Radiation therapy for angiosarcoma of the scalp

Background and purpose

Wide surgical excision is the standard treatment for angiosarcoma of the scalp, but many patients are inoperable. Therefore, we investigated the outcome of radiation therapy for angiosarcoma of the scalp.

Patients and methods

Seventeen patients with angiosarcoma of the scalp underwent radiation therapy with total scalp irradiation. Four patients had cervical lymph node metastases, but none had distant metastases. A median initial dose of 50 Gy in 25 fractions was delivered to the entire scalp. Subsequently, local radiation boost to the tumor sites achieved a median total dose of 70 Gy in 35 fractions.

Results

Fourteen of the 17 patients developed recurrences during the median follow-up period of 14 months after radiation therapy; 7 had recurrences in the scalp, including primary tumor progression in 2 patients and new disease in 5, and 12 patients developed distant metastases. The primary progression-free, scalp relapse-free, and distant metastasis-free rates were 86, 67, and 38?% at 1 year and 86, 38, and 16?% at 3 years, respectively. Thirteen patients died; the overall and cause-specific survival rates were both 73?% at 1 year and 23 and 44?% at 3 years, respectively. The median survival time was 16 months. There were no therapy-related toxicities ≥?grade 3.

Conclusion

Total scalp irradiation is safe and effective for local tumor control, but a dose of ≤?50 Gy in conventional fractions may be insufficient to eradicate microscopic tumors. For gross tumors, a total dose of 70 Gy, and >?70 Gy for tumors with deep invasion, is recommended.     

Fractionated stereotactic radiotherapy in the treatment of pituitary adenomas

Purpose

The purpose of this work was to evaluate tumor control and side effects associated with fractionated stereotactic radiotherapy (FSRT) in the management of residual or recurrent pituitary adenomas.

Patients and methods

We report on 37 consecutive patients with pituitary adenomas treated with FSRT at our department. All patients had previously undergone surgery. Twenty-nine patients had nonfunctioning, 8 had hormone-producing adenoma. The mean total dose delivered by a linear accelerator was 49.4 Gy (range 45–52.2 Gy), 5?×?1.8 Gy weekly. The mean PTV was 22.8 ccm (range 2.0–78.3 ccm). Evaluation included serial imaging tests, endocrinologic and ophthalmologic examination.

Results

Tumor control was 91.9?% for a median follow-up time of 57 months (range 2–111 months). Before FSRT partial hypopituitarism was present in 41?% of patients, while 35?% had anterior panhypopituitarism. After FSRT pituitary function remained normal in 22?%, 43?% had partial pituitary dysfunction, and 35?% had anterior panhypopituitarism. Visual acuity was stable in 76?% of patients, improved in 19?%, and deteriorated in 5?%. Visual fields remained stable in 35 patients (95?%), improved in one and worsened in 1 patient (2.7?%).

Conclusion

FSRT is an effective and safe treatment for recurrent or residual pituitary adenoma. Good local tumor control and preservation of adjacent structures can be reached, even for large tumors.     

High symptom improvement and local tumor control using stereotactic radiotherapy when given early after diagnosis of meningioma

Purpose

The goal of the present study was to analyze long-term results of fractionated stereotactic radiotherapy (SRT) in patients with a meningioma.

Methods and materials

A total of 72?patients treated between 1996 and 2008 in MAASTRO clinic (n?=?45) and University Hospital Zurich (n?=?27) were included. SRT was given as primary treatment (n?=?46), postoperatively (n?=?19) or at recurrence (n?=?7); 49?tumours (68%) were located in the skull base. Median total dose was 54?Gy.

Results

Median follow-up was 4.13?years (range 0.66–11?years). The 3- and 5-year overall survival were 92 and 79% for grade?0 and I meningioma. Progression-free survival for grade?0 and I was 95% at 3 and 5 years, and 40% for grade?II and III at 3?years. In 98.4% of patients, clinical symptoms were stable or improved. The majority of symptoms improved within 24?months after SRT. Local control is significantly better if patients are irradiated immediately after diagnosis compared to a watchful waiting policy (p?=?0.017). Grade?IV toxicity was low (4.2%, n?=?3)

Conclusion

SRT is an effective treatment with high local and clinical control. Early SRT resulted in better outcome than late treatment at progression.     

Stereotactic radiosurgery for newly diagnosed brain metastases

Background and purpose

Three doses were compared for local control of irradiated metastases, freedom from new brain metastases, and survival in patients receiving stereotactic radiosurgery (SRS) alone for one to three newly diagnosed brain metastases.

Patients and methods

In all, 134 patients were assigned to three groups according to the SRS dose given to the margins of the lesions: 13–16 Gy (n?=?33), 18 Gy (n?=?18), and 20 Gy (n?=?83). Additional potential prognostic factors were evaluated: age (≤?60 vs. >?60 years), gender, Karnofsky Performance Scale score (70–80 vs. 90–100), tumor type (non-small-cell lung cancer vs. melanoma vs. others), number of brain metastases (1 vs. 2–3), lesion size (?24 months).

Results

For 13–16 Gy, 18 Gy, and 20 Gy, the 1-year local control rates were 31, 65, and 79?%, respectively (p?p?p?p?=?0.12); 18 Gy showed a strong trend toward better local control when compared with 13–16 Gy (p?=?0.059). Freedom from new brain metastases (p?=?0.57) and survival (p?=?0.15) were not associated with SRS dose in the univariate analysis.

Conclusion

SRS doses of 18 Gy and 20 Gy resulted in better local control than 13–16 Gy. However, 20 Gy and 18 Gy must be compared again in a larger cohort of patients. Freedom from new brain metastases and survival were not associated with SRS dose.     

Efficacy and toxicity of (chemo)radiotherapy for primary subglottic cancer

Background and purpose

Primary subglottic cancer is a rare malignancy. We investigated the efficacy and toxicity of radiotherapy for subglottic cancer.

Patients and methods

Nineteen patients with primary squamous cell carcinoma of the subglottis received radiotherapy, 14 of whom also underwent chemotherapy. Of the 19 patients, 15 received definitive radiotherapy to the gross tumors with total doses of 70–70.2 Gy in 35–39 fractions, and 4 underwent preoperative radiotherapy with total doses of 37.8–55.8 Gy in 21–31 fractions, followed by total laryngectomy.

Results

Of the 19 patients, 5 developed local progression and 2 developed distant metastasis at the median follow-up period of 5 years. The 5-year local control and disease-free rates were 74 and 63%, respectively. Three patients died of tumor progression, and the 5-year overall and disease-free survival rates were 80 and 63%, respectively. Regarding acute toxicities, transient mucositis and dermatitis of grade 3 or lower were observed in all patients, but there were no late toxicities of grade 3 or higher.

Conclusion

Radiotherapy is a safe and effective treatment for patients with primary squamous cell carcinoma of the subglottis. The use of chemotherapy together with radiotherapy may enhance treatment efficacy and contribute to larynx preservation through good local control.     

Radiotherapy after radical prostatectomy: immediate or early delayed?

Background

Biochemical recurrence after radical prostatectomy (RP) is associated with risk indicators, including Gleason score, preoperative PSA level, tumor stage, seminal vesicle invasion, and positive surgical margins. The 5-year biochemical progression rate among predisposed patients is as high as 50?C70%. Post-RP treatment options include adjuvant radiotherapy (ART, for men with undetectable PSA) or salvage radiotherapy (SRT, for PSA persisting or re-rising above detection threshold). Presently, there are no published randomized trials evaluating ART vs. SRT directly.

Methods

Published data on ART and SRT were reviewed to allow a comparison of the two treatment approaches.

Results

Three randomized phase III trials demonstrated an almost 20% absolute benefit for biochemical progression-free survival after ART (60?C64?Gy) compared to a ??wait and see?? policy. The greatest benefit was achieved in patients with positive margins and pT3 tumors. SRT can be offered to patients with elevated PSA after RP. In 30?C70% of SRT patients, PSA will decrease to an undetectable level, thus giving a second curative chance. The rate of side effects for both treatments is comparably low. The role of irradiation of pelvic lymph nodes and the additional use of hormone therapy and radiation dose are discussed.

Conclusion

It remains unclear whether early SRT initiated after PSA failure is equivalent to ART. Where SRT is indicated, it should be started as early as possible.     

Factors affecting the local control of stereotactic body radiotherapy for lung tumors including primary lung cancer and metastatic lung tumors

Purpose

To identify factors affecting local control of stereotactic body radiotherapy (SBRT) for lung tumors including primary lung cancer and metastatic lung tumors.

Materials and methods

Between June 2006 and June 2009, 159 lung tumors in 144 patients (primary lung cancer, 128; metastatic lung tumor, 31) were treated with SBRT with 48?C60?Gy (mean 50.1?Gy) in 4?C5 fractions. Higher doses were given to larger tumors and metastatic tumors in principle. Assessed factors were age, gender, tumor origin (primary vs. metastatic), histological subtype, tumor size, tumor appearance (solid vs. ground glass opacity), maximum standardized uptake value of positron emission tomography using ¹⁸F-fluoro-2-deoxy-d-glucose, and SBRT doses.

Results

Follow-up time was 1?C60?months (median 18?months). The 1-, 2-, and 3-year local failure-free rates of all lesions were 90, 80, and 77?%, respectively. On univariate analysis, metastatic tumors (p?p?=?0.0246), and higher SBRT doses (p?=?0.0334) were the statistically significant unfavorable factors for local control. On multivariate analysis, only tumor origin was statistically significant (p?=?0.0027). The 2-year local failure-free rates of primary lung cancer and metastatic lung tumors were 87 and 50?%, respectively.

Conclusions

A metastatic tumor was the only independently significant unfavorable factor for local control after SBRT.     

Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy

Purpose

The aim of this study was to report the 5-year results of accelerated partial breast irradiation (APBI) using external beam three-dimensional conformal radiotherapy (3D-CRT).

Patients and methods

Between 2006 and 2011, 44 patients with low-risk, stage I–II breast cancer underwent breast-conserving surgery. Postoperative APBI was given by means of 3D-CRT using three to five non-coplanar fields. The total dose of APBI was 36.9 Gy (nine fractions of ?4.1 Gy b.i.d.). The mean follow-up time was 58.2 months for surviving patients. Survival results, side effects, and cosmetic results were assessed.

Results

One (2.3?%) local recurrence was observed, for a 5-year actuarial rate of 3.7?%. Neither regional nor distant failure was observed. Two patients died of internal disease. The 5-year disease-free, cancer-specific, and overall survival rates were 96.3, 100, and 95.1?%, respectively. Acute side effects included grade 1 (G1) erythema in 75?%, G1 parenchymal induration in 46?%, and G1 pain in 46?% of patients. No G2 or higher acute side effect occurred. Late side effects included G1, G2, and G3 fibrosis in 44, 7, and 2?% of patients, respectively, G1 skin pigmentation in 12?%, and G1 pain in 2?%. Asymptomatic fat necrosis occurred in 14?%. Cosmetic results were rated excellent or good in 86?% of cases by the patients themselves and 84?% by the physicians.

Conclusions

The 5-year local tumor control, toxicity profile, and cosmetic results of APBI delivered with external beam 3D-CRT are encouraging and comparable to other APBI series.     

Dose escalation of radiotherapy for Metastatic Spinal Cord Compression (MSCC) in patients with relatively favorable survival prognosis

Background and Purpose

Local control of metastatic spinal cord compression (MSCC) is particularly important for long-term survivors. Radiotherapy alone is the most common treatment for MSCC. The most frequently used schedule world wide is 30 Gy/10 fractions. This study investigated whether patients with favorable survival prognoses benefit from a dose escalation beyond 30 Gy.

Patients and Methods

Data from 191 patients treated with 30 Gy/10 fractions were matched to 191 patients (1:1) receiving higher doses (37.5 Gy/15 fractions or 40 Gy/20 fractions). All patients had favorable survival prognoses based on a validated scoring system and were matched for age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, ambulatory status, and time developing motor deficits. Both groups were compared for local control, progression-free survival, overall survival, and functional outcome.

Results

Local control rates at 2 years were 71 % after 30 Gy and 92 % after higher doses (p = 0.012). Two-year progression-free survival rates were 68 % and 90 %, respectively (p = 0.013). Two-year overall survival rates were 53 % and 68 %, respectively (p = 0.032). Results maintained significance in the multivariate analyses (Cox proportional hazards model; stratified model) with respect to local control (p = 0.011; p = 0.012), progression-free survival (p = 0.010; p = 0.018), and overall survival (p = 0.014; p = 0.015). Functional outcome was similar in both groups. Motor function improved in 40 % of patients after 30 Gy and 41 % after higher doses (p = 0.98).

Conclusion

Escalation of the radiation dose beyond 30 Gy resulted in significantly better local control, progression-free survival, and overall survival in patients with favorable survival prognoses.     

Postoperative chemoradiotherapy for gallbladder cancer

Purpose

The goal of this work was to analyze the outcome of adjuvant chemoradiotherapy for patients with gallbladder cancer who underwent surgical resection and to identify the prognostic factors for these patients.

Patients and methods

Between August 1989 and November 2006, 47 patients with gallbladder cancer underwent surgical resection followed by adjuvant radiotherapy. There were 21 males and 26 females, and median age was 60 years (range 44–75?years). Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40–50?Gy at 2?Gy/fraction; 41?patients also received intravenous 5-fluorouracil as a radiosensitizer. Median follow-up duration was 48?months for survivors.

Results

There were 2?isolated locoregional recurrences, 14?isolated distant metastases, and 7?combined locoregional and distant relapses. The 5-year overall survival rate was 43.7%. According to the extent of resection, the 5-year overall survival rates were 52.8%, 20.0%, and 0% in R0-, R1-, and R2-resected patients, respectively (p?=?0.0038). On multivariate analysis incorporating extent of resection, T stage, N stage, performance of lymph node dissection, and histologic differentiation, extent of resection was the only prognostic factor associated with overall survival (p?=?0.0075). Among the 37?patients with R0 resection, there was no difference of 5-year overall survival rates in patients with N0, N1, and Nx diseases (46.2%, 60.0%, and 44.4%, respectively, p?=?0.6246). As for significant treatment-related morbidity, there was only 1?patient with grade 4 gastric ulcer.

Conclusion

Adjuvant chemoradiotherapy after R0 resection can achieve a good long-term survival rate in gallbladder cancer patients, even in those with lymph node metastases, and may play a role for patients who underwent R0 resection of primary tumor without lymph node dissection.     

Adjuvant therapy after resection of brain metastases

Background

Tumor bed stereotactic radiosurgery (SRS) after resection of brain metastases is a new strategy to delay or avoid whole-brain irradiation (WBRT) and its associated toxicities. This retrospective study analyzes results of frameless image-guided linear accelerator (LINAC)-based SRS and stereotactic hypofractionated radiotherapy (SHRT) as adjuvant treatment without WBRT.

Materials and methods

Between March 2009 and February 2012, 44 resection cavities in 42 patients were treated with SRS (23 cavities) or SHRT (21 cavities). All treatments were delivered using a stereotactic LINAC. All cavities were expanded by ≥?2 mm in all directions to create the clinical target volume (CTV).

Results

The median planning target volume (PTV) for SRS was 11.1 cm³. The median dose prescribed to the PTV margin for SRS was 17 Gy. Median PTV for SHRT was 22.3 cm³. The fractionation schemes applied were: 4 fractions of 6 Gy (5 patients), 6 fractions of 4 Gy (6 patients) and 10 fractions of 4 Gy (10 patients). Median follow-up was 9.6 months. Local control (LC) rates after 6 and 12 months were 91 and 77?%, respectively. No statistically significant differences in LC rates between SRS and SHRT treatments were observed. Distant brain control (DBC) rates at 6 and 12 months were 61 and 33?%, respectively. Overall survival (OS) at 6 and 12 months was 87 and 63.5?%, respectively, with a median OS of 15.9 months. One patient treated by SRS showed symptoms of radionecrosis, which was confirmed histologically.

Conclusion

Frameless image-guided LINAC-based adjuvant SRS and SHRT are effective and well tolerated local treatment strategies after resection of brain metastases in patients with oligometastatic disease.     

Postoperative local fractionated radiotherapy for resected single brain metastases

Purpose

Evaluation of postoperative fractionated local 3D-conformal radiotherapy (3DRT) of the resection cavity in brain metastases.

Patients and methods

Between 2011 and 2016, 57 patients underwent resection of a single, previously untreated (37/57, 65%) or recurrent (20/57, 35%) brain metastasis (median maximal diameter 3.5?cm [1.1–6.5?cm]) followed by 3DRT. For definition of the gross tumor volume (GTV), the resection cavity was used and for the clinical target volume (CTV), margins of 1.0–1.5 cm were added. Median dose was 48.0?Gy (30.0–50.4?Gy) in 25 (10–28) fractions; most patients had 36.0–42.0?Gy in 3.0?Gy fractions (n?=?16, EQD2_10Gy 39.0–45.5?Gy) or 40.0–50.4?Gy in 1.8–2.0?Gy fractions (n?=?37, EQD2_10Gy 39.3–50.0?Gy).

Results

Median follow-up was 18 months. Local control rates were 83% at 1 year and 78% at 2 years and were significantly influenced by histology (breast cancer 100%, non-small lung cancer 87%, melanoma 80%, colorectal cancer 26% at 2 years, p?=?0.006) and resection status (p?<?0.0001), but not by EQD2_10Gy or size of the planning target volume (median 96.7?ml [16.7–282.8?ml]). At 1 and 2 years, 74% and 52% of the patients were free from distant brain metastases. Salvage procedures were applied in 25/27 (93%) of recurrent patients. Survival was 68% at 1 year and 41% at 2 years and was significantly improved in younger patients (p?=?0.006) with higher Karnofsky performance score (p?<?0.0001) and without prior radiotherapy (54% vs. 9% at 2 years, p?=?0.006). No cases of radiographic or symptomatic radionecrosis were observed.

Conclusion

Adjuvant fractionated local 3DRT is highly effective in radiosensitive, completely resected metastases and should be considered for treating large resection cavities as an alternative to postoperative stereotactic single dose or hypofractionated radiosurgery.

     

Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70–75?Gy in 5?weeks for advanced head and neck cancer

Background and purpose

The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70–75?Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer.

Methods and materials

A total of 39?patients with very advanced, stage?IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72?ml) were included in this phase?I dose escalation study. A total of 50?fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5?weeks. Prescribed total dose/dose per fraction for planning target volume (PTV_tumor) were 70?Gy in 1.4?Gy fractions, 72.5?Gy in 1.45?Gy fractions, and 75?Gy in 1.5?Gy fractions for 10, 13, and 16?patients, respectively. Uninvolved lymphatic nodes (PTV_uninvolved) were irradiated with 55?Gy in 1.1?Gy fractions using the concomitant integrated boost.

Results

Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade?3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was ≤?9?weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade?3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%.

Conclusion

HARTCIB (75?Gy in 5?weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.     

Intensity-modulated radiation therapy for T4 nasopharyngeal carcinoma

Purpose

The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).

Methods and materials

Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33–35 fractions. In addition, 97?% of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months.

Results

The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1?%, respectively. A total of 27 patients had locoregional recurrence: 85.2?% in-field failures, 11.1?% marginal failures, and 3.7?% out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9?%) compared to those receiving conservative treatment (32.0?%, p?=?0.051). In patients treated with 1 course of radiotherapy, grade ≥?3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6?% of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation.

Conclusion

IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.     

Breast cancer patients with metastatic spinal cord compression

Background and purpose

The goal of the present work was to investigate the predictive value of the number of extraspinal organs involved by metastases for the survival of patients with metastatic spinal cord compression (MSCC) from breast cancer.

Patients and methods

Data of 145 breast cancer patients who received 10 fractions of 3 Gy of radiotherapy (RT) alone for MSCC were retrospectively analyzed. Seven potential prognostic factors were investigated including age, Eastern Cooperative Oncology Group (ECOG) performance score, number of involved vertebrae, interval from breast cancer diagnosis to RT of MSCC, ambulatory status prior to RT, time to developing motor deficits, and the number of involved extraspinal organs.

Results

The 1-year survival rates for involvement of 0, 1, 2, and ≥?3 extraspinal organs were 86, 73, 36, and 16?% (p?<?0.001). In the multivariate analysis, the number of involved extraspinal organs remained significant (risk ratio 2.19; 95?% confidence interval 1.61–3.00; p?<?0.001). ECOG performance score (p?<?0.001), ambulatory status prior to RT (p?=?0.003), and the time to developing motor deficits (p?<?0.001) were also significantly associated with survival in the multivariate analysis.

Conclusion

The number of extraspinal organs involved by metastases is an independent prognostic factor of survival in patients with MSCC from breast cancer.     

Stereotactic radiotherapy for choroidal melanomas by means of HybridArc™

Purpose

Stereotactic radiotherapy (SRT) is suitable to treat ocular tumours. The optimal beam geometry for SRT, however, has not been defined. Here we evaluate a combination technique with dynamic conformal arcs (DCAs) and intensity-modulated static fields (IMRT), known as HybridArc? (HA).

Methods

For the first consecutive 25 cases with choroidal melanomas with volumes of 0.02 to 1.18?cm³ treated with 50?Gy in five fractions, the results with respect to dose conformity, homogeneity, and dose distributions were summarised. To describe the dose distribution at the planning target volume (PTV) boundary, we defined a spatially averaged dose gradient (SADG) and compared it with Paddick’s gradient index (GI). We made dosimetric comparisons between HA and other irradiation techniques.

Results

The PTVs ranged from 0.42 to 3.37?cm³. The conformity index (CI) was 1.25?±?0.15, and the homogeneity index (HI) 0.08?±?0.02. The SADG was (?3.5?±?0.5) Gy/mm or (?7.0?±?1.0) %/mm between the isodose levels 95 and 20%; local minima reached ?11.5?Gy/mm or ?22.9%/mm. The coefficient of determination for a nonlinear regression of GI on SADG was 0.072. After a median follow-up time of 19.6 months, local tumour control was 100% without any case of post-therapeutic enucleation. Two patients (8%) developed liver metastases.

Conclusion

SRT of ocular tumours by HA is highly appropriate, and HA is superior to intensity-modulated arc therapy (IMAT) concerning dose reduction in organs at risk (OARs). The novel gradient measure SADG is more informative than Paddick’s GI.

     

Effective local control of vertebral metastases by simultaneous integrated boost radiotherapy

Background

The primary endpoint was to improve local tumour control of patients with metastatic spinal tumours by stereotactic body radiotherapy (SBRT) and dose escalation by simultaneous, integrated boost (PTV-boost). We used a whole vertebral body (PTV-elective) contouring approach. Secondary endpoints were severity of acute and chronic adverse effects and overall survival.

Methods

In all, 33 patients with metastases of the vertebral column were treated at Erlangen University Hospital. SBRT was given in 12 or 10 fractions. The metastatic lesion (PTV-boost) received 3.6 Gy (range 3.0–4.51 Gy) per fraction for a total of 42.0 Gy (24.36–48.0 Gy) and the whole vertebra (PTV-elective) received 2.85 Gy (range 1.8–3.6 Gy) per fraction for a total of 32.39 Gy (range 21.60–38.0 Gy). Patients were followed up every 3 months.

Results

Local control rate of all patients was 93?% at 12 and 24 months. The overall survival rate was 54?% at 12 months, 38?% at 24 months and 18?% at 36 months. No radiation myelopathy occurred. The most frequently observed adverse events in 3 cases was oesophagitis grade 2.

Conclusion

SBRT with simultaneous, integrated boost was associated with excellent local control of 93?% after 24 months. This result shows the possibility of delivering escalated doses to the target while still keeping the incidence of side effects low. This study forms the basis for a future randomised controlled trial comparing conventional radiotherapy (10 fractions of 3 Gy) with hypofractionated dose intensified SBRT (12 fractions of 3 Gy + integrated boost 12 fractions of 4 Gy) for improvement of local tumour control and pain.

     

Radiation therapy for primary carcinoma of the eyelid: tumor control and visual function

Background and purpose

Surgical excision remains the standard and most reliable curative treatment for eyelid carcinoma, but frequently causes functional and cosmetic impairment of the eyelid. We therefore investigated the efficacy and safety of radiation therapy in eyelid carcinoma.

Patients and methods

Twenty-three patients with primary carcinoma of the eyelid underwent radiation therapy. Sebaceous carcinoma was histologically confirmed in 16 patients, squamous cell carcinoma in 6, and basal cell carcinoma in 1. A total dose of 50?C66.6?Gy (median, 60?Gy) was delivered to tumor sites in 18?C37 fractions (median, 30 fractions).

Results

All but 3 of the 23 patients had survived at a median follow-up period of 49?months. The overall survival and local progression-free rates were 87% and 93% at 2?years, and 80% and 93% at 5?years, respectively. Although radiation-induced cataracts developed in 3?patients, visual acuity in the other patients was relatively well preserved. There were no other therapy-related toxicities of grade 3 or greater.

Conclusion

Radiation therapy is safe and effective for patients with primary carcinoma of the eyelid. It appears to contribute to prolonged survival as a result of good tumor control, and it also facilitates functional and cosmetic preservation of the eyelid.