Radiotherapy with or without chemotherapy in the treatment of anal cancer: 20-year experience from a single institute

Purpose

To report the efficacy and toxicity of radio(chemo)therapy (RCT) in the management of squamous cell anal carcinoma (SQ-AC) and to evaluate the prognostic factors influencing the outcomes.

Patients and methods

A consecutive cohort of 138 patients with cT1-4, cN0-3, cM0 SQ-AC were treated with RCT between 1988 and 2011 at our department. Median follow-up time for surviving patients from the start of RCT was 98 months (range, 1–236 months). Patients were treated with a median radiation dose of 56 Gy (range, 4–61 Gy). Concurrent chemotherapy was administered to 119 patients (86%).

Results

The survival rates at 2, 5, and 10 years were 88?±?3, 82?±?4, and 59?±?6%, respectively, with a median overall survival (OS) of 167 months. The cumulative incidence for local recurrence at 2 and 5 years was 8?±?2 and 11?±?3%, respectively. The median disease-free survival (DFS) and colostomy-free survival (CFS) times were 132 and 135 months, respectively. In 19 patients (14%), a distant metastasis was diagnosed after a median time of 19 months. In the multivariate analysis, UICC (International Union Against Cancer) stage I-II, female gender, Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, and good/moderate histologic differentiation (G1–2) were significantly associated with a better OS, DFS, and CFS. Conformal radiotherapy planning techniques were significantly associated with a lower cumulative incidence of local recurrence (11?±?3% vs. 38?±?19% at 5 years, p?=?0.006). A higher radiation dose beyond 54 Gy was not associated with an improvement in outcome, neither for smaller—(T1/T2) nor for larger tumors (T3/T4).

Conclusion

RCT leads to excellent outcomes—especially in patients with stage I/II and G1/G2 tumors—with acceptable toxicity. The probable advantages of high-dose radiotherapy should be considered carefully against the risk of a higher rate of toxicity. Future studies are needed to investigate the role of a more intensified (systemic) treatment for patients with unfavorable prognostic factors such as T3/T4, N+, and/or poor cell differentiation.     

Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site

Purpose

The goal was to retrospectively review the outcome of patients with cervical lymph node metastases of squamuos cell carcinoma of unknown primary site (CUP) treated with radio(chemo)therapy.

Patients and methods

A total of 65?patients with CUP N1?C3, M0, treated between 1988 and 2009 were evaluated: 61?patients underwent surgical resection followed by postoperative radio(chemo)therapy, 4?patients received definitive radiochemotherapy. Radiotherapy of bilateral neck nodes?+?the parapharyngeal region (COMP-RT) was performed in 48?patients (80%) and a unilateral radiotherapy of lymph nodes (UL-RT) in 17?patients (20%).

Results

After a median follow-up time of 64?months (range 3?C219?months), the estimated 2- and 5-year overall survival (OS) rates were 71?±?6% and 48?±?7%, respectively. The recurrent free survival (RFS) rate at 2- and 5-years was 58?±?6% and 48%?±?7%, respectively. Extracapsular spread, resection status (R0 vs. R1/R2), neck lymph node level (I?CIII vs. IV?CV), and Karnofsky index (60?C70 vs. 80?C100) were significant prognostic factors for OS and RFS in the univariate analysis. Lower nodal stage (N1/N2a vs. N2b/N2c/N3) was significantly associated with a better OS. Resection status and involvement of lymph node level IV significantly affected the OS and RFS in the multivariate analysis. COMP-RT or concurrent chemotherapy was not associated with a better OS or RFS.

Conclusion

An advantage of comprehensive radiotherapy or radiochemotherapy compared with unilateral radiotherapy of lymph nodes was not observed.     

Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma

Purpose

The safety and efficacy of using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with esophageal squamous cell carcinoma were evaluated in a single-institution phase II setting.

Methods and materials

Between June 2007 and October 2009, 45 patients underwent concurrent chemoradiotherapy (n?=?27) or radiotherapy alone (n?=?18). Two planning target volumes (PTV) were defined for the SIB: PTV_C and PTV_G, with prescribed doses of 50.4 Gy to the PTV_C (1.8 Gy/fraction) and 63 Gy to the PTV_G (2.25 Gy/fraction), both given in 28 fractions.

Results

At a median follow-up interval of 20.3 months, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 42.2 and 40.7?%, respectively. The median overall survival time was 21 months; locoregional control rates were 83.3?% at 1 year and 67.5?% at 3 years. According to CTCAE (version 3.0) criteria, none of the patients developed grade 4–5 toxicity. The most common grade 2 and 3 radiation-related toxicity was radiation esophagitis, occurring in 64?% of all patients (but only 13?% as grade 3). No patient developed grade >?2 pulmonary complications.

Conclusion

SIB-IMRT is a feasible therapeutic approach for esophageal carcinoma patients and provides encouraging locoregional control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.     

Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer

Background and purpose

To evaluate the treatment outcomes of radiotherapy and prognostic factors for recurrent pancreatic cancer.

Patients and methods

The study comprised 30 patients who developed a locoregional recurrence of primarily resected pancreatic cancer and received radiotherapy between 2000 and 2013 with a median dose of 54 Gy (range, 39–60 Gy). Concurrent chemotherapy included gemcitabine for 18 patients and S-1 for seven patients. The treatment outcomes and prognostic factors were retrospectively analyzed.

Results

The median follow-up after radiotherapy was 14.6 months. The 1-year overall survival, local control, and progression-free survival rates were 69?%, 67?%, and 32?%, respectively. The median overall survival and progression-free survival rates were 15.9 and 6.9 months, respectively. Tumor marker reduction and ≥?50?% reduction were observed in 18 and two patients, respectively. Of the seven patients who exhibited pain symptoms, four and two patients were partly and completely relieved, respectively. Late grade 3 ileus and gastroduodenal bleeding were observed in one patient each. Among the clinicopathological factors evaluated, only a disease-free interval of greater than?18.9 months exhibited a significant association with improved overall survival (p?=?0.017).

Conclusions

Radiotherapy for isolated locally recurrent pancreatic cancer resulted in encouraging local control, overall survival, and palliative effects with mild toxicity, particularly in patients with a prolonged disease-free interval. This treatment strategy should be prospectively evaluated.     

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.     

Radiotherapy in elderly patients with inoperable esophageal cancer

Background

Radiation oncologists increasingly face elderly cancer patients impaired by comorbidities and reduced performance status. As less data are available for this particular group of patients, the aim of the study was to assess the prognosis of inoperable esophageal cancer patients ≥?70?years undergoing definitive radiotherapy or radiochemotherapy.

Patients and treatment protocol

Patients aged ≥?70 with inoperable carcinoma of the esophagus undergoing definitive radio(chemo)therapy between 1995 and 2006 at the University of Cologne were included retrospectively. Maximal total dose of radiotherapy administered was 63?Gy (5?×?1.8?Gy/week). Chemotherapy consisted of cisplatin (20?mg/m² on days 1–5 and days 29–33) and 5-fluorouracil (650–1,000?mg/m² on days 1–5 and days 29–33). Efficacy was compared with a cohort of 152?patients <?70?years treated with the same protocol during the same time period.

Results

A total of 51?patients aged ?≥?70 with inoperable cancer of the esophagus undergoing definitive therapy were identified (stage I/II 23.5%, stage III 56.9%, stage IV 9.8%; squamous cell carcinoma 74.5%, adenocarcinoma 25.5%). While 15?patients (29.4%) received combined radiochemotherapy (RCT), 40?patients (70.6%) were treated with radiotherapy alone (RT). Median progression-free survival (PFS) was 9.5?months; median overall survival (OS) was 13.9?months. Patients treated with RCT had a 2-year OS rate of 53.3% compared with 16.7% for RT patients (p?=?0.039). The 2-year OS for clinically lymph node negative patients was 38.5% compared with 21.2% for lymph node positive patients (p?=?0.072). Median OS was not significantly different between patients ≥?70?years versus the patient cohort (n?=?152) aged <?70?years (13.9 vs. 7.2?months, p?=?0.072) but PFS showed a significant difference (4.9 vs. 9.5?months, p?=?0.026) in favor of the >?70?years group.

Conclusion

Prognosis in elderly patients with inoperable esophageal cancer undergoing definitive radiotherapy/radiochemotherapy is limited, although it is not inferior to patients <?70?years.     

Lateral release and medial plication for recurrent patella dislocation

Purpose

This study aims to report the long-term results of lateral release and medial plication in patients with recurrent patellar dislocation.

Methods

In this study, 31 patients who underwent surgery for recurrent patellar dislocation were retrospectively reviewed between 1994 and 2004. Among the 31 patients were 12 male and 19 female patients. The average age was 23.9?±?4.8?years, and the mean follow-up period was 11.6?±?2.4?years.

Results

Three patients had postoperative dislocations. The mean Kujala score significantly improved from 57.5?±?13.2 points preoperatively to 89.2?±?8.7 points at the final follow-up (P?<?0.0001). The median Tegner activity score significantly improved from 3 (range, 1?C5) at preoperative examination to 7 (range, 3?C9) at the final follow-up (P?<?0.0001). Ten patients were rated as excellent, 18 as good, 2 as fair, and 1 as poor. The congruence angle improved from 16.5°?±?3.0° to ?2.8°?±?2.7°, and the lateral patellofemoral angle improved from ?4.2°?±?1.9° to 8.2°?±?2.5°. There was no case of osteoarthritis at the final follow-up.

Conclusions

Percutaneous lateral release and medial plication showed satisfactory results with limited morbidity in the long-term follow-up. This traditional method remains a simple and effective surgical procedure for recurrent patellar dislocation.

Level of evidence

Therapeutic, Level IV.     

Re-irradiation combined with capecitabine in locally recurrent squamous cell carcinoma of the head and neck

Background

We performed a prospective phase II trial to investigate the safety and efficacy of radiotherapy combined with capecitabine in patients suffering from a recurrence of a squamous cell carcinoma of the head and neck (SCCHN) within a previously irradiated field.

Patients and methods

A total of 31 evaluable patients with recurrent SCCHN received re-irradiation with a total dose of 50?Gy (25 fractions over 5?weeks) up to a maximum of 60?Gy combined with 900?mg/m²/day capecitabine given on the days of radiotherapy.

Results

The median time to relapse after the first course of radiotherapy was 15?months. The overall response rate in our study was 68% including 6?patients with a complete response. The median overall survival was 8.4?months. Grade 3 or 4 mucositis occurred in 4?patients and 1?patient, respectively. No grade 4 hematological toxicities were observed; 1?patient had grade 3 anemia. The cumulative median lifetime dose was 116?Gy.

Conclusion

Capecitabine combined with re-irradiation is a well-tolerated treatment in patients with recurrent SCCHN. In light of its good tolerability, it appears to be a potential option for patients with a reduced performance status and may also serve as a basis for novel treatment concepts, such as in combination with targeted therapies.     

Computed Tomography-Guided Interstitial HDR Brachytherapy (CT-HDRBT) of the Liver in Patients with Irresectable Intrahepatic Cholangiocarcinoma

Purpose

This study was designed to investigate the clinical outcome of patients with irresectable, intrahepatic cholangiocarcinoma (IHC) treated with computed tomography (CT)-guided HDR-brachytherapy (CT-HDRBT) for local tumor ablation.

Method

Fifteen consecutive patients with histologically proven cholangiocarcinoma were selected for this retrospective study. Patients were treated by high-dose-rate internal brachytherapy (HDRBT) using an Iridium-192 source in afterloading technique through CT-guided percutaneous placed catheters. A total of 27 brachytherapy treatments were performed in these patients between 2006 and 2009. Median tumor enclosing target dose was 20?Gy, and mean target volume of the radiated tumors was 131 (±?90) ml (range, 10?C257?ml). Follow-up consisted of clinical visits and magnetic resonance imaging of the liver every third month. Statistical evaluation included survival analysis using the Kaplan?CMeier method.

Results

After a median follow-up of 18 (range, 1?C27) months after local ablation, 6 of the 15 patients are still alive; 4 of them did not get further chemotherapy and are regarded as disease-free. The reached median local tumor control was 10?months; median local tumor control, including repetitive local ablation, was 11?months. Median survival after local ablation was 14?months and after primary diagnosis 21?months.

Conclusion

In view of current clinical data on the clinical outcome of cholangiocarcinoma, locally ablative treatment with CT-HDRBT represents a promising and safe technique for patients who are not eligible for tumor resection.     

Cisplatin- vs. oxaliplatin-based radiosensitizing chemotherapy for squamous cell carcinoma of the esophagus

Purpose

To compare the outcomes of two neoadjuvant radiochemotherapy (N-RCT) regimens for squamous cell carcinoma of the esophagus (ESCC).

Methods

The standard N-RCT regimen for ESCC at our institution between 2002 and 2011 was a total dose of 45 Gy (1.8-Gy fractions) with concomitant cisplatin (20 mg/m², days 1–5 and 29–33) and 5-fluorouracil (5-FU; 225 mg/m², 24 h continuous infusion on days 1–33). During the same period, a phase I/II study comparing the standard ESCC N-RCT protocol with a regimen identical except for the replacement of cisplatin with weekly oxaliplatin (40–50 mg/m²) was performed at our center. The standard regimen was used to treat 40 patients; 37 received the oxaliplatin regimen. All patients subsequently underwent radical resection with reconstruction according to tumor location and two-field lymph node dissection.

Results

Median follow-up time from the start of N-RCT was 74 months (range 3–116 months). The two patient groups were comparable in terms of demographic and baseline tumor characteristics. R0 resection was achieved in 37/39 patients (95?%) in the cisplatin-based N-RCT group, compared to 24/37 (65?%) in the oxaliplatin-based group (p?=?0.002). A pathological complete response (pCR) was seen in the resection specimens from 18/39 patients (46?%) in the cisplatin-based N-RCT group and in 8/37 (22?%) oxaliplatin-group patients. In the cisplatin group, 2- and 5-year overall survival (OS) rates were 67?±?8?% and 60?±?8?%, respectively (median OS 103 months), compared to 38?±?8?% and 32?±?8?%, respectively, for the oxaliplatin group (median OS 17 months; hazard ratio, HR 0.452; 95?% confidence interval, CI 0.244–0.839; p?=?0.012).

Conclusion

Oxaliplatin-based N-RCT resulted in poorer outcomes in ESCC patients and should not routinely replace cisplatin-based N-RCT.     

Protocol-based image-guided salvage brachytherapy

Purpose

To assess the overall clinical outcome of protocol-based image-guided salvage pulsed-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy failure particularly regarding feasibility and side effects.

Patients and methods

Eighteen consecutive patients with locally recurrent prostate cancer (median age, 69 years) were treated during 2005–2011 with interstitial PDR brachytherapy (PDR-BT) as salvage brachytherapy after radiotherapy failure. The treatment schedule was PDR-BT two times with 30 Gy (pulse dose 0.6 Gy/h, 24 h per day) corresponding to a total dose of 60 Gy. Dose volume adaptation was performed with the aim of optimal coverage of the whole prostate (V₁₀₀ >?95?%) simultaneously respecting the protocol-based dose volume constraints for the urethra (D_0.1 cc <?130?%) and the rectum (D_2 cc <?50–60?%) taking into account the previous radiation therapy. Local relapse after radiotherapy (external beam irradiation, brachytherapy with J-125 seeds or combination) was confirmed mostly via choline-PET and increased PSA levels. The primary endpoint was treatment-related late toxicities—particularly proctitis, anal incontinence, cystitis, urinary incontinence, urinary frequency/urgency, and urinary retention according to the Common Toxicity Criteria. The secondary endpoint was PSA-recurrence-free survival.

Results

We registered urinary toxicities only. Grade 2 and grade 3 toxicities were observed in up to 11.1?% (2/18) and 16.7?% (3/18) of patients, respectively. The most frequent late-event grade 3 toxicity was urinary retention in 17?% (3/18) of patients. No late gastrointestinal side effects occurred. The biochemical PSA-recurrence-free survival probability at 3 years was 57.1?%. The overall survival at 3 years was 88.9?%; 22?% (4/18) of patients developed metastases. The median follow-up time for all patients after salvage BT was 21 months (range, 8–77 months).

Conclusion

Salvage PDR-brachytherapy of the prostate following local failure after radiation therapy is a treatment option with a low rate of genitourinary side effects and no late gastrointestinal side effects. The treatment efficacy in the first 3 years is promising.     

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.     

Peptide receptor radionuclide therapy with 177Lu-DOTATATE: the IEO phase I-II study

Purpose

Peptide receptor radionuclide therapy (PRRT) is used in tumours expressing type 2 somatostatin receptors (sst₂), mainly neuroendocrine. The aim of this prospective phase I-II study was to evaluate the toxicity and efficacy of ¹⁷⁷Lu-DOTATATE in multiple cycles.

Methods

Fifty-one consecutive patients with unresectable/metastatic sst₂-positive tumours, divided into two groups, received escalating activities (3.7?C5.18?GBq/cycle, group 1; 5.18?C7.4?GBq/cycle, group 2) of ¹⁷⁷Lu-DOTATATE. Cumulative activities ranged from 3.7 to 29.2?GBq (median 26.4?GBq in median 6 cycles, group 1, 21 patients) and 5.55 to 28.9?GBq (median 25.2?GBq in 4 cycles, group 2, 30 patients), based on dosimetry.

Results

No major acute or delayed renal or haematological toxicity occurred (one grade 3 leukopenia and thrombocytopenia). Cumulative renal absorbed doses were 8?C37?Gy (9?C41?Gy bioeffective doses). A median decrease of creatinine clearance of 21.7% 6?months after PRRT, 23.9% after 1?year and 27.6% after 2?years was observed. Higher losses (>20%) occurred in patients with risk factors for renal toxicity, particularly hypertension and diabetes. Cumulative bone marrow doses were <1.5?Gy. Blood elements showed a progressive mild drop during cycles and recovered during follow-up (median 30?months). Thirty-nine patients were progressive at enrolment. Partial and complete responses occurred in 15 of 46 (32.6%) assessable patients. The median time to progression was 36?months. Overall survival was 68% at 36?months. Non-responders and patients with extensive tumour involvement had lower survival.

Conclusion

¹⁷⁷Lu-DOTATATE was well tolerated up to 29?GBq cumulative activity (up to 7.4?GBq/cycle). The maximum tolerated dose/cycle was not reached. However, considering the individual bone marrow function and the presence of risk factors for kidney toxicity, it seems safer to divide cumulative activities into lower activity cycles.     

125I brachytherapy alone for recurrent or locally advanced adenoid cystic carcinoma of the oral and maxillofacial region

Background and purpose

This retrospective study was to evaluate the local control and survival of ¹²⁵I brachytherapy for recurrent and/or locally advanced adenoid cystic carcinoma (ACC) of the oral and maxillofacial region.

Patients and methods

A total of 38 patients with recurrent and/or locally advanced ACC of the oral and maxillofacial region received ¹²⁵I brachytherapy alone from 2001–2010. Twenty-nine were recurrent cases following previous surgery and radiation therapy. The other 9 cases involved primary tumors. Overall, 12 tumors were located in the major salivary glands, 12 in the minor salivary glands, and 14 in the paranasal region, the nasal cavity or the skull base. The prescribed dose was 100–160 Gy.

Results

Patients were followed for 12–122 months (median 51 months). The 2-, 5-, and 10-year local tumor control rates were 86.3, 59, and 31.5?%, respectively. The 2-, 5-, and 10-year overall survival rates were 92.1, 65 and 34.1?%, respectively. Tumors >?6 cm had significantly lower local control and survival rates. No severe complications were observed during follow-up.

Conclusion

¹²⁵I brachytherapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent ACC.     

Comparison of two different IMRT planning techniques in the treatment of nasopharyngeal carcinoma

Purpose

To compare the effect of two different intensity-modulated radiation therapy (IMRT) planning techniques on parotid gland doses in patients with nasopharyngeal carcinoma (NPC).

Patients and methods

Radiotherapy for 10 NPC patients referred to the University of Istanbul Cerrahpasa Medical School was planned with arc- and static seven-field IMRT. The simultaneous integrated boost (SIB) technique was used to deliver 70 Gy (2.12 Gy per fraction) to the primary tumor and involved nodes; 60 Gy (1.81 Gy per fraction) to the entire nasopharynx and 54 Gy (1.63 Gy per fraction) to elective lymph nodes in 33 fractions. Plans also aimed to keep the mean parotid dose below 26 Gy and limit the maximum doses to the spinal cord and brain stem to 45 and 54 Gy, respectively. Mean parotid gland doses for the two planning techniques were compared using a paired t-test. Target coverage and dose inhomogeneity were evaluated by calculating conformity- (CI) and homogeneity index (HI) values.

Results

Target coverage and dose homogeneity were identical and good for both planning techniques: CI?=?1.05?±?0.08 and 1.05?±?0.08; HI?=?1.08?±?0.02 and 1.07?±?0.01 for arc- and static field IMRT, respectively. Mean doses to contralateral parotid glands were 25.73?±?4.27 and 27.73?±?3.5 Gy(p?=?0.008) for arc- and static field IMRT plans, respectively, whereas mean ipsilateral parotid doses were 30.65?±?6.25 and 32.55?±?5.93 Gy (non-significant p-value), respectively. Mean monitor units (MU) per fraction for the 10 patients were considerably lower for arc- than for static field treatments—540.5?±?130.39 versus 1288.4?±?197.28 (p?<?0.001).

Conclusion

Normal tissues—particularly the parotid glands—are better spared with the arc technique in patients with NPC. MU and treatment times are considerably reduced in arc IMRT plans.     

Chemoradiotherapy duration correlates with overall survival in limited disease SCLC patients with poor initial performance status who successfully completed multimodality treatment

Background and purpose

Limited data concerning treatment-related prognostic factors in limited disease (LD) small-cell lung cancer (SCLC) patients with poor initial performance status (PS) who successfully completed chemoradiotherapy (CRT) are available.

Patients and methods

A total of 125 patients with initial PS WHO 2?C3 who successfully completed CRT were retrospectively reviewed. Thoracic radiation therapy (TRT) was applied in the concurrent (group?1) or sequential (group?2) mode. Influence of treatment type, time from diagnosis to start of TRT, number of chemotherapy cycles, prophylactic cranial irradiation (PCI), occurrence of brain metastases (BMs), and duration of CRT on overall survival (OS) were analyzed.

Results

Median duration of CRT was 156?days in group?1 and 195?days in group?2 (p?Conclusion Duration of CRT affects OS in LD SCLC patients with poor initial performance status who successfully completed multimodality treatment.     

Benign painful shoulder syndrome

Background and purpose

To compare the efficacy of two different dose-fractionation schedules for radiotherapy of patients with benign painful shoulder syndrome.

Patients and methods

Between February 2006 and February 2010, 312 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received radiotherapy with an orthovoltage technique. One radiotherapy course consisted of 6 single fractions in 3?weeks. In case of insufficient remission of pain after 6?weeks, a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0?Gy. The endpoint was pain reduction. Pain was measured before, right after, and 6?weeks after radiotherapy using a visual analogue scale (VAS) and a comprehensive pain score (CPS).

Results

The overall response rate for all patients was 83% directly after and 85% 6?weeks after radiotherapy. The mean VAS values before, directly after, and 6?weeks after treatment for the 0.5 and 1.0?Gy groups were 56.8?±?23.7 and 53.2?±?21.8 (p?=?0.158), 38.2?±?26.1 and 34.0?±?24.5 (p?=?0.189), and 33.0?±?27.2 and 23.7?±?22.7 (p?=?0.044), respectively. The mean CPS before, directly after, and 6?weeks after treatment was 9.7?±?3.0 and 9.5?±?2.7 (p?=?0.309), 6.1?±?3.6 and 5.4?±?3.6 (p?=?0.096), 5.3?±?3.7 and 4.1?±?3.7 (p?=?0.052), respectively. Despite a slight advantage in the VAS analysis for the 1.0?Gy group for delayed response, the CPS analysis revealed no statistically significant differences between the two single-dose trial arms for early (p?=?0.652) and delayed response quality (p?=?0.380).

Conclusion

Radiotherapy is an effective treatment option for the management of benign painful shoulder syndrome. Concerning radiation protection, the dose for a radiotherapy series is recommended not to exceed 3?C6?Gy.     

Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer

Background

Survival and prognostic variables in patients with advanced or metastatic non-small cell lung cancer (NSCLC) requiring thoracic palliative radiotherapy using a moderately hypofractionated regime (13–15?×?3 Gy) were evaluated.

Methods

From March 2006 to April 2012, 120 patients with a physician estimated prognosis of 6–12 months were treated with this regime using CT-based 3D conformal radiotherapy. We collected data on patient characteristics, comorbidities, toxicity, and treatment parameters.

Results

Radiotherapy was completed as prescribed in 114 patients (95.0?%, premature termination 5.0?%). Acute grade 3 toxicity was seen in 6.4?% of patients. The median survival of all patients was 5.8 months. Nonmetastatic patients survived significantly longer than patients with metastatic disease (median 11.7 months vs 4.7 months, p?=?0.0001) and 18.6?% of nonmetastatic patients survived longer than 2 years. In 12.7?% radiotherapy started less than 30 days before death and 14.2?% of patients received radiotherapy within 14 days before death. In the multivariate analysis, good general condition, nonmetastatic disease, and a stable or improved general condition at the end of radiotherapy were significant. The treatment parameters, age, and comorbidities were not statistically significant.

Conclusion

Our data confirm considerable effectiveness of 13?×?3 Gy with conformal radiotherapy for patients with locally confined NSCLC not fit for radical treatment and raise doubt for this regimen in metastatic patients and ECOG ≥?2 when burden, acute toxicity, and resources are considered.