61 research outputs found
Limited Value of Staging Squamous Cell Carcinoma of the Anal Margin and Canal Using the Sentinel Lymph Node Procedure: A Prospective Study with Long-Term Follow-Up
Full text linkBackground. Selection of patients with anal cancer for groin irradiation is based on tumor size, palpation, ultrasound, and fine needle cytology. Current staging of anal cancer may result in undertreatment in small tumors and overtreatment of large tumors. This study reports the feasibility of the sentinel lymph node biopsy (SLNB) in patients with anal cancer and whether this improves the selection for inguinal radiotherapy. Methods. A total of 50 patients with squamous anal cancer were evaluated prospectively. Patients without a SLNB (n = 29) received irradiation of the inguinal lymph nodes based on lymph node status, tumor size, and location of the primary tumor. Inguinal irradiation treatment in patients with a SLNB was based on the presence of metastases in the SLN. Results. SLNs were found in all 21 patients who underwent a SLNB. There were 5 patients (24%) who had complications after SLNB and 7 patients (33%) who had a positive SLN and received inguinal irradiation. However, 2 patients with a tumor-free SLN and no inguinal irradiation developed lymph node metastases after 12 and 24 months, respectively. Conclusions. We conclude that SLNB in anal cancer is technically feasible. SLNB can identify those patients who would benefit from refrain of inguinal irradiation treatment and thereby reducing the incidence of unnecessary inguinal radiotherapy. However, because of the occurrence of inguinal lymph node metastases after a tumor-negative SLNB, introduction of this procedure as standard of care in all patients with anal carcinoma should be done with caution to avoid undertreatment of patient who otherwise would benefit from inguinal radiotherapy
Different Recurrence Pattern After Neoadjuvant Chemoradiotherapy Compared to Surgery Alone in Esophageal Cancer Patients
No full text<p>To evaluate the rate and pattern of recurrences after neoadjuvant chemoradiotherapy (CRT) in esophageal cancer patients.</p><p>We described survival and differences in recurrences from a single center between neoadjuvant CRT (carboplatin/paclitaxel and 41.4 Gy) and surgery alone for the period 2000-2011. To reduce bias, we performed a propensity score matched analysis.</p><p>A total of 204 patients were analyzed, 75 treated with neoadjuvant CRT and 129 with surgery alone. The pathologic response to neoadjuvant CRT was 69 % with a complete response rate of 25 %. After matching, baseline characteristics between the groups (both n = 75) were equally distributed. The 3- and 5-year disease-free survival was 53 and 42 % in the neoadjuvant CRT group compared with 24 and 18 % in the surgery-alone group (P = 0.011). After 3 and 5 years' CRT, patients had an estimated locoregional recurrence-free survival of 83 and 73 % compared with 52 and 49 % in the surgery-alone group (P = 0.015). The distant recurrence-free survival was comparable in both groups. Locoregional recurrences were located less in the paraesophageal lymph nodes in the CRT group than in the surgery-alone group, 9 versus 21 %, respectively (P = 0.041). With respect to differences in distant recurrences, we observed more skeletal recurrences in the surgery-alone group compared to CRT, 12 versus 1 % (P = 0.009).</p><p>The neoadjuvant CRT regimen we used offers a significant improvement in outcome, with a different recurrence pattern compared with surgery alone. This effect is probably due to both the pathologic complete response and eradication of micrometastases in CRT group.</p>
IN RESPONSE TO: STUDY TO DETERMINE ADEQUATE MARGINS IN RADIOTHERAPY PLANNING FOR ESOPHAGEAL CARCINOMA BY DETAILING PATTERNS OF RECURRENCE AFTER DEFINITIVE CHEMORADIOTHERAPY
No full textSystematic review of the role of a belly board device in radiotherapy delivery in patients with pelvic malignancies
No full textAbstractPurposeThis review analyses the literature concerning the influence of the patient position (supine, prone and prone on a belly board device (BB) on the irradiated small-bowel-volume (SB-V)) and the resulting morbidity of radiation therapy (RT) in pelvic malignancies.MethodsA literature search was performed in MEDLINE, web of science and Scopus.ResultsForty-six full papers were found, of which 33 met the eligibility criteria. Fifteen articles focussed on the irradiated SB-V using dose volume histograms (DVHs). Twenty-seven articles studied the patient setup in different patient positions.This review showed that a prone treatment position can result in a lower irradiated SB-V as compared to a supine position, but a more significant reduction of the SB-V can be reached by the additional use of a BB in prone position, for both 3D-CRT and IMRT treatment plans. This reduction of the irradiated SB-V might result in a reduced GI-morbidity. The patient position did not influence the required PTV margins for prostate and rectum.ConclusionsThe irradiated SB-V can be maximally reduced by the use of a prone treatment position combined with a BB for both 3D-CRT and IMRT, which might individually result in a reduction of GI-morbidity
F-18-FLT-PET for detection of rectal cancer
Full text linkPurpose: This pilot study was undertaken to examine the ability of F-18-3'-fluoro-3'-deoxy-L-thymidine positron emission tomography (F-18-FLT-PET)to detect rectal cancer, to identify pathologic lymph nodes and to determine the accuracy of tumour length estimation in comparison with computer tomography (CT). Methods: Nine patients with biopsy proven rectal cancer underwent CT and F-18-FLT-PET scanning prior to short-term pre-operative radiotherapy (5 x 5 Gy). Within 10 days after the start of radiotherapy a surgical resection was performed. Tumour lengths and regional lymph node visualisation on both imaging modalities were compared with pathology findings. Results: All tumours were visible on CT. F-18-FLT-PET visualised 7 out of 9 tumours (78%). The pathology-based tumours lengths correlated better with CT as compared to FLT-PET(r = 0.91, p <0.01). 18F-FLT-PET was not able to visualise pathologic lymph nodes. However, CT identified all patients with pathologic lymph nodes. Conclusion: Primary rectal cancer can be visualised by F-18-FLT-PET in the majority of cases but not in all. However, F-18-FLT-PET was not able to identify pathologic lymph nodes. Therefore, we conclude that F-18-FLT-PET has limited value for the detection of pathologic lymph nodes and tumour delineation in rectal cancer. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 98 (2011) 357-35
Oesophageal tumour progression between the diagnostic F-18-FDG-PET and the F-18-FDG-PET for radiotherapy treatment planning
No full text<p>Background and purpose: To test whether the interval between diagnostic and therapeutic FDG-PET-scanning is associated with early tumour progression.</p><p>Material and methods: All patients (n = 45) underwent two PET scans, one for staging ('baseline PET') using an HR+ positron camera or PET/CT-scanner and one for radiotherapy planning ('therapeutic PET') using a PET/CT-scanner.</p><p>Material and methods: All images were reviewed in random order by an experienced nuclear physician. If there were any discrepancies, the images were also compared directly. SUV tumour length, lymph node metastases and distant metastases were assessed.</p><p>Results: The median time between the PET scans was 22 days (range: 8-49). The SUV,a increased (>10%) (19 patients, 42%) or decreased (11 patients, 24%). Fourteen patients (31%) showed tumour length progression (>1 cm). TNM progression was found in 12 patients (27%), with newly detected mediastinal nodes (N) in eight patients (18%) and newly detected distant metastases (M) in six patients (13%). No significant prognostic factors were found. However, a trend was noted towards TNM progression for the type of PET-camera (p = 0.05, 95% CI 0.01-0.66) and for the interval between the PET scans (p = 0.09, 95% CI -0.9 to 12.5).</p><p>Conclusion: This study suggests rapid oesophageal tumour progression. Therefore, the interval between relevant imaging and start of the radiotherapy should be minimized. Furthermore, 'state of the art' PET scanners should be used. (C) 2012 Elsevier Ireland Ltd. All rights reserved.</p>
External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma
Full text linkPurpose: To assess the effectiveness of definitive radiation therapy in patients with potentially curable esophageal cancer and to evaluate the side-effects of this treatment. Methods and materials: Sixty-two patients with esophageal cancer, who were treated with definitive, curatively intended radiotherapy consisting of external radiotherapy (60 Gy in 30 fractions), preceded and followed by LDR or HDR intraluminal brachy (12 Gy in 2 fractions) were retrospectively analyzed. Results: Recurrences were reported in 38 patients (61%), of which 25(64%) failed locally first. Results: The overall survival rates at 1,2 and 5 years were 57%, 34% and 11%, respectively. The median overall survival was 15 months. No prognostic factors could be identified. Most frequently reported treatment related toxicities were esophagitis, ulcerations, (11%) and strictures (16%). In 10 patients (16%) severe toxicities, were reported including grade III ulceration (2 cases), stricture (1 case), radiation pneumonitis (1 case), perforation (1 case), esophageal-pleural-tracheal fistula (1 case), and acute esophageal bleeding (4 cases). A history of gastrectomy was significantly associated with the development of severe toxicity. Conclusion: Curatively intended radiotherapy alone can be offered to esophageal cancer patients, even when surgery and/or chemotherapy are not feasible. However, we observed severe toxicity in a substantial part of the patients. Given the relatively high rate of severe complications and the uncertainties regarding dose escalation, the addition of brachytherapy, with consequently high surface doses, should be limited to well-selected patients. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 102 (2012) 303-30
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