical resection and radiotherapy for brain metastases from 1985 to 1997 were reviewed. The patients' disease and treatment related factors were analyzed to identify factors that independently determine survival after diagnosis of brain metastasis. The patients were also grouped into three classes using the RPA-derived prognostic parameters which are: age, performance status, state of the primary disease, and presence or absence of extracranial metastases. Class 1: patients ≤ 65 years of age, Karnofsky performance status (KPS) of ≥70, with controlled primary disease and no extracranial metastases; Class 3: patients with KPS < 70. Patients who do not qualify for Class 1 or 3 are grouped as Class 2. The survival of these patients was determined from the time of diagnosis of brain metastases to the time of death. Results: The median survival of the entire group was 9.5 months. The three classes of patients as grouped had median survivals of 14.8, 9.9, and 6.0 months respectively (p = 0.0002). Age of < 65 years, KPS of ≥ 70, controlled primary disease, absence of extracranial metastases, complete surgical resection of the brain lesion(s) were found to be independent prognostic factors for survival; the total dose of radiation was not. Conclusion: Based on the results of this study, the patients and disease characteristics have significant impact on the survival of patients with brain metastases treated with a combination of surgical resection and radiotherapy. These parameters could be used in selecting

  12. A Phase 1 Study of Stereotactic Body Radiation Therapy Dose Escalation for Borderline Resectable Pancreatic Cancer After Modified FOLFIRINOX (NCT01446458).

    Science.gov (United States)

    Shaib, Walid L; Hawk, Natalyn; Cassidy, Richard J; Chen, Zhengjia; Zhang, Chao; Brutcher, Edith; Kooby, David; Maithel, Shishir K; Sarmiento, Juan M; Landry, Jerome; El-Rayes, Bassel F

    2016-10-01

    A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM. Dose level (DL) 1 was 30 Gy to the PTV, and for dose levels 2 through 4 (DL2-DL4) the dose was 36 Gy. The SIB dose to the PM was 6, 6, 7.5, and 9 Gy for DL-1, DL-2, DL-3, and DL-4, respectively. All patients received 4 treatments of modified FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) before SBRT. Thirteen patients with a median age of 64 years were enrolled. The median follow-up time was 18 months. The locations of the cancer were head (n=12) and uncinate/neck (n=1). One patient did not undergo SBRT. There were no grade 3 or 4 toxicities. Five patients did not undergo resection because of disease progression (1 local, 4 distant); 8 had R0 resection in the PM, and 5 of 8 had vessel reconstruction. Two patients had disease downstaged to T1 and T2 from T3 disease. Four patients are still alive, and 3 are disease free. The median overall survival for resected patients was not reached (9.3: not reached). The SBRT dose of 36 Gy with a 9-Gy SIB to the PM (total 45 Gy) delivered in 3 fractions is safe and well tolerated. The dose-limiting toxicity for a 45-Gy dose was not reached, and further dose escalations are needed in future trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. A Phase 1 Study of Stereotactic Body Radiation Therapy Dose Escalation for Borderline Resectable Pancreatic Cancer After Modified FOLFIRINOX (NCT01446458)

    International Nuclear Information System (INIS)

    Shaib, Walid L.; Hawk, Natalyn; Cassidy, Richard J.; Chen, Zhengjia; Zhang, Chao; Brutcher, Edith; Kooby, David; Maithel, Shishir K.; Sarmiento, Juan M.; Landry, Jerome; El-Rayes, Bassel F.

    2016-01-01

    Purpose: A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. Methods and Materials: A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM. Dose level (DL) 1 was 30 Gy to the PTV, and for dose levels 2 through 4 (DL2-DL4) the dose was 36 Gy. The SIB dose to the PM was 6, 6, 7.5, and 9 Gy for DL-1, DL-2, DL-3, and DL-4, respectively. All patients received 4 treatments of modified FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) before SBRT. Results: Thirteen patients with a median age of 64 years were enrolled. The median follow-up time was 18 months. The locations of the cancer were head (n=12) and uncinate/neck (n=1). One patient did not undergo SBRT. There were no grade 3 or 4 toxicities. Five patients did not undergo resection because of disease progression (1 local, 4 distant); 8 had R0 resection in the PM, and 5 of 8 had vessel reconstruction. Two patients had disease downstaged to T1 and T2 from T3 disease. Four patients are still alive, and 3 are disease free. The median overall survival for resected patients was not reached (9.3: not reached). Conclusion: The SBRT dose of 36 Gy with a 9-Gy SIB to the PM (total 45 Gy) delivered in 3 fractions is safe and well tolerated. The dose-limiting toxicity for a 45-Gy dose was not reached, and further dose escalations are needed in future trials.

  14. A Phase 1 Study of Stereotactic Body Radiation Therapy Dose Escalation for Borderline Resectable Pancreatic Cancer After Modified FOLFIRINOX (NCT01446458)

    Energy Technology Data Exchange (ETDEWEB)

    Shaib, Walid L.; Hawk, Natalyn [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Cassidy, Richard J. [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Chen, Zhengjia; Zhang, Chao [Department of Biostatistics, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Brutcher, Edith [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Kooby, David; Maithel, Shishir K.; Sarmiento, Juan M. [Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Landry, Jerome [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); El-Rayes, Bassel F., E-mail: bassel.el-rayes@emoryhealthcare.org [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2016-10-01

    Purpose: A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. Methods and Materials: A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM. Dose level (DL) 1 was 30 Gy to the PTV, and for dose levels 2 through 4 (DL2-DL4) the dose was 36 Gy. The SIB dose to the PM was 6, 6, 7.5, and 9 Gy for DL-1, DL-2, DL-3, and DL-4, respectively. All patients received 4 treatments of modified FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) before SBRT. Results: Thirteen patients with a median age of 64 years were enrolled. The median follow-up time was 18 months. The locations of the cancer were head (n=12) and uncinate/neck (n=1). One patient did not undergo SBRT. There were no grade 3 or 4 toxicities. Five patients did not undergo resection because of disease progression (1 local, 4 distant); 8 had R0 resection in the PM, and 5 of 8 had vessel reconstruction. Two patients had disease downstaged to T1 and T2 from T3 disease. Four patients are still alive, and 3 are disease free. The median overall survival for resected patients was not reached (9.3: not reached). Conclusion: The SBRT dose of 36 Gy with a 9-Gy SIB to the PM (total 45 Gy) delivered in 3 fractions is safe and well tolerated. The dose-limiting toxicity for a 45-Gy dose was not reached, and further dose escalations are needed in future trials.

  15. Prognostic Value of External Beam Radiation Therapy in Patients Treated With Surgical Resection and Intraoperative Electron Beam Radiation Therapy for Locally Recurrent Soft Tissue Sarcoma: A Multicentric Long-Term Outcome Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, Felipe A. [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Sole, Claudio V., E-mail: cvsole@uc.cl [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Cambeiro, Mauricio [Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona (Spain); Montero, Angel; Polo, Alfredo [Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid (Spain); Gonzalez, Carmen [School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona (Spain); Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid (Spain); Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Cuervo, Miguel [Service of Orthopedics and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); San Julian, Mikel [Service of Orthopedics and Traumatology, Clínica Universitaria, Universidad de Navarra, Pamplona (Spain); and others

    2014-01-01

    Background: A joint analysis of data from centers involved in the Spanish Cooperative Initiative for Intraoperative Electron Radiotherapy was performed to investigate long-term outcomes of locally recurrent soft tissue sarcoma (LR-STS) patients treated with a multidisciplinary approach. Methods and Materials: Patients with a histologic diagnosis of LR-STS (extremity, 43%; trunk wall, 24%; retroperitoneum, 33%) and no distant metastases who underwent radical surgery and intraoperative electron radiation therapy (IOERT; median dose, 12.5 Gy) were considered eligible for participation in this study. In addition, 62% received external beam radiation therapy (EBRT; median dose, 50 Gy). Results: From 1986 to 2012, a total of 103 patients from 3 Spanish expert IOERT institutions were analyzed. With a median follow-up of 57 months (range, 2-311 months), 5-year local control (LC) was 60%. The 5-year IORT in-field control, disease-free survival (DFS), and overall survival were 73%, 43%, and 52%, respectively. In the multivariate analysis, no EBRT to treat the LR-STS (P=.02) and microscopically involved margin resection status (P=.04) retained significance in relation to LC. With regard to IORT in-field control, only not delivering EBRT to the LR-STS retained significance in the multivariate analysis (P=.03). Conclusion: This joint analysis revealed that surgical margin and EBRT affect LC but that, given the high risk of distant metastases, DFS remains modest. Intensified local treatment needs to be further tested in the context of more efficient concurrent, neoadjuvant, and adjuvant systemic therapy.

  16. Prognostic Value of External Beam Radiation Therapy in Patients Treated With Surgical Resection and Intraoperative Electron Beam Radiation Therapy for Locally Recurrent Soft Tissue Sarcoma: A Multicentric Long-Term Outcome Analysis

    International Nuclear Information System (INIS)

    Calvo, Felipe A.; Sole, Claudio V.; Cambeiro, Mauricio; Montero, Angel; Polo, Alfredo; Gonzalez, Carmen; Cuervo, Miguel; San Julian, Mikel

    2014-01-01

    Background: A joint analysis of data from centers involved in the Spanish Cooperative Initiative for Intraoperative Electron Radiotherapy was performed to investigate long-term outcomes of locally recurrent soft tissue sarcoma (LR-STS) patients treated with a multidisciplinary approach. Methods and Materials: Patients with a histologic diagnosis of LR-STS (extremity, 43%; trunk wall, 24%; retroperitoneum, 33%) and no distant metastases who underwent radical surgery and intraoperative electron radiation therapy (IOERT; median dose, 12.5 Gy) were considered eligible for participation in this study. In addition, 62% received external beam radiation therapy (EBRT; median dose, 50 Gy). Results: From 1986 to 2012, a total of 103 patients from 3 Spanish expert IOERT institutions were analyzed. With a median follow-up of 57 months (range, 2-311 months), 5-year local control (LC) was 60%. The 5-year IORT in-field control, disease-free survival (DFS), and overall survival were 73%, 43%, and 52%, respectively. In the multivariate analysis, no EBRT to treat the LR-STS (P=.02) and microscopically involved margin resection status (P=.04) retained significance in relation to LC. With regard to IORT in-field control, only not delivering EBRT to the LR-STS retained significance in the multivariate analysis (P=.03). Conclusion: This joint analysis revealed that surgical margin and EBRT affect LC but that, given the high risk of distant metastases, DFS remains modest. Intensified local treatment needs to be further tested in the context of more efficient concurrent, neoadjuvant, and adjuvant systemic therapy

  17. Phase I study of neoadjuvant accelerated short course radiation therapy with photons and capecitabine for resectable pancreatic cancer

    International Nuclear Information System (INIS)

    Wo, Jennifer Y.; Mamon, Harvey J.; Ferrone, Cristina R.; Ryan, David P.; Blaszkowsky, Lawrence S.; Kwak, Eunice L.; Tseng, Yolanda D.; Napolitano, Brian N.; Ancukiewicz, Marek; Swanson, Richard S.; Lillemoe, Keith D.; Castillo, Carlos Fernandez-del; Hong, Theodore S.

    2014-01-01

    Purpose: In this phase I study, we sought to determine the feasibility and tolerability of neoadjuvant short course radiotherapy (SC-CRT) delivered with photon RT with concurrent capecitabine for resectable pancreatic adenocarcinoma. Materials and methods: Ten patients with localized, resectable pancreatic adenocarcinoma were enrolled from December 2009 to August 2011. In dose level I, patients received 3 Gy × 10. In dose level 2, patients received 5 Gy × 5 (every other day). In dose level 3, patients received 5 Gy × 5 (consecutive days). Capecitabine was given during weeks 1 and 2. Surgery was performed 1–3 weeks after completion of chemotherapy. Results: With an intended accrual of 12 patients, the study was closed early due to unexpected intraoperative complications. Compared to the companion phase I proton study, patients treated with photons had increased intraoperative RT fibrosis reported by surgeons (27% vs. 63%). Among those undergoing a Whipple resection, increased RT fibrosis translated to an increased mean OR time of 69 min. Dosimetric comparison revealed significantly increased low dose exposure to organs at risk for patients treated with photon RT. Conclusions: This phase I experience evaluating the tolerability of neoadjuvant SC-CRT with photon RT closed early due to unexpected intraoperative complications

  18. Clipping of tumour resection margins allows accurate target volume delineation in head and neck cancer adjuvant radiation therapy

    International Nuclear Information System (INIS)

    Bittermann, Gido; Wiedenmann, Nicole; Bunea, Andrei; Schwarz, Steffen J.; Grosu, Anca-L.; Schmelzeisen, Rainer; Metzger, Marc C.

    2015-01-01

    Background: Accurate tumour bed localisation is a key requirement for adjuvant radiotherapy. A new procedure is described for head and neck cancer treatment that improves tumour bed localisation using titanium clips. Materials and methods: Following complete local excision of the primary tumour, the tumour bed was marked with titanium clips. Preoperative gross target volume (GTV) and postoperative tumour bed were examined and the distances between the centres of gravity were evaluated. Results: 49 patients with squamous cell carcinoma of the oral cavity were prospectively enrolled in this study. All patients underwent tumour resection, neck lymph node dissection and defect reconstruction in one stage. During surgery, 7–49 clips were placed in the resection cavity. Surgical clip insertion was successful in 88% (n = 43). Clip identification and tumour bed delineation was successful in all 43 patients. The overall distance between the centres of gravity of the preoperative tumour extension to the tumour bed was 0.9 cm. A significant relationship between the preoperative tumour extension and the postoperative tumour bed volume could be demonstrated. Conclusion: We demonstrate a precise delineation of the former tumour cavity. Improvements in tumour bed delineation allow an increase of accuracy for adjuvant treatment

  19. Radiation therapy

    International Nuclear Information System (INIS)

    Peschel, R.E; Fisher, J.J.

    1986-01-01

    The new insights and controversies concerning the radiobiological properties of malignant melanoma and how these relate to new clinical approaches are reviewed. The recent clinical experience with large individual fraction sizes is analyzed. The treatment of malignant melanoma in certain specialized sites is also described. An attempt is made to place in perspective the usefulness of radiation therapy in the treatment of this complex disease. Finally, certain new applications for radiation therapy both alone and in combustion with other treatment modalities are proposed that may ultimately prove appropriate for clinical trials

  20. Phase 1/2 Study of the Addition of Cisplatin to Adjuvant Chemotherapy With Image Guided High-Precision Radiation Therapy for Completely Resected Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goody, Rebecca B. [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); MacKay, Helen [Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Pitcher, Bethany [Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Oza, Amit; Siu, Lillian L. [Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Kim, John; Wong, Rebecca K.S. [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Chen, Eric [Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Swallow, Carol [Department of Surgical Oncology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario (Canada); Knox, Jennifer [Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Kassam, Zahra [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Stronach Regional Cancer Centre, Newmarket, Ontario (Canada); Cummings, Bernard [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Feld, Ron; Hedley, David; Liu, Geoffrey; Krzyzanowska, Monika K. [Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Dinniwell, Robert; Brade, Anthony M.; Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Pintilie, Melania [Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); and others

    2016-12-01

    Purpose: Locoregional recurrence is common after surgery for gastric cancer. Adjuvant therapy improves outcomes but with toxicity. This phase 1/2 study investigated infusional 5-fluorouracil (5-FU) in combination with biweekly cisplatin delivered concurrently with image guided high-precision radiation therapy. Methods and Materials: Eligible patients had completely resected stage IB to IV (Union for International Cancer Control TNM 6th edition) nonmetastatic gastric adenocarcinoma. Treatment constituted 12 weeks of infusional 5-FU (200 mg/m{sup 2}/day) with cisplatin added in a standard 3 + 3 dose escalation protocol (0, 20, 30, and 40 mg/m{sup 2}) during weeks 1, 3, 5, and 7, and an additional week 9 dose in the final cohort. Radiation therapy (45 Gy in 25 fractions) was delivered during weeks 3 to 7. Maximum tolerated dose (MTD) was determined in phase 1 and confirmed in phase 2. Results: Among the 55 patients (median age, 54 years; range 28-77 years; 55% male), the median follow-up time was 3.0 years (range, 0.3-5.3 years). Five patients in phase 1 experienced dose-limiting toxicity, and MTD was determined as 4 cycles of 40 mg/m{sup 2} cisplatin. Twenty-seven patients were treated at MTD. Acute grade 3 to 4 toxicity rate was 37.0% at MTD and 29.1% across all dose levels. No treatment-related deaths occurred. Fourteen patients experienced recurrent disease. The 2-year overall survival (OS) and relapse-free survival were 85% and 74%, respectively. Median OS has not been reached. Quality of life (QOL) was impaired during treatment, but most scores recovered by 4 weeks. Conclusion: Cisplatin can be safely delivered with 5-FU–based chemoradiation therapy. Acute toxicity was acceptable, and patient-reported QOL showed the regimen was tolerable. Outcomes are encouraging and justify further study of this regimen.

  1. Radiation therapy

    International Nuclear Information System (INIS)

    Bader, J.L.; Glatstein, E.

    1987-01-01

    The radiation oncologist encounters the critically ill immunosuppressed patient in four settings. First, the newly diagnosed cancer patient presents for initial evaluation and treatment, with immunosuppression from the cancer itself, malnutrition, concomitant infectious disease, prior drug or alcohol abuse or other medical problems. Second, the previously treated cancer patient presents with metastatic or recurrent primary cancer causing local symptoms. Immune dysfunction in this setting may be due to prior chemotherapy and/or radiation as well as any of the original factors. Third, the patient previously treated with radiation presents with a life-threatening problem possibly due to complications of prior therapy. In this setting, the radiation oncologist is asked to evaluate the clinical problem and to suggest whether radiation might be causing part or all of the problem and what can be done to treat these sequelae of radiation. Fourth, the patient with a benign diagnosis (not cancer) is seen with a problem potentially emeliorated by radiation (e.g., kidney transplant rejection, preparation for transplant, or intractable rheumatoid arthritis). This chapter reviews these four issues and presents clinical and radiobiologic principles on which recommendations for therapy are based

  2. Phase II trial of combined surgical resection, high dose rate intraoperative radiation therapy, and external beam radiotherapy for malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Raben, A.; Rusch, V.; Mychalczak, B.; Ginsberg, R.; Burt, M.; Bains, M.; Francois, Damien; Harrison, L.B.

    1997-01-01

    Purpose: To determine the feasibility of combining extrapleural pneumonectomy (EPP) or pleurectomy / decortication (PD), high dose rate intraoperative radiation therapy (HDR-IORT) and postoperative external beam radiation hemithoracic radiation (EBHRT) to treat malignant pleural mesothelioma (MPM). Materials and Methods: From 3/94 through 9/94, 15 patients (pts) were enrolled on this trial. This included 3 females and 12 males with a median age of 59 (Range: 45-75). Eligibility criteria included biopsy proven MPM, no evidence of T4 or N3 disease by exam/CT/MRI, no evidence of metastatic disease, no previous treatment, and a Karnofsky performance status of ≥ 80%. Pts with pulmonary function tests permitting EPP, underwent EPP and HDR-IORT (N=7). The rest underwent PD/HDR-IORT (N=4). An intraoperative dose of 15 Gy was prescribed to a depth of 5 mm in tissue to the ipsilateral mediastinum, diaphragm, and chest wall. Postoperatively, 54 Gy of EBHRT was prescribed to the hemithorax, surgical scar and surgical drain site. The median surgical procedure time, median IORT time and median overall operating time was 554 minutes, 240 minutes, and 649 minutes respectively. The median dose of EBHRT was 50.4 Gy (Range 50-54 Gy). The median follow-up time is 8 months (Range: 3.5 to 28 months). Four of 15 pts had unresectable disease at the time of surgery and were taken off study. Results are presented in crude and actuarial analysis. Results: A complete resection of all visible gross disease was accomplished in 10 pts. One pt had a single focus of gross residual disease (less than 5 mm in size) left behind in the chest wall. The overall complication rate was 54%. Treatment related mortality occurred in 2 pts (18%) at 1 and 7 months respectively. This was attributed to ARDS in 1 pt (EPP/HDR-IORT) and radiation pneumonitis combined with a tracheoesophageal fistula in 1 pt (PD/HDR-IORT). Of the 6 remaining pts undergoing EPP/HDR-IORT, 2 pts developed a postoperative empyema with

  3. Phase II trial of combined surgical resection, intraoperative high dose rate brachytherapy (IORT), and external beam radiation therapy (EBRT) for malignant pleural mesothelioma (MPM)

    International Nuclear Information System (INIS)

    Raben, A.; Rusch, V.; Mychalczak, B.; Schupak, K.; Ginsburg, R.; Burt, M.; Bains, M.; Harrison, L.B.

    1996-01-01

    respiratory distress and expired. Two pts developed a postoperative empyema with bronchial stump leak; with 1 pt developing bleeding from mediastinal vessels at 7 months. This was felt to be related to late radiation toxicity. Wound dehiscence of the thoracotomy incision occurred in 1 pt. Of the 4 pts undergoing PD, 1 pt developed a tracheoesophageal fistula, and 1 developed a postoperative chest tube leak. IORT in conjunction with EPP led to prohibitive local complications and has been discontinued. Although follow-up is short, IORT with PD shows no improvement in local control compared to our historical experience. Local control with EPP/EBRT has thus far been excellent with most patients relapsing outside of the EBRT field, in distinct contrast to the reported pattern of disease progression in MPM, emphasizing the need for improved systemic therapy

  4. Computer tomography in refined diagnosis of abdominal aortic aneurysms: comparison of outcomes of radiation therapies Versus surgical and morphological studies of resected abdominal aortic fragments

    International Nuclear Information System (INIS)

    Denisova, L.B.; Platonova, A.G.; Demidov, I.N.; Emel'yanova, L.N.

    1998-01-01

    The results of computed tomography (CT) was compared with ultrasonographic and angiographic finding in 168 patients. All data of radiation diagnosis of abdominal aortic aneurysms (AAA) were compared with those of operations and morphological studies of the resected fragments of the aortic parts changed due to aneurysms. These comparisons provided a detailed characterization of the potentialities of CT performed on a third-generation unit in the presurgical diagnosis of this abnormally. At the same time, detailed XCT finding (semiotics of AAA and their complications) are given. The study shows benefits of the refined AAA by applying routine CT. The paper gives a diagnostic algorithm of using radiation studies (ultrasonography, CT, angiography) in the diagnosis of AAA. Third-generation CT units widely used in clinical practice are shown to provide necessary and complete information on the magnitude of AAA

  5. Anticipated Intraoperative Electron Beam Boost, External Beam Radiation Therapy, and Limb-Sparing Surgical Resection for Patients with Pediatric Soft-Tissue Sarcomas of the Extremity: A Multicentric Pooled Analysis of Long-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Sole, Claudio V., E-mail: cvsole@uc.cl [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Calvo, Felipe A. [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Polo, Alfredo [Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid (Spain); Cambeiro, Mauricio [Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona (Spain); Alvarez, Ana; Gonzalez, Carmen [Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Gonzalez, Jose [Service of Pediatric Orthopedics and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); San Julian, Mikel [Service of Orthopedics and Traumatology, Clínica Universidad de Navarra, Pamplona (Spain); Martinez-Monge, Rafael [Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona (Spain)

    2014-09-01

    Purpose: To perform a joint analysis of data from 3 contributing centers within the intraoperative electron-beam radiation therapy (IOERT)-Spanish program, to determine the potential of IOERT as an anticipated boost before external beam radiation therapy in the multidisciplinary treatment of pediatric extremity soft-tissue sarcomas. Methods and Materials: From June 1993 to May 2013, 62 patients (aged <21 years) with a histologic diagnosis of primary extremity soft-tissue sarcoma with absence of distant metastases, undergoing limb-sparing grossly resected surgery, external beam radiation therapy (median dose 40 Gy) and IOERT (median dose 10 Gy) were considered eligible for this analysis. Results: After a median follow-up of 66 months (range, 4-235 months), 10-year local control, disease-free survival, and overall survival was 85%, 76%, and 81%, respectively. In multivariate analysis after adjustment for other covariates, tumor size >5 cm (P=.04) and R1 margin status (P=.04) remained significantly associated with local relapse. In regard to overall survival only margin status (P=.04) retained association on multivariate analysis. Ten patients (16%) reported severe chronic toxicity events (all grade 3). Conclusions: An anticipated IOERT boost allowed for external beam radiation therapy dose reduction, with high local control and acceptably low toxicity rates. The combined radiosurgical approach needs to be tested in a prospective trial to confirm these results.

  6. Anticipated Intraoperative Electron Beam Boost, External Beam Radiation Therapy, and Limb-Sparing Surgical Resection for Patients with Pediatric Soft-Tissue Sarcomas of the Extremity: A Multicentric Pooled Analysis of Long-Term Outcomes

    International Nuclear Information System (INIS)

    Sole, Claudio V.; Calvo, Felipe A.; Polo, Alfredo; Cambeiro, Mauricio; Alvarez, Ana; Gonzalez, Carmen; Gonzalez, Jose; San Julian, Mikel; Martinez-Monge, Rafael

    2014-01-01

    Purpose: To perform a joint analysis of data from 3 contributing centers within the intraoperative electron-beam radiation therapy (IOERT)-Spanish program, to determine the potential of IOERT as an anticipated boost before external beam radiation therapy in the multidisciplinary treatment of pediatric extremity soft-tissue sarcomas. Methods and Materials: From June 1993 to May 2013, 62 patients (aged <21 years) with a histologic diagnosis of primary extremity soft-tissue sarcoma with absence of distant metastases, undergoing limb-sparing grossly resected surgery, external beam radiation therapy (median dose 40 Gy) and IOERT (median dose 10 Gy) were considered eligible for this analysis. Results: After a median follow-up of 66 months (range, 4-235 months), 10-year local control, disease-free survival, and overall survival was 85%, 76%, and 81%, respectively. In multivariate analysis after adjustment for other covariates, tumor size >5 cm (P=.04) and R1 margin status (P=.04) remained significantly associated with local relapse. In regard to overall survival only margin status (P=.04) retained association on multivariate analysis. Ten patients (16%) reported severe chronic toxicity events (all grade 3). Conclusions: An anticipated IOERT boost allowed for external beam radiation therapy dose reduction, with high local control and acceptably low toxicity rates. The combined radiosurgical approach needs to be tested in a prospective trial to confirm these results

  7. Radiation Therapy Oncology Group Protocol 02-29: A Phase II Trial of Neoadjuvant Therapy With Concurrent Chemotherapy and Full-Dose Radiation Therapy Followed by Surgical Resection and Consolidative Therapy for Locally Advanced Non-small Cell Carcinoma of the Lung

    International Nuclear Information System (INIS)

    Suntharalingam, Mohan; Paulus, Rebecca; Edelman, Martin J.; Krasna, Mark; Burrows, Whitney; Gore, Elizabeth; Wilson, Lynn D.; Choy, Hak

    2012-01-01

    Purpose: To evaluate mediastinal nodal clearance (MNC) rates after induction chemotherapy and concurrent, full-dose radiation therapy (RT) in a phase II trimodality trial (Radiation Therapy Oncology Group protocol 0229). Patients and Methods: Patients (n=57) with stage III non-small cell lung cancer (pathologically proven N2 or N3) were eligible. Induction chemotherapy consisted of weekly carboplatin (AUC = 2.0) and paclitaxel 50 mg/m 2 . Concurrent RT was prescribed, with 50.4 Gy to the mediastinum and primary tumor and a boost of 10.8 Gy to all gross disease. The mediastinum was pathologically reassessed after completion of chemoradiation. The primary endpoint of the study was MNC, with secondary endpoints of 2-year overall survival and postoperative morbidity/mortality. Results: The grade 3/4 toxicities included hematologic 35%, gastrointestinal 14%, and pulmonary 23%. Forty-three patients (75%) were evaluable for the primary endpoint. Twenty-seven patients achieved the primary endpoint of MNC (63%). Thirty-seven patients underwent resection. There was a 14% incidence of grade 3 postoperative pulmonary complications and 1 30-day, postoperative grade 5 toxicity (3%). With a median follow-up of 24 months for all patients, the 2-year overall survival rate was 54%, and the 2-year progression-free survival rate was 33%. The 2-year overall survival rate was 75% for those who achieved nodal clearance, 52% for those with residual nodal disease, and 23% for those who were not evaluable for the primary endpoint (P=.0002). Conclusions: This multi-institutional trial confirms the ability of neoadjuvant concurrent chemoradiation with full-dose RT to sterilize known mediastinal nodal disease.

  8. Optimizing Adjuvant Therapy for Resected Pancreatic Cancer

    Science.gov (United States)

    In this clinical trial, patients with resected pancreatic head cancer will be randomly assigned to receive either gemcitabine with or without erlotinib for 5 treatment cycles. Patients who do not experience disease progression or recurrence will then be r

  9. Evaluation of Resection Margins in Breast Conservation Therapy: The Pathology Perspective—Past, Present, and Future

    Directory of Open Access Journals (Sweden)

    Rajyasree Emmadi

    2012-01-01

    Full Text Available Tumor surgical resection margin status is important for any malignant lesion. When this occurs in conjunction with efforts to preserve or conserve the afflicted organ, these margins become extremely important. With the demonstration of no difference in overall survival between mastectomy versus lumpectomy and radiation for breast carcinoma, there is a definite trend toward smaller resections combined with radiation, constituting “breast-conserving therapy.” Tumor-free margins are therefore key to the success of this treatment protocol. We discuss the various aspects of margin status in this setting, from a pathology perspective, incorporating the past and current practices with a brief glimpse of emerging future techniques.

  10. Radiation therapy in the treatment of hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Jing Jin; Zhai Renyou

    2007-01-01

    The incidence of hilar cholangiocarcinoma is very rare worldwide. Radical resection is the only prognostic factor for long survival in patients with hilar cholangiocarcinoma. Postoperative radiation therapy can improve local control and survival rates for patients with palliative resection, but it remains controversial in patients with radical resection. Biliary drainage can effectively release bile duct obstruction for the majority of patients with locally advanced disease, and may even prolong survival when combined with radiation therapy. Radiation therapy includes extrernal beam therapy alone, external beam therapy with intraluminal brachytheapy and new radiation technique, such as three dimentional conformal therapy and intensity modulated radiation therapy. The propective randomized clinical study is needed for further investigation in the role of combined modality therapy especially for hilar cholangiocarcinoma. (authors)

  11. Preliminary results of pre-operative 5-FU, low dose leucovorin (LV), and concurrent radiation therapy (RT) for resectable T3 rectal cancer

    International Nuclear Information System (INIS)

    Grann, Alison; Minsky, Bruce D.; Cohen, Alfred M.; Saltz, Leonard; Kelsen, David P.; Kemeny, Nancy; Ilson, David; Guillem, Jose G.; Paty, Philip B.; Bass, Joanne

    1996-01-01

    foci of tumor in the bowel wall (clinical complete response) Therefore, the total complete response rate (clinical + pathologic) was 22% ((7(32))). Operative procedures included LAR: 16, LAR/Coloanal anastomosis: 8, APR: 8. All margins were negative. Of the 25 pts thought to initially require an APR, 17 (68%) were able to undergo sphincter preserving surgery. Of the 25 pts, 5 had involvement of the anal sphincter at initial presentation and pre-op therapy was not performed with the goal of sphincter preservation since an APR was planned regardless of the degree of downstaging. Excluding those 5 pts, the incidence of sphincter preservation would have been (17(20)) (85%). The crude incidence of failure as a component of failure was local: 0%, abdominal: 10% and distant: 3%. The 2 yr actuarial disease free survival was 86% and the overall survival was 100%. CONCLUSION: Our preliminary data reveal encouraging downstaging, acute toxicity, local control, and survival rates. Additional experience is needed in order to assess the long term results. The concurrent low dose LV regimen remains our standard pre-op combined modality approach for pts with clinically resectable T3 rectal cancer

  12. Hendee's radiation therapy physics

    CERN Document Server

    Pawlicki, Todd; Starkschall, George

    2016-01-01

    The publication of this fourth edition, more than ten years on from the publication of Radiation Therapy Physics third edition, provides a comprehensive and valuable update to the educational offerings in this field. Led by a new team of highly esteemed authors, building on Dr Hendee’s tradition, Hendee’s Radiation Therapy Physics offers a succinctly written, fully modernised update. Radiation physics has undergone many changes in the past ten years: intensity-modulated radiation therapy (IMRT) has become a routine method of radiation treatment delivery, digital imaging has replaced film-screen imaging for localization and verification, image-guided radiation therapy (IGRT) is frequently used, in many centers proton therapy has become a viable mode of radiation therapy, new approaches have been introduced to radiation therapy quality assurance and safety that focus more on process analysis rather than specific performance testing, and the explosion in patient-and machine-related data has necessitated an ...

  13. Radiation Therapy for Cancer

    Science.gov (United States)

    Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Learn about the types of radiation, why side effects happen, which ones you might have, and more.

  14. Particle radiotherapy, a novel external radiation therapy, versus liver resection for hepatocellular carcinoma accompanied with inferior vena cava tumor thrombus: A matched-pair analysis.

    Science.gov (United States)

    Komatsu, Shohei; Kido, Masahiro; Asari, Sadaki; Toyama, Hirochika; Ajiki, Tetsuo; Demizu, Yusuke; Terashima, Kazuki; Okimoto, Tomoaki; Sasaki, Ryohei; Fukumoto, Takumi

    2017-12-01

    Hepatocellular carcinoma accompanied with inferior vena cava tumor thrombus carries a dismal prognosis, and the feasibility of local treatment has remained controversial. The present study aimed to compare the outcomes of particle radiotherapy and liver resection in patients with hepatocellular carcinoma with inferior vena cava tumor thrombus. Thirty-one and 19 patients, respectively, underwent particle radiotherapy and liver resection for hepatocellular carcinoma with inferior vena cava tumor thrombus. A matched-pair analysis was undertaken to compare the short- and long-term outcomes according to tumor stage determined using the tumor-node-metastasis classification. Both stages IIIB and IV (IVA and IVB) patients were well-matched for 12 factors, including treatment policy and patient and tumor characteristics. The median survival time of matched patients with stage IIIB tumors in the particle radiotherapy group was greater than that in the liver resection group (748 vs 272 days, P = .029), whereas no significant difference was observed in the median survival times of patients with stage IV tumors (239 vs 311 days, respectively). There were significantly fewer treatment-related complications of grade 3 or greater in the particle radiotherapy group (0%) than in the liver resection group (26%). Particle radiotherapy is potentially preferable in hepatocellular carcinoma patients with stage IIIB inferior vena cava tumor thrombus and at least equal in efficiency to liver resection in those with stage IV disease, while causing significantly fewer complications. Considering the relatively high survival and low invasiveness of particle radiotherapy when compared to liver resection, this approach may represent a novel treatment modality for hepatocellular carcinoma with inferior vena cava tumor thrombus. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. BCNU wafer placement with temozolomide (TMZ) in the immediate postoperative period after tumor resection followed by radiation therapy with TMZ in patients with newly diagnosed high grade glioma: final results of a prospective, multi-institutional, phase II trial.

    Science.gov (United States)

    Burri, Stuart H; Prabhu, Roshan S; Sumrall, Ashley L; Brick, Wendy; Blaker, Brian D; Heideman, Brent E; Boltes, Peggy; Kelly, Renee; Symanowski, James T; Wiggins, Walter F; Ashby, Lynn; Norton, H James; Judy, Kevin; Asher, Anthony L

    2015-06-01

    Temozolomide (TMZ) and BCNU have demonstrated anti-glioma synergism in preclinical models. We report final data from a prospective, multi-institutional study of BCNU wafers and early TMZ followed by radiation therapy with TMZ in patients with newly diagnosed malignant glioma. 65 patients were consented in 4 institutions, and 46 patients (43 GBM, 3 AA) were eligible for analysis. After resection and BCNU wafer placement, TMZ began on day four postoperatively. Radiation and TMZ (RT/TMZ) were then administered, followed by monthly TMZ at 200 mg/m2 for the first 26 patients, which was reduced to 150 mg/m2 for the remaining 20 patients. Non-hematologic toxicities were minimal. Nine of 27 patients (33 %) who received 200 mg/m2 TMZ, but only 1 of 20 (5 %) who received 150 mg/m2, experienced grade 3/4 thrombocytopenia. Median progression free survival (PFS) and overall survival (OS) period was 8.5 and 18 months, respectively. The 1-year OS rate was 76 %, which is a significant improvement compared with the historical control 1-year OS rate of 59 % (p = 0.023). However, there was no difference in 1-year OS compared with standard RT/TMZ (p = 0.12) or BCNU wafer followed by RT/TMZ (p = 0.87) in post hoc analyses. Early post-operative TMZ can be safely administered with BCNU wafers following resection of malignant glioma at the 150 mg/m2 dose level. Although there was an OS benefit compared to historical control, there was no indication of benefit for BCNU wafers and early TMZ in addition to standard RT/TMZ or early TMZ in addition to regimens of BCNU wafers followed by RT/TMZ.

  16. Preoperative gemcitabine-based chemoradiation therapy for resectable pancreatic cancer

    International Nuclear Information System (INIS)

    Takahashi, Hidenori; Ohigashi, Hiroaki; Goto, Kunihito; Marubashi, Shigeru; Yano, Masahiko; Ishikawa, Osamu

    2013-01-01

    During the period from 2002 to 2011, a total of 240 consecutive patients with resectable pancreatic cancer received preoperative chemoradiation therapy (CRT). Among 240 patients, 201 patients underwent the subsequent pancreatectomy (resection rate: 84%). The 5-year overall survival of resected cases was 56% and the median survival of 39 unresected cases was 11 months. The 5-year locoregional recurrence rate of resected cases was 15%. The 5-year overall survival of the entire cohort (n=240) was 47%. The preoperative CRT and subsequent pancreatectomy provided a favorable surgical result, which was contributed by several characteristics of preoperative CRT: the prominent locoregional treatment effect with lower incidence of locoregional recurrence, and the discrimination between patients who are likely to benefit from subsequent surgery and those who are not. (author)

  17. Comparison of Adjuvant Radiation Therapy Alone and Chemotherapy Alone in Surgically Resected Low-Grade Gliomas: Survival Analyses of 2253 Cases from the National Cancer Data Base.

    Science.gov (United States)

    Wu, Jing; Neale, Natalie; Huang, Yuqian; Bai, Harrison X; Li, Xuejun; Zhang, Zishu; Karakousis, Giorgos; Huang, Raymond; Zhang, Paul J; Tang, Lei; Xiao, Bo; Yang, Li

    2018-04-01

    It is becoming increasingly common to incorporate chemotherapy (CT) with radiotherapy (RT) in the treatment of low-grade gliomas (LGGs) after surgical resection. However, there is a lack of literature comparing survival of patients who underwent RT or CT alone. The U.S. National Cancer Data Base was used to identify patients with histologically confirmed, World Health Organization grade 2 gliomas who received either RT alone or CT alone after surgery from 2004 to 2013. Overall survival (OS) was evaluated by Kaplan-Meier analysis, multivariable Cox proportional hazard regression, and propensity-score-matched analysis. In total, 2253 patients with World Health Organization grade 2 gliomas were included, of whom 1466 (65.1%) received RT alone and 787 (34.9%) CT alone. The median OS was 98.9 months for the RT alone group and 125.8 months for the CT alone group. On multivariable analysis, CT alone was associated with a significant OS benefit compared with RT alone (hazard ratio [HR], 0.405; 95% confidence interval, 0.277-0.592; P < 0.001). On subgroup analyses, the survival advantage of CT alone over RT alone persisted across all age groups, and for the subtotal resection and biopsy groups, but not in the gross total resection group. In propensity-score-matched analysis, CT alone still showed significantly improved OS compared with RT alone (HR, 0.612; 95% confidence interval, 0.506-0.741; P < 0.001). Our results suggest that CT alone was independently associated with longer OS compared with RT alone in patients with LGGs who underwent surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. RECQ1 A159C Polymorphism Is Associated With Overall Survival of Patients With Resected Pancreatic Cancer: A Replication Study in NRG Oncology Radiation Therapy Oncology Group 9704

    Energy Technology Data Exchange (ETDEWEB)

    Li, Donghui, E-mail: dli@mdanderson.org [Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Moughan, Jennifer [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Crane, Christopher [Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hoffman, John P. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Regine, William F. [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Abrams, Ross A. [Rush University Medical Center, Chicago, Illinois (United States); Safran, Howard [Brown University Oncology Group, Providence, Rhode Island (United States); Liu, Chang; Chang, Ping [Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Winter, Kathryn A. [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Guha, Chandan [Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York (United States); Abbruzzese, James L. [Duke University Medical Center, Durham, North Carolina (United States)

    2016-03-01

    Purpose: To confirm whether a previously observed association between RECQ1 A159C variant and clinical outcome of resectable pancreatic cancer patients treated with preoperative chemoradiation is reproducible in another patient population prospectively treated with postoperative chemoradiation. Methods and Materials: Patients were selected, according to tissue availability, from eligible patients with resected pancreatic cancer who were enrolled on the NRG Oncology Radiation Therapy Oncology Group 9704 trial of 5-fluorouacil (5-FU)-based chemoradiation preceded and followed by 5-FU or gemcitabine. Deoxyribonucleic acid was extracted from paraffin-embedded tissue sections, and genotype was determined using the Taqman method. The correlation between genotype and overall survival was analyzed using a Kaplan-Meier plot, log-rank test, and multivariate Cox proportional hazards models. Results: In the 154 of the study's 451 eligible patients with evaluable tissue, genotype distribution followed Hardy-Weinberg equilibrium (ie, 37% had genotype AA, 43% AC, and 20% CC). The RECQ1 variant AC/CC genotype carriers were associated with being node positive compared with the AA carrier (P=.03). The median survival times (95% confidence interval [CI]) for AA, AC, and CC carriers were 20.6 (16.3-26.1), 18.8 (14.2-21.6), and 14.2 (10.3-21.0) months, respectively. On multivariate analysis, patients with the AC/CC genotypes were associated with worse survival than patients with the AA genotype (hazard ratio [HR] 1.54, 95% CI 1.07-2.23, P=.022). This result seemed slightly stronger for patients on the 5-FU arm (n=82) (HR 1.64, 95% CI 0.99-2.70, P=.055) than for patients on the gemcitabine arm (n=72, HR 1.46, 95% CI 0.81-2.63, P=.21). Conclusions: Results of this study suggest that the RECQ1 A159C genotype may be a prognostic or predictive factor for resectable pancreatic cancer patients who are treated with adjuvant 5-FU before and after 5-FU-based chemoradiation. Further study is

  19. Radiation Therapy - Multiple Languages

    Science.gov (United States)

    ... W XYZ List of All Topics All Radiation Therapy - Multiple Languages To use the sharing features on this page, ... Information Translations Vietnamese (Tiếng Việt) Expand Section Radiation Therapy - Tiếng Việt (Vietnamese) ... Health Information Translations Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

  20. Radiation Therapy Side Effects

    Science.gov (United States)

    Radiation therapy has side effects because it not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Many people who get radiation therapy experience fatigue. Other side effects depend on the part of the body that is being treated. Learn more about possible side effects.

  1. Post-chemoradiation intraoperative electron-beam radiation therapy boost in resected locally advanced rectal cancer: Long-term results focused on topographic pattern of locoregional relapse

    International Nuclear Information System (INIS)

    Sole, Claudio V.; Calvo, Felipe A.; Serrano, Javier; Valle, Emilio del; Rodriguez, Marcos; Muñoz-Calero, Alberto

    2014-01-01

    Background: Patients with locally advanced rectal cancer (LARC) have a dismal prognosis. We investigated outcomes and risk factors for locoregional recurrence (LRR) in patients treated with preoperative chemoradiotherapy (CRT), surgery and IOERT. Methods: A total of 335 patients with LARC [⩾cT3 93% and/or cN+ 69%) were studied. In multivariate analyses, risk factors for LRR, IFLR and OFLR were assessed. Results: Median follow-up was 72.6 months (range, 4–205). In multivariate analysis distal margin distance ⩽10 mm [HR 2.46, p = 0.03], R1 resection [HR 5.06, p = 0.02], tumor regression grade 1–2 [HR 2.63, p = 0.05] and tumor grade 3 [HR 7.79, p < 0.001] were associated with an increased risk of LRR. A risk model was generated to determine a prognostic index for individual patients with LARC. Conclusions: Overall results after multimodality treatment of LARC are promising. Classification of risk factors for LRR has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment

  2. Complication of radiation therapy

    International Nuclear Information System (INIS)

    Imajo, Yoshinari; Suematsu, Toru; Narabayashi, Isamu; Gose, Kyuhei; Takimoto, Saeko

    1984-01-01

    The radiation pneumonitis is a major complication for patients recieving thoracic irradiation. This report describe the radiographic recognition, pathological change and imapired pulmonary functions of radiation pneumonitis. The 57 patients with lung cancer treated with radiation are analyzed on the pneumonitis by chest X-P. Among these, 50 patients (88%) develop radiation pneumonitis. Repeated CT scans give more detailed information than conventional radiograms as to exdative changes. The pathological analysis are made on the 35 patients of which affected lungs are resected after pre-operative irradiation. Three phases are recognized in the evolution of pneumonitis, the ongestive, the degenerative, and the fibrotic. Adding to the morphorogical damage, pulmonary functions also detrieorate both in ventilation and perfusion scans. (author)

  3. Preoperative Chemoradiation Therapy in Combination With Panitumumab for Patients With Resectable Esophageal Cancer: The PACT Study

    Energy Technology Data Exchange (ETDEWEB)

    Kordes, Sil [Department of Medical Oncology, Academic Medical Center, Amsterdam (Netherlands); Berge Henegouwen, Mark I. van [Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Hulshof, Maarten C. [Department of Radiotherapy, Academic Medical Center, Amsterdam (Netherlands); Bergman, Jacques J.G.H.M. [Department of Gastroenterology, Academic Medical Center, Amsterdam (Netherlands); Vliet, Hans J. van der [Department of Medical Oncology, Vrije Universiteit Medical Center, Amsterdam (Netherlands); Kapiteijn, Ellen [Department of Medical Oncology, Leiden University Medical Center, Leiden (Netherlands); Laarhoven, Hanneke W.M. van; Richel, Dick J. [Department of Medical Oncology, Academic Medical Center, Amsterdam (Netherlands); Klinkenbijl, Jean H.G. [Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Meijer, Sybren L. [Department of Pathology, Academic Medical Center, Amsterdam (Netherlands); Wilmink, Johanna W. [Department of Medical Oncology, Academic Medical Center, Amsterdam (Netherlands)

    2014-09-01

    Purpose: Preoperative chemoradiation therapy (CRT) has become the standard treatment strategy for patients with resectable esophageal cancer. This multicenter phase 2 study investigated the efficacy of the addition of the epidermal growth factor receptor (EGFR) inhibitor panitumumab to a preoperative CRT regimen with carboplatin, paclitaxel, and radiation therapy in patients with resectable esophageal cancer. Methods and Materials: Patients with resectable cT1N1M0 or cT2-3N0 to -2M0 tumors received preoperative CRT consisting of panitumumab (6 mg/kg) on days 1, 15, and 29, weekly administrations of carboplatin (area under the curve [AUC] = 2), and paclitaxel (50 mg/m{sup 2}) for 5 weeks and concurrent radiation therapy (41.4 Gy in 23 fractions, 5 days per week), followed by surgery. Primary endpoint was pathologic complete response (pCR) rate. We aimed at a pCR rate of more than 40%. Furthermore, we explored the predictive value of biomarkers (EGFR, HER 2, and P53) for pCR. Results: From January 2010 until December 2011, 90 patients were enrolled. Patients were diagnosed predominantly with adenocarcinoma (AC) (80%), T3 disease (89%), and were node positive (81%). Three patients were not resected due to progressive disease. The primary aim was unmet, with a pCR rate of 22%. Patients with AC and squamous cell carcinoma reached a pCR of 14% and 47%, respectively. R0 resection was achieved in 95% of the patients. Main grade 3 toxicities were rash (12%), fatigue (11%), and nonfebrile neutropenia (11%). None of the biomarkers was predictive for response. Conclusions: The addition of panitumumab to CRT with carboplatin and paclitaxel was safe and well tolerated but could not improve pCR rate to the preset criterion of 40%.

  4. Preoperative Chemoradiation Therapy in Combination With Panitumumab for Patients With Resectable Esophageal Cancer: The PACT Study

    International Nuclear Information System (INIS)

    Kordes, Sil; Berge Henegouwen, Mark I. van; Hulshof, Maarten C.; Bergman, Jacques J.G.H.M.; Vliet, Hans J. van der; Kapiteijn, Ellen; Laarhoven, Hanneke W.M. van; Richel, Dick J.; Klinkenbijl, Jean H.G.; Meijer, Sybren L.; Wilmink, Johanna W.

    2014-01-01

    Purpose: Preoperative chemoradiation therapy (CRT) has become the standard treatment strategy for patients with resectable esophageal cancer. This multicenter phase 2 study investigated the efficacy of the addition of the epidermal growth factor receptor (EGFR) inhibitor panitumumab to a preoperative CRT regimen with carboplatin, paclitaxel, and radiation therapy in patients with resectable esophageal cancer. Methods and Materials: Patients with resectable cT1N1M0 or cT2-3N0 to -2M0 tumors received preoperative CRT consisting of panitumumab (6 mg/kg) on days 1, 15, and 29, weekly administrations of carboplatin (area under the curve [AUC] = 2), and paclitaxel (50 mg/m 2 ) for 5 weeks and concurrent radiation therapy (41.4 Gy in 23 fractions, 5 days per week), followed by surgery. Primary endpoint was pathologic complete response (pCR) rate. We aimed at a pCR rate of more than 40%. Furthermore, we explored the predictive value of biomarkers (EGFR, HER 2, and P53) for pCR. Results: From January 2010 until December 2011, 90 patients were enrolled. Patients were diagnosed predominantly with adenocarcinoma (AC) (80%), T3 disease (89%), and were node positive (81%). Three patients were not resected due to progressive disease. The primary aim was unmet, with a pCR rate of 22%. Patients with AC and squamous cell carcinoma reached a pCR of 14% and 47%, respectively. R0 resection was achieved in 95% of the patients. Main grade 3 toxicities were rash (12%), fatigue (11%), and nonfebrile neutropenia (11%). None of the biomarkers was predictive for response. Conclusions: The addition of panitumumab to CRT with carboplatin and paclitaxel was safe and well tolerated but could not improve pCR rate to the preset criterion of 40%

  5. Prostate Cancer (Radiation Therapy)

    Science.gov (United States)

    ... be considered carefully, balancing the advantages against the disadvantages as they relate to the individual man's age, ... therapy with photon or x-rays: Uses advanced technology to tailor the x-ray or photon radiation ...

  6. Radiation biology and radiation therapy

    International Nuclear Information System (INIS)

    Wideroee, R.

    1975-01-01

    Radiation biology and radiation therapy can be compared with investigations in different layers of earth. Radiation biology works upwards from the elementary foundations, therapy works downwards with roots to secure and improve the clinical 'surface work'. The Ellis formula (Strandquist), which is a collection of clinical experience, is suited to form connections with radiobiology in the middle layers, and cooperation can give impulses for research. The structure and conditions of tumours and the complicated problems met with are discussed, based on the Carmel symposium of 1969. The oxygen problem in anoxic tumours is not yet solved. Experimental investigations of the effect itself give partly contradictory results. From a clinical viewpoint reoxygenation is of the utmost significance for obtaining control over the primary tumour, and advanced irradiation programmes will here give better results than the traditional ones. New chemicals, e.g. R 0 -07-0582, appear to reduce the OER value to 1.5, thereby making neutron therapy superfluous. Finally a problem from fundamental research is dealt with, wherein two hypotheses explaining the β-effect are described. The repair hypothesis gives a simple explanation but leaves many questions unanswered. The other hypothesis explains the β-effect as two neighbouring single breaks of the DNA molecule. It still presents difficulties, and is scarcely the correct explanation. (JIW)

  7. Radiation Therapy for Cancer

    Science.gov (United States)

    ... can cause pain. Radiation given to shrink a tumor near the esophagus , which can interfere with a patient’s ability to eat and drink. How is radiation therapy planned for an individual ... show the location of a patient’s tumor and the normal areas around it. These scans ...

  8. Postoperative radiation therapy for adenoid cystic carcinoma

    International Nuclear Information System (INIS)

    Oguchi, Masahiko; Shikama, Naoto; Gomi, Koutarou; Shinoda, Atsunori; Nishikawa, Atsushi; Arakawa, Kazukiyo; Sasaki, Shigeru; Takei, Kazuyoshi; Sone, Syusuke

    2000-01-01

    The authors retrospectively assessed the usefulness of postoperative radiation therapy after local resection of adenoid cystic carcinoma, with emphasis on organ-conserving treatment and the cosmetic results. Between 1985 and 1995, 32 patients underwent local resection followed by postoperative radiation therapy with curative and organ-conserving intent. None of patients received any form of chemotherapy as part of their initial treatment. Radiation therapy was carried out by techniques that were appropriate for the site and extension of each tumor. The 5-year local control, disease-free, and overall survival rates of all patients were 76%, 68%, and 86%, respectively. The 5-year local control rate and disease-free survival rate of patients with microscopically positive margins were 89% and 75%, respectively, and higher than in patients with macroscopically residual disease, but no significant difference in 5-year overall survival rate was observed. The postoperative cosmetic results in 29 patients with head and neck lesions were evaluated. No difference was documented between the cosmetic results postoperatively setting and after postoperative radiotherapy, and no significant differences in cosmetic results were observed according to radiation dose. The combination of local resection with organ-conserving intent and postoperative radiation therapy provided good cosmetic results in patients with T1 or T2 lesions. Postoperative radiation therapy with smaller fractions is useful, because good local control can be achieved in patients with adenoid cystic carcinoma having microscopically positive margins without inducing any late adverse reactions. However, the number of patients was too small and the follow-up period was too short to draw any definite conclusion in regard to fraction size. A much longer follow-up study with a larger number patients will be required to accurately determine the optimal treatment intensity and duration of treatment. (K.H.)

  9. Radiation therapy in extrahepatic bile duct carcinoma

    International Nuclear Information System (INIS)

    Mahe, Marc; Romestaing, Pascale; Talon, Bernard; Ardiet, J.M.; Salerno, Nathalie; Sentenac, Irenee; Gerard, J.P.

    1991-01-01

    Fifty-one patients with carcinoma of the extrahepatic bile ducts (EHBD) received radiation therapy between Jan 1980-Dec 1988. The location of the tumors was: proximal third, 20 patients; middle third, 23; distal third, 3; diffuse, 5 patients. Thirty-six patients underwent surgery with complete gross resection in 14 (10/14 with positive margins), incomplete gross resection in 12 and only biopsy in 10. Fifteen patients had only biliary drainage without laparotomy after cytologic diagnosis of malignancy in 11/15. Radiation therapy was done with curative intent after complete or incomplete resection (n=26) and it was palliative in patients who had no resection or only biliary drainage (n=25). Twenty-five patients received external radiation-therapy (ERT) alone to the tumor and lymph nodes (mean dose 45 Gy/2Gy per fraction for cure, 35 Gy/10 fractions for palliation), 8 patients had only iridium-192 ( 192 Ir) implant (50-60 Gy at a 1 cm radius for cure, 30 Gy for palliation), 17 patients had both ERT + 192 Ir(ERT 42.5 Gy + 192 Ir 10-15 Gy for cure; ERT 20 Gy/5 fractions + 192 Ir 20-30 Gy for palliation) and one intra-operative irradiation + ERT. The overall survival rate for the entire group was 55, 28.5 and 15 percent at 12, 24, 36 months and median survival 12 months. Median survival was 22 months in patients treated with curative intent and only 10 months after palliative treatment (p0.03). Among patients who had curative treatment, median survival was 27.5 months after complete gross resection and 13 months after incomplete gross resection (p0.045). After complete gross resection 5/14 patients were alive without evolutive disease at 11, 19, 20, 23 and 41 months, 2 were alive with metastases at 25 and 27 months and 7/14 died of cancer from 7 to 59 months. The rate of complications was low: 3 cholangitis responsive to antibiotics, 1 hemobilia and 2 gastric ulcers. These results are encouraging especially for patients with complete gross resection but they must be

  10. Limb-sparing management with surgical resection, external-beam and intraoperative electron-beam radiation therapy boost for patients with primary soft tissue sarcoma of the extremity. A multicentric pooled analysis of long-term outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, Felipe A. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Sole, Claudio V. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Instituto de Radiomedicina, Service of Radiation Oncology, Santiago (Chile); Polo, Alfredo; Montero, Angel [Hospital Universitario Ramon y Cajal, Service of Radiation Oncology, Madrid (Spain); Cambeiro, Mauricio; Martinez-Monge, Rafael [Clinica Universidad de Navarra, Service of Radiation Oncology, Pamplona (Spain); Alvarez, Ana [Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Cuervo, Miguel [Hospital General Universitario Gregorio Maranon, Service of Orthopedics and Traumatology, Madrid (Spain); Julian, Mikel San [Clinica Universidad de Navarra, Service of Orthopedics and Traumatology, Pamplona (Spain)

    2014-10-15

    A joint analysis of data from three contributing centres within the intraoperative electron-beam radiation therapy (IOERT) Spanish program was performed to investigate the main contributions of IORT to the multidisciplinary treatment of high-risk extremity soft tissue sarcoma (STS). Patients with an histologic diagnosis of primary extremity STS, with absence of distant metastases, undergoing limb-sparing surgery with radical intent, external beam radiotherapy (median dose 45 Gy) and IOERT (median dose 12.5 Gy) were considered eligible for participation in this study. From 1986-2012, a total of 159 patients were analysed in the study from three Spanish institutions. With a median follow-up time of 53 months (range 4-316 years), 5-year local control (LC) was 82 %. The 5-year IOERT in-field control, disease-free survival (DFS) and overall survival (OS) were 86, 62 and 72 %, respectively. On multivariate analysis, only microscopically involved margin (R1) resection status retained significance in relation to LC (HR 5.20, p < 0.001). With regard to IOERT in-field control, incomplete resection (HR 4.88, p = 0.001) and higher IOERT dose (≥ 12.5 Gy; HR 0.32, p = 0.02) retained a significant association in multivariate analysis. From this joint analysis emerges the fact that an IOERT dose ≥ 12.5 Gy increases the rate of IOERT in-field control, but DFS remains modest, given the high risk of distant metastases. Intensified local treatment needs to be tested in the context of more efficient concurrent, neo- and adjuvant systemic therapy. (orig.) [German] Um den therapeutischen Beitrag einer intraoperativen Bestrahlung mit Elektronen (IOERT) als Teil eines multidisziplinaeren Behandlungskonzepts von Weichteilsarkomen (STS) im Extremitaetenbereich mit hohem Risikoprofil evaluieren zu koennen, wurde anhand des spanischen IOERT-Programms eine gepoolte Datenanalyse von drei teilnehmenden Zentren vorgenommen. Eingeschlossen in diese Studie wurden Patienten mit histologisch

  11. Radiation therapy for primary spinal cord tumors in adults

    International Nuclear Information System (INIS)

    Jeremic, B.; Grujicic, D.; Jovanovic, D.; Djuric, L.; Mijatovic, L.

    1990-01-01

    This paper evaluates the role of radiation therapy in management of primary spinal cord tumors in adults. Records of 21 patients with primary spinal cord tumors treated with radiation therapy after surgery were retrospectively reviewed. Histologic examination showed two diffuse and 10 localized ependymomas, six low-grade gliomas, and three malignant gliomas. Surgery consisted of gross tumor resection in six patients, subtotal resection in three patients, and biopsy in 12 patients. Three patients also received chemotherapy. Radiation dose range from 45 to 55 Cy

  12. Management of stage III thymoma with postoperative radiation therapy

    International Nuclear Information System (INIS)

    Krueger, J.B.; Sagerman, R.H.; King, G.A.

    1987-01-01

    The results of postoperative radiation therapy in 12 patients with Stage III thymoma treated during the period 1966-1986 were reviewed. Surgical therapy consisted of total resection in one, subtotal resection in seven, and biopsy only in four. Megavoltage irradiation in the dose range of 3,000-5,600 cGy was employed, with the majority receiving a dose of at least 5,000 cGy. The local control rate was 67%. The actuarial 5-year observed and adjusted survival rates were 57% and 75%, respectively. These results indicate that postoperative radiation therapy is an effective therapeutic modality in the control of Stage III thymoma

  13. Involved Node Radiation Therapy

    DEFF Research Database (Denmark)

    Maraldo, Maja V; Aznar, Marianne C; Vogelius, Ivan R

    2012-01-01

    PURPOSE: The involved node radiation therapy (INRT) strategy was introduced for patients with Hodgkin lymphoma (HL) to reduce the risk of late effects. With INRT, only the originally involved lymph nodes are irradiated. We present treatment outcome in a retrospective analysis using this strategy...... to 36 Gy). Patients attended regular follow-up visits until 5 years after therapy. RESULTS: The 4-year freedom from disease progression was 96.4% (95% confidence interval: 92.4%-100.4%), median follow-up of 50 months (range: 4-71 months). Three relapses occurred: 2 within the previous radiation field......, and 1 in a previously uninvolved region. The 4-year overall survival was 94% (95% confidence interval: 88.8%-99.1%), median follow-up of 58 months (range: 4-91 months). Early radiation therapy toxicity was limited to grade 1 (23.4%) and grade 2 (13.8%). During follow-up, 8 patients died, none from HL, 7...

  14. Radiation therapy physics

    CERN Document Server

    1995-01-01

    The aim of this book is to provide a uniquely comprehensive source of information on the entire field of radiation therapy physics. The very significant advances in imaging, computational, and accelerator technologies receive full consideration, as do such topics as the dosimetry of radiolabeled antibodies and dose calculation models. The scope of the book and the expertise of the authors make it essential reading for interested physicians and physicists and for radiation dosimetrists.

  15. Modeling Internal Radiation Therapy

    NARCIS (Netherlands)

    van den Broek, Egon; Schouten, Theo E.; Pellegrini, M.; Fred, A.; Filipe, J.; Gamboa, H.

    2011-01-01

    A new technique is described to model (internal) radiation therapy. It is founded on morphological processing, in particular distance transforms. Its formal basis is presented as well as its implementation via the Fast Exact Euclidean Distance (FEED) transform. Its use for all variations of internal

  16. Current perspectives of radiation therapy. History of radiation therapy

    International Nuclear Information System (INIS)

    Itami, Jun

    2011-01-01

    More than 100 years have passed since the discovery of X-Strahlen by Roentgen. The history of radiation therapy has evolved under mutual stimulating relationships of the external beam radiation therapy by X-ray tubes and accelerators, and the internal radiation therapy employing radium and other radionuclides. The currently employed technologies in radiation therapy have its origin already till nineteen sixties and the development of physics and engineering have realized the original concept. (author)

  17. Chemoradiation therapy and resection for carcinoma of the esophagus: short-term results

    International Nuclear Information System (INIS)

    Parker, E.F.; Marks, R.D. Jr.; Kratz, J.M.; Chaikhouni, A.; Warren, E.T.; Bartles, D.M.

    1985-01-01

    The purpose of this report is to record the results of a treatment protocol for patients with carcinoma of the esophagus. In May, 1980, the authors initiated a program of chemoradiation therapy preliminary to resection in patients in whom the protocol was applicable. The chemotherapy consisted of mitomycin-C, 10 mg as a bolus intravenous injection on day 1, and 5-fluorouracil, 1,000 mg per square meter of body surface area given intravenously on each of days 1 through 4. The radiation therapy consisted of 3,000 rads in three weeks using cobalt 60 or 6 MeV or greater, with ports to cover the tumor and mediastinum. Among the patients treated according to the protocol, the operability rate was increased. The resectability rate remained about the same as in our previous experience. The operative mortality was lessened appreciably. The percentage of resected specimens of the esophagus showing residual tumor decreased. However, the absence of any residual tumor in the surgical specimen has not conferred any improved chance of long-term survival to date

  18. Abdominoendorectal resection with peranal anastomosis in the treatment of radiation injuries of the rectum

    Energy Technology Data Exchange (ETDEWEB)

    Athanasiadis, S.; Girona, J.

    1982-01-01

    During the period 1974-1980 39 patients underwent operations at the Prosper Hospital in Recklinghausen for radiation injuries to the rectum or rectosigmoid. They comprised 22 patients with rectovaginal fistulas, 6 with ulcers, 3 suffering from severe hemorrhagic proctitis, 5 with rectal strictures, 1 with necrosis, and 2 with radiation ulcers and carcinoma. A sphincter-saving operative method of treating postirradiation damage of the rectum is presented. The technique involves the peranal anastomosis of healthy colon to the midanal canal using a sleeve anastomosis. Technical and functional results of resectional surgery for the rectal complications of radiation therapy are reported. Subjectively, total continence was present in 78%, only 1 patient was incontinent because of flatus and watery stools.

  19. The abdominoendorectal resection with peranal anastomosis in the treatment of radiation injuries of the rectum

    International Nuclear Information System (INIS)

    Athanasiadis, S.; Girona, J.

    1982-01-01

    During the period 1974-1980 39 patients underwent operations at the Prosper Hospital in Recklinghausen for radiation injuries to the rectum or rectosigmoid. They comprised 22 patients with rectovaginal fistulas, 6 with ulcers, 3 suffering from severe hemorrhagic proctitis, 5 with rectal strictures, 1 with necrosis, and 2 with radiation ulcers and carcinoma. A sphincter-saving operative method of treating postirradiation damage of the rectum is presented. The technique involves the peranal anastomosis of healthy colon to the midanal canal using a sleeve anastomosis. Technical and functional results of resectional surgery for the rectal complications of radiation therapy are reported. Subjectively, total continence was present in 78%, only 1 patient was incontinent because of flatus and watery stools. (orig.) [de

  20. Role of radiation therapy for 'juvenile' angiofibroma

    Energy Technology Data Exchange (ETDEWEB)

    Gudea, F.; Vega, M.; Canals, E.; Montserrat, J.M.; Valdano, J. (Univ. Autonoma de Barcelona (Spain). Hospital de la Santa Creu i Sant Pau (Spain))

    1990-09-01

    Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm which occurs primarily in male adolescents and is characterized by aggressive local growth. The controversy concerning appropriate treatment for patients with juvenile angiofibroma persists. Radiation therapy and survival resection have both been reported to be effective to control a high proportion of these tumours. The case reported here demonstrates a locally advanced JNA controlled by radiation therapy. (author).

  1. Principles of radiation therapy

    International Nuclear Information System (INIS)

    Richter, M.P.; Share, F.S.; Goodman, R.L.

    1985-01-01

    Radiation oncology now represents the integration of knowledge obtained over an 80-year period from the physics and biology laboratories and the medical clinic. Such integration is recent; until the supervoltage era following World War II, the chief developments in these three areas for the most part were realized independently. The physics and engineering laboratories have now developed a dependable family of sources of ionizing radiations that can be precisely directed at tumor volumes at various depths within the body. The biology laboratory has provided the basic scientific support underlying the intensive clinical experience and currently is suggesting ways of using ionizing radiations more effectively, such as modified fractionation schedules relating to cell cycle kinetics and the use of drugs and chemicals as modifiers of radiation response and normal tissue reaction. The radiation therapy clinic has provided the patient stratum on which the acute and chronic effects of irradiation have been assessed, and the patterns of treatment success and failure identified. The radiation therapist has shared with the surgeon and medical oncologist the responsibility for clarifying the natural history of a large number of human neoplasms, and through such clarifications, has developed more effective treatment strategies. Several examples of this include the improved results in the treatment of Hodgkin's disease, squamous cell carcinoma of the cervix, seminoma, and epithelial neoplasms of the upper aerodigestive tract

  2. Radiation therapy for digestive tumors

    International Nuclear Information System (INIS)

    Piedbois, P.; Levy, E.; Thirion, P.; Martin, L.; Calitchi, E.; Otmezguine, Y.; Le Bourgeois, J.P.

    1995-01-01

    This brief review of radiation therapy of digestive tumors in 1994 seeks to provide practical answers to the most commonly asked questions: What is the place of radiation therapy versus chemotherapy for the treatment of these patients ? What are the approved indications of radiation therapy and which avenues of research are being explored ? Radiation therapy is used in over two-thirds of patients referred to an oncology department for a gastrointestinal tract tumor. The main indications are reviewed: cancer of the rectum and anal canal and, to a lesser extent, cancer of the esophagus and pancreas. The main focuses of current research include radiation therapy-chemotherapy combinations, intraoperative radiation therapy, and radiation therapy of hepatobiliary tumors. (authors). 23 refs., 1 fig

  3. Radiation therapy for chordomas

    International Nuclear Information System (INIS)

    Ikeda, Hajime; Takahashi, Takeo; Nakamura, Yuji; Niibe, Hideo

    1995-01-01

    Chordomas are slow-growing primary malignant bone tumors which originate from remnants of the fetal notochordal system. They are difficult to control by surgery alone. Four patients with chordomas treated with radiation therapy were studied, and the effectiveness of radiotherapy was evaluated. These 4 (3.8%) patients were among 106 patients with primary malignant bone tumors referred to us from 1959 to 1987. Primary sites were the sacrococcygeal region in three patients and the clivus in one. The patients' ages ranged from 51 to 75 years. The male : female ratio was 1 : 1. Patients received 48 to 60 Gy of radiation to the primary sites. Because the radiosensitivity of the tumors was low, the responses were poor. The duration of survival was 6, 33, 68, and 125 months. The cause of death in each case was local recurrence of tumor. As a result, a dose greater than 60 Gy is thought to be necessary for curative radiotherapy. Proton beam therapy seems to be best choice for chordomas in the clivus, and mixed-beam (proton and megavolt age X-ray) therapy or multiportal irradiation, which gives an ideal spatial dose distribution, seems to be most suitable for sacrococcygeal chordomas. (author)

  4. Clinical results of radiation therapy for thymoma

    Energy Technology Data Exchange (ETDEWEB)

    Masunaga, Shin-ichiro; Ono, Koji; Hiraoka, Masahiro; Sasai, Keisuke; Kitakabu, Yoshizumi; Abe, Mitsuyuki (Kyoto Univ. (Japan). Faculty of Medicine); Takahashi, Masaji; Tsutsui, Kazushige; Fushiki, Masato

    1992-05-01

    From August 1968 to December 1989, 58 patients with thymoma were treated by radiotherapy using cobalt-60 gamma ray. Eleven cases were treated by radiothrapy alone, 1 by preoperative radiotheapy, 43 by postoperative radiotherapy, and 3 in combination with intraoperative radiotherapy. The following points were clarified: (a) Postoperative and intraoperative radiotherapy were effective; (b) For postoperative radiotherapy, operability was the major factor influencing survival and local control, and Stage I and II tumors resected totally or subtotally as well as Stage III tumors resected totally were good indications for such therapy; (c) The patients with complicating myasthenia gravis had a longer survival time and better local control rate than those without it. Radiation pneumonitis was observed in 17 patients, and none of them died of this complication. In all cases in combination with intraoperative radiotherapy, dry desquamation was observed within the irradiated field. (author).

  5. Clinical results of radiation therapy for thymoma

    International Nuclear Information System (INIS)

    Masunaga, Shin-ichiro; Ono, Koji; Hiraoka, Masahiro; Sasai, Keisuke; Kitakabu, Yoshizumi; Abe, Mitsuyuki; Takahashi, Masaji; Tsutsui, Kazushige; Fushiki, Masato.

    1992-01-01

    From August 1968 to December 1989, 58 patients with thymoma were treated by radiotherapy using cobalt-60 gamma ray. Eleven cases were treated by radiothrapy alone, 1 by preoperative radiotheapy, 43 by postoperative radiotherapy, and 3 in combination with intraoperative radiotherapy. The following points were clarified: (a) Postoperative and intraoperative radiotherapy were effective; (b) For postoperative radiotherapy, operability was the major factor influencing survival and local control, and Stage I and II tumors resected totally or subtotally as well as Stage III tumors resected totally were good indications for such therapy; (c) The patients with complicating myasthenia gravis had a longer survival time and better local control rate than those without it. Radiation pneumonitis was observed in 17 patients, and none of them died of this complication. In all cases in combination with intraoperative radiotherapy, dry desquamation was observed within the irradiated field. (author)

  6. Technical advances in radiation therapy

    International Nuclear Information System (INIS)

    Sause, W.T.

    1986-01-01

    Substantial advances have been made in radiation therapy. Many of these advances can be applied in most radiation therapy departments without expensive improvements in equipment. Changes in radiation fractionation, chemotherapeutic sensitization, intraoperative radiation, and interstitial implants can be performed with experience and improved physician training in most medium-sized departments. Advances that require investments in expensive equipment such as particle radiation and hyperthermia will need to be evaluated at designated treatment centers. 106 references

  7. Internal Radiation Therapy for Cancer

    Science.gov (United States)

    When getting internal radiation therapy, a source of radiation is put inside your body, in either liquid or solid form. It can be used treat different kinds of cancer, including thyroid, head and neck, breast, cervix, prostate, and eye. Learn more about how what to expect when getting internal radiation therapy.

  8. Role of radiation therapy for stage III thymoma

    International Nuclear Information System (INIS)

    Chun, Ha Chung; Lee, Myung Za

    2001-01-01

    To evaluate the effectiveness and tolerance of the postoperative radiation therapy for patients with Stage III thymoma and to define the optimal radiotherapeutic regimen. We retrospectively analyzed the records of 24 patients with Stage III thymoma who were referred for postoperative radiation therapy in our institution from June, 1987 to May, 1999. Surgical therapy consisted of total resection in one patient, subtotal resection in seventeen, and biopsy alone in six patients. Age of the patients was ranged from 20 to 62 years with mean age of 47 years. Male to female ratio was 14 to 10. Radiation therapy was delivered with linear accelerator producing either 6 MeV or 10 MeV photons. The irradiated volume included anterior mediastinum and known residual disease. The supraclavicular fossae were not irradiated. The delivered total dose was ranged from 30 to 56 Gy. One patient received 30 Gy and eighteen patients received minimum of 50 Gy. Follow up period was ranged from 12 months to 8 years with median follow up of 40 months. The overall local control rate for entire group of patients was 67% at 5 years. The cumulative local failure rates at one, three and five year were 18%, 28% and 33%, respectively. In patients treated with subtotal resection and biopsy alone, local control rate was 76% and 33%, respectively. The actuarial observed survival rate at 5 years was 57%, and actuarial adjusted survival at 5 years was 72%. The difference between 5 year survival rates for patients treated with subtotal resection and biopsy alone was not statistically significant (62% vs 30%). We might conclude that postoperative radiation therapy was safe and effective treatment for patients with Stage III thymoma. Postoperative radiation therapy is recommended in cases where tumor margin is close or incomplete resection is accomplished

  9. Clinical applications of continuous infusion chemotherapy ahd concomitant radiation therapy

    International Nuclear Information System (INIS)

    Rosenthal, C.J.; Rotman, M.

    1986-01-01

    This book presents information on the following topics: theoretical basis and clinical applications of 5-FU as a radiosensitizer; treatment of hepatic metastases from gastro intestingal primaries with split course radiation therapy; combined modality therapy with 5-FU, Mitomycin-C and radiation therapy for sqamous cell cancers; treatment of bladder carcinoma with concomitant infusion chemotherapy and irradiation; a treatment of invasiv bladder cancer by the XRT/5FU protocol; concomitant radiation therapy and doxorubicin by continuous infusion in advanced malignancies; cis platin by continuous infusion with concurrent radiation therapy in malignant tumors; combination of radiation with concomitant continuous adriamycin infusion in a patient with partially excised pleomorphic soft tissue sarcoma of the lower extremeity; treatment of recurrent carcinoma of the paranasal sinuses using concomitant infusion cis-platinum and radiation therapy; hepatic artery infusion for hepatic metastases in combination with hepatic resection and hepatic radiation; study of simultaneous radiation therapy, continuous infusion, 5FU and bolus mitomycin-C; cancer of the esophagus; continuous infusion VP-16, bolus cis-platinum and simultaneous radiation therapy as salvage therapy in small cell bronchogenic carcinoma; and concomitant radiation, mitomycin-C and 5-FU infusion in gastro intestinal cancer

  10. Radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Katsumasa

    2001-01-01

    In Japan, where the mortality rate of prostate cancer is lower than in Western countries, radical prostatectomy or hormonal therapy has been applied more frequently than radiation therapy. However, the number of patients with prostate cancer has been increasing recently and the importance of radiation therapy has rapidly been recognized. Although there have been no randomized trials, results from several institutions in Western countries suggest that similar results of cancer control are achieved with either radiation therapy or radical prostatectomy. For higher-risk cases, conformal high-dose therapy or adjuvant hormonal therapy is more appropriate. In this article, the results of radiation therapy for prostate cancer were reviewed, with a view to the appropriate choice of therapy in Japan. (author)

  11. Stereotactic body radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Simon S. [Univ. Hospitals Seidman Cancer Center, Cleveland, OH (United States). Dept. of Radiation Oncology; Case Western Reserve Univ., Cleveland, OH (United States). Case Comprehensive Cancer Center; Teh, Bin S. [The Methodist Hospital Cancer Center and Research Institute, Houston, TX (United States). Weill Cornell Medical College; Lu, Jiade J. [National Univ. of Singapore (Singapore). Dept. of Radiation Oncology; Schefter, Tracey E. (eds.) [Colorado Univ., Aurora, CO (United States). Dept. of Radiation Oncology

    2012-11-01

    Comprehensive an up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. Examines in detail retrospective studies and prospective clinical trials for various organ sites from around the world. Written by world-renowned experts in SBRT from North America, Asia and Europe. Stereotactic body radiation therapy (SBRT) has emerged as an innovative treatment for various primary and metastatic cancers, and the past five years have witnessed a quantum leap in its use. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists.

  12. Smart Radiation Therapy Biomaterials.

    Science.gov (United States)

    Ngwa, Wilfred; Boateng, Francis; Kumar, Rajiv; Irvine, Darrell J; Formenti, Silvia; Ngoma, Twalib; Herskind, Carsten; Veldwijk, Marlon R; Hildenbrand, Georg Lars; Hausmann, Michael; Wenz, Frederik; Hesser, Juergen

    2017-03-01

    Radiation therapy (RT) is a crucial component of cancer care, used in the treatment of over 50% of cancer patients. Patients undergoing image guided RT or brachytherapy routinely have inert RT biomaterials implanted into their tumors. The single function of these RT biomaterials is to ensure geometric accuracy during treatment. Recent studies have proposed that the inert biomaterials could be upgraded to "smart" RT biomaterials, designed to do more than 1 function. Such smart biomaterials include next-generation fiducial markers, brachytherapy spacers, and balloon applicators, designed to respond to stimuli and perform additional desirable functions like controlled delivery of therapy-enhancing payloads directly into the tumor subvolume while minimizing normal tissue toxicities. More broadly, smart RT biomaterials may include functionalized nanoparticles that can be activated to boost RT efficacy. This work reviews the rationale for smart RT biomaterials, the state of the art in this emerging cross-disciplinary research area, challenges and opportunities for further research and development, and a purview of potential clinical applications. Applications covered include using smart RT biomaterials for boosting cancer therapy with minimal side effects, combining RT with immunotherapy or chemotherapy, reducing treatment time or health care costs, and other incipient applications. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Radiation therapy in old patients. Side effects and results of radiation therapy in old patients

    International Nuclear Information System (INIS)

    Geinitz, H.; Zimmermann, F.B.; Molls, M.

    1999-01-01

    Background: Despite a growing number of elderly patients receiving radiation therapy little is known about side effects and outcome of irradiation in this section of the population. Methods: In a review article epidemiologic data, aspects of radiation-biology as well as side effects and outcome of radiation therapy of elderly patients are discussed. Results: Cancer incidence rises with age and is exceeding 3.5% for males older than 85 years. With a life expectancy of more than 4 years, curative therapy is indicated even at this age. Furthermore, several retrospective studies indicate that local control and disease-Specific survival after radiation therapy of elderly patients is comparable with that of younger persons. The exception contains elderly patients with grade-III to IV gliomas or with rectal carcinoma who show a reduced survival which is perhaps caused by less aggressive combined treatment (tumor resection). Although some biological and molecular data indicate a rise in radiation sensitivity with growing age like the reduction of the capacity of some DNA-repair enzymes, there is no convincing evidence in animal studies or in retrospective clinical studies that radiation therapy is generally less well tolerated by older individuals. Some age-depending differences in organ toxicities are described in 3 large studies, which evaluate the data of patients who were enrolled in different EORTC-trials: Older patients suffer more of functional mucositis in case of radiation therapy to the head and neck, they have an increased weight loss and a higher frequency of late esophageal damage when irradiated in the thorax, and they show a higher prevalence of sexual dysfunction when treated with radiation therapy to the pelvis. On the other hand younger patients suffer more from acute toxicity like skin damage, nausea, and deterioration of the performance status during pelvic radiotherapy. When discussing the dose intensity of radiation therapy concomitant disease which

  14. The physics of radiation therapy

    CERN Document Server

    Khan, Faiz M

    2009-01-01

    Dr. Khan's classic textbook on radiation oncology physics is now in its thoroughly revised and updated Fourth Edition. It provides the entire radiation therapy team—radiation oncologists, medical physicists, dosimetrists, and radiation therapists—with a thorough understanding of the physics and practical clinical applications of advanced radiation therapy technologies, including 3D-CRT, stereotactic radiotherapy, HDR, IMRT, IGRT, and proton beam therapy. These technologies are discussed along with the physical concepts underlying treatment planning, treatment delivery, and dosimetry. This Fourth Edition includes brand-new chapters on image-guided radiation therapy (IGRT) and proton beam therapy. Other chapters have been revised to incorporate the most recent developments in the field. This edition also features more than 100 full-color illustrations throughout.

  15. Different Approaches in Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Rolf-Dieter eKortmann

    2011-12-01

    Full Text Available Radiation therapy is a cornerstone in the therapeutic management of craniopharyngioma. The close proximity to neighbouring eloquent structures pose a particular challenge to radiation therapy. Modern treatment technologies including fractionated 3-d conformal radiotherapy, intensity modulated radiation therapy and recently proton therapy are able to precisely cover the target while preserving surrounding tissue,Tumour controls between 80 and in access of 90 % can be achieved. Alternative treatments consisting of radiosurgery, intracavitary application of isotopes and brachytherapy also offer an acceptable tumour control and might be given in selected cases. More research is needed to establish the role of each treatment modality.

  16. Preoperative radiation therapy and iododeoxyuridine for large retroperitoneal sarcomas

    International Nuclear Information System (INIS)

    Robertson, John M.; Sondak, Vernon K.; Weiss, Sharon A.; Sussman, Jeffrey J.; Chang, Alfred E.; Lawrence, Theodore S.

    1995-01-01

    Purpose: Local failure is frequent after conventional therapy for patients with retroperitoneal sarcomas. A Phase I/II multimodality approach was used, combining iododeoxyuridine (IdUrd) and radiation therapy, followed by attempted surgical resection, with the goal of improving local control. Methods and Materials: Patients with retroperitoneal sarcomas were treated with three to five consecutive cycles of treatment. Each 14-day cycle consisted of a continuous intravenous infusion of IdUrd on days 1-5, twice a day radiation therapy (1.25 Gy/fraction) on days 8-12, and a break on day 13 and 14. Surgical resection was attempted after three or five cycles. Patients resected after three cycles received an additional two cycles of treatment with radiation directed to the tumor bed. IdUrd dose was escalated in Phase I fashion (1000 mg/m 2 /day, 1333 mg/m 2 /day, and 1600 mg/m 2 /day). The median potential follow-up was 31 months. Results: Sixteen patients (13 with high grade tumors) were treated. The median maximum tumor size was 17 cm. Resection margins were negative in four patients, microscopically positive in four patients, and grossly positive in three patients. Five patients were not resected. The only grade 4 acute toxicity observed was vomiting which occurred in three patients receiving upper abdominal radiation. Postsurgical and long-term complications were rare. Median survival overall and for resected patients were 18 and 32 months, respectively. Local control was observed in three out of four patients with negative margins (9, 40+, and 51+ months), two out of four patients with microscopically positive margins (4 and 22 months), and one out of three patients with grossly positive margins (46+ months). The overall freedom from local progression was 45% at 24 months. Conclusion: Retroperitoneal sarcomas can be resected after preoperative radiation therapy and IdUrd, with encouraging local control in patients resected with negative or microscopically positive

  17. Sphincter preservation with preoperative radiation therapy and coloanal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Minsky, Bruce D; Cohen, Alfred M; Enker, Warren E; Paty, Philip

    1995-02-01

    Purpose: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods and Materials: Thirty patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (2: T2, 28: T3) involving the distal half of the rectum and required an abdominoperineal resection. The median tumor size was 4 cm (range: 1.5-6 cm) and the median distance from the anal verge was 4 cm (range: 3-7 cm). The whole pelvis received 46.8 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 43 months (range: 6-82 months). Results: Of the 29 patients who underwent resection, 3 (10%) had a complete pathologic response and 24 (83%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 4-year actuarial: 23%. The 4-year actuarial survival was 75%. One patient developed a partial disruption of the anastomosis and two developed rectal stenosis. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in 22 of the 24 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 77%. The median number of bowel movements/day was two (range: 1-6). Conclusions: This technique may be an alternative to an abdominoperineal resection in selected patients. Continued follow-up is needed to determine if this approach ultimately has similar local control and survival rates as an abdominoperineal resection.

  18. Sphincter preservation with preoperative radiation therapy and coloanal anastomosis

    International Nuclear Information System (INIS)

    Minsky, Bruce D.; Cohen, Alfred M.; Enker, Warren E.; Paty, Philip

    1995-01-01

    Purpose: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods and Materials: Thirty patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (2: T2, 28: T3) involving the distal half of the rectum and required an abdominoperineal resection. The median tumor size was 4 cm (range: 1.5-6 cm) and the median distance from the anal verge was 4 cm (range: 3-7 cm). The whole pelvis received 46.8 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 43 months (range: 6-82 months). Results: Of the 29 patients who underwent resection, 3 (10%) had a complete pathologic response and 24 (83%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 4-year actuarial: 23%. The 4-year actuarial survival was 75%. One patient developed a partial disruption of the anastomosis and two developed rectal stenosis. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in 22 of the 24 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 77%. The median number of bowel movements/day was two (range: 1-6). Conclusions: This technique may be an alternative to an abdominoperineal resection in selected patients. Continued follow-up is needed to determine if this approach ultimately has similar local control and survival rates as an abdominoperineal resection

  19. Bladder preservation for locally advanced bladder cancer by transurethral resection, systemic chemotherapy and radiation

    International Nuclear Information System (INIS)

    Honda, Masahito; Satoh, Mototaka; Tujimoto, Yuichi; Takada, Tuyoshi; Matsumiya, Kiyomi; Fujioka, Hideki

    2006-01-01

    Twenty-three out of 31 patients with clinical T2-4a N0 M0 bladder cancer and given a trial of trimodality therapy including transurethral resection (TUR), systemic chemotherapy and radiation between 1991 and 2002 completed this therapy. The other 8 dropped out because of insufficient clinical effect. Local bladder recurrence was seen in 3 patients and the bladder preservation rate was 64.5%. Nineteen of the 23 patients showed a complete histological response on a subsequent TUR specimen, the other 4 were not examined for histological response. Thirteen of the 19 patients showed a complete histological response after maximal TUR and systemic chemotherapy, while 6 did after TUR, chemotherapy and radiotherapy. Bladder cancer was T2 in, 15, T3 in 1, and T4a in 3 patients. The CR rate for T2 cancer was significantly higher than that for T3-4a cancer. The 5-year disease-specific survival of the 23 patients treated with preservation therapy was 67.1%. Some of the patients with locally advanced bladder cancer may benefit from this preservation therapy. (author)

  20. Optimization of radiation therapy

    International Nuclear Information System (INIS)

    Ohtsubo, Masaaki

    1990-01-01

    In radiotherapy, dose optimization is to give adequate dose uniformly over target volume and minimize the dose to normal and adjacent critical organs. Therefore, it is necessary to analyze dose distribution in detail. This paper presents a method for quantitatively assessing treatment planning by analysis of dose distribution. For this purpose, several parameters were introduced, such as D T, min (minimum target absorbed dose), NUF (nonuniformity factor), volume rate of damaged lung and spinal cord, R T/T (ratio of target volume to treatment volume), LE (local efficiency), integral dose, etc. And some criteria were made using these parameters, and were applied to evaluate various plans in external beam radiation therapy for lung and esophagus cancer. In these parameters, NUF was especially useful to obtain three-dimensional dose information of target volume, and value of NUF was in agreement with the information provided by dose volume histogram. AP-PA parallel opposed fields technique was inferior in D T,min and NUF. In lung cancer, there was no spinal cord injury in oblique parallel opposed fields technique, and this technique is particularly useful when target volume is in posterior. In these two techniques, R T/T was small and hot spots were frequently observed. R T/T was largest in oblique wedged two-fields technique, but this technique was inferior in D T, min and NUF. About D T, min and NUF, four fields technique was the best, but in this technique spinal cord complication often occurred in case that target volume was in the middle. In moving beam technique (360deg rotation or arc), integral dose is large, and the more target volume is in posterior, the more often spinal cord complication occurs. In esophageal cancer, three fields technique was the best to avoid spinal cord injury. It seems that this method is very useful for optimization in radiation treatment planning. (author)

  1. Safety and feasibility of liver resection with continued antiplatelet therapy using aspirin.

    Science.gov (United States)

    Monden, Kazuteru; Sadamori, Hiroshi; Hioki, Masayoshi; Ohno, Satoshi; Saneto, Hiromi; Ueki, Toru; Yabushita, Kazuhisa; Ono, Kazumi; Sakaguchi, Kousaku; Takakura, Norihisa

    2017-07-01

    Aspirin is widely used for the secondary prevention of ischemic stroke and cardiovascular disease. Perioperative aspirin may decrease thrombotic morbidity, but may also increase hemorrhagic morbidity. In particular, liver resection carries risks of bleeding, leading to higher risks of hemorrhagic morbidity. Our institution has continued aspirin therapy perioperatively in patients undergoing liver resection. This study examined the safety and feasibility of liver resection while continuing aspirin. We retrospectively evaluated 378 patients who underwent liver resection between January 2010 and January 2016. Patients were grouped according to preoperative aspirin prescription: patients with aspirin therapy (aspirin users, n = 31); and patients without use of aspirin (aspirin non-users, n = 347). Aspirin users were significantly older (P aspirin users than among aspirin non-users, no significant difference was identified. No postoperative hemorrhage was seen among aspirin users. Liver resection can be safely performed while continuing aspirin therapy without increasing hemorrhagic morbidity. Our results suggest that interruption of aspirin therapy is unnecessary for patients undergoing liver resection. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  2. A case of radiation optic neuropathy after resection of a pituitary adenoma

    International Nuclear Information System (INIS)

    Yoshii, Masaru; Okisaka, Shigekuni; Yanagawa, Youichi; Takiguchi, Hiroshi

    1995-01-01

    A case of optic neuropathy after postoperative radiation therapy is reported. A 69-year-old woman had a partial resection of a pituitary adenoma in 1990 and was treated with 45 Gy of irradiation to the postoperative pituitary lesion for one month. Seven months later she had sudden right visual field loss. Goldmann perimetry examination revealed remarked visual field defect in her right eye with visual acuity of 1.0. The right relative afferent pupillary defect was positive. The value of critical flicker fusion for her right eye was reduced and the amplitude of steady-state pattern-reversal visually evoked cortical potential was significantly less for the right monocular stimulation than that for the fellow eye stimulation, but Ganzfeld electroretinograms were normal for both eyes. Magnetic resonance imaging using Gadolinium-diethylene triaminepenta-acetic acid revealed enhancement on the right optic nerve, which had not been recognized immediately after the radiation therapy, without any suggestion of right optic nerve compression by the residual pituitary adenoma. (author)

  3. A case of radiation optic neuropathy after resection of a pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Yoshii, Masaru; Okisaka, Shigekuni; Yanagawa, Youichi; Takiguchi, Hiroshi [National Defense Medical Coll., Tokorozawa, Saitama (Japan)

    1995-06-01

    A case of optic neuropathy after postoperative radiation therapy is reported. A 69-year-old woman had a partial resection of a pituitary adenoma in 1990 and was treated with 45 Gy of irradiation to the postoperative pituitary lesion for one month. Seven months later she had sudden right visual field loss. Goldmann perimetry examination revealed remarked visual field defect in her right eye with visual acuity of 1.0. The right relative afferent pupillary defect was positive. The value of critical flicker fusion for her right eye was reduced and the amplitude of steady-state pattern-reversal visually evoked cortical potential was significantly less for the right monocular stimulation than that for the fellow eye stimulation, but Ganzfeld electroretinograms were normal for both eyes. Magnetic resonance imaging using Gadolinium-diethylene triaminepenta-acetic acid revealed enhancement on the right optic nerve, which had not been recognized immediately after the radiation therapy, without any suggestion of right optic nerve compression by the residual pituitary adenoma. (author).

  4. Intraoperative radiation therapy for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru; Yamada, Hiromu; Andoh, Takashi; Hirata, Toshifumi; Nishimura, Yasuaki; Miwa, Yoshiaki; Shimizu, Kotoyuki; Yanagawa, Shigeo [Gifu Univ. (Japan). Faculty of Medicine

    1991-11-01

    Intraoperative radiation therapy (IORT) was used as part of the initial therapy for malignant glioma in 32 of 73 patients with histologically verified anaplastic astrocytoma (grade III astrocytoma) and glioblastoma multiforme. The initial treatment for all cases was subtotal or total tumor resection combined with external irradiation and chemotherapy. IORT was performed 1 week after tumor resection, with doses of 10-50 Gy (mean 26.7 Gy) in one session. Fourteen of 32 cases had IORT two times because of tumor recurrence. The IORT patients had survival rates at 24 and 36 months after initial treatment of 57.1 and 33.5% (median survival 26.2 months). The other 41 patients had 23.6 and 13.1% survivals (median survival 20.7 months), which were significantly lower (p<0.01). Tumor recurrence within the original lesion site was suspected because of clinical condition, computed tomography, and magnetic resonance imaging studies in 65.6% of the IORT group (21 cases) 12 months after initial treatment. Twenty cases of death in the IORT group, including five autopsy cases, demonstrated regional tumor recurrence with a high incidence of intraventricular tumor invasion. The authors consider IORT is beneficial for selected malignant glioma patients, including tumor recurrence, because of prolonged survival. (author).

  5. Radiation Therapy for Lung Cancer

    Science.gov (United States)

    ... is almost always due to smoking. TREATING LUNG CANCER Lung cancer treatment depends on several factors, including the ... org TARGETING CANCER CARE Radiation Therapy for Lung Cancer Lung cancer is the second most common cancer in ...

  6. Radiation therapy for gastric cancer

    International Nuclear Information System (INIS)

    Dobelbower, R.R.; Bagne, F.; Ajlouni, M.I.; Milligan, A.J.

    1988-01-01

    Adenocarcinoma of the stomach is a moderately radioresponsive neoplasm. Attempts to treat patients with unresectable disease with external beam radiation therapy alone have generally failed because of problems with tumor localization and adequate dose delivery as well as the inherent radioresponsiveness of the gastric mucosa and the organs intimately related to the stomach. Combining external beam therapy and chemotherapy (acting as a systemic agent and as a radiosensitizer) seems to be of some (albeit limited) benefit in the management of unresectable adenocarcinoma of the stomach. Optimum combinations of radiation therapy, chemotherapy, and radiation sensitizers in this situation remain to be determined. The authors discuss strides which have been made in the treatment of gastric cancer. They also address the unanswered clinical questions which remain regarding the use of radiation therapy in the treatment of this highly lethal disease

  7. Intraoperative radiation therapy for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru; Yamada, Hiromu; Andoh, Takashi; Takada, Mitsuaki; Hirata, Toshifumi; Funakoshi, Takashi; Doi, Hidetaka; Yanagawa, Shigeo [Gifu Univ. (Japan). Faculty of Medicine

    1989-04-01

    Intraoperative radiation therapy (IOR) is an ideal means of exterminating residual tumor after surgical resection. In this study, the clinical results of IOR using a Scanditronix Microtron MM-22 were evaluated in 14 patients with malignant glioma, five of whom had recurrent tumors. Between July, 1985 and October, 1986, 11 patients with glioblastoma multiforme (GB) were irradiated 18 times (mean, 1.6 times/case), and three with astrocytoma (Kernohan grade III) underwent IOR once each. The target-absorbed dose at 1 to 2 cm deeper than the tumor resection surface was 15 to 50 Gy. During irradiation, a cotton bolus was placed in the dead space after over 91% of the tumor had been resected. As a rule, external irradiation therapy was also given postoperatively at a dose of 30 to 52 Gy. One patient died of pneumonia and disseminated intravascular coagulation syndrome 1 month postoperatively. The 1- and 2-year survival rates of the ramaining 13 patients were 84.6% and 61.5%, respectively; among the 10 with GB, they were 80% and 50%. Generally, the smaller the tumor size, the better the results. There were no adverse effects, despite the dose 15 to 50 Gy applied temporally to the tumor bed. IOR was especially effective against small, localized tumors, but was not always beneficial in cases of large tumors, particularly those with a contralateral focus. The improved survival rate in this series demonstrates that IOR is significantly effective in the 'induction of remission' following surgical excision of malignant gliomas. (author).

  8. Hepatic artery infusion (HAI) for hepatic metastases in combination with hepatic resection and hepatic radiation

    International Nuclear Information System (INIS)

    Merrick, H.W.; Dobelbower, R.R.; Ringleint, J.F.; Skeel, R.T.

    1986-01-01

    Renewed interest in hepatic artery infusion has been stimulated by the development of a totally implantable pump which eliminates many of the problems encountered by the external pumps and catheters. As the potential benefit of hepatic artery infusion would be greater if either all gross disease were removed by prior resection, or alternatively, if non-resectable disease were irradiated in conjunction with hepatic artery infusion, the authors initiated a phase I-II trial to evaluate combined modality therapy

  9. Tracheoinnominate artery fistula as a complication of radiation therapy

    International Nuclear Information System (INIS)

    Reiter, D.; Piccone, B.R.; Littman, P.; Lisker, S.A.

    1979-01-01

    Tracheoinnominate artery fistulization is a well-known complication of tracheostomy and of tracheal resection. The first known occurrence of this problem in a patient in whom no transtracheal procedure had ever been performed is reported, and high-dose radiation therapy delivered three years before for a mediastinal malignancy is suggested as the cause. No evidence of tumor was found in or adjacent to the tracheovascular communication. The tracheoinnominate artery fistula must be considered a potential complication of radiation therapy as well as of surgery

  10. Radiation therapy following targeted therapy in oligometastatic renal cell carcinoma.

    Science.gov (United States)

    Gravis, Gwenaelle; Faure, Marjorie; Rybikowski, Stanislas; Dermeche, Slimane; Tyran, Marguerite; Calderon, Benoit; Thomassin, Jeanne; Walz, Jochen; Salem, Naji

    2015-11-01

    Up to 40% of patients with renal cell carcinoma (RCC) with initially localized disease eventually develop metastasis following nephrectomy. The current standard of care for metastatic RCC (mRCC) is targeted therapy. However, complete response remains rare. A state of oligometastatic disease may exist, in which metastases are present in a limited number of locations; such cases may benefit from metastasis-directed local therapy, based on the evidence supporting resection of limited-volume metastases, allowing for improved disease control. We retrospectively analyzed 7 cases of response of RCC metastases, in patients treated with targeted therapies followed by radiation therapy (RT) of residual metastatic lesions in Paoli-Calmettes Institute (Marseille, France). We analyzed disease response rates, response to sequential strategy, relapse at the irradiated locations and disease evolution. The median follow-up was 34.1 months (range, 19.2-54.5 months). No progression at the irradiated sites was observed. A total of 5 patients had stable disease at the irradiated locations at the last follow-up; 3 remained in complete remission at the assessment, and 2 were stable. Excellent local response and clinical benefit may be achieved without added toxicity. In conclusion, sequential therapeutic strategies with RT following systemic treatment using sunitinib appear to be highly effective in patients with progressive mRCC and prompt the conduction of further confirmatory trials.

  11. Radiation Therapy (For Parents)

    Science.gov (United States)

    ... dose given. Radiation on the brain may affect learning and memory. Your doctor can offer advice and may prescribe medications to make your child more comfortable during radiation treatment. Make sure you avoid giving your child any medicines, including herbal medicines or over-the-counter (OTC) ...

  12. A cost-effectiveness analysis of adjuvant therapies for resected adenocarcinoma of the rectum

    International Nuclear Information System (INIS)

    Lee, Jason H.

    1997-01-01

    PURPOSE: Several prospective randomized trials have shown a significant survival advantage with adjuvant chemotherapy and radiation therapy following surgical resection of adenocarcinoma of the rectum. Recent and ongoing trials are evaluating the role of modulated and/or protracted venous infusion [PVI] chemotherapy with pelvic irradiation [PRT]. The economic implications of additional therapies compared with their incremental benefits have not been rigorously analyzed. This study attempts to assess the incremental cost effectiveness of adjuvant therapy over surgery alone, and secondly, adjuvant therapy with PVI delivery systems versus rapid infusion. METHODS: A Markov model was constructed to describe the natural history of rectal carcinoma [stage B2, C] following surgical resection in a hypothetical cohort of 60 year old patients. This model was used to perform two sets of comparisons: [1] surgery alone versus adjuvant bolus fluorouracil [5-FU] with PRT, and [2] bolus 5-FU with PRT versus PVI 5-FU with PRT. Relapse rates and overall survival were derived from an early GITSG trial for the first comparison and from the NCCTG 86-47-51 trial for the second comparison. Medicare reimbursement rates and reports from health maintenance organizations were used to obtain net medical costs of adjuvant treatments, routine follow-up, advanced recurrent disease, and terminal illness as a result of rectal carcinoma. Total years of life and medical costs were projected over an 8-year time horizon for the first comparison [GITSG data] and over a 5-year time horizon for the second comparison [NCCTG data]. Monetary and nonmonetary benefits were discounted at 5% per year. Adjustments for quality of life, costs of adverse effects from treatment, and indirect costs of disease or treatment were not included in this current analysis. RESULTS: The main survival and economic outcomes for each treatment arm in the two comparisons are reported in the table below. For the first comparison

  13. Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only.

    Science.gov (United States)

    Zhong, Qinghua; Yuan, Zixu; Ma, Tenghui; Wang, Huaiming; Qin, Qiyuan; Chu, Lili; Wang, Jianping; Wang, Lei

    2017-02-02

    Radiation-induced rectovaginal fistula (RVF) is a severe and difficult complication after pelvic malignancy radiation. This study was to retrospectively compare the outcomes of restorative resection and colostomy only in remission of anorectal symptoms. We enrolled a cohort of 26 consecutive cases who developed RVF after pelvic radiation. Two main procedures for these patients in our institution were used: one was restorative resection and pull-through coloanal anastomosis with a prophylactic colostomy, and another was a simple colostomy without resection. Thus, we divided these patients into these two groups. Anorectal symptoms including rectal pain, bleeding, tenesmus, and perineal mucous discharge were recorded and scored prior to surgery and at postoperative multiple time points. The baseline was similar among the two groups. All patients acquired good efficacy with improved symptoms at postoperative 6, 12, and 24 months, when compared to baseline. In addition, the resection group showed a better remission of tenesmus (6 months 33.3 vs 0%; 12 months 66.7 vs 16.7%) and perineal mucous discharge (6 months 88.9 vs 6.7%; 12 months 77.8 vs 15.4%; 24 months 85.7 vs 25.0%). Furthermore, three (30%) patients in the resection group successfully reversed stomas while no stoma was closed in the simple colostomy group. Both restorative resection procedure and colostomy only can improve anorectal symptoms of radiation-induced RVF, but restorative resection can completely relieve anorectal symptoms in selected cases.

  14. Radiation Therapy of Pituitary Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Park, Moon Baik; Hong, Seong Eong [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    Radiation treatment results were analyzed in a retrospective analysis of 47 patients with pituitary adenoma treated with radiation alone or combined with surgery from 1974 through 1987 at the Department of Therapeutic Radiology of Kyung Hee University. The 5-year overall survival rates for all patients was 80.4%. Radiation therapy was effective for improving visual symptoms and headache, but could not normalize amenorrhea and galactorrhoea. There was no difference of survival rate between radiation alone and combination with surgery. Prognostic factors such as age, sex, disease type, visual field, headache and surgical treatment were statistically no significant in survival rates of these patients.

  15. Radiation Therapy of Pituitary Tumors

    International Nuclear Information System (INIS)

    Park, Moon Baik; Hong, Seong Eong

    1989-01-01

    Radiation treatment results were analyzed in a retrospective analysis of 47 patients with pituitary adenoma treated with radiation alone or combined with surgery from 1974 through 1987 at the Department of Therapeutic Radiology of Kyung Hee University. The 5-year overall survival rates for all patients was 80.4%. Radiation therapy was effective for improving visual symptoms and headache, but could not normalize amenorrhea and galactorrhoea. There was no difference of survival rate between radiation alone and combination with surgery. Prognostic factors such as age, sex, disease type, visual field, headache and surgical treatment were statistically no significant in survival rates of these patients

  16. Predictors for secondary therapy after surgical resection of nonfunctioning pituitary adenomas.

    Science.gov (United States)

    Ratnasingam, Jeyakantha; Lenders, Nele; Ong, Benjamin; Boros, Samuel; Russell, Anthony W; Inder, Warrick J; Ho, Ken K Y

    2017-12-01

    Factors determining recurrence of nonfunctioning pituitary adenomas (NFAs) that require further therapy are unclear as are postoperative follow-up imaging guidelines. We aimed to identify predictors for secondary therapy after surgical resection of NFAs and use this knowledge to inform postoperative management. A single-centre retrospective study of surgically resected NFAs in 108 patients followed for up to 15 years. Serial tumour images were analysed for size, location and growth rate (GR) and tissue analysed for hormone cell type and proliferation indices with secondary treatment as outcome measure. Twenty-four of 66 (36%) patients harbouring a postoperative remnant required secondary treatment, all occurring within 10 years. No secondary treatment was required in any of 42 patients with complete tumour resection. Age, gender, remnant volume and tumour histology were not different between patients requiring and not requiring secondary therapy. Remnant GRs in those requiring secondary therapy were more than 10-fold higher (Prisk for secondary therapy. Tumour GR in the first three postoperative years correlated significantly (r 2 =.6, P<.01) with GR during the period of follow-up. In surgically resected NFAs further treatment is dependent on the presence of residual tumour, growth rate and location but not tumour histology. Postoperative growth rate of NFAs in the first 3 years of imaging can be used to tailor long-term follow-up to optimize use of health resources. © 2017 John Wiley & Sons Ltd.

  17. A clinical study of 14 patients with radiation colitis; A case of radiation colitis treated by abdominoperineal resection of the rectum and lumbar plasty

    Energy Technology Data Exchange (ETDEWEB)

    Futamura, Manabu; Tanaka, Sengai; Oshita, Hiroo; Nagao, Naritoshi (Gifu City Hospital (Japan))

    1991-12-01

    Clinical study of 14 patients with radiation colitis who were treated surgically at our clinic in the past 16-year period and a patient whose treatment was very difficult are reported. Primary lesions included 13 cervical carcinomas and one ovarian cancer. Ten cases received surgery combined with radiation and 4 did radiation. Radiation dose was 6055 rad on average. Latent time ranged from 6 months to 25 years with the average of 8 years and 9 months. No significant correlation between radiation dose and latent time was noted. Symptoms included obstruction and stenosis in 56% (8/14), hematoemesis in 46% (5/14), and fistula in 46% (5/14). All lesions presented as remarkably adhesion and stenosis, and resection with anastomosis was performed in 9 (64%), colostomy in 5 (46%), and urostomy in 2 (14%). Lumbar plasty was added in one case. A 65-year-old female patient who had undergone radiation therapy 13 years before had a rectal perforation and pelvic fistula. Abdominoperineal resection of the rectum and closure of the fistula by transferring the major gluteal muscle pedicle were performed. The patient is followed on ambulant basis for more than one year, and no evidence of recurrence has been observed. (author).

  18. Radiation therapy in pseudotumour haemarthrosis

    Energy Technology Data Exchange (ETDEWEB)

    Lal, P.; Biswal, B.M.; Thulkar, S.; Patel, A.K.; Venkatesh, R.; Julka, P.K. [Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi (India). Departments of Radiation Oncology, Radiodiagnosis and Haematology

    1998-11-01

    Total or partial deficiency of factor VIII and IX in the coagulation cascade leads to haemophilia. Haemophilia affecting weight-bearing joints gives a `pseudotumour` or haemarthrosis-like condition. Surgery and cryoprecipitate infusions have been the treatment for this condition. Radiocolloids and radiation therapy have been used with some benefit. One case of ankle pseudotumour which was treated by low-dose external beam radiation is presented here. Copyright (1998) Blackwell Science Pty Ltd 14 refs., 2 figs.

  19. Radiation therapy in pseudotumour haemarthrosis

    International Nuclear Information System (INIS)

    Lal, P.; Biswal, B.M.; Thulkar, S.; Patel, A.K.; Venkatesh, R.; Julka, P.K.

    1998-01-01

    Total or partial deficiency of factor VIII and IX in the coagulation cascade leads to haemophilia. Haemophilia affecting weight-bearing joints gives a 'pseudotumour' or haemarthrosis-like condition. Surgery and cryoprecipitate infusions have been the treatment for this condition. Radiocolloids and radiation therapy have been used with some benefit. One case of ankle pseudotumour which was treated by low-dose external beam radiation is presented here. Copyright (1998) Blackwell Science Pty Ltd

  20. Intensity-modulated radiation therapy.

    Science.gov (United States)

    Goffman, Thomas E; Glatstein, Eli

    2002-07-01

    Intensity-modulated radiation therapy (IMRT) is an increasingly popular technical means of tightly focusing the radiation dose around a cancer. As with stereotactic radiotherapy, IMRT uses multiple fields and angles to converge on the target. The potential for total dose escalation and for escalation of daily fraction size to the gross cancer is exciting. The excitement, however, has greatly overshadowed a range of radiobiological and clinical concerns.

  1. Transvaginal coloanal anastomosis after rectal resection for the treatment of a rectovaginal fistula induced by radiation.

    Science.gov (United States)

    Brezean, I

    2014-01-01

    Although decreasing in number, radiation induced rectovaginal fistulas are caused by some radiation injuries and chronic ischemic lesions. Most of the experienced authors recommend anterior rectal resection with coloanal anastomosis accessed through the abdominal-perineum area for high fistula. We present a patient with a fistula that developed 23 years after hysterectomy and radiotherapy. In this case we performed an abdominal-transvaginal rectal resection with transverse coloplastypouch, coloanal anastomosis and protection ileostomy three months after a terminal sigmoidostomy. The dissection of the distal rectum by posteriour colpotomy and coloanal transvaginalan astomosis is a technical variant that may prove advantage ous compared to the procedures featured in the literature as solutions by rectal resection for rectovaginal fistula. Celsius.

  2. Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study

    NARCIS (Netherlands)

    Walma, M S; Burbach, J P M; Verheijen, P M; Pronk, A; van Grevenstein, W M U

    INTRODUCTION: Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound

  3. Preliminary report of a new treatment strategy for advanced pelvic malignancy: surgical resection and radiation therapy using afterloading catheters plus an inflatable displacement prosthesis in the treatment of advanced primary and recurrent rectal cancer

    International Nuclear Information System (INIS)

    Edington, H.D.; Hancock, S.; Coe, F.L.; Sugarbaker, P.H.

    1986-01-01

    An unsolved problem in colon and rectal surgery involves the treatment of locally invasive primary and recurrent rectal cancer. An approach is described that uses intracavitary iridium-192 sources in combination with a pelvic displacement prosthesis to augment external beam radiation doses to sites of residual disease identified at surgery. This approach should permit administration of tumoricidal doses of radiation to positive surgical margins minimizing radiation toxicity to the small bowel. The radiation source and all prosthetic materials are removed at the bedside within 2 weeks of surgery, ensuring accurate radiation dosimetry, minimizing infectious complications, and sparing the patient the need for full high-dose pelvic irradiation

  4. Outcomes of radiation therapy for maxillary sinus carcinoma

    International Nuclear Information System (INIS)

    Komiyama, Takafumi; Kato, Daiki; Hara, Ryusuke; Itami, Jun; Onishi, Hiroshi; Kuriyama, Kengo; Tanaka Shiho; Araki, Tsutomu

    2004-01-01

    We evaluated the outcome of radiation therapy for maxillary sinus carcinoma treated in our institution. From 1984 to 2001, 48 patients with maxillary sinus carcinoma were irradiated with or without chemotherapy and surgery. Patients ranged from 20-89 years of age (median, 68 years) and included 29 men and 19 women. The clinical T factors for these patients, according to the International Union Against Cancer (UICC) classification (1997), were T2 (n=2), T3 (n=13), and T4 (n=29). Lymph node involvement was observed in 13 patients. The follow-up period ranged from 2.5 to 150 months (median, 25 months). The total radiotherapy dose ranged from 40 Gy to 72.8 Gy. Forty-three patients underwent surgery. Intra-arterial chemotherapy was delivered in 39 patients, and systemic chemotherapy was delivered in 7 patients. Fourteen patients were classified as ''unresected'' (radiation therapy with or without antrostomy), and 34 patients as ''resected'' (partial, total, or extended total maxillectomy with pre-or postoperative irradiation). The 5-year overall survival rate (OS), cause-specific survival rate (CSS), and local control rate (LC) of all patients were 52%, 64%, and 75%, respectively. There was no significant difference between the ''unresected'' and ''resected'' groups in OS, CSS, or LC. Local recurrence was observed in 12 patients. In the ''resected'' group, for local control, it was important to reduce viable tumor before maxillectomy. Preoperative ≥60 Gy irradiation was considered to be effective to reduce tumor viability. There was no significant difference between the ''unresected'' and ''resected'' groups in OS, CSS, or LC. In the ''resected'' group, preoperative irradiation ≥60 Gy was considered to be effective for local control. In radical treatment of maxillary sinus carcinoma, maxillectomy is not always necessary. Concurrent chemoradiation therapy with or without antrostomy is a reasonable treatment strategy. (author)

  5. Postoperative radiation therapy for lung cancer

    International Nuclear Information System (INIS)

    Teshima, Teruki; Chatani, Masashi; Inoue, Toshihiko; Kurokawa, Eiji; Kodama, Ken; Doi, Osamu

    1987-01-01

    From January 1978 through December 1982, a total of 241 cases with lung cancer underwent surgery. Twenty-nine cases (operative death: 7, relative non-curative operation: 13, exploratory thoracotomy: 9) were excluded because they did not receive radiation therapy (RT). The remaining 212 cases were available for this analysis. Forty-two of them were treated with RT postoperatively. Three-year survival rates according to curability in the non-RT and RT groups were 83 % and 71 % (NS) in the curative operation group. In the relatively curative operation group, the corresponding figures were 40 % and 33 % (NS), and in the absolutely non-curative operation group, 3 % and 20 % (p < 0.01), respectively. The analysis of background factors revealed that in the curative operation group the rate of combined resection and in the relatively curative operation group pT3 and combined resection were significantly higher in the RT group than non-RT group. In the absolutely non-curative operation group, the rate of pM1 was significantly lower in RT group than the non-RT group. The pattern of failure of the RT group by histology was analysed. Local and regional failure was most common in the squamous cell carcinoma group and distant failure in the adenocarcinoma group. However, in the adenocarcinoma group local and regional or supraclavicular lymph node failure was also frequently noted. The relationship between the radiation field and local and regional or supraclavicular lymph node failure was analysed. In the squamous cell carcinoma group, in-field failure was most common, whereas in the adenocarcinoma group, outside (marginal) failure was common, especially in the supraclavicular lymph nodes. Concerning squamous cell carcinoma, microscopic or macroscopic residual tumor at the surgical margin, which includes the chest wall, stump (BS or VS) and pericardium was well controlled in each operation group with more than 50 Gy of RT. (J.P.N.)

  6. Pion radiation therapy

    International Nuclear Information System (INIS)

    Kligerman, M.M.

    1975-01-01

    Results are summarized from studies on the relative biological effects as compared with x or γ radiation and OER of negative pi mesons produced by the Berkeley 184-inch synchrocyclotron or the NIMROD 7-GeV proton synchrocyclotron at the Rutherford High Energy Laboratory in England using cultured animal cells or Vicia faba cells as the test system. Preliminary results are reported from similar radiobiological studies at the Los Alamos Meson Physics Facility. The relative response of human tissues to peak pion irradiation was compared with 140 kV x rays in a single patient with multiple malignant melanoma by observing the acute response of the skin surrounding metastatic modules following exposure to either pions or x radiation. Color photographs of the irradiated areas made at least twice weekly and densitometry measurements and observations by radiation therapists indicated that maximum erythemia occurred during the fifth, sixth, or seventh week after the start of a schedule of fractionated exposure to 15 fractions over 19 elapsed days. X irradiation was delivered at a dose rate of 500 rads/min to modules to deliver 55, 66, or 75 percent of a skin surface dose of 5,200 rads and pion irradiation, at doses numerically 50 percent of the x ray dose, was delivered at a dose rate of 5 to 7 rads/min. Dose response curves were plotted. Results of histological examinations of skin samples taken 24 weeks following irradiation are reported. Results are discussed relative to the destruction of melanoma cells following pion or x ray treatment

  7. Radiation therapy for prostate cancer.

    Science.gov (United States)

    Koontz, Bridget F; Lee, W Robert

    2013-07-01

    Radiation therapy is an effective treatment for newly diagnosed prostate cancer, salvage treatment, or for palliation of advanced disease. Herein we briefly discuss the indications, results, and complications associated with brachytherapy and external beam radiotherapy, when used as monotherapy and in combination with each other or androgen deprivation. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Radiation therapy and herpes zoster

    International Nuclear Information System (INIS)

    Kaneko, Itsuo; Matsushima, Hideno; Yamada, Teruyo; Moriya, Hiroshi

    1975-01-01

    The relationship between herpes zoster and radiation therapy was discussed and the combination of herpes zoster with malignancies was observed. Reported were five cases of herpes zoster (four breast and one lung carcinoma) out of 317 cases of malignancies which were irradiated in our clinic and include considerations about the etiologic relationship. (J.P.N.)

  9. Curative Radiation Therapy for T2N0M0

    International Nuclear Information System (INIS)

    Park, In Kyu; Kim, Jae Choel

    1995-01-01

    Purpose : Surgery is the treatment of choice for resectable non-small cell lung cancer. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. A retrospective analysis of patients with stage I non-small cell lung cancer treated with curative radiation therapy was performed to determine the results of curative radiation therapy and patterns of failure, and to identify factors that may influence survival. Materials and Methods : From 1986 through 1993, 39 patients with T2N0M0 non-small cell lung cancer were treated with curative radiation therapy at department of radiation oncology, Kyungpook national university hospital All patients were not candidates for surgical resection because of either patient refusal (16 patients), poor pulmonary function (12 patients), old age (7 patients), poor performance (2 patients) or coexisting medical disease (2 patients). Median age of patients was 67 years. Histologic cell type was squamous cell carcinoma in 1. All patients were treated with megavoltage irradiation and radiation dose raged from 5000cGy to 6150 cGy with a median dose of 600cGy. The median follow-up was 17 months with a range of 4 to 82 months. Survival was measured from the date therapy initiated. Results : The overall survival rate for entire patients was 40.6% at 2 years and 27.7% at 3 years, with a median survival time of 21 months he disease-free survival at 2 and 3 years was 51.7% and 25.8%, respectively. Of evaluable 20 Patients with complete response, 15 Patients were considered to have failed. Of these, 13 patients showed local failure and 2 patients failed distantly. Response to treatment (p=0.0001), tumor size (p=0.0019) and age p=0.0247) were favorably associated with overall survival. Only age was predictive for disease-free survival (p=0.0452). Conclusion : Radiation therapy is an effective treatment for small (less than 3 cm) tumors, and should be offered as an

  10. Target volumes in gastric cancer radiation therapy

    International Nuclear Information System (INIS)

    Caudry, M.; Maire, J.P.; Ratoanina, J.L.; Escarmant, P.

    2001-01-01

    The spread of gastric adenocarcinoma may follow three main patterns: hemato-genic, lymphatic and intraperitoneal. A GTV should be considered in preoperative or exclusive radiation therapy. After non-radical surgery, a 'residual GTV' will be defined with the help of the surgeon. The CTV encompasses three intricated volumes. a) A 'tumor bed' volume. After radical surgery, local recurrences appear as frequent as distant metastases. The risk depends upon the depth of parietal invasion and the nodal status. Parietal infiltration may extend beyond macroscopic limits of the tumor, especially in dinitis plastica. Therefore this volume will include: the tumor and the remaining stomach or their 'bed of resection', a part of the transverse colon, the duodenum, the pancreas and the troncus of the portal vein. In postoperative RT, this CTV also includes the jejuno-gastric or jejuno-esophageal anastomosis. b) A peritoneal volume. For practical purposes, two degrees of spread must be considered: (1) contiguous microscopic extension from deeply invasive T3 and T4 tumors, that remain amenable to local sterilization with doses of 45-50 Gy, delivered in a CTV including the peritoneal cavity at the level of the gastric bed, and under the parietal incision; (2) true 'peritoneal carcinomatosis', with widespread seeds, where chemotherapy (systemic or intraperitoneal) is more appropriate. c) A lymphatic volume including the lymph node groups 1 to 16 of the Japanese classification. This volume must encompass the hepatic pedicle and the splenic hilum. In proximal tumors, it is possible to restrict the lover part of the CTV to the lymphatic volume, and therefore to avoid irradiation of large intestinal and renal volumes. In distal and proximal tumors, involvement of resection margins is of poor prognosis -a radiation boost must be delivered at this level. The CTV in tumors of the cardia should encompass the lover part of the thoracic esophagus and the corresponding posterior mediastinum. In

  11. Postoperative radiation therapy for grade II and III intracranial ependymoma

    International Nuclear Information System (INIS)

    Mansur, David B.; Perry, Arie; Rajaram, Veena; Michalski, Jeff M.; Park, T.S.; Leonard, Jeffrey R.; Luchtman-Jones, Lori; Rich, Keith M.; Grigsby, Perry W.; Lockett, Mary Ann; Wahab, Sasha H.; Simpson, Joseph

    2005-01-01

    Purpose: To retrospectively determine the long-term outcome of intracranial ependymoma patients treated with surgery and postoperative radiation therapy. Methods and materials: Sixty patients were treated at our institution between 1964 and 2000. Forty patients had World Health Organization Grade II ependymoma, and 20 patients had Grade III ependymoma. The median patient age was 10.7 years. The majority of patients were male (55%), had infratentorial tumors (80%), and had subtotal resections (72%). Postoperative radiation therapy was delivered to all patients to a median total dose of 50.4 Gy. Craniospinal radiation therapy was used in the earlier era in only 12 patients (20%). Results: The median follow-up of surviving patients was 12.5 years. The 5-year and 10-year disease-free survival rates for all patients were 58.4% and 49.5%, respectively. The 5-year and 10-year overall survival rates for all patients were 71.2% and 55.0%, respectively. Supratentorial tumor location was independently associated with a worse disease-free survival. Subtotal resection and supratentorial location predicted a worse overall survival, but this failed to reach statistical significance. No statistically significant effect on prognosis was observed with tumor grade, patient age, or radiation dose or volume. Conclusion: Our long-term follow-up indicates that half of ependymoma patients will have disease recurrences, indicating the need for more effective treatments

  12. Radiation therapy of early glottic cancer

    International Nuclear Information System (INIS)

    Neri, S.

    1987-01-01

    The control of early glottic cancer is equally satisfactory with either surgical resection or radiation therapy; this last method gives the patient good functional results. During the period from 1/1978 to 12/1985, 73 patients with early glottic carcinoma (T1 N0 M0) were treated in the Institute of Radiotherapy L. Galvani, University of Bologna; 45 were stage T1a (tumor limited to one vocal cord) and 28 were stage T1b (tumor of both vocal cords or involving anterior commissure); radiation treatment utilized a 60 Co machine and 5x5 cm fields; the median dose was 67.2 Gy (range 50-76) with conventional fractionation. Ten patients had local recurrence; the median time of recurrence was 13.4 months; 9/10 were treated by surgery and 2/10 died, so the overall control by radiotherapy with surgery in reserve was 100% in T1a tumers and 90.6% in T1b ones. The 5-years disease free survival rate was 93.1% in T1a tumors and 69% in T1b; lesions involving anterior commissure had the worst prognosis, independent of the dose and time-dose factor (3/10 recurrences in the group treated with TDF less than 110 and 4/18 recurrences in the group with TDF more than 110)

  13. Radiation therapy for malignant lid tumor

    International Nuclear Information System (INIS)

    Totsuka, Seiichi; Itsuno, Hajime

    1991-01-01

    The case of a 42-year-old man with Meibomian gland carcinoma in his right lower lid is reported. The tumor found in the nasal part of the lower lid, was 12 mm x 13 mm in size. First, surgical resection was performed. The pathological diagnosis of the frozen section was 'undifferentiated basal cell epithelioma'. Second, cryotherapy was performed all over the cut surface. Later, the permanent section was pathologically diagnosed as 'undifferentiated Meibomian gland carcinoma'. Total 50 Gy irradiation therapy was therefore performed using a 9 Mev Linac electron beam, 25 x 20 mm field, with a lead protector for the cornea and lens. A lead contact lens did not afford good results because it was too easily shifted on the cornea, owing to its weight. Therefore, we made a racket-shaped lead protector. Fixed well with tape, this protector afforded good protective effect. Three years after treatment, the patient has good visual function, with no recurrence. This racket-shaped lead protector is thought to be useful in radiation therapy for malignant lid tumors. (author)

  14. Radiation therapy for carcinoma of the endometrium

    International Nuclear Information System (INIS)

    Potish, R.A.

    1987-01-01

    Carcinoma of the endometrium is the most common malignant tumor in the female genital tract. Radiation therapy continues to play a major role in the management of endometrial carcinoma, both as primary therapy and as adjuvant treatment. The utility of pelvic external beam therapy and intracavitary therapy is long established. However, the modern era of surgical staging has lead to an appreciation of the role of radiation therapy beyond the pelvis. Radiation therapy has been shown to be of particular benefit in peritoneal and nodal spread. The classic management of endometrial cancer is reviewed and relatively new and somewhat controversial topics, such as preoperative intracavitary therapy followed by external beam therapy are discussed

  15. Conservative treatment of rectal cancer with local excision and postoperative radiation therapy

    International Nuclear Information System (INIS)

    Minsky, B.D.

    1995-01-01

    The conventional surgical treatment for patients with potentially curable transmural and/or node positive rectal cancer is a low anterior resection or abdominoperineal resection. Recently, there has been increasing interest in the use of local excision and postoperative radiation therapy as primary therapy for selected rectal cancers. The limited data suggest that the approach of local excision and postoperative radiation therapy should be limited to patients with either T 1 tumours with adverse pathological factors or T 2 tumours. Transmural tumours, which have a 24% local failure rate, are treated more effectively with standard surgery and pre- or postoperative therapy. The results of local excision and postoperative radiation therapy are encouraging, but more experience is needed to determine if this approach ultimately has similar local control and survival rates as standard surgery. (author)

  16. Radiation therapy of brain metastases

    Energy Technology Data Exchange (ETDEWEB)

    Sauer, R; Huenig, R [Kantonsspital Basel (Switzerland). Universitaetsinstitut fuer Medizinische Radiologie

    1975-08-01

    Experiences are reported obtained with radiation therapy of brain metastases in 121 patients during the last 15 years. The treatment to a lesser extent aimed at prolongation of survival but much more at the attempt to alleviate troubles and to spare pain. The indication thus involved medical points of view as well as ethical ones. The radiotherapy of cerebral metastases comprises the whole cranial volume and requires a focal dose of minimally 4,000 R within four weeks. In 53% of the patients, the regression of neurological symptoms was considerable, in 18% even complete, partly beginning already after a few days of treatment. The number of recurrences was small. Under conditions of rigorous indication, the radiation therapy of brain metastases offers a rewarding palliative measure.

  17. Oray surgery and radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Carl, W

    1975-07-01

    Clinical evidence seems to indicate that careful oral surgery after radiation therapy contributes little, if anything at all, to the onset of osteoradionecrosis. In many cases the process of bone dissolution has already well progressed before teeth have to be extracted. The bone changes can be demonstrated radiographically and clinically. The teeth in the immediate area become very mobile and cause severe pain during mastication. Whether this condition could have been prevented by extractions before radiation therapy is difficult to establish. Osteoradionecrosis may be encountered in edentulous jaws. It manifests itself clinically by bone segments which break loose and penetrate through the mucosa leaving a defect which does not heal over. More research and more comparative studies are needed in this area in order to make reasonably accurate predictions.

  18. Radiation Therapy and Hearing Loss

    International Nuclear Information System (INIS)

    Bhandare, Niranjan; Jackson, Andrew; Eisbruch, Avraham; Pan, Charlie C.; Flickinger, John C.; Antonelli, Patrick; Mendenhall, William M.

    2010-01-01

    A review of literature on the development of sensorineural hearing loss after high-dose radiation therapy for head-and-neck tumors and stereotactic radiosurgery or fractionated stereotactic radiotherapy for the treatment of vestibular schwannoma is presented. Because of the small volume of the cochlea a dose-volume analysis is not feasible. Instead, the current literature on the effect of the mean dose received by the cochlea and other treatment- and patient-related factors on outcome are evaluated. Based on the data, a specific threshold dose to cochlea for sensorineural hearing loss cannot be determined; therefore, dose-prescription limits are suggested. A standard for evaluating radiation therapy-associated ototoxicity as well as a detailed approach for scoring toxicity is presented.

  19. A Systematic Overview of Radiation Therapy Effects in Oesophageal Cancer

    International Nuclear Information System (INIS)

    Ask, Anders; Albertsson, Maria; Jaerhult, Johannes; Cavallin-Staahl, Eva

    2003-01-01

    A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately. This synthesis of the literature on radiation therapy for oesophageal cancer is based on data from 42 randomized trials and 2 meta-analyses. A total of 44 scientific articles are included, involving 5,772 patients. The conclusions reached can be summarized as follows: There is fairly strong evidence that preoperative radiotherapy does not improve the survival in patients with potentially resectable oesophageal cancer. There is moderate evidence that preoperative chemo-radiotherapy has no beneficial impact on the survival of patients with potentially resectable oesophageal cancer. There is no scientific evidence that postoperative radiotherapy improves survival in patients with resectable oesophageal cancer. The documentation is, however, poor, consisting of only three randomized trials. There is fairly strong evidence that concomitant (but not sequential) chemo-radiotherapy gives significantly better survival rate than radiotherapy alone in inoperable oesophageal cancer. The results of the reported clinical trials are, however, conflicting, and no solid conclusion can be drawn. Hyperfractionated radiotherapy has been compared with conventionally fractionated radiotherapy in two randomized studies with conflicting results and no firm conclusion can be drawn

  20. Radiation therapy of gynecological cancer

    International Nuclear Information System (INIS)

    Nori, D.; Hilaris, B.S.

    1987-01-01

    This book consists of three parts: General Principles; Clinical Applications; and Special Topics. Some of the papers are: Introduction to Basic Radiobiology; Staging and Work-up Procedures for Patients with Gynecological Cancers; Radiation Therapy in the Treatment of Cancer of the Cervix; Role of Interstitial Implantation in Gynecological Cancer; Role of Radiocolloids in Gynecological Cancer; Radiosensitizers and Protectors; and Management of Lymphoma Associated with Pregnancy

  1. The Role of Radiation Therapy in the Unresectable Rectal Cancers

    International Nuclear Information System (INIS)

    Kim, Woo Cheol; Seong, Jin Sil; Kim, Gwi Eon

    1995-01-01

    Purpose : Unresectable rectal cancer has a grave prognosis, regardless of the therapy used and median survival is less than 1 year. Also, it is reported by many authors that 50-80% of unresectable lesions were rendered respectable by radiation therapy and the median survival time for the completely resected patients were better than that of the unresected patients. So we analyzed retrospectively our data for the better treatment outcome in these patients. Materials and Methods : From 1980 to 1992, 45 patients with initially unresectable tumors in the rectum were treated with radiation therapy with/without surgery in Department of Radiation Oncology, Yonsei Cancer Center. 10 MV radiation and multiple field technique( box or AP/PA) were used. The total dose was 8-70 Gy and median dose was 48 Gy. We evaluated the lesion status at 45-50 Gy for operability. If the lesions appeared to be respectable, the patients were operated on 4-6 weeks after radiation therapy. But if the lesions were still fixed, the radiation dose was increased to 60-65 Gy. Results : For all patients, the 2-year actuarial survival was 13.3% and median survival was 9.5 months. Of 6 patients who had received less than 45 Gy, only 17% of patients responded, but in the patients who had received more than 45 Gy, 60% of response rate was achieved. Six of the 24 patients(25%) underwent surgical resections following RT. For patients undergoing curative resection, the two-year survival was 50%, but that of the patients without resection was 9.5% (p<0.01). Survival of patients with complete response following RT was 50% at 2 years. Survival of patients with partial response, stable disease and progressive disease after RT was 13.4%, 15.4%, 0% respectively (p<0.05). Conclusion: Our data suggests that the efforts which can increase the response rate and aggressive surgical approach are needed to achieve the better local control and survival in unresectable rectal cancers

  2. Radiation therapy for pleural mesothelioma

    International Nuclear Information System (INIS)

    Seydel, H.G.

    1986-01-01

    There is clear evidence that both pleural and peritoneal malignant mesothelioma are increasing in incidence in the United States. There is a recognized long period of latency from asbestos exposure to the emergence and diagnosis of tumor. Considering the levels of asbestos utilization in the mid-20th century, we must expect that the number of cases will continue to increase until the end of this century. Evaluation of treatment options is thus a critical issue in determining treatment approaches for this disease. Recognized only recently, mesothelioma has no effective treatment, and patients are reported only anecdotally as cured. Pleural mesothelioma is the more common presentation, but even here the reports are from small, uncontrolled series. Only one study is available in which a concomitant comparison of treatment methods was carried out. Randomized clinical studies regarding treatment of pleural mesothelioma have only recently been initiated by the clinical cooperative groups. There is thus a paucity of information on treatment in general and radiation therapy specifically for malignant mesothelioma. This chapter reviews the reported experience using radiation therapy alone and combined with other modalities for the treatment of malignant pleural mesothelioma and considers the potential for improvement of the results of current methods of radiation therapy

  3. Results of conservative surgery and radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Osteen, R.T.; Smith, B.L. (Harvard Medical School, Boston, MA (USA))

    1990-10-01

    For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that removal of a quadrant of the breast for small lesions is safe but excessive. It may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma. It also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive. Although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins, it appears that a patient with predominantly invasive ductal carcinoma can be treated without re-excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease. Patients with indeterminate margins should have a re-excision. Axillary dissection provides prognostic information and prevents progression of the disease within the axilla. Axillary dissections limited to level I will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes. When combined with radiation therapy to the axilla, a level I dissection results in a limited number of patients with progressive axillary disease. Patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels I and II. 60 references.

  4. Multibeam radiation therapy treatment application

    International Nuclear Information System (INIS)

    Manens, J.P.; Le Gall, G.; Chenal, C.; Ben Hassel, M.; Fresne, F.; Barillot, C.; Gibaud, B.; Lemoine, D.; Bouliou, A.; Scarabin, J.M.

    1991-01-01

    A software package has been developed for multibeam radiation therapy treatment application. We present in this study a computer-assisted dosimetric planning procedure which includes: i), an analytical stage for setting up the large volume via 2D and 3D displays; ii), a planning stage for issue of a treatment strategy including dosimetric simulations; and iii), a treatment stage to drive the target volume to the radiation unit isocenter. The combined use of stereotactic methods and multimodality imagery ensures spatial coherence and makes target definition and cognition of structure environment more accurate. The dosimetric planning suited to the spatial reference (the stereotactic frame) guarantees optimal distribution of the dose, computed by the original 3D volumetric algorithm. A computer-driven chair-framework cluster was designed to position the target volume at the radiation unit isocenter [fr

  5. Late complications of radiation therapy

    International Nuclear Information System (INIS)

    Masaki, Norie

    1998-01-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  6. Late complications of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Masaki, Norie [Osaka Prefectural Center for Adult Diseases (Japan)

    1998-03-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  7. Development of local radiation therapy

    International Nuclear Information System (INIS)

    Lee, Seung Hoon; Lim, Sang Moo; Choi, Chang Woon; Chai, Jong Su; Kim, Eun Hee; Kim, Mi Sook; Yoo, Seong Yul; Cho, Chul Koo; Lee, Yong Sik; Lee, Hyun Moo

    1999-04-01

    The major limitations of radiation therapy for cancer are the low effectiveness of low LET and inevitable normal tissue damage. Boron Neutron Capture Therapy (BNCT) is a form of potent radiation therapy using Boron-10 having a high propensityof capturing theraml neutrons from nuclear reactor and reacting with a prompt nuclear reaction. Photodynamic therapy is a similiar treatment of modality to BNCT using tumor-seeking photosenistizer and LASER beam. If Boron-10 and photosensitizers are introduced selectively into tumor cells, it is theoretically possible to destroy the tumor and to spare the surrounding normal tissue. Therefore, BNCT and PDT will be new potent treatment modalities in the next century. In this project, we performed PDT in the patients with bladder cancers, oropharyngeal cancer, and skin cancers. Also we developed I-BPA, new porphyrin compounds, methods for estimation of radiobiological effect of neutron beam, and superficial animal brain tumor model. Furthermore, we prepared preclinical procedures for clinical application of BNCT, such as the macro- and microscopic dosimetry, obtaining thermal neutron flux from device used for fast neutron production in KCCH have been performed

  8. Development of local radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hoon; Lim, Sang Moo; Choi, Chang Woon; Chai, Jong Su; Kim, Eun Hee; Kim, Mi Sook; Yoo, Seong Yul; Cho, Chul Koo; Lee, Yong Sik; Lee, Hyun Moo

    1999-04-01

    The major limitations of radiation therapy for cancer are the low effectiveness of low LET and inevitable normal tissue damage. Boron Neutron Capture Therapy (BNCT) is a form of potent radiation therapy using Boron-10 having a high propensityof capturing theraml neutrons from nuclear reactor and reacting with a prompt nuclear reaction. Photodynamic therapy is a similiar treatment of modality to BNCT using tumor-seeking photosenistizer and LASER beam. If Boron-10 and photosensitizers are introduced selectively into tumor cells, it is theoretically possible to destroy the tumor and to spare the surrounding normal tissue. Therefore, BNCT and PDT will be new potent treatment modalities in the next century. In this project, we performed PDT in the patients with bladder cancers, oropharyngeal cancer, and skin cancers. Also we developed I-BPA, new porphyrin compounds, methods for estimation of radiobiological effect of neutron beam, and superficial animal brain tumor model. Furthermore, we prepared preclinical procedures for clinical application of BNCT, such as the macro- and microscopic dosimetry, obtaining thermal neutron flux from device used for fast neutron production in KCCH have been performed.

  9. Aesthetic results following partial mastectomy and radiation therapy

    International Nuclear Information System (INIS)

    Matory, W.E. Jr.; Wertheimer, M.; Fitzgerald, T.J.; Walton, R.L.; Love, S.; Matory, W.E.

    1990-01-01

    This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant Breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 x 1 cm and 15 x 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. Patients satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part

  10. Awake Craniotomy for Tumor Resection: Further Optimizing Therapy of Brain Tumors.

    Science.gov (United States)

    Mehdorn, H Maximilian; Schwartz, Felix; Becker, Juliane

    2017-01-01

    In recent years more and more data have emerged linking the most radical resection to prolonged survival in patients harboring brain tumors. Since total tumor resection could increase postoperative morbidity, many methods have been suggested to reduce the risk of postoperative neurological deficits: awake craniotomy with the possibility of continuous patient-surgeon communication is one of the possibilities of finding out how radical a tumor resection can possibly be without causing permanent harm to the patient.In 1994 we started to perform awake craniotomy for glioma resection. In 2005 the use of intraoperative high-field magnetic resonance imaging (MRI) was included in the standard tumor therapy protocol. Here we review our experience in performing awake surgery for gliomas, gained in 219 patients.Patient selection by the operating surgeon and a neuropsychologist is of primary importance: the patient should feel as if they are part of the surgical team fighting against the tumor. The patient will undergo extensive neuropsychological testing, functional MRI, and fiber tractography in order to define the relationship between the tumor and the functionally relevant brain areas. Attention needs to be given at which particular time during surgery the intraoperative MRI is performed. Results from part of our series (without and with ioMRI scan) are presented.

  11. Basal cell carcinoma after radiation therapy

    International Nuclear Information System (INIS)

    Shimbo, Keisuke; Terashi, Hiroto; Ishida, Yasuhisa; Tahara, Shinya; Osaki, Takeo; Nomura, Tadashi; Ejiri, Hirotaka

    2008-01-01

    We reported two cases of basal cell carcinoma (BCC) that developed after radiation therapy. A 50-year-old woman, who had received an unknown amount of radiation therapy for the treatment of intracranial germinoma at the age of 22, presented with several tumors around the radiation ulcer. All tumors showed BCC. A 33-year-old woman, who had received an unknown amount of radiation therapy on the head for the treatment of leukemia at the age of 2, presented with a black nodule within the area of irradiation. The tumor showed BCC. We discuss the occurrence of BCC after radiation therapy. (author)

  12. Delayed radiation-induced inflammation accompanying a marked carbohydrate antigen 19-9 elevation in a patient with resected pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mattes, Malcolm D.; Cardinal, Jon S.; Jacobson, Geraldine M. [West Virginia University School of Medicine, Morgantown (United States)

    2016-06-15

    Although carbohydrate antigen (CA) 19-9 is a useful tumor marker for pancreatic cancer, it can also become elevated from a variety of benign and malignant conditions. Herein we describe an unusual presentation of elevated CA 19-9 in an asymptomatic patient who had previously undergone adjuvant chemotherapy and radiation therapy for resected early stage pancreatic cancer. The rise in CA 19-9 might be due to delayed radiation-induced inflammation related to previous intra-abdominal radiation therapy with or without radiation recall induced by gemcitabine. After treatment with corticosteroids the CA 19-9 level decreased to normal, and the patient has not developed any evidence of recurrent cancer to date.

  13. Intraoperative radiation therapy for patients with pancreatic carcinoma

    International Nuclear Information System (INIS)

    Abe, Tetsuo; Itoh, Kei; Agawa, Senichiro; Ishihara, Yukio; Konishi, Toshiro

    2001-01-01

    We studied the efficacy and complications of intraoperative radiation therapy (IORT) in 40 subjects with unresected pancreatic carcinoma (Group A) and 8 with resected pancreatic carcinoma (Group B). These 2 groups were compared to groups not treated by IORT; 59 subjects with unresected pancreatic carcinoma (Group C) and 55 with resected pancreatic carcinoma (Group D). The 6-month survival in Group A was 55%, and 1-year survival 26% compared to 20% 6-month survival and 9% 1-year survival in Group C with a median survival of 7 months in Group A and 4 months in group C; all statistically significant. Pain control was 81.8% in Group A, reduction in tumor size was 50% and reduction of tumor marker, CA19-9 was 56.3% in Group A. Survival in Groups B and D did not differ significantly. The histological efficacy of IORT in Group A was confirmed in autopsy of fibrosis and scar formation in radiation fields of the pancreas. Two patients in Group B had major morbidity leading to death; 1 from leakage in the pancreatojejunal anastomosis accompanied by pancreatic necrosis and the other from duodenal perforation with rupture of the portal vein and hepatic artery. This study demonstrates the efficacy of IORT in patients with unresected pancreatic carcinoma. Prophylactic bypass and shielding of the residual pancreas with lead or reducing the IORT or external beam radiation therapy (EBRT) dose should be considered in patients with unresected or resected pancreatic carcinoma, however, to prevent serious complications due to radiation injury of the duodenum and pancreas. (author)

  14. DNA repair related to radiation therapy

    International Nuclear Information System (INIS)

    Klein, W.

    1979-01-01

    The DNA excision repair capacity of peripheral human lymphocytes after radiation therapy has been analyzed. Different forms of application of the radiation during the therapy have been taken into account. No inhibition of repair was found if cells were allowed a certain amount of accomodation to radiation, either by using lower doses or longer application times. (G.G.)

  15. External Beam Radiation Therapy for Cancer

    Science.gov (United States)

    External beam radiation therapy is used to treat many types of cancer. it is a local treatment, where a machine aims radiation at your cancer. Learn more about different types of external beam radiation therapy, and what to expect if you're receiving treatment.

  16. Radiation therapy of humeroscapular periarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Hassenstein, E; Nuesslin, F; Renner, K [Medizinische Hochschule Hannover (Germany, F.R.). Abt. fuer Strahlentherapie und Spezielle Onkologie; Hartweg, H [Basel Univ. (Switzerland). Inst. fuer Medizinische Radiologie

    1979-02-01

    The effectiveness of radiation therapy in 233 cases with periarthritis humeroscapularis is reviewed in a prospective study from the Basel canton hospital. The patients are studied with regard to different parameters, such as duration of the anamnesis, importance of the dose, moment of evaluation of the results and influence of a 2-series technique. The total result, comprising 43.3% cases without complaints, 30.9% being better, and 25.8% whose troubles had not changed, is compared with the compiled statistical data of 4957 cases found in literature. The gonadal load is discussed on the basis of our own investigations.

  17. Insufficiency fracture after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Dong Ryul; Huh, Seung Jae [Dept.of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

  18. Three-dimensional conformal radiation therapy: the tomo-therapy approach

    International Nuclear Information System (INIS)

    Linthout, N.; Verellen, D.; Coninck, P. de; Bel, A.; Storme, G.

    2000-01-01

    Conformal radiation therapy allows the possibility of delivering high doses at the tumor volume whilst limiting the dose to the surrounding tissues and diminishing the secondary effects. With the example of the conformal radiation therapy used at the AZ VU8 (3DCRT and tomo-therapy), two treatment plans of a left ethmoid carcinoma will be evaluated and discussed in detail. The treatment of ethmoid cancer is technically difficult for both radiation therapy and surgery because of the anatomic constraints and patterns of local spread. A radiation therapy is scheduled to be delivered after surgical resection of the tumor. The treatment plan for the radiation therapy was calculated on a three-dimensional (3D) treatment planning system based on virtual simulation with a beam's eye view: George Sherouse's Gratis. An effort was made to make the plan as conformal and as homogeneous as possible to deliver a dose of 66 Gy in 33 fractions at the tumor bed with a maximum dose of 56 Gy to the right optic nerve and the chiasma. To establish the clinical utility and potential advantages of tomo-therapy over 3DCRT for ethmoid carcinoma, the treatment of this patient was also planned with Peacock Plant. For both treatment plans the isodose distributions and cumulative dose volume histograms (CDVH) were computed. Superimposing the CDVHs yielded similar curves for the target and an obvious improvement for organs at risk such as the chiasma, brainstem and the left eye when applying tomo-therapy. These results have also been reflected in the tumor control probabilities (equal for both plans) and the normal tissue complication probabilities (NTCP), yielding significant reductions in NTCP for tomo-therapy. The probability of uncomplicated tumor control was 52.7% for tomo-therapy against 38.3% for 3DCRT. (authors)

  19. Radiation therapy of thoracic and abdominal tumors

    International Nuclear Information System (INIS)

    LaRue, S.M.; Gillette, S.M.; Poulson, J.M.

    1995-01-01

    Until recently, radiotherapy of thoracic and abdominal tumors in animals has been limited. However, the availability of computerized tomography and other imaging techniques to aid in determining the extent of tumor, an increase in knowledge of dose tolerance of regional organs, the availability of isocentrically mounted megavoltage machines, and the willingness of patients to pursue more aggressive treatment is making radiation therapy of tumors in these regions far more common. Tumor remission has been reported after radiation therapy of thymomas. Radiation therapy has been used to treat mediastinal lymphoma refractory to chemotherapy, and may be beneficial as part of the initial treatment regimen for this disease. Chemodectomas are responsive to radiation therapy in human patients, and favorable response has also been reported in dogs. Although primary lung tumors in dogs are rare, in some cases radiation therapy could be a useful primary or adjunctive therapy. Lung is the dose-limiting organ in the thorax. Bladder and urethral tumors in dogs have been treated using intraoperative and external-beam radiation therapy combined with chemotherapy. These tumors are difficult to control locally with surgery alone, although the optimal method of combining treatment modalities has not been established. Local control of malignant perianal tumors is also difficult to achieve with surgery alone, and radiation therapy should be used. Intraoperative radiation therapy combined with external-beam radiation therapy has been used for the management of metastatic carcinoma to the sublumbar lymph nodes. Tolerance of retroperitoneal tissues may be decreased by disease or surgical manipulation

  20. Radiation therapy for operable rectal cancer

    International Nuclear Information System (INIS)

    Bondar, G.V.; Semikoz, N.G.; Bashejev, V.Kh.; Borota, O.V.; Bondarenko, M.V.; Kiyashko, O.Yu.

    2012-01-01

    The authors present a review of the literature on modern tendencies of radiation therapy application to treatment of operable rectal cancer. Many randomized control studies compared the efficacy of combination of radiation therapy (pre-operative or post-operative) and surgery versus surgery only demonstrating various results. Meta-analysis of the data on efficacy of combination of radiation therapy and standard surgery revealed 22 randomized control studies (14 with pre-operative radiation therapy and 8 with post-operative radiation therapy) with total number of 8507 patients (Colorectal Cancer Collaborative Group, 2000). The use of combination treatment reduced the number of isolated locoregional relapses both with pre-operative (22.5 - 12.5 %; p < 0.00001) and post-operative radiation therapy (25.8 - 16.7 %; p - 0.00001). The influence on total survival was not significant (62 % vs. 63 %; p - 0.06).

  1. Postoperative Radiation Therapy of Craniopharyngioma

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Kyung Hwan; Kim, Il Han; Park, Charn Il; Cho, Byung Kyu [Seoul National University College of Medicine, Seoul (Korea, Republic of); Yun, Hyong Geln [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1993-06-15

    Between December 1979 and September 1989, 23 patients with craniopharyngioma who underwent surgery and postoperative radiation therapy were retrospectively evaluated to assess the efficacy of this management at the Department of Therapeutic Radiology, Seoul National University Hospital. Total removal of tumor was attempted in all patients. Of these, surgeons tried total removal in eight patients, but revealed residual mass by postoperative CT, and partial removal was done in 15 patients. The morphology of tumor on the operative finding was grouped into three types : cystic 13 (57%), solid 4 (17%), and mixed 6 (26%). Cystic type was predominant in {<=}20 years old group. Actuarial overall survival rates at 5 and 10 years were 95% and 81% respectively and actuarial tumor control rates were 74% and 50%. Surgical extent was not related to the survival rates(p=0.41). Pediatric and adolescent Patients(age of {<=}20 year) had a trend of better survival than that of adult patients(p=0.10). The results indicated that limited surgical excision followed by radiation therapy is recommended when total excision is not possible.

  2. Postoperative Radiation Therapy of Craniopharyngioma

    International Nuclear Information System (INIS)

    Shin, Kyung Hwan; Kim, Il Han; Park, Charn Il; Cho, Byung Kyu; Yun, Hyong Geln

    1993-01-01

    Between December 1979 and September 1989, 23 patients with craniopharyngioma who underwent surgery and postoperative radiation therapy were retrospectively evaluated to assess the efficacy of this management at the Department of Therapeutic Radiology, Seoul National University Hospital. Total removal of tumor was attempted in all patients. Of these, surgeons tried total removal in eight patients, but revealed residual mass by postoperative CT, and partial removal was done in 15 patients. The morphology of tumor on the operative finding was grouped into three types : cystic 13 (57%), solid 4 (17%), and mixed 6 (26%). Cystic type was predominant in ≤20 years old group. Actuarial overall survival rates at 5 and 10 years were 95% and 81% respectively and actuarial tumor control rates were 74% and 50%. Surgical extent was not related to the survival rates(p=0.41). Pediatric and adolescent Patients(age of ≤20 year) had a trend of better survival than that of adult patients(p=0.10). The results indicated that limited surgical excision followed by radiation therapy is recommended when total excision is not possible

  3. Radiation therapy of peritoneal mesothelioma

    International Nuclear Information System (INIS)

    Lederman, G.; Recht, A.

    1986-01-01

    The role of radiation therapy in the treatment of peritoneal mesotheliomas remains ill-defined despite its association with the few long-term survivals reported for this disease. The rationale for local therapy is clear as the disease most often is confined to the peritoneal cavity at the time of initial diagnosis and remains there for much of the subsequent course. Effective local treatment of this intra-abdominal disease would likely improve survival. The absence of randomized studies has made analysis of the various treatments of the disease and the few reported success difficult. Nonetheless, scrutiny of the available data may offer insights and guide future clinical trials, as well as the clinician responsible for the treatment of current patients with peritoneal mesothelioma. The radiotherapeutic approach to oncology stresses anatomic considerations in an attempt to understand the patterns of spread of the primary tumor. The observed location and bulk of disease by clinical examination, radiologic study, surgical exploration, and autopsy suggest mechanisms of metastases (direct extension, lymphatic or hematogenous). This dictates the administration of radiation that best achieves a successful outcome

  4. Hypofractionated stereotactic radiation therapy for recurrent glioblastoma: single institutional experience

    International Nuclear Information System (INIS)

    Ciammella, Patrizia; Podgornii, Ala; Galeandro, Maria; D’Abbiero, Nunziata; Pisanello, Anna; Botti, Andrea; Cagni, Elisabetta; Iori, Mauro; Iotti, Cinzia

    2013-01-01

    Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. Tumor control and survival have improved with the use of radiotherapy (RT) plus concomitant and adjuvant chemotherapy, but the prognosis remain poor. In most cases the recurrence occurs within 7–9 months after primary treatment. Currently, many approaches are available for the salvage treatment of patients with recurrent GBM, including resection, re-irradiation or systemic agents, but no standard of care exists. We analysed a cohort of patients with recurrent GBM treated with frame-less hypofractionated stereotactic radiation therapy with a total dose of 25 Gy in 5 fractions. Of 91 consecutive patients with newly diagnosed GBM treated between 2007 and 2012 with conventional adjuvant chemo-radiation therapy, 15 underwent salvage RT at recurrence. The median time interval between primary RT and salvage RT was 10.8 months (range, 6–54 months). Overall, patients undergoing salvage RT showed a longer survival, with a median survival of 33 vs. 9.9 months (p= 0.00149). Median overall survival (OS) from salvage RT was 9.5 months. No patients demonstrated clinically significant acute morbidity, and all patients were able to complete the prescribed radiation therapy without interruption. Our results suggest that hypofractionated stereotactic radiation therapy is effective and safe in recurrent GBM. However, until prospective randomized trials will confirm these results, the decision for salvage treatment should remain individual and based on a multidisciplinary evaluation of each patient

  5. Risk analysis of external radiation therapy

    International Nuclear Information System (INIS)

    Arvidsson, Marcus

    2011-09-01

    External radiation therapy is carried out via a complex treatment process in which many different groups of staff work together. Much of the work is dependent on and in collaboration with advanced technical equipment. The purpose of the research task has been to identify a process for external radiation therapy and to identify, test and analyze a suitable method for performing risk analysis of external radiation therapy

  6. Considering the role of radiation therapy for gastrointestinal stromal tumor

    Directory of Open Access Journals (Sweden)

    Corbin KS

    2014-05-01

    Full Text Available Kimberly S Corbin,1 Hedy L Kindler,2 Stanley L Liauw31Department of Radiation Oncology, Memorial Medical Center, Springfield, IL, USA; 2Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA; 3Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USAAbstract: Gastrointestinal stromal tumors (GISTs are rare mesenchymal tumors arising in the gastrointestinal tract. Over the last decade, the management and prognosis of GISTs has changed dramatically with molecular characterization of the c-kit mutation and the adoption of targeted systemic therapy. Currently, the standard of care for resectable tumors is surgery, followed by adjuvant imatinib for tumors at high risk for recurrence. Inoperable or metastatic tumors are treated primarily with imatinib. Despite excellent initial response rates, resistance to targeted therapy has emerged as a common clinical problem, with relatively few therapeutic solutions. While the treatment of GISTs does not commonly include radiotherapy, radiation therapy could be a valuable contributing modality. Several case reports indicate that radiation can control locally progressive, drug-resistant disease. Further study is necessary to define whether radiation could potentially prevent or delay the onset of drug resistance, or improve outcomes when given in combination with imatinib.Keywords: GIST, imatinib, radiotherapy

  7. Missed Radiation Therapy and Cancer Recurrence

    Science.gov (United States)

    Patients who miss radiation therapy sessions during cancer treatment have an increased risk of their disease returning, even if they eventually complete their course of radiation treatment, according to a new study.

  8. Radiobiology of systemic radiation therapy.

    Science.gov (United States)

    Murray, David; McEwan, Alexander J

    2007-02-01

    Although systemic radionuclide therapy (SRT) is effective as a palliative therapy in patients with metastatic cancer, there has been limited success in expanding patterns of utilization and in bringing novel systemic radiotherapeutic agents to routine clinical use. Although there are many factors that contribute to this situation, we hypothesize that a better understanding of the radiobiology and mechanism of action of SRT will facilitate the development of future compounds and the future designs of prospective clinical trials. If these trials can be rationalized to the biological basis of the therapy, it is likely that the long-term outcome would be enhanced therapeutic efficacy. In this review, we provide perspectives of the current state of low-dose-rate (LDR) radiation research and offer linkages where appropriate with current clinical knowledge. These include the recently described phenomena of low-dose hyper-radiosensitivity-increased radioresistance (LDH-IRR), adaptive responses, and biological bystander effects. Each of these areas require a major reconsideration of existing models for radiation action and an understanding of how this knowledge will integrate into the evolution of clinical SRT practice. Validation of a role in vivo for both LDH-IRR and biological bystander effects in SRT would greatly impact the way we would assess therapeutic response to SRT, the design of clinical trials of novel SRT radiopharmaceuticals, and risk estimates for both therapeutic and diagnostic radiopharmaceuticals. We believe that the current state of research in LDR effects offers a major opportunity to the nuclear medicine community to address the basic science of clinical SRT practice, to use this new knowledge to expand the use and roles of SRT, and to facilitate the introduction of new therapeutic radiopharmaceuticals.

  9. Treatment of eccrine porocarcinoma with metastasis to the parotid gland using intensity-modulated radiation therapy: a case report

    Directory of Open Access Journals (Sweden)

    Lentsch Eric J

    2010-05-01

    Full Text Available Abstract Introduction Cutaneous eccrine porocarcinomas are uncommon malignant tumors of the sweat gland. Case Presentation A 76-year-old Caucasian man presented to our hospital with a left temporal mass. We describe a case of eccrine porocarcinoma with metastasis to the parotid gland with special emphasis on the role of surgical resection and adjuvant radiation therapy. Conclusion Besides surgical resection, little is known about the role of adjuvant therapy in managing eccrine porocarcinomas. Radiation therapy should be considered within a multidisciplinary approach in patients with primary or recurrent eccrine porocarcinomas.

  10. Radiation therapy for prostatic cancer

    International Nuclear Information System (INIS)

    Kimura, Akira; Minowada, Shigeru; Tomoishi, Junzo; Kinoshita, Kenji; Matsuda, Tadayoshi

    1983-01-01

    A conformation radiotherapy system with collimators, whose openings can be controlled symmetrically by computerized techniques during rotational irradiation by a linear accelerator, has been developed for routine use in our hospital. Forty-four patients underwent radiation therapy, including this particular modality of radiotherapy, for prostatic cancer during the period of July 1976 through December 1981. Eight patients were classified as stage A, 10 stage B, 10 stage C, and 16 as stage D. Twenty-nine patients underwent conformation radiotherapy, two rotation radiotherapy, eight 2-port opposing technique radiotherapy, one 4-field radiotherapy, and four underwent a combination of 2-port opposing technique and conformation radiotherapy. Transient mild side effects such as diarrhea occurred in seven cases, while severe side effects such as rectal stricture or contracted bladder occurred in three cases. The latter occurred only in one case among 29 of conformation radiotherapy and in two among eight of 2-port opposing technique radiotherapy. The results of the treatment of short intervals in stage B, C, and D are as follows: prostatic size was reduced in 26 cases among 36, serum acid phosphatase level was reduced in 15 among 18 who had showed high acid phosphatase levels before treatment, although almost all cases underwent simultaneous hormonal therapy. The effects of radiotherapy alone were verified in two cases of stage B in which radiotherapy preceded hormonal therapy. Prostatic size and serum acid phosphatase level were reduced by radiotherapy alone. (author)

  11. Radiation therapy for intracranial ependymomas: impact of age on outcome

    International Nuclear Information System (INIS)

    Pham, Houng T.; Sneed, Penny K.; Wara, William M.; Edwards, Michael S.; Wilson, Charles B.; Larson, David A.

    1997-01-01

    Purpose: The records of patients with intracranial ependymoma who received radiation therapy at UCSF were reviewed retrospectively to evaluate the impact of Karnofsky performance status (KPS), age, histology, and treatment on outcome. Materials and Methods: Between 1978 and 1996, 45 patients with intracranial ependymoma received postoperative radiation therapy. Overall survival (OS) and progression free survival (PFS) were calculated from the date of diagnosis. Median follow up for surviving patients was 72 months. Ages ranged from 4 months to 56 years, with a median of 8 years. The tumor was infratentorial in 35 and supratentorial in 10. All patients had either biopsy (3), subtotal resection (30), or gross total resection (12). There were 29 low grade and 16 anaplastic ependymomas. Thirty-seven patients received standard fractionation to a median dose of 54 Gy. Eight patients received hyperfractionation at 1.0 Gy BID to a median dose of 72 Gy. Thirty-eight patients had partial brain irradiation and seven had craniospinal irradiation. Twenty-three patients received adjuvant chemotherapy. For the infants ≤ 3 years old (n=12), all but one had a subtotal resection and most received chemotherapy prior to radiation therapy. Seven infants received radiation therapy at the time of disease progression and five had radiation therapy prior to progression. Most of the patients > 3 years old were irradiated prior to progression. Results: The five-year actuarial OS and PFS were 65% and 46% for the whole group. Histology and treatment factors such as extent of resection, hyperfractionation, and adjuvant chemotherapy did not significantly affect outcome. Overall, (25(45)) patients had disease progression. Only two patients failed in the brain outside the primary site. Six patients developed leptomeningeal spread (four concurrent with local failure and two subsequent to local failure). Five-year OS for patients ≤ 3 years old was 21% versus 80% for patients > 3 years old (p=0

  12. Radiation therapy sources, equipment and installations

    International Nuclear Information System (INIS)

    2011-03-01

    The safety code for Telegamma Therapy Equipment and Installations, (AERB/SC/MED-1) and safety code for Brachytherapy Sources, Equipment and Installations, (AERB/SC/MED-3) were issued by AERB in 1986 and 1988 respectively. These codes specified mandatory requirements for radiation therapy facilities, covering the entire spectrum of operations ranging from the setting up of a facility to its ultimate decommissioning, including procedures to be followed during emergency situations. The codes also stipulated requirements of personnel and their responsibilities. With the advent of new techniques and equipment such as 3D-conformal radiation therapy, intensity modulated radiation therapy, image guided radiation therapy, treatment planning system, stereotactic radiosurgery, stereotactic radiotherapy, portal imaging, integrated brachytherapy and endovascular brachytherapy during the last two decades, AERB desires that these codes be revised and merged into a single code titled Radiation Therapy Sources, Equipment, and Installations

  13. Protection of the patient in radiation therapy

    International Nuclear Information System (INIS)

    1991-01-01

    In the ICRP report (ICRP-Pub-44) a broad picture of radiotheraphy is presented useful to all involved in the care of cancer patients, for instance to physicians, including medical oncologists, and to medical physicists, radiographers, dosimetrists, and administrators. Information is given on the general principles of radiation therapy including external beam therapy and brachytherapy; the accuracy of radiation delivery and quality assurance; the biological radiation response; the expected risk to specific organs or tissues from therapeutic irradiation; the absorbed dose to tissues inside and outside the useful radiation beams; the organization and planning of radiation oncology services; radiation therapy staff education, training and duties; and finally medical research involving the use of radiation therapy. (orig./HP) [de

  14. Melioidosis: reactivation during radiation therapy

    International Nuclear Information System (INIS)

    Jegasothy, B.V.; Goslen, J.B.; Salvatore, M.A.

    1980-01-01

    Melioidosis is caused by Pseudomonas pseudomallei, a gram-negative, motile bacillus which is a naturally occurring soil saprophyte. The organism is endemic in Southeast Asia, the Philippines, Australia, and parts of Central and South America. Most human disease occurs from infection acquired in these countries. Infection with P pseudomallei may produce no apparent clinical disease. Acute pneumonitis or septicemia may result from inhalation of the organism, and inoculation into sites of trauma may cause localized skin abscesses, or the disease may remain latent and be reactivated months or years later by trauma, burns, or pneumococcal pneumonia, diabetic ketoacidosis, influenza, or bronchogenic carcinoma. The last is probably the commonest form of melioidosis seen in the United States. We present the first case of reactivation of melioidosis after radiation therapy for carcinoma of the lung, again emphasizing the need to consider melioidosis in a septic patient with a history of travel, especially to Southeast Asia

  15. Radiation therapy of brain tumor

    International Nuclear Information System (INIS)

    Sung, K. J.; Lee, D. H.; Park, C. Y.

    1980-01-01

    One hundred and six cases of brain tumors were treated at the Yonsei Cancer Center from January 1972 to August 1978 by Co-60 teletherapy unit. We analyses their clinical findings, histopathological findings, treatment and results. In those cases which computerized tomography had been used before and after radiation therapy, changes in tumor size and the presence of edema or necrosis following treatment was evaluated. 1. Among 106 cases, 90 cases were primary brain tumors and 16 cases were metastatic brain tumors. Pituitary tumors (38), glioma (34) and pinealoma (10) composed of most of primary brain tumors. 2. Post treatment follow-up was possible in 38 cases more than 1 years. Four among 11 cases of giloma expired and survivors had considerable neurological symptoms except 2 cases. Sixty five percent (12/20) of pituitary tumors showed improvement of visual symptoms and all cases (7) of pinealoma which post treatment follow-up was possible, showed remarkable good response. 3. Findings of CT scan after radiation treatment were compatible with results of clinical findings and post treatment follow-up. It showed complete regression of tumor mass in one case of pinealoma and medulloblastoma. One case of pituitary tumor showed almost complete regression of tumor mass. It also showed large residual lesion in cases of glioblastoma multiforme and cystic astrocytoma.

  16. Targeted drugs in radiation therapy

    International Nuclear Information System (INIS)

    Favaudon, V.; Hennequin, C.; Hennequin, C.

    2004-01-01

    New drugs aiming at the development of targeted therapies have been assayed in combination with ionizing radiation over the past few years. The rationale of this concept comes from the fact that the cytotoxic potential of targeted drugs is limited, thus requiring concomitant association with a cytotoxic agent for the eradication of tumor cells. Conversely a low level of cumulative toxicity is expected from targeted drugs. Most targeted drugs act through inhibition of post-translational modifications of proteins, such as dimerization of growth factor receptors, prenylation reactions, or phosphorylation of tyrosine or serine-threonine residues. Many systems involving the proteasome, neo-angiogenesis promoters, TGF-β, cyclooxygenase or the transcription factor NF-κB, are currently under investigation in hopes they will allow a control of cell proliferation, apoptosis, cell cycle progression, tumor angiogenesis and inflammation. A few drugs have demonstrated an antitumor potential in particular phenotypes. In most instances, however, radiation-drug interactions proved to be strictly additive in terms of cell growth inhibition or induced cell death. Strong potentiation of the response to radiotherapy is expected to require interaction with DNA repair mechanisms. (authors)

  17. Nonsurgical treatment for cancer using radiation therapy

    International Nuclear Information System (INIS)

    Ogi, Yasuo

    2012-01-01

    The number of people who are dying from cancer has been increasing in association with population aging. Radiation therapy is now one of the three major cancer treatment methods, along with surgery and chemotherapy. People used to consider radiation therapy only as a ''noninvasive cancer treatment''; however, with the ceaseless effort by medical experts and corporations, different radiation therapy types and techniques including the latest technical advances have come out one after another, and the improvements in radiation therapies have provided treatments that are not only less traumatizing to patients but also as effective and therapeutic as surgery in certain body regions. The importance of radiation therapy has become and will become even greater in the society with more elderly cancer patients who do not have the physical strength to undergo surgery. In this article, the history of radiation therapy, rapidly developed high-precision radiation therapy techniques, and unsolved issues are discussed, and then, ''MHI vero4DRT'', which is the high-precision image-guided radiation therapy equipment developed for solving such issues, is introduced. (author)

  18. Job satisfaction among radiation therapy educators.

    Science.gov (United States)

    Swafford, Larry G; Legg, Jeffrey S

    2007-01-01

    Job satisfaction is one of the most consistent variables related to employee retention and is especially relevant considering the shortage of radiation therapists and radiation therapy educators in the United States. To investigate job satisfaction levels among radiation therapy educators certified by the American Registry of Radiologic Technologists and employed in programs accredited by the Joint Review Committee on Education in Radiologic Technology. The long form of the Minnesota Satisfaction Questionnaire (MSQ) was mailed to 158 radiation therapy educators to measure job satisfaction. Overall job satisfaction and subscales were calculated based on MSQ methodology. A total of 90 usable surveys were returned for a 56.9% response rate. With a "general satisfaction" score of 69.64, radiation therapy educators ranked in the lowest 25th percentile of the nondisabled norm scale for job satisfaction. Respondents reported higher degrees of job satisfaction on the moral values, social service and achievement subscales. Lower job satisfaction levels were associated with the company policies and practices, advancement and compensation subscales. Radiation therapy educators report low job satisfaction. Educational institutions must tailor recruitment and retention efforts to better reflect the positive aspects of being a radiation therapy educator. Furthermore, improving retention and recruitment efforts might help offset the current shortages of radiation therapy educators and, ultimately, clinical radiation therapists.

  19. Chemotherapy and molecular target therapy combined with radiation therapy

    International Nuclear Information System (INIS)

    Akimoto, Tetsuo

    2012-01-01

    Combined chemotherapy and radiation therapy has been established as standard treatment approach for locally advanced head and neck cancer, esophageal cancer and so on through randomized clinical trials. However, radiation-related morbidity such as acute toxicity also increased as treatment intensity has increased. In underlining mechanism for enhancement of normal tissue reaction in chemo-radiation therapy, chemotherapy enhanced radiosensitivity of normal tissues in addition to cancer cells. Molecular target-based drugs combined with radiation therapy have been expected as promising approach that makes it possible to achieve cancer-specific enhancement of radiosensitivity, and clinical trials using combined modalities have been performed to evaluate the feasibility and efficacy of this approach. In order to obtain maximum radiotherapeutic gain, a detailed understanding of the mechanism underlying the interaction between radiation and Molecular target-based drugs is indispensable. Among molecular target-based drugs, inhibitors targeting epidermal growth factor receptor (EGFR) and its signal transduction pathways have been vigorously investigated, and mechanisms regarding the radiosensitizing effect have been getting clear. In addition, the results of randomized clinical trials demonstrated that radiation therapy combined with cetuximab resulted in improvement of overall and disease-specific survival rate compared with radiation therapy in locally advanced head and neck cancer. In this review, clinical usefulness of chemo-radiation therapy and potential molecular targets for potentiation of radiation-induced cell killing are summarized. (author)

  20. Modern Radiation Therapy for Hodgkin Lymphoma

    DEFF Research Database (Denmark)

    Specht, Lena; Yahalom, Joachim; Illidge, Tim

    2014-01-01

    Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced...... on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy......, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom...

  1. Long-term outcomes for adult craniopharyngioma following radiation therapy

    International Nuclear Information System (INIS)

    Masson-Cote, Laurence; Masucci, Giuseppina Laura; Millar, Barbara-Ann; Laperriere, Normand J.; Atenafu, Eshetu G.; Cusimano, Michael; Croul, Sidney; Mason, Warren; Sahgal, Arjun; Dept. of Radiation Oncology, Sunnybrook Health Sciences Center, Univ. of Toronto, Toronto

    2013-01-01

    Background. We report long-term outcomes in adult patients with craniopharyngioma following surgery and radiation therapy (RT). Material and methods. Fifty-three patients treated with RT (median, 50 Gy in 25 fractions) between 1980 and 2009 with pathologically confirmed craniopharyngioma were reviewed (53% solid and 47% cystic/solid). The median age was 53 years (range, 22-76), 53% were female, 83% were sub-totally resected, 6% were gross totally resected and 11% had a biopsy and/or cyst aspiration alone. RT was delivered adjuvantly in 53% of patients as opposed to salvage intent upon progression. Results. Median follow-up was seven years (86 months, range, 8-259). The 5- and 10-year progression-free survival (PFS) rates were 85% and 69%, overall survival (OS) rates were 76% and 70%, and cause-specific survival (CSS) rates were both 88%, respectively. Both univariable and multivariable analysis identified age ( 2 surgeries prior to RT (p =0.01). Neither the intent of radiation or tumor type (cystic vs. solid/cystic) were prognostic or predictive. New endocrinopathies and visual dysfunction were observed in 53% and 17% of patients post-surgery, and in 11% and 6% post-RT, respectively. Conclusion. We report long-term favorable PFS, CSS and OS for craniopharyngioma post-RT. We observe age as a significant prognostic factor, however, timing of radiation was not

  2. Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy.

    Science.gov (United States)

    Weidenhagen, Rolf; Hartl, Wolfgang H; Gruetzner, Klaus U; Eichhorn, Martin E; Spelsberg, Fritz; Jauch, Karl W

    2010-11-01

    Anastomotic leakage after esophagectomy is an important determinant of early and late morbidity and mortality. Control of the septic focus is essential when treating patients with anastomotic leakages. Surgical and endoscopic treatment options are limited. Between 2005 and 2009, we treated 6 patients who experienced an intrathoracic anastomotic leakage after esophageal resection. After all established therapeutic measures had failed, we explored the feasibility of an endoscopically assisted mediastinal vacuum therapy. We were able to heal intrathoracic esophageal leakages in all 6 patients without any local complications and without the need for reoperation. One patient died because of a progressive pneumonia. Endoscopic vacuum-assisted closure of anastomotic leakages may help to overcome the limitations that are associated with intermittent endoscopic treatment and conventional drainage therapy. Our preliminary results suggest that this new concept may be suitable for those patients. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Radiation therapy facilities in the United States

    International Nuclear Information System (INIS)

    Ballas, Leslie K.; Elkin, Elena B.; Schrag, Deborah; Minsky, Bruce D.; Bach, Peter B.

    2006-01-01

    Purpose: About half of all cancer patients in the United States receive radiation therapy as a part of their cancer treatment. Little is known, however, about the facilities that currently deliver external beam radiation. Our goal was to construct a comprehensive database of all radiation therapy facilities in the United States that can be used for future health services research in radiation oncology. Methods and Materials: From each state's health department we obtained a list of all facilities that have a linear accelerator or provide radiation therapy. We merged these state lists with information from the American Hospital Association (AHA), as well as 2 organizations that audit the accuracy of radiation machines: the Radiologic Physics Center (RPC) and Radiation Dosimetry Services (RDS). The comprehensive database included all unique facilities listed in 1 or more of the 4 sources. Results: We identified 2,246 radiation therapy facilities operating in the United States as of 2004-2005. Of these, 448 (20%) facilities were identified through state health department records alone and were not listed in any other data source. Conclusions: Determining the location of the 2,246 radiation facilities in the United States is a first step in providing important information to radiation oncologists and policymakers concerned with access to radiation therapy services, the distribution of health care resources, and the quality of cancer care

  4. Intensity-Modulated Radiation Therapy in Childhood Ependymoma

    International Nuclear Information System (INIS)

    Schroeder, Thomas M.; Chintagumpala, Murali; Okcu, M. Fatih; Chiu, J. Kam; Teh, Bin S.; Woo, Shiao Y.; Paulino, Arnold C.

    2008-01-01

    Purpose: To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma. Methods and Materials: From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months. Results: The 3-year overall survival rate was 87% ± 9%. The 3-year local control rate was 68% ± 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy. Conclusions: Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival

  5. Electrospun nanofibrous scaffolds increase the efficacy of stem cell-mediated therapy of surgically resected glioblastoma

    Science.gov (United States)

    Bagó, Juli R.; Pegna, Guillaume J.; Okolie, Onyi; Mohiti-Asli, Mahsa; Loboa, Elizabeth G.; Hingtgen, Shawn D.

    2017-01-01

    Engineered stem cell (SC)-based therapy holds enormous promise for treating the incurable brain cancer glioblastoma (GBM). Retaining the cytotoxic SCs in the surgical cavity after GBM resection is one of the greatest challenges to this approach. Here, we describe a biocompatible electrospun nanofibrous scaffold (bENS) implant capable of delivering and retaining tumor-homing cytotoxic stem cells that suppress recurrence of post-surgical GBM. As a new approach to GBM therapy, we created poly(l-lactic acid) (PLA) bENS bearing drug-releasing human mesenchymal stem cells (hMSCs). We discovered that bENS-based implant increased hMSC retention in the surgical cavity 5-fold and prolonged persistence 3-fold compared to standard direct injection using our mouse model of GBM surgical resection/recurrence. Time-lapse imaging showed cytotoxic hMSC/bENS treatment killed co-cultured human GBM cells, and allowed hMSCs to rapidly migrate off the scaffolds as they homed to GBMs. In vivo, bENS loaded with hMSCs releasing the anti-tumor protein TRAIL (bENSsTR) reduced the volume of established GBM xenografts 3-fold. Mimicking clinical GBM patient therapy, lining the post-operative GBM surgical cavity with bENSsTR implants inhibited the re-growth of residual GBM foci 2.3-fold and prolonged post-surgical median survival from 13.5 to 31 days in mice. These results suggest that nanofibrous-based SC therapies could be an innovative new approach to improve the outcomes of patients suffering from terminal brain cancer. PMID:27016620

  6. Risk management of radiation therapy. Survey by north Japan radiation therapy oncology group

    International Nuclear Information System (INIS)

    Aoki, Masahiko; Abe, Yoshinao; Yamada, Shogo; Hareyama, Masato; Nakamura, Ryuji; Sugita, Tadashi; Miyano, Takashi

    2004-01-01

    A North Japan Radiation Oncology Group (NJRTOG) survey was carried out to disclose the risk management of radiation therapy. During April 2002, we sent questionnaires to radiation therapy facilities in northern Japan. There were 31 replies from 27 facilities. Many incidents and accidents were reported, including old cases. Although 60% of facilities had a risk management manual and/or risk manager, only 20% had risk management manuals for radiation therapy. Eighty five percent of radiation oncologists thought that incidents may be due to a lack of manpower. Ninety percent of radiation oncologists want to know the type of cases happened in other facilities. The risk management system is still insufficient for radiation therapy. We hope that our data will be a great help to develop risk management strategies for radiation therapy for all radiation oncologists in Japan. (author)

  7. Indications for radiation therapy and surgery in the treatment of fibromatosis

    International Nuclear Information System (INIS)

    Spear, M.A.; Jennings, L.C.; Efird, J.T.; Mankin, H.J.; Springfield, D.S.; Gebhardt, M.C.; Spiro, I.J.; Rosenberg, A.E.; Suit, H.D.

    1995-01-01

    Purpose: To determine the roles of radiation and surgery in treating fibromatosis (desmoid tumors). Methods and Materials: Records of 92 patients treated at the Massachusetts General Hospital between 1971 and 1992 were analyzed. Treatment consisted of: radiation, 15 tumors; surgery, 37 tumors; radiation plus surgery, 40 tumors. Radiation doses ranged from 10 Gy to 72 Gy, and were delivered as megavoltage external beam, brachytherapy or a combination. Minimum follow up was 1 year (median 6.2 yrs). The margin status of resected specimens included: 14 negative, 11 negative at 18 yrs and 0% for age <18 yrs. Conclusions: Surgery remains the primary treatment of choice for fibromatosis. Radiation therapy, however, is also effective either as a primary treatment or a surgical adjuvent. Additional advantage in recurrence free survival with peri-operative treatment was seen in patients for whom negative margins were not achieved. Thus, radiation might be recommended to these patients, particularly if the lesion is located such that further recurrence and resection could result in a significant functional or cosmetic defect. Radiation would also be recommended as a primary therapy for those in which a primary resection could not be expected without such deficits. It should also be noted when considering the potential consequences of recurrence that these lesions may often fail locally even with negative margins. Of further interest lesions located in the planter or palmer regions appear as a different disease entity, with a very benign course in adults and an extremely aggressive course in children

  8. Treatment outcome of thymic epithelial tumor: prognostic factors and optimal postoperative radiation therapy

    International Nuclear Information System (INIS)

    Oh, Dong Ryul; Ahn, Yong Chan; Kim, Kwan Min; Kim, Jhin Gook; Shim, Young Mog; Han, Jung Ho

    2005-01-01

    This study was conducted to analyze treatment outcome and prognostic significance of World Health Organization (WHO)-defined thymic epithelial tumor (TET) subtype and to assess optimal radiation target volume in patients receiving surgery and adjuvant radiation therapy with TET. The record of 160 patients with TET, who received surgical resection at the Samsung medical Center, from December 1994 to June 2004, were reviewed. 99 patients were treated with postoperative radiation therapy (PORT). PORT was recommended when patients had more than one findings among suspicious incomplete resection or positive resection margin or Masaoka stage II ∼ IV or WHO tumor type B2 ∼ C. PORT performed to primary tumor bed only with a mean dose of 54 Gy. The prognostic factor and pattern of failure were analyzed retrospectively. The overall survival rate at 5 years was 87.3%. Age (more than 60 years 77.8%, less than 60 years 91.1%; ρ = 0.03), Masaoka stage (I 92.2%, II 95.4%, III 82.1%, IV 67.5%; ρ = 0.001), WHO tumor type (A-B1 96.0%, B2-C 82.3%; ρ = 0.001), Extent of resection (R0 resection 92.3%, R1 or 2 resection 72.6%; ρ = 0.001) were the prognostic factors according to univariate analysis. But WHO tumor type was the only significant prognostic factor according to multivariate analysis. Recurrence was observed in 5 patients of 71 Masoka stage I-III patients who received grossly complete tumor removal (R0, R1 resection ) and PORT to primary tumor bed. Mediastinal recurrence was observed in only one patients. There were no recurrence within irradiation field. WHO tumor type was the important prognostic factor to predict survival of patients with TET. This study suggest that PORT to only primary tumor bed was optimal. To avoid pleura-or pericardium-based recurrence, further study of effective chemotherapy should be investigated

  9. Study on external beam radiation therapy

    International Nuclear Information System (INIS)

    Kim, Mi Sook; Yoo, Seoung Yul; Yoo, Hyung Jun; Ji, Young Hoon; Lee, Dong Han; Lee, Dong Hoon; Choi, Mun Sik; Yoo, Dae Heon; Lee, Hyo Nam; Kim, Kyeoung Jung

    1999-04-01

    To develop the therapy technique which promote accuracy and convenience in external radiation therapy, to obtain the development of clinical treatment methods for the global competition. The contents of the R and D were 1. structure, process and outcome analysis in radiation therapy department. 2. Development of multimodality treatment in radiation therapy 3. Development of computation using networking techniques 4. Development of quality assurance (QA) system in radiation therapy 5. Development of radiotherapy tools 6. Development of intraoperative radiation therapy (IORT) tools. The results of the R and D were 1. completion of survey and analysis about Korea radiation therapy status 2. Performing QA analysis about ICR on cervix cancer 3. Trial of multicenter randomized study on lung cancers 4. Setting up inter-departmental LAN using MS NT server and Notes program 5. Development of ionization chamber and dose-rate meter for QA in linear accelerator 6. Development on optimized radiation distribution algorithm for multiple slice 7. Implementation on 3 dimensional volume surface algorithm and 8. Implementation on adaptor and cone for IORT

  10. Study on external beam radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Sook; Yoo, Seoung Yul; Yoo, Hyung Jun; Ji, Young Hoon; Lee, Dong Han; Lee, Dong Hoon; Choi, Mun Sik; Yoo, Dae Heon; Lee, Hyo Nam; Kim, Kyeoung Jung

    1999-04-01

    To develop the therapy technique which promote accuracy and convenience in external radiation therapy, to obtain the development of clinical treatment methods for the global competition. The contents of the R and D were 1. structure, process and outcome analysis in radiation therapy department. 2. Development of multimodality treatment in radiation therapy 3. Development of computation using networking techniques 4. Development of quality assurance (QA) system in radiation therapy 5. Development of radiotherapy tools 6. Development of intraoperative radiation therapy (IORT) tools. The results of the R and D were 1. completion of survey and analysis about Korea radiation therapy status 2. Performing QA analysis about ICR on cervix cancer 3. Trial of multicenter randomized study on lung cancers 4. Setting up inter-departmental LAN using MS NT server and Notes program 5. Development of ionization chamber and dose-rate meter for QA in linear accelerator 6. Development on optimized radiation distribution algorithm for multiple slice 7. Implementation on 3 dimensional volume surface algorithm and 8. Implementation on adaptor and cone for IORT.

  11. Vacuum-assisted closure therapy for infected perineal wounds after abdominoperineal resection. A retrospective cohort study.

    Science.gov (United States)

    Walma, M S; Burbach, J P M; Verheijen, P M; Pronk, A; van Grevenstein, W M U

    2016-02-01

    Perineal wound complications are a main problem after abdominoperineal resection (APR). There is little evidence concerning perineal wound management. This study describes and evaluates the role of vacuum-assisted closure (VAC) therapy in wound management strategies of perineal wound infections after APR. Patients undergoing APR for malignant disease between January 2007 and January 2013 were identified retrospectively. Data regarding occurrence and management of perineal wound complications were collected. Perineal wound infections were classified into minor or major complications and time to wound healing was measured. Time to wound healing was compared between patients receiving routine care or with additional VAC therapy. Of 171 included patients, 76 (44.4%) had minor and 36 (21.1%) major perineal wound infections. Management of major infected perineal wounds consisted of drainage (n = 16), debridement (n = 4), drainage combined with debridement (n = 4), VAC therapy alone (n = 5), or VAC therapy combined with other treatments (n = 7). Median duration of perineal wound healing in major infected wounds was 141 days (range 17-739). Median time to wound healing was not different in patients treated with (172 days, range 23-368) or without VAC therapy (131 days, range 17-739). In this study, VAC therapy did not shorten time to wound healing. However, prospective studies are required to investigate the role of VAC therapy in management of infected perineal wounds after APR. Up to then, wound management will remain to be based on clinical perception and 'gut-feeling'. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  12. Cardiovascular effects of radiation therapy

    International Nuclear Information System (INIS)

    Alvarez, Jose A.G.; Leiva, Gustavo

    2001-01-01

    Therapeutic mediastinal irradiation can induce heart disease with variable degree of cardiac engagement. Heart disease manifestations depend on the grade of involvement of the different cardiac structures. During the first two years following irradiation, pericarditis with or without pericardial effusion is the most common manifestation of toxicity related to radiation therapy. Later on, after a latency period of five to ten years, a constrictive pericarditis may develop. Other type of late cardiac toxicities due to irradiation are restrictive cardiomyopathy, multiple valvular disease, coronary artery disease and different atrioventricular conduction disturbances. The therapeutic approach to this kind of heart disease has to be focused on its progressive course and in the possibility of a global involvement of all the cardiac structures. Pericardiectomy is strongly recommended for recurrent pericardial effusion with cardiac tamponade. Cardiac surgery for myocardial revascularization or valvular disease can be performed with variable results; the presence of myocardial fibrosis can significantly affect perioperative management and long-term results. Cardiac transplantation is a promissory option for those patients with end-stage cardiac failure. Immunosuppressive regimens are not associated with recurrence of malignancy. (author) [es

  13. Dietary protection during radiation therapy

    International Nuclear Information System (INIS)

    Bounous, G.; Le Bel, E.; Shuster, J.; Gold, P.; Tahan, W.T.; Bastin, E.; Centre Hospitalier Universitaire de Sherbrooke; Montreal General Hospital, Quebec

    1975-01-01

    Eighteen patients receiving Cobalt 60 irradiation for abdominal or pelvic malignancies were assigned at random to eat either a semi-hydrolyzed diet (Flexical: 10 g% casein hydrolsate; 14 g% triglycerides, 20% of which medium chain; 66% disaccharides) or a normal diet. There are no significant differences between these two groups with respect to age and the ratio of ideal to actual caloric intake. The patients in the control group received on the average a total of 3,900 rd and those in the Flexical group 4,040 rd. Generally, Flexical appeared to have a significant positive effect on body weight. In addition, radiation-induced diarrhea was not a problem in the Flexical group. In the latter-group, serum proteins including immunoglobulins remained essentially unchanged during therapy while a moderate but significant fall was observed in all control patients. No significant difference between the two groups was observed with respect to peripheral blood hematocrit, red and white cell counts. However, the drop in blood lymphocytes following irradiation was significantly less in the Flexical group. The mechanisms of radioprotection are discussed. These preliminary data indicate that the nutritional and perhaps the immunological status of cancer patients receiving intensive irradiation can be maintained by dietary measures. (orig.) [de

  14. The Outcomes of Ultralow Anterior Resection or an Abdominoperineal Pull-Through Resection and Coloanal Anastomosis for Radiation-Induced Recto-Vaginal Fistula Patients.

    Science.gov (United States)

    Karakayali, Feza Yarbug; Tezcaner, Tugan; Ozcelik, Umit; Moray, Gokhan

    2016-05-01

    The purpose of this study was to evaluate the outcomes of patients who underwent colorectal resections and coloanal anastomosis for radiation-induced recto-vaginal fistulas (RVFs). The effect of the surgical treatment technique on bowel function, fecal continence, and quality of life of patients was also evaluated. Twenty-one female patients, who received adjuvant chemotherapy and external beam pelvic radiation for cervix carcinoma after radical hysterectomy + pelvic/paraaortic lymph node dissection, having RVF but without tumor recurrence, were included. All patients underwent an ultralow anterior resection (n = 11) or an abdominoperineal pull-through resection and straight coloanal anastomosis (n = 10). A bowel functions questionnaire and a Fecal Incontinence Quality of Life (FIQLI) questionnaire were applied to patients pre-operatively and also 6 months after the ileostomy closure procedures. No recurrent RVF was observed in a mean follow-up period of 20 months after ostomy reversal procedures. The FIQLI depression, lifestyle, and embarrassment scores were significantly improved on the follow-up questionnaire. The mean pre- and post-operative incontinence scores were not significantly different. The spontaneous closure rate after a simple diverting stoma is quite low and local repair procedures usually result in failure. In selected patients, performing a nearly total rectum resection and maintaining the intestinal continuity with a coloanal anastomosis may be accepted as a safe and curative option. Recurrence-free outcome and the improvement of the quality of life of the patients represent the efficiency of this treatment modality.

  15. Minimally invasive liver resection to obtain tumor-infiltrating lymphocytes for adoptive cell therapy in patients with metastatic melanoma

    Directory of Open Access Journals (Sweden)

    Alvarez-Downing Melissa M

    2012-06-01

    Full Text Available Abstract Background Adoptive cell therapy (ACT with tumor-infiltrating lymphocytes (TIL in patients with metastatic melanoma has been reported to have a 56% overall response rate with 20% complete responders. To increase the availability of this promising therapy in patients with advanced melanoma, a minimally invasive approach to procure tumor for TIL generation is warranted. Methods A feasibility study was performed to determine the safety and efficacy of laparoscopic liver resection to generate TIL for ACT. Retrospective review of a prospectively maintained database identified 22 patients with advanced melanoma and visceral metastasis (AJCC Stage M1c who underwent laparoscopic liver resection between 1 October 2005 and 31 July 2011. The indication for resection in all patients was to receive postoperative ACT with TIL. Results Twenty patients (91% underwent resection utilizing a closed laparoscopic technique, one required hand-assistance and another required conversion to open resection. Median intraoperative blood loss was 100 mL with most cases performed without a Pringle maneuver. Median hospital stay was 3 days. Three (14% patients experienced a complication from resection with no mortality. TIL were generated from 18 of 22 (82% patients. Twelve of 15 (80% TIL tested were found to have in vitro tumor reactivity. Eleven patients (50% received the intended ACT. Two patients were rendered no evidence of disease after surgical resection, with one undergoing delayed ACT with generated TIL after relapse. Objective tumor response was seen in 5 of 11 patients (45% who received TIL, with one patient experiencing an ongoing complete response (32+ months. Conclusions Laparoscopic liver resection can be performed with minimal morbidity and serve as an effective means to procure tumor to generate therapeutic TIL for ACT to patients with metastatic melanoma.

  16. Extramammary Paget's disease: role of radiation therapy

    International Nuclear Information System (INIS)

    Guerrieri, M.; Back, M.F.

    2002-01-01

    Extra mammary Paget's disease (EMPD) is an uncommon premalignant skin condition that has been traditionally managed with surgery. A report of long-standing Paget's disease with transformation to invasive adenocarcinoma definitively managed with radiation therapy is presented. A review of cases of extramammary Paget's disease treated with radiation therapy is discussed. The use of radiation therapy should be considered in selected cases, as these studies demonstrate acceptable rates of local control when used as an adjunct to surgery, or as a definitive treatment modality. Copyright (2002) Blackwell Science Pty Ltd

  17. Can Bone Tissue Engineering Contribute to Therapy Concepts after Resection of Musculoskeletal Sarcoma?

    Directory of Open Access Journals (Sweden)

    Boris Michael Holzapfel

    2013-01-01

    Full Text Available Resection of musculoskeletal sarcoma can result in large bone defects where regeneration is needed in a quantity far beyond the normal potential of self-healing. In many cases, these defects exhibit a limited intrinsic regenerative potential due to an adjuvant therapeutic regimen, seroma, or infection. Therefore, reconstruction of these defects is still one of the most demanding procedures in orthopaedic surgery. The constraints of common treatment strategies have triggered a need for new therapeutic concepts to design and engineer unparalleled structural and functioning bone grafts. To satisfy the need for long-term repair and good clinical outcome, a paradigm shift is needed from methods to replace tissues with inert medical devices to more biological approaches that focus on the repair and reconstruction of tissue structure and function. It is within this context that the field of bone tissue engineering can offer solutions to be implemented into surgical therapy concepts after resection of bone and soft tissue sarcoma. In this paper we will discuss the implementation of tissue engineering concepts into the clinical field of orthopaedic oncology.

  18. Combined therapy for non-resectable squamous cell carcinoma of the oral cavity

    International Nuclear Information System (INIS)

    Noorman van der Dussen, M.F.

    1986-01-01

    A promising way to acquire information about individual tumour behaviour seems to be the determination of cell kinetic properties and, even more importantly, the changes they undergo during treatment. Ideally, knowledge of changes in cell cycle at all times is desirable so that optimal regulation of the chosen chemotherapy and/or radiotherapy could lead to maximal cell death of the tumour cells with minimal toxicity for the host cells. A possible gain for increasing insight into the characteristics of a particular tumour is DNA flow cytometry. By taking multiple biopsies before and during the chemotherapy/radiotherapy treatment, it is perhaps possible to predict the expected clinical results. Research relating to this is described in this dissertation: 16 patients with non-resectable tumours of the oral cavity were treated with concurrent intra-arterial chemotherapy and radiotherapy. Multiple biopsies were analyzed with DNA flow cytometry and an attempt was made to correlate the clinical response with the acquired cellular kinetic data. The purpose of the research can be summarized as: 1. Is regional cure of non-resectable squamous cell carcinomas possible using the method described? 2. Is it possible, using DNA flow cytometry, to predict the chance of successful therapy? (Auth.)

  19. Extrahepatic Bile Duct Cancers: Surgery Alone Versus Surgery Plus Postoperative Radiation Therapy

    International Nuclear Information System (INIS)

    Gwak, Hee Keun; Kim, Woo Chul; Kim, Hun Jung; Park, Jeong Hoon

    2010-01-01

    Purpose: The goal of this study was to determine the role of radiotherapy after curative-intent surgery in the management of extrahepatic bile duct (EHBD) cancers. Methods and Materials: From 1997 through 2005, 78 patients with EHBD cancer were surgically staged. These patients were stratified by the absence of adjuvant radiation (n = 47, group I) versus radiation (n = 31, group II) after resection. Pathology examination showed 27 cases in group I and 20 cases in group II had microscopically positive resection margins. The patients in group II received 45 to 54 Gy of external beam radiotherapy. The primary endpoints of this study were overall survival, disease-free survival, and prognostic factors. Results: There were no differences between the 5-year overall survival rates for the two groups (11.6% in group I vs. 21% in group II). However, the patients with microscopically positive resection margins who received adjuvant radiation therapy had higher median disease-free survival rates than those who underwent surgery alone (21 months vs. 10 months, respectively, p = 0.042). Decreasing local failure was found in patients who received postoperative radiotherapy (61.7% in group I and 35.6% in group II, p = 0.02). Outcomes of the patients with a positive resection margin and lymph node metastasis who received postoperative radiation therapy were doubled compared to those of patients without adjuvant radiotherapy. Resection margin status, lymph node metastasis, and pathology differentiation were significant prognostic factors in disease-free survival. Conclusions: Adjuvant radiotherapy might be useful in patients with EHBD cancer, especially for those patients with microscopic residual tumors and positive lymph nodes after resection for increasing local control.

  20. Detoxication and antiproteolytic therapy of radiation complications

    International Nuclear Information System (INIS)

    Yakhontov, N.E.; Klimov, I.A.; Lavrikova, L.P.; Martynov, A.D.; Provorova, T.P.; Serdyukov, A.S.; Shestakov, A.F.

    1984-01-01

    49 patients with uterine cervix and ovarian carcinomas were treated with detoxication and antiproteolytic therapy of radiation-induced side-effects. The therapy permits to complete without interruption the remote gamma-therapy course and to reduce patients in-hospital periods by 10+- 1 days. The prescription of hemoder intravenous injection in a dose of 450 ml and contrical intramuscular injection (10000 AtrE) in cases of pronounced manifestations of radiation-induced side-effects (asthenia, leukopenia, enterocolitis) for 3 days should be considered an efficient therapy

  1. Heavy ion facility for radiation therapy

    International Nuclear Information System (INIS)

    Leemann, C.; Alonso, J.; Clark, D.; Grunder, H.; Hoyer, E.; Lou, K.; Staples, J.; Voelker, F.

    1977-03-01

    The accelerator requirements of particle radiation therapy are reviewed and a preliminary design of a heavy ion synchrotron for hospital installation is presented. Beam delivery systems and multi-treatment room arrangements are outlined

  2. Effect of radiation therapy against intracranial hemangiopericytoma

    Energy Technology Data Exchange (ETDEWEB)

    Uemura, Shozaburo; Kuratsu, Jun-ichi; Hamada, Jun-ichiro; Yoshioka, Susumu; Kochi, Masato; Ushio, Yukitaka [Kumamoto Univ. (Japan). School of Medicine; Nakahara, Tadashi; Kishida, Katsuaki

    1992-06-01

    Seven cases of intracranial hemangiopericytoma were studied retrospectively to investigate the efficacy of radiation therapy. Tumor response evaluated by computed tomography and magnetic resonance imaging was obvious after 20-30 Gy irradiation. The total reduction rate was 80-90% and continued as long as 5-7 months after treatment. In five patients receiving radiation therapy before radical removal, the tumors were easily removed without massive hemorrhage. Histological inspection of specimens after irradiation showed a significant disappearance of tumor cells. Pyknosis frequently occurred in endothelial cells, and proliferating vessels with hyalinoid degeneration were also seen. Reticulin fibers between tumor cells were fewer, split, or absent. Preoperative radiation therapy is useful in the treatment of hemangiopericytoma involving considerable surgical risk. Postoperative radiation therapy should be given even if removal is complete. (author).

  3. Radiation therapy services in South Africa

    African Journals Online (AJOL)

    available were pooled according to health regions and related to population ... Megavoltage radiation therapy units in South Africa. Photon. Electron. Machine energy beam. Tvl .... Remote afrerloading brachytherapy devices have developed ...

  4. Pediatric radiation therapy. A Japanese nationwide survey

    International Nuclear Information System (INIS)

    Nemoto, Kenji; Nagata, Yasushi; Hirokawa, Yutaka

    2006-01-01

    A national survey on the current status of pediatric radiation therapy was performed in October 2004. We sent questionnaires to 638 radiotherapy facilities in Japan (except for Kansai area) and 245 responses were analyzed. According to the database of committee of Japanese Society of Therapeutic Radiology and Oncology (JASTRO), the number of pediatric patients who received radiation therapy during 2003 in Japan was 1,101. The most frequent pediatric malignancy was brain tumor, followed by leukemia and lymphoma. The total effort of radiation therapy for children was two to six times larger than that for adult patients. An additional fee seems to be necessary for the highly technical and laborious radiation therapy required for children. (author)

  5. Effect of radiation therapy against intracranial hemangiopericytoma

    International Nuclear Information System (INIS)

    Uemura, Shozaburo; Kuratsu, Jun-ichi; Hamada, Jun-ichiro; Yoshioka, Susumu; Kochi, Masato; Ushio, Yukitaka; Nakahara, Tadashi; Kishida, Katsuaki.

    1992-01-01

    Seven cases of intracranial hemangiopericytoma were studied retrospectively to investigate the efficacy of radiation therapy. Tumor response evaluated by computed tomography and magnetic resonance imaging was obvious after 20-30 Gy irradiation. The total reduction rate was 80-90% and continued as long as 5-7 months after treatment. In five patients receiving radiation therapy before radical removal, the tumors were easily removed without massive hemorrhage. Histological inspection of specimens after irradiation showed a significant disappearance of tumor cells. Pyknosis frequently occurred in endothelial cells, and proliferating vessels with hyalinoid degeneration were also seen. Reticulin fibers between tumor cells were fewer, split, or absent. Preoperative radiation therapy is useful in the treatment of hemangiopericytoma involving considerable surgical risk. Postoperative radiation therapy should be given even if removal is complete. (author)

  6. Intensity-Modulated Radiation Therapy (IMRT)

    Science.gov (United States)

    ... type your comment or suggestion into the following text box: Comment: E-mail: Area code: Phone no: Thank ... Accelerator Prostate Cancer Treatment Head and Neck Cancer Treatment Introduction to Cancer Therapy (Radiation Oncology) ...

  7. Modern radiation therapy for primary cutaneous lymphomas

    DEFF Research Database (Denmark)

    Specht, Lena; Dabaja, Bouthaina; Illidge, Tim

    2015-01-01

    Primary cutaneous lymphomas are a heterogeneous group of diseases. They often remain localized, and they generally have a more indolent course and a better prognosis than lymphomas in other locations. They are highly radiosensitive, and radiation therapy is an important part of the treatment......, either as the sole treatment or as part of a multimodality approach. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques that form the focus of these guidelines. The International Lymphoma Radiation Oncology Group has developed these guidelines after multinational...... meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the International Lymphoma Radiation Oncology Group steering committee on the use of radiation therapy in primary cutaneous lymphomas in the modern era....

  8. Targeted Radiation Therapy for Cancer Initiative

    Science.gov (United States)

    2017-11-01

    AWARD NUMBER: W81XWH-08-2-0174 TITLE: Targeted Radiation Therapy for Cancer Initiative PRINCIPAL INVESTIGATOR: Dusten Macdonald, MD...for Cancer Initiative 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Dusten Macdonald, MD 5d. PROJECT NUMBER...Cancer Initiative Final Report INTRODUCTION: The full potential of radiation therapy has not been realized due to the inability to locate and

  9. Nursing care update: Internal radiation therapy

    International Nuclear Information System (INIS)

    Lowdermilk, D.L.

    1990-01-01

    Internal radiation therapy has been used in treating gynecological cancers for over 100 years. A variety of radioactive sources are currently used alone and in combination with other cancer treatments. Nurses need to be able to provide safe, comprehensive care to patients receiving internal radiation therapy while using precautions to keep the risks of exposure to a minimum. This article discusses current trends and issues related to such treatment for gynecological cancers.20 references

  10. 42 CFR 410.35 - X-ray therapy and other radiation therapy services: Scope.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false X-ray therapy and other radiation therapy services... Other Health Services § 410.35 X-ray therapy and other radiation therapy services: Scope. Medicare Part B pays for X-ray therapy and other radiation therapy services, including radium therapy and...

  11. Care of the patient receiving radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yasko, J.M.

    1982-12-01

    External radiation therapy, or teletherapy, is the use of ionizing radiation to destroy cancer cells. Clinical use of ionizing radiation as treatment for cancer began with the discovery of x-rays in 1895, the identification of natural radioactivity (radium) in 1896, and the first reported cure of cancer, a basal cell epithelioma, induced by radiation in 1899. Initially, radiation was administered as a single large dose and produced severe, life-threatening side effects. The basis for the use of ionizing radiation in daily increments for a period of weeks was provided by Regaud in 1922; ten years later, Coutard clinically developed the method of dose fractionation, which remains in use today. Although the use of ionizing radiation as a treatment is over eighty years old, only in recent years have advancements in its clinical application been based on research related to the biologic effect of radiation on human cells. To effectively care for the patient prior to, during, and at the completion of external radiation therapy, the nurse must know the physical and biologic basis of external radiation therapy and its clinical application.

  12. Care of the patient receiving radiation therapy

    International Nuclear Information System (INIS)

    Yasko, J.M.

    1982-01-01

    External radiation therapy, or teletherapy, is the use of ionizing radiation to destroy cancer cells. Clinical use of ionizing radiation as treatment for cancer began with the discovery of x-rays in 1895, the identification of natural radioactivity (radium) in 1896, and the first reported cure of cancer, a basal cell epithelioma, induced by radiation in 1899. Initially, radiation was administered as a single large dose and produced severe, life-threatening side effects. The basis for the use of ionizing radiation in daily increments for a period of weeks was provided by Regaud in 1922; ten years later, Coutard clinically developed the method of dose fractionation, which remains in use today. Although the use of ionizing radiation as a treatment is over eighty years old, only in recent years have advancements in its clinical application been based on research related to the biologic effect of radiation on human cells. To effectively care for the patient prior to, during, and at the completion of external radiation therapy, the nurse must know the physical and biologic basis of external radiation therapy and its clinical application

  13. [A Case of Locally Advanced Thoracic Esophageal Cancer with Larynx Preservation and Curative Resection via Combined Modality Therapy].

    Science.gov (United States)

    Iwama, Mitsuru; Kimura, Yutaka; Shiraishi, Osamu; Kato, Hiroaki; Hiraki, Yoko; Tanaka, Yumiko; Yasuda, Atsushi; Shinkai, Masayuki; Imano, Motohiro; Imamoto, Haruhiko; Yasuda, Takushi

    2017-11-01

    Prognosis of locally advanced esophageal cancer is poor. The greatest prognostic factor of locally advanced esophageal cancer is a local control. We experienced a case of T4 locally advanced thoracic esophageal cancer who was successfully resected without any combined resection after multimodality therapy. A male in 75-year-old. was diagnosed with type 3 locally advanced upper thoracic esophageal cancer whose metastatic right recurrent laryngeal lymph node invaded into the trachea. Definitive chemoradiation therapy(CRT)was performed, leading to a significant shrinkage of the main tumor, but T4 lesion remained. Next, adding DCF therapy(docetaxel, CDDP and 5-FU), a relief of T4 was finally obtained. Then, salvage surgery with subtotalesophagectomy and retrosternalesophagealreconstruction with gastric tube was performed, resulting in R0 resection without any combined resection. The postoperative course was uneventful, and the patient has been alive without recurrence for 1 year after surgery. In locally advanced cancer, focusing on T4 downstaging, it is significantly important in terms of safety, curativity and organ preservation to perform surgery after a sure sign of T4 relief by multimodality therapy.

  14. Radiation therapy apparatus having retractable beam stopper

    International Nuclear Information System (INIS)

    Coad, G.L.

    1983-01-01

    This invention relates to a radiation therapy apparatus which utilized a linear translation mechanism for positioning a beam stopper. An apparatus is described wherein the beam stopper is pivotally attached to the therapy machine with an associated drive motor in such a way that the beam stopper retracts linearly

  15. Effects of transplantation and resection of a radiation-induced rat insulinoma on glucose homeostasis and the endocrine pancreas

    International Nuclear Information System (INIS)

    Flatt, P.R.; Tan, K.S.; Powell, C.J.; Swanston-Flatt, S.K.; Marks, V.; Bailey, C.J.

    1986-01-01

    Twenty-one days after s.c. subscapular transplantation of a radiation-induced insulinoma, male NEDH rats exhibited hyperinsulinaemia and hypoglycaemia. These features were associated with islet atrophy, degenerative changes in pancreatic A and B cells, and decreases in the pancreatic contents of insulin, glucagon and somatostatin. The immunoreactive glucagon and somatostatin contents of extrapancreatic tissues of insulinoma-bearing rats were unchanged. Surgical resection of the tumour resulted in an immediate fall of plasma insulin, attaining concentrations similar to those of anaesthetised control rats by 10 min. The estimated half-life of insulin was 3.5 min. Hypoglycaemia persisted until 60 min after resection, followed by hyperglycaemia of 1-2 days duration. Glucose tolerance was impaired 1 day after tumour resection despite the coexistence of raised insulin concentrations. Evidence for abnormal pancreatic B cell function was gained by injection of arginine which failed to evoke a plasma insulin response in the resected rats. Two days after resection, plasma glucose and insulin concentrations were similar to those of control rats. Plasma glucose and insulin responses to glucose and arginine were suggestive of tumour recurrence by 12 days. A single large encapsulated tumour was eventually observed in each rat, with resection giving a 17-56 day prolongation of life. (author)

  16. Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

    NARCIS (Netherlands)

    A. Wijnmaalen (Arendjan); P.A. Helle (Peter); P.C.M. Koper (Peter); P.P. Jansen (Peter); P. Hanssens (Patrick); C.G.G. Boeken Kruger (Cornelis); W.L.J. van Putten (Wim)

    1997-01-01

    textabstractPurpose: To evaluate the results of transurethral resection (TUR), external beam radiotherapy (EBRT), and interstitial radiation (IRT) with iridium-192, using the afterloading technique in patients with muscle invasive bladder cancer. Methods and Materials: From May 1989 until September

  17. Evolution of radiation therapy: technology of today

    International Nuclear Information System (INIS)

    Shrivastava, S.K.; Mishra, Shagun

    2013-01-01

    The three well established arms of treatment are surgery, radiation therapy and chemotherapy. The management of cancer is multidisciplinary; Radiation Oncologists along with Surgical Oncologists and Medical Oncologists are responsible for cancer therapeutics. They all work in close collaboration with Pathologists and Radiologists for cancer diagnosis and staging and rely on Oncology Nurses, Physiotherapists, Occupational Therapists, Nutritionists and Social Workers for optimal treatment and rehabilitation of cancer patients. Therefore cancer management is a team work for getting the best results. Radiation therapy is one of the most effective methods of treating cancer

  18. The clinical efficacy of consolidation chemotherapy for resectable esophageal squamous cell cancer after trimodality therapy.

    Science.gov (United States)

    Sun, Yanan; Cheng, Siguo; Lu, Yufei; Zheng, Xiaoli; Ye, Ke; Ge, Hong

    2016-01-01

    We aimed to assess the clinical outcome of consolidation chemotherapy for resectable esophageal squamous cell cancer (ESCC) after trimodality therapy. From January 2005 to December 2012, a total of 192 consecutive locally advanced ESCC patients who underwent trimodality therapy successfully was included. Grouping was based on the degree of myelosuppression occurred during preoperative chemoradiotherapy. Of the 192 patients, 120 patients underwent trimodality therapy only (TT group), while 72 patients received consolidation chemotherapy additionally after trimodality therapy (TC group). Preoperative chemoradiotherapy included two cycles of chemotherapy concurrently with radiotherapy. The chemotherapy regimen consisted of cisplatin 20 mg/m2/day and fluorouracil 400 mg/m2/day administered intravenously infusion on days 1-5 of a 21 days cycle. Concurrent radiotherapy was delivered in a total of 40 Gy in 20 fractions. All patients underwent surgery successfully. For 72 patients in TC group, additional 1-4 cycles of consolidation chemotherapy were administered, and chemotherapy regimen was as before. The 5-year survival rate was 43.5% in TT group, as compared with 48.8% in TC group. (P = 0.238). The 5.year progression.free survival. (PFS) rates were 34.0% in TT group and 38.8% in TC group. (P = 0.049). Risk reduction in PFS was remarkable for males and those who did not achieve pathologic complete response. (pCR). The incidence rate of disease progression did not differ significantly. (P = 0.200). The addition of consolidation chemotherapy demonstrates no survival benefit for patients with locally advanced ESCC, but PFS is significantly improved, especially for males and those who did not achieve pCR.

  19. Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis

    International Nuclear Information System (INIS)

    Kelly, Patrick; Das, Prajnan; Varadhachary, Gauri R.; Fontanilla, Hiral P.; Krishnan, Sunil; Delclos, Marc E.; Jhingran, Anuja; Eifel, Patricia J.; Crane, Christopher H.

    2012-01-01

    Objectives: Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis. Patients and Methods: Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at University of Texas M.D. Anderson Cancer between 2002 and 2009. All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed. Results: The 2-year PFS and OS rates for the entire cohort were 32% and 57%, respectively. However, in patients treated with definitive radiation therapy, the rates were 48% and 76%, and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40% experienced Grade 2 or higher late toxicities. Conclusions: The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.

  20. Protective prostheses during radiation therapy

    International Nuclear Information System (INIS)

    Poole, T.S.; Flaxman, N.A.

    1986-01-01

    Current applications and complications in the use of radiotherapy for the treatment of oral malignancy are reviewed. Prostheses are used for decreasing radiation to vital structures not involved with the lesion but located in the field of radiation. With a program of oral hygiene and proper dental care, protective prostheses can help decrease greatly the morbidity seen with existing radiotherapy regimens

  1. Radiation therapy for metastatic spinal tumors

    International Nuclear Information System (INIS)

    Kida, Akio; Fukuda, Haruyuki; Taniguchi, Shuji; Sakai, Kazuaki

    2000-01-01

    The results of radiation therapy for metastatic spinal tumors were evaluated in terms of pain relief, improvement of neurological impairment, and survival. Between 1986 and 1995, 52 symptomatic patients with metastatic spinal tumors treated with radiation therapy were evaluated. The patients all received irradiation of megavoltage energy. Therapeutic efficacy was evaluated in terms of pain relief and improvement of neurological impairment. Pain relief was observed in 29 (61.7%) of 47 patients with pain. Therapy was effective for 17 (70.8%) of 24 patients without neurological impairment, and efficacy was detected in 12 (52.2%) of 23 patients with neurological impairment. Improvement of neurological symptoms was obtained in seven (25.0%) of 28 patients with neurological impairment. Radiation therapy was effective for pain relief in patients with metastatic spinal tumors. In patients with neurological impairment, less pain relief was observed than in those without impairment. Improvement of neurological impairment was restricted, but radiation therapy was thought to be effective in some cases in the early stage of neurological deterioration. Radiation therapy for metastatic spinal tumors contraindicated for surgery was considered effective for improvement of patients' activities of daily living. (author)

  2. Modern radiation therapy for extranodal lymphomas

    DEFF Research Database (Denmark)

    Yahalom, Joachim; Illidge, Tim; Specht, Lena

    2015-01-01

    Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL...... and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have...... there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition...

  3. Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases

    Energy Technology Data Exchange (ETDEWEB)

    Lester-Coll, Nataniel H., E-mail: nataniel.lester-coll@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Rutter, Charles E.; Bledsoe, Trevor J. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Goldberg, Sarah B. [Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut (United States); Decker, Roy H.; Yu, James B. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2016-06-01

    Introduction: Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. Methods and Materials: A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemic therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. Results: In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). Conclusions: Video-assisted thoracic

  4. Long term control of a maxillary sinus mucoepidermoid carcinoma with low dose radiation therapy: a case report

    International Nuclear Information System (INIS)

    Vulpe, Horia; Giuliani, Meredith; Goldstein, David; Perez-Ordonez, Bayardo; Dawson, Laura A; Hope, Andrew

    2013-01-01

    Mucoepidermoid carcinoma of the maxillary sinus is a rare malignancy of the head and neck. The location of this tumour near vital structures and its large size at presentation makes surgical resection with negative margins challenging. In incurable cases, relief from symptoms such as epistaxis may be achieved with radiation therapy. We present a case of mucoepidermoid carcinoma of the maxillary sinus that was effectively palliated with a short course of radiation therapy, achieving complete cessation of bleeding, decrease in tumour size, and long term control. We surveyed the literature on mucoepidermoid carcinomas and propose that some tumours may be particularly radiosensitive, benefiting from even short courses of radiation therapy

  5. Impaired skin integrity related to radiation therapy

    International Nuclear Information System (INIS)

    Ratliff, C.

    1990-01-01

    Skin reactions associated with radiation therapy require frequent nursing assessment and intervention. Preventive interventions and early management can minimize the severity of the skin reaction. With the understanding of the pathogenesis of radiation skin reactions, the ET nurse can determine who is at risk and then implement preventive measures. Because radiation treatment is fractionated, skin reactions do not usually occur until midway through the course of therapy and will subside within a few weeks after completion of radiation. Many patients and their families still fear that radiation causes severe burns. Teaching and anticipatory guidance by the ET nurse is needed to assist patients and their families to overcome this fear, and to educate them on preventive skin care regimens

  6. Non-randomized therapy trial to determine the safety and efficacy of heavy ion radiotherapy in patients with non-resectable osteosarcoma

    Directory of Open Access Journals (Sweden)

    Bischof Marc

    2010-03-01

    Full Text Available Abstract Background Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. For effective treatment, local control of the tumor is absolutely critical, because the chances of long term survival are EURAMOS1. Local photon radiotherapy has previously been used in small series and in an uncontrolled, highly individualized fashion, which, however, documented that high dose radiotherapy can, in principle, be used to achieve local control. Generally the radiation dose that is necessary for a curative approach can hardly be achieved with conventional photon radiotherapy in patients with non-resectable tumors that are usually located near radiosensitive critical organs such as the brain, the spine or the pelvis. In these cases particle Radiotherapy (proton therapy (PT/heavy ion therapy (HIT may offer a promising new alternative. Moreover, compared with photons, heavy ion beams provide a higher physical selectivity because of their finite depth coverage in tissue. They achieve a higher relative biological effectiveness. Phase I/II dose escalation studies of HIT in adults with non-resectable bone and soft tissue sarcomas have already shown favorable results. Methods/Design This is a monocenter, single-arm study for patients ≥ 6 years of age with non-resectable osteosarcoma. Desired target dose is 60-66 Cobalt Gray Equivalent (Gy E with 45 Gy PT (proton therapy and a carbon ion boost of 15-21 GyE. Weekly fractionation of 5-6 × 3 Gy E is used. PT/HIT will be administered exclusively at the Ion Radiotherapy Center in Heidelberg. Furthermore, FDG-PET imaging characteristics of non-resectable osteosarcoma before and after PT/HIT will be investigated prospectively. Systemic disease before and after PT/HIT is targeted by standard chemotherapy protocols and is not part of this trial. Discussion The primary objectives of this trial are the determination of feasibility and toxicity of HIT. Secondary objectives are tumor response

  7. Radiation therapy for cancer patients

    International Nuclear Information System (INIS)

    Mileikowsky, C.

    1987-01-01

    This patent describes an apparatus for irradiating a patient comprising: a source of a radiation beam directed along a radiation axis; means mounting the source for pivotal movement about a first horizontal axis which intersects the source, is stationary with respect to the apparatus, and extends in a direction substantially normal to the radiation axis, whereby the beam is capable of an angular scan in a vertical plane; table means adapted to support a patient to be irradiated; and suspension means mounted the table means for arcuate movement to any positions angularly spaced about the first horizontal axis and for pivoting movement about a second horizontal axis displacement from and substantially parallel to the first horizontal axis. The suspension means maintain the second horizontal axis in substantially intersecting relation to the radiation axis in each of the positions while maintaining a fixed angular position of the table means with respect to the environment

  8. Two cases of colorectal cancer developed more than 30 years after pelvic radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Minami, Mituaki; Aoki, Youzou; Uesaka, Kazunobu; Enomoto, Katuhiko; Shimamoto, Tetuya; Hirabayashi, Naoki [Hashimoto Municipal Hospital, Wakayama (Japan)

    2000-03-01

    We experienced two cases of advanced colorectal cancer developed after radiation therapy. One case was a 66-year old female who had received irradiation for her uterine cancer 35 years before. She was treated for a radiation colitis and a radiation dermatitis 6 years ago. Sigmoid colon cancer was pointed out by barium enema and colonoscopy, and Hartmann's operation was performed. The other case was a 68-year old man who had received irradiation for left malignant orchionous 30 years before. He had the radiation dermatitis in both inguinal region, and had received skin graft for the left inguinal dermatitis. He complained of anal bleeding, and rectal cancer was found out by the colonoscopy. Low anterior resection was performed. Their pathological findings showed mucinous adenocarcinoma. In a review of the Japanese literature, colorectal cancers developed more than 30 years after pelvic radiation therapy have been reported in only 8 cases including these two cases. (author)

  9. Two cases of colorectal cancer developed more than 30 years after pelvic radiation therapy

    International Nuclear Information System (INIS)

    Minami, Mituaki; Aoki, Youzou; Uesaka, Kazunobu; Enomoto, Katuhiko; Shimamoto, Tetuya; Hirabayashi, Naoki

    2000-01-01

    We experienced two cases of advanced colorectal cancer developed after radiation therapy. One case was a 66-year old female who had received irradiation for her uterine cancer 35 years before. She was treated for a radiation colitis and a radiation dermatitis 6 years ago. Sigmoid colon cancer was pointed out by barium enema and colonoscopy, and Hartmann's operation was performed. The other case was a 68-year old man who had received irradiation for left malignant orchionous 30 years before. He had the radiation dermatitis in both inguinal region, and had received skin graft for the left inguinal dermatitis. He complained of anal bleeding, and rectal cancer was found out by the colonoscopy. Low anterior resection was performed. Their pathological findings showed mucinous adenocarcinoma. In a review of the Japanese literature, colorectal cancers developed more than 30 years after pelvic radiation therapy have been reported in only 8 cases including these two cases. (author)

  10. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up

    International Nuclear Information System (INIS)

    Wagman, Raquel; Minsky, Bruce D.; Cohen, Alfred M.; Guillem, Jose G.; Paty, Philip P.

    1998-01-01

    Background: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods: Thirty six patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (5,T 2; 31,T 3 ) involving the distal half of the rectum and clinically required an abdominoperineal resection. The median tumor size was 3.8 cm [range: 1.5-7 cm] and the median distance from the anal verge was 4 cm [range: 3-7 cm]. The whole pelvis received 46.80 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 56 months [range: 4-121 months]. Results: Of the 35 patients who underwent resection, 5 (14%) had a complete pathologic response and 27 (77%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 5-year actuarial: 21%. The 5-year actuarial survival was 64%. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in the 27 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 85%. The median number of bowel movements/day was 2 (range: 0-8). Conclusions: Our data suggest that preoperative radiation therapy allows sphincter preservation in 77% of selected patients who would otherwise require an abdominoperineal resection, and 85% have good to excellent sphincter function. Given the moderate local failure rate, we now routinely use preoperative combined modality therapy plus postoperative chemotherapy for patients with clinical T 3 disease

  11. Long-term outcomes for adult craniopharyngioma following radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Masson-Cote, Laurence; Masucci, Giuseppina Laura; Millar, Barbara-Ann; Laperriere, Normand J. [Dept. of Radiation Oncology, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada); Atenafu, Eshetu G. [Dept. of Biostatistics, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada); Cusimano, Michael [Dept. of Surgery, Div. of Neurosurgery, St. Michaels Hospital, Toronto (Canada); Croul, Sidney [Dept. of Pathology, Univ. of Toronto, Toronto (Canada); Mason, Warren [Dept. of Medicine, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada); Sahgal, Arjun [Dept. of Radiation Oncology, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada), E-mail: Arjun.sahgal@rmp.uhn.on.ca; Dept. of Radiation Oncology, Sunnybrook Health Sciences Center, Univ. of Toronto, Toronto (Canada)

    2013-01-15

    Background. We report long-term outcomes in adult patients with craniopharyngioma following surgery and radiation therapy (RT). Material and methods. Fifty-three patients treated with RT (median, 50 Gy in 25 fractions) between 1980 and 2009 with pathologically confirmed craniopharyngioma were reviewed (53% solid and 47% cystic/solid). The median age was 53 years (range, 22-76), 53% were female, 83% were sub-totally resected, 6% were gross totally resected and 11% had a biopsy and/or cyst aspiration alone. RT was delivered adjuvantly in 53% of patients as opposed to salvage intent upon progression. Results. Median follow-up was seven years (86 months, range, 8-259). The 5- and 10-year progression-free survival (PFS) rates were 85% and 69%, overall survival (OS) rates were 76% and 70%, and cause-specific survival (CSS) rates were both 88%, respectively. Both univariable and multivariable analysis identified age (<53 or {>=}53) as a prognostic factor for OS (p =0.0003) and CSS (p =0.05). PFS was observed to be worse in patients with >2 surgeries prior to RT (p =0.01). Neither the intent of radiation or tumor type (cystic vs. solid/cystic) were prognostic or predictive. New endocrinopathies and visual dysfunction were observed in 53% and 17% of patients post-surgery, and in 11% and 6% post-RT, respectively. Conclusion. We report long-term favorable PFS, CSS and OS for craniopharyngioma post-RT. We observe age as a significant prognostic factor, however, timing of radiation was not.

  12. Cancer of the larynx: radiation therapy. III

    International Nuclear Information System (INIS)

    Wang, C.C.

    1976-01-01

    Radiation therapy is the treatment of choice for a T1 and T2 tumor with normal cord mobility and/or an exophytic lesion. It not only provides excellent control of the disease, but also preserves a good, useful voice in approximately 90 percent of the irradiated patients. For a T2 lesion with impaired cord mobility and/or moderate ulceration, a trial course of radiotherapy is initially given. If the tumor shows good regression and/or a return of normal cord mobility after a dose of 4000 rads, radiation therapy may be continued to a curative dose level, about 6500 rads. Surgery is reserved for treating residual disease six to eight weeks after radiation therapy or for recurrence. A T3 lesion with complete cord fixation and/or deep ulceration with nodes does not respond favorably to radiation therapy, and a planned combination of irradiation and laryngectomy is advised. Disease that extends beyond the larynx, T4, is rarely curable by radiation therapy alone. If the lesion is still operable, a combined approach of radiation and surgery is preferred; if not, palliative radiation therapy is given. Lymph node metastases from laryngeal carcinoma indicate advanced disease and is managed by preoperative irradiation and radical neck dissection. Under a program of therapeutic individualization, two-thirds to three-quarters of patients with cancer of the larynx can be cured by irradiation with preservation of a good, useful voice. In the remainder, the larynx must be sacrificed to save the patient's life. The ultimate control of laryngeal cancer lies in eradicating the extensive primary lesion and metastatic nodes, a common problem in the management of squamous cell carcinoma elsewhere in the body

  13. The role of radiation therapy in the management of desmoid tumors

    International Nuclear Information System (INIS)

    Schulz-Ertner, D.; Zierhut, D.; Mende, U.; Harms, W.; Branitzki, P.; Wannenmacher, M.

    2002-01-01

    Purpose: To investigate the role of radiation therapy (RT) in the management of desmoid tumors. Patients and Methods: Retrospective analysis was performed on 28 patients with desmoid tumors treated with radiation therapy between March 1989 and March 1999. Tumor site was intraabdominal in three, abdominal wall in three and extraabdominal in 22 patients. Median tumor dose was 48 Gy (range 36-60 Gy). Radiation therapy was delivered postoperatively in 26 of 28 patients, two patients received radiation therapy for unresectable recurrent tumors. Results: Median follow-up was 46 months (range 13-108 months). Actuarial 5-year control rate was 73%. We observed six recurrences, located within the radiation field in one patient, out of field in two and at the field margin in three patients. All patients with intraabdominal tumors have been controlled without severe side effects. Conclusions: Radiation therapy is an effective treatment after incomplete resection of desmoid tumors. We did not observe a benefit for tumor doses exceeding 50 Gy. In some patients with circumscribed intraabdominal desmoid tumors, radiation therapy might be a treatment option with low toxicity, if 3-D treatment planning is utilized. (orig.) [de

  14. Impact of radiation therapy on sexual life

    International Nuclear Information System (INIS)

    Leroy, T.; Gabelle Flandin, I.; Habold, D.; Hannoun-Levi, J.M.

    2012-01-01

    The aim of this study was to evaluate the impact of radiation therapy on sexual life. The analysis was based on a Pubmed literature review. The keywords used for this research were 'sexual, radiation, oncology, and cancer'. After a brief reminder on the anatomy and physiology, we explained the main complications of radiation oncology and their impact on sexual life. Preventive measures and therapeutic possibilities were discussed. Radiation therapy entails local, systematic and psychological after-effects. For women, vaginal stenosis and dyspareunia represent the most frequent side effects. For men, radiation therapy leads to erectile disorders for 25 to 75% of the patients. These complications have an echo often mattering on the patient quality of life of and on their sexual life post-treatment reconstruction. The knowledge of the indications and the various techniques of irradiation allow reducing its potential sexual morbidity. The information and the education of patients are essential, although often neglected. In conclusion, radiation therapy impacts in variable degrees on the sexual life of the patients. Currently, there are not enough preventive and therapeutic means. Patient information and the early screening of the sexual complications are at stake in the support of patients in the reconstruction of their sexual life. (authors)

  15. Post-operative chemosensitized radiation with modulated 5-fluorouracil (5-FU) following resection of adenocarcinoma of the esophagus and esophagogastric (EG) junction

    International Nuclear Information System (INIS)

    Kurtzman, S.M.; Whittington, R.; Vaughn, D.; Rosato, E.F.; Haller, D.G.

    1995-01-01

    Purpose: To evaluate the survival and toxicity of post-operative chemosensitized radiation with modulated 5-FU chemotherapy in patients with resected adenocarcinomas of the esophagus and EG junction. Materials and Methods: One hundred and ninety-two patients with localized adenocarcinomas of the esophagus and EG junction were treated with single or combined modality therapy. The results in the first 165 patients treated between 1972 and 1989 demonstrated that survival was improved with chemosensitized radiation therapy following surgical resection. In the final group of patients treated between 1985 and 1989 a 96 hour inpatient 5-FU infusion was used to provide chemosensitization in those patients. Twenty-seven patients have been treated between January 1990 and December 1994 using a new outpatient regimen with modulated 5-FU chemotherapy for chemosensitization. Radiation and chemotherapy commenced within 6 weeks of surgery. The dose of radiation was 54 Gy in patients with no residual tumor, and 59.4 to 63.0 Gy in patients with positive margins or residual tumor. Modulated 5-FU using bolus 5-FU with Leukovorin +/-α-interferon (α-IFN) was given during the first and fifth week of radiation. Results: Median follow-up of surviving patients treated with modulated 5-FU is 15 months (max - 46 mos). Survival is 71% at 1 year, 45% at 2 years and 39% at 3 years. This compares favorably with the survival with 5-FU infusion, 75% - 1 year, 35% - 2 year, and 10% - 3 year. The toxicity of modulated 5-FU was no different from that observed in patients treated with 5-FU infusion. Three patients treated with modulated 5-FU leukovorin and α-IFN required intravenous hydration, and two patients experienced grade 3 leukopenia. There were two radiation related events in these patients, one case of radiation pneumonitis and one patient with pericarditis. Conclusions: Based on this experience, aggressive therapy of adenocarcinomas of the esophagus and EG junction with surgery and

  16. The tolerance of skin grafts to postoperative radiation therapy in patients with soft-tissue sarcoma

    International Nuclear Information System (INIS)

    Lawrence, W.T.; Zabell, A.; McDonald, H.D.

    1986-01-01

    During the last ten years at the National Cancer Institute, 11 patients have received 12 courses of postoperative adjuvant radiation therapy to skin grafts used for wound closure after the resection of soft-tissue sarcomas. The intervals between grafting and the initiation of radiation ranged between 3 and 20 weeks, and 4 patients received chemotherapy at the same time as their radiation. Ten of the 12 irradiated grafts remained intact after the completion of therapy. One graft had several small persistently ulcerated areas that required no further surgical treatment, and one graft required a musculocutaneous flap for reconstruction of a persistent large ulcer. Acute radiation effects on the grafted skin sometimes developed at slightly lower doses than usually seen with normal skin, but these acute effects necessitated a break in therapy on only five occasions. Concurrent chemotherapy and a relatively short interval between grafting and the initiation of radiation seemed to contribute to more severe radiation reactions. This experience indicates that postoperative adjuvant radiation therapy can be delivered to skin grafted areas without undue fear of complications, especially if the graft is allowed to heal adequately prior to initiating therapy and if chemotherapy is not given in conjunction with radiation

  17. Results of radiation therapy in periarthritis humeroscapularis

    International Nuclear Information System (INIS)

    Schultze, J.; Schlichting, G.; Galalae, R.; Kimmig, B.; Koltze, H.

    2004-01-01

    Background: radiation therapy is applied in painful degenerative shoulder diseases. Aim of this work was to evaluate the contribution of radiation therapy to symptomatic improvement in periarthritis humeroscapularis. Methods: ninety-four patients with periarthritis humeroscapularis were treated in two institutions. Mean age was 68 years, sex distribution were 32 men and 62 women. In 58 cases the right side was affected, left in 36 cases. At single doses of 0,75 Gy once a week a total dose of 6 Gy was applied The treatment effect was evaluated by the standardized von Pannewitz-score at the end of the treatment up to 6 months thereafter. Results: the treatment results of all the 94 patients were documentated at the end of therapy. Seventy-one patients were followed at least for further 4 months. Radiogenic side-effects were not noticed. The symptoms of 54 patients (57.4%) were improved or vanished, in 40 cases the symptoms were not significantly affected (42.6%). Four months after therapy 42 of 71 patients were improved (59.2%), 29 unchanged (40.8%). The treatment effect occured typically up to 2 months after therapy, there were no age-related differences. Also in recurrent radiation therapies the symptoms improved, in 80 percent after one preceding therapy, however only in 31.2 percent after multiple prior radiotherapies. (orig.)

  18. Radiation therapy of gastric carcinoma

    International Nuclear Information System (INIS)

    Asakawa, Hiroshi; Yamada, Shogo

    1980-01-01

    A total of 136 cases with gastric cancer was treated with radiation and some anti-cancer drugs. The tumor responded markedly to radiation in 37% of 92 cases, irradiated more than 5000 rad and regressed completely in only 5% of them. Out of them, the permanent cure was achieved in 3% of T2-4 M0 cases. Serious complications, such as hemorrhagic gastritis, massive bleeding, chronic ulcer of the stomach and perforation, were also observed in a few per cent of them. It was suggested that in the treatment of inoperable gastric cancer, the combination treatment of radiation and chemotherapy should be chosen as a valuable therapeutic procedure to get a good palliation. (author)

  19. Radiation therapy of gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Asakawa, H; Yamada, S [Miyagi Prefectural Adult Disease Center, Natori (Japan)

    1980-10-01

    A total of 136 cases with gastric cancer was treated with radiation and some anti-cancer drugs. The tumor responded markedly to radiation in 37% of 92 cases, irradiated more than 5000 rad and regressed completely in only 5% of them. Out of them, the permanent cure was achieved in 3% of T2-4 M0 cases. Serious complications, such as hemorrhagic gastritis, massive bleeding, chronic ulcer of the stomach and perforation, were also observed in a few per cent of them. It was suggested that in the treatment of inoperable gastric cancer, the combination treatment of radiation and chemotherapy should be chosen as a valuable therapeutic procedure to get a good palliation.

  20. Radiation therapy in elderly patients

    International Nuclear Information System (INIS)

    Durdux, C.; Boisserie, T.; Gisselbrecht, M.

    2009-01-01

    Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatment against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation, as dose, irradiated volume and fractionation. (authors)

  1. Predicting Behavioral Problems in Craniopharyngioma Survivors after Conformal Radiation Therapy

    Science.gov (United States)

    Dolson, Eugenia P.; Conklin, Heather M.; Li, Chenghong; Xiong, Xiaoping; Merchant, Thomas E.

    2009-01-01

    Background Although radiation therapy is a primary treatment for craniopharyngioma, it can exacerbate existing problems related to the tumor and pre-irradiation management. Survival is often marked by neurologic deficits, panhypopituitarism, diabetes insipidus, cognitive deficiencies and behavioral and social problems. Procedure The Achenbach Child Behavior Checklist (CBCL) was used to evaluate behavioral and social problems during the first five years of follow-up in 27 patients with craniopharyngioma treated with conformal radiation therapy. Results All group averages for the CBCL scales were within the age-typical range at pre-irradiation baseline. Extent of surgical resection was implicated in baseline differences for the Internalizing, Externalizing, Behavior Problem and Social scores. Significant longitudinal changes were found in Internalizing, Externalizing, Behavior Problem and School scores that correlated with tumor and treatment related factors. Conclusions The most common variables implicated in post-irradiation behavioral and social problems were CSF shunting, presence of an Ommaya reservoir, diabetes insipidus, and low pre-irradiation growth hormone levels. PMID:19191345

  2. Monte Carlo techniques in radiation therapy

    CERN Document Server

    Verhaegen, Frank

    2013-01-01

    Modern cancer treatment relies on Monte Carlo simulations to help radiotherapists and clinical physicists better understand and compute radiation dose from imaging devices as well as exploit four-dimensional imaging data. With Monte Carlo-based treatment planning tools now available from commercial vendors, a complete transition to Monte Carlo-based dose calculation methods in radiotherapy could likely take place in the next decade. Monte Carlo Techniques in Radiation Therapy explores the use of Monte Carlo methods for modeling various features of internal and external radiation sources, including light ion beams. The book-the first of its kind-addresses applications of the Monte Carlo particle transport simulation technique in radiation therapy, mainly focusing on external beam radiotherapy and brachytherapy. It presents the mathematical and technical aspects of the methods in particle transport simulations. The book also discusses the modeling of medical linacs and other irradiation devices; issues specific...

  3. Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer

    International Nuclear Information System (INIS)

    McMillan, Matthew T.; Ojerholm, Eric; Roses, Robert E.; Plastaras, John P.; Metz, James M.; Mamtani, Ronac; Karakousis, Giorgos C.; Fraker, Douglas L.; Drebin, Jeffrey A.; Stripp, Diana; Ben-Josef, Edgar; Datta, Jashodeep

    2015-01-01

    Purpose: Prolonged radiation therapy treatment time (RTT) is associated with worse survival in several tumor types. This study investigated whether delays during adjuvant radiation therapy impact overall survival (OS) in gastric cancer. Methods and Materials: The National Cancer Data Base was queried for patients with resected gastric cancer who received adjuvant radiation therapy with National Comprehensive Cancer Network–recommended doses (45 or 50.4 Gy) between 1998 and 2006. RTT was classified as standard (45 Gy: 33-36 days, 50.4 Gy: 38-41 days) or prolonged (45 Gy: >36 days, 50.4 Gy: >41 days). Cox proportional hazards models evaluated the association between the following factors and OS: RTT, interval from surgery to radiation therapy initiation, interval from surgery to radiation therapy completion, radiation therapy dose, demographic/pathologic and operative factors, and other elements of adjuvant multimodality therapy. Results: Of 1591 patients, RTT was delayed in 732 (46%). Factors associated with prolonged RTT were non-private health insurance (OR 1.3, P=.005) and treatment at non-academic facilities (OR 1.2, P=.045). Median OS and 5-year actuarial survival were significantly worse in patients with prolonged RTT compared with standard RTT (36 vs 51 months, P=.001; 39 vs 47%, P=.005); OS worsened with each cumulative week of delay (P<.0004). On multivariable analysis, prolonged RTT was associated with inferior OS (hazard ratio 1.2, P=.002); the intervals from surgery to radiation therapy initiation or completion were not. Prolonged RTT was particularly detrimental in patients with node positivity, inadequate nodal staging (<15 nodes examined), and those undergoing a cycle of chemotherapy before chemoradiation therapy. Conclusions: Delays during adjuvant radiation therapy appear to negatively impact survival in gastric cancer. Efforts to minimize cumulative interruptions to <7 days should be considered

  4. Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    McMillan, Matthew T. [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Ojerholm, Eric [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Roses, Robert E., E-mail: Robert.Roses@uphs.upenn.edu [Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Plastaras, John P.; Metz, James M. [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Mamtani, Ronac [Department of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Karakousis, Giorgos C.; Fraker, Douglas L.; Drebin, Jeffrey A. [Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Stripp, Diana; Ben-Josef, Edgar [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Datta, Jashodeep [Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States)

    2015-10-01

    Purpose: Prolonged radiation therapy treatment time (RTT) is associated with worse survival in several tumor types. This study investigated whether delays during adjuvant radiation therapy impact overall survival (OS) in gastric cancer. Methods and Materials: The National Cancer Data Base was queried for patients with resected gastric cancer who received adjuvant radiation therapy with National Comprehensive Cancer Network–recommended doses (45 or 50.4 Gy) between 1998 and 2006. RTT was classified as standard (45 Gy: 33-36 days, 50.4 Gy: 38-41 days) or prolonged (45 Gy: >36 days, 50.4 Gy: >41 days). Cox proportional hazards models evaluated the association between the following factors and OS: RTT, interval from surgery to radiation therapy initiation, interval from surgery to radiation therapy completion, radiation therapy dose, demographic/pathologic and operative factors, and other elements of adjuvant multimodality therapy. Results: Of 1591 patients, RTT was delayed in 732 (46%). Factors associated with prolonged RTT were non-private health insurance (OR 1.3, P=.005) and treatment at non-academic facilities (OR 1.2, P=.045). Median OS and 5-year actuarial survival were significantly worse in patients with prolonged RTT compared with standard RTT (36 vs 51 months, P=.001; 39 vs 47%, P=.005); OS worsened with each cumulative week of delay (P<.0004). On multivariable analysis, prolonged RTT was associated with inferior OS (hazard ratio 1.2, P=.002); the intervals from surgery to radiation therapy initiation or completion were not. Prolonged RTT was particularly detrimental in patients with node positivity, inadequate nodal staging (<15 nodes examined), and those undergoing a cycle of chemotherapy before chemoradiation therapy. Conclusions: Delays during adjuvant radiation therapy appear to negatively impact survival in gastric cancer. Efforts to minimize cumulative interruptions to <7 days should be considered.

  5. Role of specimen US for predicting resection margin status in breast conserving therapy.

    Science.gov (United States)

    Moschetta, M; Telegrafo, M; Introna, T; Coi, L; Rella, L; Ranieri, V; Cirili, A; Stabile Ianora, A A; Angelelli, G

    2015-01-01

    To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

  6. Radiation Therapy of Suprasellar Germ Cell Tumors

    International Nuclear Information System (INIS)

    Park, Woo Yoon; Choi, Doo Ho; Choi, Eun Kyung; Kim, Il Han; Ha, Sung Whan; Park, Charn Il

    1988-01-01

    A retrospective study was performed on 15 patients with suprasellar germ cell tumors treated by megavoltage external beam irradiation between Feb. 1979 and Dec. 1985. Follow-up period of survivors was 30 to 91 months. Histologic diagnosis was obtained before radiation therapy in 10 patients (9 germinomas and 1 mixed). Five patients were treated without histologic verification. In 9 patients with biopsy-proven germinomas radiation therapy was delivered to the craniospinal axis in 6, to the whole brain in 3. In 5 patients with mixed germ cell tumor or elevated tumor marker, irradiation was delivered to the craniospinal axis in 2, to the whole brain in 2, and to the primary site only in 1. Total doses ranged from 5,000 to 5,500 cGy to the primary site, 3,000 to 4,400 cGy to the whole brain, and 1,300 to 3,000 cGy to the spine. In these 14, local tumor was controlled and primary or spinal failure was not observed. One patient without elevated tumor marker was treated to the whole brain, The tumor was not controlled and he had spinal recurrence. It is proven that radiation therapy is an effective treatment for suprasellar germ cell tumors. The neuroendocrinologic presentation, tumor marker status, early response to radiation measured on CT seem to be useful means for selecting patients for radiation therapy when tissue diagnosis is not available

  7. Advanced Small Animal Conformal Radiation Therapy Device.

    Science.gov (United States)

    Sharma, Sunil; Narayanasamy, Ganesh; Przybyla, Beata; Webber, Jessica; Boerma, Marjan; Clarkson, Richard; Moros, Eduardo G; Corry, Peter M; Griffin, Robert J

    2017-02-01

    We have developed a small animal conformal radiation therapy device that provides a degree of geometrical/anatomical targeting comparable to what is achievable in a commercial animal irradiator. small animal conformal radiation therapy device is capable of producing precise and accurate conformal delivery of radiation to target as well as for imaging small animals. The small animal conformal radiation therapy device uses an X-ray tube, a robotic animal position system, and a digital imager. The system is in a steel enclosure with adequate lead shielding following National Council on Radiation Protection and Measurements 49 guidelines and verified with Geiger-Mueller survey meter. The X-ray source is calibrated following AAPM TG-61 specifications and mounted at 101.6 cm from the floor, which is a primary barrier. The X-ray tube is mounted on a custom-made "gantry" and has a special collimating assembly system that allows field size between 0.5 mm and 20 cm at isocenter. Three-dimensional imaging can be performed to aid target localization using the same X-ray source at custom settings and an in-house reconstruction software. The small animal conformal radiation therapy device thus provides an excellent integrated system to promote translational research in radiation oncology in an academic laboratory. The purpose of this article is to review shielding and dosimetric measurement and highlight a few successful studies that have been performed to date with our system. In addition, an example of new data from an in vivo rat model of breast cancer is presented in which spatially fractionated radiation alone and in combination with thermal ablation was applied and the therapeutic benefit examined.

  8. Radiation therapy for resistant sternal hydatid disease

    International Nuclear Information System (INIS)

    Ulger, S.; Barut, H.; Tunc, M.; Aydinkarahaliloglu, E.; Aydin, E.; Karaoglanoglu, N.; Gokcek, A.

    2013-01-01

    Hydatid disease is a zoonotic infectious disease for which there are known treatment procedures and effective antibiotics; however, there are resistant cases that do not respond to medication or surgery. We report a case diagnosed as hydatid disease of the chest wall and treated with radiation therapy (RT) after medical and surgical therapy had failed. In conclusion, RT represents an alternative treatment modality in resistant cases. (orig.)

  9. Recurrent primary lumbar vertebra chondrosarcoma: Marginal resection and Iodine-125 seed therapy

    Directory of Open Access Journals (Sweden)

    Chunpeng Ren

    2014-01-01

    Full Text Available Chondrosarcomas are uncommon in the spinal column. En bloc excisions with wide margins are of critical importance but not always feasible in spine. We report the outcome in a case of recurrent lumbar vertebral chondrosarcoma treated with marginal resection and iodine-125 seeds placed in the resected tumor bed.

  10. Oral complications of radiation therapy

    International Nuclear Information System (INIS)

    Lockhart, P.B.

    1986-01-01

    Comprehensive management of patients receiving radiotherapy to the head and neck dictates that they have a thorough dental evaluation as part of their overall treatment planning. Early and appropriate patient education and dental treatment, along with careful management during and after radiotherapy, will significantly decrease the incidence and severity of complications, improve quality of life, and increase tolerance to therapy. 49 refs.; 16 figs.; 1 table

  11. Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections.

    Science.gov (United States)

    Gulec, Seza A; Pennington, Kenneth; Hall, Michael; Fong, Yuman

    2009-01-08

    Extended liver resections are being performed more liberally than ever. The extent of resection of liver metastases, however, is restricted by the volume of the future liver remnant (FLR). An intervention that would both accomplish tumor control and induce compensatory hypertrophy, with good patient tolerability, could improve clinical outcomes. A 53-year-old woman with a history of cervical cancer presented with a large liver mass. Subsequent biopsy indicated poorly differentiated carcinoma with necrosis suggestive of squamous cell origin. A decision was made to proceed with pre-operative chemotherapy and Y-90 microsphere SIRT with the intent to obtain systemic control over the disease, downsize the hepatic lesion, and improve the FLR. A surgical exploration was performed six months after the first SIRT (three months after the second). There was no extrahepatic disease. The tumor was found to be significantly decreased in size with central and peripheral scarring. The left lobe was satisfactorily hypertrophied. A formal right hepatic lobectomy was performed with macroscopic negative margins. Selective internal radiation treatment (SIRT) with yttrium-90 (Y-90) microspheres has emerged as an effective liver-directed therapy with a favorable therapeutic ratio. We present this case report to suggest that the portal vein radiation dose can be substantially increased with the intent of inducing portal/periportal fibrosis. Such a therapeutic manipulation in lobar Y-90 microsphere treatment could accomplish the end points of PVE with avoidance of the concern regarding tumor progression.

  12. Thyorid function after mantle field radiation therapy

    International Nuclear Information System (INIS)

    Daehnert, W.; Kutzner, J.; Grimm, W.

    1981-01-01

    48 patients with malignant lymphoma received a 60 Co-radiation dose of 30 to 50 Gy using the mantle field technique. Thyroid function tests were performed 34 to 92 months after radiation therapy. One patient developed myxedema, ten (20.8%) had subclinical hypothyroidism and six (12.5%) latent hypothyroidism. The incidence of hypothyroidism after treatment of malignant lymphomas is summarized in a review of the literature. Discrepancies on the incidence of hypothyroidism were found, and their possible cause is discussed. Periodic examinations of all patients with thyroid radiation exposure are recommended. The examination can be limited to measurement of TSH concentration and palpation of the thyroid for nodules. (orig.) [de

  13. Preoperative combination therapy of 5-fluorouracil suppository and radiation for carcinoma of the rectum

    International Nuclear Information System (INIS)

    Mizusawa, Hirokazu

    1986-01-01

    The effect of adjuvant preoperative treatments with radiation and 5-fluorouracil (5-FU) on rectal carcinomas was investigated. The radiation therapy was administered in the area including the rectum and regional lymph nodes up to the level of the promontorium with 10 doses of 300 rad in three-week periods (a total dose of 3,000 rad). The suppository containing 100 mg of 5-FU was given intrarectally twice daily in the same period (a total dose of 4,000 mg of 5-FU). The surgical procedure with either abdominoperineal excision or anterior resection was performed within 14 days after the last preoperative treatment. The resected specimens were examined microscopically. The mean thickness of excised tumor-free tissue around the rectal wall having the most extended tumor growth was 6.2 mm in 16 patients receiving the treatment with radiation and 5-FU, 3.9 mm in 31 patients with 5-FU alone and 3.7 mm in 19 patients without preoperative treatments. Lymph node metastases were detected in 3 of 17 patients (19 %) with radiation and 5-FU, in 18 of 33 patients (55 %) with 5-FU alone, and in 11 of 24 patients (46 %) without preoperative treatments. The extensive degenerative pictures of cancer cells such as nuclear picnosis, and the growth of collagen fibers in carcinoma foci were observed in resected specimens with radiation and 5-FU treatments. Those findings suggest that preoperative adjuvant therapy with moderate dose of radiation and 5-FU affected significantly rectal carcinomas. There were no adverse effects. It seems likely, thus, that this combined therapy could prevent postoperative local or intrapelvic recurrence, which was the most frequent form of recurrence after curative surgery in rectal cancer. (author)

  14. Radiation therapy for esophageal carcinoma

    International Nuclear Information System (INIS)

    Chatani, Masashi; Matayoshi, Yoshinobu; Masaki, Norie

    1992-01-01

    From 1977 through 1989, 149 patients with esophageal carcinoma were treated with external irradiation (EI) with or without high-dose rate intraluminal irradiation (HDRII) using remote afterloading system. Concerning complete response group EI alone showed higher local control rate than EI + HDRII, especially in ulcerative type. Another problem is the EI field. Fourteen of 22 patients who were salvaged by surgery due to local recurrence after EI showed marginal or out-field metastasis of the lymph node. These preliminary results suggest that HDRII is not effective for the local control of the ulcerative lesion as a boost therapy, EI should be given for the entire regional lymph nodes. (author)

  15. Electron beams in radiation therapy

    International Nuclear Information System (INIS)

    Bruinvis, I.A.D.

    1987-01-01

    Clinical electron beams in interaction with beam flattening and collimating devices are studied, in order to obtain the means for adequate electron therapy. A treatment planning method for arbitrary field shapes is developed that takes the properties of the collimated electron beams into account. An electron multiple-scattering model is extended to incorporate a model for the loss of electrons with depth, in order to improve electron beam dose planning. A study of ionisation measurements in two different phantom materials yields correction factors for electron beam dosimetry. (Auth.)

  16. Hemostatic radiation therapy in advanced gastric cancer

    International Nuclear Information System (INIS)

    Novaes, P.E.R.S.; Possik, R.A.; Peres, O.; Abrao, A.

    1987-01-01

    Nine patients with advanced bleeding gastric cancer are treated with 4MVC linear accelerator or cobaltotherapy inparallel opposed fields to epigastric region. The radiation therapy is employed as an hemostatic procedure and the results of treatment are analysed. The doses ranged of 1000 rad to 4000 rad, 150 to 300 rad/day, five days a week. (M.A.C.) [pt

  17. Preoperative breast radiation therapy: Indications and perspectives

    DEFF Research Database (Denmark)

    Lightowlers, S V; Boersma, L J; Fourquet, A

    2017-01-01

    Preoperative breast radiation therapy (RT) is not a new concept, but older studies failed to change practice. More recently, there has been interest in revisiting preoperative RT using modern techniques. This current perspective discusses the indications, summarises the published literature and t...

  18. Results of radiation therapy for vulvar carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Pirtoli, L; Rottoli, M L [Florence Univ. (Italy). Ist. di Radiologia

    1982-01-01

    Radical radiation therapy was given to 19 patients with vulvar squamous cell carcinoma, and as a palliative to 17. Complete regression of the tumor was achieved in 17 patients (47%). The 5-year survival rate was 8/31 patients (26%) in the overall series and 8/19 patients (42%) in the radically irradiated group.

  19. Radiation therapy in patients with hematologic diseases

    International Nuclear Information System (INIS)

    Hennequin, C.; Maylin, C.

    1995-01-01

    Radiation therapy has a significant place in the treatment of hematologic diseases. Irradiation is a key component of the treatment strategy for Hodgkin's disease and has benefited from clinical studies aimed at improving its therapeutic index. There have been many recent improvements, in particular with regard to accuracy of techniques, imagery, dosimetry, and implementation of quality-control procedures. In localized non-Hodgkin's lymphoma, the gold-standard treatment is radiation therapy coupled with a short course of chemotherapy. In contrast, the place of irradiation in disseminated lymphomas remains to be defined. Prophylactic irradiation of the brain is still used in patients with acute lymphoblastic leukemia. Radiation therapy is of value as palliative treatment of bone lesions of myeloma, in chemo-resistant lymphomas, and in relapses of leukemia. Total body irradiation is a cumbersome but irreplaceable method, which has also benefited from recent clinical and biological studies. Optimal radiation therapy with the best possible therapeutic index requires adequate technological and human resources. (authors). 30 refs., 1 tab

  20. PET/CT in Radiation Therapy Planning

    DEFF Research Database (Denmark)

    Specht, Lena; Berthelsen, Anne Kiil

    2018-01-01

    Radiation therapy (RT) is an important component of the management of lymphoma patients. Most lymphomas are metabolically active and accumulate 18F-fluorodeoxyglucose (FDG). Positron emission tomography with computer tomography (PET/CT) imaging using FDG is used routinely in staging and treatment...

  1. Use of microvascular flaps including free osteocutaneous flaps in reconstruction after composite resection for radiation-recurrent oral cancer

    International Nuclear Information System (INIS)

    Rosen, I.B.; Bell, M.S.; Barron, P.T.; Zuker, R.M.; Manktelow, R.T.

    1979-01-01

    Fourteen patients underwent microsurgical free flap procedures for reconstruction after composite resection of radiation-recurrent oral cancer. The use of attached metatarsal bone in nine patients for mandibular reconstruction is in our view a significant advance in this field. Two failures occurred, one due to sepsis and one to delayed thrombosis. Our experience indicates that this procedure deserves a place in the surgical treatment of patients afflicted with oral malignancy

  2. Adjuvant postoperative radiation therapy for carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Moon, Hye Seong; Kim, Seung Cheol; Kim, Chong Il; Ahn, Jung Ja

    2003-01-01

    This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study, The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, Iymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was 45 - 50 Gy. Vagina cuff irradiation was performed, after completion of the external beam irradiation, al a low-dose rate of CS-137, with the total dose of 4488-4932 chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months (15-108 months), The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95% and 94%, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Our results indicate that postoperative radiation therapy can

  3. Planning of radiation therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Iwata, Takeo

    1981-01-01

    The esophageal malignant tumors occur mostly at the pulmonary esophagus, whereas such tumors also occur at the cervical and abdominal esophagus. Moreover, histologically, such malignant tumors are mostly carcinoma planocellulare and yet, there are not a few cases of adenomatous carcinoma and indifferentiated carcinoma. X-ray pictures reveal various types, such as infundibular, spiral and serrated forms, which are related to the radioactive therapuetic effects. However, the most difficult condition in radioactive therapies for the esophagus is that this organ is adjacent to important viscera at the surroundings, thus the most irradiating field covers the normal tissues. For such radiating sites, instead of the conventional simple radiation by 2 guns, a further progress was considered by trying to pursue more efficient and effective methods for radiating therapies in classfication by the generating or causing sites of carcinoma, in application of computers. (author)

  4. Drug delivery system and radiation therapy

    International Nuclear Information System (INIS)

    Shibata, Tokushi

    2005-01-01

    This paper describes the review of radiation therapy, neutron capture therapy (NCT) and drug delivery system for the latter. In cancer radiation therapy, there are problems of body movement like breathing, needless irradiation of normal tissues, difficulty to decide the correct irradiation position and tumor morphology. NCT has advantages to overcome these, and since boron has a big cross section for thermal neutron, NPT uses the reaction 10 B(n, α) 7 Li in the target cancer which previously incorporated the boron-containing drug. During the period 1966-1996, 246 patients were treated with this in Japan and the treatment has been continued thereafter. The tasks for NCT are developments of drug delivery system efficient to deliver the drug into the tumor and of convenient neutron source like the accelerator. (S.I.)

  5. Combined therapy of urinary bladder radiation injury

    International Nuclear Information System (INIS)

    Zaderin, V.P.; Polyanichko, M.F.

    1982-01-01

    A scheme of therapy of radiation cystitis is suggested. It was developed on the basis of evaluation of literature data and clinical of 205 patients with radiation injury of the urinary bladder. The method is based on general and local therapy of damaged tissues by antiinflammatory drugs, anesthetics and stimulators of reparative regeneration. Severe ulcerative and incrustation cystites, refractory to conservative therapy, were treated by surgery, using antiseptics and reparation stimulators before, during and after operation. As a result, there were hardly any complications after reconstruction of the bladder with intestinal and peritoneal tissues. 104 patients (96.1%) were cured completely and ability to work was restored in 70 patients (76.9%) [ru

  6. Radiation therapy of Graves' ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Toshiki; Koga, Sukehiko; Anno, Hirofumi; Komai, Satoshi (Fujita-Gakuen Health Univ., Toyoake, Aichi (Japan))

    1992-01-01

    During the decade from 1978 to 1987, 20 patients with Graves' ophthalmopathy were treated with irradiation of 2000 cGy to the orbital tissue. We examined the effects of the therapy on 17 such patients. Exophthalmos tended to decrease. When the degree of deviation of the exophthalmic eye was small, the effect of therapy tended to be better than when it was large. Two cases that showed an increase in retrobulbar fatty tissue without thickening of the extraocular muscles did not respond as well as those that had thickening of the extraocular muscles. Diplopia tended to improve both subjectively and objectively. Ocular movement improved in 11 of the 17 patients. There were no serious radiation injuries after the radiation therapy, except for some transient swelling of the eyelid. (author).

  7. Computer models for optimizing radiation therapy

    International Nuclear Information System (INIS)

    Duechting, W.

    1998-01-01

    The aim of this contribution is to outline how methods of system analysis, control therapy and modelling can be applied to simulate normal and malignant cell growth and to optimize cancer treatment as for instance radiation therapy. Based on biological observations and cell kinetic data, several types of models have been developed describing the growth of tumor spheroids and the cell renewal of normal tissue. The irradiation model is represented by the so-called linear-quadratic model describing the survival fraction as a function of the dose. Based thereon, numerous simulation runs for different treatment schemes can be performed. Thus, it is possible to study the radiation effect on tumor and normal tissue separately. Finally, this method enables a computer-assisted recommendation for an optimal patient-specific treatment schedule prior to clinical therapy. (orig.) [de

  8. A case of constrictive pericarditis developing 2 years after radiation therapy for carcinoma of the esophagus

    International Nuclear Information System (INIS)

    Hara, Youichi; Kuroda, Hiroaki; Ishiguro, Shingo; Hamasaki, Takafumi; Ashida, Yasushi; Tonomoto, Nagahisa; Miyasaka, Shigeto; Mori, Tohru

    1997-01-01

    A case of constrictive pericarditis developing 2 years after radiation therapy for esophageal carcinoma is reported. A man of 48 years old was diagnosed as early esophageal carcinoma and treated with radiation theraphy of 60 Gy. After 12 months, he developed acute pericarditis, which remitted spontaneously. After 18 months, he developed constrictive pericarditis, which did response to medical treatment, and became NYHA grade 4. After 25 months, pericardial sac and epicardium were resected. But dilatation of right ventricular dimension was not enough and hemodynamics did not recover. However, subjective symptom was extremely improved, and he left the hospital by walk at 29 days after the surgery. (K.H.)

  9. Treatment of Locally Advanced Pancreatic Cancer: The Role of Radiation Therapy

    International Nuclear Information System (INIS)

    Johung, Kimberly; Saif, Muhammad Wasif; Chang, Bryan W.

    2012-01-01

    Pancreatic cancer remains associated with an extremely poor prognosis. Surgical resection can be curative, but the majority of patients present with locally advanced or metastatic disease. Treatment for patients with locally advanced disease is controversial. Therapeutic options include systemic therapy alone, concurrent chemoradiation, or induction chemotherapy followed by chemoradiation. We review the evidence to date regarding the treatment of locally advanced pancreatic cancer (LAPC), as well as evolving strategies including the emerging role of targeted therapies. We propose that if radiation is used for patients with LAPC, it should be delivered with concurrent chemotherapy and following a period of induction chemotherapy.

  10. Database for radiation therapy images

    International Nuclear Information System (INIS)

    Shalev, S.; Cosby, S.; Leszczynski, K.; Chu, T.

    1989-01-01

    The authors have developed a database for images acquired during simulation and verification of radiation treatments. Simulation images originate as planning films that are digitized with a video camera, or through direct digitization of fluoroscopic images. Verification images may also be digitized from portal films or acquired with an on-line portal imaging system. Images are classified by the patient, the fraction, the field direction, static or dynamic (movie) sequences, and the type of processing applied. Additional parameters indicate whether the source is a simulation or treatment, whether images are digitized film or real-time acquisitions, and whether treatment is portal or double exposure for beam localization. Examples are presented for images acquired, processed, stored, and displayed with on-line portal imaging system (OPIUM) and digital simulation system (FLIP)

  11. Local Failure in Resected N1 Lung Cancer: Implications for Adjuvant Therapy

    International Nuclear Information System (INIS)

    Higgins, Kristin A.; Chino, Junzo P.; Berry, Mark; Ready, Neal; Boyd, Jessamy; Yoo, David S.; Kelsey, Chris R.

    2012-01-01

    Purpose: To evaluate actuarial rates of local failure in patients with pathologic N1 non–small-cell lung cancer and to identify clinical and pathologic factors associated with an increased risk of local failure after resection. Methods and Materials: All patients who underwent surgery for non–small-cell lung cancer with pathologically confirmed N1 disease at Duke University Medical Center from 1995–2008 were identified. Patients receiving any preoperative therapy or postoperative radiotherapy or with positive surgical margins were excluded. Local failure was defined as disease recurrence within the ipsilateral hilum, mediastinum, or bronchial stump/staple line. Actuarial rates of local failure were calculated with the Kaplan-Meier method. A Cox multivariate analysis was used to identify factors independently associated with a higher risk of local recurrence. Results: Among 1,559 patients who underwent surgery during the time interval, 198 met the inclusion criteria. Of these patients, 50 (25%) received adjuvant chemotherapy. Actuarial (5-year) rates of local failure, distant failure, and overall survival were 40%, 55%, and 33%, respectively. On multivariate analysis, factors associated with an increased risk of local failure included a video-assisted thoracoscopic surgery approach (hazard ratio [HR], 2.5; p = 0.01), visceral pleural invasion (HR, 2.1; p = 0.04), and increasing number of positive N1 lymph nodes (HR, 1.3 per involved lymph node; p = 0.02). Chemotherapy was associated with a trend toward decreased risk of local failure that was not statistically significant (HR, 0.61; p = 0.2). Conclusions: Actuarial rates of local failure in pN1 disease are high. Further investigation of conformal postoperative radiotherapy may be warranted.

  12. Local Failure in Resected N1 Lung Cancer: Implications for Adjuvant Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Higgins, Kristin A., E-mail: kristin.higgins@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Chino, Junzo P [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Berry, Mark [Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC (United States); Ready, Neal [Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC (United States); Boyd, Jessamy [US Oncology, Dallas, TX (United States); Yoo, David S; Kelsey, Chris R [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

    2012-06-01

    Purpose: To evaluate actuarial rates of local failure in patients with pathologic N1 non-small-cell lung cancer and to identify clinical and pathologic factors associated with an increased risk of local failure after resection. Methods and Materials: All patients who underwent surgery for non-small-cell lung cancer with pathologically confirmed N1 disease at Duke University Medical Center from 1995-2008 were identified. Patients receiving any preoperative therapy or postoperative radiotherapy or with positive surgical margins were excluded. Local failure was defined as disease recurrence within the ipsilateral hilum, mediastinum, or bronchial stump/staple line. Actuarial rates of local failure were calculated with the Kaplan-Meier method. A Cox multivariate analysis was used to identify factors independently associated with a higher risk of local recurrence. Results: Among 1,559 patients who underwent surgery during the time interval, 198 met the inclusion criteria. Of these patients, 50 (25%) received adjuvant chemotherapy. Actuarial (5-year) rates of local failure, distant failure, and overall survival were 40%, 55%, and 33%, respectively. On multivariate analysis, factors associated with an increased risk of local failure included a video-assisted thoracoscopic surgery approach (hazard ratio [HR], 2.5; p = 0.01), visceral pleural invasion (HR, 2.1; p = 0.04), and increasing number of positive N1 lymph nodes (HR, 1.3 per involved lymph node; p = 0.02). Chemotherapy was associated with a trend toward decreased risk of local failure that was not statistically significant (HR, 0.61; p = 0.2). Conclusions: Actuarial rates of local failure in pN1 disease are high. Further investigation of conformal postoperative radiotherapy may be warranted.

  13. Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new.

    Science.gov (United States)

    Boyle, John; Czito, Brian; Willett, Christopher; Palta, Manisha

    2015-08-01

    Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates.

  14. Some method for teaching physics to residents in radiation therapy

    International Nuclear Information System (INIS)

    Hughes, D.B.

    A method is presented for teaching physics to residents in radiation therapy. Some of the various responsabilities of a hospital physicist are listed, with particular reference to radiation therapy departments [pt

  15. Effect of loperamide and delay of bowel motility on bile acid malabsorption caused by late radiation damage and ileal resection

    Energy Technology Data Exchange (ETDEWEB)

    Valdes Olmos, R. (Nederlands Kanker Inst., Amsterdam (Netherlands). Dept. of Nuclear Medicine); Hartog Jager, F. den; Hoefnagel, C.; Taal, B. (Nederlands Kanker Inst., Amsterdam (Netherlands). Dept. of Gastroenterology)

    1991-05-01

    Selenium-75 homocholic acid conjugated with taurine ({sup 75}Se-HCAT) was used during loperamide administration in seven patients suspected of having bile acid malabsorption due to late radiation damage and small-bowel resection in order to document the aetiology of ileal dysfunction and to adjust therapeutic mamagement. In two patients with ileal resection up to 50 cm and in one patient without resection, a reduction of bowel motility by loperamide resulted in marked normalization of the {sup 75}Se-HCAT retention measurements. Sequential scintigraphic {sup 75}Se-HCAT imaging demonstrated a significant improvement in the {sup 75}Se-HCAT reabsorption and recirculation, accompanied in one case by prolongation of colonic retention of the radiopharmaceutical. In four patients with more than 80 cm resection, the {sup 75}Se-HCAT test was abnormal during loperamide administration. In two of these patients for whom baseline values were available, no improvement in the pattern of {sup 75}Se-HCAT absorption was observed. In conclusion, the first results of loperamide {sup 75}Se-HCAT in patients suspected of having bile acid malabsorption and abnormal baseline {sup 75}Se-HCAT are promising. Intervention with loperamide is easy and seems to improve the clinical value of the test with direct therapeutic implications. Sequential {sup 75}Se-HCAT imaging is essential for interpreting changes in the {sup 75}Se-HCAT retention measurements. (orig.).

  16. External and internal radiation therapy: Past and future directions

    Directory of Open Access Journals (Sweden)

    Sadeghi Mahdi

    2010-01-01

    Full Text Available Cancer is a leading cause of morbidity and mortality in the modern world. Treatment modalities comprise radiation therapy, surgery, chemotherapy and hormonal therapy. Radiation therapy can be performed by using external or internal radiation therapy. However, each method has its unique properties which undertakes special role in cancer treatment, this question is brought up that: For cancer treatment, whether external radiation therapy is more efficient or internal radiation therapy one? To answer this question, we need to consider principles and structure of individual methods. In this review, principles and application of each method are considered and finally these two methods are compared with each other.

  17. Pulsed laser radiation therapy of skin tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kozlov, A.P.; Moskalik, K.G.

    1980-11-15

    Radiation from a neodymium laser was used to treat 846 patients with 687 precancerous lesions or benign tumors of the skin, 516 cutaneous carcinomas, 33 recurrences of cancer, 51 melanomas, and 508 metastatic melanomas in the skin. The patients have been followed for three months to 6.5 years. No relapses have been observed during this period. Metastases to regional lymph nodes were found in five patients with skin melanoma. Pulsed laser radiation may be successfully used in the treatment of precancerous lesions and benign tumors as well as for skin carcinoma and its recurrences, and for skin melanoma. Laser radiation is more effective in the treatment of tumors inaccessible to radiation therapy and better in those cases in which surgery may have a bad cosmetic or even mutilating effect. Laser beams can be employed in conjunction with chemo- or immunotherapy.

  18. Conformal proton radiation therapy for pediatric low-grade astrocytomas

    International Nuclear Information System (INIS)

    Hug, E.B.; Loma Linda Univ. Medical Center, Loma Linda, CA; Darthmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Muenter, M.W.; Archambeau, J.O.; DeVries, A.; Loredo, L.N.; Grove, R.I.; Slater, J.D.; Liwnicz, B.

    2002-01-01

    Background: To evaluate the safety and efficacy of proton radiation therapy (PRT) for intracranial low-grade astrocytomas, the authors analyzed the first 27 pediatric patients treated at Loma Linda University Medical Center (LLUMC). Patients and Method: Between September 1991 and August 1997, 27 patients (13 female, 14 male) underwent fractionated proton radiation therapy for progressive or recurrent low-grade astrocytoma. Age at time of treatment ranged from 2 to 18 years (mean: 8.7 years). Tumors were located centrally (diencephatic) in 15 patients, in the cerebral and cerebellar hemispheres in seven patients, and in the brainstem in five patients. 25/27 patients (92%) were treated for progressive, unresectable, or residual disease following subtotal resection. Tissue diagnosis was available in 23/27 patients (85%). Four patients with optic pathway tumors were treated without histologic confirmation. Target doses between 50.4 and 63.0 CGE (cobalt gray equivalent, mean: 55.2 CGE) were prescribed at 1.8 CGE per fraction, five treatments per week. Results: At a mean follow-up period of 3.3 years (0.6-6.8 years), 6/27 patients experienced local failure (all located within the irradiated field), and 4/27 patients had died. By anatomic site these data translated into rates of local control and survival of 87% (13/15 patients) and 93% (14/15 patients) for central tumors, 71% (5/7 patients) and 86% (6/7 patients) for hemispheric tumors, and 60% (3/5 patients) and 60% (3/5 patients) for tumors located in the brainstem. Proton radiation therapy was generally well tolerated. All children with local control maintained their performance status. One child with associated neurofibromatosis, Type 1, developed Moyamoya disease. All six patients with optic pathway tumors and useful vision maintained or improved their visual status. Conclusions: This report on pediatric low-grade astrocytomas confirms proton radiation therapy as a safe and efficacious 3-D conformal treatment

  19. Comparison of particle-radiation-therapy modalities

    International Nuclear Information System (INIS)

    Fairchild, R.G.; Bond, V.P.

    1981-01-01

    The characteristics of dose distribution, beam alignment, and radiobiological advantages accorded to high LET radiation were reviewed and compared for various particle beam radiotherapeutic modalities (neutron, Auger electrons, p, π - , He, C, Ne, and Ar ions). Merit factors were evaluated on the basis of effective dose to tumor relative to normal tissue, linear energy transfer (LET), and dose localization, at depths of 1, 4, and 10 cm. In general, it was found that neutron capture therapy using an epithermal neutron beam provided the best merit factors available for depths up to 8 cm. The position of fast neutron therapy on the Merit Factor Tables was consistently lower than that of other particle modalities, and above only 60 Co. The largest body of clinical data exists for fast neutron therapy; results are considered by some to be encouraging. It then follows that if benefits with fast neutron therapy are real, additional gains are within reach with other modalities

  20. START: an advanced radiation therapy information system.

    Science.gov (United States)

    Cocco, A; Valentini, V; Balducci, M; Mantello, G

    1996-01-01

    START is an advanced radiation therapy information system (RTIS) which connects direct information technology present in the devices with indirect information technology for clinical, administrative, information management integrated with the hospital information system (HIS). The following objectives are pursued: to support decision making in treatment planning and functional and information integration with the rest of the hospital; to enhance organizational efficiency of a Radiation Therapy Department; to facilitate the statistical evaluation of clinical data and managerial performance assessment; to ensure the safety and confidentiality of used data. For its development a working method based on the involvement of all operators of the Radiation Therapy Department, was applied. Its introduction in the work activity was gradual, trying to reuse and integrate the existing information applications. The START information flow identifies four major phases: admission, visit of admission, planning, therapy. The system main functionalities available to the radiotherapist are: clinical history/medical report linking function; folder function; planning function; tracking function; electronic mail and banner function; statistical function; management function. Functions available to the radiotherapy technician are: the room daily list function; management function: to the nurse the following functions are available: patient directing function; management function. START is a departmental client (pc-windows)-server (unix) developed on an integrated database of all information of interest (clinical, organizational and administrative) coherent with the standard and with a modular architecture which can evolve with additional functionalities in subsequent times. For a more thorough evaluation of its impact on the daily activity of a radiation therapy facility, a prolonged clinical validation is in progress.

  1. Postoperative radiation therapy for carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Uno, Takashi; Isobe, Koichi; Yamamoto, Seiji; Kawata, Tetsuya; Ito, Hisao

    2006-01-01

    Postoperative radiation therapy (PORT) for cervical cancer has been empirically performed for patients with pathologic risk factors for recurrence after surgery. The efficacy of PORT is mainly supported by retrospective studies. Despite convincing evidence demonstrating a reduction in pelvic recurrence rates when PORT is employed, there is no evidence that it eventually improves patient survival. Local recurrence, such as vaginal stump recurrence, is not always fatal if diagnosed earlier. Some patients, unfortunately, may develop distant metastases even after PORT. The positive effects of PORT also may be counterbalanced by increased toxicities that result from combining local therapies. These factors obscure the efficacy of PORT for cervical cancer patients. There has been no consensus on the predictive value of risk factors for recurrence, which renders indication of PORT for early-stage cervical cancer quite variable among institutions. Today, efforts have been made to divide patients into three risk groups based on the combination of risk factors present after radical hysterectomy. In Europe/USA and Japan, however, a fundamental difference exists in the indications for radical surgery, highlighting differences in the concept of PORT; ''adjuvant pelvic irradiation for stage IB-IIA patients after complete resection'' in Europe/USA and ''pelvic irradiation after surgery irrespective of initial clinical stage and surgical margin status'' in Japan. Thus, it is questionable whether scientific evidence established in Europe/USA is applicable to Japanese clinical practice. The purpose of this article is to review the role of PORT by interpreting the results of clinical studies. (author)

  2. Stereotactic Body Radiation Therapy for Locally Progressive and Recurrent Pancreatic Cancer after Prior Radiation

    Directory of Open Access Journals (Sweden)

    Philip Sutera

    2018-03-01

    Full Text Available IntroductionPancreatic adenocarcinoma is an aggressive malignancy that has consistently demonstrated poor outcomes despite aggressive treatments. Despite multimodal treatment, local disease progression and local recurrence are common. Management of recurrent or progressive pancreatic carcinomas proves a further challenge. In patients previously treated with radiation therapy, stereotactic body radiation therapy (SBRT is a promising modality capable of delivering high dose to the tumor while limiting dose to critical structures. We aimed to determine the feasibility and tolerability of SBRT for recurrent or local pancreatic cancer in patients previously treated with external beam radiation therapy (EBRT.Materials and methodsPatients treated with EBRT who developed recurrent or local pancreatic ductal adenocarcinoma treated with SBRT reirradiation at our institution, from 2004 to 2014 were reviewed. Our primary endpoints included overall survival (OS, local control, regional control, and late grade 3+ radiation toxicity. Endpoints were analyzed with the Kaplan–Meier method. The association of these survival endpoints with risk factors was studied with univariate Cox proportional hazards models.ResultsWe identified 38 patients with recurrent/progressive pancreatic cancer treated with SBRT following prior radiation therapy. Prior radiation was delivered to a median dose of 50.4 Gy in 28 fractions. SBRT was delivered to a median dose of 24.5 Gy in 1–3 fractions. Surgical resection was performed on 55.3% of all patients. Within a median follow-up of 24.4 months (inter-quartile range, 14.9–32.7 months, the median OS from diagnosis for the entire cohort was 26.6 months (95% CI: 20.3–29.8 with 2-year OS of 53.0%. Median survival from SBRT was 9.7 months (95% CI, 5.5–13.8. The 2-year freedom from local progression and regional progression was 58 and 82%, respectively. For the entire cohort, 18.4 and 10.5% experienced late grade 2

  3. Radiation therapy: age-related macular degeneration.

    Science.gov (United States)

    Mendez, Carlos A Medina; Ehlers, Justis P

    2013-01-01

    Age-related macular degeneration (AMD) is the leading cause of severe irreversible vision loss in patients over the age of 50 years in the developed world. Neovascular AMD (NVAMD) is responsible for 90% of the cases with severe visual loss. In the last decade, the treatment paradigm for NVAMD has been transformed by the advent of anti-vascular endothelial growth factor therapy. Despite the excellent results of anti-vascular endothelial growth factor therapy, frequent injections remain a necessity for most patients. The burden of these frequent visits as well as the cumulative risks of indefinite intravitreal injections demand continued pursuit of more enduring therapy that provides similar functional results. Radiotherapy has been studied for two decades as a potential therapy for NVAMD. Because of its antiangiogenic properties, radiation therapy remains a promising potential adjunctive resource for the treatment of choroidal neovascularization secondary to NVAMD. This review considers the past, present and future of radiation as a treatment or combination treatment of NVAMD. Copyright © 2013 S. Karger AG, Basel.

  4. [The possibility of local control of cancer by neoadjuvant chemoradiation therapy with gemcitabine and surgical resection for advanced cholangiocarcinoma].

    Science.gov (United States)

    Nakagawa, Kei; Katayose, Yu; Rikiyama, Toshiki; Okaue, Adoru; Unno, Michiaki

    2009-11-01

    Surgical resection is the gold standard of treatment for cholangiocarcinoma. However, there are also many recurrences after operation, because of the anatomical background and the tendency of invasion. We thought that eliminating the remnant of the cancer could yield a better prognosis. Therefore, an introduction of the neoadjuvant chemoradiation therapy with gemcitabine and surgical resection for advanced cholangiocarcinoma patient (NACRAC) was planned. The safety of NACRAC was confirmed by a pilot study. The recommended dose of gemcitabine (600 mg/m2) was determined by a phase I study. A phase II study is now being performed for evaluating the effectiveness and safety. NACRAC may control the frontal part of the tumor with difficult distinctions made by MDCT, and abolishing the cancer remnant is expected. The possibility of extended prognosis by NACRAC can be considered.

  5. Radiation therapy with fast neutrons: A review

    International Nuclear Information System (INIS)

    Jones, D.T.L.; Wambersie, A.

    2007-01-01

    Because of their biological effects fast neutrons are most effective in treating large, slow-growing tumours which are resistant to conventional X-radiation. Patients are treated typically 3-4 times per week for 4-5 weeks (sometimes in combination with X-radiation) for a variety of conditions such as carcinomas of the head and neck, salivary gland, paranasal sinus and breast; soft tissue, bone and uterine sarcomas and malignant melanomas. It is estimated that about 27,000 patients have undergone fast neutron therapy to date

  6. Tobacco Smoking During Radiation Therapy for Head-and-Neck Cancer Is Associated With Unfavorable Outcome

    International Nuclear Information System (INIS)

    Chen, Allen M.; Chen, Leon M.; Vaughan, Andrew; Sreeraman, Radhika; Farwell, D. Gregory; Luu, Quang; Lau, Derick H.; Stuart, Kerri; Purdy, James A.; Vijayakumar, Srinivasan

    2011-01-01

    Purpose: To evaluate the effect of continued cigarette smoking among patients undergoing radiation therapy for head-and-neck cancer by comparing the clinical outcomes among active smokers and quitters. Methods and Materials: A review of medical records identified 101 patients with newly diagnosed squamous cell carcinoma of the head and neck who continued to smoke during radiation therapy. Each active smoker was matched to a control patient who had quit smoking before initiation of radiation therapy. Matching was based on tobacco history (pack-years), primary site, age, sex, Karnofsky Performance Status, disease stage, radiation dose, chemotherapy use, year of treatment, and whether surgical resection was performed. Outcomes were compared by use of Kaplan-Meier analysis. Normal tissue effects were graded according to the Radiation Therapy Oncology Group/European Organization for the Treatment of Cancer toxicity criteria. Results: With a median follow-up of 49 months, active smokers had significantly inferior 5-year overall survival (23% vs. 55%), locoregional control (58% vs. 69%), and disease-free survival (42% vs. 65%) compared with the former smokers who had quit before radiation therapy (p < 0.05 for all). These differences remained statistically significant when patients treated by postoperative or definitive radiation therapy were analyzed separately. The incidence of Grade 3 or greater late complications was also significantly increased among active smokers compared with former smokers (49% vs. 31%, p = 0.01). Conclusions: Tobacco smoking during radiation therapy for head-and-neck cancer is associated with unfavorable outcomes. Further studies analyzing the biologic and molecular reasons underlying these differences are planned.

  7. The role of intraoperative radiation therapy in patients with pancreatic cancer.

    Science.gov (United States)

    Palta, Manisha; Willett, Christopher; Czito, Brian

    2014-04-01

    Intraoperative radiation therapy (IORT) techniques allow for the delivery of high doses of radiation therapy while excluding part or all of the nearby dose-limiting sensitive structures. Therefore, the effective radiation dose is increased and local tumor control potentially improved. This is pertinent in the case of pancreatic cancer because local failure rates are as high as 50%-80% in patients with resected and locally advanced disease. Available data in patients receiving IORT after pancreaticoduodenectomy reveal an improvement in local control, though overall survival benefit is unclear. Series of patients with locally advanced pancreatic cancer also suggest pain relief, and in select studies, improved survival associated with the inclusion of IORT. At present, no phase III data clearly supports the use of IORT in the management of pancreatic cancer. © 2013 Published by Elsevier Inc.

  8. A case of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Kanno, Toru; Ito, Masaaki; Tsuji, Hiroshi; Kawase, Norio; Taki, Yoji

    2002-01-01

    A 76-year-old man complained of difficulty in urination and miction pain with abacterial pyuria after radiation therapy for prostate cancer. Transurethral resection of the prostate was performed and histopathologically widespread necrosis was observed in the prostate. Thereafter retention of urine and fever occurred and computed tomography scan revealed an abscess of the penile corpus. The abscess was drained, but the fever continued. He developed an abacterial lung abscess and abacterial necrotic ulcerating lesions on his back, his left leg and his lower abdomen. Macroscopic findings demonstrated typical features of pyoderma gangrenosum. Steroid treatment was initiated and the response to steroid therapy was dramatic. Finally urinary diversion using an ileal conduit was performed. We found few cases of pyoderma gangrenosum involving lesions other than those of the skin in the literature. This is the first report of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer. (author)

  9. A case of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kanno, Toru; Ito, Masaaki; Tsuji, Hiroshi; Kawase, Norio; Taki, Yoji [Toyooka Hospital, Hyogo (Japan)

    2002-09-01

    A 76-year-old man complained of difficulty in urination and miction pain with abacterial pyuria after radiation therapy for prostate cancer. Transurethral resection of the prostate was performed and histopathologically widespread necrosis was observed in the prostate. Thereafter retention of urine and fever occurred and computed tomography scan revealed an abscess of the penile corpus. The abscess was drained, but the fever continued. He developed an abacterial lung abscess and abacterial necrotic ulcerating lesions on his back, his left leg and his lower abdomen. Macroscopic findings demonstrated typical features of pyoderma gangrenosum. Steroid treatment was initiated and the response to steroid therapy was dramatic. Finally urinary diversion using an ileal conduit was performed. We found few cases of pyoderma gangrenosum involving lesions other than those of the skin in the literature. This is the first report of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer. (author)

  10. Radiation therapy for head and neck cancers

    International Nuclear Information System (INIS)

    Gillette, S.M.; Gillette, E.L.

    1995-01-01

    Radiation therapy may be indicated for larger invasive tumors of the head and neck that may be difficult to surgically excise or for which surgery would be significantly disfiguring. Previous studies of oral squamous cell carcinomas indicate that it should be possible to control approximately 80% of all but the most advanced local or locoregional tumors. Aggressive radiation therapy to total doses of 56 Gy or greater may be required. That can be done by using smaller doses per fraction and gradually reducing the size of the field so that the highest dose is given only to the tumor with a relatively tight margin. Malignant melanomas can be controlled locally apparently with a few large fractions. Metastatic disease limits survival; therefore, some type of systemic therapy seems to be needed to improve survival of those patients. Canine oral fibrosarcomas require a very high dose for a reasonable probability of control. It seems that a dose of 56 Gy given in 3.3 Gy fractions might provide local control of 50% of the tumors. It is likely that a combination of surgery and radiation would significantly improve the probability for control. Oral squamous cell carcinomas of cats must also be treated very aggressively to improve local control. Tumors of the nasal cavity are usually very large and invasive at the time of diagnosis. Radiation therapy has been shown to be effective in some instances. It is possible that with better definition of the tumor through computerized tomography imaging and improved treatment planning, control of these difficult to manage nasal tumors can be improved

  11. Radiation Therapy in Elderly Skin Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee [Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2008-06-15

    To evaluate the long term results (local control, survival, failure, and complications) after radiation therapy for skin cancer in elderly patients. The study spanned from January 1990 to October 2002. Fifteen elderly patients with skin cancer were treated by radiotherapy at the Keimyung University Dongsan Medical Center. The age distribution of the patients surveyed was 72 to 95 years, with a median age of 78.8 years. The pathologic classification of the 15 patients included squamous cell carcinoma (10 patients), basal cell carcinoma (3 patients), verrucous carcinoma (1 patient) and skin adnexal origin carcinoma (1 patient). The most common tumor location was the head (13 patients). The mean tumor diameter was 4.9 cm (range 2 to 9 cm). The radiation dose was delivered via an electron beam of 6 to 15 MeV. The dose range was adjusted to the tumor diameter and depth of tumor invasion. The total radiation dose ranged from 50{approx}80 Gy (mean: 66 Gy) with a 2 Gy fractional dose prescribed to the 80% isodose line once a day and 5 times a week. One patient with lymph node metastasis was treated with six MV photon beams boosted with electron beams. The length of the follow-up periods ranged from 10 to 120 months with a median follow-up period of 48 months. The local control rates were 100% (15/15). In addition, the five year disease free survival rate (5YDFS) was 80% and twelve patients (80%) had no recurrence and skin cancer recurrence occurred in 3 patients (20%). Three patients have lived an average of 90 months (68{approx}120 months) without recurrence or metastasis. A total of 9 patients who died as a result of other causes had a mean survival time of 55.8 months after radiation therapy. No severe acute or chronic complications were observed after radiation therapy. Only minor complications including radiation dermatitis was treated with supportive care. The results suggest that radiation therapy is an effective and safe treatment method for the treatment of skin

  12. Cell cycle kinetics and radiation therapy

    International Nuclear Information System (INIS)

    Mendelsohn, M.L.

    1975-01-01

    Radiation therapy as currently practiced involves the subtle largely empirical art of balancing the recurrence of cancer due to undertreatment against severe damage to local tissues due to overtreatment. Therapeutic results too often fall short of desired success rates; yet, the therapist is continually tantalized to the likelihood that a slight shift of therapeutic ratio favoring normal tissue over cancer would have a profoundly beneficial effect. The application of cell cycle kinetics to radiation therapy is one hope for improving the therapeutic ratio; but, as I will try to show, kinetic approaches are complex, poorly understood, and presently too elusive to elicit confidence or to be used clinically. Their promise lies in their diversity and in the magnitude of our ignorance about how they work and how they should be used. Potentially useful kinetic approaches to therapy can be grouped into three classes. The first class takes advantage of intracyclic differential sensitivity, an effect involving the metabolism and biology of the cell cycle; its strategies are based on synchronization of cells over intervals of hours to days. The second class involves the distinction between cycling and noncycling cells; its strategies are based on the resistance of noncycling cells to cycle-linked radiation sensitizers and chemotherapeutic agents. The third class uses cell repopulation between fractions; its strategies are based on the relative growth rates of tumor and relevant normal tissue before and after perturbation

  13. Perspectives of radiation therapy in benign diseases

    International Nuclear Information System (INIS)

    Schultze, J.; Eilf, K.

    2006-01-01

    Purpose: the numbers of patients with nonmalignant diseases referred for radiation therapy had to be evaluated for the last 4 years. Patients and methods: in the years 2002, 2004, and 2005 radiation therapy was performed in 61, 40, and 26 patients, respectively. Regularly, more women than men were treated, median age annually was 57, 54, and 55 years, respectively (table 1). The radiotherapy scheme was not modified within the evaluated period. Results: the proportion of nonmalignant diseases among all patients treated decreased from 4.7% in 2002 to 3.3% in 2004 and 2.2% in 2005, respectively. A shift was noticed toward the treatment of four main diseases (endocrine orbitopathy, prevention of heterotopic ossification, meningeoma, tendinitis, table 2). The number of referring physicians decreased from 19 to six. Conclusion: due to administrative restrictions for treatment in hospitals, budget restrictions in private practices and lasting, insufficient revenues for radiotherapy in nonmalignant diseases, radiation therapy for the entire group of benign diseases is endangered. (orig.)

  14. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma

    International Nuclear Information System (INIS)

    Kresl, John J.; Schild, Steven E.; Henning, George T.; Gunderson, Leonard L.; Donohue, John; Pitot, Henry; Haddock, Michael G.; Nagorney, David

    2002-01-01

    Purpose: This study was performed to evaluate the outcome of patients with gallbladder cancer who received postoperative concurrent chemotherapy and radiation therapy. Methods and Materials: Curative resection followed by adjuvant combined modality therapy with external beam radiation therapy (EBRT) and chemotherapy was attempted in 21 consecutive gallbladder carcinoma (GBC) patients at the Mayo Clinic from 1985 through 1997. All patients received concurrent 5-fluorouracil during EBRT. EBRT fields encompassed the tumor bed and regional lymph nodes (median dose of 54 Gy in 1.8-2.0-Gy fractions). One patient received 15 Gy intraoperatively after EBRT. A retrospective analysis was performed for the end points of local control, distant failure, and overall survival. Results: After maximal resection, 12 patients had no residual disease on pathologic evaluation, 5 had microscopic residual disease, and 4 had gross residual disease. One patient had Stage I disease, and 20 had Stage III-IV disease. With median follow-up of 5 years (range: 2.6-11.5 years), 5-year survival for the entire cohort was 33%. The 5-year survival rate of patients with Stage I-III disease was 65% vs. 0% for those with Stage IV disease (p 54 Gy (microscopic residual, 3 patients; gross residual, 1 patient; negative but narrow margins, 2 patients) vs. 65% for the 15 who received a lower dose (3, gross residual; 2, microresidual; 10, negative margins). Conclusion: Patients with completely resected (negative margins) GBC followed by adjuvant EBRT plus 5-fluorouracil chemotherapy had a relatively favorable prognosis, with a 5-year survival rate of 64%. These results seem to be superior to historical surgical controls from the Mayo Clinic and other institutions, which report 5-year survival rates of approximately 33% with complete resection alone. Both tumor stage and extent of resection seemed to influence survival and local control. More aggressive measures using current cancer therapies and integration

  15. Combined adjuvant radiation and interferon-alpha 2B therapy in high-risk melanoma patients: the potential for increased radiation toxicity

    International Nuclear Information System (INIS)

    Hazard, Lisa J.; Sause, William T.; Noyes, R. Dirk

    2002-01-01

    Purpose: Surgically resected melanoma patients with high-risk features commonly receive adjuvant therapy with interferon-alpha 2b combined with radiation therapy; the purpose of our study was to evaluate the potential enhancement of radiation toxicity by interferon. Methods and Materials: Patients at LDS Hospital and the University of Utah Medical Center in Salt Lake City treated with interferon during radiotherapy or within 1 month of its completion were retrospectively identified, and their charts were reviewed. If possible, the patients were asked to return to the LDS Hospital radiation therapy department for follow-up. Results: Five of 10 patients receiving interferon-alpha 2b therapy during radiation therapy or within 1 month of its completion experienced severe subacute/late complications of therapy. Severe subacute/late complications included two patients with peripheral neuropathy, one patient with radiation necrosis in the brain, and two patients with radiation necrosis in the s.c. tissue. One patient with peripheral neuropathy and one patient with radiation necrosis also developed lymphedema. Conclusions: In vitro studies have identified a radiosensitizing effect by interferon-alpha on certain cell lines, which suggests the possibility that patients treated with interferon and radiation therapy may experience more severe radiation toxicities. We have observed severe subacute/late complications in five of 10 patients treated with interferon-alpha 2b during radiation therapy or within 1 month of its completion. Although an observational study of 10 patients lacks the statistic power to reach conclusions regarding the safety and complication rates of combined interferon and radiation therapy, it is sufficient to raise concerns and suggest the need for prospective studies

  16. Chronic neuroendocrinological sequelae of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sklar, C.A. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Constine, L.S. [Univ. of Rochester Medical Center, Rochester, NY (United States)

    1995-03-30

    A variety of neuroendocrine disturbances are observed following treatment with external radiation therapy when the hypothalamic-pituitary axis (HPA) is included in the treatment field. Radiation-induced abnormalities are generally dose dependent and may develop many years after irradiation. Growth hormone deficiency and premature sexual development can occur following doses as low as 18 Gy fractionated radiation and are the most common neuroendocrine problems noted in children. Deficiency of gonadotropins, thyroid stimulating hormone, and adrenocorticotropin are seen primarily in individuals treated with > 40 Gy HPA irradiation. Hyperprolactinemia can be seen following high-dose radiotherapy (>40 Gy), especially among young women. Most neuroendocrine disturbances that develop as a result of HPA irradiation are treatable; patients at risk require long-term endocrine follow-up. 23 refs., 6 figs., 2 tabs.

  17. Generalized Morphea after Breast Cancer Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Jonathan Kushi

    2011-01-01

    Full Text Available We present a case of a 69-year-old woman who received external beam radiation for the treatment of breast cancer. Seven months later, she developed generalized morphea involving the area of irradiated skin of the breast as well as distant sites of the groin and distal lower extremity. Postirradiation morphea is an uncommon yet well-documented phenomenon, usually confined to the radiated site and the immediate surrounding tissue. To our knowledge, this is only the fourth reported case of morphea occurring distant from the radiation field. While most cases of postirradiation morphea have been shown to either resolve spontaneously or respond to topical corticosteroids, our patient required systemic therapy with methotrexate, which resulted in clinical improvement. With this paper, we hope to bring further awareness to this phenomenon and demonstrate a successful treatment response with the use of methotrexate in postirradiation generalized morphea.

  18. Dose distribution following selective internal radiation therapy

    International Nuclear Information System (INIS)

    Fox, R.A.; Klemp, P.F.; Egan, G.; Mina, L.L.; Burton, M.A.; Gray, B.N.

    1991-01-01

    Selective Internal Radiation Therapy is the intrahepatic arterial injection of microspheres labelled with 90Y. The microspheres lodge in the precapillary circulation of tumor resulting in internal radiation therapy. The activity of the 90Y injected is managed by successive administrations of labelled microspheres and after each injection probing the liver with a calibrated beta probe to assess the dose to the superficial layers of normal tissue. Predicted doses of 75 Gy have been delivered without subsequent evidence of radiation damage to normal cells. This contrasts with the complications resulting from doses in excess of 30 Gy delivered from external beam radiotherapy. Detailed analysis of microsphere distribution in a cubic centimeter of normal liver and the calculation of dose to a 3-dimensional fine grid has shown that the radiation distribution created by the finite size and distribution of the microspheres results in an highly heterogeneous dose pattern. It has been shown that a third of normal liver will receive less than 33.7% of the dose predicted by assuming an homogeneous distribution of 90Y

  19. Radiation therapy of hemangiomas, 1909-1959

    International Nuclear Information System (INIS)

    Fuerst, C.J.; Lundell, M.; Holm, L.E.; Karolinska Sjukhuset, Stockholm

    1987-01-01

    Radium and roentgen therapies for hemangiomas of the skin (mainly strawberry hemangiomas) were used between 1909 and 1959 at Radiumhemmet, Stockholm. The total number of admitted patients with hemangioma of the skin during this period was 20012. About 90% were treated with irradiation and radium therapy was the most commonly used modality. Needles, tubes and flat applicators containing radium were used. Roentgen therapy was given by using standard machines available at the time. A small number of patients were treated with 32 P plaques. Most hemangiomas were located in the head-neck region (47%) and 30% were located on the thorax and upper part of the abdomen. The median age at the first treatment was 6 months and 90% of all patients were younger than 2 years of age at the time of treatment. The purpose of the investigation was to define a cohort, useful for studies on possible late effects following exposure to ionizing radiation in childhood. (orig.)

  20. Image-guided radiation therapy: physician's perspectives

    International Nuclear Information System (INIS)

    Gupta, T.; Anand Narayan, C.

    2012-01-01

    The evolution of radiotherapy has been ontogenetically linked to medical imaging. Over the years, major technological innovations have resulted in substantial improvements in radiotherapy planning, delivery, and verification. The increasing use of computed tomography imaging for target volume delineation coupled with availability of computer-controlled treatment planning and delivery systems have progressively led to conformation of radiation dose to the target tissues while sparing surrounding normal tissues. Recent advances in imaging technology coupled with improved treatment delivery allow near-simultaneous soft-tissue localization of tumor and repositioning of patient. The integration of various imaging modalities within the treatment room for guiding radiation delivery has vastly improved the management of geometric uncertainties in contemporary radiotherapy practice ushering in the paradigm of image-guided radiation therapy (IGRT). Image-guidance should be considered a necessary and natural corollary to high-precision radiotherapy that was long overdue. Image-guided radiation therapy not only provides accurate information on patient and tumor position on a quantitative scale, it also gives an opportunity to verify consistency of planned and actual treatment geometry including adaptation to daily variations resulting in improved dose delivery. The two main concerns with IGRT are resource-intensive nature of delivery and increasing dose from additional imaging. However, increasing the precision and accuracy of radiation delivery through IGRT is likely to reduce toxicity with potential for dose escalation and improved tumor control resulting in favourable therapeutic index. The radiation oncology community needs to leverage this technology to generate high-quality evidence to support widespread adoption of IGRT in contemporary radiotherapy practice. (author)

  1. Fiber-optic dosimeters for radiation therapy

    Science.gov (United States)

    Li, Enbang; Archer, James

    2017-10-01

    According to the figures provided by the World Health Organization, cancer is a leading cause of death worldwide, accounting for 8.8 million deaths in 2015. Radiation therapy, which uses x-rays to destroy or injure cancer cells, has become one of the most important modalities to treat the primary cancer or advanced cancer. The newly developed microbeam radiation therapy (MRT), which uses highly collimated, quasi-parallel arrays of x-ray microbeams (typically 50 μm wide and separated by 400 μm) produced by synchrotron sources, represents a new paradigm in radiotherapy and has shown great promise in pre-clinical studies on different animal models. Measurements of the absorbed dose distribution of microbeams are vitally important for clinical acceptance of MRT and for developing quality assurance systems for MRT, hence are a challenging and important task for radiation dosimetry. On the other hand, during the traditional LINAC based radiotherapy and breast cancer brachytherapy, skin dose measurements and treatment planning also require a high spatial resolution, tissue equivalent, on-line dosimeter that is both economical and highly reliable. Such a dosimeter currently does not exist and remains a challenge in the development of radiation dosimetry. High resolution, water equivalent, optical and passive x-ray dosimeters have been developed and constructed by using plastic scintillators and optical fibers. The dosimeters have peak edge-on spatial resolutions ranging from 50 to 500 microns in one dimension, with a 10 micron resolution dosimeter under development. The developed fiber-optic dosimeters have been test with both LINAC and synchrotron x-ray beams. This work demonstrates that water-equivalent and high spatial resolution radiation detection can be achieved with scintillators and optical fiber systems. Among other advantages, the developed fiber-optic probes are also passive, energy independent, and radiation hard.

  2. Clinical experience of radiation therapy for Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo [Gunma Univ., Maebashi (Japan). School of Medicine

    1996-11-01

    The effect of radiation therapy for Graves` ophthalmopathy was evaluated. Ten patients with Graves` ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves` ophthalmopathy. (author)

  3. Clinical experience of radiation therapy for Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo

    1996-01-01

    The effect of radiation therapy for Graves' ophthalmopathy was evaluated. Ten patients with Graves' ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves' ophthalmopathy. (author)

  4. Radiation therapy in Africa: distribution and equipment

    International Nuclear Information System (INIS)

    Levin, C.V.; Meghzifene, A.; Gueddari, B. el

    1999-01-01

    Africa is the least developed continent as regards radiation oncology resources. The documented ASR of cancer is of the order of 1 to 2 per 1000. With improving health care this is becoming more significant. This review was undertaken to help develop priorities for the region. Radiation Oncology departments in Africa were identified and a survey of their equipment performed. These were compared to the reported situation in 1991. Population tables for the year 2000 were compared to available megavoltage machines. Of 56 countries in Africa, only 22 are confidently known to have megavoltage therapy concentrated in the southern and northern extremes of the continent. The 155 megavoltage machines operating represents over 100% increase over the past 8 years. The population served by each megavoltage machine ranges from 0.6 million to 70 million per machine. Overall, only 50% of the population have some access to Radiation Oncology services. Progress has been made in initiating radiation oncology in Ghana, Ethiopia and Namibia. There has been some increase in machines in Algeria, Egypt, Libya, Morocco and Tunisia. However, a large backlog exists for basic radiation services. (author.)

  5. A Phase III Study of Conventional Radiation Therapy Plus Thalidomide Versus Conventional Radiation Therapy for Multiple Brain Metastases (RTOG 0118)

    International Nuclear Information System (INIS)

    Knisely, Jonathan P.S.; Berkey, Brian; Chakravarti, Arnab; Yung, Al W.K.; Curran, Walter J.; Robins, H. Ian; Movsas, Benjamin; Brachman, David G.; Henderson, Randall H.; Mehta, Minesh P.

    2008-01-01

    Purpose: To compare whole-brain radiation therapy (WBRT) with WBRT combined with thalidomide for patients with brain metastases not amenable to resection or radiosurgery. Patients and Methods: Patients with Zubrod performance status 0-1, MRI-documented multiple (>3), large (>4 cm), or midbrain brain metastases arising from a histopathologically confirmed extracranial primary tumor, and an anticipated survival of >8 weeks were randomized to receive WBRT to a dose of 37.5 Gy in 15 fractions with or without thalidomide during and after WBRT. Prerandomization stratification used Radiation Therapy Oncology Group (RTOG) Recursive Partitioning Analysis (RPA) Class and whether post-WBRT chemotherapy was planned. Endpoints included overall survival, progression-free survival, time to neurocognitive progression, the cause of death, toxicities, and quality of life. A protocol-planned interim analysis documented that the trial had an extremely low probability of ever showing a significant difference favoring the thalidomide arm given the results at the time of the analysis, and it was therefore closed on the basis of predefined statistical guidelines. Results: Enrolled in the study were 332 patients. Of 183 accrued patients, 93 were randomized to receive WBRT alone and 90 to WBRT and thalidomide. Median survival was 3.9 months for both arms. No novel toxicities were seen, but thalidomide was not well tolerated in this population. Forty-eight percent of patients discontinued thalidomide because of side effects. Conclusion: Thalidomide provided no survival benefit for patients with multiple, large, or midbrain metastases when combined with WBRT; nearly half the patients discontinued thalidomide due to side effects

  6. Dosimetric and motion analysis of margin-intensive therapy by stereotactic ablative radiotherapy for resectable pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Heinzerling John H

    2011-10-01

    Full Text Available Abstract Background The retroperitoneal margin is a common site of positive surgical margins in patients with resectable pancreatic cancer. Preoperative margin-intensive therapy (MIT involves delivery of a single high dose of ablative radiotherapy (30 Gy focused on this surgically inaccessible margin, utilizing stereotactic techniques in an effort to reduce local failure following surgery. In this study, we investigated the motion of regional organs at risk (OAR utilizing 4DCT, evaluated the dosimetric effects of abdominal compression (AC to reduce regional motion, and compared various planning techniques to optimize MIT. Methods 10 patients were evaluated with 4DCT scans. All 10 patients had scans using AC and seven of the 10 patients had scans both with and without AC. The peak respiratory abdominal organ and major vessel centroid excursion was measured. A "sub-GTV" region was defined by a radiation oncologist and surgical oncologist encompassing the retroperitoneal margin typically lateral and posterior to the superior mesenteric artery (SMA, and a 3-5 mm margin was added to constitute the PTV. Identical 3D non-coplanar SABR (3DSABR plans were designed for the average compression and non-compression scans. Compression scans were planned with 3DSABR, coplanar IMRT (IMRT, and Cyberknife (CK planning techniques. Dose volume analysis was undertaken for various endpoints, comparing OAR doses with and without AC and for different planning methods. Results The mean PTV size was 20.2 cm3. Regional vessel motion of the SMA, celiac trunk, and renal vessels was small ( 5 mm, so AC has been used in all patients enrolled thus far. AC did not significantly increase OAR dose including the stomach and traverse colon. There were several statistically significant differences in the doses to OARs as a function of the type of planning modality used. Conclusions AC does not significantly reduce the limited motion of structures in close proximity to the MIT target

  7. Sequential transurethral surgery, multiple drug chemotherapy and radiation therapy for invasive bladder carcinoma: Initial report

    International Nuclear Information System (INIS)

    Cervek, J.; Cufer, T.; Kragelj, B.; Zakotnik, B.; Stanonik, M.

    1993-01-01

    Forty-seven patients with muscle-invasive bladder cancer (T2--T4, Nx, MO) were treated by transurethral resection, followed by 3--4 cycles of combination chemotherapy (methothrexate 30 mg/m2 on days 1, 14; cis-platinum 100 mg/m2 on day 2; vinblastine 3 mg/m2 on days 1, 14; repeated every 21 days), and external beam irradiation (64--66 Gy to the bladder and 40 Gy to the pelvic lymphatics). Complete remission after transurethral resection and chemotherapy was achieved in 24 out of 45 patients (53%). Cystectomy was performed in patients without complete response to transurethral resection and chemotherapy. The therapy was completed as planned in 45/47 patients. After transurethral resection, chemotherapy, and radiation therapy, biopsy proven complete response was achieved in 62% (28/45); Stage T2T3 in 67% (23/24), Stage T4 in 45% (5/11) of patients. Among 19 patients with positive biopsy findings after transurethral resection and chemotherapy, 14 underwent cystectomy. After follow-up of 4--55 months (median 23 months) 75% (34/45) are alive, 68% (31/45) have had their bladders preserved, and 53% (24/45) are free of the primary tumor. The actuarial survival of all 45 patients is 73%. Moderate nausea and vomiting during treatment were common; severe leukopenia and mucositis were observed in five patients. Late side effects such as miction disorders and diarrhea were predominantly mild. Although the observation period has been too short to allow a definitive evaluation of treatment results, the authors feel both from the point of bladder preservation and disease-free survival that the presented treatment approach is successful in a majority of T2T3 patients, whereas a large tumor size (T4) renders this treatment less effective. 17 refs., 4 figs., 4 tabs

  8. Quantification of late complications after radiation therapy

    International Nuclear Information System (INIS)

    Jung, Horst; Beck-Bornholdt, Hans-Peter; Svoboda, Vladimir; Alberti, Winfried; Herrmann, Thomas

    2001-01-01

    Background: An increasing number of patients survive cancer after having received radiation therapy. Therefore, the occurrence of late normal tissue complications among long-term survivors is of particular concern. Methods: Sixty-three patients treated by radical surgery and irradiation for rectal carcinoma were subjected to an unconventional sandwich therapy. Preoperative irradiation was given in four fractions of 5 Gy each applied within 2 or 3 days; postoperative irradiation consisted mostly of 15x2 Gy (range, 20-40 Gy). A considerable proportion of these patients developed severe late complications (Radiother Oncol 53 (1999) 177). The data allowed a detailed analysis of complication kinetics, leading to a new model which was tested using data from the literature. Results: Data on late complications were obtained for eight different organs with a follow-up of up to 10 years. For the various organs, the percentage of patients being free from late complications, plotted as a function of time after start of radiation therapy, was adequately described by exponential regression. From the fit, the parameter p a was obtained, which is the percentage of patients at risk in a given year of developing a complication in a given organ during that year. The rate p a remained about constant with time. Following sandwich therapy, the annual incidence of complications in the bladder, ileum, lymphatic and soft tissue, and ureters was about the same (p a =10-14%/year), whereas complications in bone or dermis occurred at lower rates (4.7 or 7.5%/year, respectively). Discussion: Numerous data sets collected from published reports were analyzed in the same way. Many of the data sets studied were from patients in a series where there was a high incidence of late effects. Three types of kinetics for the occurrence of late effects after radiotherapy were identified: Type 1, purely exponential kinetics; Type 2, exponential kinetics, the slope of which decreased exponentially with time

  9. Survival Benefit of Adjuvant Radiation Therapy for Gastric Cancer following Gastrectomy and Extended Lymphadenectomy

    Directory of Open Access Journals (Sweden)

    R. A. Snyder

    2012-01-01

    Full Text Available Purpose. Although randomized trials suggest a survival benefit of adjuvant chemotherapy and radiation therapy (XRT for gastric adenocarcinoma, its use in patients who undergo an extended lymphadenectomy is less clear. The purpose of this study was to determine if a survival benefit exists in gastric cancer patients who receive adjuvant XRT following resection with extended lymphadenectomy. Methods. The SEER registry was queried for records of patients with resected gastric adenocarcinoma from 1988 to 2007. Multivariable Cox regression models were used to assess independent prognostic factors affecting overall survival (OS and disease-specific survival (DSS. Results. Of 15,060 patients identified, 3,208 (21% received adjuvant XRT. Adjuvant XRT was independently associated with improved OS (HR 0.67, CI 0.64–0.71 and DSS (HR 0.69, CI 0.65–0.73 in stages IB through IV (M0. This OS and DSS benefit persisted regardless of the extent of lymphadenectomy. Furthermore, lymphadenectomy with >25 LN resected was associated with improved OS and DSS compared with 25 LNs results in improved OS and DSS compared with patients who have fewer LNs resected.

  10. External beam radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Forman, Jeffrey D.

    1996-01-01

    Purpose/Objectives: The intent of this course is to review the issues involved in the management of non-metastatic adenocarcinoma of the prostate. -- The value of pre-treatment prognostic factors including stage, grade and PSA value will be presented, and their value in determining therapeutic strategies will be discussed. -- Controversies involving the simulation process and treatment design will be presented. The value of CT scanning, Beams-Eye View, 3-D planning, intravesicle, intraurethral and rectal contrast will be presented. The significance of prostate and patient movement and strategies for dealing with them will be presented. -- The management of low stage, low to intermediate grade prostate cancer will be discussed. The dose, volume and timing of irradiation will be discussed as will the role of neo-adjuvant hormonal therapy, neutron irradiation and brachytherapy. The current status of radical prostatectomy and cryotherapy will be summarized. Treatment of locally advanced, poorly differentiated prostate cancer will be presented including a discussion of neo-adjuvant and adjuvant hormones, dose-escalation and neutron irradiation. -- Strategies for post-radiation failures will be presented including data on cryotherapy, salvage prostatectomy and hormonal therapy (immediate, delayed and/or intermittent). New areas for investigation will be reviewed. -- The management of patients post prostatectomy will be reviewed. Data on adjuvant radiation and therapeutic radiation for biochemical or clinically relapsed patients will be presented. This course hopes to present a realistic and pragmatic overview for treating patients with non-metastatic prostatic cancer

  11. Optical Tracking Technology in Stereotactic Radiation Therapy

    International Nuclear Information System (INIS)

    Wagner, Thomas H.; Meeks, Sanford L.; Bova, Frank J.; Friedman, William A.; Willoughby, Twyla R.; Kupelian, Patrick A.; Tome, Wolfgang

    2007-01-01

    The last decade has seen the introduction of advanced technologies that have enabled much more precise application of therapeutic radiation. These relatively new technologies include multileaf collimators, 3-dimensional conformal radiotherapy planning, and intensity modulated radiotherapy in radiotherapy. Therapeutic dose distributions have become more conformal to volumes of disease, sometimes utilizing sharp dose gradients to deliver high doses to target volumes while sparing nearby radiosensitive structures. Thus, accurate patient positioning has become even more important, so that the treatment delivered to the patient matches the virtual treatment plan in the computer treatment planning system. Optical and image-guided radiation therapy systems offer the potential to improve the precision of patient treatment by providing a more robust fiducial system than is typically used in conventional radiotherapy. The ability to accurately position internal targets relative to the linac isocenter and to provide real-time patient tracking theoretically enables significant reductions in the amount of normal tissue irradiated. This report reviews the concepts, technology, and clinical applications of optical tracking systems currently in use for stereotactic radiation therapy. Applications of radiotherapy optical tracking technology to respiratory gating and the monitoring of implanted fiducial markers are also discussed

  12. Palliative radiation therapy for multiple myeloma

    International Nuclear Information System (INIS)

    Minowa, Yasushi; Sasai, Keisuke; Ishigaki, Takashi; Nagata, Yasushi; Hiraoka, Masahiro

    1996-01-01

    Radiation therapy is a useful palliative modality for refractory lesions of multiple myeloma. It has been reported that total doses of 10 to 20 Gy are usually adequate to obtain some degree of pain relief. However, there are many patients who need additional doses to obtain sufficient pain relief. In this study. we retrospectively analyzed the records of patients with multiple myeloma irradiated at our department, in an attempt to develop an effective treatment policy for this disease. Twenty-nine patients with 53 lesions were treated between 1968 and 1993. Total irradiation doses were 4 to 60 Gy (median 40 Gy) with daily fractions of 2 Gy or less, and 16 to 51 Gy (median 30 Gy) with daily fractions greater than 2 Gy. Evaluated were 59 symptoms, including pain (68%), neurological abnormalities (15%), and masses (28%). Symptomatic remission was obtained in 33 of 36 (92%) lesions with pain, 6 of 8 (75%) with neurological abnormalities, and 13 of 15 (87%) mass lesions. Pain was partially relieved at a median TDF of 34, and completely at a median TDF of 66 (equivalent to 40-42 Gy with daily fractions of 2 Gy). Radiation therapy is an effective and palliative treatment method for symptomatic multiple myeloma. However, the treatment seems to require higher radiation doses than those reported to obtain adequate relief of symptoms. (author)

  13. Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy as Preoperative Treatment for Localized Gastric Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Chakravarty, Twisha; Crane, Christopher H. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Mansfield, Paul F. [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Briere, Tina M.; Beddar, A. Sam [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Mok, Henry; Reed, Valerie K.; Krishnan, Sunil; Delclos, Marc E. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Das, Prajnan, E-mail: PrajDas@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

    2012-06-01

    Purpose: The goal of this study was to evaluate dosimetric parameters, acute toxicity, pathologic response, and local control in patients treated with preoperative intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy for localized gastric adenocarcinoma. Methods: Between November 2007 and April 2010, 25 patients with localized gastric adenocarcinoma were treated with induction chemotherapy, followed by preoperative IMRT and concurrent chemotherapy and, finally, surgical resection. The median radiation therapy dose was 45 Gy. Concurrent chemotherapy was 5-fluorouracil and oxaliplatin in 18 patients, capecitabine in 3, and other regimens in 4. Subsequently, resection was performed with total gastrectomy in 13 patients, subtotal gastrectomy in 7, and other surgeries in 5. Results: Target coverage, expressed as the ratio of the minimum dose received by 99% of the planning target volume to the prescribed dose, was a median of 0.97 (range, 0.92-1.01). The median V{sub 30} (percentage of volume receiving at least 30 Gy) for the liver was 26%; the median V{sub 20} (percentage of volume receiving at least 20 Gy) for the right and left kidneys was 14% and 24%, respectively; and the median V{sub 40} (percentage of volume receiving at least 40 Gy) for the heart was 18%. Grade 3 acute toxicity developed in 14 patients (56%), including dehydration in 10, nausea in 8, and anorexia in 5. Grade 4 acute toxicity did not develop in any patient. There were no significant differences in the rates of acute toxicity, hospitalization, or feeding tube use in comparison to those in a group of 50 patients treated with preoperative three-dimensional conformal radiation therapy with concurrent chemotherapy. R0 resection was obtained in 20 patients (80%), and pathologic complete response occurred in 5 (20%). Conclusions: Preoperative IMRT for gastric adenocarcinoma was well tolerated, accomplished excellent target coverage and normal structure sparing, and led to appropriate

  14. Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy as Preoperative Treatment for Localized Gastric Adenocarcinoma

    International Nuclear Information System (INIS)

    Chakravarty, Twisha; Crane, Christopher H.; Ajani, Jaffer A.; Mansfield, Paul F.; Briere, Tina M.; Beddar, A. Sam; Mok, Henry; Reed, Valerie K.; Krishnan, Sunil; Delclos, Marc E.; Das, Prajnan

    2012-01-01

    Purpose: The goal of this study was to evaluate dosimetric parameters, acute toxicity, pathologic response, and local control in patients treated with preoperative intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy for localized gastric adenocarcinoma. Methods: Between November 2007 and April 2010, 25 patients with localized gastric adenocarcinoma were treated with induction chemotherapy, followed by preoperative IMRT and concurrent chemotherapy and, finally, surgical resection. The median radiation therapy dose was 45 Gy. Concurrent chemotherapy was 5-fluorouracil and oxaliplatin in 18 patients, capecitabine in 3, and other regimens in 4. Subsequently, resection was performed with total gastrectomy in 13 patients, subtotal gastrectomy in 7, and other surgeries in 5. Results: Target coverage, expressed as the ratio of the minimum dose received by 99% of the planning target volume to the prescribed dose, was a median of 0.97 (range, 0.92–1.01). The median V 30 (percentage of volume receiving at least 30 Gy) for the liver was 26%; the median V 20 (percentage of volume receiving at least 20 Gy) for the right and left kidneys was 14% and 24%, respectively; and the median V 40 (percentage of volume receiving at least 40 Gy) for the heart was 18%. Grade 3 acute toxicity developed in 14 patients (56%), including dehydration in 10, nausea in 8, and anorexia in 5. Grade 4 acute toxicity did not develop in any patient. There were no significant differences in the rates of acute toxicity, hospitalization, or feeding tube use in comparison to those in a group of 50 patients treated with preoperative three-dimensional conformal radiation therapy with concurrent chemotherapy. R0 resection was obtained in 20 patients (80%), and pathologic complete response occurred in 5 (20%). Conclusions: Preoperative IMRT for gastric adenocarcinoma was well tolerated, accomplished excellent target coverage and normal structure sparing, and led to appropriate pathologic

  15. State of the art of radiation therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Itasaka, Satoshi

    2014-01-01

    Radiation therapy has a critical role in the treatment of esophageal cancer. To improve the treatment outcome of radiotherapy, not only strengthening the treatment intensity but also decreasing the long term toxicity is needed. To reduce the long term cardiopulmonary toxicity of chemoradiation, JCOG is now running a clinical trial which combines three dimensional conformal radiation therapy (3D-CRT) and mild irradiation dose. New techniques of radiation therapy, such as intensity modulated radiation therapy (IMRT) or particle therapy are also promising in both treatment intensity and decreased toxicity. (author)

  16. Intensity-modulated radiation therapy: dynamic MLC (DMLC) therapy, multisegment therapy and tomotherapy. An example of QA in DMLC therapy

    International Nuclear Information System (INIS)

    Webb, S.

    1998-01-01

    Intensity-modulated radiation therapy will make a quantum leap in tumor control. It is the new radiation therapy for the new millennium. The major methods to achieve IMRT are: 1. Dynamic multileaf collimator (DMLC) therapy, 2. multisegment therapy, and 3. tomotherapy. The principles of these 3 techniques are briefly reviewed. Each technique presents unique QA issues which are outlined. As an example this paper will present the results of a recent new study of an important QA concern in DMLC therapy. (orig.) [de

  17. Megavoltage radiation therapy: Meeting the technological needs

    International Nuclear Information System (INIS)

    Van Dyk, J.

    2002-01-01

    Full text: In its simplest description, the purpose of radiation therapy is to hit the target and to miss all other parts of the patient. While there are multiple technological methods available for doing this, the actual radiation treatment needs to be considered in the broader context of the total radiation treatment process. This process contains multiple steps, each of which has an impact on the quality of the treatment and on the possible clinical outcome. One crucial step in this process is the determination of the location and extent of the disease relative to the adjacent normal tissues. This can be done in a variety of ways, ranging from simple clinical examination to the use of complex 3-D imaging, sometimes aided by contrast agents. As part of this localization process, it is very important that patient immobilization procedures be implemented to ensure that the same patient position will be used during both the planning and the daily treatment stages. With the knowledge of the location of the target and the critical tissues, decisions can be made about the appropriate beam arrangements to provide adequate tumour coverage while sparing the healthy tissues. This beam arrangement may have to be confirmed on a therapy simulator prior to actual implementation of the radiation treatment. In summary, the treatment process includes diagnosis, patient immobilization, target and normal tissue localization, beam selection, beam shaping, dose calculation, technique optimization, simulation, prescription, treatment verification and, finally, treatment. Dependent on the type of disease, it is not necessary that every patient undergoes all of the steps in the process; however, it is necessary that each step of the process used for a particular patient be carried out with the greatest accuracy. Uncertainties at any stage of the process will be carried through to subsequent stages and have an impact on clinical outcome. It is, therefore, important to recognize, when

  18. Novel strategies in glioblastoma surgery aim at safe, supra-maximum resection in conjunction with local therapies.

    Science.gov (United States)

    Wolbers, John G

    2014-01-01

    The biggest challenge in neuro-oncology is the treatment of glioblastoma, which exhibits poor prognosis and is increasing in incidence in an increasing aging population. Diverse treatment strategies aim at maximum cytoreduction and ensuring good quality of life. We discuss multimodal neuronavigation, supra-maximum tumor resection, and the postoperative treatment gap. Multimodal neuronavigation allows the integration of preoperative anatomic and functional data with intraoperative information. This approach includes functional magnetic resonance imaging (MRI) and diffusion tensor imaging in preplanning and ultrasound, computed tomography (CT), MRI and direct (sub)cortical stimulation during surgery. The practice of awake craniotomy decreases postoperative neurologic deficits, and an extensive supra-maximum resection appears to be feasible, even in eloquent areas of the brain. Intraoperative MRI- and fluorescence-guided surgery assist in achieving this goal of supra-maximum resection and have been the subject of an increasing number of reports. Photodynamic therapy and local chemotherapy are properly positioned to bridge the gap between surgery and chemoradiotherapy. The photosensitizer used in fluorescence-guided surgery persists in the remaining peripheral tumor extensions. Additionally, blinded randomized clinical trials showed firm evidence of extra cytoreduction by local chemotherapy in the tumor cavity. The cutting-edge promise is gene therapy although both the delivery and efficacy of the numerous transgenes remain under investigation. Issues such as the choice of (cell) vector, the choice of therapeutic transgene, the optimal route of administration, and biosafety need to be addressed in a systematic way. In this selective review, we present various evidence and promises to improve survival of glioblastoma patients by supra-maximum cytoreduction via local procedures while minimizing the risk of new neurologic deficit.

  19. Why do patients drop out during radiation therapy?

    International Nuclear Information System (INIS)

    Huh, Seung Jae; Ahn, Yong Chan; Kim, Dae Yong; Shin, Kyung Hwan; Lee, Kyu Chan; Chong, Won A; Kim, Hyun Joo; Wu, Hong Gyun

    1998-01-01

    This study is to see how much proportion of the patients receiving radiation therapy drop out during radiation therapy and to analyze the reason for the incomplete treatment. The base population of this study was 1,100 patients with registration numbers 901 through 2,000 at Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea. Authors investigated the incidence of incomplete radiation therapy, which was defined as less than 95% of initially planned radiation dose, and the reasons for incomplete radiation therapy. One hundred and twenty eight patients (12%) did not complete the planned radiation therapy. The performance status of the incompletely treated patients was generally poorer than that of the base population, and the aim of radiation therapy was more commonly palliative. The most common reason for not completing the planned treatment was the patients' refusal of further radiation therapy because of the distrust of radiation therapy and/or the poor economic status. Careful case selection for radiation therapy with consideration of the socioeconomic status of the patients in addition to the clinical indication would be necessary for the reduction of incomplete treatment, especially in the palliative setting

  20. Oral care of the cancer patient receiving radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Holtzhausen, T [Medical Univ. of Southern Africa, Pretoria (South Africa). Dept. of Community Dentistry

    1982-07-01

    Radiation therapy is frequently being used for the patient with oral cancer. The survival rate is increasing, due to more effective treatment technique. The question of whether any teeth should be extracted, the mode of therapy and the side effects of radiation like Xerostomia, caries, stomatitis, trismus and osteo-radionecrosis and also post radiation care are discussed.

  1. Phase 2 Study of Docetaxel, Cisplatin, and Concurrent Radiation for Technically Resectable Stage III-IV Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Inohara, Hidenori, E-mail: hinohara@ent.med.osaka-u.ac.jp [Department of Otorhinolaryngology—Head and Neck Surgery, Osaka University Faculty of Medicine, Suita, Osaka (Japan); Takenaka, Yukinori; Yoshii, Tadashi; Nakahara, Susumu; Yamamoto, Yoshifumi; Tomiyama, Yoichiro [Department of Otorhinolaryngology—Head and Neck Surgery, Osaka University Faculty of Medicine, Suita, Osaka (Japan); Seo, Yuji; Isohashi, Fumiaki; Suzuki, Osamu; Yoshioka, Yasuo; Sumida, Iori; Ogawa, Kazuhiko [Department of Radiation Oncology, Osaka University Faculty of Medicine, Suita, Osaka (Japan)

    2015-04-01

    Purpose: We investigated the efficacy and safety of weekly low-dose docetaxel and cisplatin therapy concurrent with conventionally fractionated radiation in patients with technically resectable stage III-IV squamous cell carcinoma of the head and neck. Methods and Materials: Between March 2004 and October 2011, we enrolled 117 patients, of whom 116 were analyzable (43 had oropharyngeal cancer, 54 had hypopharyngeal cancer, and 19 had laryngeal cancer), and 85 (73%) had stage IV disease. Radiation consisted of 66 Gy in 33 fractions. Docetaxel, 10 mg/m{sup 2}, followed by cisplatin, 20 mg/m{sup 2}, administered on the same day were given once a week for 6 cycles. The primary endpoint was overall complete response (CR) rate after chemoradiation therapy. Human papillomavirus (HPV) DNA in oropharyngeal cancer was examined by PCR. Results: Of 116 patients, 82 (71%) completed treatment per protocol; 102 (88%) received the full radiation therapy dose; and 90 (78%) and 12 (10%) patients received 6 and 5 chemotherapy cycles, respectively. Overall CR rate was 71%. After median follow-up of 50.9 months (range: 15.6-113.9 months for surviving patients), 2-year and 4-year overall survival rates were 82% and 68%, respectively. Cumulative 2-year and 4-year local failure rates were 27% and 28%, respectively, whereas distant metastasis rates were 15% and 22%, respectively. HPV status in oropharyngeal cancer was not associated with treatment efficacy. Acute toxicity included grade 3 and 4 in-field mucositis in 73% and 5% of patients, respectively, whereas myelosuppression and renal injury were minimal. No patients died of toxicity. Feeding tube dependence in 8% and tracheostomy in 1% of patients were evident at 2 years postchemoradiation therapy in patients who survived without local treatment failure. Conclusions: Local control and survival with this regimen were satisfactory. Although acute toxicity, such as mucositis, was common, late toxicity, such as laryngoesophageal

  2. Radiation therapy for carcinoma of the eyelid

    International Nuclear Information System (INIS)

    Tsuchiya, Miwako; Takahashi, Mitsuhiro; Shinozaki, Jun; Kaneda, Koichi; Oda, Norio; Tabuchi, Yoshiko

    1987-01-01

    Between 1969 and 1985, 30 patients with carcinomas of the eyelid were treated by radiation, including 19 primary cases and 11 secondary cases. The latter were less controlable than the former. According to histology, there were 21 squamous cell carcinomas, 6 basal cell carcinomas and 3 adenocarcinomas. Among the 21 patients with squamous cell carcinomas, 5 had local recurrences, 10 had lymph node metastasis and 3 had distant metastasis. Patients with other histological classifications had no local recurrences, except for one who received incomplete therapy due to diabetes. Almost all of the controlled patients with squamous cell carcinomas were treated with a TDF value greater than 90. Although the visual function was damaged by irradiation in seven patients, the lesions of 6 of them were too advanced to avoid radiation injuries. (author)

  3. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical neutron radiation therapy system. 892.5300... analysis and display equipment, patient and equipment support, treatment planning computer programs...

  4. Radiation therapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Taylor, W.J.; Richardson, G.; Hafermann, M.D.

    1979-01-01

    Since 1965, 401 patients with prostate cancer have received intensive local pelvic radiation therapy at the Virginia Mason Medical Center. Two hundred twenty-one of this series were in the Stage C category. The 36 Stage B cancers were either medically nonoperable, or advanced extent, or had high-grade histopathology. Ten patients each were in diffuse Stage A or Stage D groups, the latter receiving local palliative inensive treatment to the prostate area. The mean age of the patients was 67.6 years. The five year survival of the Stage C group was 57.7%. There was no apparent influence on the survival of irradiated Stage C patients who received estrogen therapy. Current treatment techniques employ 10 megavolt photon beam with whole pelvic nodal fields and bilateral are rotational boost fields. The incidence of reactions and complications is presented

  5. Imaging after radiation therapy of thoracic tumors

    International Nuclear Information System (INIS)

    Ghaye, B.; Wanet, M.; El Hajjam, M.

    2016-01-01

    Radiation-induced lung disease (RILD) is frequent after therapeutic irradiation of thoracic malignancies. Many technique-, treatment-, tumor- and patient-related factors influence the degree of injury sustained by the lung after irradiation. Based on the time interval after the completion of the treatment RILD presents as early and late features characterized by inflammatory and fibrotic changes, respectively. They are usually confined to the radiation port. Though the typical pattern of RILD is easily recognized after conventional two-dimensional radiation therapy (RT), RILD may present with atypical patterns after more recent types of three or four-dimensional RT treatment. Three atypical patterns are reported: the modified conventional, the mass-like and the scar-like patterns. Knowledge of the various features and patterns of RILD is important for correct diagnosis and appropriate treatment. RILD should be differentiated from recurrent tumoral disease, infection and radiation-induced tumors. Due to RILD, the follow-up after RT may be difficult as response evaluation criteria in solid tumours (RECIST) criteria may be unreliable to assess tumor control particularly after stereotactic ablation RT (SABR). Long-term follow-up should be based on clinical examination and morphological and/or functional investigations including CT, PET-CT, pulmonary functional tests, MRI and PET-MRI. (authors)

  6. Intraoperative radiation therapy for glioblastoma multiforme

    International Nuclear Information System (INIS)

    Matsutani, Masao; Tanaka, Yoshiaki; Matsuda, Tadayoshi

    1986-01-01

    Intraoperative radiation therapy (IOR) is quite applicable for radioresistant malignant gliomas, because of precise demarcations of the treatment volume under direct vision, minimum damage to surrounding normal tissues, and a high target absorbed dose of 1500 to 2000 rad. Fifteen patients with glioblatoma were treated with IOR, and the 2-year survival rate was 61.1 %. The result apparently indicate that areas adjacent to the margin of almost complete removal should be irradated with a sufficient dose to sterilize the remaining malignant remnants, and IOR is one of the logical treatment modalities for local control of malignant gliomas. (author)

  7. Impact of radiation therapy for benign diseases

    International Nuclear Information System (INIS)

    Kantor, G.; Van Houtte, P.; Beauvois, S.; Roelandts, M.

    1997-01-01

    Radiation therapy of benign diseases represent a wide panel of indications. Some indications are clearly identified as treatment of arteriovenous malformations (AVM), hyperthyroid ophthalmopathy, postoperative heterotopic bone formations or keloid scars. Some indications are under evaluation as complications induced by neo-vessels of age-related macular degeneration or coronary restenosis after angioplasty. Some indications remain controversial with poor evidence of efficiency as treatment of bursitis, tendinitis or Dupuytren's disease. Some indications are now obsolete such as warts, or contra-indicated as treatment of infant and children. (authors)

  8. Memory and survival after microbeam radiation therapy

    International Nuclear Information System (INIS)

    Schueltke, Elisabeth; Juurlink, Bernhard H.J.; Ataelmannan, Khalid; Laissue, Jean; Blattmann, Hans; Braeuer-Krisch, Elke; Bravin, Alberto; Minczewska, Joanna; Crosbie, Jeffrey; Taherian, Hadi; Frangou, Evan; Wysokinsky, Tomasz; Chapman, L. Dean; Griebel, Robert; Fourney, Daryl

    2008-01-01

    Background: Disturbances of memory function are frequently observed in patients with malignant brain tumours and as adverse effects after radiotherapy to the brain. Experiments in small animal models of malignant brain tumour using synchrotron-based microbeam radiation therapy (MRT) have shown a promising prolongation of survival times. Materials and methods: Two animal models of malignant brain tumour were used to study survival and memory development after MRT. Thirteen days after implantation of tumour cells, animals were submitted to MRT either with or without adjuvant therapy (buthionine-SR-sulfoximine = BSO or glutamine). We used two orthogonal 1-cm wide arrays of 50 microplanar quasiparallel microbeams of 25 μm width and a center-to-center distance of about 200 μm, created by a multislit collimator, with a skin entrance dose of 350 Gy for each direction. Object recognition tests were performed at day 13 after tumour cell implantation and in monthly intervals up to 1 year after tumour cell implantation. Results: In both animal models, MRT with and without adjuvant therapy significantly increased survival times. BSO had detrimental effects on memory function early after therapy, while administration of glutamine resulted in improved memory

  9. Therapy of deep radiation ulcer after the mammacarcinoma operation

    International Nuclear Information System (INIS)

    Nabeshima, Kengo; Imai, Susumu; Makino, Koreo; Koike, Makoto; Hayata, Yoshiharu.

    1976-01-01

    Eight cases of deep radiation ulcer after mammacarcinoma operations were treated in our clinic in the past 10 years. Four of them were treated by the large thoracic-abdominal flap after bony chest wall resection. Referring to these experiences we considered that the following four points were important. 1. Ulcers should be repaired in one stage if possible. 2. Necrotic mass and injured tissues should be resected completely. 3. The large tissue defect after the debridement can be covered directly with the opposite large thoracic-abdominal flap. 4. The I. II. III perforating branches of the internal mammary arteries should be kept intract in constructing the thoracic-abdominal flap. (auth.)

  10. A case showing a blistering disorder in radiation dermatitis during radiation therapy

    International Nuclear Information System (INIS)

    Nonoshita, Takeshi; Nakamura, Katsumasa; Shioyama, Yoshiyuki

    2007-01-01

    We experienced a case showing a blistering disorder in radiation dermatitis during radiation therapy for thymic cancer. Application of steroid to the lesion improved blisters. The literature on bullous eruption including radiation-induced bullous pemhigoid was critically reviewed. (author)

  11. A Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT and intraoperative radiation therapy (IORT in patients with retroperitoneal soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Roeder Falk

    2012-07-01

    Full Text Available Abstract Background Local control rates in patients with retroperitoneal soft tissue sarcoma (RSTS remain disappointing even after gross total resection, mainly because wide margins are not achievable in the majority of patients. In contrast to extremity sarcoma, postoperative radiation therapy (RT has shown limited efficacy due to its limitations in achievable dose and coverage. Although Intraoperative Radiation Therapy (IORT has been introduced in some centers to overcome the dose limitations and resulted in increased outcome, local failure rates are still high even if considerable treatment related toxicity is accepted. As postoperative administration of RT has some general disadvantages, neoadjuvant approaches could offer benefits in terms of dose escalation, target coverage and reduction of toxicity, especially if highly conformal techniques like intensity-modulated radiation therapy (IMRT are considered. Methods/design The trial is a prospective, one armed, single center phase I/II study investigating a combination of neoadjuvant dose-escalated IMRT (50–56 Gy followed by surgery and IORT (10–12 Gy in patients with at least marginally resectable RSTS. The primary objective is the local control rate after five years. Secondary endpoints are progression-free and overall survival, acute and late toxicity, surgical resectability and patterns of failure. The aim of accrual is 37 patients in the per-protocol population. Discussion The present study evaluates combined neoadjuvant dose-escalated IMRT followed by surgery and IORT concerning its value for improved local control without markedly increased toxicity. Trial registration NCT01566123

  12. A Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma

    International Nuclear Information System (INIS)

    Roeder, Falk; Hensley, Frank W; Buechler, Markus W; Debus, Juergen; Koch, Moritz; Weitz, Juergen; Bischof, Marc; Schulz-Ertner, Daniela; Nikoghosyan, Anna V; Huber, Peter E; Edler, Lutz; Habl, Gregor; Krempien, Robert; Oertel, Susanne; Saleh-Ebrahimi, Ladan

    2012-01-01

    Local control rates in patients with retroperitoneal soft tissue sarcoma (RSTS) remain disappointing even after gross total resection, mainly because wide margins are not achievable in the majority of patients. In contrast to extremity sarcoma, postoperative radiation therapy (RT) has shown limited efficacy due to its limitations in achievable dose and coverage. Although Intraoperative Radiation Therapy (IORT) has been introduced in some centers to overcome the dose limitations and resulted in increased outcome, local failure rates are still high even if considerable treatment related toxicity is accepted. As postoperative administration of RT has some general disadvantages, neoadjuvant approaches could offer benefits in terms of dose escalation, target coverage and reduction of toxicity, especially if highly conformal techniques like intensity-modulated radiation therapy (IMRT) are considered. The trial is a prospective, one armed, single center phase I/II study investigating a combination of neoadjuvant dose-escalated IMRT (50–56 Gy) followed by surgery and IORT (10–12 Gy) in patients with at least marginally resectable RSTS. The primary objective is the local control rate after five years. Secondary endpoints are progression-free and overall survival, acute and late toxicity, surgical resectability and patterns of failure. The aim of accrual is 37 patients in the per-protocol population. The present study evaluates combined neoadjuvant dose-escalated IMRT followed by surgery and IORT concerning its value for improved local control without markedly increased toxicity. NCT01566123

  13. The impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Park, Seho; Park, Hyung-Seok; Kim, Seung-ll; Koo, Ja-Seung; Park, Byeong-Woo; Lee, Kyong-Sik

    2011-01-01

    The aim of the study was to investigate the parameters affecting positive margin and the impact of positive margin on outcomes after breast-conserving therapy in patients with breast cancer. Characteristics and survival of 705 patients attempted breast-conserving therapy between January 1994 and December 2004 were retrospectively analyzed using χ 2 tests, the Kaplan-Meier methods and multivariate analyses. Ninety-five (13.5%) showed positive margins at initial resection. Among them, 28 (4.0%) had negative margin on the initial frozen section; however, they finally turned out a focally positive margin with intraductal carcinoma on the permanent pathology. Positive margin at initial resection was significantly associated with lobular histology (P=0.001), four or more involved lymph nodes (P=0.015) and the presence of extensive intraductal component (P<0.001). A focally positive margin did not influence local (P=0.250; 95% confidence interval, 0.612-6.592) or regional failure (P=0.756; 95% confidence interval, 0.297-5.311). Patients with a focally positive margin showed an advanced nodal stage and received a higher dose of irradiation and more systemic therapy. Nodal involvements were the most significant factor for locoregional failure. Although the achievement of negative margins is the best way to reduce local failure, patients with a focally positive margin and favorable risk factors such as node negativity and older age could have an option of close follow-up with adequate boost irradiation and adjuvant therapy instead of conversion to total mastectomy. (author)

  14. Gene expression profiles in cervical cancer with radiation therapy alone and chemo-radiation therapy

    International Nuclear Information System (INIS)

    Lee, Kyu Chan; Kim, Joo Young; Hwang, You Jin; Kim, Meyoung Kon; Choi, Myung Sun; Kim, Chul Young

    2003-01-01

    To analyze the gene expression profiles of uterine cervical cancer, and its variation after radiation therapy, with or without concurrent chemotherapy, using a cDNA microarray. Sixteen patients, 8 with squamous cell carcinomas of the uterine cervix, who were treated with radiation alone, and the other 8 treated with concurrent chemo-radiation, were included in the study. Before the starting of the treatment, tumor biopsies were carried out, and the second time biopsies were performed after a radiation dose of 16.2-27 Gy. Three normal cervix tissues were used as a control group. The microarray experiments were performed with 5 groups of the total RNAs extracted individually and then admixed as control, pre-radiation therapy alone, during-radiation therapy alone, pre-chemoradiation therapy, and during chemoradiation therapy. The 33P-labeled cDNAs were synthesized from the total RNAs of each group, by reverse transcription, and then they were hybridized to the cDNA microarray membrane. The gene expression of each microarrays was captured by the intensity of each spot produced by the radioactive isotopes. The pixels per spot were counted with an Arrayguage, and were exported to Microsoft Excel. The data were normalized by the Z transformation, and the comparisons were performed on the Z-ratio values calculated. The expressions of 15 genes, including integrin linked kinase (ILK), CDC28 protein kinase 2, Spry 2, and ERK 3, were increased with the Z-ratio values of over 2.0 for the cervix cancer tissues compared to those for the normal controls. Those genes were involved in cell growth and proliferation, cell cycle control, or signal transduction. The expressions of the other 6 genes, including G protein coupled receptor kinase 6, were decreased with the Z-ratio values of below -2.0. After the radiation therapy, most of the genes, with a previously increase expressions, represented the decreased expression profiles, and the genes, with the Z-ratio values of over 2.0, were

  15. Postoperative Radiation Therapy for Non-Small Cell Lung Cancer and Thymic Malignancies

    International Nuclear Information System (INIS)

    Gomez, Daniel R.; Komaki, Ritsuko

    2012-01-01

    For many thoracic malignancies, surgery, when feasible, is the preferred upfront modality for local control. However, adjuvant radiation plays an important role in minimizing the risk of locoregional recurrence. Tumors in the thoracic category include certain subgroups of non-small cell lung cancer (NSCLC) as well as thymic malignancies. The indications, radiation doses, and treatment fields vary amongst subtypes of thoracic tumors, as does the level of data supporting the use of radiation. For example, in the setting of NSCLC, postoperative radiation is typically reserved for close/positive margins or N2/N3 disease, although such diseases as superior sulcus tumors present unique cases in which the role of neoadjuvant vs. adjuvant treatment is still being elucidated. In contrast, for thymic malignancies, postoperative radiation therapy is often used for initially resected Masaoka stage III or higher disease, with its use for stage II disease remaining controversial. This review provides an overview of postoperative radiation therapy for thoracic tumors, with a separate focus on superior sulcus tumors and thymoma, including a discussion of acceptable radiation approaches and an assessment of the current controversies involved in its use

  16. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, G. [Klinik am Eichert, Goeppingen (Germany). Dept. of Radiooncology and Radiation Therapy; Radiooncologic Univ. Clinic, Tuebingen (Germany); Kocher, M.; Mueller, R.P. [Koeln Univ. (Germany). Clinic of Radiation Therapy; Kortmann, R.D.; Paulsen, F.; Jeremic, B.; Bamberg, M. [Radiooncologic Univ. Clinic, Tuebingen (Germany)

    2002-04-01

    patients was estimated to be 0.2%. Other side effects are rare too, and do also depend on the damage produced by tumor itself or preceding surgery. They include deterioration of vision in 1.7% of all cases, vascular changes in 6.3%, neuropsychological disorders such as dementia in 0.7% and secondary malignancies in 0.8%, if single doses of 2.0 Gy and total doses of 50 Gy are not exceeded. Conclusion: Conventional radiation therapy of pituitary adenoma is highly effective. It is recommended after subtotal resection of primary tumors such as macroadenomas, after gross total resection from endocrine active adenomas with postsurgical hormone secretion and for recurrent tumors. Radiosurgery seems to be a possible treatment alternative in experienced centers, and only in patients with adenomas smaller than 25-30 mm with a minimum distance of 2-3 mm to the chiasm. (orig.)

  17. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    International Nuclear Information System (INIS)

    Becker, G.; Kocher, M.; Mueller, R.P.

    2002-01-01

    was estimated to be 0.2%. Other side effects are rare too, and do also depend on the damage produced by tumor itself or preceding surgery. They include deterioration of vision in 1.7% of all cases, vascular changes in 6.3%, neuropsychological disorders such as dementia in 0.7% and secondary malignancies in 0.8%, if single doses of 2.0 Gy and total doses of 50 Gy are not exceeded. Conclusion: Conventional radiation therapy of pituitary adenoma is highly effective. It is recommended after subtotal resection of primary tumors such as macroadenomas, after gross total resection from endocrine active adenomas with postsurgical hormone secretion and for recurrent tumors. Radiosurgery seems to be a possible treatment alternative in experienced centers, and only in patients with adenomas smaller than 25-30 mm with a minimum distance of 2-3 mm to the chiasm. (orig.)

  18. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Das, Prajnan, E-mail: PrajDas@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eng, Cathy [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rodriguez-Bigas, Miguel A.; Chang, George J.; Skibber, John M.; You, Y. Nancy [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Maru, Dipen M. [Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Munsell, Mark F. [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Clemons, Marilyn V. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kopetz, Scott E.; Garrett, Christopher R.; Shureiqi, Imad [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-02-01

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m{sup 2} to 825 mg/m{sup 2} orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation.

  19. Particle Therapy Using Protons or Carbon Ions for Unresectable or Incompletely Resected Bone and Soft Tissue Sarcomas of the Pelvis

    Energy Technology Data Exchange (ETDEWEB)

    Demizu, Yusuke, E-mail: y_demizu@nifty.com [Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo (Japan); Jin, Dongcun; Sulaiman, Nor Shazrina; Nagano, Fumiko; Terashima, Kazuki; Tokumaru, Sunao [Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo (Japan); Akagi, Takashi [Department of Radiation Physics, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo (Japan); Fujii, Osamu [Department of Radiation Oncology, Hakodate Goryokaku Hospital, Hakodate, Hokkaido (Japan); Daimon, Takashi [Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo (Japan); Sasaki, Ryohei [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo (Japan); Fuwa, Nobukazu [Department of Radiation Oncology, Ise Red Cross Hospital, Ise, Mie (Japan); Okimoto, Tomoaki [Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo (Japan)

    2017-06-01

    Purpose: To retrospectively analyze the treatment outcomes of particle therapy using protons or carbon ions for unresectable or incompletely resected bone and soft tissue sarcomas (BSTSs) of the pelvis. Methods and Materials: From May 2005 to December 2014, 91 patients with nonmetastatic histologically proven unresectable or incompletely resected pelvic BSTSs underwent particle therapy with curative intent. The particle therapy used protons (52 patients) or carbon ions (39 patients). All patients received a dose of 70.4 Gy (relative biologic effectiveness) in 32 fractions (55 patients) or 16 fractions (36 patients). Results: The median patient age was 67 years (range 18-87). The median planning target volume (PTV) was 455 cm{sup 3} (range 108-1984). The histologic type was chordoma in 53 patients, chondrosarcoma in 14, osteosarcoma in 10, malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma in 5, and other in 9 patients. Of the 91 patients, 82 had a primary tumor and 9 a recurrent tumor. The median follow-up period was 32 months (range 3-112). The 3-year rate of overall survival (OS), progression-free survival (PFS), and local control was 83%, 72%, and 92%, respectively. A Cox proportional hazards model revealed that chordoma histologic features and a PTV of ≤500 cm{sup 3} were significantly associated with better OS, and a primary tumor and PTV of ≤500 cm{sup 3} were significantly associated with better PFS. Ion type and number of fractions were not significantly associated with OS, PFS, or local control. Late grade ≥3 toxicities were observed in 23 patients. Compared with the 32-fraction protocol, the 16-fraction protocol was associated with significantly more frequent late grade ≥3 toxicities (18 of 36 vs 5 of 55; P<.001). Conclusions: Particle therapy using protons or carbon ions was effective for unresectable or incompletely resected pelvic BSTS, and the 32-fraction protocol was effective and relatively less toxic. Nevertheless, a

  20. Radiation protection principles for radioiodine therapy

    International Nuclear Information System (INIS)

    Reiners, C.; Lassmann, M.

    1999-01-01

    In Germany, approximately 30,000 treatments with radioiodine are performed yearly on patients with benign or malignant thyroid diseases. These are carried out generally in specialized therapy wards which are equipped with radiation protection facilities. Ambulant (fractionated) radioiodine treatment is not permitted in Germany. More recently, the situation has been that the discharge of patients is permitted, when they have spent a stay of at least 48 hours in the ward without the dose rate exceeding 3.5 μSv/hour at 2 meters distance from them, corresponding to 1 mSv/year (this correlates to a residual activity in the body of the patient of 250 MBq). The radiation exposure of personnel in the therapy ward due to both external and internal exposure lies within a range of a few mSv per year. According to recent studies, the exposure to family members and close friends via external exposure, inhalation or incorporation does not exceed the effective dose of 1 mSv/year. This value has been laid down in a recommendation by the European Union as the dose constraint for children; for adults younger than 60 years of age, 3 mSv are recommended, for older persons 15 mSv. (orig.) [de

  1. Mapping the literature of radiation therapy.

    Science.gov (United States)

    Delwiche, Frances A

    2013-04-01

    This study characterizes the literature of the radiation therapy profession, identifies the journals most frequently cited by authors writing in this discipline, and determines the level of coverage of these journals by major bibliographic indexes. Cited references from three discipline-specific source journals were analyzed according to the Mapping the Literature of Allied Health Project Protocol of the Nursing and Allied Health Resources Section of the Medical Library Association. Bradford's Law of Scattering was applied to all journal references to identify the most frequently cited journal titles. Journal references constituted 77.8% of the total, with books, government documents, Internet sites, and miscellaneous sources making up the remainder. Although a total of 908 journal titles were cited overall, approximately one-third of the journal citations came from just 11 journals. MEDLINE and Scopus provided the most comprehensive indexing of the journal titles in Zones 1 and 2. The source journals were indexed only by CINAHL and Scopus. The knowledgebase of radiation therapy draws heavily from the fields of oncology, radiology, medical physics, and nursing. Discipline-specific publications are not currently well covered by major indexing services, and those wishing to conduct comprehensive literature searches should search multiple resources.

  2. Long-sustaining response in a patient with non-resectable, distant recurrence of glioblastoma multiforme treated by interstitial photodynamic therapy using 5-ALA: case report.

    Science.gov (United States)

    Stummer, Walter; Beck, Tobias; Beyer, Wolfgang; Mehrkens, Jan Hendrik; Obermeier, Andreas; Etminan, Nima; Stepp, Herbert; Tonn, Jörg-Christian; Baumgartner, Reinhold; Herms, Jochen; Kreth, Friedrich Wilhelm

    2008-03-01

    Glioblastoma multiforme continues to be a devastating disease despite modest improvements in survival achieved at present, and there is an urgent need for innovative treatment concepts. Five-aminolevulinic acid (ALA) is a drug which induces protoporphyrin IX accumulation in malignant gliomas and has been explored for fluorescence-guided resections of these tumors. ALA is also under investigation as a photosensitizer. We report a case of a patient with prior left frontal glioblastoma multiforme treated by surgery, radiation and chemotherapy, who developed a remote lesion in the left insula, which was refractory to secondary treatments. In a compassionate use setting she was treated by oral application of ALA (20 mg/kg bodyweight), and stereotactic phototherapy achieved by positioning four laser diffusors using 3-dimensional irradiation planning, and a 633 nm diode laser. The lesion disappeared 24 h after therapy. Circumferential contrast enhancement was observed at 72 h, which disappeared in the course of subsequent months. Edema resolved completely. The patient is still free of recurrence 56 months after treatment, demonstrating an impressive and long-lasting response to this novel mode of therapy.

  3. Clinical results of radiation therapy for thymic tumors

    Energy Technology Data Exchange (ETDEWEB)

    Masunaga, Shin-ichiro; Ono, Koji; Hiraoka, Masahiro; Kitakabu, Yoshizumi; Abe, Mitsuyuki (Kyoto Univ. (Japan). Faculty of Medicine); Takahashi, Masaji; Fushiki, Masato

    1991-12-01

    From August 1968 to December 1989, 58 patients with thymoma, and 3 with thymic carcinoma were treated by radiotherapy using cobalt-60 gamma ray. Eleven cases were treated by radiotherapy alone, 1 by preoperative radiotherapy, 45 by postoperative radiotherapy, and 4 in combination with intraoperative radiotherapy. In thymoma, postoperative and intraoperative radiotherapies were effective, while concerning postoperative radiotherapy, operability was the major factor influencing survival and local control, and Stage I and II tumors resected totally or subtotally as well as Stage III tumors resected totally were good indications for such therapy. Cases of thymoma complicated by myasthenia gravis had a longer survival time and better local control rate than those without it. In the treatment of thymic carcinoma, it was suggested that the tumors can be controlled using complete resection and sufficient postoperative radiotherpay. (author).

  4. Clinical results of radiation therapy for thymic tumors

    International Nuclear Information System (INIS)

    Masunaga, Shin-ichiro; Ono, Koji; Hiraoka, Masahiro; Kitakabu, Yoshizumi; Abe, Mitsuyuki; Takahashi, Masaji; Fushiki, Masato.

    1991-01-01

    From August 1968 to December 1989, 58 patients with thymoma, and 3 with thymic carcinoma were treated by radiotherapy using cobalt-60 gamma ray. Eleven cases were treated by radiotherapy alone, 1 by preoperative radiotherapy, 45 by postoperative radiotherapy, and 4 in combination with intraoperative radiotherapy. In thymoma, postoperative and intraoperative radiotherapies were effective, while concerning postoperative radiotherapy, operability was the major factor influencing survival and local control, and Stage I and II tumors resected totally or subtotally as well as Stage III tumors resected totally were good indications for such therapy. Cases of thymoma complicated by myasthenia gravis had a longer survival time and better local control rate than those without it. In the treatment of thymic carcinoma, it was suggested that the tumors can be controlled using complete resection and sufficient postoperative radiotherpay. (author)

  5. Better Efficacy of Synchrotron Spatially Microfractionated Radiation Therapy Than Uniform Radiation Therapy on Glioma

    International Nuclear Information System (INIS)

    Bouchet, Audrey; Bräuer-Krisch, Elke; Prezado, Yolanda; El Atifi, Michèle; Rogalev, Léonid; Le Clec'h, Céline; Laissue, Jean Albert; Pelletier, Laurent; Le Duc, Géraldine

    2016-01-01

    Purpose: Synchrotron microbeam radiation therapy (MRT) is based on the spatial fractionation of the incident, highly focused synchrotron beam into arrays of parallel microbeams, typically a few tens of microns wide and depositing several hundred grays. This irradiation modality was shown to have a high therapeutic impact on tumors, especially in intracranial locations. However, mechanisms responsible for such a property are not fully understood. Methods and Materials: Thanks to recent progress in dosimetry, we compared the effect of MRT and synchrotron broad beam (BB) radiation therapy delivered at comparable doses (equivalent to MRT valley dose) on tumor growth control and on classical radiobiological functions by histologic evaluation and/or transcriptomic analysis. Results: MRT significantly improved survival of rats bearing 9L intracranial glioma compared with BB radiation therapy delivered at a comparable dose (P<.001); the efficacy of MRT and BB radiation therapy was similar when the MRT dose was half that of BB. The greater efficacy of MRT was not correlated with a difference in cell proliferation (Mki67 and proliferating cell nuclear antigen) or in transcriptomic stimulation of angiogenesis (vascular endothelial growth factor A or tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2) but was correlated with a higher cell death rate (factor for apoptosis signals) and higher recruitment of macrophages (tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 1 and CD68 transcripts) a few days after MRT. Conclusions: These results show the superiority of MRT over BB radiation therapy when applied at comparable doses, suggesting that spatial fractionation is responsible for a specific and particularly efficient tissue response. The higher induction of cell death and immune cell activation in brain tumors treated by MRT may be involved in such responses.

  6. Better Efficacy of Synchrotron Spatially Microfractionated Radiation Therapy Than Uniform Radiation Therapy on Glioma

    Energy Technology Data Exchange (ETDEWEB)

    Bouchet, Audrey, E-mail: audrey.m.bouchet@gmail.com [Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble (France); Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble (France); Bräuer-Krisch, Elke; Prezado, Yolanda [Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble (France); El Atifi, Michèle [Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble (France); Grenoble University Hospital, Grenoble (France); Rogalev, Léonid; Le Clec' h, Céline [Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble (France); Laissue, Jean Albert [University of Bern, Bern (Switzerland); Pelletier, Laurent, E-mail: laurent.pelletier@ujf-grenoble.fr [Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble (France); Grenoble University Hospital, Grenoble (France); Le Duc, Géraldine [Biomedical Beamline, European Synchrotron Radiation Facility, Grenoble (France)

    2016-08-01

    Purpose: Synchrotron microbeam radiation therapy (MRT) is based on the spatial fractionation of the incident, highly focused synchrotron beam into arrays of parallel microbeams, typically a few tens of microns wide and depositing several hundred grays. This irradiation modality was shown to have a high therapeutic impact on tumors, especially in intracranial locations. However, mechanisms responsible for such a property are not fully understood. Methods and Materials: Thanks to recent progress in dosimetry, we compared the effect of MRT and synchrotron broad beam (BB) radiation therapy delivered at comparable doses (equivalent to MRT valley dose) on tumor growth control and on classical radiobiological functions by histologic evaluation and/or transcriptomic analysis. Results: MRT significantly improved survival of rats bearing 9L intracranial glioma compared with BB radiation therapy delivered at a comparable dose (P<.001); the efficacy of MRT and BB radiation therapy was similar when the MRT dose was half that of BB. The greater efficacy of MRT was not correlated with a difference in cell proliferation (Mki67 and proliferating cell nuclear antigen) or in transcriptomic stimulation of angiogenesis (vascular endothelial growth factor A or tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2) but was correlated with a higher cell death rate (factor for apoptosis signals) and higher recruitment of macrophages (tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 1 and CD68 transcripts) a few days after MRT. Conclusions: These results show the superiority of MRT over BB radiation therapy when applied at comparable doses, suggesting that spatial fractionation is responsible for a specific and particularly efficient tissue response. The higher induction of cell death and immune cell activation in brain tumors treated by MRT may be involved in such responses.

  7. A current perspective on stereotactic body radiation therapy for pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Hong JC

    2016-10-01

    Full Text Available Julian C Hong, Brian G Czito, Christopher G Willett, Manisha Palta Department of Radiation Oncology, Duke University, Durham, NC, USA Abstract: Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT, which uses image-guided, conformal, high-dose radiation. SBRT has demonstrated promising local control rates and resultant quality of life with acceptable rates of toxicity. Over the past decade, increasing clinical experience and data have supported SBRT as a local treatment modality. Nevertheless, additional research is required to further evaluate the role of SBRT and improve upon the persistently poor outcomes associated with pancreatic cancer. This review discusses the existing clinical experience and technical implementation of SBRT for pancreatic cancer and highlights the directions for ongoing and future studies. Keywords: pancreatic cancer, stereotactic body radiation therapy, SBRT, radiation therapy

  8. Image Guidance and Assessment of Radiation Induced Gene Therapy

    National Research Council Canada - National Science Library

    Pelizzari, Charles

    2004-01-01

    Image guidance and assessment techniques are being developed for combined radiation/gene therapy, which utilizes a radiation-inducible gene promoter to cause expression of tumor necrosis factor alpha...

  9. Film Dosimetry for Intensity Modulated Radiation Therapy

    International Nuclear Information System (INIS)

    Benites-Rengifo, J.; Martinez-Davalos, A.; Celis, M.; Larraga, J.

    2004-01-01

    Intensity Modulated Radiation Therapy (IMRT) is an oncology treatment technique that employs non-uniform beam intensities to deliver highly conformal radiation to the targets while minimizing doses to normal tissues and critical organs. A key element for a successful clinical implementation of IMRT is establishing a dosimetric verification process that can ensure that delivered doses are consistent with calculated ones for each patient. To this end we are developing a fast quality control procedure, based on film dosimetry techniques, to be applied to the 6 MV Novalis linear accelerator for IMRT of the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City. The procedure includes measurements of individual fluence maps for a limited number of fields and dose distributions in 3D using extended dose-range radiographic film. However, the film response to radiation might depend on depth, energy and field size, and therefore compromise the accuracy of measurements. In this work we present a study of the dependence of Kodak EDR2 film's response on the depth, field size and energy, compared with those of Kodak XV2 film. The first aim is to devise a fast and accurate method to determine the calibration curve of film (optical density vs. doses) commonly called a sensitometric curve. This was accomplished by using three types of irradiation techniques: Step-and-shoot, dynamic and static fields

  10. Potential for heavy particle radiation therapy

    International Nuclear Information System (INIS)

    Raju, M.R.; Phillips, T.L.

    1977-03-01

    Radiation therapy remains one of the major forms of cancer treatment. When x rays are used in radiotherapy, there are large variations in radiation sensitivity among tumors because of the possible differences in the presence of hypoxic but viable tumor cells, differences in reoxygenation during treatment, differences in distribution of the tumor cells in their cell cycle, and differences in repair of sublethal damage. When high-LET particles are used, depending upon the LET distribution, these differences are reduced considerably. Because of these differences between x rays and high-LET particle effects, the high-LET particles may be more effective on tumor cells for a given effect on normal cells. Heavy particles have potential application in improving radiotherapy because of improved dose localization and possible advantages of high-LET particles due to their radiobiological characteristics. Protons, because of their defined range, Bragg peak, and small effects of scattering, have good dose localization characteristics. The use of protons in radiotherapy minimizes the morbidity of radiotherapy treatment and is very effective in treating deep tumors located near vital structures. Fast neutrons have no physical advantages over 60 Co gamma rays but, because of their high-LET component, could be very effective in treating tumors that are resistant to conventional radiations. Negative pions and heavy ions combine some of the advantages of protons and fast neutrons

  11. Radiation therapy for epithelial ovarian cancer

    International Nuclear Information System (INIS)

    Dembo, A.J.

    1987-01-01

    Several principles governing the cure of patients with ovarian cancer by radiotherapy were established during the last decade. The author reviews some of the studies at The Princess Margaret Hospital (PMH), which led to the establishment of the following principles: The entire peritoneal cavity should be encompassed by the treatment field, because once the disease has spread beyond the ovary, the entire peritoneal cavity is at risk for recurrent cancer. The moving-strip and open-field techniques are equally effective in tumor control. Late complications can be kept to a minimum (<5% bowel surgery, <1% radiation hepatitis, < 1% treatment mortality), but their frequency increases with increasing total radiation dosage, increasing fraction size, and possibly the extent of the previous surgical procedures (Dembo 1985a). Optimal selection of patients for radiotherapy compared with other forms of treatment is based on grouping of patients according to prognostic factors, including presenting stage of disease, amount and site of residual tumor, and histophatologic features. The potential exists for abdominopelvic radiation to be applied curatively as consolidation or as salvage therapy for patients whose disease has not been completely eradicated by chemotherapy;however, further study is needed to clarify the magnitude of this benefit, the situations in which radiotherapy is indicated, and factors that determine the toxicity of the combined-modality treatment

  12. Radiation therapy of psoriasis and parapsoriasis

    International Nuclear Information System (INIS)

    Wiskemann, A.

    1982-01-01

    Selective UV-Phototherapy with lambda 300-320 nm (SUP) as well as oral photochemotherapy with 8-methoxy-psoralen plus UVA-radiation (PUVA intern) are very effective in clearing the lesions of the generalized psoriasis and those of the chronic forms of parapsoriasis. Being treated with 4 suberythemal doses per week psoriasis patients are free or nearly free of symptoms after averagely 6.3 weeks of SUP-therapy or after 5.3 weeks of PUVA orally. The PUVA-therapy is mainly indicated in pustular, inverse and erythrodermic psoriasis as well as in parapsoriasis en plaques and variegata. In all other forms of psoriasis and in pityriasis lichenoides-chronica, we prefer the SUP-therapy because of less acute or chronic side effects, and because of its better practicability. X-rays are indicated in psoriais of nails, grenz-rays in superficial psoriatic lesions of the face, the armpits, the genitals and the anal region. (orig.) [de

  13. Radiation therapy for malignant gliomas in adults. Analysis of treatment results regarding factors on the radiation technique

    International Nuclear Information System (INIS)

    Tanaka, Yoshiaki; Kawamori, Jiro; Saito, Tsutomu; Karasawa, Katsuyuki; Shitara, Nobuyuki; Matsutani, Masao.

    1997-01-01

    During 19 years, 309 patients with astrocytic tumors (173 of glioblastoma multiforme (GBM), 41 of anaplastic astrocytoma (AA), and 95 of astrocytoma) were treated with radiation therapy. Initially a dose of 50 Gy was given with an extended field, then the target volume was decreased to the contrast enhancing lesion plus 1-2 cm margin and treated to the total dose ranging from 60 Gy to 66 Gy for GBM and about 60 Gy for AA. Fifty-four patients underwent surgical resection combined with a single dose of 15-20 Gy by intraoperative radiation therapy (IORT). The one-, 2-, and 3-year survival rates and the median survival time (MST) of patients with GBM were 56%, 27%, 16%, and 495 days, respectively. For patients with AA, these were 63%, 50%, 33%, and 762 days, respectively. From analysis on GBM, patients treated with IORT were survived longer than without IORT, significantly (p 2 , were significantly inferior than with less portal size (p<0.05). Patients treated with conformation radiotherapy (CFRT) were superior on survival rates than without it on GBM, however, there was no difference on AA. The treatment factors for radiation therapy which affected for prolonging survival time were considered as dose, size of irradiated portals, application of IORT and CFRT, especially on patients with GBM. (author)

  14. Indications for surgical resection of benign pancreatic tumors; Indikationen zur chirurgischen Therapie benigner Pankreastumoren

    Energy Technology Data Exchange (ETDEWEB)

    Isenmann, R.; Henne-Bruns, D. [Chirurgische Universitaetsklinik, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie, Ulm (Germany)

    2008-08-15

    Benign pancreatic tumors should undergo surgical resection when they are symptomatic or - in the case of incidental discovery - bear malignant potential. This is the case for the majority of benign pancreatic tumors, especially for intraductal papillary mucinous neoplasms or mucinous cystic adenomas. In addition, resection is indicated for all tumors where preoperative diagnostic fails to provide an exact classification. Several different operative techniques are available. The treatment of choice depends on the localization of the tumor, its size and on whether there is evidence of malignant transformation. Partial duodenopancreatectomy is the oncological treatment of choice for tumors of the pancreatic head whereas for tumors of the pancreatic tail a left-sided pancreatectomy is appropriate. Middle pancreatectomy or duodenum-preserving resection of the pancreatic head is not a radical oncologic procedure. They should only be performed in cases of tumors without malignant potential. (orig.) [German] Die Indikationsstellung zur Resektion benigner Pankreastumoren ist gegeben, wenn es sich um einen symptomatischen Tumor handelt oder - bei einem Zufallsbefund - um einen Tumor mit Potenzial zur malignen Entartung. Dies besteht bei der Mehrzahl der benignen Pankreastumoren, insbesondere bei der intraduktalen papillaeren muzinoesen Neoplasie (IPMN) oder muzinoesen Zystadenomen. Operativer Abklaerung beduerfen auch Tumoren, die unter Ausschoepfung aller diagnostischer Moeglichkeiten nicht eindeutig klassifizierbar sind. An chirurgischen Therapieverfahren stehen verschiedene Techniken zur Verfuegung. Die Wahl des Verfahren haengt von der Groesse und Lokalisation des Tumors ab und von der Frage, ob eine maligne Entartung bereits stattgefunden hat. Das onkologisch korrekte Standardresektionsverfahren bei Tumoren des Pankreaskopfes ist die partielle Duodenopankreatektomie, bei Tumoren des Pankreasschwanzes die Pankreaslinksresektion. Eine segmentale Resektion des

  15. Chemoradiation Therapy for Potentially Resectable Gastric Cancer: Clinical Outcomes Among Patients Who Do Not Undergo Planned Surgery

    International Nuclear Information System (INIS)

    Kim, Michelle M.; Mansfield, Paul F.; Das, Prajnan; Janjan, Nora A.; Badgwell, Brian D.; Phan, Alexandria T.; Delclos, Marc E.; Maru, Dipen; Ajani, Jaffer A.; Crane, Christopher H.; Krishnan, Sunil

    2008-01-01

    Purpose: We retrospectively analyzed treatment outcomes among resectable gastric cancer patients treated preoperatively with chemoradiation therapy (CRT) but rendered ineligible for planned surgery because of clinical deterioration or development of overt metastatic disease. Methods and Materials: Between 1996 and 2004, 39 patients with potentially resectable gastric cancer received preoperative CRT but failed to undergo surgery. At baseline clinical staging, 33 (85%) patients had T3-T4 disease, and 27 (69%) patients had nodal involvement. Most patients received 45 Gy of radiotherapy with concurrent 5-fluorouracil-based chemotherapy. Twenty-one patients underwent induction chemotherapy before CRT. Actuarial times to local control (LC), distant control (DC), and overall survival (OS) were calculated by the Kaplan-Meier method. Results: The cause for surgical ineligibility was development of metastatic disease (28 patients, 72%; predominantly peritoneal, 18 patients), poor performance status (5 patients, 13%), patient/physician preference (4 patients, 10%), and treatment-related death (2 patients, 5%). With a median follow-up of 8 months (range, 1-95 months), actuarial 1-year LC, DC, and OS were 46%, 12%, and 36%, respectively. Median LC and OS were 11.0 and 10.1 months, respectively. Conclusions: Patients with potentially resectable gastric cancer treated with preoperative CRT are found to be ineligible for surgery principally because of peritoneal progression. Patients who are unable to undergo planned surgery have outcomes comparable to that of patients with advanced gastric cancer treated with chemotherapy alone. CRT provides durable LC for the majority of the remaining life of these patients

  16. The Outcome of Postoperative Radiation Therapy for Patients with Stage II Pancreatic Cancer (T3 or N1 Disease)

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won; Chun, Misun; Kim, Myung Wook; Kim, Wook Hwan; Kang, Seok Yun; Kang, Seung Hee; Oh, Young Taek; Lee, Sunyoung; Yang, Juno [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2007-12-15

    Purpose: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. Materials and Methods: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. Results: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. Conclusion: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.

  17. The Outcome of Postoperative Radiation Therapy for Patients with Stage II Pancreatic Cancer (T3 or N1 Disease)

    International Nuclear Information System (INIS)

    Kim, Sang Won; Chun, Misun; Kim, Myung Wook; Kim, Wook Hwan; Kang, Seok Yun; Kang, Seung Hee; Oh, Young Taek; Lee, Sunyoung; Yang, Juno

    2007-01-01

    Purpose: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. Materials and Methods: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. Results: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. Conclusion: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer

  18. Whole-brain hippocampal sparing radiation therapy: Volume-modulated arc therapy vs intensity-modulated radiation therapy case study

    International Nuclear Information System (INIS)

    Lee, Katrina; Lenards, Nishele; Holson, Janice

    2016-01-01

    The hippocampus is responsible for memory and cognitive function. An ongoing phase II clinical trial suggests that sparing dose to the hippocampus during whole-brain radiation therapy can help preserve a patient's neurocognitive function. Progressive research and advancements in treatment techniques have made treatment planning more sophisticated but beneficial for patients undergoing treatment. The aim of this study is to evaluate and compare hippocampal sparing whole-brain (HS-WB) radiation therapy treatment planning techniques using volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). We randomly selected 3 patients to compare different treatment techniques that could be used for reducing dose to the hippocampal region. We created 2 treatment plans, a VMAT and an IMRT, from each patient's data set and planned on the Eclipse 11.0 treatment planning system (TPS). A total of 6 plans (3 IMRT and 3 VMAT) were created and evaluated for this case study. The physician contoured the hippocampus as per the Radiation Therapy Oncology Group (RTOG) 0933 protocol atlas. The organs at risk (OR) were contoured and evaluated for the plan comparison, which included the spinal cord, optic chiasm, the right and left eyes, lenses, and optic nerves. Both treatment plans produced adequate coverage on the planning target volume (PTV) while significantly reducing dose to the hippocampal region. The VMAT treatment plans produced a more homogenous dose distribution throughout the PTV while decreasing the maximum point dose to the target. However, both treatment techniques demonstrated hippocampal sparing when irradiating the whole brain.

  19. [Resected non-small cell bronchogenic carcinoma stage pIIIA-N2. Which patients will benefit most from adjuvant therapy?].

    Science.gov (United States)

    Gómez, Ana M; Jarabo, José Ramón; Fernandez, Cristina; Calatayud, Joaquín; Fernández, Elena; Torres, Antonio J; Balibrea, José L; Hernando, Florentino

    2014-04-01

    Controversy persists as regards the indications and results of surgery in the treatment of patients with stage pIIIA-N2 non-small cell lung cancer (NSCLC). The objective of this study was to analyze the overall survival of a multicentre series of these patients and the role of adjuvant treatment, looking for factors that may define subgroups of patients with an increased benefit from this treatment. A retrospective study was conducted on 287 patients, with stage pIIIA-N2 NSCLC subjected to complete resection, taken from a multi-institutional database of 2.994 prospectively collected consecutive patients who underwent surgery for lung cancer. Adjuvant treatment was administered in 238 cases (82.9%). Analyses were made of the age, gender, histological type, administration of induction and adjuvant chemotherapy and/or radiation therapy treatments. The 5-year survival was 24%, with a median survival of 22 months. Survival was 26.5% among patients receiving with adjuvant treatment, versus 10.7% for those without it (P=.069). Age modified the effect of adjuvant treatment on survival (interaction P=.049). In patients under 70 years of age with squamous cell carcinoma, adjuvant treatment reduced the mortality rate by 37% (hazard ratio: 0,63; 95% CI; 0,42-0,95; P=.036). Completely resected patients with stage pIIIA-N2 NSCLC receiving adjuvant treatment reached higher survival rates than those who did not. Maximum benefit was achieved by the subgroup of patients under 70 years of age with squamous cell carcinoma. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  20. Melanomas: radiobiology and role of radiation therapy

    International Nuclear Information System (INIS)

    Peschel, Richard E.

    1995-01-01

    Purpose/Objective: This course will review the radiobiology of malignant melanoma (MM) and the clinical use of radiation therapy for metastatic melanoma and selected primary sites. The course will emphasize the scientific principles underlying the clinical treatment of MM. Introduction: The incidence of malignant melanoma has one of the fastest growth rates in the world. In 1991, there were 32,000 cases and 7,000 deaths from MM in the United States. By the year 2000, one of every 90 Americans will develop MM. Wide local excision is the treatment of choice for Stage I-II cutaneous MM. Five-year survival rates depend on (a) sex: female-63%, male-40%; (b) tumor thickness: t 4 mm-25%; (c) location: extremity-60%, trunk-41%; and (d) regional lymph node status: negative-77%, positive-31%. Despite adequate surgery, 45-50% of all MM patients will develop metastatic disease. Radiobiology: Both the multi-target model: S = 1-(1-e-D/Do)n and the linear quadratic mode: -In(S) = alpha x D + beta x D2 predict a possible benefit for high dose per fraction (> 400 cGy) radiation therapy for some MM cell lines. The extrapolation number (n) varies from 1-100 for MM compared to other mammalian cells with n=2-4. The alpha/beta ratios for a variety of MM cell lines vary from 1 to 33. Other radiobiologic factors (repair of potentially lethal damage, hypoxia, reoxygenation, and repopulation) predict a wide variety of clinical responses to different time-dose prescriptions including high dose per fraction (> 400 cGy), low dose per fraction (200-300 cGy), or b.i.d. therapy. Based on a review of the radiobiology of MM, no single therapeutic strategy emerges which could be expected to be successful for all tumors. Time-Dose Prescriptions: A review of the retrospective and prospective clinical trials evaluating various time-dose prescriptions for MM reveals: (1) MM is a radiosensitive tumor over a wide range of diverse time-dose prescriptions; and (2) The high clinical response rates to a

  1. Exposure Risks Among Children Undergoing Radiation Therapy: Considerations in the Era of Image Guided Radiation Therapy

    International Nuclear Information System (INIS)

    Hess, Clayton B.; Thompson, Holly M.; Benedict, Stanley H.; Seibert, J. Anthony; Wong, Kenneth; Vaughan, Andrew T.; Chen, Allen M.

    2016-01-01

    Recent improvements in toxicity profiles of pediatric oncology patients are attributable, in part, to advances in the field of radiation oncology such as intensity modulated radiation (IMRT) and proton therapy (IMPT). While IMRT and IMPT deliver highly conformal dose to targeted volumes, they commonly demand the addition of 2- or 3-dimensional imaging for precise positioning—a technique known as image guided radiation therapy (IGRT). In this manuscript we address strategies to further minimize exposure risk in children by reducing effective IGRT dose. Portal X rays and cone beam computed tomography (CBCT) are commonly used to verify patient position during IGRT and, because their relative radiation exposure is far less than the radiation absorbed from therapeutic treatment beams, their sometimes significant contribution to cumulative risk can be easily overlooked. Optimizing the conformality of IMRT/IMPT while simultaneously ignoring IGRT dose may result in organs at risk being exposed to a greater proportion of radiation from IGRT than from therapeutic beams. Over a treatment course, cumulative central-axis CBCT effective dose can approach or supersede the amount of radiation absorbed from a single treatment fraction, a theoretical increase of 3% to 5% in mutagenic risk. In select scenarios, this may result in the underprediction of acute and late toxicity risk (such as azoospermia, ovarian dysfunction, or increased lifetime mutagenic risk) in radiation-sensitive organs and patients. Although dependent on variables such as patient age, gender, weight, body habitus, anatomic location, and dose-toxicity thresholds, modifying IGRT use and acquisition parameters such as frequency, imaging modality, beam energy, current, voltage, rotational degree, collimation, field size, reconstruction algorithm, and documentation can reduce exposure, avoid unnecessary toxicity, and achieve doses as low as reasonably achievable, promoting a culture and practice of “gentle IGRT.”

  2. Exposure Risks Among Children Undergoing Radiation Therapy: Considerations in the Era of Image Guided Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hess, Clayton B. [Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California (United States); Thompson, Holly M. [Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento, California (United States); Benedict, Stanley H. [Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California (United States); Seibert, J. Anthony [Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento, California (United States); Wong, Kenneth [Department of Radiation Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, University of California David Geffen School of Medicine, Los Angeles, California (United States); Vaughan, Andrew T. [Department of Radiation Oncology, University California Davis Comprehensive Cancer Center, Sacramento, California (United States); Chen, Allen M., E-mail: allenmchen@yahoo.com [Department of Radiation Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, University of California David Geffen School of Medicine, Los Angeles, California (United States)

    2016-04-01

    Recent improvements in toxicity profiles of pediatric oncology patients are attributable, in part, to advances in the field of radiation oncology such as intensity modulated radiation (IMRT) and proton therapy (IMPT). While IMRT and IMPT deliver highly conformal dose to targeted volumes, they commonly demand the addition of 2- or 3-dimensional imaging for precise positioning—a technique known as image guided radiation therapy (IGRT). In this manuscript we address strategies to further minimize exposure risk in children by reducing effective IGRT dose. Portal X rays and cone beam computed tomography (CBCT) are commonly used to verify patient position during IGRT and, because their relative radiation exposure is far less than the radiation absorbed from therapeutic treatment beams, their sometimes significant contribution to cumulative risk can be easily overlooked. Optimizing the conformality of IMRT/IMPT while simultaneously ignoring IGRT dose may result in organs at risk being exposed to a greater proportion of radiation from IGRT than from therapeutic beams. Over a treatment course, cumulative central-axis CBCT effective dose can approach or supersede the amount of radiation absorbed from a single treatment fraction, a theoretical increase of 3% to 5% in mutagenic risk. In select scenarios, this may result in the underprediction of acute and late toxicity risk (such as azoospermia, ovarian dysfunction, or increased lifetime mutagenic risk) in radiation-sensitive organs and patients. Although dependent on variables such as patient age, gender, weight, body habitus, anatomic location, and dose-toxicity thresholds, modifying IGRT use and acquisition parameters such as frequency, imaging modality, beam energy, current, voltage, rotational degree, collimation, field size, reconstruction algorithm, and documentation can reduce exposure, avoid unnecessary toxicity, and achieve doses as low as reasonably achievable, promoting a culture and practice of “gentle IGRT.”.

  3. The Effect of Therapy Oriented CT in Radiation Therapy Planning

    International Nuclear Information System (INIS)

    Kim, Sung Kyu; Shin, Sei One; Kim, Myung Se

    1987-01-01

    The success of radiation therapy depends on exact treatment of the tumor with significant high dose for maximizing local control and excluding the normal tissues for minimizing unwanted complications. To achieve these goals, correct estimation of target volume in three dimension, exact dose distribution in tumor and normal critical structures and correction of tissue inhomogeneity are required. The effect of therapy oriented CT (planning CT) were compared with conventional simulation method in necessity of planning change, set dose, and proper distribution of tumor dose. Of 365 new patients examined, planning CT was performed in 104 patients (28%). Treatment planning was changed in 47% of head and neck tumor, 79% of intrathoracic tumor and 63% of abdominal tumor. In breast cancer and musculoskeletal tumors, planning CT was recommended for selection of adequate energy and calculation of exact dose to critical structures such as kidney or spinal cord. The average difference of tumor doses between CT planning and conventional simulation was 10% in intrathoracic and intra-abdominal tumors but 20% in head and neck tumors which suggested that tumor dose may be overestimated in conventional simulation. Although some limitations and disadvantages including the cost and irradiation during CT are still criticizing, our study showed that CT planning is very helpful in radiotherapy planning

  4. Guidelines for radiation therapy in clinical research on bladder cancer

    International Nuclear Information System (INIS)

    Shipley, W.U.; VanderSchueren, E.; Kitagawa, T.; Gospodarowicz, M.K.; Frommhold, H.; Magno, L.; Mochizuki, S.; VanderBogaert, W.; VanderWerf-Messing, B.

    1986-01-01

    Bladder cancer is a heterogeneous disease and that there are important tumor characteristics that will predict significant differences in radiation responsiveness. These should in all instances be well documented prospectively in any treatment protocol. However, in this chapter the authors stress a number of factors related to the tumor at presentation as well as the administration of the radiation therapy that can importantly affect the efficacy of the radiation on the patient's tumor, as well as on his or her normal tissues. As Radiation Oncologists, they are most interested in the conducting and reporting of prospective clinical investigations in the use of radiation therapy in the treatment of patients with bladder carcinoma who will be treated with planned preservation of their bladder, but whose radiation therapy may be combined with additional planned bladder-sparing surgery, intraoperative radiation therapy, or chemotherapy

  5. Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

    International Nuclear Information System (INIS)

    Wijnmaalen, Arendjan; Helle, Peter A.; Koper, Peter C.M.; Jansen, Peter P.; Hanssens, Patrick E.J.; Boeken Kruger, Cornelis G.G.; Putten, Wim L.J. van

    1996-01-01

    Purpose: In our center interstitial radiation has played an important role in the treatment of bladder cancer patients for over 40 years. Radium needles, that were initially used, were replaced by caesium needles in 1983, whereas the afterloading iridium wire technique was adopted in 1989. Patients with solitary tumors (T1, T2 and T3) with a surface diameter of < 5 cm are considered for interstitial radiation. In this study we report on the results of the afterloading iridium wire technique in patients with muscle invasive bladder cancer. Materials and Methods: From May 1989 to September 1993 interstitial radiation using iridium wires was part of the treatment in 46 patients with muscle invasive bladder cancer (37 T2, 9 T3). The mean age was 67 years. After transurethral resection of all visible tumor (if possible), in most cases 40 Gy (20 x 2.0 Gy, midplane dose) external beam radiation was delivered to the true pelvis, followed by 30 Gy interstitial radiation using iridium-192 wires covering the tumor area in the bladder. Results: After a median follow-up of 26 months, bladder relapses occurred in 7 patients. In 5 of them the tumor relapsed in the initial area, in 1 patient elsewhere in the bladder and in 1 patient tumor recurred in and outside the initial site. Recurrence was superficial (T1) in 4 patients. A relapse in the urethra was found once. Metastases developed in 13 patients, in 8 without bladder relapse. During the observation period 17 patients died, 13 due to bladder cancer. The actuarial bladder relapse-free survival at 4 years was 74% and 82% for T2 and T3 tumors, respectively. The actuarial distant metastases-free survival was 65% for both categories. No serious toxicity was recorded. Conclusion: In a selected group of patients with muscle invasive bladder cancer transurethral resection in combination with external beam and interstitial radiation provides an excellent opportunity to preserve the bladder with a high chance of success. Development of

  6. A quantitative analysis of craniopharyngioma cyst expansion during and after radiation therapy and surgical implications.

    Science.gov (United States)

    Lamiman, Kelly; Wong, Kenneth K; Tamrazi, Benita; Nosrati, Jason D; Olch, Arthur; Chang, Eric L; Kiehna, Erin N

    2016-12-01

    OBJECTIVE When complete resection of craniopharyngioma is not achievable or the sequelae are prohibitive, limited surgery and radiation therapy have demonstrated excellent local disease control while minimizing treatment-related sequelae. When residual tissue exists, there is a propensity for further cyst development and expansion during and after radiation therapy. This can result in obstructive hydrocephalus, visual changes, and/or clinical decline. The authors present a quantitative analysis of cyst expansion during and after radiotherapy and examine how it affected subsequent management. METHODS The authors performed an institutional review board-approved retrospective study of patients with histologically confirmed craniopharyngioma treated between 2000 and 2015 with surgery and intensity-modulated radiation therapy (IMRT) at a single institution. Volumetric measurements of cyst contours were generated by radiation oncology treatment planning software postoperatively, during IMRT, and up to 12 months after IMRT. Patient, tumor, and treatment-related variables were collected until the last known follow-up and were analyzed. RESULTS Twenty-seven patients underwent surgery and IMRT. The median total radiation dose was 54 Gy. Of the 27 patients, 11 patients (40.7%) demonstrated cyst expansions within 1 year of IMRT. Of note, all tumors with cyst expansion were radiographically Puget Grade 2. Maximal cyst expansion peaked at 4.27 months following radiation therapy, with a median volume growth of 4.1 cm 3 (mean 9.61 cm 3 ) above the postoperative cyst volume. Eight patients experienced spontaneous cyst regression without therapeutic intervention. Three patients experienced MRI-confirmed cyst enlargement during IMRT, all of whom required adaptive planning to ensure adequate coverage of the entire tumor volume. Two of these 3 patients required ventriculoperitoneal shunt placement and additional intervention. One underwent additional resection, and the other had

  7. Resection of the primary tumour versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases (UICC stage IV): SYNCHRONOUS - a randomised controlled multicentre trial (ISRCTN30964555)

    International Nuclear Information System (INIS)

    Rahbari, Nuh N; Koch, Moritz; Büchler, Markus W; Kieser, Meinhard; Weitz, Jürgen; Lordick, Florian; Fink, Christine; Bork, Ulrich; Stange, Annika; Jäger, Dirk; Luntz, Steffen P; Englert, Stefan; Rossion, Inga

    2012-01-01

    Currently, it remains unclear, if patients with colon cancer and synchronous unresectable metastases who present without severe symptoms should undergo resection of the primary tumour prior to systemic chemotherapy. Resection of the primary tumour may be associated with significant morbidity and delays the beginning of chemotherapy. However, it may prevent local symptoms and may, moreover, prolong survival as has been demonstrated in patients with metastatic renal cell carcinoma. It is the aim of the present randomised controlled trial to evaluate the efficacy of primary tumour resection prior to systemic chemotherapy to prolong survival in patients with newly diagnosed colon cancer who are not amenable to curative therapy. The SYNCHRONOUS trial is a multicentre, randomised, controlled, superiority trial with a two-group parallel design. Colon cancer patients with synchronous unresectable metastases are eligible for inclusion. Exclusion criteria are primary tumour-related symptoms, inability to tolerate surgery and/or systemic chemotherapy and history of another primary cancer. Resection of the primary tumour as well as systemic chemotherapy is provided according to the standards of the participating institution. The primary endpoint is overall survival that is assessed with a minimum follow-up of 36 months. Furthermore, it is the objective of the trial to assess the safety of both treatment strategies as well as quality of life. The SYNCHRONOUS trial is a multicentre, randomised, controlled trial to assess the efficacy and safety of primary tumour resection before beginning of systemic chemotherapy in patients with metastatic colon cancer not amenable to curative therapy. http://www.controlled-trials.com/ISRCTN30964555

  8. Quality assurance in radiation therapy: clinical aspects

    International Nuclear Information System (INIS)

    Souhami, L.

    1984-01-01

    A survey was conducted in Latin America to evaluate the clinical aspects of quality assurance in radiotherapy. A questionnaire was prepared and sent to 46 institutions. Twenty-seven centers (58.5%), from nine countries, answered the questionnaire. The study was divided into three topics: a) patient-related statistics; b) staffing and education; and c) equipment and facilities. Radiotherapy training programs are available in only 37% of the centers studied. A large number of megavoltage units are old, operating at a shorter than optimum distance with sources of very low activity. The number of high energy linear accelerators is unsatisfactory. Problems in treatment planning facilities were also identified. Regionalization of radiation therapy services is recommended as a possible way to improve quality at a reasonable cost

  9. Radiation therapy of the nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Chatani, M.; Matayoshi, Y.; Masaki, N.; Fujii, T.; Umatani, K.; Yoshino, K.; Sato, T.

    1993-01-01

    Between September 1977 and December 1989, 89 consecutive patients of nasopharyngeal carcinoma were treated with radiation therapy. The study comprized of 66 males and 23 females; their ages ranged 17 to 80 years (mean 55 years). Five-years survival rates according to stage were as follows: stages I and II (n=10), 90%; stage III (n=10), 43%; stage IV (n=69), 47%. The important prognostic factors for predicting poor prognostic in this series, which were shown by stepwise proportional hazard (Cox) model, were the level of lactate dehydrogenase (LDH) and neck node involvement. LDH level also influenced nodal failure (p=0.0002) and distant metastatis (p=0.006). (orig.) [de

  10. Radiation therapy in the elderly patient

    International Nuclear Information System (INIS)

    Brady, L.W.; Markoe, A.M.

    1986-01-01

    Since cancer is primarily a disease of the older population, the major questions relate to the stage of the disease at the time of initial presentation, a decision as to whether the tumor can be cured or only palliated, and how best to design a treatment program which maximizes the potential for cure or palliation with the minimum in terms of complications as a consequence of the treatment program being pursued. Within this decision, specific emphasis is to be placed on treatment programs that can be tolerated by the older patient without compromising the potential for tumor control. Therefore, the basic goals in cancer management using radiation therapy techniques relate to the potential for cure of the patient, emphasis on improvement in the quality of life as related to improvement relative to symptoms and the potential for preservation of anatomy and function

  11. Method of radiation therapy treatment planning

    International Nuclear Information System (INIS)

    Hodes, L.

    1976-01-01

    A technique of radiation therapy treatment planning designed to allow the assignment of dosage limits directly to chosen points in the computer-displayed cross-section of the patient. These dosage limits are used as constraints in a linear programming attempt to solve for beam strengths, minimizing integral dosage. If a feasible plan exists, the optimized plan will be displayed for approval as an isodose pattern. If there is no feasible plan, the operator/therapist can designate some of the point dosage constraints as ''relaxed.'' Linear programming will then optimize for minimum deviation at the relaxed points. This process can be iterated and new points selected until an acceptable plan is realized. In this manner the plan is optimized for uniformity as well as overall low dosage. 6 claims, 6 drawing figures

  12. Who Benefits From Adjuvant Radiation Therapy for Gastric Cancer? A Meta-Analysis

    International Nuclear Information System (INIS)

    Ohri, Nitin; Garg, Madhur K.; Aparo, Santiago; Kaubisch, Andreas; Tome, Wolfgang; Kennedy, Timothy J.; Kalnicki, Shalom; Guha, Chandan

    2013-01-01

    Purpose: Large randomized trials have demonstrated significant survival benefits with the use of adjuvant chemotherapy or chemoradiation therapy for gastric cancer. The importance of adjuvant radiation therapy (RT) remains unclear. We performed an up-to-date meta-analysis of randomized trials testing the use of RT for resectable gastric cancer. Methods and Materials: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized trials testing adjuvant (including neoadjuvant) RT for resectable gastric cancer. Hazard ratios describing the impact of adjuvant RT on overall survival (OS) and disease-free survival (DFS) were extracted directly from the original studies or calculated from survival curves. Pooled estimates were obtained using the inverse variance method. Subgroup analyses were performed to determine whether the efficacy of RT varies with chemotherapy use, RT timing, geographic region, type of nodal dissection performed, or lymph node status. Results: Thirteen studies met all inclusion criteria and were used for this analysis. Adjuvant RT was associated with a significant improvement in both OS (HR = 0.78, 95% CI: 0.70-0.86, P<.001) and DFS (HR = 0.71, 95% CI: 0.63-0.80, P<.001). In the 5 studies that tested adjuvant chemoradiation therapy against adjuvant chemotherapy, similar effects were seen for OS (HR = 0.83, 95% CI: 0.67-1.03, P=.087) and DFS (HR = 0.77, 95% CI: 0.91-0.65, P=.002). Available data did not reveal any subgroup of patients that does not benefit from adjuvant RT. Conclusion: In randomized trials for resectable gastric cancer, adjuvant RT provides an approximately 20% improvement in both DFS and OS. Available data do not reveal a subgroup of patients that does not benefit from adjuvant RT. Further study is required to optimize the implementation of adjuvant RT for gastric cancer with regard to patient selection and integration with systemic therapy

  13. Radiation Therapy in Peru: Achievements and Challenges

    International Nuclear Information System (INIS)

    Guerrero, P.; Má, C.; Venegas, D.; Bustamante, R.

    2015-01-01

    Peru is the fastest growing economy in Latin America (sustained increase in GDP, low inflation and poverty reduction). The health system is fragmented and until 2012, almost half of the population had no health insurance. The current government poses: Improved access to health and education, employment and social security, reducing extreme poverty, within a context of social inclusion. The Plan for Prevention and Control of Cancer (“Plan Esperanza”) was established in 2012 in order to reduce cancer mortality and morbidity, with greater access to oncology services (promotion, prevention, early diagnosis, treatment and palliative care). With an area of 1 285 216 square kilometers and almost 30 million inhabitants, cancer treatment resources are scarce. Regarding Radiation Therapy, until 2007, it existed only in Lima, the capital city (over 9 million inhabitants). Later, another services were established in two more regions. At present, there is 23 radiotherapy machines in whole country. In this regard, Plan Esperanza is working on strengthening Radiation Therapy Services nationwide. Considering the population demand and availability of other cancer services (chemotherapy, oncologic surgery), the regions where need create new radiotherapy services were identified: 3 Hospitals in Lima (in peripheral areas: Cayetano Heredia at the North, Hipólito Unanue at East and Maria Auxiliadora at South). Also, other Regions of the country: Piura, Lambayeque, La Libertad at North; Junín in the Central Highland, Cusco in the Southern Highland, and Loreto in the Northern Forest. Each with 2 linear accelerators, except Loreto, where they will consider two 60 Cobalt bomb instead, due to the geographical conditions. Moreover, one linear accelerator in Arequipa Region will be acquired. In Lima, the Hospitals are projected to become operational in 2016, while in the Regions, the Ministry of Health is providing them technical assistance in needs identification, planning and

  14. Definition of treatment geometry in radiation therapy

    International Nuclear Information System (INIS)

    Aaltonen, P.

    1996-01-01

    When accurate systems for quality assurance and treatment optimization are employed, a precise system for fixation and dosimetric and portal verification are as important as a continued and standardized code of practice for dosimetry and patient follow-up, including registration of tumour responses and acute and late normal tissue reactions. To improve the accuracy of existing dose response relations in order to improve future therapy the treatment geometry and dose delivery concepts have to be accurately defined and uniformly employed. A Nordic working group was set up in 1991 (by Nordic Association of Clinica Physics) to standardize the concepts and quantities used during the whole radiotherapy process in the Nordic countries. Now the group is finalizing its report ''Specification of Dose Delivery in Radiation Therapy''. The report emphasizes that the treatment geometry shall be consistent with the geometry used during the diagnostic work up. The patient fixation is of importance early in the diagnostic phase to ensure that the same reference points and patients position will be used both during the diagnostic work up, simulation and treatment execution. Reference Coordinate System of the patient is a concept based on defined anatomic reference points. This Patient Reference System is a local system which has validity for the tissues, organs and volumes defined during radiotherapy. The reference points of the Patient Reference System should in turn be used for beam set-up. The treatment geometry is then defined by using different concepts describing tissues which are mobile in the Patient Reference System, and finally, volumes which are fixed in this coordinate system. A Set-up Margin has to be considered for movements of the volumes defined in the Reference Coordinate System of the Patient in relation to the radiation beam. The Set-up Margin is dependent on the treatment technique and it is needed in the treatment planning procedure to ensure that the prescribed

  15. Definition of treatment geometry in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Aaltonen, P [Finnish Centre for Radiation and Nuclear Safety (STUK), Helsinki (Finland)

    1996-08-01

    When accurate systems for quality assurance and treatment optimization are employed, a precise system for fixation and dosimetric and portal verification are as important as a continued and standardized code of practice for dosimetry and patient follow-up, including registration of tumour responses and acute and late normal tissue reactions. To improve the accuracy of existing dose response relations in order to improve future therapy the treatment geometry and dose delivery concepts have to be accurately defined and uniformly employed. A Nordic working group was set up in 1991 to standardize the concepts and quantities used during the whole radiotherapy process in the Nordic countries. Now the group is finalizing its report ``Specification of Dose Delivery in Radiation Therapy``. The report emphasizes that the treatment geometry shall be consistent with the geometry used during the diagnostic work up. The patient fixation is of importance early in the diagnostic phase to ensure that the same reference points and patients position will be used both during the diagnostic work up, simulation and treatment execution. Reference Coordinate System of the patient is a concept based on defined anatomic reference points. This Patient Reference System is a local system which has validity for the tissues, organs and volumes defined during radiotherapy. The reference points of the Patient Reference System should in turn be used for beam set-up. The treatment geometry is then defined by using different concepts describing tissues which are mobile in the Patient Reference System, and finally, volumes which are fixed in this coordinate system. A Set-up Margin has to be considered for movements of the volumes defined in the Reference Coordinate System of the Patient in relation to the radiation beam. The Set-up Margin is dependent on the treatment technique and it is needed in the treatment planning procedure to ensure that the prescribed dose to the Target Volume is delivered.

  16. Squamous cell carcinoma of the trachea in a non-smoking woman after radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ishiwa, Naoki; Yamada, Kouzou; Nakayama, Haruhiko; Noda, Kazumasa [Kanagawa Cancer Center, Yokohama (Japan); Kameda, Youichi; Maehara, Takamitsu

    2000-04-01

    Few cases of squamous cell carcinoma of the trachea have been reported in non-smoking women. We report one case which was probably due to radiation therapy. A 50-year-old non-smoking woman was referred to our hospital because wheezing and dyspnea had been aggravated for 3 months. She had received radiation therapy ({sup 60}Cobalt) after standard radical mastectomy for right breast cancer 13 years previously. Bronchoscopic findings and chest CT scan showed tracheal stenosis due to the tumor. Sleeve resection of the trachea was performed, and the tumor was histologically diagnosed as poorly differentiated squamous cell carcinoma. We may consider this case to be radiation-induced cancer compatible with the most strict criteria of radiation induced malignancy. (author)

  17. Experimental frontiers in radiation therapy of cancer

    International Nuclear Information System (INIS)

    Kaplan, H.S.

    1979-01-01

    Eighty years of the history of radiation therapy are reviewed. Discovery of X-ray, radioactivity and radium was made at the end of the 19th Century. The products of nuclear fission reactions such as 60 Co and the high-energy beam generated by megavoltage devices are used as effective tools to ionize beneath the skin surface where cancerous change is present. Development of more selective devices was performed from both the irradiating means and chemically sensitive and selective sensitizers. Differential radioprotection is also a valid means to improve therapeutic gain. The radiosensitivity of mammalian cells is reduced approximately 3-fold when they are irradiated in nitrogen atmosphere rather than in air or in oxygen. As the differential modification of radiosensitivity currently used, the following means are practiced: (a) increased yield of irreversible radiation lesions, (b) increased intrinsic sensitivity of target DNA, (c) inhibition of repair, (d) optimization of dose fractionation schedules and (e) differential radioprotection of normal tumors. With 156 references up to 1978. (Yamashita, S.)

  18. Influencing programmable pacemakers by radiation therapy

    International Nuclear Information System (INIS)

    Wilm, M.; Kronholz, H.L.; Schuetz, J.; Koch, T.

    1994-01-01

    More than 300,000 pacemakers are implanted worldwide. During radiation therapy a damage of the pacemaker elektronic is possible. Twenty pacemakers have been irradiated with photons or electrons experimentally in three different situations: a) pacemaker and pacemaker electrode outside of the irradiation field; b) pacemaker outside, pacemaker electrode inside the irradiation field; c) all things inside the irradiation field. The voltage in the pacemaker electrode produced by the electric field of the accelerator did not exceed 0.8 mV if the electrode was outside the irradiation field. Induced voltage was up to 1.2 mV during irradiation with electrons (18 MeV) and the electrode being inside the treatment field with more than two thirds of its length. After delivering of not more than 10 Gy (photons) to the pacemaker, a decreasing amplitude of the pacemaker pulse occurred. The pulse frequency did not show any deviation. This seems to signal a severe early irreversible damage of the pacemaker that may cause sudden breakdown days or weeks after radiation. Two pacemakers showed a complete breakdown after irradiation with not more than 10 Gy. The others had a complete breakdown beyond doses of 50 Gy. (orig./MG) [de

  19. Diagnostic imaging and radiation therapy equipment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1990-05-01

    This is the third edition of CSA Standard C22.2 No. 114 (now CAN/CSA-C22.2 No. 114), which is one of a series of standards issued by the Canadian Standards Association under Part II of the Canadian Electrical Code. This edition marks an important shift towards harmonization of Canadian requirements with those of the European community and the United States. Also important to this edition is the expansion of its scope to include the complete range of diagnostic imaging and radiation therapy equipment, rather than solely radiation-emitting equipment. In so doing, equipment previously addressed by CSA Standard C22.2 No. 125, Electromedical Equipment, specifically lasers for medical applications and diagnostic ultrasound units, is now dealt with in the new edition. By virtue of this expanded scope, many of the technical requirements in the electromedical equipment standard have been introduced to the new edition, thereby bringing CSA Standard C22.2 No. 114 up to date. 14 tabs., 16 figs.

  20. Diagnostic imaging and radiation therapy equipment

    International Nuclear Information System (INIS)

    1990-05-01

    This is the third edition of CSA Standard C22.2 No. 114 (now CAN/CSA-C22.2 No. 114), which is one of a series of standards issued by the Canadian Standards Association under Part II of the Canadian Electrical Code. This edition marks an important shift towards harmonization of Canadian requirements with those of the European community and the United States. Also important to this edition is the expansion of its scope to include the complete range of diagnostic imaging and radiation therapy equipment, rather than solely radiation-emitting equipment. In so doing, equipment previously addressed by CSA Standard C22.2 No. 125, Electromedical Equipment, specifically lasers for medical applications and diagnostic ultrasound units, is now dealt with in the new edition. By virtue of this expanded scope, many of the technical requirements in the electromedical equipment standard have been introduced to the new edition, thereby bringing CSA Standard C22.2 No. 114 up to date. 14 tabs., 16 figs

  1. Ultraviolet radiation therapy and UVR dose models

    Energy Technology Data Exchange (ETDEWEB)

    Grimes, David Robert, E-mail: davidrobert.grimes@oncology.ox.ac.uk [School of Physical Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland and Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Gray Laboratory, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ (United Kingdom)

    2015-01-15

    Ultraviolet radiation (UVR) has been an effective treatment for a number of chronic skin disorders, and its ability to alleviate these conditions has been well documented. Although nonionizing, exposure to ultraviolet (UV) radiation is still damaging to deoxyribonucleic acid integrity, and has a number of unpleasant side effects ranging from erythema (sunburn) to carcinogenesis. As the conditions treated with this therapy tend to be chronic, exposures are repeated and can be high, increasing the lifetime probability of an adverse event or mutagenic effect. Despite the potential detrimental effects, quantitative ultraviolet dosimetry for phototherapy is an underdeveloped area and better dosimetry would allow clinicians to maximize biological effect whilst minimizing the repercussions of overexposure. This review gives a history and insight into the current state of UVR phototherapy, including an overview of biological effects of UVR, a discussion of UVR production, illness treated by this modality, cabin design and the clinical implementation of phototherapy, as well as clinical dose estimation techniques. Several dose models for ultraviolet phototherapy are also examined, and the need for an accurate computational dose estimation method in ultraviolet phototherapy is discussed.

  2. Ultraviolet radiation therapy and UVR dose models

    International Nuclear Information System (INIS)

    Grimes, David Robert

    2015-01-01

    Ultraviolet radiation (UVR) has been an effective treatment for a number of chronic skin disorders, and its ability to alleviate these conditions has been well documented. Although nonionizing, exposure to ultraviolet (UV) radiation is still damaging to deoxyribonucleic acid integrity, and has a number of unpleasant side effects ranging from erythema (sunburn) to carcinogenesis. As the conditions treated with this therapy tend to be chronic, exposures are repeated and can be high, increasing the lifetime probability of an adverse event or mutagenic effect. Despite the potential detrimental effects, quantitative ultraviolet dosimetry for phototherapy is an underdeveloped area and better dosimetry would allow clinicians to maximize biological effect whilst minimizing the repercussions of overexposure. This review gives a history and insight into the current state of UVR phototherapy, including an overview of biological effects of UVR, a discussion of UVR production, illness treated by this modality, cabin design and the clinical implementation of phototherapy, as well as clinical dose estimation techniques. Several dose models for ultraviolet phototherapy are also examined, and the need for an accurate computational dose estimation method in ultraviolet phototherapy is discussed

  3. Radiation therapy tolerance doses for treatment planning

    International Nuclear Information System (INIS)

    Lyman, J.T.

    1987-01-01

    To adequately plan acceptable dose distributions for radiation therapy treatments it is necessary to ensure that normal structures do not receive unacceptable doses. Acceptable doses are generally those that are below a stated tolerance dose for development of some level of complication. To support the work sponsored by the National Cancer Institute, data for the tolerance of normal tissues or organs to low-LET radiation has been compiled from a number of sources. These tolerance dose data are ostensibly for uniform irradiation of all or part of an organ, and are for either 5% (TD 5 ) or 50% (TD 50 ) complication probability. The ''size'' of the irradiated organ is variously stated in terms of the absolute volume or the fraction of the organ volume irradiated, or the area or the length of the treatment field. The accuracy of these data is questionable. Much of the data represent doses that one or several experienced therapists have estimated could be safely given rather than quantitative analyses of clinical observations. Because these data have been obtained from multiple sources with possible different criteria for the definition of a complication, there are sometimes different values for what is apparently the same end point. 20 refs., 1 fig., 1 tab

  4. Liver cancer and selective internal radiation therapy

    International Nuclear Information System (INIS)

    Sutton, C.

    2002-01-01

    Liver cancer is the biggest cancer-related killer of adults in the world. Liver cancer can be considered as two types: primary and secondary (metastatic). Selective Internal Radiation Therapy (SIRT) is a revolutionary treatment for advanced liver cancer that utilises new technologies designed to deliver radiation directly to the site of tumours. SIRT, on the other hand, involves the delivery of millions of microscopic radioactive spheres called SIR-Spheres directly to the site of the liver tumour/s, where they selectively irradiate the tumours. The anti-cancer effect is concentrated in the liver and there is little effect on cancer at other sites such as the lungs or bones. The SIR-Spheres are delivered through a catheter placed in the femoral artery of the upper thigh and threaded through the hepatic artery (the major blood vessel of the liver) to the site of the tumour. The microscopic spheres, each approximately 35 microns (the size of four red blood cells or one-third the diameter of a strand of hair), are bonded to yttrium-90 (Y-90), a pure beta emitter with a physical half-life of 64.1 hours (about 2.67 days). The microspheres are trapped in the tumour's vascular bed, where they destroy the tumour from inside. The average range of the radiation is only 2.5 mm, so it is wholly contained within the patient's body; after 14 days, only 2.5 percent of the radioactive activity remains. The microspheres are suspended in water for injection. The vials are shipped in lead shields for radiation protection. Treatment with SIR-Spheres is generally not regarded as a cure, but has been shown to shrink the cancer more than chemotherapy alone. This can increase life expectancy and improve quality of life. On occasion, patients treated with SIR-Spheres have had such marked shrinkage of the liver cancer that the cancer can be surgically removed at a later date. This has resulted in a long-term cure for some patients. SIRTeX Medical Limited has developed three separate cancer

  5. Management of optic pathway and chiasmatic-hypothalamic gliomas in children with radiation therapy

    International Nuclear Information System (INIS)

    Erkal, Haldun Suekrue; Serin, Meltem; Cakmak, Ahmet

    1997-01-01

    Background and purpose: Optic pathway and chiasmatic-hypothalamic gliomas are rare childhood tumors. This study presents the experience in management of these tumors with radiation therapy. Materials and methods: Thirty-three children with the diagnosis of optic pathway and chiasmatic-hypothalamic gliomas were treated with radiation therapy from 1973 through 1994 in the Department of Radiation Oncology at Ankara University Faculty of Medicine. Twenty-four children had optic pathway gliomas and nine had chiasmatic-hypothalamic gliomas. Evidence of neurofibromatosis was present in six children. Subtotal resection was performed in 22 children and a biopsy in seven. The most common prescription for total tumor dose was 50 Gy, delivered in 2 Gy daily fractions. Follow-up ranged from 0.5 to 16.1 years (mean, 13.6 years). Results: Overall, progression-free and cause-specific survival probabilities for the entire group were 93%, 82% and 93%, respectively, at 5 years and 79%, 77% and 88%, respectively, at 10 years. Differences in overall, progression-free and cause-specific survival probabilities between optic pathway and chiasmatic-hypothalamic gliomas were not statistically significant. Absence of evidence of neurofibromatosis correlated with significantly better progression-free and cause-specific survival probabilities. Conclusion: Radiation therapy is effective in stabilization or improvement of vision and prevention of tumor progression in both optic pathway and chiasmatic-hypothalamic gliomas

  6. Precise positioning of patients for radiation therapy

    International Nuclear Information System (INIS)

    Verhey, L.J.; Goitein, M.; McNulty, P.; Munzenrider, J.E.; Suit, H.D.

    1982-01-01

    A number of immobilization schemes which permit precise daily positioning of patients for radiation therapy are discussed. Pretreatment and post-treatment radiographs have been taken with the patient in the treatment position and analyzed to determine the amount of intratreatment movement. Studies of patients in the supine, seated and decubitus positions indicate mean movements of less than 1 mm with a standard deviation of less than 1 mm. Patients immobilized in the seated position with a bite block and a mask have a mean movement of about 0.5 mm +/- 0.3 mm (s.d.), and patients immobilized in the supine position with their necks hyperextended for submental therapy evidence a mean movement of about 1.4 mm +/- 0.9 mm (s.d.). With the exception of those used for the decubitus position, the immobilization devices are simply fabricated out of thermoplastic casting materials readily available from orthopedic supply houses. A study of day-to-day reproducibility of patient position using laser alignment and pretreatment radiographs for final verification of position indicates that the initial laser alignment can be used to position a patient within 2.2 mm +/- 1.4 mm (s.d.) of the intended position. These results indicate that rigid immobilization devices can improve the precision of radiotherapy, which would be advantageous with respect to both tumor and normal tissue coverage in certain situations

  7. Proton-beam radiation therapy dosimetry standardization

    International Nuclear Information System (INIS)

    Gall, K.P.

    1995-01-01

    Beams of protons have been used for radiation therapy applications for over 40 years. In the last decade the number of facilities treating patients and the total number of patients being treated has begun go grow rapidly. Due to the limited and experimental nature of the early programs, dosimetry protocols tended to be locally defined. With the publication of the AAPM Task Group 20 report open-quotes Protocol for Dosimetry of Heavy Charged Particlesclose quotes and the open-quotes European Code of Practice for Proton-Beam Dosimetryclose quotes the practice of determining dose in proton-beam therapy was somewhat unified. The ICRU has also recently commissioned a report on recommendations for proton-beam dosimetry. There have been three main methods of determining proton dose; the Faraday cup technique, the ionization chamber technique, and the calorimeter technique. For practical reasons the ionization chamber technique has become the most widely used. However, due to large errors in basic parameters (e.g., W-value) is also has a large uncertainty for absolute dose. It has been proposed that the development of water calorimeter absorbed dose standards would reduce the uncertainty in absolute proton dose as well as the relative dose between megavoltage X-ray beams and proton beams. The advantages and disadvantages are discussed

  8. Improvement of cerebral hypometabolism after resection of radiation-induced necrotic lesion in a patient with cerebral arteriovenous malformation

    International Nuclear Information System (INIS)

    Harada, Yae; Hirata, Kenji; Nakayama, Naoki; Yamaguchi, Shigeru; Yoshida, Michiharu; Onodera, Shunsuke; Manabe, Osamu; Shiga, Tohru; Terae, Satoshi; Shirato, Hiroki; Tamaki, Nagara

    2015-01-01

    A 55-year-old woman underwent radiosurgery for a left cerebral hemisphere arteriovenous malformation (AVM) and developed radiation-induced necrosis causing a massive edema in the surrounding brain tissues. Despite various therapies, the edema expanded to the ipsilateral hemisphere and induced neurological symptoms. The radiation-induced necrotic lesion was surgically removed 4 years after radiosurgery. While the preoperative FDG PET revealed severe hypometabolism in the left cerebrum, the necrotomy significantly ameliorated the brain edema, glucose metabolism (postoperative FDG PET), and symptoms. This case indicates that radiation necrosis-induced neurological deficits may be associated with brain edema and hypometabolism, which could be reversed by appropriate necrotomy

  9. Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy

    International Nuclear Information System (INIS)

    Torres, Mylin A.; Ballo, Matthew T.; Butler, Charles E.; Feig, Barry W.; Cormier, Janice N.; Lewis, Valerae O.; Pollock, Raphael E.; Pisters, Peter W.; Zagars, Gunar K.

    2007-01-01

    Purpose: The aim of this study was to evaluate outcome and treatment toxicity after wide local re-excision (WLE), with or without additional radiation therapy, for patients with isolated first local recurrence of soft-tissue sarcoma arising within a previously irradiated field. Methods: A retrospective review was performed of 62 consecutive patients. All patients underwent prior resection and external beam radiation. For recurrent disease, 25 patients were treated with WLE alone, and 37 patients were treated with WLE and additional radiation (45- 64 Gy). In 33 patients, the radiation was delivered via an afterloaded brachytherapy, single-plane implant. Results: The 5-year disease specific and distant metastasis-free survival rates were 65% and 73%, respectively. Local control (LC) at 5 years was 51%, and on multivariate analysis, a positive surgical resection margin (p< 0.001) was associated with a lower rate of LC. Reirradiation was not associated with improved LC; however complications requiring outpatient or surgical management were more common in patients who had undergone reirradiation (80% vs. 17%, p < 0.001). Amputation was also more common in the subgroup of patients who underwent extremity reirradiation (35% with radiation vs. 11% without, p = 0.05), although only one amputation was performed to resolve a treatment complication. Conclusion: Conservative surgery alone results in LC in a minority of patients who have failed locally after previous excision and external beam radiation. Although selection biases and small patient numbers confound the analysis, local treatment intensification with additional radiation does not clearly improve outcome after surgical excision alone, and is associated with an increase in complications

  10. Radiation therapy for primary orbital lymphoma

    International Nuclear Information System (INIS)

    Chao, Cliff K.S.; Lin Hsiusan; Rao Devineni, V.; Smith, Morton

    1995-01-01

    Purpose: The influence of tumor size, grade, thoroughness of staging workup, and radiation dose on disease control, radiation-related complications, and incidence of systemic progression of primary orbital lymphoma is analyzed. Methods and Materials: Twenty patients with Stage I primary orbital lymphoma were treated from August 1976 through August 1991 at Mallinckrodt Institute of Radiology. Staging workups included physical examination, chest x-ray, complete blood count (CBC), liver function test, and computerized tomography (CT) scan of the orbit, abdomen, and pelvis. Nineteen patients had bone marrow biopsy. The histological types based on the National Cancer Institute working formulation were 9 low-grade and 11 intermediate-grade, including five lymphocytic lymphomas of intermediate differentiation. The extension of disease and the volume of tumor were evaluated by CT scan of the orbit. The most commonly used radiation therapy technique was single anterior direct field with 4 MV or 6 MV photons. Lens was shielded or not treated in eight patients. Dose ranged from 20 to 43.2 Gy. Thirteen of 20 patients received 30 Gy. Minimum follow-up was 24 months (median, 4 years). Results: Local control was achieved in all 20 patients. One patient with lymphocytic lymphoma with intermediate differentiation developed disseminated disease. Actuarial disease-free survival (DFS) was 100% and 90% at 2 and 5 years, respectively. No retinopathy was observed. Cataracts were noted in seven patients at 1 to 10 years following irradiation (median, 2 years). Three patients developed lacrimal function disorder, however, no corneal ulceration occurred. Conclusions: Thirty Gy in 15 fractions appears to be a sufficient dose for local control with acceptable morbidity, especially for low-grade, as well as certain types of intermediate-grade lymphomas, such as diffuse small cleaved cell and lymphocytic lymphoma of intermediate differentiation. Systemic dissemination is minimal, provided local

  11. Radiation therapy for primary orbital lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Chao, Cliff K.S.; Hsiusan, Lin; Rao Devineni, V; Smith, Morton

    1995-02-15

    Purpose: The influence of tumor size, grade, thoroughness of staging workup, and radiation dose on disease control, radiation-related complications, and incidence of systemic progression of primary orbital lymphoma is analyzed. Methods and Materials: Twenty patients with Stage I primary orbital lymphoma were treated from August 1976 through August 1991 at Mallinckrodt Institute of Radiology. Staging workups included physical examination, chest x-ray, complete blood count (CBC), liver function test, and computerized tomography (CT) scan of the orbit, abdomen, and pelvis. Nineteen patients had bone marrow biopsy. The histological types based on the National Cancer Institute working formulation were 9 low-grade and 11 intermediate-grade, including five lymphocytic lymphomas of intermediate differentiation. The extension of disease and the volume of tumor were evaluated by CT scan of the orbit. The most commonly used radiation therapy technique was single anterior direct field with 4 MV or 6 MV photons. Lens was shielded or not treated in eight patients. Dose ranged from 20 to 43.2 Gy. Thirteen of 20 patients received 30 Gy. Minimum follow-up was 24 months (median, 4 years). Results: Local control was achieved in all 20 patients. One patient with lymphocytic lymphoma with intermediate differentiation developed disseminated disease. Actuarial disease-free survival (DFS) was 100% and 90% at 2 and 5 years, respectively. No retinopathy was observed. Cataracts were noted in seven patients at 1 to 10 years following irradiation (median, 2 years). Three patients developed lacrimal function disorder, however, no corneal ulceration occurred. Conclusions: Thirty Gy in 15 fractions appears to be a sufficient dose for local control with acceptable morbidity, especially for low-grade, as well as certain types of intermediate-grade lymphomas, such as diffuse small cleaved cell and lymphocytic lymphoma of intermediate differentiation. Systemic dissemination is minimal, provided local

  12. 21 CFR 892.5750 - Radionuclide radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... system. (a) Identification. A radionuclide radiation therapy system is a device intended to permit an... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radionuclide radiation therapy system. 892.5750... patient's body. This generic type of device may include signal analysis and display equipment, patient and...

  13. DOE Research Contributions to Radiation and Cancer Therapy

    Science.gov (United States)

    dropdown arrow Site Map A-Z Index Menu Synopsis DOE Research Contributions to Radiation and Cancer Therapy Possible: DOE Advanced Biomedical Technology Research, page 10 Over the time span of many years, DOE's research has made many contributions to radiation and cancer therapy, including PEREGRINE and Boron Neutron

  14. Influence of radiation therapy on T-lymphocyte subpopulations

    International Nuclear Information System (INIS)

    Job, G.

    1984-01-01

    The author claims this to be the first time where monoclonal antibodies are used in a long-term study in order to determine the influence of radiation therapy on T-lymphozyte-subpopulations in patients suffering from malignant growths. The influence of radiation therapy on B-cells, T-cells and macrophages was also checked. Two groups of patients were given two different radiation doses, and examined separately in order to discover possible effects of the dosage. Radiation therapy reduced B- and T-lymphocytes to the same degree as the total lymphozyte population so that their shares in percent remained unchanged. The same was also found for macrophages. Determination of clones and suppressor T-lymphozytes before, during and after radiation showed T-lymphozytes to have a higher resistance against the influence of radiation than clones. Suppressor cells also regenerated more quickly than clones after the end of the therapy. While radiation therapy was applied the clone/suppressor cell ratio dropped to values lower than those of the healthy reference group. After the end of the therapy this quotient dropped even further in some cases while in others it began to rise slowly, but even 6 months after the end of the therapy it was still lower than normal. As a number of diseases show an increased 'immunoregulatory quotient' it would be conceivable to influence this quotient with radiation therapy in order to achieve a therapeutic effect. (orig./MG) [de

  15. Source book of educational materials for radiation therapy. Final report

    International Nuclear Information System (INIS)

    Pijar, M.L.

    1979-08-01

    The Source Book is a listing of educational materials in radiation therapy technology. The first 17 sections correspond to the subjects identified in the ASRT Curriculum Guide for schools of radiation therapy. Each section is divided into publications and in some sections audiovisuals and training aids. Entries are listed without endorsement

  16. Physics fundamentals and biological effects of synchrotron radiation therapy

    International Nuclear Information System (INIS)

    Prezado, Y.

    2010-01-01

    The main goal of radiation therapy is to deposit a curative dose in the tumor without exceeding the tolerances in the nearby healthy tissues. For some radioresistant tumors, like gliomas, requiring high doses for complete sterilization, the major obstacle for curative treatment with ionizing radiation remains the limited tolerance of the surrounding healthy tissue. This limitation is particularly severe for brain tumors and, especially important in children, due to the high risk of complications in the development of the central nervous system. In addition, the treatment of tumors close to an organ at risk, like the spinal cord, is also restricted. One possible solution is the development of new radiation therapy techniques exploiting radically different irradiation modes and modifying, in this way, the biological equivalent doses. This is the case of synchrotron radiation therapy (SRT). In this work the three new radiation therapy techniques under development at the European Synchrotron Radiation Facility (ESRF), in Grenoble (France) will be described, namely: synchrotron stereotactic radiation therapy (SSRT), microbeam radiation therapy (MRT) and minibeam radiation therapy. The promising results in the treatment of the high grade brain tumors obtained in preclinical studies have paved the way to the clinical trials. The first patients are expected in the fall of 2010. (Author).

  17. Early effect of external beam radiation therapy on the anal sphincter: A study using anal manometry and transrectal ultrasound

    International Nuclear Information System (INIS)

    Birnbaum, E.H.; Dreznik, Z.; Myerson, R.J.; Lacey, D.L.; Fry, R.D.; Kodner, I.J.; Fleshman, J.W.

    1992-01-01

    The early of pelvic irradiation on the anal sphincter has not been previously investigated. This study prospectively evaluated the acute effect of preoperative radiation on anal function. Twenty patients with rectal carcinoma received 4,500 cGy of preoperative external beam radiation. The field of radiation included the sphincter in 10 patients and was delivered above the anorectal ring in 10 patients. Anal manometry and transrectal ultrasound were performed before and four weeks after radiotherapy. No significant difference in mean maximal squeeze or resting pressure was found after radiation therapy. An increase in mean minimal sensory threshold was significant. Histologic examination revealed minimal radiation changes at the distal margin in 8 of 10 patients who underwent low anterior resection and in 1 of 3 patients who underwent abdominoperineal resection. The authors conclude that preoperative radiation therapy has minimal immediate effect on the anal sphincter and is not a major contributing factor to postoperative incontinence in patients after sphincter-saving operations for rectal cancer

  18. Scalp Dose Evaluation According Radiation Therapy Technique of Whole Brain Radiation Therapy

    International Nuclear Information System (INIS)

    Jang, Joon Yung; Park, Soo Yun; Kim, Jong Sik; Choi, Byeong Gi; Song, Gi Won

    2011-01-01

    Opposing portal irradiation with helmet field shape that has been given to a patient with brain metastasis can cause excess dose in patient's scalp, resulting in hair loss. For this reason, this study is to quantitatively analyze scalp dose for effective prevention of hair loss by comparing opposing portal irradiation with scalp-shielding shape and tomotherapy designed to protect patient's scalp with conventional radiation therapy. Scalp dose was measured by using three therapies (HELMET, MLC, TOMO) after five thermo-luminescence dosimeters were positioned along center line of frontal lobe by using RANDO Phantom. Scalp dose and change in dose distribution were compared and analyzed with DVH after radiation therapy plan was made by using Radiation Treatment Planning System (Pinnacle3, Philips Medical System, USA) and 6 MV X-ray (Clinac 6EX, VARIAN, USA). When surface dose of scalp by using thermo-luminescence dosimeters was measured, it was revealed that scalp dose decreased by average 87.44% at each point in MLC technique and that scalp dose decreased by average 88.03% at each point in TOMO compared with HELMET field therapy. In addition, when percentage of volume (V95%, V100%, V105% of prescribed dose) was calculated by using Dose Volume Histogram (DVH) in order to evaluate the existence or nonexistence of hotspot in scalp as to three therapies (HELMET, MLC, TOMO), it was revealed that MLC technique and TOMO plan had good dose coverage and did not have hot spot. Reducing hair loss of a patient who receives whole brain radiotherapy treatment can make a contribution to improve life quality of the patient. It is expected that making good use of opposing portal irradiation with scalp-shielding shape and tomotherapy to protect scalp of a patient based on this study will reduce hair loss of a patient.

  19. Scalp Dose Evaluation According Radiation Therapy Technique of Whole Brain Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Joon Yung; Park, Soo Yun; Kim, Jong Sik; Choi, Byeong Gi; Song, Gi Won [Dept. of Radiation Oncology, Samsung Medical Center, Seoul (Korea, Republic of)

    2011-09-15

    Opposing portal irradiation with helmet field shape that has been given to a patient with brain metastasis can cause excess dose in patient's scalp, resulting in hair loss. For this reason, this study is to quantitatively analyze scalp dose for effective prevention of hair loss by comparing opposing portal irradiation with scalp-shielding shape and tomotherapy designed to protect patient's scalp with conventional radiation therapy. Scalp dose was measured by using three therapies (HELMET, MLC, TOMO) after five thermo-luminescence dosimeters were positioned along center line of frontal lobe by using RANDO Phantom. Scalp dose and change in dose distribution were compared and analyzed with DVH after radiation therapy plan was made by using Radiation Treatment Planning System (Pinnacle3, Philips Medical System, USA) and 6 MV X-ray (Clinac 6EX, VARIAN, USA). When surface dose of scalp by using thermo-luminescence dosimeters was measured, it was revealed that scalp dose decreased by average 87.44% at each point in MLC technique and that scalp dose decreased by average 88.03% at each point in TOMO compared with HELMET field therapy. In addition, when percentage of volume (V95%, V100%, V105% of prescribed dose) was calculated by using Dose Volume Histogram (DVH) in order to evaluate the existence or nonexistence of hotspot in scalp as to three therapies (HELMET, MLC, TOMO), it was revealed that MLC technique and TOMO plan had good dose coverage and did not have hot spot. Reducing hair loss of a patient who receives whole brain radiotherapy treatment can make a contribution to improve life quality of the patient. It is expected that making good use of opposing portal irradiation with scalp-shielding shape and tomotherapy to protect scalp of a patient based on this study will reduce hair loss of a patient.

  20. Radiation therapy among atomic bomb survivors, Hiroshima and Nagasaki

    International Nuclear Information System (INIS)

    Pinkston, J.A.; Antoku, Shigetoshi; Russell, W.J.

    1980-10-01

    In the continuing evaluations of atomic bomb survivors for late radiation effects, not only doses from the A-bombs but those from other radiation sources must be considered, for the latter may be concomitantly acting factors causing bias among these investigations. In the present study, among 73 Hiroshima and 22 Nagasaki Adult Health Study (AHS) subjects who reported receiving radiation therapy, from 1970 through 1979, the medical records of 72 and 20, respectively, were reviewed, and 41 Hiroshima and 14 Nagasaki subjects were confirmed to have received radiation therapy. The data obtained in the present study were pooled with those of the previous investigation on radiation therapy exposures of AHS subjects prior to 1970. A total of 190 subjects have been documented as receiving radiation therapy and their doses were estimated. Energies used in treatments and diseases treated are discussed. Malignancies developed subsequent to radiation therapy in seven cases; five after treatment for malignancies and two after treatment for benign diseases. Neoplasms of 12 AHS subjects may have been induced by earlier radiation therapy; 5 in the earlier study and 7 in the present one. These investigations underscore the need for continued documentation of exposures to ionizing radiation for medical reasons, especially from sources incurring relatively high doses. Bias in assessments of late radiation effects among A-bomb survivors can thus be avoided. (author)

  1. Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in barrett esophagus after endoscopic resection

    NARCIS (Netherlands)

    Peters, F.; Kara, M.; Rosmolen, W.; Aalders, M.; ten Kate, F.; Krishnadath, K.; van Lanschot, J.; Fockens, P.; Bergman, J.

    2005-01-01

    BACKGROUND AND STUDY AIMS: The aim of the study was to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of residual high-grade dysplasia or early cancer (HGD/EC) after endoscopic resection in Barrett esophagus. PATIENTS AND METHODS: Study patients were separated into group A,

  2. A clinical study of esophagectomy after chemo-radiation therapy for advanced esophageal carcinoma

    International Nuclear Information System (INIS)

    Takeda, Shigeru; Tokuno, Kazuhisa; Nishimura, Taku; Yoshino, Shigefumi; Oka, Masaaki

    2007-01-01

    The aim of this study was to evaluate the efficacy of preoperative neoadjuvant therapy (NAT) including chemo-radiation or radiation in patients with T3/T4 advanced esophageal squamous cell carcinoma. We reviewed 115 patients with T3/T4 tumors from January 1994 through August 2006. Forty-seven patients received NAT, and the remaining 68 patients had surgery alone. Of these 47 patients, 14 patients underwent esophagectomy following NAT, and 33 patients underwent consecutive chemoradiation. Patients treated with esophagectomy following NAT had a better two-year survival (45.5%) and the median survival time (486 days) was compared with patients treated with chemo-radiation only (10.4%, 242 days) (p=0.026). Of these patients treated with esophagectomy following NAT, the patients undergone curative resection had a better one-year survival rate (83.3%) and the median survival time (2,055 days) was compared with the patients received with non-curative resection (20.0%, 273 days) (p=0.042). Two patients having grade 3 effect by NAT had a long disease free survival. There was no significant difference in postoperative morbidity and mortality rate between the patients received NAT and the patients treated with surgery alone. These results suggest that NAT may be useful for advanced esophageal cancer. (author)

  3. The clinical effect of combination therapy for oral cancer with S-1, superselective intra-arterial chemotherapy, and radiation therapy

    International Nuclear Information System (INIS)

    Yamamoto, Chika; Yoshikawa, Hiromasa; Fukumoto, Shunsuke; Higuchi, Takashi; Yoshida, Masanori; Yasumori, Koutarou; Horinouchi, Yasufumi; Uehara, Satoru

    2011-01-01

    Combination therapy with S-1, superselective intra-arterial infusion of carboplatin (CBDCA) and radiation therapy has been used to treat patients with oral cancer since 2005. In this study, the histopathological effects and toxicities following concurrent chemoradiotherapy were examined. The subjects consisted of 15 patients (10 men and 5 women) who were treated with S-1 (60-80 mg/day, 4 weeks), superselective intra-arterial infusion of CBDCA (300 mg/body) and radiation therapy (total dose 30-36 Gy) in our department from 2005 to 2009. Nine patients, showed T2 disease, 3 showed T3 disease, and another 3 showed T4 diseases. The primary cancer sites were the tongue (6 cases), buccal mucosa (4 cases), mandible gingival (3 cases), maxillary gingival (1 case), and the floor of the mouth (1 case). The histopathological effects were evaluated according to Oboshi-Shimosato classification. Grade IV was shown in 10 cases (66.7%), grade III in 1 case (6.7%), II bin 3 cases (20.0%), and II a in 1 case (6.7%). All patients completed the treatment. The pathological response of the resected tumor was grade IIb or higher in 14 cases (93.3%). While good histological effects were noted, there was one patient for whom viable tumor cells remained in the central part of the tumor. The present study indicates that further investigation is needed to determine the best dosing and dosing schedule. (author)

  4. Modern role and issues of radiation therapy for benign diseases

    International Nuclear Information System (INIS)

    Miyashita, Tsuguhiro; Tateno, Atsushi; Kumazaki, Tatsuo

    1999-01-01

    Cases of radiation therapy for benign diseases have diminished in number because of recent alternative methods and knowledge about radiation carcinogenesis. In contrast to this tendency, our cases of benign diseases have recently increased. The facts made us reconsider today's radiation therapy of benign diseases. We reviewed 349 patients who were diagnosed as having benign tumors or non-neoplastic conditions and treated by radiation therapy in the past sixteen years. Analyzed items were the annual transition of treatment number, sorts of diseases, patients' age and sex, and the goal of therapy. Of all radiation therapy patients, benign diseases account for 9.26%. The annual percentages were 0.5%, 6.0%, 11.2% and 13.7% at intervals of five years since 1982. The majority was 246 post-operative irradiation for keloids (71%) and 41 pituitary adenomas (12%). Compared with malignant tumors, benign disease patients were statistically younger and female-dominant. Applications of radiation therapy in keloids and pituitary adenomas had definite goals, but were unclear in other rare diseases. Benign diseases should be treated by radiation therapy as the second or third option, provided the patients have serious symptoms and their diseases do not respond to other modalities. It seems to be widely accepted that favorite cases such as keloids and pituitary adenomas are treated by radiation therapy. But, optimal radiation therapies for other rare benign diseases have not been established. Therefore, the building of databases on radiation therapy on benign diseases should be pursued. Since benign disease patients were young and female-dominant and had many remaining years, their carcinogenicity potential should be considered. (author)

  5. Safety of low anterior resection in the presence of chronic radiation changes in dogs

    International Nuclear Information System (INIS)

    Meese, D.L.; Bubrick, M.P.; Paulson, G.L.; Feeney, D.A.; Johnston, G.R.; Strom, R.L.; Hitchcock, C.R.

    1986-01-01

    Thirty mongrel dogs underwent 4000- or 5000-rad single treatment orthovoltage irradiation to the pelvis according to the nominal standard dose equation. Following a resting period of six months, 21 dogs were randomized to low anterior resection with either stapled or handsewn anastomoses. Anastomotic leaks were evaluated on clinical and radiographic grounds. The radiographic leak rate was 81 percent for sutured and 0 percent for stapled anastomoses. The clinical leak rate was 18 percent for sutured and 0 percent for stapled anastomoses. The difference between the 4000- and 5000-rad groups was not significant. The data suggest that late effects of irradiation do not preclude the safe construction of low anterior anastomoses, and that the circular stapling device is superior to hand-sewn techniques

  6. Radiation therapy of malignant melanoma: Experience with high individual treatment doses

    International Nuclear Information System (INIS)

    Habermalz, H.J.; Fischer, J.J.

    1984-01-01

    Melanoma is a complex tumor, metastasizes early both by lymphatic and blood vessels, and which may invoke a significant host ''immune,'' response. One can imagine a number of potentially useful roles for an effective radiation therapy regimen: 1. Treatment of the primary lesion. For small lesions located on the extremities, surgery may be simpler and obviate the risk of radiation failure. In other areas, e.g., head and neck, which may require more cosmetically or functionally debilitating surgery, a trial of radiation therapy may be worthwhile. 2. Preoperative radiation to the primary lesion before surgical resection in the hope of preventing tumor dissemination. 3. Prophylactic, local and regional lymph node radiation therapy. It has been popular in the past to remove malignant melanoma with wide local excision and dissection of adjacent node areas. It is still an open question whether some or any additional patients will be cured by the more vigorous local and extended treatment. Generally, those procedures have fallen into disfavor because of the associated morbidity. Presumably subclinical amounts of malignant melanoma could be sterilized with doses of radiation smaller than those necessary for bulk tumor. Wide field irradiation to the areas surrounding the primary lesion and the adjacent lymph nodes, to doses causing little morbidity, may well be worth clinical trial. 4. In combination with other forms of therapy, e.g., chemotherapy, immunotherapy, hyperthermia, to reduce the number of malignant cells in localized areas known to contain diseases. This may be particularly important prior to initiation of immunotherapy which may be much more effective in the absence of gross disease

  7. CT follow-up after radiation therapy for pituitary adenomas

    International Nuclear Information System (INIS)

    Rush, S.C.; Newall, J.

    1988-01-01

    Between 1973 and 1985, 105 patients received radiation therapy as all or part of their treatment for pituitary tumor at the New York University Medical Center. Of these, 48 patients underwent computed tomography (CT) at a minimum of 2 years following treatment, with detailed reports available for analysis of tumor regression. There were 28 men with a median age of 46 years (range, 18-71 years) and 20 women with a median age of 53 years (range, 28-80 years). Tumors were classified as secretory in 23 patients, nonsecretory in 21, and undetermined in four. Sixteen patients were treated with radiation therapy alone, 23 patients with surgery and radiation therapy, and the other with bromocriptine and radiation therapy, with or without surgery. With a median follow-up of 5 years (range, 2-14 years), 16 patients developed an empty sella, 25 patients had residual sellar mass, and seven patients had persistent extrasellar components or no change in their intrasellar mass. Among patients who did not have hypopituitarism at the inception of radiation therapy, five of 13 with empty sellas and 12 of 22 with residual mass subsequently required therapy. The authors conclude that residual mass is commonly found in long-term follow-up after radiation therapy, that isolated imaging studies revealing such findings after treatment in no way herald a diagnosis of recurrence, and that hypopituitarism following pituitary radiation therapy does not correlate with the ablation or persistence of tissue within the sella

  8. Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method.

    Science.gov (United States)

    Goodman, Karyn A; Patton, Caroline E; Fisher, George A; Hoffe, Sarah E; Haddock, Michael G; Parikh, Parag J; Kim, John; Baxter, Nancy N; Czito, Brian G; Hong, Theodore S; Herman, Joseph M; Crane, Christopher H; Hoffman, Karen E

    2016-01-01

    To summarize results of a Clinical Practice Statement on radiation therapy for stage II-III rectal cancer, which addressed appropriate customization of (neo)adjuvant radiation therapy and use of non-surgical therapy for patients who are inoperable or refuse abdominoperineal resection. The RAND/University of California, Los Angeles, Appropriateness Method was applied to combine current evidence with multidisciplinary expert opinion. A systematic literature review was conducted and used by the expert panel to rate appropriateness of radiation therapy options for different clinical scenarios. Treatments were categorized by median rating as Appropriate, May Be Appropriate, or Rarely Appropriate. In the neoadjuvant setting, chemoradiation was rated Appropriate and the ratings indicated short-course radiation therapy, chemotherapy alone, and no neoadjuvant therapy are potential options in selected patients. However, neoadjuvant endorectal brachytherapy was rated Rarely Appropriate. For adjuvant therapy, chemoradiation (plus ≥4 months of chemotherapy) was rated Appropriate and chemotherapy alone May Be Appropriate for most scenarios. For medically inoperable patients, definitive external beam radiation therapy and chemotherapy alone were rated May Be Appropriate, whereas endorectal brachytherapy and chemoradiation plus endorectal brachytherapy were possible approaches for some scenarios. The last option, definitive chemoradiation, was rated Appropriate to May Be Appropriate based on performance status. Finally, for patients with low-lying tumors refusing abdominoperineal resection, definitive chemoradiation alone, chemoradiation plus endorectal brachytherapy, and chemoradiation plus external beam radiation therapy were all rated Appropriate. This Clinical Practice Statement demonstrated the central role of radiation therapy in stage II-III rectal cancer management and evaluated ways to better individualize its use in the neoadjuvant, adjuvant, and definitive settings

  9. Inadvertent destruction of the spinal cord by radiation therapy

    International Nuclear Information System (INIS)

    Bhavilai, D.

    1974-01-01

    A case of radiation myelopathy following cobalt therapy of a carcinoma of the esophagus is presented. A permanent quadriplegia resulted. Radiation myelopathy can result from treatment with x-rays or radioactive cobalt regardless of whether the condition being treated involves the spinal cord. No effective treatment is known. Prevention requires keeping the radiation at low level

  10. Treatment of Recurrent Chordomas by Percutaneous Ethanol Injection Therapy and Radiation Therapy

    International Nuclear Information System (INIS)

    Nakajo, M.; Ohkubo, K.; Fukukura, Y.; Nandate, T.; Nakajo, M.

    2006-01-01

    We report a case of recurrent sacral chordomas that have been successfully controlled by the combination therapy of percutaneous ethanol injection therapy (PEIT) and radiation therapy in a 71-year-old man. PEIT may be one of the adjuvant therapies for recurrent chordomas

  11. A current perspective on stereotactic body radiation therapy for pancreatic cancer.

    Science.gov (United States)

    Hong, Julian C; Czito, Brian G; Willett, Christopher G; Palta, Manisha

    2016-01-01

    Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable) pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT), which uses image-guided, conformal, high-dose radiation. SBRT has demonstrated promising local control rates and resultant quality of life with acceptable rates of toxicity. Over the past decade, increasing clinical experience and data have supported SBRT as a local treatment modality. Nevertheless, additional research is required to further evaluate the role of SBRT and improve upon the persistently poor outcomes associated with pancreatic cancer. This review discusses the existing clinical experience and technical implementation of SBRT for pancreatic cancer and highlights the directions for ongoing and future studies.

  12. A virtual radiation therapy workflow training simulation

    International Nuclear Information System (INIS)

    Bridge, P.; Crowe, S.B.; Gibson, G.; Ellemor, N.J.; Hargrave, C.; Carmichael, M.

    2016-01-01

    Aim: Simulation forms an increasingly vital component of clinical skills development in a wide range of professional disciplines. Simulation of clinical techniques and equipment is designed to better prepare students for placement by providing an opportunity to learn technical skills in a “safe” academic environment. In radiotherapy training over the last decade or so this has predominantly comprised treatment planning software and small ancillary equipment such as mould room apparatus. Recent virtual reality developments have dramatically changed this approach. Innovative new simulation applications and file processing and interrogation software have helped to fill in the gaps to provide a streamlined virtual workflow solution. This paper outlines the innovations that have enabled this, along with an evaluation of the impact on students and educators. Method: Virtual reality software and workflow applications have been developed to enable the following steps of radiation therapy to be simulated in an academic environment: CT scanning using a 3D virtual CT scanner simulation; batch CT duplication; treatment planning; 3D plan evaluation using a virtual linear accelerator; quantitative plan assessment, patient setup with lasers; and image guided radiotherapy software. Results: Evaluation of the impact of the virtual reality workflow system highlighted substantial time saving for academic staff as well as positive feedback from students relating to preparation for clinical placements. Students valued practice in the “safe” environment and the opportunity to understand the clinical workflow ahead of clinical department experience. Conclusion: Simulation of most of the radiation therapy workflow and tasks is feasible using a raft of virtual reality simulation applications and supporting software. Benefits of this approach include time-saving, embedding of a case-study based approach, increased student confidence, and optimal use of the clinical environment

  13. Scatter Dose in Patients in Radiation Therapy

    International Nuclear Information System (INIS)

    Schmidt, W. F. O.

    2003-01-01

    Patients undergoing radiation therapy are often treated with high energy radiation (bremsstrahlung) which causes scatter doses in the patients from various sources as photon scatter coming from collimator, gantry, patient, patient table or room (walls, floor, air) or particle doses resulting from gamma-particle reactions in the atomic nucleus if the photon energies are above 8 MeV. In the last years new treatment techniques like IMRT (esp the step-and-shoot- or the MIMIC-techniques) have increased interest in these topics again. In the lecture an overview about recent measurements on scatter doses resulting from gantry, table and room shall be given. Scatter doses resulting from the volume treated in the patient to other critical parts of the body like eyes, ovarii etc. have been measured in two diploma works in our institute and are compared with a program (PERIDOSE; van der Giessen, Netherlands) to estimate them. In some cases these scatter doses have led to changes of treatment modalities. Also an overview and estimation of doses resulting from photon-particle interactions is given according to a publication from Gudowska et al.(Gudowska I, Brahme A, Andreo P, Gudowski W, Kierkegaard J. Calculation of absorbed dose and biological effectiveness from photonuclear reactions in a bremsstrahlung beam of end point 50 MeV. Phys Med Biol 1999; 44(9):2099-2125.). Energy dose has been calculated with Monte Carlo-methods and is compared with analytical methods for 50 MV bremsstrahlung. From these data biologically effective doses from particles in different depths of the body can be estimated also for energies used in normal radiotherapy. (author)

  14. Radiation Therapy for Chloroma (Granulocytic Sarcoma)

    Energy Technology Data Exchange (ETDEWEB)

    Bakst, Richard; Wolden, Suzanne [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Yahalom, Joachim, E-mail: yahalomj@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-04-01

    Objectives: Chloroma (granulocytic sarcoma) is a rare, extramedullary tumor of immature myeloid cells related to acute nonlymphocytic leukemia or myelodysplastic syndrome. Radiation therapy (RT) is often used in the treatment of chloromas; however, modern studies of RT are lacking. We reviewed our experience to analyze treatment response, disease control, and toxicity associated with RT to develop treatment algorithm recommendations for patients with chloroma. Patients and Methods: Thirty-eight patients who underwent treatment for chloromas at our institution between February 1990 and June 2010 were identified and their medical records were reviewed and analyzed. Results: The majority of patients that presented with chloroma at the time of initial leukemia diagnosis (78%) have not received RT because it regressed after initial chemotherapy. Yet most patients that relapsed or remained with chloroma after chemotherapy are in the RT cohort (90%). Thirty-three courses of RT were administered to 22 patients. Radiation subsite breakdown was: 39% head and neck, 24% extremity, 9% spine, 9% brain, 6% genitourinary, 6% breast, 3% pelvis, and 3% genitourinary. Median dose was 20 (6-36) Gy. Kaplan-Meier estimates of progression-free survival and overall survival in the RT cohort were 39% and 43%, respectively, at 5 years. At a median follow-up of 11 months since RT, only 1 patient developed progressive disease at the irradiated site and 4 patients developed chloromas at other sites. RT was well tolerated without significant acute or late effects and provided symptom relief in 95% of cases. Conclusions: The majority of patients with chloromas were referred for RT when there was extramedullary progression, marrow relapse, or rapid symptom relief required. RT resulted in excellent local disease control and palliation of symptoms without significant toxicity. We recommend irradiating chloromas to at least 20 Gy, and propose 24 Gy in 12 fractions as an appropriate regimen.

  15. Whole-brain hippocampal sparing radiation therapy: Volume-modulated arc therapy vs intensity-modulated radiation therapy case study

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Katrina, E-mail: Trinabena23@gmail.com; Lenards, Nishele; Holson, Janice

    2016-04-01

    The hippocampus is responsible for memory and cognitive function. An ongoing phase II clinical trial suggests that sparing dose to the hippocampus during whole-brain radiation therapy can help preserve a patient's neurocognitive function. Progressive research and advancements in treatment techniques have made treatment planning more sophisticated but beneficial for patients undergoing treatment. The aim of this study is to evaluate and compare hippocampal sparing whole-brain (HS-WB) radiation therapy treatment planning techniques using volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). We randomly selected 3 patients to compare different treatment techniques that could be used for reducing dose to the hippocampal region. We created 2 treatment plans, a VMAT and an IMRT, from each patient's data set and planned on the Eclipse 11.0 treatment planning system (TPS). A total of 6 plans (3 IMRT and 3 VMAT) were created and evaluated for this case study. The physician contoured the hippocampus as per the Radiation Therapy Oncology Group (RTOG) 0933 protocol atlas. The organs at risk (OR) were contoured and evaluated for the plan comparison, which included the spinal cord, optic chiasm, the right and left eyes, lenses, and optic nerves. Both treatment plans produced adequate coverage on the planning target volume (PTV) while significantly reducing dose to the hippocampal region. The VMAT treatment plans produced a more homogenous dose distribution throughout the PTV while decreasing the maximum point dose to the target. However, both treatment techniques demonstrated hippocampal sparing when irradiating the whole brain.

  16. Whole-brain hippocampal sparing radiation therapy: Volume-modulated arc therapy vs intensity-modulated radiation therapy case study.

    Science.gov (United States)

    Lee, Katrina; Lenards, Nishele; Holson, Janice

    2016-01-01

    The hippocampus is responsible for memory and cognitive function. An ongoing phase II clinical trial suggests that sparing dose to the hippocampus during whole-brain radiation therapy can help preserve a patient׳s neurocognitive function. Progressive research and advancements in treatment techniques have made treatment planning more sophisticated but beneficial for patients undergoing treatment. The aim of this study is to evaluate and compare hippocampal sparing whole-brain (HS-WB) radiation therapy treatment planning techniques using volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). We randomly selected 3 patients to compare different treatment techniques that could be used for reducing dose to the hippocampal region. We created 2 treatment plans, a VMAT and an IMRT, from each patient׳s data set and planned on the Eclipse 11.0 treatment planning system (TPS). A total of 6 plans (3 IMRT and 3 VMAT) were created and evaluated for this case study. The physician contoured the hippocampus as per the Radiation Therapy Oncology Group (RTOG) 0933 protocol atlas. The organs at risk (OR) were contoured and evaluated for the plan comparison, which included the spinal cord, optic chiasm, the right and left eyes, lenses, and optic nerves. Both treatment plans produced adequate coverage on the planning target volume (PTV) while significantly reducing dose to the hippocampal region. The VMAT treatment plans produced a more homogenous dose distribution throughout the PTV while decreasing the maximum point dose to the target. However, both treatment techniques demonstrated hippocampal sparing when irradiating the whole brain. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  17. Predicting Radiation Pneumonitis After Stereotactic Ablative Radiation Therapy in Patients Previously Treated With Conventional Thoracic Radiation Therapy

    International Nuclear Information System (INIS)

    Liu Hui; Zhang Xu; Vinogradskiy, Yevgeniy Y.; Swisher, Stephen G.; Komaki, Ritsuko; Chang, Joe Y.

    2012-01-01

    Purpose: To determine the incidence of and risk factors for radiation pneumonitis (RP) after stereotactic ablative radiation therapy (SABR) to the lung in patients who had previously undergone conventional thoracic radiation therapy. Methods and Materials: Seventy-two patients who had previously received conventionally fractionated radiation therapy to the thorax were treated with SABR (50 Gy in 4 fractions) for recurrent disease or secondary parenchymal lung cancer (T 10 and mean lung dose (MLD) of the previous plan and the V 10 -V 40 and MLD of the composite plan were also related to RP. Multivariate analysis revealed that ECOG PS scores of 2-3 before SABR (P=.009), FEV1 ≤65% before SABR (P=.012), V 20 ≥30% of the composite plan (P=.021), and an initial PTV in the bilateral mediastinum (P=.025) were all associated with RP. Conclusions: We found that severe RP was relatively common, occurring in 20.8% of patients, and could be predicted by an ECOG PS score of 2-3, an FEV1 ≤65%, a previous PTV spanning the bilateral mediastinum, and V 20 ≥30% on composite (previous RT+SABR) plans. Prospective studies are needed to validate these predictors and the scoring system on which they are based.

  18. A Systematic Overview of Radiation Therapy Effects in Rectal Cancer

    International Nuclear Information System (INIS)

    Glimelius, Bengt; Groenberg, Henrik; Jaerhult, Johannes; Wallgren, Arne; Cavallin-Staahl, Eva

    2003-01-01

    given with acceptable acute toxicity. The long-term consequences of radiotherapy appear to be limited with adequate radiation techniques, although they have been less extensively studied. Longer follow-up periods are needed before firm conclusions can be drawn. Peroperative radiotherapy, preferably preoperative since it is more effective, is routinely recommended for most patients with rectal cancer since it can substantially decrease the risk of a local failure and increases survival. In a primarily non-resectable tumour, preoperative radiotherapy can cause tumour regression allowing subsequent radical surgery. This therapy is routinely indicated. Whether radiochemotherapy is more efficient than radiotherapy alone is not clear, since the results of four small randomized trials are partly conflicting. Preoperative radiotherapy, frequently combined with chemotherapy, has been used to increase the chances of sphincter-preserving surgery in low-lying tumours. The literature is inconclusive with respect to how frequently this occurs. Radiotherapy frequently produces symptom relief in patients with rectal cancer not amendable to surgery

  19. On probabilistically defined margins in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Papiez, Lech; Langer, Mark [Department of Radiation Oncology, Indiana University, Indianapolis, IN (United States)

    2006-08-21

    Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

  20. On probabilistically defined margins in radiation therapy

    International Nuclear Information System (INIS)

    Papiez, Lech; Langer, Mark

    2006-01-01

    Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

  1. Radiation therapy in Ewing's sarcoma: an update of the CESS 86 trial

    International Nuclear Information System (INIS)

    Dunst, Juergen; Juergens, Herbert; Sauer, Rolf; Pape, Hildegard; Paulussen, Michael; Winkelmann, Winfried; Ruebe, Christian

    1995-01-01

    Purpose: We present an update analysis of the multiinstitutional Ewing's sarcoma study CESS 86. Methods and Materials: From January 1986 through June 1991, 177 patients with localized Ewing's sarcoma of bone, aged 25 years or less, were recruited. Chemotherapy consisted of four 9-week courses of vincristine, actinomycin D, cyclophosphamide, and adriamycin (VACA) in low-risk tumors (extremity tumors 3 ), or vincristine, actinomycin D, ifosfamide, and adriamycin (VAIA) in high-risk tumors (central tumors and extremity tumors ≥ 100 cm 3 ). Local therapy was an individual decision in each patient and was either radical surgery (amputation, wide resection) or resection plus postoperative irradiation with 45 Gy or definitive radiotherapy with 60 Gy (45 Gy plus boost). Irradiated patients were randomized concerning the type of fractionation in either conventional fractionation (once daily 1.8-2.0 Gy, break of chemotherapy) or hyperfractionated split-course irradiation simultaneously with the VACA/VAIA chemotherapy (twice daily 1.6 Gy, break of 12 days after 22.4 Gy and 44.8 Gy, total dose and treatment time as for conventional fractionation). For quality assurance in radiotherapy, a central treatment planning program was part of the protocol. Results: Forty-four patients (25%) received definitive radiotherapy; 39 (22%) had surgery, and 93 (53%) had resection plus postoperative irradiation. The overall 5-year survival was 69%. Thirty-one percent of the patients relapsed, 30% after radiotherapy, 26% after radical surgery, and 34% after combined local treatment. The better local control after radical surgery (100%) and resection plus radiotherapy (95%) as compared to definitive radiotherapy (86%) was not associated with an improvement in relapse-free or overall survival because of a higher frequency of distant metastases after surgery (26% vs. 29% vs. 16%). In irradiated patients, hyperfractionated split-course irradiation and conventional fractionation yielded the same

  2. New modalities in radiation therapy for treatment of cancer

    International Nuclear Information System (INIS)

    Kumar, Deepak

    2013-01-01

    Cancer is a generic term for a large group of diseases characterized by rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. Cancer mortality is the second and most common cause of death in the USA and in most European countries. In India, it is the fourth leading disease and the major cause of death. Cancer remains one of the most dreadful disease and approximately ten million cases of cancer occur in the world every year. The course of cancer treatment depends on the type of cancer, its location, and its state of advancement. Cancer is treated with surgery, chemotherapy, radiation therapy, hormone therapy, biological therapy and targeted therapy. Radiation therapy is an important an affordable modality for cancer treatment with minimal side effects. Radiation kills cancer cells with high-energy rays targeted directly to the tumor. Radiation therapy works by damaging the DNA and preventing its replication: therefore, it preferentially kills cancer cells, which rapidly divides. Radiation therapy is used for cure, control, and palliation of cancers in more than 60% of cancer patients. The goal of radiotherapy is to treat the cancer and spare the normal tissue as much as possible. Advances have been made in radiotherapy that allow delivery of higher doses of radiation to the tumor while sparing a greater amount of surrounding tissue, thus achieving more cures and fewer acute and long-term side effects. Technological advances and research are being continued to result in improvements in the field. Several new devices and techniques are used these days in radiotherapy for accurate treatment of cancer. Teletherapy (external radiation therapy) used focused radiation beams targeting well defined tumor through extremely detailed imaging scans. Conventional external beam radiation therapy (2DXRT) is delivered via two-dimensional beams using linear accelerator machines (X

  3. Two case reports of a cerebrovascular disorder after radiation therapy

    International Nuclear Information System (INIS)

    Ono, Jiro; Mimaki, Takashi; Tagawa, Tetsuzo

    1985-01-01

    The use of radiation therapy has significantly improved the prognosis of certain brain tumors. However, a few patients have been reported who developed cerebrovasculopathy accompanying transient ischemic attacks several months to several years after radiation therapy. The present report described cerebrovascular disorders after radiation therapy for brain tumors. The first case was an 8-year-6-month-old boy treated with a total dose of 5,200 rads after partial removal of a right periventricular astrocytoma extending into the thalamus. Two years and 7 months after completion of the radiation therapy, he showed transient ischemic attacks of numbness in the right upper limb and right hemiparesis. Arteriography revealed stenosis or occlusion of the anterior and middle cerebral arteries. Preoperative arteriography did not show occlusion nor narrowing of the cerebral arteries. The second case was a 2-year-8-month-old boy diagnosed as diencephalic syndrome, because of marked emaciation and a huge tumor mass expanding into the diencephalon and frontal lobe on the brain CT scan. He was irradiated with up to 5,000 rads. Seven months after radiation therapy, he developed transient right hemiparesis. Arteriography revealed stenosis or occlusion of the middle sized cerebral arteries. Although radiation therapy is acceptable in children with certain brain tumors, and very few patients develop postradiation vasculopathy, the risk of radiation therapy requires more careful consideration in the treatment of intracranial tumors. (author)

  4. Insufficiency fractures following radiation therapy for gynecologic malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Ikushima, Hitoshi; Takegawa, Yoshihiro; Matsuki, Hirokazu; Yasuda, Hiroaki; Kawanaka, Takashi; Shiba, Atsushi; Kishida, Yoshiomi; Iwamoto, Seiji; Nishitani, Hiromu [Tokushima Univ. (Japan). School of Medicine

    2002-12-01

    The purpose of this study was to investigate the incidence, clinical and radiological findings of insufficiency fractures (IF) of the female pelvis following radiation therapy. We retrospectively reviewed the radiation oncology records of 108 patients with gynecologic malignancies who underwent external beam radiation therapy of the whole pelvis. All patients underwent conventional radiography and computed tomography (CT) scan every 6 months in follow-up after radiation therapy and magnetic resonance imaging (MRI) and radionuclide bone scan were added when the patients complained of pelvic pain. Thirteen of 108 patients (12%) developed IF in the irradiated field with a median interval of 6 months (range 3-51) from the completion of external beam radiation therapy. All patients who developed IF were postmenopausal women. Age of the patients who developed IF was significantly higher than that of the other patients. The parts of IF were sacroiliac joints, pubis, sacral body and 5th lumbar vertebra and six of 14 patients had multiple lesions. Treatment with rest and nonsteroidal anti-inflammatory drugs lead to symptomatic relief in all patients, although symptoms lasted from 3 to 20 months. Radiation-induced pelvic IF following radiation therapy for gynecologic malignancies were frequently observed in the post-menopausal patients within 1 year after external beam radiation therapy. Symmetrical fractures of the bilateral sacroiliac joint and pubis were the characteristic pattern of pelvic IF. All patients healed with conservative treatment, and nobody became non-ambulant. (author)

  5. Intratumoural interleukin-2 therapy can induce regression of non-resectable mastocytoma in dogs

    NARCIS (Netherlands)

    Ziekman, P.G.P.M; den Otter, W.; Tan, J.F.V.; Teske, E.; Kirpensteijn, J.; Koten, J.W.; Jacobs, J.J.

    2013-01-01

    Abstract AIM: Mast cell tumours (MCT) are common skin tumours in dogs. If complete surgical removal of the tumours is not possible, then another therapy is needed. In the current study we tested the therapeutic effect of intratumoural injection of interleukin-2 (IL-2). MATERIALS AND METHODS: Seven

  6. The Indiana University proton radiation therapy project

    International Nuclear Information System (INIS)

    Bloch, C.; Derenchuk, V.; Cameron, J.; Fasano, M.; Gilmore, J.; Hashemian, R.; Hornback, N.; Low, D.A.; Morphis, J.; Peterson, C.; Rosselot, D.; Sandison, G.; Shen, R.N.; Shidnia, H.

    1993-01-01

    A fixed horizontal beam line at the Indiana University cyclotron facility (IUCF) has been equipped for proton radiation therapy treatment of head, neck, and brain tumors. The complete system will be commissioned and ready to treat patients early in 1993. IUCF can produce external proton beams from 45 to 200 MeV in energy, which corresponds to a maximum range in water of 26 cm. Beam currents over 100 nA are easily attained, allowing dose rates in excess of 200 cGy/min, even for large fields. Beam spreading systems have been tested which provide uniform fields up to 20 cm in diameter. Range modulation is accomplished with a rotating acrylic device, which provides uniform depth dose distributions from 3 to 18 cm in extent. Tests have been conducted on detectors which monitor the beam position and current, and the dose symmetry. This report discusses those devices, as well as the cyclotron characteristics, measured beam properties, safety interlocks, computerized dose delivery/monitoring system, and future plans. (orig.)

  7. Postoperative radiation therapy for malignant glioma

    International Nuclear Information System (INIS)

    Teshima, Teruki; Inoue, Toshihiko; Chatani, Masashi; Hata, Kiyoshi; Taki, Takuyu; Nii, Yasuo; Nakagawa, Hidemitsu

    1987-01-01

    From December 1977 through September 1984, a total of 39 cases of malignant glioma were treated with radiation therapy (RT) postoperatively. Twenty-nine cases were classified into glioblastoma (GM) and 10 astrocytoma (AS) (low grade : 6 and anaplastic : 4) histologically. One third of cases received 50 Gy/25 FRX/5 WKS of whole brain RT. Another two thirds of cases underwent 60 Gy/30 FRX/6 WKS of whole brain or 50 Gy/25 FRX/5 WKS of whole brain + additional 20 Gy/10 FRX/2 WKS of localized field RT. Chemotherapy (BLM, MeCCNU and ACNU) was given for 34 cases. Survivals at 3 years for GM and AS were 12 % and 68 %, respectively (p < 0.01). Prognostic factors for GM were age (p < 0.02), neurologic function (RTOG) (p < 0.01), AJC-staging T-factor (p < 0.05), pre-RT LDH level (p < 0.05) and volume of residual tumor (p < 0.05). Corresponding factors for AS were histological subclassification (p < 0.05) and neurologic function (RTOG) (p < 0.05). However, RT dose and field did not impact on survival significantly. Acute adverse effects of RT were otitis media or externa (70 %) and conjunctivitis (8 %). Retinal bleeding was noted in three long-term survivors at 2 years after RT. (author)

  8. Radiation therapy for the solitary plasmacytoma

    Directory of Open Access Journals (Sweden)

    Esengül Koçak

    2010-06-01

    Full Text Available Plasma-cell neoplasms are classically categorized into four groups as: multiple myeloma (MM, plasma-cell leukemias, solitary plasmacytomas (SP of the bone (SPB, and extramedullary plasmacytomas (EMP. These tumors may be described as localized or diffuse in presentation. Localized plasma-cell neoplasms are rare, and include SP of the skeletal system, accounting for 2-5% of all plasma-cell neoplasms, and EMP of soft tissue, accounting for approximately 3% of all such neoplasms. SP is defined as a solitary mass of neoplastic plasma cells either in the bone marrow or in various soft tissue sites. There appears to be a continuum in which SP often progresses to MM. The main treatment modality for SP is radiation therapy (RT. However, there are no conclusive data in the literature on the optimal RT dose for SP. This review describes the interrelationship of plasma-cell neoplasms, and attempts to determine the minimal RT dose required to obtain local control.

  9. Radianttrademark Liquid Radioisotope Intravascular Radiation Therapy System

    International Nuclear Information System (INIS)

    Eigler, N.; Whiting, J.; Chernomorsky, A.; Jackson, J.; Knapp, F.F. Jr.; Litvack, F.

    1998-01-01

    RADIANTtrademark is manufactured by United States Surgical Corporation, Vascular Therapies Division, (formerly Progressive Angioplasty Systems). The system comprises a liquid β-radiation source, a shielded isolation/transfer device (ISAT), modified over-the-wire or rapid exchange delivery balloons, and accessory kits. The liquid β-source is Rhenium-188 in the form of sodium perrhenate (NaReO 4 ), Rhenium-188 is primarily a β-emitter with a physical half-life of 17.0 hours. The maximum energy of the β-particles is 2.1 MeV. The source is produced daily in the nuclear pharmacy hot lab by eluting a Tungsten-188/Rhenium-188 generator manufactured by Oak Ridge National Laboratory (ORNL). Using anion exchange columns and Millipore filters the effluent is concentrated to approximately 100 mCi/ml, calibrated, and loaded into the (ISAT) which is subsequently transported to the cardiac catheterization laboratory. The delivery catheters are modified Championtrademark over-the-wire, and TNTtrademark rapid exchange stent delivery balloons. These balloons have thickened polyethylene walls to augment puncture resistance; dual radio-opaque markers and specially configured connectors

  10. Stereotactic radiation therapy for large vestibular schwannomas

    International Nuclear Information System (INIS)

    Mandl, Ellen S.; Meijer, Otto W.M.; Slotman, Ben J.; Vandertop, W. Peter; Peerdeman, Saskia M.

    2010-01-01

    Background and purpose: To evaluate the morbidity and tumor-control rate in the treatment of large vestibular schwannomas (VS) after stereotactic radiation therapy in our institution. Material and methods: Twenty-five consecutive patients (17 men, 8 women) with large VS (diameter 3.0 cm or larger), treated with stereotactic radiotherapy (SRT) or stereotactic radiosurgery (SRS) between 1992 and 2007, were retrospectively studied after a mean follow-up period of three years with respect to tumor-control rate and complications. Results: Actuarial 5-year maintenance of pre-treatment hearing level probability of 30% was achieved. Five of 17 patients suffered permanent new facial nerve dysfunction. The actuarial 5-year facial nerve preservation probability was 80%. Permanent new trigeminal nerve neuropathy occurred in two of 15 patients, resulting in an actuarial 5-year trigeminal nerve preservation probability of 85%. Tumor progression occurred in four of 25 (16%) patients. The overall 5-year tumor control probability was 82%. Conclusion: Increased morbidity rates were found in patients with large VS treated with SRT or SRS compared to the published series on regular sized VS and other smaller retrospective studies on large VS.

  11. The results of radiation therapy for intracranial meningiomas. With special reference to the natural course of the tumor size after radiotherapy

    International Nuclear Information System (INIS)

    Kobayashi, Katsuhiro; Murakami, Masao; Kubo, Takeshi; Kono, Koichi; Okamoto, Yoshiaki; Kuroda, Yasumasa

    1998-01-01

    Twenty-four cases with intracranial meningioma received radiation therapy from 1967 to 1995 at Tenri Hospital. Two received preoperative radiotherapy and 22 post operative radiotherapy. Of all, 11 were benign, 9 were malignant and 4 were reported only as meningioma. The extent of surgery consisted of total resection in 4, subtotal resection in 10, partial resection in 6, biopsy in 2, exploration in 1 and unknown in 1. Twelve were initial treatments and another 12 were salvage treatments. In all cases, radiation therapy was given a mean dose of 53.6 Gy with 6 or 10 MV X-rays using conventional fractionation. The mean follow-up interval is 56.7 months. Total cause specific survival at 5 and 10 years were 79% and 69%, respectively. The 10-year recurrence-free survival was 100% in benign and 61% in malignant meningiomas. The clinical course of benign meningiomas suggested the value of postoperative radiation therapy, but that of malignant meningiomas were divided into 2 groups, in which some one had recurrence just after completion of radiotherapy or another had local control. It seemed that there were some radio-resistant varieties in malignant meningiomas. The result of the consecutive follow-up by enhanced CT or MRI revealed benign meningiomas had a tendency to decrease in size in a long interval and some malignant meningiomas changed their size soon after radiotherapy. From analysis of our study we conclude that radiation therapy is a useful post-surgical treatment for intracranial meningiomas. (author)

  12. Adjuvant chemo radiation in completely resected gastric cancer: experience of the National Cancer Institute of Chile

    International Nuclear Information System (INIS)

    Isa O, Nicolas; Russo N, Moises; Lopez V, Hernan

    2014-01-01

    Background: Gastric cancer is one of the most lethal tumors in the Chilean population. Aim: To report the results of adjuvant chemoradiotherapy in advanced gastric cancer. Material and Methods: Review of medical records of patients with locoregionally advanced gastric cancer, subjected to a curative resection and treated with adjuvant chemoradiotherapy. The treatment was based on he INT 0116/SSWOG protocol, which includes 5-fluorouracil as a single agent. Patients were followed for a median of 58 months. Results: The records of 168 patients (99 men) treated between 2004 nd 2011, were reviewed. Median survival as 41 months. Median lapses between surgery and onset of chemo and radiotherapy were 12 and 17 weeks, respectively. Overall three and five years survival was 53 and 41%, respectively. On multivariate analysis the factors associated with a lower survival were an antral location of the tumor, presence of signet ring cells and more than 5 involved lymph nodes. Conclusions: Three and five years survival of gastric cancer patients subjected to adjuvant chemoradiotherapy was 53 and 41% respectively.These results are similar to those reported elsewhere

  13. Intraoperative radiation therapy for locally advanced gynecological malignancies

    International Nuclear Information System (INIS)

    Haddock, M.G.; Petersen, I.A.; Webb, M.J.; Wilson, T.O.; Podratz, K.C.; Gunderson, L.L.

    1996-01-01

    Purpose: Evaluate disease control and survival in patients with locally advanced gynecological malignancies who received intraoperative radiation therapy with electrons (IOERT) as a component of treatment. Methods and Materials: Between March 1983 and June 1995, 63 patients (pts) with locally advanced primary (9 pts) or recurrent (54 pts) gynecological malignancies received IOERT as a component of attempted curative therapy. The site of origin was uterine cervix in 40 pts, uterine corpus in 16 pts, vagina in 5 pts, and ovary in 2 pts. Thirty-eight patients with recurrent disease had been previously irradiated (median prior RT dose 5040 cGy, range 900-8400). External beam radiotherapy (EBRT) was given to 43 of 63 pts either before or after IOERT (900-6570 cGy, median 4960 cGy). Chemotherapy was given to 21 pts prior to IOERT and following IOERT in 2 pts. IOERT doses ranged from 800 cGy to 2500 cGy with a median of 1750 cGy. The median IOERT dose was 2000 cGy in 20 patients with gross residual disease and 1500 cGy in 43 patients with microscopic residual disease. Endpoints included central control within the IOERT cone, local control, distant failure, disease free survival and overall survival. Variables evaluated for impact on disease outcome included tumor grade, primary site, prior RT, IOERT dose, EBRT dose, residual disease at time of IOERT, and use of chemotherapy. Results: Survival and disease control data are presented in the table below. There was no impact of any disease or treatment related variable on local or central failure. Pts with microscopic residual disease at the time of IOERT had significantly fewer distant metastases than pts with gross residual (5 yr 31% vs. 77%, p = 0.001) and improved survival (5 yr 37% vs. 10%, p = 0.02). Patients with recurrent disease after previous RT had survival and disease control rates which were similar to those seen in pts without priot RT. Toxicity ≥ grade 3 due to IOERT was observed in 11 pts (17%). Conclusion: A

  14. Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system

    International Nuclear Information System (INIS)

    Kawamura, Masashi; Nakagawa, Hirofumi; Kataoka, Masaaki

    1992-01-01

    From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer were registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p<0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significant). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system. (author)

  15. Overall Survival Benefit From Postoperative Radiation Therapy for Organ-Confined, Margin-Positive Prostate Cancer

    International Nuclear Information System (INIS)

    Dillman, Robert O.; Hafer, Russell; Cox, Craig; McClure, Stephanie E.

    2011-01-01

    Purpose: Radical prostatectomy for invasive prostate cancer is associated with positive margin rates in 10% to 50% of resected specimens. Postoperative radiation therapy may benefit patients who have organ-confined prostate cancer with positive margins. Methods and Materials: We performed a retrospective analysis to examine whether adjunctive radiation therapy enhanced long-term survival for prostate cancer patients who underwent prostatectomy for localized prostate cancer but with positive margins. We used the Hoag Cancer Center database to identify patients diagnosed with invasive prostate cancer. Relative and overall survival rates were calculated. Results: Among 1,474 patients diagnosed with localized invasive prostate cancer during the years 1990 to 2006 and undergoing prostatectomy, 113 (7.7%) were identified who had positive margins and did not have local extension of disease, positive lymph nodes, or distant metastases. A total of 17 patients received adjunctive radiation therapy (Group A), whereas 96 did not (Group B; 3 received hormonal therapy). Both groups had a median age of 64 years and median follow-up of 7.5 years. In Group A, no patients have died as of last follow-up, but in Group B, 18 have died. Estimated 10-year and 15-year overall survival rates were both 100% for Group A compared with 85% and 57% respectively for Group B (p 2 = 0.050, log rank). Relative 10- and 15 year survival rates were both 100% for Group A compared with 100% and 79% respectively for Group B. Conclusions: This retrospective analysis suggests that prostate cancer patients with localized disease but positive margins do derive a survival benefit from adjuvant radiation therapy.

  16. Postoperative radiation therapy for major salivary gland cancer

    International Nuclear Information System (INIS)

    Kato, Fumio; Yahara, Katsuya; Ohguri, Takayuki

    2003-01-01

    A retrospective study was performed on 29 patients with major salivary gland cancer treated with postoperative irradiation between 1981 and 2002. Univariate and multivariate analyses of age, gender, cancer grade, T stage, N stage, surgical resectability, concomitant chemotherapy, and neoadjuvant or adjuvant chemotherapy were performed for disease-free survival. The 5-year survival rates and 5-year disease-free survival rate were 61.6% and 41.4%, respectively. Both univariate and multivariate analyses showed that cancer grade and surgical resectability influenced survival rates. Chemotherapy did not influence the disease-free survival. The total dose of postoperative radiation was 47.6±8.8 Gy in the complete excision group as planned, but was 56.1±7.9 Gy in the incomplete excision group, which may be insufficient and lead to poor treatment outcome. (author)

  17. Chondronecrosis of the cricoid cartilage following radiation therapy

    International Nuclear Information System (INIS)

    Tanabe, Masahiro; Isshiki, Nobuhiko; Kojima, Hisayoshi

    1979-01-01

    Chondronecrosis of the laryngeal cartilage following radiation therapy is a rare but serious complication. We report herein a case of post-radiation chondronecrosis and discuss factors predisposing to its development. A 67-year-old man received telecobalt therapy for cancer of the right vocal cord. A year after the radiation therapy given in a dose of 7,000r, the patient developed dysphagia and dyspnea. Following tracheotomy, he underwent total laryngectomy. The surgical specimen showed no cancer but chondronecrosis of the cricoid cartilage was present. After laryngectomy he developed progressive soft tissue necrosis of the neck and died following a carotid hemorrhage. (author)

  18. Radiation therapy quality control in MRCCC radiotherapy units

    International Nuclear Information System (INIS)

    Fielda Djuita; Rina Taurisia; Andreas Nainggolan

    2011-01-01

    Increasing cancer patients in Indonesia is not supported with the number of equipment that is able to treat cancer patients, especially in the radiation therapy field. Therefore, several private hospitals have joined to provide radiation therapy services and one of them is MRCCC. As a new hospital providing services in radiotherapy field, the writer tries to present our quality control program that we have done in our hospital. Purpose: As quality control to radiation therapy clinical practice. Methods: Descriptive essay of what we do in our institution. Conclusion: Average output photon and electron lower more than tolerance dose. (author)

  19. Long-term effects of radiation therapy on white matter of the corpus callosum: a diffusion tensor imaging study in children

    Energy Technology Data Exchange (ETDEWEB)

    Makola, Monwabisi [University of Cincinnati, College of Medicine, Cincinnati, OH (United States); Douglas Ris, M. [Texas Children' s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States); Mahone, E.M. [Kennedy Krieger Institute, Department of Neuropsychology, Baltimore, MD (United States); Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD (United States); Yeates, Keith Owen [University of Calgary, Department of Psychology, Alberta Children' s Hospital Research Institute, Hotchkiss Brain Institute, Calgary, AB (Canada); Cecil, Kim M. [Imaging Research Center, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH (United States); University of Cincinnati College of Medicine, Neuroscience Graduate Program, Cincinnati, OH (United States); University of Cincinnati College of Medicine, Department of Environmental Health, Cincinnati, OH (United States)

    2017-12-15

    Despite improving survival rates, children are at risk for long-term cognitive and behavioral difficulties following the diagnosis and treatment of a brain tumor. Surgery, chemotherapy and radiation therapy have all been shown to impact the developing brain, especially the white matter. The purpose of this study was to determine the long-term effects of radiation therapy on white matter integrity, as measured by diffusion tensor imaging, in pediatric brain tumor patients 2 years after the end of radiation treatment, while controlling for surgical interventions. We evaluated diffusion tensor imaging performed at two time points: a baseline 3 to 12 months after surgery and a follow-up approximately 2 years later in pediatric brain tumor patients. A region of interest analysis was performed within three regions of the corpus callosum. Diffusion tensor metrics were determined for participants (n=22) who underwent surgical tumor resection and radiation therapy and demographically matched with participants (n=22) who received surgical tumor resection only. Analysis revealed that 2 years after treatment, the radiation treated group exhibited significantly lower fractional anisotropy and significantly higher radial diffusivity within the body of the corpus callosum compared to the group that did not receive radiation. The findings indicate that pediatric brain tumor patients treated with radiation therapy may be at greater risk of experiencing long-term damage to the body of the corpus callosum than those treated with surgery alone. (orig.)

  20. Long-term effects of radiation therapy on white matter of the corpus callosum: a diffusion tensor imaging study in children

    International Nuclear Information System (INIS)

    Makola, Monwabisi; Douglas Ris, M.; Mahone, E.M.; Yeates, Keith Owen; Cecil, Kim M.

    2017-01-01

    Despite improving survival rates, children are at risk for long-term cognitive and behavioral difficulties following the diagnosis and treatment of a brain tumor. Surgery, chemotherapy and radiation therapy have all been shown to impact the developing brain, especially the white matter. The purpose of this study was to determine the long-term effects of radiation therapy on white matter integrity, as measured by diffusion tensor imaging, in pediatric brain tumor patients 2 years after the end of radiation treatment, while controlling for surgical interventions. We evaluated diffusion tensor imaging performed at two time points: a baseline 3 to 12 months after surgery and a follow-up approximately 2 years later in pediatric brain tumor patients. A region of interest analysis was performed within three regions of the corpus callosum. Diffusion tensor metrics were determined for participants (n=22) who underwent surgical tumor resection and radiation therapy and demographically matched with participants (n=22) who received surgical tumor resection only. Analysis revealed that 2 years after treatment, the radiation treated group exhibited significantly lower fractional anisotropy and significantly higher radial diffusivity within the body of the corpus callosum compared to the group that did not receive radiation. The findings indicate that pediatric brain tumor patients treated with radiation therapy may be at greater risk of experiencing long-term damage to the body of the corpus callosum than those treated with surgery alone. (orig.)

  1. COMPARISON OF HYPOFRACTIONATED RADIATION THERAPY VERSUS CONVENTIONAL RADIATION THERAPY IN POST MASTECTOMY BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Abhilash

    2016-03-01

    Full Text Available INTRODUCTION Breast cancer is the most common cancer in women worldwide and a leading cause of cancer death in females and accounts for 1.8 million new cases and approximately 0.5 million deaths annually. Patients who present with locally advanced breast cancer (LABC require multidisciplinary team approach that incorporates diagnostic imaging, surgery, chemotherapy and histopathological assessment, including molecular-based studies, radiation, and, if indicated, biologic and hormonal therapies. Hypofractionated radiation therapy following mastectomy has been used in many institutions for several decades and have demonstrated equivalent local control, cosmetic and normal tissues between 50 Gy in 25 fractions and various hypofractionated radiotherapy prescriptions employing 13-16 fractions. Evidence suggests that hypofractionated radiotherapy may also be safe and effective for regional nodal disease. AIMS AND OBJECTIVES To compare the local control and side effects of hypofractionated radiation therapy with conventional radiation therapy in post mastectomy carcinoma breast with stage II and III and to compare the tolerability and compliance of both schedules. MATERIALS AND METHODS The study was conducted on 60 histopathologically proven patients of carcinoma of breast, treated surgically with modified radical mastectomy. Group I patients were given external radiation to chest flap and drainage areas, a dose of 39 Gy/13 fractions/3.1 weeks, a daily dose 3 Gy for 13 fractions in 4 days a week schedule and Group II patients were given external radiation to chest flap and drainage areas, a dose of 50 Gy/25 fractions/5 weeks, to receive a daily dose 2 Gy for 25 fractions in a 5 days a week schedule. RESULTS The median age at presentation in Group I and II was 48 and 50 years respectively. Locoregional control after completion of radiotherapy in Group I vs. Group II was 26/30 (86.7% vs. 27/30 (90% respectively. Acute reactions and their grades in Group

  2. Quality of Life in a Prospective, Multicenter Phase 2 Trial of Neoadjuvant Full-Dose Gemcitabine, Oxaliplatin, and Radiation in Patients With Resectable or Borderline Resectable Pancreatic Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Serrano, Pablo E. [Department of Surgery, University Health Network, University of Toronto, Toronto, ON (Canada); Herman, Joseph M. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Griffith, Kent A.; Zalupski, Mark M. [Center for Cancer Biostatistics, Biostatistics Unit, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan (United States); Kim, Edward J. [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan (United States); Bekaii-Saab, Tanios S. [Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio (United States); Ben-Josef, Edgar [Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan (United States); Dawson, Laura A. [Princess Margaret Cancer Center, University Health Network, Toronto, ON (Canada); Ringash, Jolie [Princess Margaret Cancer Center, University Health Network, Toronto, ON (Canada); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON (Canada); Wei, Alice C., E-mail: alice.wei@uhn.ca [Department of Surgery, University Health Network, University of Toronto, Toronto, ON (Canada); Princess Margaret Cancer Center, University Health Network, Toronto, ON (Canada); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON (Canada)

    2014-10-01

    Purpose: To determine the health-related quality of life (QOL) during and after neoadjuvant chemoradiation therapy and surgery for patients with pancreatic adenocarcinoma. Methods and Materials: Participants of a prospective, phase 2 multi-institutional trial treated with neoadjuvant chemoradiation followed by surgery completed QOL questionnaires (European Organization for Research and Treatment in Cancer Quality of Life Questionnaire version 3.0 [EORTC-QLQ C30], EORTC-Pancreatic Cancer module [EORTC-PAN 26], and Functional Assessment of Cancer Therapy Hepatobiliary and Pancreatic subscale [FACT-Hep]) at baseline, after 2 cycles of neoadjuvant therapy, after surgery, at 6 months from initiation of therapy, and at 6-month intervals for 2 years. Mean scores were compared with baseline. A change >10% was considered a minimal clinically important difference. Results: Of 71 participants in the trial, 55 were eligible for QOL analysis. Compliance ranged from 32% to 74%. The EORTC-QLQ C30 global QOL did not significantly decline after neoadjuvant therapy, whereas the Functional Assessment of Cancer Therapy global health measure showed a statistically, but not clinically significant decline (−8, P=.02). This was in parallel with deterioration in physical functioning (−14.1, P=.001), increase in diarrhea (+16.7, P=.044), and an improvement in pancreatic pain (−13, P=.01) as per EORTC-PAN 26. Because of poor patient compliance in the nonsurgical group, long-term analysis was performed only from surgically resected participants (n=36). Among those, global QOL returned to baseline levels after 6 months, remaining near baseline through the 24-month visit. Conclusions: The study regimen consisting of 2 cycles of neoadjuvant therapy was completed without a clinically significant QOL deterioration. A transient increase in gastrointestinal symptoms and a decrease in physical functioning were seen after neoadjuvant chemoradiation. In those patients who underwent surgical

  3. Quality of Life in a Prospective, Multicenter Phase 2 Trial of Neoadjuvant Full-Dose Gemcitabine, Oxaliplatin, and Radiation in Patients With Resectable or Borderline Resectable Pancreatic Adenocarcinoma

    International Nuclear Information System (INIS)

    Serrano, Pablo E.; Herman, Joseph M.; Griffith, Kent A.; Zalupski, Mark M.; Kim, Edward J.; Bekaii-Saab, Tanios S.; Ben-Josef, Edgar; Dawson, Laura A.; Ringash, Jolie; Wei, Alice C.

    2014-01-01

    Purpose: To determine the health-related quality of life (QOL) during and after neoadjuvant chemoradiation therapy and surgery for patients with pancreatic adenocarcinoma. Methods and Materials: Participants of a prospective, phase 2 multi-institutional trial treated with neoadjuvant chemoradiation followed by surgery completed QOL questionnaires (European Organization for Research and Treatment in Cancer Quality of Life Questionnaire version 3.0 [EORTC-QLQ C30], EORTC-Pancreatic Cancer module [EORTC-PAN 26], and Functional Assessment of Cancer Therapy Hepatobiliary and Pancreatic subscale [FACT-Hep]) at baseline, after 2 cycles of neoadjuvant therapy, after surgery, at 6 months from initiation of therapy, and at 6-month intervals for 2 years. Mean scores were compared with baseline. A change >10% was considered a minimal clinically important difference. Results: Of 71 participants in the trial, 55 were eligible for QOL analysis. Compliance ranged from 32% to 74%. The EORTC-QLQ C30 global QOL did not significantly decline after neoadjuvant therapy, whereas the Functional Assessment of Cancer Therapy global health measure showed a statistically, but not clinically significant decline (−8, P=.02). This was in parallel with deterioration in physical functioning (−14.1, P=.001), increase in diarrhea (+16.7, P=.044), and an improvement in pancreatic pain (−13, P=.01) as per EORTC-PAN 26. Because of poor patient compliance in the nonsurgical group, long-term analysis was performed only from surgically resected participants (n=36). Among those, global QOL returned to baseline levels after 6 months, remaining near baseline through the 24-month visit. Conclusions: The study regimen consisting of 2 cycles of neoadjuvant therapy was completed without a clinically significant QOL deterioration. A transient increase in gastrointestinal symptoms and a decrease in physical functioning were seen after neoadjuvant chemoradiation. In those patients who underwent surgical

  4. Management of cannabis-induced periodontitis via resective surgical therapy: A clinical report.

    Science.gov (United States)

    Momen-Heravi, Fatemeh; Kang, Philip

    2017-03-01

    There is a lack of clinical research on the potential effect of cannabis use on the periodontium as well as its effect on treatment outcomes. The aim of this case report is to illustrate the clinical presentation of periodontal disease in a young woman who was a chronic cannabis user, as well as successful treatment involving motivating the patient to quit cannabis use and undergo nonsurgical and surgical therapy. A 23-year-old woman sought care at the dental clinic for periodontal treatment. During a review of her medical history, the patient reported using cannabis frequently during a 3-year period, which coincided with the occurrence of gingival inflammation. She used cannabis in the form of cigarettes that were placed at the mandibular anterior region of her mouth for prolonged periods. Localized prominent papillary and marginal gingival enlargement of the anterior mandible were present. The mandibular anterior teeth showed localized severe chronic periodontitis. The clinicians informed the patient about the potentially detrimental consequences of continued cannabis use; she was encouraged to quit, which she did. The clinicians performed nonsurgical therapy (scaling and root planing) and osseous surgery. The treatment outcome was evaluated over 6 months; improved radiographic and clinical results were observed throughout the follow-up period. Substantial availability and usage of cannabis, specifically among young adults, requires dentists to be vigilant about clinical indications of cannabis use and to provide appropriate treatments. Behavioral modification, nonsurgical therapy, and surgical therapy offer the potential for successful management of cannabis-related periodontitis. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  5. Optimization of adaptive radiation therapy in cervical cancer: Solutions for photon and proton therapy

    NARCIS (Netherlands)

    van de Schoot, A.J.A.J.

    2016-01-01

    In cervical cancer radiation therapy, an adaptive strategy is required to compensate for interfraction anatomical variations in order to achieve adequate dose delivery. In this thesis, we have aimed at optimizing adaptive radiation therapy in cervical cancer to improve treatment efficiency and

  6. Delivery of intraoperative radiation therapy after pneumonectomy: experimental observations and early clinical results

    International Nuclear Information System (INIS)

    Pass, H.I.; Sindelar, W.F.; Kinsella, T.J.

    1987-01-01

    Intraoperative radiation therapy (IORT) is capable of delivering high doses of radiation to mediastinal structures while sparing lung parenchyma, heart, and other locoregional tissues. A canine model of pulmonary resection and IORT was investigated by performing a pneumonectomy in 15 adult foxhounds followed by 0 cGy, 2000 cGy, 3000 cGy, 4000 cGy. No clinical complications developed in 4 animals in the 2000-cGy group. However, 2 of the 8 animals given a high dose died of esophageal hemorrhage or carinal necrosis. Esophagitis occurred in 10 of 12 animals, and none of the animals experienced bronchial stump dehiscence. In a limited Phase I protocol, 4 patients with non-small cell lung cancer were treated with resection and 2500 cGy of IORT to two separate ports encompassing the superior and inferior mediastinum. Two patients experienced life-threatening bronchopleural fistulas, and 2 patients died as a consequence of esophageal problems. One patients had recurrence with brain metastases, and the 1 long-term survivor is free from disease. As opposed to the animal model of thoracic IORT, the clinical study demonstrated major toxicity with respiratory and esophageal morbidity. The therapeutic usefulness of thoracic IORT in the management of lung cancer must be questioned in view of this small but consistent series of patients. Further carefully designed clinical studies using lower doses of IORT are needed

  7. Reassessment of radiation therapy for the management of lung cancer in patients with chronic pulmonary disease

    International Nuclear Information System (INIS)

    Green, N.; Weinstein, H.

    1983-01-01

    Surgery has remained the mainstay of definitive treatment for lung cancer. Radiation therapy has been advocated when the location of the lung cancer precludes resection or the severity or the cardiopulmonary impairment indicates that the patient cannot withstand the proposed resection. Extended field irradiation h