共查询到20条相似文献，搜索用时 15 毫秒
1.
Christian Rønn Hansen Jørgen Johansen Eva Samsøe Elo Andersen Jørgen B.B. Petersen Kenneth Jensen Lisbeth J. Andersen Hella M.B. Sand Anders S. Bertelsen Cai Grau 《Radiotherapy and oncology》2018,126(1):43-47
Background and purpose
Defining margins around the Gross Tumour Volume (GTV) to create a Clinical Target Volume (CTV) for head and neck cancer radiotherapy has traditionally been based on presumed knowledge of anatomical routes of spread. However, using a concentric geometric expansion around the GTV may be more reproducible. The purpose of this study was to analyse the inter-observer consistency of geometric CTV delineation with adaptation for anatomical boundaries versus anatomically defined CTVs.Material and methods
Radiation oncologists at four Danish cancer centres delineated high, intermediate and elective dose CTVs (CTV1, CTV2 and CTV3, respectively) in a patient-case template (stage IV squamous cell carcinoma of the oropharynx), first using mainly anatomical margins (original standard) and then using concentric geometric expansion (new standard). Each centre made a dummy-run radiotherapy plan based on the delineated CTVs. The difference between the CTV contours and the radiotherapy plans was evaluated across the centres.Results
Anatomy-based contours were significantly more heterogenous and showed larger volume differences between centres than geometric margins. Dice similarity coefficient increased by 0.29 and mean surface distance decreased by 4 mm for CTV1. Use of consistent CTV volumes resulted in more consistent irradiated volumes between centres.Conclusion
Introduction of geometric margins resulted in more uniform CTV1 and CTV2 delineation. Geometric CTV expansion was easier, left less room for misinterpretation, and resulted in more uniform treatment plans with similar irradiated high and intermediate dose volumes across all centres. 相似文献2.
Corinne Johnson Gareth Price Jonathan Khalifa Corinne Faivre-Finn Andre Dekker Christopher Moore Marcel van Herk 《Radiotherapy and oncology》2018,126(2):355-361
Background and purpose
The gross tumour volume (GTV) is predictive of clinical outcome and consequently features in many machine-learned models. 4D-planning, however, has prompted substitution of the GTV with the internal gross target volume (iGTV). We present and validate a method to synthesise GTV data from the iGTV, allowing the combination of 3D and 4D planned patient cohorts for modelling.Material and methods
Expert delineations in 40 non-small cell lung cancer patients were used to develop linear fit and erosion methods to synthesise the GTV volume and shape. Quality was assessed using Dice Similarity Coefficients (DSC) and closest point measurements; by calculating dosimetric features; and by assessing the quality of random forest models built on patient populations with and without synthetic GTVs.Results
Volume estimates were within the magnitudes of inter-observer delineation variability. Shape comparisons produced mean DSCs of 0.8817 and 0.8584 for upper and lower lobe cases, respectively. A model trained on combined true and synthetic data performed significantly better than models trained on GTV alone, or combined GTV and iGTV data.Conclusions
Accurate synthesis of GTV size from the iGTV permits the combination of lung cancer patient cohorts, facilitating machine learning applications in thoracic radiotherapy. 相似文献3.
Sarthak Tandon Munish Gairola Parveen Ahlawat Sheh Rawat Archana Aggarwal Kanika Sharma Sandeep Tiwari Ahmad M. Karimi Vinayakumar Muttagi Nishtha Sachdeva Manindra Bhushan 《Journal of the Egyptian National Cancer Institute》2018,30(3):107-115
Objectives
Comparison of two fractionation schedules of intensity modulated radiotherapy (IMRT) for locally advanced head and neck cancer – simultaneous integrated boost (SIB-IMRT) and simultaneous modulated accelerated radiotherapy (SMART) boost in terms of toxicity and survival end-point measures.Patients and methods
Sixty patients with locally advanced head and neck cancer were randomized in two treatment arms (SIB-IMRT [control arm] and SMART boost arm [study arm]). In the control arm, patients received 70, 63 and 56?Gy in 35 fractions to clinical target volumes (CTV) 1, 2 and 3, respectively. In the study arm, patients received 60 and 50?Gy to CTV 1 and CTV 3, respectively. Toxicities, progression free survival (PFS) and overall survival (OS) were compared between both arms.Results
Baseline patient-related characteristics were comparable between the arms except for primary site of tumour. No significant differences were noted in acute toxicities between the arms except for fatigue which was statistically higher for control arm. No significant differences in 2-year late toxicities were observed. The median follow-up duration was 25.5 (range, 1.8–39.9) months. The 2-year PFS was 53.3% and 80.0% (p?=?0.028) for control and study arm, respectively. The 2-year OS was 60.0% and 86.7% (p?=?0.020) in control and study arms, respectively. Multivariate analysis showed clinical stage and site to be significant predictors for OS and PFS, respectively.Conclusions
The SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT. 相似文献4.
Chiara De-Colle Apostolos Menegakis David Mönnich Stefan Welz Simon Boeke Bence Sipos Falko Fend Paul-Stefan Mauz Inge Tinhofer Volker Budach Jehad Abu Jawad Martin Stuschke Panagiotis Balermpas Claus Rödel Anca-Ligia Grosu Amir Abdollahi Jürgen Debus Claus Belka Daniel Zips 《Radiotherapy and oncology》2018,126(1):125-131
Introduction
Preclinical and clinical data suggest that the chemokine pathway governed by SDF-1 and CXCR4 contributes to a resistant phenotype. This retrospective biomarker study aims to explore the specific prognostic value of SDF-1 and CXCR4 expression in locally advanced head and neck squamous cell carcinomas (HNSCC) treated with primary radiochemotherapy (RT-CT).Material and methods
Biopsies from 141 HNSCC tumours of the oral cavity, oropharynx and hypopharynx were evaluated for SDF-1 and CXCR4 expression by immunofluorescence. SDF-1 and CXCR4 expression was correlated with clinico-pathological characteristics and outcome after RT-CT.Results
Patients with tumours exhibiting overexpression of intracellular SDF-1 and CXCR4 have a higher risk for loco-regional relapse and a worse overall survival after RT-CT (multivariate analysis, hazard ratio 2.33, CI [1.18–4.62], p?=?0.02 and hazard ratio 2.02, CI [1.13–3.59], p?=?0.02, respectively). Similar results were observed when only the subgroup of HPV DNA negative patients were analysed (hazard ratio 2.23 and 2.16, p?=?0.02 and p?=?0.01, respectively).Conclusions
Our data support the importance of SDF-1 and CXCR4 expression for loco-regional control and overall survival in HNSCC after primary radiochemotherapy. Prospective multivariate validation and further studies into CXCR4 inhibition to overcome radiation resistance are warranted. 相似文献5.
Emanuele Cereda Silvia Cappello Sara Colombo Catherine Klersy Ilaria Imarisio Annalisa Turri Marilisa Caraccia Valeria Borioli Teresa Monaco Marco Benazzo Paolo Pedrazzoli Franco Corbella Riccardo Caccialanza 《Radiotherapy and oncology》2018,126(1):81-88
Background
To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT).Methods
In a single-center, randomized, pragmatic, parallel-group controlled trial (ClinicalTrials.gov: NCT02055833; February 2014–August 2016), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with ONS (N?=?78) or without ONS (N?=?81) from the start of RT and continuing for up to 3 months after its end.Primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, phase angle and quality of life and anti-cancer treatment tolerance.Results
In patients with the primary endpoint assessed (modified intention-to-treat population), counseling plus ONS (N?=?67) resulted in smaller loss of body weight than nutritional counseling alone (N?=?69; mean difference, 1.6?kg [95%CI, 0.5–2.7]; P?=?0.006). Imputation of missing outcomes provided consistent findings. In the ONS-supplemented group, higher protein-calorie intake and improvement in quality of life over time were also observed (P?<?0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR=0.40 [95%CI, 0.18–0.91], P?=?0.029).Conclusion
In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance. 相似文献6.
Mona Kamal David I. Rosenthal Stefania Volpe Ryan P. Goepfert Adam S. Garden Katherine A. Hutcheson Karine A. Al Feghali Mohamed Ahmed Mohamed Meheissen Salman A. Eraj Amy E. Dursteler Bowman Williams Joshua B. Smith Jeremy M. Aymard Joel Berends Aubrey L. White Steven J. Frank William H. Morrison G. Brandon Gunn 《Radiotherapy and oncology》2018,126(1):75-80
Purpose
To identify a clinically meaningful cut-point for the single item dry mouth question of the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN).Methods
Head and neck cancer survivors who had received radiation therapy (RT) completed the MDASI-HN, the University of Michigan Hospital Xerostomia Questionnaire (XQ), and the health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ-5D). The Bayesian information criteria (BIC) were used to test the prediction power of each tool for EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify a cut point of the MDASI-HN dry mouth score (MDASI-HN-DM) with EQ-5D VAS, using a ROC-based approach; regression analysis was used to confirm the threshold effect size.Results
Two-hundred seven respondents formed the cohort. Median follow-up from the end of RT to questionnaire completion was 88?months. The single item MDASI-HN-DM score showed a linear relationship with the XQ composite score (ρ?=?0.80, p?<?0.001). The MDASI-HN-DM displayed improved model performance for association with EQ-5D VAS as compared to XQ (BIC of 1803.7 vs. 2016.9, respectively). RPA showed that an MDASI-HN-DM score of ≥6 correlated with EQ-5D VAS decline (LogWorth 5.5).Conclusion
The single item MDASI-HN-DM correlated with the multi-item XQ and performed favorably in the prediction of QOL. A MDASI-HN-DM cut point of ≥6 correlated with decline in QOL. 相似文献7.
8.
A.S. Gerlich J.M. van der Velden A.N.T.J. Kotte C.L. Tseng G. Fanetti W.S.C. Eppinga N. Kasperts M.P.W. Intven F.A. Pameijer M.E.P. Philippens H.M. Verkooijen E. Seravalli 《Radiotherapy and oncology》2018,126(3):534-540
Background and purpose
The use of Stereotactic Body Radiotherapy (SBRT) for bone metastases is increasing rapidly. Therefore, knowledge of the inter-observer differences in tumor volume delineation is essential to guarantee precise dose delivery. The aim of this study is to compare inter-observer agreement in bone metastases delineated on different imaging modalities.Material and methods
Twenty consecutive patients with bone metastases treated with SBRT were selected. All patients received CT and MR imaging in treatment position prior to SBRT. Five observers from three institutions independently delineated gross tumor volume (GTV) on CT alone, CT with co-registered MRI and MRI alone. Four contours per imaging modality per patient were available, as one set of contours was shared by 2 observers. Inter-observer agreement, expressed in generalized conformity index [CIgen], volumes of contours and contours center of mass (COM) were calculated per patient and imaging modality.Results
Mean GTV delineated on MR (45.9 ± 52.0 cm3) was significantly larger compared to CT–MR (40.2 ± 49.4 cm3) and CT (34.8 ± 41.8 cm3). A considerable variation in CIgen was found on CT (mean 0.46, range 0.15–0.75) and CT–MRI (mean 0.54, range 0.17–0.71). The highest agreement was found on MRI (mean 0.56, range 0.20–0.77). The largest variations of COM were found in anterior–posterior direction for all imaging modalities.Conclusions
Large inter-observer variation in GTV delineation exists for CT, CT–MRI and MRI. MRI-based GTV delineation resulted in larger volumes and highest consistency between observers. 相似文献9.
Lisanne V. van Dijk Walter Noordzij Charlotte L. Brouwer Ronald Boellaard Johannes G.M. Burgerhof Johannes A. Langendijk Nanna M. Sijtsema Roel J.H.M. Steenbakkers 《Radiotherapy and oncology》2018,126(1):89-95
Background and purpose
Current prediction of radiation-induced xerostomia 12 months after radiotherapy (Xer12m) is based on mean parotid gland dose and baseline xerostomia (Xerbaseline) scores. The hypothesis of this study was that prediction of Xer12m is improved with patient-specific characteristics extracted from 18F-FDG PET images, quantified in PET image biomarkers (PET-IBMs).Patients and methods
Intensity and textural PET-IBMs of the parotid gland were collected from pre-treatment 18F-FDG PET images of 161 head and neck cancer patients. Patient-rated toxicity was prospectively collected. Multivariable logistic regression models resulting from step-wise forward selection and Lasso regularisation were internally validated by bootstrapping. The reference model with parotid gland dose and Xerbaseline was compared with the resulting PET-IBM models.Results
High values of the intensity PET-IBM (90th percentile (P90)) and textural PET-IBM (Long Run High Grey-level Emphasis 3 (LRHG3E)) were significantly associated with lower risk of Xer12m. Both PET-IBMs significantly added in the prediction of Xer12m to the reference model. The AUC increased from 0.73 (0.65–0.81) (reference model) to 0.77 (0.70–0.84) (P90) and 0.77 (0.69–0.84) (LRHG3E).Conclusion
Prediction of Xer12m was significantly improved with pre-treatment PET-IBMs, indicating that high metabolic parotid gland activity is associated with lower risk of developing late xerostomia. This study highlights the potential of incorporating patient-specific PET-derived functional characteristics into NTCP model development. 相似文献10.
Matthew J. Ferris Jim Zhong Jeffrey M. Switchenko Kristin A. Higgins Richard J. Cassidy Mark W. McDonald Bree R. Eaton Kirtesh R. Patel Conor E. Steuer H. Michael Baddour Andrew H. Miller Deborah W. Bruner Canhua Xiao Jonathan J. Beitler 《Radiotherapy and oncology》2018,126(1):100-106
Background and purpose
Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients.Materials and methods
At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose–volume histograms, and associations with MFI-20 scores were analyzed.Results
Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p < 0.05). Each 1 Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p = 0.026), and 0.25 (p = 0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1 Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p = 0.027), and 0.25 (p = 0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores.Conclusions
In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue. 相似文献11.
Pernille Lassen Benjamin Lacas Jean-Pierre Pignon Andy Trotti Bjorn Zackrisson Qiang Zhang Jens Overgaard Pierre Blanchard 《Radiotherapy and oncology》2018,126(1):107-115
Background and purpose
Evaluate the prognostic and predictive impact of HPV-associated p16-expression and assess the combined prognostic impact of p16 and smoking on altered fractionated radiotherapy (AFRT) for oropharyngeal cancer (OPC) within the frames of the update of the Meta-Analysis of Radiotherapy in Carcinomas of Head and neck (MARCH).Materials and methods
Patients with OPC, known tumor p16-status and smoking history were identified from the MARCH update, resulting in a dataset of 815 patients from four randomized trials (RTOG9003, DAHANCA6&7, RTOG0129, ARTSCAN). Analysis was performed using a Cox model stratified by trial and adjusted on gender, age, T-stage, N-stage, type of radiotherapy fractionation, p16, smoking. Primary endpoint was progression-free survival (PFS).Results
In total, 465 patients (57%) had p16-positive tumors and 350 (43%) p16-negative. Compared to p16-negative, p16-positive patients had significantly better PFS (HR?=?0.42 [95% CI: 0.34–0.51], 28.9% absolute increase at 10?years) and OS (HR?=?0.40 [0.32–0.49], 32.1% absolute increase at 10?years). No interaction between p16-status and fractionation schedule was detected. Smoking negatively impacted outcome; in the p16-positive subgroup, never smokers had significantly better PFS than former/current smokers (HR?=?0.49 [0.33–0.75], 24.2% survival benefit at 10?years).Conclusions
No predictive impact of p16-status on response to AFRT could be detected but the strong prognostic impact of p16-status was confirmed and especially p16-positive never smoking patients have superior outcome after RT. 相似文献12.
Joanna Izewska Mary Coffey Pierre Scalliet Eduardo Zubizarreta Tania Santos Ioannis Vouldis Peter Dunscombe 《Radiotherapy and oncology》2018,126(2):183-190
Background and purpose
The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region.Materials and methods
The 31 QUATRO reports collected over 10 years include extensive data describing the quality of radiotherapy at the audited centres. A coding key was developed to aggregate and review these data in terms of recommendations for improvement and positive findings (commendations).Results
Overall 759 recommendations and 600 commendations were given. Eight centres recognized as centres of competence differed from other centres mostly because they operated complete quality management systems and were adequately staffed. Other centres had excessive staff workloads and many gaps in the process of care. Insufficient equipment levels were prevalent. Patient centredness, communication, dosimetry, quality control and radiation protection were frequently commended by QUATRO.Conclusions
This analysis points to barriers to quality care such as insufficient staffing, education/training, equipment and lack of quality management. It highlights the correlation between the human resources availability and quality of care. It has also identified common action items for enhancing quality of radiotherapy programmes in the Region. 相似文献13.
Josep M. Borras Cai Grau Julieta Corral Karen Wong Michael B. Barton Jacques Ferlay Freddie Bray Yolande Lievens 《Radiotherapy and oncology》2018,126(2):198-204
Background and purpose
The optimal number of radiotherapy fractions is a relevant input for planning resource needs. An estimation of the total number of fractions by country and tumour site is assessed for 2012 and 2025.Methods
European cancer incidence data by tumour site and country for 2012 and 2025 were extracted from the GLOBOCAN database. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model, producing an evidence-based proportion of incident cases with an indication for radiotherapy and fractions by indication. An indication was defined as a clinical situation in which radiotherapy was the treatment of choice.Results
The total number of fractions if radiotherapy was given according to guidelines to all patients with an indication in Europe was estimated to be 30 million for 2012; with a forecasted increase of 16.1% by 2025, yet with differences by country and tumour. The average number of fractions per course was 17.6 with a small range of differences following stage at diagnosis. Among the treatments with radical intent the average was 24 fractions, while it decreased to 2.5 among palliative treatments.Discussion
An increase in the total number of fractions is expected in many European countries in the coming years following the trends in cancer incidence. In planning radiotherapy resources, these increases should be balanced to the evolution towards hypofractionation, along with increased complexity and quality assurance. 相似文献14.
Ahmed Mostafa Mahmoud Yahia M. Ismail Alaadin Hussien Yasser Debaky Ihab S. Ahmed Hisham S. Wahba Mikhael Manar Moneer 《Journal of the Egyptian National Cancer Institute》2018,30(4):143-150
Background
Peritoneal carcinomatosis originating from colorectal cancer (PC-CRC) carries a dismal prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) have been offered to those patients with substantial health and economic burden, nevertheless not all patients are fitting this treatment modality and outcome is generally still poor.Objective
To elicit predictive factors associated with the success of CRS and HIPEC in PC-CRC patients.Patients and methods
This is a pilot study including 30 consecutive patients with PC-CRC; 20 of them (66.7%) presented with metachronous peritoneal disease. All patients were planned for CRS and HIPEC with Mitomycin-C after receiving preoperative systemic chemotherapy for 3?months.Results
On exploration, CRS and HIPEC were successful in 17 patients (56.6%) who had completeness of cytoreduction score 0–1 (CC-0/1), whereas failure (CC-2) was encountered in 13 patients (43.3%). The presence of ascites, extensive peritoneal disease (PCI?>?20) was significantly correlated with failure to achieve CRS and HIPEC (p?<?0.001); also, the primary rectal site showed a trend towards significance (p?=?0.08). The cumulative overall survival (OS) and progression-free survival (PFS) at 2?years were 66.6 and 62.6%, respectively. Patients who achieved CC-0/1 had significantly prolonged OS compared to CC-2 (p?<?0.001). On multivariate analysis, the CC score and the original site were independent prognostic factors for OS (p?=?0.04 and 0.02, respectively).Conclusion
In patients with PC-CRC, malignant ascites and PCI?>?20 are poor prognostic factors associated with failure to accomplish CRS with consequent poor survival. 相似文献15.
Tim Lustberg Johan van Soest Mark Gooding Devis Peressutti Paul Aljabar Judith van der Stoep Wouter van Elmpt Andre Dekker 《Radiotherapy and oncology》2018,126(2):312-317
Background and purpose
Contouring of organs at risk (OARs) is an important but time consuming part of radiotherapy treatment planning. The aim of this study was to investigate whether using institutional created software-generated contouring will save time if used as a starting point for manual OAR contouring for lung cancer patients.Material and methods
Twenty CT scans of stage I–III NSCLC patients were used to compare user adjusted contours after an atlas-based and deep learning contour, against manual delineation. The lungs, esophagus, spinal cord, heart and mediastinum were contoured for this study. The time to perform the manual tasks was recorded.Results
With a median time of 20?min for manual contouring, the total median time saved was 7.8?min when using atlas-based contouring and 10?min for deep learning contouring. Both atlas based and deep learning adjustment times were significantly lower than manual contouring time for all OARs except for the left lung and esophagus of the atlas based contouring.Conclusions
User adjustment of software generated contours is a viable strategy to reduce contouring time of OARs for lung radiotherapy while conforming to local clinical standards. In addition, deep learning contouring shows promising results compared to existing solutions. 相似文献16.
T.P. Hanna J. Shafiq G.P. Delaney S.K. Vinod S.R. Thompson M.B. Barton 《Radiotherapy and oncology》2018,126(2):191-197
Background
To describe the population benefit of radiotherapy in a high-income setting if evidence-based guidelines were routinely followed.Methods
Australian decision tree models were utilized. Radiotherapy alone (RT) benefit was defined as the absolute proportional benefit of radiotherapy compared with no treatment for radical indications, and of radiotherapy over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemoradiotherapy over RT. Five-year local control (LC) and overall survival (OS) benefits were measured. Citation databases were systematically queried for benefit data. Meta-analysis and sensitivity analysis were performed.Findings
48% of all cancer patients have indications for radiotherapy, 34% curative and 14% palliative. RT provides 5-year LC benefit in 10.4% of all cancer patients (95% Confidence Interval 9.3, 11.8) and 5-year OS benefit in 2.4% (2.1, 2.7). CRT provides 5-year LC benefit in an additional 0.6% of all cancer patients (0.5, 0.6), and 5-year OS benefit for an additional 0.3% (0.2, 0.4). RT benefit was greatest for head and neck (LC 32%, OS 16%), and cervix (LC 33%, OS 18%). CRT LC benefit was greatest for rectum (6%) and OS for cervix (3%) and brain (3%). Sensitivity analysis confirmed a robust model.Interpretation
Radiotherapy provides significant 5-year LC and OS benefits as part of evidence-based cancer care. CRT provides modest additional benefits. 相似文献17.
Rony Benson Prashant Giridhar Bhanu Prasad Venkatesulu Supriya Mallick Mohd Waseem Raza Goura Kishor Rath 《Journal of the Egyptian National Cancer Institute》2017,29(1):1-9
Introduction
Local recurrences after curative treatment have a potential for cure with salvage surgery or with re-irradiation.Methods
We reviewed the PubMed for articles published in English with key words squamous cell carcinoma, recurrent, re-irradiation, prognostic factors to find relevant articles describing prognostic factors, re-irradiation, and outcome for recurrent head and neck squamous cell carcinoma.Results
Various factors including age, performance status, time for recurrence, previous radiation dose volume and site of recurrence, previous use of chemotherapy are all prognostic factors in recurrent head and neck squamous cell carcinoma. Surgery is feasible in very select subgroup of patients and must be done when feasible. Re-irradiation with the aid of modern sophisticated technology is safe and confers durable and clinically meaningful survival benefit. Re-irradiation in head and neck recurrent squamous cell carcinoma may provide an expected median survival of 10–12 months. Chemotherapy may be added along with radiation in the recurrent setting.Conclusion
Treatment approaches may have to be personalized. Re surgery must be done in all patients in whom it is feasible. In patients in whom surgery is not feasible, re-irradiation must be evaluated as a therapeutic option especially in patients with limited volume recurrence. 相似文献18.
Jee Suk Chang Jeongshim Lee Mison Chun Kyung Hwan Shin Won Park Jong Hoon Lee Jin Hee Kim Won Sup Yoon Ik Jae Lee Juree Kim Hye Li Park Yong Bae Kim 《Radiotherapy and oncology》2018,126(1):139-147
Background and purpose
To validate the ESTRO guideline on clinical target volume (CTV) delineation for breast cancer using a multi-centre dataset.Materials and methods
Patients with axial imaging of gross locoregional recurrence (LRR) were identified from 10 participating institutions. All patients received RT, albeit not to all regional node. The location of LRR was transferred to the corresponding area on representative axial computed tomography images and compared with ESTRO-CTV.Results
The locations of LRRs in 234 patients with 337 recurrence lesions were mapped. The ESTRO-CTV encompassed 97.6% of all LRRs, except in lymph node level 4 and the pectoralis muscle. Although 8.8% of level 4 failures occurred outside the ESTRO-CTV, cranial to the subclavian artery, all nodes were located within 6 mm cranially. Another 20% occurred posterolateral to anterior scalene muscles; however, 11/16 cases had simultaneous multiple lymph node recurrences, and 8/16 initially had N2-3 tumours. Local recurrence at the pectoralis muscle was prominent in patients undergoing mastectomy but not breast-conservation surgery (28% vs. 2.9%, P?=?.001).Conclusions
Our mapping data demonstrated that the ESTRO-CTV, with some considerations, successfully encompassed most LRRs in patients undergoing contemporary management, thus validating ESTRO-CTV to be valuable for highly conformal radiation therapy techniques. 相似文献19.
20.
Anne W. Lee Wai Tong Ng Jian Ji Pan Sharon S. Poh Yong Chan Ahn Hussain AlHussain June Corry Cai Grau Vincent Grégoire Kevin J. Harrington Chao Su Hu Dora L. Kwong Johannes A. Langendijk Quynh Thu Le Nancy Y. Lee Jin Ching Lin Tai Xiang Lu William M. Mendenhall Joseph T. Wee 《Radiotherapy and oncology》2018,126(1):25-36