46 research outputs found
Reirradiation of metastatic spinal cord compression: Definitive results of two randomized trials
No full textPurpose: Incidence, outcome and prognostic factors of metastatic spinal cord compression (MSCC) patients reirradiated for in-field recurrence were analyzed. Radiation therapists' attitude in reirradiate spinal cord relapses, doses adopted and incidence of myelopathy were also examined.Materials and methods: Data deriving from 579 evaluable patients entered two randomized trials on radiotherapy (RT) for MSCC were revised.Results: Twenty-four (4.15%) patients had an in-field recurrence and 12 (50%) were reirradiated. At the time of analysis all reirradiated patients had died. Median time from first and second RI was 5 months (range, 2-31). Six patients received an 8 Gy single-dose, 2 patients 5 x 3 Gy and remaining four patients 2 x 8, 5 x 4, or a single dose of 7 and 4 Gy, respectively. The median cumulative Biologically Effective Dose (BED) calculated was 114.5 Gy(2) (range. 80-120 Gy(2)). Six of seven (85.7%) ambulant patients maintained walking ability, whereas none of five not ambulant patients recovered the function. Median duration of response was 4.5 months (range, 1-24). The effect of reirradiation on motor function was significantly associated with walking capacity before reirradiation. Myelopathy was never recorded.Conclusions: In MSCC reirradiation was safe and effective. Patient walking capacity before reirradiation was the strongest prognostic factor for functional outcome. Reirradiation was given in about one-half of patients with in-field recurrence and different doses and fractionations were used, even though cumulative BED was in all cases <= 120 Gy(2). (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 98 (2011) 234-23
Low and medium doses of hypofractionated stereotactic radiotherapy could be suboptimal for early-stage lung cancer
No full textPurpose: This study aimed to analyze the outcome of low and medium doses of hypofractionated stereotactic body radiotherapy (SBRT) in early stage lung cancer. Methods: Thirty-five early stage lung cancer patients were treated with SBRT. Initially, SBRT was administered with a low dose of 5 x 8Gy in all cases. Subsequently, a medium dose of 5 x 10Gy for peripherally located lesions was given, continuing to prescribe 5 x 8Gy in centrally located ones. Study endpoints were local control (LC), LC duration, survival and toxicity. Results: Patients had a good performance status, and T1-2 stage cancer. The SBRT doses of 5 x 8Gy and 5 x 10Gy were administered to 57% and 43% of patients, respectively. At first evaluation after SBRT, local control was obtained in all cases but only 15 (43%) had a complete response. Median duration of LC was 41 months and there was a trend in favor of 5 x 10Gy with respect to 5 x 8Gy in 2- and 3-year LC rates (93% and 69%, versus 60% and 50%, p = 0.1). Four of the 15 (27%) complete responders had local relapse after a quite long median time of 31.5 months. Median overall survival was 40 months. No examined variables (i.e., dose, volume, T stage, and site) significantly conditioned LC, duration of LC, failure rate and survival. Both SBRT schedules were well tolerated. Conclusion: Outcome of low and medium SBRT doses in terms of LC, duration of LC, patterns of failure and survival was suboptimal compared with recently reported results of SBRT in early stage lung cancer patients
Management of Metastatic Spinal Cord Compression
No full text Metastatic spinal cord compression, diagnosed in 3–7% of cancer patients, is one of the most dreaded complications of metastatic cancer. It is an oncologic emergency, which must be diagnosed early and treated promptly to achieve the best results and avoid progressive pain, paralysis, sensory loss and sphincter incontinence. Patients who are ambulatory at the time of the diagnosis have a higher probability of obtaining good response to treatment and a longer survival. In clinical practice, back pain accompanies metastatic spinal cord compression in most cases, even in patients with no neurologic deficits. Magnetic resonance imaging is the best tool for diagnosing metastatic spinal cord compression and is able to identify spinal cord compression in 32–35% patients with back pain, bone metastases and normal neurologic examination. Moreover, magnetic resonance imaging gives the extension of the lesion, can diagnose other unsuspected clinical metastatic spinal cord compression sites, and is useful for the radiation oncologist in defining the target volume. Radiotherapy is the treatment of choice in most cases, whereas surgery is advised only in selected patients (ie, if stabilization is necessary, if radiotherapy has already been given in the same area, when vertebral body collapse causes bone impingement on the cord or nerve roots, when there are diagnostic doubts, or when computed tomography-guided percutaneous vertebral biopsy cannot be performed). Laminectomy should be abandoned in favor of more aggressive surgery (ie, posterior, anterior, and/or lateral approach, tumor mass resection, and stabilization of the spine). Generally, radiotherapy must be administered 7–10 days after surgery. The optimal radiation schedule has not been defined. However, as recently suggested by some clinical trials, even the hypofractionated radiotherapy regimens are effective and can be used without increasing radiation-induced myelopathy. Moderate doses of dexamethasone should be used in the early phases of therapy. After radiotherapy, spinal recurrence is generally found in sites different from the first compression area. A close post-treatment follow-up is suggested using clinical parameters (pain, motor and sphincter function), and magnetic resonance imaging should be performed only when a second metastatic spinal cord compression and/or myelopathy are clinically suspected. </jats:p
Exploring All Avenues for Radiotherapy in Oligorecurrent Prostate Cancer Disease Limited to Lymph Nodes: A Systematic Review of the Role of Stereotactic Body Radiotherapy
No full textStereotactic body radiotherapy (SBRT) is emerging as a treatment option in patients affected by oligorecurrent prostate cancer disease limited to lymph nodes, a subgroup of patients who would otherwise be treated only with androgen deprivation therapy (ADT)
Stereotactic radiotherapy for oligometastases in the lymph nodes
No full textEven though systemic therapy is standard treatment for lymph node metastases, metastasis-directed stereotactic radiotherapy (SRT ) seems to be a valid option in oligometastatic patients with a low disease burden. Positron emission tomography-computed tomography (PET -CT ) is the gold standard for assessing metastases to the lymph nodes; co-registration of PET -CT images and planning CT images are the basis for gross tumor volume (GTV ) delineation. Appropriate techniques are needed to overcome target motion. SRT schedules depend on the irradiation site, target volume and dose constraints to the organs at risk (OARs) of toxicity. Although several fractionation schemes were reported, total doses of 48–60 Gy in 4–8 fractions were proposed for mediastinal lymph node SRT, with the spinal cord, esophagus, heart and proximal bronchial tree being the dose limiting OAR s. Total doses ranged from 30 to 45 Gy, with daily fractions of 7–12 Gy for abdominal lymph nodes, with dose limiting OARs being the liver, kidneys, bowel and bladder. SRT on lymph node metastases is safe; late side effects, particularly severe, are rar
The vicious circle of treatment-induced toxicities in locally advanced head and neck cancer and the impact on treatment intensity
No full textThe intensity of the available treatment approaches for locally-advanced head and neck cancer (HNC) is at the upper limit of tolerance of acute toxicities. Several factors including breakthrough cancer pain, mucositis, dysphagia, local and systemic infections, and nutritional problems are related to treatment intensity. Particularly, pain, as symptom directly associated with the disease or combined with other treatment-related factors, has a major impact on quality of life of HNC patients and ultimately can influence the efficacy of treatments in HNC. Here, a Multidisciplinary Board of Italian Experts has addressed these issues, with the aim to identify the unmet need and appropriate strategies for the maintenance of optimal treatment intensity in HNC
The vicious Circle of treatment-induced toxicities in locally advanced head and neck cancer and the impact on treatment intensity
No full textStereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a two-institution experience
No full textObjective: Stereotactic body radiotherapy (SBRT) is emerging as a treatment option in oligometastatic cancer patients. This retrospective study aimed to analyze local control, biochemical progression-free survival (b-PFS), and toxicity in patients affected by isolated prostate cancer lymph node metastases. Finally, we evaluated androgen deprivation therapy-free survival (ADT-FS). Methods: Forty patients with 47 isolated lymph nodes of recurrent prostate cancer were treated with SBRT. Mostly, two different fractionation schemes were used: 5 × 7 Gy in 23 (48.9 %) lesions and 5 × 8 Gy in 13 (27.7 %) lesions. Response to treatment was assessed with periodical PSA evaluation. Toxicity was registered according to RTOG/EORTC criteria. Results: With a mean follow-up of 30.18 months, local control was achieved in 98 % of the cases, with a median b-PFS of 24 months. We obtained a 2-year b-PFS of 44 % with 40 % of the patients ADT-free at last follow-up (mean value 26.18 months; range 3.96–59.46), whereas 12.5 % had a mean ADT-FS of 13.58 months (range 2.06–37.13). Late toxicity was observed in one (2.5 %) patient who manifested a grade 3 gastrointestinal toxicity 11.76 months after the end of SBRT. Conclusion: Our study demonstrates that SBRT is safe, effective, and minimally invasive in the eradication of limited nodal metastases, yielding an important delay in prescribing ADT
Corrigendum to “The vicious circle of treatment-induced toxicities in locally advanced head and neck cancer and the impact on treatment intensity” [Crit. Rev. Oncol./Hematol. 116 (2017) 82–88]
No full textThe authors regret that the names and surnames did not appear in the correct order. These should appear as: Paolo BossiaMaria Cossu RoccabRenzo CorvÃ2cRoberta DepennidVittorio GuardamagnaeFranco MarinangelifFrancesco Miccichà ̈gFabio TrippahThe authors would like to apologise for any inconvenience caused
Correction: Ripamonti, C.; Trippa, F.; Barone, G.; Maranzano, E. Prevention and Treatment of Bone Metastases in Breast Cancer. J. Clin. Med. 2013, 2, 151–175
No full textThe authors wish to make the following corrections to this paper [1]: The authors’ names: [...
