Influence of overall treatment time and radiobiological parameters on biologically effective doses in cervical cancer patients treated with radiation therapy alone

The aim of the study was to examine the influence of overall treatment time (OTT) on the value of calculated biological effective doses (BEDs) for different biological variables. These variables were: tumour proliferation rate, different cell radiosensitivity (alpha=0.2, 0.3, and 0.4 /Gy), and different start time for repopulation (Tk=21, 28, and 35 days). Also the influence of age (), Hb level (), tumor proliferation rate (bromodeoxyuridine labelling index; BrdUrdLI), and DNA ploidy on survival after shorter (60 days) OTT was investigated. The study included 229 patients with cervix carcinoma treated entirely by standard radiotherapy (RT) (external beam RT plus low-medium dose-rate (LDR/MDR) brachytherapy (BT) at the Center of Oncology in Krakow. The linear quadratic equation was used to calculate BED, which is proportional to log cell kill. BEDs 10 (for tumours) were calculated with consideration of OTT for each patient and tumour proliferation rate (standardized potential doubling time; standardized Tpot) based on BrdUrdLI assessed on biopsy material before RT. Median OTT was 90 days (range 30-210). The mean calculated total BED for point A for tumour and 'early reactions' was equal to 103.0 Gy10. The longest median survival time--52 months--was seen for patients treated with OTT 8.8%) BED loss was 1.4 Gy/day and for slowly proliferating tumours (BrdUrdLI 50 years (p=0.003) and high Hb level (>116 g/l) (p=0.041). For longer treatments (OTT >60 days) the unfavourable parameters were: age 相似文献   

Clinical radiobiology of stage T2-T3 bladder cancer

PURPOSE: To evaluate the relationship between total radiation dose and overall treatment time (OTT) with the treatment outcome, with adjustment for selected clinical factors, in patients with Stage T2-T3 bladder cancer treated with curative radiotherapy (RT). METHODS AND MATERIALS: The analysis was based on 480 patients with Stage T2-T3 bladder cancer who were treated at the Center of Oncology in Gliwice between 1975 and 1995. The mean total radiation dose was 65.5 Gy, and the mean OTT was 51 days. In 261 patients (54%), planned and unplanned gaps occurred during RT. Four fractionation schedules were used: (1) conventional fractionation (once daily, 1.8-2.5 Gy/fraction); (2) protracted fractionation (pelvic RT, once daily, 1.6-1.7 Gy/fraction, boost RT, once daily, 2.0 Gy/fraction); (3) accelerated hyperfractionated boost (pelvic RT, once daily, 2.0 Gy/fraction; boost RT, twice daily, 1.3-1.4 Gy/fraction); and (4) accelerated hyperfractionation (pelvic and boost RT, twice daily, 1.2-1.5 Gy/fraction). In all fractionation schedules, the total radiation dose was similar (average 65.5 Gy), but the OTT was different (mean 53 days for conventional fractionation, 62 days for protracted fractionation, 45 days for accelerated hyperfractionated boost, and 41 days for accelerated hyperfractionation). A Cox proportional hazard model and maximum likelihood logistic model were used to evaluate the relationship between the treatment-related parameters (total radiation dose, dose per fraction, and OTT) and clinical factors (clinical T stage, hemoglobin level and bladder capacity before RT) and treatment outcome. RESULTS: With a median follow-up of 76 months, the actuarial 5-year local control rate was 47%, and the overall survival rate was 40%. The logistic analysis, which included the total dose, OTT, and T stage, revealed that all of these factors were significantly related to tumor control probability (p = 0.021 for total radiation dose, p = 0.038 for OTT, and p = 0.00068 for T stage). A multivariate Cox model, which included the treatment-related parameters and other clinical factors, revealed that the hemoglobin level and bladder capacity before RT and T-stage were statistically significant factors determining local control and overall survival. The total radiation dose was of borderline statistical significance for overall survival (p = 0.087), and OTT did not reach statistical significance. CONCLUSION: The results of our study showed that the treatment outcome after RT for bladder cancer depends mainly on clinical factors: hemoglobin level and bladder capacity before RT, and clinical T stage. An increase in the total radiation dose seemed to be associated with a better treatment outcome. The effect of the OTT was difficult to define, because it was influenced by other prognostic factors.     

Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma.

BACKGROUND AND PURPOSE: The prognosis of patients with portal vein tumor thrombosis (PVTT) from hepatocellular carcinoma (HCC) is poor; without treatment, their survival is less than 3months. We retrospectively evaluated the treatment outcomes of conformal radiation therapy (CRT) in patients with HCC-PVTT. MATERIALS AND METHODS: Thirty-eight HCC patients with PVTT in whom other treatment modalities were not indicated underwent CRT. The total dose was translated into a biologic effective dose (BED) of 23.4-59.5Gy(10) (median 50.7Gy(10)) as the alpha/beta ratio=10. Predictive factors including the age, performance status, Child-Pugh classification, PVTT size, and BED were evaluated for tumor response and survival. RESULTS: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 6 (15.8%), 11 (28.9%), 17 (44.7%), and 4 (10.5%) patients, respectively. The response rate (CR+PR) was 44.7%. The PVTT size (<30 vs. 30mm) and BED (<58 vs. 58Gy(10)) were significant factors for tumor response. The median survival and 1-year survival rate were 9.6months and 39.4%. The Child-Pugh classification (A vs. B) and BED were significant factors for survival. CONCLUSIONS: CRT is effective not only for tumor response but also for survival in HCC-PVTT patients in whom other treatment modalities are not indicated.     

Impact of overall treatment time on local control of anal cancer treated with radiochemotherapy

Between 1987 and 2000, 111 patients with epidermoid anal cancer (T1-T4 Nx M0) were assigned to primary simultaneous radiochemotherapy (RCT) with a radiation dose of 45 Gy, performed either as a split course with 2-Gy single fractions (schedule A, 1987-1996, n = 65 patients) or continuously with fractions of 1.8 Gy (schedule B, 1996-2000; n = 38 patients). The chemotherapy consisted of continuous infusions of 5-fluorouracil (5-FU; 800/1,000 mg/m(2)/day, on 4/5 consecutive days, during weeks 1 and 5) together with one (schedule A) or two (schedule B) short infusions of mitomycin C (10 mg/m(2)) during the first course of 5-FU. Associations between clinical outcome and various prognostic factors were assessed in 103 patients who completed these schedules. For both patient groups combined, 5-year local control rate was 67% and 5-year survival rate 71%. Advanced tumor stage, size, and nodal status significantly decreased the 5-year local control rate as well as the overall treatment time (OTT) >41 days (58% for OTT >41 days vs. 79% for OTT < or =41 days; p = 0.04). However, we did not find a correlation with the prescribed radiotherapy schedule (A or B). In conclusion, in patients with anal carcinomas treated with RCT with a radiation dose of 45 Gy, the predominant determinant of local control is the resulting OTT and not the administration schedule (split course or continuous radiotherapy).     

Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy

: Some studies have described pelvic tumor control and survival rates in invasive carcinoma of uterine cervix when the overall time in a course of definitive irradiation is prolonged. We attempt to confirm or deny these observations and evaluate the impact of timing of brachytherapy on outcome. We also explore the hypothesis that more extensive tumors technically require prolongation of the course of irradiation; thus decreased tumor control and survival in these patients may not necessarily be the result of time/dose factor. : Records of 1224 patients (Stage IB to III) treated with definitive irradiation (combination of external beam and two intracavitary insertions to deliver doses of 70 to 90 Gy to point A) were reviewed. Follow-up was obtained in 97% of the patients (median, 12 years; minimum, 3 years; maximum, 28 years). The relationship between outcome and overall treatment and time of intracavitary insertions was analyzed in each stage and according to tumor size/extent. : There was strong correlation between overall treatment time (OTT) and tumor stage (≤ 7 weeks: 81% for Stage IB; 74% for Stage IIA; 52% for Stage IIB; and 47% for Stage III). Interuptions of therapy accounting for prolongation of treatment time ocurred in 25–30% of patients, most frequently because of holidays and weekends and side effects of therapy. Overall treatment time had a major impact on pelvic tumor control in Stages IB, IIA, and IIB; in Stage IB 10-year actuarial pelvic failure rates were 7% with OTT ≤ 7 weeks, 22% with 7.1 to 9 weeks, and 36% with >9 weeks (p ≤ o.01). For Stage IIA the corresponding values were 14%, 27% and 36% (p = 0.08), and in Stage IIB pelvic failure rates were 20%, 28%, and 34%, respectively (p = 0.09). In Stage III, pelvic failure was 30%, 40%, and 505 respectively (p = 0.08). There was also a strong correlation between OTT and 10-year cause-specific survival (CSS); in Stage IB rates were 86% with OTT of ≤7 weeks, 78% for 7.1 to 9 weeks, and 55% for ≥9 weeks (p < 0.01). The corresponding rates in Stage IIA were 73%, 41%, and 48% (p ≤ 0.01). For patients with Stage IIB, CSS rates were 72% for OTT ≤7 weeks, 60% for 7.1 to 9 weeks, and 70 for >9 weeks (p = 0.01). Patients with Stage III disease had 45% to 10-year CSS when treatment was delivered in 9 weeks or less and 36% for longer overall (p = 0.16). In multivariate analysis of patients with Stage IB and IIA, OTT and clinical stage were the most important prognostic factors for pelvic tumor control, disease-free survival, and CSS. Tumor size was a prognostic factor for CSS. In Stages IIB and III, OTT, clinical stage, unilateral or bilateral parametrical invasion, and dose to point A were significant prognostic factors for pelvic tumor control, disease-free survival, and CSS. Prolongation of time had a significant impact on pelvic tumor control and CSS regardless of tumor size, except in Stage IB tumors ≤3 cm. Regression analysis confirms previous reports that prolongation of OTT results in decreased pelvic tumor control rate of 0.85% per day for all patients, 0.37% per day in Stages IB and IIA, 0.68% per day in Stage IIB, and 0.54% for Stage III patients treated with ≥85 Gy to point A. Performance of all intracavity insertions within 4.5 weeks from initiation of irradiation of yeilded decreased pelvic failture rates in some groups of patients (8.8 vs. 18% in Stage IB and IIA tumors ≤4 cm and 12.3 vs. 35% in Stage IBB) (p ≤ 0.01). : Prolongation of treatment time in patients with Stage IB, IIA, IIB, and III carcinoma of the uterine cervix has a significant impact on pelvic tumor control and CSS. The effect of OTT was present regardless of tumor size except in Stage IB tumors ≤3 cm. This may be related to biologic factors such as cell repopulation and increased proliferation resulting from treatment interruptions, in addition to initial clonogenic cells burden. Irradiation for patients with invasive carcinoma of the cervix should be delivered in the shortest possible overall time.     

Analysis of prognostic variables in hyperthermia treatment of 161 patients

From 1977-1982, 161 patients were treated using hyperthermia as an adjuvant in Phase I trials. Microwave applicators (MW), capacitively coupled plates (RF plates), interstitial localized current fields (LCF), and magnetic induction heating (MI) techniques were used together with radiation in 135 patients, with chemotherapy in 10 patients, and alone in 16 patients. Tumor volume response categories were no response (NR, less than 50% decrease); partial response (PR, 50% less than or equal to volume decrease less than 100%); and complete response (CR, complete disappearance). The CR rates and total response rates (CR + PR) were 38/160 (24%) and 90/160 (56%), respectively. There were highly significant differences among techniques in CR vs PR + NR (p = .001), and in CR + PR vs NR (p less than .0005). Response did not vary significantly with histologic category. Overall toxicity was 16%, and did not vary significantly with technique (p = .193). In the patient group treated with hyperthermia and radiation, multivariate analysis revealed that a set of three variables had prognostic importance for CR: technique (p = .011), radiation dose (p = .019), and tumor volume (p = .001, negatively correlated). A good correlation also existed between CR and the minimum tumor temperature averaged over all treatments, TMIN (p less than .0005). Temperature variables themselves were correlated with tumor volume. Minimum T correlated negatively with volume (p = .017) and TMAX correlated positively with volume (p = .026). In fewer than 50% of patients could minimum T greater than 40.7 degrees C be achieved. Our conclusions are: TMIN, tumor volume, radiation dose, and heating technique have prognostic value for initial response; variation in CR vs technique reflects variation in tumor volume treated and in minimum temperature achieved with these techniques; and acute toxicity of treatment is infrequent, but serious toxicity is possible with the interstitial technique.     

Integration of irinotecan and cisplatin with early concurrent conventional radiotherapy for limited-disease SCLC (LD-SCLC)

Background  This study was conducted using irinotecan and cisplatin (IP) concurrently with thoracic radiation therapy to evaluate the response and toxicity of this protocol in the treatment of patients with limited-disease small cell lung cancer (LD-SCLC). Methods  Twenty-seven chemotherapy-naive patients with LD-SCLC received two cycles of weekly irinotecan 60 mg/m² and cisplatin 60 mg/m² before the initiation of the thoracic radiation therapy. Results  Of the 29 patients with LD-SCLC enrolled in the study, 27 were eligible for evaluation of response and toxicity. The median age was 62 years; 26 patients (90%) were men. Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 5 patients (17%) and 1 in 18 patients (62%). Ten patients (37%) achieved a complete response (CR), 14 patients (52%) achieved a partial response (PR), while 3 patients (11%) had progressive disease (PD); one of the 3 nonresponders achieved a PR after commencing concurrent chemoradiotherapy; therefore, the overall response rate was 93%. The median survival time was 20.2 months and 1- and 2-year survival rates were 69% and 53.2%, respectively. The median progression-free survival (PFS) was 11.8 months, and 1- and 2-year PFS times were 52% and 34.1%, respectively. Neutropenia was the most prevalent hematological toxicity and it was evident as grade 3 in 14 patients (52%). Asthenia was the most prevalent nonhematological toxicity, in 18 patients (67%); esophagitis occurred in 15 patients (56%). No treatment-related deaths (due to sepsis or bleeding) were reported in the study. Conclusion  Irinotecan and cisplatin is considered to be an effective and safe chemotherapeutic regimen when used concurrently with thoracic radiation therapy for the treatment of patients with LD-SCLC.     

Late radiation toxicity after whole brain radiotherapy: the influence of antiepileptic drugs

This retrospective study had the following aims: (a) calculation of actuarial rate of late radiation toxicity after whole-brain radiotherapy (WBRT), (b) correlation of clinical symptoms with changes of computed tomography (CT) scans, and (c) analysis of potentially predictive factors with special regard to concomitant treatment with antiepileptic drugs. We analyzed 49 adult patients, selected from a preexisting data base. Inclusion criteria were as follows: no previous brain irradiation; WBRT without boost; CT, clinical, and neurologic examination before and more than 3 months after completion of WBRT. Uni- and multivariate tests of various patient- and treatment-related parameters as possible predictive factors for clinical symptoms of late radiation toxicity (scored according to the RTOG/EORTC system) as well as cerebral atrophy and white matter abnormalities were performed. Median age was 54 years. Patients were treated for brain metastases (n = 37), primary cerebral lymphoma (n = 2), primary brain tumors (n = 7), or with prophylactic intention (n = 3). Carbamazepine was given to 15 patients, phenytoin to 12, and barbiturate to 7, respectively; 42 patients also received corticosteroids. The median dose of WBRT was 30 Gy (range 27-66 Gy). Median fraction size was 3 Gy (1-3 Gy). Nine patients received two fractions per day. The biologically effective dose (BED) according to the linear-quadratic model ranged between 90 and 141 Gy (median, 120 Gy; alpha/beta value, 1 Gy). Median follow-up was 10 months (range, 4-130 months). In 16 cases, symptoms of late radiation toxicity grade I-III appeared. Actuarial rates were 32% after 1 year, 49% after 2 years, and 83% after 5 years. Actuarial rates of cerebral atrophy were 50% after 1 year and 84% after 2 years (white matter abnormalities: 25% and 85%, respectively). There was a significant correlation between atrophy and white matter abnormalities, but not between CT changes and clinical symptoms. CT changes were dependent on BED, absence of barbiturate use, and preexisting cerebral atrophy. Clinical symptoms usually were dependent on BED too, but treatment with carbamazepine was more important in the multivariate model. Neither other drugs nor other factors influenced late radiation toxicity. A detailed analysis showed that most carbamazepine-treated symptomatic patients took the drug during WBRT as well as during follow-up. Actuarial rates of grade I-III symptoms were 18% versus 50% after 1 year with or without carbamazepine. Even after exclusion of carbamazepine-treated patients, CT changes and clinical symptoms did not correlate. In conclusion, a BED <120 Gy was associated with a lower rate of late radiation toxicity after WBRT. The anticonvulsant drug carbamazepine showed a surprisingly clear influence on clinical symptoms of late radiation toxicity; that might be explained by the fact that the side effects of long-term drug treatment are indistinguishable from mild or moderate true radiation sequelae, rather than that it has a role in the pathogenesis of radiation-induced changes.     

The impact of overall treatment time on outcomes in radiation therapy for non-small cell lung cancer

PURPOSE: A retrospective study was carried out to evaluate the impact of overall treatment time (OTT) on the results of radiation therapy for non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From Jan. 1990 to Dec. 1996, 256 patients with stages I-IIIb NSCLC entered this analysis. All patients received definitive radiotherapy. Biologically effective dose (BED) was used to standardize the irradiation effects. The correlation between OTT and local progression-free survival was analyzed by linear-regression and Cox proportional hazard models. The prognostic variables for survival and distant metastasis were also briefly studied. RESULTS: OTT had been shortened in 64 patients because of an accelerated hyperfractioned irradiation, while OTT was prolonged i n 114 patients due to interruptions of irradiation courses. The main ca uses of interruption were machine breakdown or delayed preparations of c errobend block for boost fields (55%), holidays (11%) and treatment toxi city and side effects (34%).Patients tre ated with prolonged OTT (> 45 days) had significant poorer local progression-free survival than whom with OTT of 相似文献   

局限期小细胞肺癌放化疗后疗效与脑转移的关系探讨*

目的:探讨局限期小细胞肺癌（LD-SCLC ）放化疗后疗效与脑转移的关系。方法:回顾性分析天津医科大学肿瘤医院放疗科2009年4 月至2012年4 月间行放化疗的149 例LD-SCLC患者临床资料,放化疗后疗效评价根据RECIST标准分为完全缓解（CR）、部分缓解（PR）、病情稳定（SD）及疾病进展（PD）,客观缓解包括CR和PR。生存分析采用Kaplan-Meier 法并用Log-rank进行检验,χ2检验进行组间比较。结果:全组患者的中位生存时间（OS）为20.0 个月,3 年OS为33.0% 。多因素分析发现,放化疗后疗效（P < 0.001）及是否出现脑转移（P < 0.001）是影响患者OS的重要因素。全组共43例（28.8%）出现脑转移,CR、PR、SD/PD 患者分别有12例（29.3%）、9 例（11.8%）、22例（68.8%）出现脑转移（P = 0.027）。 放化疗后疗效与无脑转移生存率（BMFS）之间差异具有统计学意义（P = 0.005）,CR、PR、SD及PD患者的2 年BMFS分别为79.5% 、71.9% 、45.8% 和49.6% 。进一步分析发现,放化疗后达CR者,行脑预防性放疗（PCI）与未行PCI 患者的生存率亦存在统计学差异（P = 0.007）。 结论:LD-SCLC患者放化疗后达CR者有较好的BMFS和较低的脑转移率,且行脑预防照射者OS亦优于未行脑预防者,建议放化疗后达CR患者,应尽快考虑脑预防放疗。      

Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy

PURPOSE: To investigate radiation necrosis in patients treated for glioma in terms of incidence, outcomes, predictive and prognostic factors. METHODS AND MATERIALS: Records were reviewed for 426 patients followed up until death or for at least 3 years. Logistic regression analysis was performed to identify predictive and prognostic factors. Multivariate survival analysis was conducted using Cox proportional hazards regression. Separate analyses were performed for the subset of 352 patients who received a biologically effective dose (BED) > or =85.5 Gy2 (> or =45 Gy/25 fractions) who were at highest risk for radionecrosis. RESULTS: Twenty-one patients developed radionecrosis (4.9%). Actuarial incidence plateaued at 13.3% after 3 years. In the high-risk subset, radiation parameters confirmed as risk factors included total dose (p < 0.001), BED (p < 0.005), neuret (p < 0.001), fraction size (p = 0.028), and the product of total dose and fraction size (p = 0.001). No patient receiving a BED <96 Gy2 developed radionecrosis. Subsequent chemotherapy significantly increased the risk of cerebral necrosis (p = 0.001) even when adjusted for BED (odds ratio [OR], 5.8; 95% confidence interval [CI], 1.6-20.3) or length of follow-up (OR, 5.4; 95% CI, 1.5-19.3). Concurrent use of valproate appeared to delay the onset of necrosis (p = 0.013). The development of radionecrosis did not affect survival (p = 0.09). CONCLUSIONS: Cerebral necrosis is unlikely at doses below 50 Gy in 25 fractions. The risk increases significantly with increasing radiation dose, fraction size, and the subsequent administration of chemotherapy.     

Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung.

To determine if chemotherapy dose intensity (DI) influences treatment outcome, 60 published studies in limited- and extensive-stage small-cell carcinoma of the lung (SCCL) were retrospectively analyzed for relationship between intended DI and response (complete response [CR] or partial response [PR]) or median survival (MS). Agents used in the regimens included cyclophosphamide (C), doxorubicin (A), vincristine (V), etoposide (E), and cisplatin (P). Relative DI (RDI) of each study regimen was calculated against a reference regimen, and weighted regression analysis was used. Additionally, analysis of individual drug RDI within combinations was performed. For CAV, increasing RDI of the regimen showed no correlation with outcome. For the individual drugs, C RDI correlated positively, while A RDI correlated negatively with attainment of CR in limited disease, but both only after unduly influential observations were eliminated. In extensive-stage disease, A RDI correlated positively with CR+, PR but only in randomized trials, and this correlation lost statistical significance after unduly influential observations were eliminated. For CAE and CAVE, the RDI of the regimens correlated positively with MS in extensive-stage disease as did the C RDI. In limited disease, the C RDI correlated negatively with MS. For EP, no significant correlations were seen. We conclude that DI-outcome correlations are not consistent for these chemotherapy regimens in SCCL. Meta-analysis of retrospective data can generate hypotheses for testing in prospective clinical trials, but study sample and method of analysis can appreciably affect conclusions.     

肺寡转移瘤立体定向消融放疗的长期疗效观察

目的:评价立体定向消融放疗(SABR)在肺部寡转移瘤患者中的有效性和安全性。方法:回顾性分析2011—2018年行SABR的159例肺部转移瘤的患者资料,采用 Kaplan- Meier方法计算局控率(LCR)和总生存(OS),并采用 log- rank法单因素分析和 ...     

低分割3DCRT治疗早期非小细胞肺癌的临床观察

 目的评价拒绝手术或有手术禁忌症的早期非小细胞肺癌患者接受低分割三维适形放射治疗(3DCRT)的疗效、不良反应和并发症。方法39例经病理组织学和(或)细胞学确诊拒绝手术或有手术禁忌症的早期非小细胞肺癌患者接受3DCRT,分割剂量为4~6Gy/次,5次/周,总量DT为60~76Gy,相对生物剂量为80.6~100.4Gy,靶区仅包括肿瘤原发灶和转移淋巴结,其中18例配合化疗2~4周期。结果CR率为66.7%(26/39),其中相对生物剂量<90Gy的CR率50%(9/18),≥90GyCR率80.9%(17/21),两者比较差异有统计学意义(P<0.05)。1、3、5年生存率分别为100%、84.2%、33.3%,中位生存期42月,较传统手术疗效略低。未出现3级以上的放射性食管炎,只有1例发生4级放射性肺炎,其余均为3级以下。结论3DCRT能否代替手术治疗早期非小细胞肺癌尚须进一步开展随机研究。     

18FDG-PET based radiation planning of mediastinal lymph nodes in limited disease small cell lung cancer changes radiotherapy fields: a planning study.

BACKGROUND AND PURPOSE: To investigate the influence of selective irradiation of 18FDG-PET positive mediastinal nodes on radiation fields and normal tissue exposure in limited disease small cell lung cancer (LD-SCLC). MATERIAL AND METHODS: Twenty-one patients with LD-SCLC, of whom both CT and PET images were available, were studied. For each patient, two three-dimensional conformal treatment plans were made with selective irradiation of involved lymph nodes, based on CT and on PET, respectively. Changes in treatment plans as well as dosimetric factors associated with lung and esophageal toxicity were analyzed and compared. RESULTS: FDG-PET information changed the treatment field in 5 patients (24%). In 3 patients, this was due to a decrease and in 2 patients to an increase in the number of involved nodal areas. However, there were no significant differences in gross tumor volume (GTV), lung, and esophageal parameters between CT- and PET-based plans. CONCLUSIONS: Incorporating FDG-PET information in radiotherapy planning for patients with LD-SCLC changed the treatment plan in 24% of patients compared to CT. Both increases and decreases of the GTV were observed, theoretically leading to the avoidance of geographical miss or a decrease of radiation exposure of normal tissues, respectively. Based on these findings, a phase II trial, evaluating PET-scan based selective nodal irradiation, is ongoing in our department.     

Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important?

To evaluate if biologically effective dose (BED), and in particular the duration of radiation treatment, has an effect on local relapse risk. Between January 2000 and December 2008 a total of 762 patients with T1-2 N0/+ breast cancer was treated with breast-conserving surgery and radiotherapy, with and without hormone therapy and chemotherapy. Adjuvant radiation therapy was administered to a total dose of 60-66 Gy in 30-33 fractions. The computed BEDs were divided in four groups: <43.1, 43.1-44.9, 45.0-46.1, and >46.1 Gy (A-D, respectively). Kaplan-Meier method was used to calculate local relapse rates. Cox regression method was used to identify prognostic factors of local relapse. Evaluated variables were age, tumor histology, tumor size, surgical margin status, axillary nodal status, tumor grading, adjuvant therapies, adjuvant chemotherapy alone, adjuvant hormone therapy alone, adjuvant anthracyclines, and BEDs values. 8-year local relapse rates were 18.0% for group A, 8.5% for group B, 4.6% for group C, and 2.7% for group D (P=0.008). Multivariate Cox regression analysis showed that BEDs values were associated with higher local relapse risk (P=0.001). In our study, a prolongation of radiotherapy treatment, intended as a lower BED value, after breast-conserving surgery is associated with an increased risk of local relapse. Considering the wide range of results published in other studies, hypofractionation for breast cancer should be considered, at the moment, feasible in selected patients.     

Stereotactic Body Radiation Therapy for Salvage Treatment of Recurrent Non-Small Cell Lung Cancer

PurposeThis study analyzes the outcomes and toxicity of stereotactic body radiation therapy (SBRT) as salvage treatment for recurrent non-small cell lung cancer (NSCLC).Methods and MaterialsThis retrospective analysis considered patients treated with thoracic SBRT and a history of prior external beam radiation therapy (EBRT), SBRT, or surgical resection for NSCLC. Follow-up included positron emission tomography and computed tomography imaging at 2- to 3-month intervals. Key outcomes were presented with the Kaplan–Meier method.ResultsForty patients with 52 treatments were included at a mean of 11.82 months after treatment with EBRT (n = 21), SBRT (n = 15), surgical resection (n = 9), and SBRT after EBRT (n = 7). Median imaging and clinical follow-up were 13.39 and 19.01 months, respectively. SBRT delivered a median dose of 40 Gy in 4 fractions. Median biologically effective dose (BED) was 79.60 Gy. Median gross tumor volume and planning target volume were 10.80 and 26.25 cm³, respectively. Local control was 65%, with a median time to local failure of 13.52 months. Local control was 87% after previous SBRT but only 33% after surgery. Median overall survival was 24.46 months, and median progression-free survival (PFS) was 14.11 months. Patients presenting after previous SBRT had improved local control (P = .021), and the same result was obtained including patients with SBRT after EBRT (P = .0037). Treatments after surgical resection trended toward worse local control (P = .061). Patients with BED ≥80 Gy had improved local PFS (P = .032), PFS (P = .021), time without any treatment failure (P = .033), and time to local failure (P = .041). Using the Kaplan–Meier method, BED ≥80 Gy was predictive of improved local PFS (P = .01) and PFS (P < .005). Toxicity consisted of 10 instances of grade <3 toxicity (16%) and no grade ≥3 toxicity.ConclusionsSalvage treatment for recurrent NSCLC with SBRT was effective and well tolerated, particularly after initial treatment with SBRT. When possible, salvage SBRT should aim to achieve a BED of ≥80 Gy.     

化疗结合早期加速超分割放疗治疗局限期小细胞肺癌的疗效

目的观察化疗与早期同步加速超分割放疗治疗局限期小细胞肺癌的近期疗效和毒副反应,比较EC方案和EP方案之间的差别。方法40例符合条件的局限期小细胞肺癌行EC方案(E依托泊甙100mg,第1~5d;C卡铂400~500mg第1d)或EP方案(E依托泊甙100mg,第1~5d;P顺铂40mg第1~3d)化疗6个周期,在化疗早期进行加速超分割放疗45Gy/30次/3周。观察近期疗效和毒副反应,主要是放射性食管炎、放射性肺炎和骨髓抑制情况。结果近期总有效率为95.0%(38/40),EC组有效率95.65%,EP组有效率94.12%,2组间的有效率无明显差别(P=0.871)。放射性食管炎和放射性肺炎以2~3度为主,无4级以上的反应。骨髓抑制在EC方案方案组明显。EC组和EP组的中位生存时间均为24个月。结论化疗结合早期加速超分割放疗治疗局限期小细胞肺癌的近期疗效满意,毒副反应能够耐受,长期效果需进一步观察。     

调强放疗总疗程时间延长对局部晚期鼻咽癌疗效的影响

目的 探讨在调强放疗(IMRT)模式下总疗程时间(OTT)延长对局部晚期鼻咽癌疗效的影响.方法 对2001年5月至2007年4月在本中心首诊接受IMRT的376例T3-4N0-3M0期鼻咽癌患者进行回顾分析.以中位OTT为界分为OTT≤45 d和>45 d两组并比较差异,用Cox回归模型行多因素预后分析,放疗时间与局部控制率关系采用直线回归分析.结果 全组OTT≤45 d和>45 d组鼻咽2年局部控制率相似(94.9%和93.1%;χ2=2.83,P>0.05),T3期患者的也相似(96.3%和98.7%;χ2=2.18,P>0.05),T4期患者的不同(92.2%和83.1%;χ2=6.30,P<0.05).放疗中断发生在治疗开始3周前、3周后或3周前后的2年局部控制率相似(98%、96%或93%;χ2=2.21,P=0.531).放化疗模式下OTT>45 d组比OTT≤45 d组2年局部控制率低(93.1%和97.5%;χ2=4.69,P=0.030).多因素分析显示OTT是T4期患者局部控制率的影响因素.直线回归分析显示T4期患者疗程每延长1 d,2年局部控制率大约下降2.7%.OTT≤45 d和>45 d组的2年无瘤生存率、无远转生存率及总生存率均相似[84.1%和78.7%(χ2=0.02,P=0.881)、87.0%和86.1%(χ2=0.85,P=0.358)、91. 7%和92.2%(χ2=0.06,P=0.806)],T3及T4期患者的均也相似[83.7%和83.2%(χ2=0.07,P=0.798)、86.6%和85.7%(χ2=0.02,P=0.898)、93.7%和94.8%(χ2=0.03,P=0.862)及81.4%和72.3%(χ2=0.16,P=0.687)、82.6%和86.9%(χ2=1.78,P=0.182)、88.3%和87.5%(χ2=0.60,P=0.438)].多因素分析显示T分期、N分期是无瘤生存和总生存的影响因素,N分期是无远转生存率的影响因素.结论 IMRT模式下OTT延长将导致T4期鼻咽癌患者局部控制率降低,临床上应尽量避免疗程延长.     

食管癌同期放化疗后局部失败相关因素分析

背景和目的:目前同期放化疗是不能手术食管癌的标准治疗方法,局部未控和复发仍是治疗失败的主要原因。本文主要总结我科收治的食管癌同期放化疗后局部未控和复发情况,分析影响局部未控和复发的相关因素。方法:对132例食管癌患者行同期放化疗。第一周期化疗与放射治疗同时开始,第二周期化疗在放疗剂量达40Gy时给予。以二项分类logistic回归分析影响局部未控和复发的因素。结果:至随访截止时间,全组患者射野内未控和复发54例,射野内未控和复发并淋巴结或其他器官转移20例,射野外复发5例。logistic回归分析显示与局部未控和复发相关的因素为近期疗效和放疗剂量。放疗后病灶完全缓解和部分缓解者,局部未控和复发率分别为44.9%和79.6%(P<0.001),平均复发时间分别为12.9个月和6.1个月(P=0.002)。放疗剂量为50～60Gy、60.1～69.9Gy、≥70Gy时,局部未控和复发率分别为69%、61%、52%(P=0.027),平均局部失败时间分别为5.3个月、9.1个月、10.3个月(P=0.038)。结论:影响局部未控和复发的因素为近期疗效和放疗剂量。