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Breast (Edinburgh, Scotland) Nov 2019Progress in radiotherapy (RT) for early breast cancer, driven by advances in radiobiology and radiation techniques is enabling individualised target volume and... (Review)
Review
Progress in radiotherapy (RT) for early breast cancer, driven by advances in radiobiology and radiation techniques is enabling individualised target volume and dose-fractionation according to recurrence risk. Conventionally fractionated WBI (CF-WBI) has been justified on the basis that it spares dose-limiting late-responding normal tissues more than breast cancer. However, randomised clinical trials (RCTs) testing hypofractionated WBI (HF-WBI) showed equivalent tumour control, improved acute toxicity and similar late toxicity between selected HF-WBI schedules and CF-WBI. RCTs showed that tumour bed boost (TBB) after WBI improved local control but increased breast fibrosis compared to no TBB. RCT comparing sequential TBB and simultaneous integrated TBB using dose intensity modulation showed similar toxicity. Partial breast irradiation (PBI) limits target volume to the tumour bed, which permits safe treatment acceleration. RCTs showed that PBI resulted in low local relapse rates but in some RCTs, higher rates of late toxicity and adverse cosmetic outcome than WBI. Given heterogeneity of PBI techniques, target volumes and dose-fractionation schedules used in RCTs, interpretation of results to distinguish whether outcome variations are caused by target volume or dose-fractionation effect is challenging. RCTs demonstrating efficacy of post-mastectomy RT (PMRT) included the chest wall and regional nodes but did not distinguish relative contributions of nodal target sub-volumes. In patients with smaller axillary tumour burden, IMC irradiation is controversial. RCTs were not powered for comparison between CF-PMRT and HF-PMRT. No increase in arm or shoulder dysfunction with HF-PMRT was observed. No RCT data exist on HF-PMRT in patients with breast reconstruction.
Topics: Breast Neoplasms; Dose Fractionation, Radiation; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Segmental; Neoplasm Recurrence, Local; Postoperative Period; Radiotherapy, Adjuvant; Randomized Controlled Trials as Topic; Risk Assessment
PubMed: 31839165
DOI: 10.1016/S0960-9776(19)31128-2 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2022Optic nerve glioma is a rather rare tumor. It predominantly arises in pediatric patients, including those with type I neurofibromatosis. This neoplasm is accompanied by...
UNLABELLED
Optic nerve glioma is a rather rare tumor. It predominantly arises in pediatric patients, including those with type I neurofibromatosis. This neoplasm is accompanied by decreased visual function and exophthalmos. Treatment strategy is individualized depending on age, volume and spread of tumor, as well as severity of clinical manifestations. Possible treatment options are surgical resection, chemotherapy, radiotherapy and their combination. Radiotherapy can be recommended for patients with intact visual functions, no severe proptosis and trophic lesions. Classic fractionation mode is used as a standard. Currently, the possibility of hypofractionated irradiation is being considered.
OBJECTIVE
To evaluate safety and efficacy of hypofractionated radiotherapy in patients with optic nerve glioma.
MATERIAL AND METHODS
Sixteen patients with optic nerve gliomas underwent hypofractionated stereotactic irradiation (CyberKnife) between May 2014 and October 2019. Single focal dose was 5.5 Gy. There were 5 fractions up to total focal dose of 27.5 Gy. The sample enrolled 14 children with a median age of 4 years (range 23 months - 13 years) and 2 adults aged 47 and 66 years, respectively. Median of tumor volume was 2.77 cm (range 1.69-10.01 cm).
RESULTS
Tumor growth control was achieved in all patients, partial remission was observed in 5 (32%) patients. None patient had deterioration of visual function. Improvement of visual acuity was noted in 3 (19%) cases. Visual field enlargement occurred in 4 (67%) out of 6 patients who were preoperatively examined. After irradiation, proptosis decreased by ≥ 1 mm in 9 (60%) out of 15 patients.
Topics: Adult; Child; Child, Preschool; Exophthalmos; Humans; Infant; Neoplasms; Optic Nerve Glioma; Radiation Dose Hypofractionation; Radiosurgery; Treatment Outcome
PubMed: 36252196
DOI: 10.17116/neiro20228605174 -
International Journal of Radiation... May 2021As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, tumor control probability (TCP) after stereotactic... (Review)
Review
PURPOSE
As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, tumor control probability (TCP) after stereotactic radiosurgery (SRS) and fractionated stereotactic radiosurgery (fSRS) for brain metastases was modeled based on pooled dosimetric and clinical data from published English-language literature.
METHODS AND MATERIALS
PubMed-indexed studies published between January 1995 and September 2017 were used to evaluate dosimetric and clinical predictors of TCP after SRS or fSRS for brain metastases. Eligible studies had ≥10 patients and included detailed dose-fractionation data with corresponding ≥1-year local control (LC) data, typically evaluated as a >20% increase in diameter of the targeted lesion using the pre-SRS diameter as a reference.
RESULTS
Of 2951 potentially eligible manuscripts, 56 included sufficient dose-volume data for analyses. Accepting that necrosis and pseudoprogression can complicate the assessment of LC, for tumors ≤20 mm, single-fraction doses of 18 and 24 Gy corresponded with >85% and 95% 1-year LC rates, respectively. For tumors 21 to 30 mm, an 18 Gy single-fraction dose was associated with 75% LC. For tumors 31 to 40 mm, a 15 Gy single-fraction dose yielded ∼69% LC. For 3- to 5-fraction fSRS using doses in the range of 27 to 35 Gy, 80% 1-year LC has been achieved for tumors of 21 to 40 mm in diameter.
CONCLUSIONS
TCP for SRS and fSRS are presented. For small lesions ≤20 mm, single doses of ≈18 Gy appear generally associated with excellent rates of LC; for melanoma, higher doses seem warranted. For larger lesions >20 mm, local control rates appear to be ≈ 70% to 75% with usual doses of 15 to 18 Gy, and in this setting, fSRS regimens should be considered. Greater consistency in reporting of dosimetric and LC data is needed to facilitate future pooled analyses. As systemic and biologic therapies evolve, updated analyses will be needed to further assess the necessity, efficacy, and toxicity of SRS and fSRS.
Topics: Brain; Brain Neoplasms; Disease Progression; Humans; Melanoma; Models, Biological; Models, Theoretical; Necrosis; Probability; Radiation Dose Hypofractionation; Radiosurgery; Treatment Outcome; Tumor Burden
PubMed: 33390244
DOI: 10.1016/j.ijrobp.2020.10.034 -
Radiation Oncology (London, England) Mar 2021Whole brain radiation (WBRT) may lead to acute xerostomia and dry eye from incidental parotid and lacrimal exposure, respectively. We performed a prospective... (Observational Study)
Observational Study
BACKGROUND
Whole brain radiation (WBRT) may lead to acute xerostomia and dry eye from incidental parotid and lacrimal exposure, respectively. We performed a prospective observational study to assess the incidence/severity of this toxicity. We herein perform a secondary analysis relating parotid and lacrimal dosimetric parameters to normal tissue complication probability (NTCP) rates and associated models.
METHODS
Patients received WBRT to 25-40 Gy in 10-20 fractions using 3D-conformal radiation therapy without prospective delineation of the parotids or lacrimals. Patients completed questionnaires at baseline and 1 month post-WBRT. Xerostomia was assessed using the University of Michigan xerostomia score (scored 0-100, toxicity defined as ≥ 20 pt increase) and xerostomia bother score (scored from 0 to 3, toxicity defined as ≥ 2 pt increase). Dry eye was assessed using the Subjective Evaluation of Symptom of Dryness (SESoD, scored from 0 to 4, toxicity defined as ≥ 2 pt increase). The clinical data were fitted by the Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS) NTCP models.
RESULTS
Of 55 evaluable patients, 19 (35%) had ≥ 20 point increase in xerostomia score, 11 (20%) had ≥ 2 point increase in xerostomia bother score, and 13 (24%) had ≥ 2 point increase in SESoD score. For xerostomia, parotid V-V correlated best with toxicity, with AUC 0.68 for xerostomia score and 0.69-0.71 for bother score. The values for the D, m and n parameters of the LKB model were 22.3 Gy, 0.84 and 1.0 for xerostomia score and 28.4 Gy, 0.55 and 1.0 for bother score, respectively. The corresponding values for the D, γ and s parameters of the RS model were 23.5 Gy, 0.28 and 0.0001 for xerostomia score and 32.0 Gy, 0.45 and 0.0001 for bother score, respectively. For dry eye, lacrimal V-V were found to correlate best with toxicity, with AUC values from 0.67 to 0.68. The parameter values of the LKB model were 53.5 Gy, 0.74 and 1.0, whereas of the RS model were 54.0 Gy, 0.37 and 0.0001, respectively.
CONCLUSIONS
Xerostomia was most associated with parotid V-V, and dry eye with lacrimal V-V. NTCP models were successfully created for both toxicities and may help clinicians refine dosimetric goals and assess levels of risk in patients receiving palliative WBRT.
Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Cranial Irradiation; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Dry Eye Syndromes; Humans; Lacrimal Apparatus; Middle Aged; Organs at Risk; Parotid Gland; Probability; Prospective Studies; Radiation Injuries; Radiotherapy, Conformal; Risk Assessment; Xerostomia; Young Adult
PubMed: 33743773
DOI: 10.1186/s13014-021-01786-6 -
The Journal of Clinical Endocrinology... Dec 2020To summarize our experience in the treatment of pituitary somatotroph adenomas by fractionated intensity-modulated radiotherapy (IMRT), describe the treatment outcomes,...
OBJECTIVE
To summarize our experience in the treatment of pituitary somatotroph adenomas by fractionated intensity-modulated radiotherapy (IMRT), describe the treatment outcomes, and determine predictors.
METHODS AND MATERIALS
Patients with pituitary somatotroph adenoma treated by IMRT in our institution from August 2009 to January 2019 were reviewed. A total of 113 patients (37 male) were included in this study. The median age was 33 years (range 12-67 years). A total of 112 patients had not achieved complete remission after surgery, and 1 patient was treated by radiotherapy (RT) alone because she refused to surgery. The median growth hormone level was 8.6 ng/mL (range 2-186 ng/mL) and the median insulin-like growth factor (IGF)-1 level was 732 ng/mL (range 314-1485 ng/mL) pre-RT. The radiation doses to clinical target volume were usually 50-56 Gy in 25 to 30 fractions and to gross tumor volume were 60.2 Gy in 28 fractions while simultaneous integrated boost-IMRT used. After RT, the patients were followed up with endocrine testing every 6 to 12 months and magnetic resonance imaging annually. Endocrine complete remission was defined as a normal sex- and age-adjusted IGF-1 level without any pituitary suppressive medications. The outcomes including endocrine remission and new hypopituitarism after RT were recorded. The median follow-up time was 36 months (range 6-105.5 months).
RESULTS
The endocrine complete remission rates of IGF-1 at 1, 2, 3, and 5 years were 6%, 22.8%, 48.6%, and 74.3%, respectively. The median time to complete remission was 36.2 ± 3.8 months. The tumor control rate was 99% during the follow-up. The overall incidence of RT-induced hypopituitarism was 28.3% at the last follow-up. Univariate and multivariate analysis demonstrated that tumor sizes before RT, pre-RT IGF-1 level, and age significant predicted the endocrine remission.
CONCLUSIONS
IMRT is a highly effective treatment for pituitary somatotroph adenoma. Endocrine remission rate, tumor control rate, the median time to remission and hypopituitarism incidence are similar to stereotactic radiosurgery. Age and IGF-1 level before RT were significant predictive factors in endocrine remission.
Topics: Adenoma; Adolescent; Adult; Aged; Child; Dose Fractionation, Radiation; Female; Growth Hormone-Secreting Pituitary Adenoma; Humans; Male; Middle Aged; Prognosis; Radiotherapy, Intensity-Modulated; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32930785
DOI: 10.1210/clinem/dgaa651 -
Radiation Oncology (London, England) Aug 2021Multifocal manifestation of high-grade glioma is a rare disease with very unfavourable prognosis. The pathogenesis of multifocal glioma and pathophysiological...
BACKGROUND
Multifocal manifestation of high-grade glioma is a rare disease with very unfavourable prognosis. The pathogenesis of multifocal glioma and pathophysiological differences to unifocal glioma are not fully understood. The optimal treatment of patients suffering from multifocal high-grade glioma is not defined in the current guidelines, therefore individual case series may be helpful as guidance for clinical decision-making.
METHODS
Patients with multifocal high-grade glioma treated with conventionally fractionated radiation therapy (RT) in our institution with or without concomitant chemotherapy between April 2011 and April 2019 were retrospectively analysed. Multifocality was neuroradiologically assessed and defined as at least two independent contrast-enhancing foci in the MRI T1 contrast-enhanced sequence. IDH mutational status and MGMT methylation status were assessed from histopathology records. GTV, PTV as well as the V30Gy, V45Gy and D2% volumes of the brain were analysed. Overall and progression-free survival were calculated from the diagnosis until death and from start of radiation therapy until diagnosis of progression of disease in MRI for all patients.
RESULTS
20 multifocal glioma cases (18 IDH wild-type glioblastoma cases, one diffuse astrocytic glioma, IDH wild-type case with molecular features of glioblastoma and one anaplastic astrocytoma, IDH wild-type case) were included into the analysis. Resection was performed in two cases and stereotactic biopsy only in 18 cases before the start of radiation therapy. At the start of radiation therapy patients were 61 years old in median (range 42-84 years). Histopathological examination showed IDH wild-type in all cases and MGMT promotor methylation in 11 cases (55%). Prescription schedules were 60 Gy (2 Gy × 30), 59.4 Gy (1.8 Gy × 33), 55 Gy (2.2 Gy × 25) and 50 Gy (2.5 Gy × 20) in 15, three, one and one cases, respectively. Concomitant temozolomide chemotherapy was applied in 16 cases, combined temozolomide/lomustine chemotherapy was applied in one case and concomitant bevacizumab therapy in one case. Median number of GTVs was three. Median volume of the sum of the GTVs was 26 cm. Median volume of the PTV was 425.7 cm and median PTV to brain ratio 32.8 percent. Median D2% of the brain was 61.5 Gy (range 51.2-62.7) and median V30Gy and V45 of the brain were 59.9 percent (range 33-79.7) and 40.7 percent (range 14.9-64.1), respectively. Median survival was eight months (95% KI 3.6-12.4 months) and median progression free survival after initiation of RT five months (95% CI 2.8-7.2 months). Grade 2 toxicities were detected in eight cases and grade 3 toxicities in four cases consisting of increasing edema in three cases and one new-onset seizure. One grade 4 toxicity was detected, which was febrile neutropenia related to concomitant chemotherapy.
CONCLUSION
Conventionally fractionated RT with concomitant chemotherapy could safely be applied in multifocal high-grade glioma in this case series despite large irradiation treatment fields.
Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Chemoradiotherapy; Dose Fractionation, Radiation; Female; Glioma; Humans; Male; Middle Aged; Radiotherapy; Retrospective Studies
PubMed: 34454558
DOI: 10.1186/s13014-021-01886-3 -
Pediatric Blood & Cancer May 2023Radiation therapy normal tissue dose constraints are critical when treating pediatric patients. However, there is limited evidence supporting proposed constraints, which... (Review)
Review
BACKGROUND
Radiation therapy normal tissue dose constraints are critical when treating pediatric patients. However, there is limited evidence supporting proposed constraints, which has led to variations in constraints over the years. In this study, we identify these variations in dose constraints within pediatric trials both in the United States and in Europe used in the past 30 years.
PROCEDURE
All pediatric trials from the Children's Oncology Group website were queried from inception until January 2022 and a sampling of European studies was included. Dose constraints were identified and built into an organ-based interactive web application with filters to display data by organs at risk (OAR), protocol, start date, dose, volume, and fractionation scheme. Dose constraints were evaluated for consistency over time and compared between pediatric US and European trials RESULTS: One hundred five closed trials were included-93 US trials and 12 European trials. Thirty-eight separate OAR were found with high-dose constraint variability. Across all trials, nine organs had greater than 10 different constraints (median 16, range 11-26), including serial organs. When comparing US versus European dose tolerances, the United States constraints were higher for seven OAR, lower for one, and identical for five. No OAR had constraints change systematically over the last 30 years.
CONCLUSION
Review of pediatric dose-volume constraints in clinical trials showed substantial variability for all OAR. Continued efforts focused on standardization of OAR dose constraints and risk profiles are essential to increase consistency of protocol outcomes and ultimately to reduce radiation toxicities in the pediatric population.
Topics: Humans; Child; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Organs at Risk; Dose Fractionation, Radiation; Radiation Injuries
PubMed: 36880707
DOI: 10.1002/pbc.30270 -
Journal of Chromatography. A Jan 2021Petroleum is an extremely heterogeneous material. It consists of a wide range of aliphatic, aromatic, and compounds containing heteroatoms such as metals, sulfur, and... (Review)
Review
Petroleum is an extremely heterogeneous material. It consists of a wide range of aliphatic, aromatic, and compounds containing heteroatoms such as metals, sulfur, and nitrogen. The American Society for Testing and Materials (ASTM) methods are used globally as accepted analytical methods for petroleum, petrochemicals, and fuels. A major drawback of ASTM methods is that they require multistep sample preparation that consumes substantial volumes of samples. Thus, the challenge in the petrochemical analysis is to develop rapid and simpler sample preparation procedures that can be automated. An assessment based on the current literature, specifically on the sample preparation of petroleum samples, leads to the authors' conclusion that microextraction provides an excellent complement to current methods. In this review, solvent and sorbent-based microextraction techniques in the context of the consideration of petroleum and crude oil, and samples related to the petrochemical industry, are discussed.
Topics: Liquid Phase Microextraction; Petroleum; Solid Phase Microextraction; Solvents
PubMed: 33340743
DOI: 10.1016/j.chroma.2020.461795 -
Cancer Radiotherapie : Journal de La... 2022We present an update of the French society of oncological radiotherapy recommendation regarding indication, doses, and technique of radiotherapy for intrathoracic...
We present an update of the French society of oncological radiotherapy recommendation regarding indication, doses, and technique of radiotherapy for intrathoracic metastases. The recommendations for delineation of the target volumes and critical organs are detailed.
Topics: Dose Fractionation, Radiation; France; Humans; Lung Neoplasms; Organs at Risk; Palliative Care; Radiation Oncology; Radiosurgery; Radiotherapy Dosage; Radiotherapy, Conformal; Radiotherapy, Image-Guided
PubMed: 34953714
DOI: 10.1016/j.canrad.2021.08.011 -
Cancer Radiotherapie : Journal de La... 2022We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of laryngeal cancers. Intensity modulated radiotherapy is...
We present the update of the recommendations of the French society of oncological radiotherapy on radiotherapy of laryngeal cancers. Intensity modulated radiotherapy is the standard of care radiotherapy for the management of laryngeal cancers. Early stage T1 or T2 tumours can be treated either by radiotherapy or conservative surgery. For tumours requiring total laryngectomy (T2 or T3), an organ preservation strategy by either induction chemotherapy followed by radiotherapy or chemoradiotherapy with cisplatin is recommended. For T4 tumours, a total laryngectomy followed by radiotherapy is recommended when feasible. Dose regimens for definitive and postoperative radiotherapy are detailed in this article, as well as the selection and delineation of tumour and lymph node target volumes.
Topics: Cisplatin; Dose Fractionation, Radiation; France; Humans; Induction Chemotherapy; Laryngeal Neoplasms; Laryngectomy; Neoplasm Staging; Organ Sparing Treatments; Postoperative Care; Radiation Oncology; Radiation-Sensitizing Agents; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated; Tomography, X-Ray Computed
PubMed: 34953705
DOI: 10.1016/j.canrad.2021.09.004