Salvage radiotherapy in patients with recurrent esophageal carcinoma

Purpose

The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported.

Patients and methods

A consecutive cohort of 54?patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy?+?surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19?months (range 4?C79?months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45?Gy (range 30?C68?Gy).

Results

Median follow-up time for surviving patients from the start of R(C)T was 38?months (range 10?C105?months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12?months (95%?confidence interval (CI) 7?C17?months) and the median recurrence-free interval was 8?months (95%?CI 4?C12?months). The survival rates at 1, 2, and 3?years were 55?±?7%, 29?±?6%, and 19?±?5%, respectively. The recurrence-free survival rates at 1, 2, and 3?years were 44?±?7%, 22?±?6%, and 15?±?5%, respectively. A radiation dose ???45?Gy and conformal RT were associated with a better prognosis.

Conclusion

RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherpy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45?Gy are recommended.     

Image-guided stereotactic radiotherapy for patients with vestibular schwannoma

Strahlentherapie und Onkologie - Local tumor control and functional outcome after linac-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for vestibular...     

Surgery vs. radiotherapy in patients with uveal melanoma

Background

The treatment modalities for uveal melanoma (UM) include surgery and radiotherapy (RT). The utilization of RT as a strategy for organ preservation has been increasing, but the survival difference between the two aforementioned treatment modalities has not been reported.

Methods

An observational and cohort study was performed using a propensity score with an already existing public database. Patients diagnosed with UM within the period from 2004–2013 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. One-to-one matching and inverse probability of treatment weighting (IPTW) using the propensity score were used to estimate and compare survival rates.

Results

Overall, 3291 patients were treated: 2503 received RT only (RT group) and 788 received surgical resection only (surgery group). The RT group had an improved crude 5?year overall survival (OS) rate compared with the surgery group (76% vs. 60%, P < 0.001), and an improved 5?year melanoma-specific survival (MSS) rate (89% vs. 73%, P < 0.001). Compared to the surgery group, the RT group was associated with improved OS (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.38–0.73, P < 0.001) and MSS (HR 0.48, 95% CI 0.35–0.65, P < 0.001) in the matched cohort. The survival benefit of the RT group maintained after adjustment with IPTW, both in OS and MSS.

Conclusions

To our knowledge, the present study was the first to demonstrate the survival difference between the two treatment modalities for UM using both the propensity score matching and weighting methods with the SEER database. The current study suggests that RT may provide a survival advantage over surgery in the treatment of UM.

     

脑转移瘤立体定向放射治疗进展

MRI在脑转移瘤的诊断、治疗以及随访中有重要作用。原发灶状况、脑转移瘤的体积、立体定向放疗前后是否加全脑放疗、一般状况评分、回归分割分析(RPA)分级、是否存在颅外转移等是影响脑转移瘤治疗效果的主要因素。单纯立体定向放疗逐渐成为脑转移瘤治疗的主流,分次立体定向放疗在脑转移瘤治疗中的作用尚未完全明确。     

植入心脏起搏器肿瘤患者放射治疗的研究进展

通过总结不同国际准则的一些建议,结合国内外多家临床机构及科研单位起搏器植入肿瘤患者放疗的具体病例和最新研究进展,分析放疗实施过程中各种因素对心脏起搏器的影响,探讨及总结植入心脏起搏器肿瘤患者放疗的临床经验。科学合理地设计治疗方案,制定放疗计划,降低风险等级,将影响起搏器的不利因素减少到最低,对于植入心脏起搏器恶性肿瘤患者,是可以安全有效地完成放疗的。     

人类免疫缺陷病毒阳性恶性肿瘤患者放射治疗的急性放射性反应观察

目的 观察并评估人类免疫缺陷病毒(HIV)阳性的肿瘤患者放射治疗的急性放射性反应。方法 回顾性分析云南省肿瘤医院2008年2月至2013年12月收治的14例HIV阳性恶性肿瘤患者,在接受放射治疗期间和治疗后1个月的放射不良反应。急性反应依据照射部位分类,参照不良事件通用术语标准(CTCAE 3.0版)分级。结果 7例患者放疗中断或延期,2例未完成放疗。皮肤、黏膜反应多见,如皮炎、咽炎、腹泻。8例患者放疗期间出现3级急性放射反应,其中,6例患者有3级皮肤反应,2例有3级黏膜反应。结论 放射治疗对HIV阳性的肿瘤患者是一种有效的治疗手段,但会引发重的急性放射反应。     

A policy for radiotherapy in patients with implanted pacemakers.

As the prevalence of implanted pacemakers increases, the likelihood that cancer requiring radiotherapy will develop in pacemaker-bearing patients increases proportionately. A management policy for pacemaker-dependent patients who require radiotherapy helps assure that they will be safely and efficiently treated with external beam radiation. Guidelines for external beam treatment have been set forth in the ASTRO Newsletter. These guidelines are the basis of the specific policy that was developed and implemented. This policy (1) requires a cardiology consultation and discussion with the manufacturer before treatment, (2) prohibits the use of a betatron, (3) suggests that attempts be made to limit the dose received by the pacemaker to 2-Gy, (4) requires that pacemaker dose be calculated, measured, and recorded in the patient chart, (5) requires cardiac monitoring in accordance with the degree of patient pacemaker dependence, and (6) requires a follow-up cardiology consultation after the patient's final treatment. Adherence to this policy is assured by use of a worksheet that is included in each pacemaker patient's chart.     

The robustness of prostate radiotherapy for patients with hip prosthesis

The aim of this study was to investigate prostate radiotherapy techniques for the patients with hip prosthesis in 4 different field setups. Volumetric Modulated Arc Therapy (VMAT) technique was used in 4 different cases: (1) using full VMAT arcs (VMAT_F); (2) same arcs as in case 1 but with avoidance sectors (VMAT_ASEC); (3) as case 2 but with the addition of a lateral static field through the prosthesis (VMAT_ASEC+STAT); (4) as in case 1 but with an automated structure avoidance option to avoid irradiation through the prosthesis (VMAT_ASTR). Fifteen previously treated prostate patients were retrospectively selected to this study. Treatment plans were created for all patients using all 4 techniques. The potential prosthesis misalignment in the treatment setup was modeled by moving the prosthesis 0.5, 1.0, and 1.5 cm ventrally and dorsally and recalculating the plans in each case. For VMAT_ASEC, the dose parameters for organs at risk were the highest and the dose coverage of the target volume was the poorest when compared to the other techniques. For VMAT_ASEC+STAT, the movement of the prosthesis changed the target dose distribution the most. VMAT_F and VMAT_ASTR fulfilled the planning criteria the best, even when the prosthesis was misaligned. VMAT_F radiated through the prosthesis more than VMAT_ASTR and increased the dose near the prosthesis surface when compared to VMAT_ASTR. VMAT_ASTR and VMAT_F were the most robust techniques for the patients with the hip prosthesis considering plan quality and the effect of positioning errors. The increased prosthesis surface dose with VMAT_F and possible dose calculation uncertainties favors the use of VMAT_ASTR.     

96例脑胶质瘤术后放射治疗预后影响因素分析

目的探讨脑胶质瘤患者术后放射治疗的存活、预后影响因素。方法回顾性分析我院2009年3月至2013年11月收治的96例脑胶质瘤术后放射治疗患者,随访2~63个月,应用Kaplan-Meier法计算生存率及生存时间,Log-rank法做单因素分析,对单因素分析有意义的因素(P<0.05)采用Cox模型进行多因素分析。结果本组患者1、2、3年生存率分别为88.7%、68.5%、48.9%,生存时间中位数为37.51个月。单因素分析显示,放射治疗前卡氏功能状态(KPS)评分、年龄、病理分级及手术切除程度是影响胶质瘤患者预后的重要因素;多因素分析显示,年龄、放射治疗前KPS评分、手术切除程度是影响预后的独立因素。结论年龄>40岁、放射治疗前KPS评分>70分、手术全切可提高脑胶质瘤术后放射治疗患者的生存率。     

Peripheral lymphocyte populations in patients treated with pelvic and mediastinal radiotherapy

Solid tumor bearing patients often show a large variety of immunologic alterations: increase in immune complexes number, reduced NK activity, decreased IL-2 production, T4/T8 reverse and s.o. Most literature data generally concern chemotherapy and/or radiotherapy pretreated patients, so it is difficult to relate the immunological alterations with either antineoplastic treatments or the disease itself. We tried to evaluate any possible alteration of immunological parameters in patients with solid neoplasms who underwent radiotherapy on mediastinum or pelvis. The aim was to detect any variation in peripheral lymphoid sub-populations (even per site of irradiation) and a possible activation of an immune therapy. The evaluable patients were 38 (12 treated with surgery). The minimum dose delivered was 5000 cGys through conventional fractionation. The immunological parameters (T, B, N, T4, T8, H/S) were evaluated before the treatment, at the end and every 2 months during follow-up. Cases were analyzed also per single irradiation volume. No statistically significant variation in immunological parameters was found, although suppressor activity was confirmed as prevailing in immune responsiveness of cancer patients. Thus any significant correlation between immunological state and disease evolution or response to treatment has still to be verified.     

Primary radiotherapy of prostatic carcinoma--the results at Essen with 173 patients

173 patients suffering from prostate carcinomas of stages A to C received percutaneous irradiations. The five-year survival is 100% in stage A (n = 6), 79% in stage B (n = 41), and 68% in stage C (n = 126). 116 patients received only percutaneous irradiation after needle biopsy, 30 patients were irradiated subsequently to surgical intervention, and 27 were treated by hormones during primary therapy. An analysis was made about survival, recurrence rate, metastasis-free interval, and incidence of metastases in dependence on stage, grading, and different forms of primary treatment. The importance of stage and grading as prognostic factors is confirmed by the results of this study. Extended primary therapy (surgery and/or hormones) seems to bring no benefit as compared to radiotherapy alone. Transurethral resection of the prostate as a surgical/diagnostic intervention has an unfavorable influence on the prognosis.     

沙利度胺联合放疗治疗食管癌长期生存分析

目的 研究沙利度胺下调食管癌患者放疗中血清血管内皮生长因子(vascular endothelial growth factor,VEGF)水平对食管癌患者长期生存的影响。方法 根据81例食管癌患者放疗中血清VEGF水平分为用药组(沙利度胺)32例和未用药组49例,通过随访观察分析其总生存率(OS)和无进展生存率(PFS),根据32例使用沙利度胺处理后的血清VEGF水平变化,又分降低组20例和升高组12例,分析其OS和PFS。对预后因素进行单因素和多因素分析。结果 用药组和未用药组的中位生存期及1、3年生存率分别为17.0个月、59.4%、31.5%和18.7个月、56.4%、28.6%;两组的OS和PFS分别比较,差异均无统计学意义。VEGF水平降低组和升高组的中位生存期及1、3年生存率分别为19.7个月、65.0%、42.1%和10.7个月、43.3%、8.3%;两组OS和PFS比较,差异均有统计学意义(χ²=4.345、4.157,P<0.05)。多因素分析显示,临床分期是食管癌患者总生存率的独立预后因素,性别、病变部位对患者预后没有影响。结论 对于用药后VEGF水平降低患者,沙利度胺联合放疗能够增加食管癌患者远期疗效。     

Time evaluation of image-guided radiotherapy in patients with spinal bone metastases

Purpose

Time is an important factor during immobilization for radiotherapy (RT) of painful spinal bone metastases. The different RT techniques currently in use have differing impacts on medical staff requirements, treatment planning and radiation delivery. This prospective analysis aimed to evaluate time management during RT of patients with spine metastases, focusing particularly on the impact of image-guided RT (IGRT).

Materials and methods

Between 21 March 2013 and 17 June 2013, we prospectively documented the time associated with the core work procedures involving the patient during the first day of RT at three different linear accelerators (LINACs). The study included 30 patients; 10 in each of three groups. Groups 1 and 2 were treated with a single photon field in the posterior–anterior direction; group 3 received a three-dimensional conformal treatment plan.

Results

The median overall durations of one treatment session were 24 and 25.5 min for the conventional RT groups and 15 min for IGRT group. The longest single procedure was patient immobilization in group 1 (median 9.5 min), whereas this was image registration and matching in groups 2 and 3 (median duration 9.5 and 5 min, respectively). Duration of irradiation (beam-on time) was similar for all groups at 4 or 5 min. The shortest immobilization procedure was observed in group 3 with a median of 3 min, compared to 4 min in group 2 and 9.5 min in group 1.

Conclusion

With this analysis, we have shown for the first time that addition of modern IGRT does not extend the overall treatment time for patients with painful bone metastases and can be applied as part of clinical routine in a palliative setting. The choice of treatment technique should be based upon the patient’s performance status, as well as the size of the target volume and location of the metastasis.     

Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma

Background

Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL).

Methods

From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016.

Results

Median follow-up after RT was 7.5 years (range 0–14.4 years). Mean overall survival (OS) after RT was 31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was 13.3 years, with 5? and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of 36.3 months (range 2.3–13.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.0–13.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preservation was not significant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient files for tinnitus and facial and trigeminal nerve toxicity. Significant differences appeared regarding hearing impairment, gait uncertainty, and imbalance.

Conclusion

These data confirm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller lesions, while FSRT can be offered independently of tumor size. Patient self-reported outcome during follow-up is of high value. The established questionnaire could be validated in the independent cohort.