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Strahlentherapie Und Onkologie : Organ... Jan 2017This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in... (Review)
Review
AIM
This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.
METHODS
Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.
RESULTS
Several large-scale trials on moderate hypofractionation with single doses from 2.4-3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2-3 years.
CONCLUSION
Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.
Topics: Dose-Response Relationship, Radiation; Evidence-Based Medicine; Germany; Humans; Male; Prostatic Neoplasms; Radiation Dose Hypofractionation; Radiation Injuries; Radiotherapy, Conformal; Risk Assessment; Treatment Outcome
PubMed: 27628966
DOI: 10.1007/s00066-016-1041-5 -
AJR. American Journal of Roentgenology Nov 2015Over the past decade, efforts have increasingly been made to decrease radiation dose from medical imaging. However, there remain varied opinions about whether, for whom,... (Review)
Review
OBJECTIVE
Over the past decade, efforts have increasingly been made to decrease radiation dose from medical imaging. However, there remain varied opinions about whether, for whom, by whom, and how these potential risks should be discussed with patients. We aimed to provide a review of the literature regarding awareness and communication of potential radiation-induced cancer risks from medical imaging procedures in hopes of providing guidance for communicating these potential risks with patients.
MATERIALS AND METHODS
We performed a systematic literature review on the topics of radiation dose and radiation-induced cancer risk awareness, informed consent regarding radiation dose, and communication of radiation-induced cancer risks with patients undergoing medical imaging. We included original research articles from North America and Europe published between 1995 and 2014.
RESULTS
From more than 1200 identified references, a total of 22 original research articles met our inclusion criteria. Overall, we found that there is insufficient knowledge regarding radiation-induced cancer risks and the magnitude of radiation dose associated with CT examinations among patients and physicians. Moreover, there is minimal sharing of information before nonacute imaging studies between patients and physicians about potential long-term radiation risks.
CONCLUSION
Despite growing concerns regarding medical radiation exposure, there is still limited awareness of radiation-induced cancer risks among patients and physicians. There is also no consensus regarding who should provide patients with relevant information, as well as in what specific situations and exactly what information should be communicated. Radiologists should prioritize development of consensus statements and novel educational initiatives with regard to radiation-induced cancer risk awareness and communication.
Topics: Communication; Diagnostic Imaging; Humans; Informed Consent; Neoplasms, Radiation-Induced; Physician-Patient Relations; Radiation Dosage
PubMed: 26295534
DOI: 10.2214/AJR.15.15057 -
Journal of Medical Imaging and... Jun 2021SpaceOAR, an absorbable polyethylene glycol hydrogel, increases the space between the prostate and rectum to reduce the radiation received by the rectum during prostate...
SpaceOAR, an absorbable polyethylene glycol hydrogel, increases the space between the prostate and rectum to reduce the radiation received by the rectum during prostate cancer radiation therapy. The objective of this systematic review was to evaluate controlled studies on the dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer. Eight studies were included in the review. All of the studies showed SpaceOAR to reduce the radiation dose volume to the rectum over numerous dosimetry levels. Of the four studies that assessed toxicity, one reported SpaceOAR to significantly decrease acute Grade 1 diarrhoea and two reported SpaceOAR to significantly decrease late Grade 1 and Grade ≥2 rectal toxicities. Two studies assessed cumulative incidence of toxicity at 3 years in which one reported SpaceOAR to significantly decrease urinary incontinence and Grade ≥1 and Grade ≥2 rectal toxicities, and the other reported SpaceOAR to significantly decrease Grade 1 diarrhoea and Grade 2 proctitis. Moreover, one study reported that fewer SpaceOAR patients experienced 10-point declines in bowel quality of life at 3 years, but another study reported no significant difference in 10-point declines in bowel quality of life between the SpaceOAR and control groups at 5 years. With the current research available, SpaceOAR may be beneficial to those who did not meet the standard rectal dose-volume criteria, have higher risk factors of developing rectal toxicities post-radiation, or wish to decrease the length and costs of radiotherapy by increasing the dose of radiation per fraction.
Topics: Humans; Male; Prostatic Neoplasms; Quality of Life; Radiotherapy Dosage; Rectum
PubMed: 33855816
DOI: 10.1111/1754-9485.13179 -
Critical Reviews in Food Science and... Jan 2018Legume lectins are carbohydrate-binding proteins of non-immune origin. Significant amounts of lectins have been found in Phaseolus vulgaris beans as far back as in the... (Review)
Review
Legume lectins are carbohydrate-binding proteins of non-immune origin. Significant amounts of lectins have been found in Phaseolus vulgaris beans as far back as in the last century; however, many questions about their potential biological roles still remain obscure. Studies have shown that lectins are anti-nutritional factors that can cause intestinal disorders. Owing to their ability to act as toxic allergens and hemagglutinins, the Phaseolus vulgaris lectins are of grave concern for human health and safety. Nonetheless, their potential beneficial health effects, such as anti-cancer, anti-human immunodeficiency virus (anti-HIV), anti-microbial infection, preventing mucosal atrophy, reducing type 2 diabetes and obesity, promoting nutrients absorption and targeting drugs, are of immense interest. The significance of Phaseolus vulgaris lectins in biological researches and the potential biomedical applications have placed tremendous emphasis on the development of purification strategies to obtain the protein in pure and stable forms. These purification strategies entail considerations such as effects of proteolysis, heating, gamma radiation, and high-hydrostatic-pressure that can have crucial outcomes in either eliminating or improving bioactivities of the lectins. Thus, up-to-date research findings of Phaseolus vulgaris lectins on different aspects such as anti-nutritional and health impacts, purification strategies and novel processing trends, are systematically reviewed.
Topics: Animals; Anti-HIV Agents; Anti-Infective Agents; Anticarcinogenic Agents; Diet; Digestion; Drug Stability; Female; Food Handling; Health Promotion; Humans; Immunity; Intestinal Diseases; Male; Phytohemagglutinins
PubMed: 26479307
DOI: 10.1080/10408398.2015.1096234 -
JPMA. the Journal of the Pakistan... Jan 2021To build evidence about the effectiveness of computerized tomography virtual hysterosalpingography (CT-VHSG) in the evaluation of female infertility and to assess the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To build evidence about the effectiveness of computerized tomography virtual hysterosalpingography (CT-VHSG) in the evaluation of female infertility and to assess the estimated radiation dose imposed.
METHODS
A systematic review method was utilized to evaluate relevant diagnostic studies. Electronic database was searched from July to October 2017. Hand search was also conducted when applicable. Study quality was assessed according to standardised criteria. Heterogeneity was assessed using subjective and statistical measures. Meta-analysis was judged appropriate and conducted using Open met-analyst software utilizing the random effect model.
RESULTS
Based on the assessment of risk of bias of the eligible studies, five studies were included in the final review. Random effects models showed that CT-VHSG has high diagnostic performance (pooled sensitivity 0.992 and specificity 0.98, with negative and positive likelihood ratios of 14.671 and 0.04 respectively). CT-VHSG had comparatively lesser radiation dose than conventional HSG (pooled mean effective dose 4.14 mSV vs 6 mSV respectively).
CONCLUSIONS
CT-VHSG is a reliable procedure with high diagnostic performance in evaluation of the female reproductive tract. CT-VHSG can be regarded as generally safe imaging diagnostic technique in the infertility workup. In contrary to common belief, CT-VHSG has comparable or lower radiation dose than conventional HSG.
Topics: Female; Humans; Hysterosalpingography; Infertility, Female; Radiation Dosage; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 33484533
DOI: 10.47391/JPMA.537 -
Radiotherapy and Oncology : Journal of... Dec 2010Intensity-modulated radiation therapy (IMRT) could represent a new tool to improve the therapeutic ratio in the treatment of glioblastoma. This systematic review... (Review)
Review
BACKGROUND AND PURPOSE
Intensity-modulated radiation therapy (IMRT) could represent a new tool to improve the therapeutic ratio in the treatment of glioblastoma. This systematic review investigates the evidence behind the application of IMRT to glioblastoma, assessing the potential benefits from both the clinical and dosimetrical perspective.
MATERIALS AND METHODS
Two independent researchers systematically identified all relevant articles available on PubMed and MEDLINE databases until December 2009.
RESULTS
Ultimately, seventeen studies were included in the analysis, for a total of 204 treated patients and 148 patient datasets used in planning studies. Most dosimetrical studies provided statistical analysis. Clinical series did not include any randomized controlled study, ultimately hindering a meta-analysis. From the dosimetrical point of view, conformal radiotherapy and IMRT provide similar results in terms of target coverage, while IMRT is better in terms of dose conformity, in reducing the maximum dose to the organs at risk and in healthy brain sparing. In clinical reports, a wide variability was recorded concerning dose per fraction, total dose, and chemotherapy administration. A comprehensive qualitative comparison with literature on similar non-IMRT clinical series showed that in most IMRT series excellent compliance and low rates of toxicity were recorded. Hypofractionated regimens in association with chemotherapy showed results that are even superior to the standard treatment.
CONCLUSIONS
According to the available data, the dosimetrical advantages of IMRT translate into the clinical capability of delivering higher dose levels in a shorter time. This approach in glioblastoma patients with good prognosis suggests the possibility of improving outcomes without an increase in toxicity.
Topics: Brain Neoplasms; Glioblastoma; Humans; Radiotherapy Dosage; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated
PubMed: 20926149
DOI: 10.1016/j.radonc.2010.08.018 -
Radiotherapy and Oncology : Journal of... Jun 2024This systematic review examines the role of dosimetric parameters in predicting temporal lobe necrosis (TLN) risk in nasopharyngeal carcinoma (NPC) patients treated with... (Meta-Analysis)
Meta-Analysis Review
This systematic review examines the role of dosimetric parameters in predicting temporal lobe necrosis (TLN) risk in nasopharyngeal carcinoma (NPC) patients treated with three-dimensional conformal RT (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). TLN is a serious late complication that can adversely affect the quality of life of NPC patients. Understanding the relationship between dosimetric parameters and TLN can guide treatment planning and minimize radiation-related complications. A comprehensive search identified relevant studies published up to July 2023. Studies reporting on dosimetric parameters and TLN in NPC patients undergoing 3D-CRT, IMRT, and VMAT were included. TLN incidence, follow-up duration, and correlation with dosimetric parameters of the temporal lobe were analyzed. The review included 30 studies with median follow-up durations ranging from 28 to 110 months. The crude incidence of TLN varied from 2.3 % to 47.3 % and the average crude incidence of TLN is approximately 14 %. Dmax and D1cc emerged as potential predictors of TLN in 3D-CRT and IMRT-treated NPC patients. Threshold values of >72 Gy for Dmax and >62 Gy for D1cc were associated with increased TLN risk. However, other factors should also be considered, including host characteristics, tumor-specific features and therapeutic factors. In conclusion, this systematic review highlights the significance of dosimetric parameters, particularly Dmax and D1cc, in predicting TLN risk in NPC patients undergoing 3D-CRT, IMRT, and VMAT. The findings provide valuable insights that can help in developing optimal treatment planning strategies and contribute to the development of clinical guidelines in this field.
Topics: Humans; Nasopharyngeal Carcinoma; Temporal Lobe; Necrosis; Radiation Injuries; Nasopharyngeal Neoplasms; Radiotherapy, Intensity-Modulated; Radiotherapy Dosage; Radiotherapy, Conformal
PubMed: 38537680
DOI: 10.1016/j.radonc.2024.110258 -
The Journal of Clinical and Aesthetic... Jun 2023Phototherapy has gained popularity in the recent decades for the treatment of various immune-mediated dermatological conditions since it is more-cost effective and less...
Phototherapy has gained popularity in the recent decades for the treatment of various immune-mediated dermatological conditions since it is more-cost effective and less toxic compared to systemic therapies. This systematic review aims to inform dermatology providers of the risks and benefits of phototherapy, especially in patients at risk for malignancies. Ionizing energy from phototherapy results in DNA photolesions, namely of cyclobutane pyrimidine dimers (CPDs) and 6-4 photoproducts (6-4PPs). Without adequate repair, these mutations increase the risk for carcinogenesis. Additionally, phototherapy can also indirectly cause DNA damage through the formation of reactive oxygen species (ROS), which damage of several structural and functional proteins and DNA. When choosing a phototherapy modality, it also important to take into consideration the side effect profiles associated with each modality. For instance, a 10-fold higher dose of NB-UVB is required to produce a similar amount of CPDs compared with BB-UVB. Patients who undergo UVA with psoralen (PUVA) can be susceptible to developing skin malignancies up to 25 years after receiving their last treatment. It would behoove providers to consider optimal radiation dosage given each patients' level of skin pigmentation and potential for photoadaptation. Additionally, there are measures have been proposed to minimize deleterious skin changes, such as a 42-degree Celsius heat treatment using a 308nm excimer laser prior to UVB phototherapy and low frequency, low intensity electromagnetic fields along with UVB. However, as performing routine skin exams, remain paramount in the prevention of phototherapy-induced neoplasia.
PubMed: 37361361
DOI: No ID Found -
Oral Surgery, Oral Medicine, Oral... Feb 2010Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field... (Review)
Review
OBJECTIVE
Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone.
STUDY DESIGN
Systematic review of the literature.
RESULTS
Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation.
CONCLUSION
This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.
Topics: Animals; Bone Development; Bone Marrow Transplantation; Bone Morphogenetic Proteins; Bone Remodeling; Bone Substitutes; Bone Transplantation; Bone and Bones; Cranial Irradiation; Dose-Response Relationship, Radiation; Guided Tissue Regeneration, Periodontal; Humans; Jaw Neoplasms; Mandible; Mandibular Neoplasms; Osteogenesis, Distraction; Osteoradionecrosis; Plastic Surgery Procedures; Tissue Engineering
PubMed: 20123406
DOI: 10.1016/j.tripleo.2009.10.001 -
Journal of Clinical Medicine Research Apr 2017Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There... (Review)
Review
Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There is a lack of data in the literature regarding the effectiveness of bevacizumab for the treatment of RN. The purpose of this review was to perform a comprehensive analysis of all reported cases using bevacizumab for the treatment of brain RN. In September 2016, we performed a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane Library. The research for the review was conducted using a combination of the keywords "radiation necrosis", "radiotherapy" and "bevacizumab" alongside the fields comprising article title, abstract and keywords. Randomized trials, non-randomized trials, prospective studies, retrospective studies and single case reports were included in the review. Our research generated 21 studies and 125 cases where bevacizumab had been used for the treatment of RN. The median follow-up was 8 months and the most frequent bevacizumab dose used was 7.5 mg/kg for 2 weeks with a median of four cycles. Low-dose bevacizumab resulted in effectiveness with improvement in both clinical and radiographic response. The median decrease in T1 contrast enhancement and in T2/FLAIR signal abnormality was 64% and 60%, respectively. A reduction in steroidal therapy was observed in majority of patients treated. Based on the data of our review, bevacizumab appears to be a promising agent for the treatment of brain RN. Future prospective studies are required to evaluate the role of bevacizumab in RN and to define the optimal scheduling, dosage and duration of therapy.
PubMed: 28270886
DOI: 10.14740/jocmr2936e