204 research outputs found
Targeted therapy combined with thoracic radiotherapy for non-small cell lung cancer
No full textIntroductionIn recent years, there has been undoubted progress in the evaluation and development of targeted agents for non-small cell lung cancer (NSCLC). At the same time, remarkable progress in radiation therapy (RT) has been developed largely due to our ability to more effectively focus and deliver radiation to the tumor target volume. Both developments brought the idea of combining the radiation with molecularly targeted agents in order to improve outcomes in NSCLC patients who have limited survival times with standard chemoradiotherapy.MethodsWe identified patients with gastric cancer treated with post-operative radiation at our institution between 2002 and 2016. Acute and late toxicities were evaluated per RTOG/EORTC Radiation Toxicity Grading Scale. Statistical analysis was performed using Chi-square tests, t tests, log-rank, and logistic regression.ResultsCetuximab has no survival benefit, and it seems to be toxic in this patient population. Bevacizumab has severe toxicity including tracheoesophageal fistulae formation in addition to its ineffectiveness. It is difficult to have an opinion about TKIs when combined with RT since most of the studies were conducted on unselected patients. For oligometastatic/oligoprogressive NSCLC patients, it seems to be reasonable to use a combined regimen since combined regimen resulted in superior survival time; however, the patients should be followed up closely with respect to the toxicity. In patients with brain metastases, the use of concomitant RT + TKIs increased survival with acceptable toxicity levels.ConclusionsIn this review, we summarize the recent literature about the use of molecularly targeted agents with concurrent RT in NSCLC patients
Comment on Sridharan V et al., 'Effects of radiation on the epidermal growth factor receptor pathway in the heart'
No full text[Abstract not Available
Role and Timing of Radiotherapy in High-Risk Endometrial Cancer
No full textEndometrial cancer is the most common gynecological tumor in developed countries, and its incidence is increasing because of an increased prevalence of obesity and an aging population. Although most patients present with early-stage low-risk disease, a rise in the incidence is attributed to an increasing number of high-risk cases at the time of diagnosis. Despite optimal surgical treatment, the prognosis of high-risk endometrial cancer (HREC) is poor because of increased risk of local and distant recurrences and therefore, adjuvant treatment should be considered. Although the definition of high-risk patients varies between cooperative groups, the recent endometrial consensus conference defined high-risk patients as follows: (1) stage I endometrioid, grade 3, >= 50% myometrial invasion; (2) stage II disease; (3) stage III endometrioid, no residual disease; and (4) non-endometrioid histology. The optimal adjuvant treatment is controversial; however, multimodality treatment is recommended. External radiotherapy seems to be reasonable in HREC and is indicated to improve pelvic relapses. The use of adjuvant chemotherapy is also reasonable for preventing or delaying distant metastases. There is limited evidence for the benefit of vaginal cuff brachytherapy after external radiotherapy. Optimal sequence of radiation and chemotherapy is not well defined; however, concurrent chemoradiotherapy plus adjuvant chemotherapy, "sandwich" approach, and providing radiotherapy after the completion of chemotherapy may be reasonable. The role of adjuvant radiotherapy with systemic therapy for treating HREC remains an area of active investigation. Adjuvant treatment of HREC is evolving, and patients should be individually treated with respect to the stage, histology, and prognostic factors
Locally advanced squamous cell cervical cancer in a patient with septate uterus
Get PDFA 33-year-old premenopausal multiparous woman with the history of septate uterus was referred to the hospital with menorrhagia and inter-menstrual bleeding occurring for the last 6 months. Work-up revealed a stage IIB cervical cancer. The patient underwent curative chemo/radiotherapy. The patient’s septate uterus presented several difficulties during application. Brachytherapy was applied using standard computed tomography-compatible tandem and ovoids. The high-risk clinical target volume (HR-CTV), intermediate risk CTV, and organs at risk were contoured according to the Groupe Européen de Curiethérapie – European Society for Radiology and Oncology (GEC-ESTRO) guidelines. Treatment was performed via 3-dimensional high-dose-rate technique with 192Ir, with brachytherapy dose of 28 Gy in 4 fractions/7 Gy each, prescribed to the HR-CTV. Treatment was well tolerated with manageable acute toxicities. To the best of our knowledge, the current case is the second case of septate uterus with locally advanced cervical carcinoma. Due to the lack of guidelines about brachytherapy applications in patients with uterine anomaly and owing to the anatomical anomaly, brachytherapy application is challenging in this patients population
Stereotactic body radiotherapy and tyrosine kinase inhibitors in patients with oligometastatic renal cell carcinoma: a multi-institutional study
No full text© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.Purpose: Few studies have determined the viability of stereotactic body radiotherapy (SBRT) and tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC). We examined the results of RCC patients who had five or fewer lesions and were treated with TKI and SBRT. Methods: The clinical data of 42 patients with 96 metastases treated between 2011 and 2020 were retrospectively evaluated. The prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were assessed in uni- and multivariable analyses. Results: Median follow-up and time between TKI therapy and SBRT were 62.3 and 3.7 months, respectively. The 2‑year OS and PFS rates were 58.0% and 51.3%, respectively, and 2‑year local control rate was 94.1% per SBRT-treated lesion. In univariable analysis, the time between TKI therapy and SBRT and treatment response were significant prognostic factors for OS and PFS. In multivariable analysis, a time between TKI therapy and SBRT of less than 3 months and complete response were significant predictors of better OS and PFS. Only 12 patients (28.6%) had a systemic treatment change at a median of 18.2 months after SBRT, mostly in patients with a non-complete treatment response after this therapy. Two patients (4.8%) experienced grade III toxicity, and all side effects observed during metastasis-directed therapy subsided over time. Conclusion: We demonstrated that SBRT in combination with TKIs is an effective and safe treatment option for RCC patients with ≤ 5 metastases. However, distant metastasis was observed in 60% of the patients, indicating that distant disease control still has room for improvement
The Impact of Body Mass Index on Radiotherapy Technique in Patients With Early-Stage Endometrial Cancer A Single-Center Dosimetric Study
No full textObjective: We aimed to evaluate the impact of body mass index on radiotherapy (RT) technique in patients with early-stage endometrial cancer. Materials and Methods: Twenty-seven consecutive patients were included in the study and divided into 3 groups with respect to their body mass index (normal weight, 18.5Y24.9 kg/m(2); overweight, 25-29.9 kg/m(2); obese, 30-39.9 kg/m(2)). Treatment plans using field-in-field (FIF) and 3-dimesional conformal RT (3D-CRT) were compared for the doses in the planning target volume (PTV), organs-at-risk (OAR) volumes, dose homogeneity index, and monitor unit counts required for the treatment. Results: The FIF technique was superior to 3D-CRT with respect to the maximum and mean doses received by OAR and dose homogeneity index values. The subgroup analyses revealed that the maximum dose received by the right femur and the mean doses received by the rectum and bladder were significantly reduced only in obese patients (Ps = 0.021, 0.008, and 0.008, respectively). The FIF technique significantly reduced the PTV volumes irradiated with greater than 105% of the prescribed dose (P < 0.001). The volumes of bowel and bone marrow receiving more than the prescribed dose of 30 Gy were significantly reduced only in obese patients (Ps = 0.025 and 0.043, respectively). The volumes of bladder, bowel, and bone marrow receiving more than the prescribed dose of 45 Gy were significantly reduced in only obese patients (Ps = 0.011, 0.011, and 0.008, respectively). Conclusions: Considering the lower maximum doses in OAR and PTV, we demonstrate the FIF technique to be more advantageous than 3D-CRT during adjuvant RT for early-stage endometrial cancer patients. This advantage is more prominent in obese patients. Therefore, FIF technique represents an effective pelvic RT treatment option for obese patients in clinics that do not have access to or prefer an alternative to intensity-modulated RT
HER-2 positive primary solid neuroendocrine carcinoma of the breast: a case report and review of the literature
No full textPrimary pure neuroendocrine carcinoma of the breast is an extremely rare tumor. We report a case of primary solid neuroendocrine carcinoma in a 77-year-old postmenopausal woman who was admitted to the hospital with masses on her right breast and axillary region. Radical mastectomy with axillary lymph node resection was performed. Immunohistochemical stainings of the tumor cells with synaptophysin, GCDFP-15, estrogen, progesterone, and c-erbB-2 were positive. Five of 16 lymph nodes were metastatic. She did not receive adjuvant chemotherapy. After 15 months of follow-up she is free of the disease. Literature review revealed that this is the second case of HER-2 positive primary neuroendocrine tumor of the breast
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