Particle Radiation Therapy for Gastrointestinal Cancers

Particle irradiation of cancerous disease has gained great traction in recent years. The ability for particle therapy centers to deliver radiation with a highly conformal dose distribution while maintaining minimal exit or excess dose delivered to normal tissue, coupled with various biological advantages particularly found with heavy-ion beams, enables treatment of diseases inapproachable with conventional radiotherapy. Here, we present a review of the current status of particle therapy with regard to cancers of the gastrointestinal tract, including esophagus, liver, pancreas, and recurrent rectal cancer.     

Magnetic Resonance-Guided Radiation Therapy for Head and Neck Cancers

Despite the significant evolution of radiation therapy (RT) techniques in recent years, many patients with head and neck cancer still experience significant toxicities during and after treatments. The increased soft tissue contrast and functional sequences of magnetic resonance imaging (MRI) are particularly attractive in head and neck cancer and have led to the increasing development of magnetic resonance-guided RT (MRgRT). This approach refers to the inclusion of the additional information acquired from a diagnostic or planning MRI in radiation treatment planning, and now extends to online high-quality daily imaging generated by the recently developed MR-Linac. MRgRT holds numerous potentials, including enhanced baseline and planning evaluations, anatomical and functional treatment adaptation, potential for hypofractionation, and multiparametric assessment of response. This article offers a structured review of the current literature on these established and upcoming roles of MRI for patients with head and neck cancer undergoing RT.     

Radiation Therapy for Primary Eyelid Cancers in Tunisia

Management of eyelid cancers is based on surgery and/or radiotherapy (RT). The treatment objective is to control tumors with acceptable functional and esthetic outcomes. The aim of this study was to evaluate the results of radiation therapy in management of epithelial eyelid cancers, reviewing retrospectively the clinical records of patients treated in our institution from January 1989 to December 2013. We focused on clinical and histological features, treatment characteristics, tolerance and disease control. One hundred and eight patients (62 men and 46 women) were enrolled, with a mean age of 61 years [ranges 1587]. The most frequent tumor location was the inner canthus (42.6%). Median tumor size was 21 mm [ranges 470]. Histological type was basal cell carcinoma in 88 cases (81.5%), squamous cell carcinoma in 16 (14.8%) and sebaceous carcinoma in 4 (3.7%). Radiation therapy was exclusive in 67 cases (62%) and postoperative for positive or close margins in the remaining cases. Kilovoltage external beam radiotherapy (KVRT) was used in 63 patients (58.3%) and lowdoserate interstitial brachytherapy in 37 (34.3%). Eight (7.4%) were treated with cobalt or with a combination of KVRTcobalt, KVRTelectron beams, KVRTbrachytherapy or cobaltelectron beams. The total delivered radiation doses were 70 Gy (2 Gy/fraction) in 62 patients (57.4%), 66 Gy (2 Gy/fraction) in 37 (34.3%) and 61.2 Gy (3.4Gy/fraction) in 9 (8.3%). After a median followup of 64 months, we noted 10 cases of local recurrences(9.2%): 7 after exclusive and 3 after postoperative RT. No local recurrence occurred in patients treated with brachytherapy. Actuarial 5year local recurrencefree rate, diseasefree survival and overall survival were respectively 90%, 90% and 97%. Tstage was found to be a significant factor for recurrence (p0.047). All acute radiationrelated reactions were scored grade I or II. Delayed effects were eye watering in 24 cases (22.2%), eye dryness in 19 (17.6%), unilateral cataract in 7 (6.4%) and ectropion in 4 (3.7%). Radiation therapy and especially brachytherapy is an efficient treatment of eyelid cancers, allowing eye conservation and functional preservation with good local control rates and acceptable toxicity.     

恶性肿瘤急诊放射治疗

从１９７８年１０月～１９９３年１０月回顾性分析了收治的肿瘤急症患者１７０例，并施行肿瘤急诊放疗（ＯｎｃｏｌｏｇｉｃＥｍｅｒｇｅｎｃｙＲａｄｉａｔｉｏｎＴｈｅｒａｐｙ，ＯＥＲＴ）。常见的肿瘤急症有：上腔静脉综合症（ＳＶＣＳ）；肿瘤引起的器官受压或腔道堵塞；肿瘤引起中枢神经系统压迫；癌瘤骨转移或浸润、压迫神经引起的剧痛；实体癌瘤自发性溃破出血。阐述了肿瘤急诊放疗的方法和效果，各种肿瘤急诊放疗有效率为７０～９０％。肿瘤急诊放疗应掌握果断、准确、及时、安全、有效的原则。     

Preparing Patients for Sexual Dysfunction After Radiation for Anorectal Cancers: A Systematic Review

PurposeSuccessful multimodality treatment of anorectal cancers has led to increased numbers of survivors who experience permanent, life-changing side effects of treatment. Little is known about sexual dysfunction (SD) in this population. The etiology of SD after anorectal cancer treatment is complex and multifactorial. However, pelvic radiation plays a significant negative role in anatomic, hormonal, and physiological aspects of sexual function.Methods and MaterialsA systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Information was organized by key concepts useful for patient education, including (1) rates of SD after pelvic radiation for rectal cancer, (2) rates of SD after pelvic radiation for anal cancer, (3) mechanisms of SD and methods to reduce rates of SD, and (4) issues and opportunities related to patient education and discussion of SD after pelvic radiation.ResultsSD after pelvic radiation for anorectal cancers is common in both men and women. Higher radiation doses may increase the risk for vaginal stenosis; however, it is unclear whether there are similar dose–volume relationships for men. Vaginal dilators and advanced radiation techniques can reduce the radiation dose to sexual organs at risk. Improvement is needed regarding counseling and education of patients about SD.ConclusionsThis review provides information from previously published studies that clinicians may use in their discussions with patients embarking on pelvic radiation for anorectal cancers. More modern, standardized, and complete data are needed to quantify the risk of SD after treatment. Some methods of sexual toxicity reduction have been studied, but further study into interventions aimed at treating postradiation sexual function are needed.     

放疗与动脉内化疗联合应用治疗脑恶性胶质瘤

采用小剂量卡氮芥动脉内灌注化疗与放疗联合应用治疗脑恶性胶质瘤２４例，既避免了大剂量超选择动脉插管给药化疗所致的脑坏死，又利用了化疗对放疗的潜在增敏作用，取得满意疗效，总有效率达９１．６％，无严重并发症。     

Radiation Therapy for Brain Metastases from Malignant Melanoma

Thirty-nine patients who completed whole-brain irradition treatment for brain metastases from malignant melanoma were analyzed. Median survival was 2 months, mean survival 4 months. Only 3 patients survived for 1 year, the longest survival being 19 months after irradiation. Twenty-one (53.8%) showed marked clinical improvement and 6 (40%) of the 15 evaluable patients had some objective regression of the brain metastases. A treatment of 7 fractions of 4.8 Gy in 9 to 14 days and concomitant chemotherapy with dacarbazine and lomustine in 16 patients was well tolerated. This seems to be a beneficial treatment for patients with a comparatively small intracranial tumour burden.     

Radiation Therapy of Primary Malignant Lymphoma of the Brain

Primary malignant lymphoma of the brain (PMLB) is uncommon. Between 1975 and 1982, the authors observed 11 patients with histologically confirmed PMLB. Mean survival after radiation therapy was 7 months with 5 patients surviving for more than 2 years. Multifocal lesions were seen in 9 patients and spontaneous regression was seen at computed tomography in 2 patients. Radiation doses in excess of 30 Gy controlled the primary tumor, but intracranial recurrences occurred even after whole brain irradiation to 40 Gy. Only one patient had a relapse outside the central nervous system, and none had clinical evidence of seeding to the spinal canal. The authors postulate that PMLB usually is a multifocal intracranial disease, and that whole brain irradiation of at least 30 to 40 Gy should be given to all patients with this disease.     

直肠肛管恶性黑色素瘤的诊治

直肠肛管恶性黑色素瘤（anorectal malignant melanoma,ARMM）是一种少见的肿瘤,仅占到所有黑色素瘤的1％左右。由于大多数患者在诊断时处于疾病的后期,所以预后极差,据报道经积极治疗的患者5年生存率仅在10％左右。目前国内外对本病的研究多为小样本的分散报道。