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Current Oncology (Toronto, Ont.) Apr 2020The Canadian Cancer Society estimated that 220,400 new cases of cancer would be diagnosed in 2019. Of the affected patients, more than 60% will survive for 5 years or... (Review)
Review
The Canadian Cancer Society estimated that 220,400 new cases of cancer would be diagnosed in 2019. Of the affected patients, more than 60% will survive for 5 years or longer after their cancer diagnosis. Furthermore, nearly 40% will receive at least 1 course of radiotherapy (rt). Radiotherapy is used with both curative and palliative intent: to treat early-stage or locally advanced tumours (curative) and for symptom management in advanced disease (palliative). It can be delivered systemically (external-beam rt) or internally (brachytherapy). Although technique improvements have drastically reduced the occurrence of rt-related toxicity, most patients still experience burdensome rt side effects (seffs). Radiotherapy seffs are local or locoregional, and manifest in tissues or organs that were irradiated. Side effects manifesting within weeks after rt completion are termed "early seffs," and those occurring months or years after treatment are termed "late seffs." In addition to radiation oncologists, general practitioners in oncology and primary care providers are involved in survivorship care and management of rt seffs. Here, we present an overview of common seffs and their respective management: anxiety, depression, fatigue, and effects related to the head-and-neck, thoracic, and pelvic treatment sites.
Topics: Female; Humans; Male; Neoplasms; Radiotherapy; Radiotherapy Dosage; Survivorship
PubMed: 32489253
DOI: 10.3747/co.27.6233 -
The British Journal of Radiology Mar 2019Extraordinary normal tissue response to highly spatially fractionated X-ray beams has been explored for over 25 years. More recently, alternative radiation sources have... (Review)
Review
Extraordinary normal tissue response to highly spatially fractionated X-ray beams has been explored for over 25 years. More recently, alternative radiation sources have been developed and utilized with the aim to evoke comparable effects. These include protons, which lend themselves well for this endeavour due to their physical depth dose characteristics as well as corresponding variable biological effectiveness. This paper addresses the motivation for using protons to generate spatially fractionated beams and reviews the technological implementations and experimental results to date. This includes simulation and feasibility studies, collimation and beam characteristics, dosimetry and biological considerations as well as the results of in vivo and in vitro studies. Experimental results are emerging indicating an extraordinary normal tissue sparing effect analogous to what has been observed for synchrotron generated X-ray microbeams. The potential for translational research and feasibility of spatially modulated proton beams in clinical settings is discussed.
Topics: Animals; Dose Fractionation, Radiation; Humans; Proton Therapy; Radiometry; Radiotherapy Dosage
PubMed: 30359081
DOI: 10.1259/bjr.20180466 -
Ugeskrift For Laeger Oct 2019This review summarises the potential usage of proton therapy in Denmark. About one third of Danes are diagnosed with cancer, and half of these need radiotherapy in the... (Review)
Review
This review summarises the potential usage of proton therapy in Denmark. About one third of Danes are diagnosed with cancer, and half of these need radiotherapy in the course of treatment. Radiation dose cannot be adequately increased without giving rise to unacceptable, high risk of toxicity, but proton therapy is encouraging due to a unique depth dose distribution. In some cases, the benefit of proton therapy is obvious, but in most cases the gain is less obvious, and patients should only receive treatment within clinical trials. Clinical studies on proton therapy with focus on reduction of radiation-induced side effects and improvement of quality of life should be conducted.
Topics: Denmark; Humans; Proton Therapy; Quality of Life; Radiation Injuries; Radiotherapy Dosage
PubMed: 31610837
DOI: No ID Found -
Brachytherapy 2012This report presents an update to the American Brachytherapy Society (ABS) high-dose-rate (HDR) brachytherapy guidelines for locally advanced cervical cancer.
PURPOSE
This report presents an update to the American Brachytherapy Society (ABS) high-dose-rate (HDR) brachytherapy guidelines for locally advanced cervical cancer.
METHODS
Members of the ABS with expertise in cervical cancer formulated updated guidelines for HDR brachytherapy using tandem and ring, ovoids, cylinder, or interstitial applicators for locally advanced cervical cancer. These guidelines were written based on medical evidence in the literature and input of clinical experts in gynecologic brachytherapy.
RESULTS
The ABS affirms the essential curative role of tandem-based brachytherapy in the management of locally advanced cervical cancer. Proper applicator selection, insertion, and imaging are fundamental aspects of the procedure. Three-dimensional imaging with magnetic resonance or computed tomography or radiographic imaging may be used for treatment planning. Dosimetry must be performed after each insertion before treatment delivery. Applicator placement, dose specification, and dose fractionation must be documented, quality assurance measures must be performed, and followup information must be obtained. A variety of dose/fractionation schedules and methods for integrating brachytherapy with external-beam radiation exist. The recommended tumor dose in 2-Gray (Gy) per fraction radiobiologic equivalence (normalized therapy dose) is 80-90Gy, depending on tumor size at the time of brachytherapy. Dose limits for normal tissues are discussed.
CONCLUSION
These guidelines update those of 2000 and provide a comprehensive description of HDR cervical cancer brachytherapy in 2011.
Topics: Brachytherapy; Female; Humans; Practice Guidelines as Topic; Radiotherapy Dosage; United States; Uterine Cervical Neoplasms
PubMed: 22265437
DOI: 10.1016/j.brachy.2011.07.002 -
International Journal of Hyperthermia :... 2016Planning of combined radiotherapy and hyperthermia treatments should be performed taking the synergistic action between the two modalities into account. This work... (Review)
Review
Planning of combined radiotherapy and hyperthermia treatments should be performed taking the synergistic action between the two modalities into account. This work evaluates the available experimental data on cytotoxicity of combined radiotherapy and hyperthermia treatment and the requirements for integration of hyperthermia and radiotherapy treatment planning into a single planning platform. The underlying synergistic mechanisms of hyperthermia include inhibiting DNA repair, selective killing of radioresistant hypoxic tumour tissue and increased radiosensitivity by enhanced tissue perfusion. Each of these mechanisms displays different dose-effect relations, different optimal time intervals and different optimal sequences between radiotherapy and hyperthermia. Radiosensitisation can be modelled using the linear-quadratic (LQ) model to account for DNA repair inhibition by hyperthermia. In a recent study, an LQ model-based thermoradiotherapy planning (TRTP) system was used to demonstrate that dose escalation by hyperthermia is equivalent to ∼10 Gy for prostate cancer patients treated with radiotherapy. The first step for more reliable TRTP is further expansion of the data set of LQ parameters for normally oxygenated normal and tumour tissue valid over the temperature range used clinically and for the relevant time intervals between radiotherapy and hyperthermia. The next step is to model the effect of hyperthermia in hypoxic tumour cells including the physiological response to hyperthermia and the resulting reoxygenation. Thermoradiotherapy planning is feasible and a necessity for an optimal clinical application of hyperthermia combined with radiotherapy in individual patients.
Topics: Animals; Combined Modality Therapy; Humans; Hyperthermia, Induced; Models, Biological; Neoplasms; Radiation Tolerance; Radiotherapy Dosage
PubMed: 26670625
DOI: 10.3109/02656736.2015.1110757 -
Annals of Palliative Medicine Mar 2020Whole-breast radiotherapy after breast-conserving surgery (BCS) can improve patient survival while reducing local tumor recurrence. Although standard breast radiotherapy... (Review)
Review
Whole-breast radiotherapy after breast-conserving surgery (BCS) can improve patient survival while reducing local tumor recurrence. Although standard breast radiotherapy can achieve good tumor control and cosmetic effects with low toxicity, the 5- to 7-week treatment time is relatively long for patients and can result in wasted medical resources. Therefore, there is a growing trend toward hypofractionated radiotherapy (HFRT), which accelerates partial-breast irradiation. Both short-course radiotherapy and conventional fractionated radiotherapy are safe and effective treatment modes, with similar survival and local tumor control effects as those of conventional radiotherapy (CRT), and adverse reactions can be tolerated. Compared with conventional fractionated radiotherapy, short-course radiotherapy saves medical resources and has a shorter total treatment time, reduced treatment costs, and an improved quality of life for patients.
Topics: Breast Neoplasms; Female; Humans; Mastectomy, Segmental; Neoplasm Recurrence, Local; Neoplasm Staging; Radiation Dose Hypofractionation; Radiotherapy Dosage; Radiotherapy, Adjuvant; Treatment Outcome
PubMed: 32233620
DOI: 10.21037/apm.2020.02.18 -
Journal of Thoracic Oncology : Official... Oct 2020
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Radiotherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted
PubMed: 32981597
DOI: 10.1016/j.jtho.2020.07.004 -
Head & Neck Apr 2016The development of intensity-modulated radiotherapy (IMRT) has played a major role in improving outcomes and decreasing morbidity in patients with head and neck cancer.... (Review)
Review
The development of intensity-modulated radiotherapy (IMRT) has played a major role in improving outcomes and decreasing morbidity in patients with head and neck cancer. This review addresses this vital modality with a focus on the important role of the head and neck surgeon. The technique as well as its benefits and points of caution are outlined, the definitions of tumor and treatment volumes are discussed, and the dose and fractionation are detailed. Following this are several sections dedicated to the role of the head and neck surgeon in the planning of both definitive and postoperative radiotherapy to the primary site and neck. There is a focus throughout on anatomic and surgical considerations; commonly encountered situations are illustrated. With a deeper understanding of this technique and their own pivotal contribution to target delineation, head and neck surgeons will be poised to expand their role and improve cancer care for their patients. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2368-E2373, 2016.
Topics: Dose Fractionation, Radiation; Head and Neck Neoplasms; Humans; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Surgeons
PubMed: 26705685
DOI: 10.1002/hed.24338 -
Radiotherapy and Oncology : Journal of... Mar 2018The aim of this publication is to compile available literature data and expert experience regarding skin brachytherapy (BT) in order to produce general recommendations... (Review)
Review
PURPOSE
The aim of this publication is to compile available literature data and expert experience regarding skin brachytherapy (BT) in order to produce general recommendations on behalf of the GEC-ESTRO Group.
METHODS
We have done an exhaustive review of published articles to look for general recommendations.
RESULTS
Randomized controlled trials, systemic reviews and meta-analysis are lacking in literature and there is wide variety of prescription techniques successfully used across the radiotherapy centers. BT can be delivered as superficial application (also called contact BT or plesiotherapy) or as interstitial for tumours thicker than 5 mm within any surface, including very irregular. In selected cases, particularly in tumours located within curved surfaces, BT can be advantageous modality from dosimetric and planning point of view when compared to external beam radiotherapy. The general rule in skin BT is that the smaller the target volume, the highest dose per fraction and the shortest overall length of treatment can be used.
CONCLUSION
Skin cancer incidence is rising worldwide. BT offers an effective non-invasive or minimally invasive and relative short treatment that particularly appeals to elder and frail population.
Topics: Brachytherapy; Dose Fractionation, Radiation; Humans; Practice Guidelines as Topic; Radiotherapy Dosage; Skin Neoplasms
PubMed: 29455924
DOI: 10.1016/j.radonc.2018.01.013 -
Radiotherapy and Oncology : Journal of... Oct 2022FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to... (Review)
Review
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
Topics: Humans; Dose Fractionation, Radiation; Radiotherapy Dosage
PubMed: 35952978
DOI: 10.1016/j.radonc.2022.08.004