共查询到20条相似文献，搜索用时 31 毫秒
1.
Kentaro Ishii Toshiko Yamanaga Ryo Ogino Yukinari Hosokawa Shun Kishimoto Ryuta Nakahara Chiaki Shimada Ryu Kawamorita Takuhito Tada Yoshiki Hayashi Toshifumi Nakajima 《Practical radiation oncology》2018,8(2):e49-e55
Purpose
This study aimed to compare bowel and urinary health-related quality of life (HRQOL) between prostate-only (PO) volumetric modulated arc therapy (VMAT) and whole-pelvis (WP) VMAT in patients with localized prostate cancer.Methods and materials
A total of 234 patients treated with definitive VMAT to 78 Gy in 39 fractions were enrolled. Of these, 108 patients received PO-VMAT and 126 patients received initial WP-VMAT to 46.8 Gy in 26 fractions using a simultaneous integrated boost technique. HRQOL was prospectively assessed before radiation therapy (baseline), and 3, 6, 12, and 24 months after treatment using the Expanded Prostate Cancer Index Composite (EPIC).Results
Baseline HRQOL scores did not differ significantly between the 2 groups. No significant between-group differences in HRQOL change from baseline were observed for all bowel and urinary EPIC domains. The proportion of patients showing a clinically relevant decrease in bowel and urinary HRQOL scores from baseline was similar between the groups throughout the follow-up period. An analysis of individual HRQOL items showed that patients undergoing WP-VMAT were more likely to report moderate/big problems with bloody stools (P = .039) and overall bowel problems (P = .008) than those undergoing PO-VMAT at 12 months. There was no significant between-group difference in any individual items at 24 months, however.Conclusions
Bowel and urinary HRQOL is largely similar for patients receiving PO-VMAT and WP-VMAT during 24 months of follow-up, with the only differences seen in responses to specific bowel HRQOL items at 12 months. 相似文献2.
Michael G. Chang Nitai Mukhopadhyay Diane Holdford Vicki Skinner Siddharth Saraiya Drew Moghanaki Mitchell S. Anscher 《Practical radiation oncology》2018,8(3):e149-e157
Purpose
This study evaluates the safety and efficacy of moderately hypofractionated radiation therapy (RT) with simultaneous integrated boost (HSIB) intensity modulated RT (IMRT) that includes coverage of the seminal vesicles (SVs) and pelvic lymph nodes (LNs).Methods and materials
Men with localized prostate cancer were prospectively enrolled in a phase 1/2 trial to receive HSIB-IMRT to the prostate, ± SV, ± pelvic LN using a risk-based method. Low-risk patients received 69.6 Gy to only the prostate in 29 fractions. Intermediate-risk (IR) and high-risk (HR) patients received 30 fractions with 72 Gy to the prostate, 54 Gy to the SV, and 50.4 Gy to the pelvic LN when risk of LN involvement exceeded 15% by the Roach formula. IR and HR patients received androgen deprivation therapy. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively evaluated with patient- and physician-reported surveys.Results
Fifty-five men were enrolled, and 49 had at least 1 year of follow-up with 19.2% low-risk, 40.4% IR, and 40.4% HR disease. The median age was 69 years; median follow-up time was 36.9 months. Twenty-six patients received pelvic nodal HSIB-IMRT. At 2 years, the cumulative incidence of physician-reported late grade 2+ GU and GI toxicity was 32.6% and 18.4% respectively. At 2 years, only 10.2% grade 2+ GU toxicities and 2.0% grade 2+ GI toxicities remained unresolved. At last follow-up, the prevalence of unresolved physician-reported late grade 2+ GU and GI toxicity was 4.1% and 0%. The median patient-reported American Urologic Association-International Prostate Symptom Score fell from 10 at baseline to 7.5 at 2 years. The 3-year biochemical relapse-free survival rate for the cohort was 96%.Conclusions
HSIB-IMRT with risk-based nodal coverage results in excellent biochemical control. Although the cumulative incidence of physician-reported GU toxicity was higher than anticipated, late GI and GU toxicity was relatively transient. 相似文献3.
Purpose
Stereotactic body radiation therapy (SBRT) is increasingly being used for the management of localized prostate cancer. This trend combined with declining use of brachytherapy (BT) has pushed issues and questions regarding the use of SBRT to the forefront. A systematic literature review was conducted to review the current evidence of biochemical disease-free survival (bDFS) and toxicity of SBRT in high-risk (HR) prostate cancer.Methods and materials
A search was carried out on the PubMed and Embase databases. Studies were included if HR patients were treated using SBRT monotherapy or as a boost and bDFS was reported. Selected high-dose-rate (HDR) BT studies including HR patients from published reviews were selected to compare with SBRT results. Data from recent published phase 3 trials involving HR patients were also compared.Results
Our search yielded 8862 articles. Of these, 20 studies with a median follow-up from 1.6 to 7 years were included in this review. The 5-year bDFS was 81% to 91% in monotherapy studies and 90% to 98% in boost studies. For reference, 19 studies that reported treating HR patients with HDR monotherapy or boost were selected. The 5-year bDFS in HDR monotherapy studies and boost studies was 85% to 93% and 72% to 93%, respectively. The incidence of late grade 3 genitourinary toxicity was 0% to 4.4% and 0% to 2.3% in SBRT monotherapy and SBRT boost studies, respectively.Conclusion
The evidence for SBRT in HR patients in this review is based on observational studies with relatively few patients and short follow-up (level III evidence). Based on these data and the principles surrounding treatment, SBRT boost should ideally be validated in clinical trials. SBRT monotherapy should be used cautiously in highly selected HR patients outside of a clinical trial.Summary
Stereotactic body radiation therapy (SBRT) is increasingly being used for the management of clinically localized prostate cancer. This trend, combined with the decline in the use of brachytherapy, has pushed issues and questions regarding the use of SBRT to the forefront. A systematic literature review was conducted to establish the current evidence of biochemical and toxicity outcomes of SBRT in high-risk prostate cancer. 相似文献4.
Zachary D. Horne Michael J. Dohopolski David A. Clump Steven A. Burton Dwight E. Heron 《Practical radiation oncology》2018,8(3):e117-e123
Purpose
Local failure following concurrent chemoradiation and in-lobe failures following stereotactic body radiation therapy (SBRT) are common. We evaluated our institutional experience using SBRT as salvage in this setting.Methods and materials
Seventy-two patients were reirradiated with SBRT for residual, locally recurrent, or new primary non-small cell lung cancer within or adjacent to a high-dose external beam radiation therapy or SBRT field. Kaplan-Meier analysis with log-rank test were used to estimate endpoints and differentiate cohorts.Results
Median follow-up was 17.9 months. Patients had residual or recurrent disease (54.2%); 45.8% had new lung primaries. Median reirradiated T size was 2.5 cm (range, 0.8-7.8 cm). Median pre-retreatment maximum standardized uptake value (SUVmax) was 7.15 (range, 1.2-37.6). The most common SBRT reirradiation regimen was 48 Gy in 4 fractions (range, 17-60 Gy in 1-5 fractions). Median progression-free survival was 15.2 months, and median overall survival was 20.8 months. Two-year local failure was 21.6%. Patients with SUVmax at reirradiation <7.0 had a 2-year local control of 93.1% versus 61.1% above the median (P < .001). The 2-year rate of distant metastases was 10.4% versus 54.1% in patients treated for a new primary versus residual or recurrent disease (P < .001). Median progression-free survival was 31.9 months versus 8.4 months, respectively (P = .037). Median survival of patients treated for new primary was 25.2 months versus 16.2 months with residual or recurrent disease (P = .049), and median survival for patients with reirradiation SUVmax below the median was 42.0 months versus 9.8 months above the median (P < .001). Acute any-grade toxicity was seen in 29.2% of patients, acute grade 3 toxicity in 11.1%, and late grade 3 toxicity in 1.4% with no treatment-related deaths.Conclusions
SBRT appears to be a safe and effective means of salvaging recurrent, residual, or new primary NSCLC in or adjacent to a previous high-dose radiation field. 相似文献5.
Daniel A. Hamstra Neil Mariados John Sylvester Dhiren Shah Eric Gross Richard Hudes David Beyer Steven Kurtzman Jeffrey Bogart R. Alex Hsi Michael Kos Rodney Ellis Mark Logsdon Shawn Zimberg Kevin Forsythe Hong Zhang Edward Soffen Patrick Francke Jeff Michalski 《Practical radiation oncology》2018,8(1):e7-e15
Background
We previously reported the results of a phase 3 trial evaluating a prostate/rectal hydrogel spacer during prostate intensity modulated radiation therapy, which resulted in decreased rectal dose and toxicity and less decline in bowel quality of life (QOL). A secondary analysis was performed to correlate penile bulb dose and sexual QOL.Methods and materials
Sexual QOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) by mean scores, the proportion of patients with a minimal clinically important difference (MID), and analyses of the different items composing the sexual domain.Results
A total of 222 men enrolled with median follow-up of 37 months. Hydrogel reduced penile bulb mean dose, maximum dose, and percentage of penile bulb receiving 10 to 30 Gy (all P < .05) with mean dose indirectly correlated with erections sufficient for intercourse at 15 months (P = .03). Baseline EPIC was low (53 [standard deviation ± 24]) with no difference between arms (P > .1). A total of 41% (88/222) of men had adequate baseline sexual QOL (EPIC >60 (mean, 77 [± 8.3]). This subgroup at 3 years had better sexual function (P = .03) with a spacer with a smaller difference in sexual bother (P = .1), which resulted in a higher EPIC summary on the spacer arm (58 [±24.1] vs control 45 [± 24.4]) meeting threshold for MID without statistical significance (P = .07). There were statistically nonsignificant differences favoring spacer for the proportion of men with MID and 2× MID declines in sexual QOL with 53% vs 75% having an 11-point decline (P = .064) and 41% vs 60% with a 22-point decline (P = .11). At 3 years, more men potent at baseline and treated with spacer had “erections sufficient for intercourse" (control 37.5% vs spacer 66.7%, P = .046) as well as statistically higher scores on 7 of 13 items in the sexual domain (all P < .05).Conclusions
The use of a hydrogel spacer decreased dose to the penile bulb, which was associated with improved erectile function compared with the control group based on patient-reported sexual QOL. 相似文献6.
David E. Long Mark Tann Ke Huang Gregory Bartlett James O. Galle Yukie Furukawa Mary Maluccio John A. Cox Feng-Ming Kong Susannah G. Ellsworth 《Practical radiation oncology》2018,8(6):429-436
Purpose
Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated.Methods and materials
We studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT. The following dosimetric endpoints were compared for FLIGHT versus standard SBRT planning: functional residual capacity <15 Gy (FRC15HIDA), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation.Results
Compared with standard planning, FLIGHT significantly improved FRC15HIDA (mean improvement: 5.3%) as well as MLD, EUD, and FEUD (P < .05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m2, FRC15HIDA <2.11%/min/m2, and MELD ≥11 (P < .05).Conclusions
FLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning. 相似文献7.
Merrylee McGuffin Naila Devji Lyann Kehoe Anne Carty Steve Russell Lisa Di Prospero Carlo DeAngelis Alex Kiss Danny Vesprini Andrew Loblaw Laura D’Alimonte 《Practical radiation oncology》2018,8(2):116-122
Introduction
Radiation therapy is a standard treatment option for prostate cancer. With growing use of escalated doses and tighter margins, procedures to limit rectal size variation are needed to reduce prostate motion, increase treatment accuracy, and minimize rectal toxicity. This prospective study was done to determine whether the introduction of an antiflatulent medication would decrease rectal distention at computed tomography (CT) simulation and throughout a course of radiation therapy.Methods and materials
Patients undergoing a radical course of radiation therapy to the prostate/prostate bed were eligible to participate. Participants were randomly assigned to the intervention arm (antiflatulent medication) or the control arm (no medication). For each participant, the number of CT simulation rescans was recorded. Rectal diameters were measured on CT simulation and treatment cone beam CT scans. Acute rectal toxicities were assessed at baseline and weekly using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0. A χ2 analysis was used to compare the number of participants requiring a rescan in each study arm. Change in rectal diameter over time was assessed using repeated measures analysis of variance.Results
A total of 78 patients participated, with equal numbers assigned to each study arm. There was no significant difference between arms in the number of participants requiring a CT simulation rescan (P = .5551). There was no significant variation in rectal diameter between arms (P = .8999); however, there was a significant effect of time (P = .0017) and a significant interaction effect between study arm and time on rectal diameter (P = .0141). No acute rectal toxicities above grade 2 were reported.Conclusions
The addition of antiflatulent medication did not affect the frequency of CT simulation rescans. Both time and the interaction between study arm and time had a statistically significant effect on rectal diameter, although neither finding was clinically significant. Instead, standardized bowel preparation education developed for this study may have been sufficient to limit rectal size variation. 相似文献8.
D.R. Henderson J.R. Murray S.L. Gulliford A.C. Tree K.J. Harrington N.J. Van As 《Clinical oncology (Royal College of Radiologists (Great Britain))》2018,30(9):539-547
Aims
There are limited data on dosimetric correlates of toxicity in stereotactic body radiotherapy (SBRT) for prostate cancer. We aimed to identify potential relationships between dose and toxicity using conventional dose–volume histograms (DVHs) and dose–surface maps (DSMs).Materials and methods
Urinary bladder trigone and rectum DSMs were produced for a single-institution service evaluation cohort of 50 patients receiving SBRT for localised prostate cancer, together with conventional DVHs for bladder and rectum. Patients had been prospectively recruited to this cohort and treated according to a pre-defined protocol to a dose of 36.25 Gy in five fractions. Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) toxicity data were recorded prospectively. Logistic regression was used to identify dosimetric predictors of acute IPSS+10 (rise of 10 points or more above baseline) and grade 2+ RTOG toxicity.Results
On univariate analysis, trigone area receiving 40 Gy and trigone Dmax were associated with IPSS+10 (odds ratio 1.06 [1.02–1.11], P = 0.007 and odds ratio 1.54 [1.06–2.25], P = 0.024, respectively). These two variables were highly correlated. In a multivariate model, including all baseline variables, trigone Dmax remained associated with IPSS+10 (odds ratio 1.91 [1.13–3.22], P = 0.016). These findings were not significant with Holm–Bonferroni correction for multiple testing (corrected P value threshold 0.006). No associations were seen between rectal toxicity and DVH or DSM parameters.Conclusions
Our study suggests a potential relationship between high doses to the urinary bladder trigone and patient-reported urinary toxicity in prostate SBRT, and is consistent with previous studies in conventionally fractionated radiotherapy, justifying further evaluation in larger cohorts. 相似文献9.
Clinical response to radium-223 dichloride in men with metastatic castrate-resistant prostate cancer
Purpose/Objective
Radium-223 prolongs survival and decreases symptomatic skeletal events in men with metastatic castrate-resistant prostate cancer and is indicated in patients with painful bone metastases. However, pain responses are rarely reported and often asked about by patients. Further, patients and their physicians are concerned about a lack of pain response portending a poor treatment response and may be inclined to change systemic therapies before completing 6?cycles. We evaluated the likelihood and time course of pain response, potential predictors of response, and its prognostic value in patients receiving radium-223.Materials and Methods
We reviewed the charts of patients who received radium-223 in our department. All patients were planned for 6?cycles with a prescribed dose of 50–55?kBq/kg at each administration. Pain scores, subjective response to pain, analgesic use, treatment toxicities, and laboratory values were recorded at each visit. Symptomatic skeletal events and survival were also recorded.Results
48 patients received at least one cycle of radium-223 and 27 (56%) received all 6 planned cycles. Median survival from first treatment was 16.0?months (95% CI 8.9 to 19.2?months). 33% experienced at least one symptomatic skeletal event during or after treatment. 62.5% of men reported a decrease in pain from pre-treatment baseline. Of men with improved pain, 96% experienced an improvement before the third cycle. Pain relief was not associated with a decrease in ALK-P or PSA or improved survival.Conclusions
Approximately two-thirds of patients who undergo treatment with radium-223 will experience an improvement in pain and, if it occurs, it will most likely occur within the first two cycles. Patients should be counseled about this timeline and, if pain improvement isn't achieved, palliative radiation and oral analgesic readjustment should be considered. Pain response is not associated with survival and should not be used to evaluate the effectiveness of treatment. 相似文献10.
V. Murthy M. Gupta G. Mulye S. Maulik M. Munshi R. Krishnatry R. Phurailatpam R. Mhatre G. Prakash G. Bakshi 《Clinical oncology (Royal College of Radiologists (Great Britain))》2018,30(7):442-447
Aims
Stereotactic body radiotherapy (SBRT) in low- and intermediate-risk prostate cancer has shown encouraging results. However, its use in high-risk patients is limited due to lack of data regarding adequate radiotherapy dose, need for pelvic nodal treatment and androgen deprivation therapy. Herein we report our experience of SBRT in this subgroup.Materials and methods
Analysis of a prospectively maintained database of 68 consecutive patients of the National Comprehensive Cancer Network (NCCN) high-risk, very high-risk and node-positive adenocarcinoma prostate treated with SBRT was undertaken. All patients were treated with rotational intensity-modulated radiotherapy with daily image guidance. The dose delivered to the prostate and gross node was 35–37.5 Gy in 5 alternate day fractions. Node-positive patients received 25 Gy to pelvic nodal regions until the common iliac nodes. Treatment was delivered in 7–10 days. All patients received long-term androgen deprivation therapy (79% medical and 21% surgical).Results
Most patients (65%) had a Gleason score ≥ 8. The median prostate-specific antigen was 42. Twenty patients were high risk (30%), 11 (16%) very high risk and 37 (54%) node positive. No acute Radiation Therapy Oncology Group grade ≥ 3 genitourinary or gastrointestinal toxicity was noted. Acute grade 2 genitourinary and gastrointestinal toxicity were 12% and 3%, respectively. Late grade 3 genitourinary and gastrointestinal toxicity was 3% and 0%, respectively. There was no increase in acute or late gastrointestinal toxicity with prophylactic pelvic nodal radiotherapy. Prior transurethral resection of prostate (n = 11) did not increase toxicity. At a median follow-up of 18 months, 97% patients were alive and 94% were biochemically controlled.Conclusion
SBRT is safe in the treatment of high-risk, very high-risk and node-positive prostate cancer, even with prophylactic pelvic radiotherapy or prior transurethral resection of prostate. Longer follow-up is required to determine efficacy. 相似文献11.
A. Zapatero M. Roch D. Büchser P. Castro L. Fernández-Banda G. Pozo O. Liñán C. Martin de Vidales A. Cruz-Conde F. García-Vicente 《Clinical & translational oncology》2017,19(9):1161-1167
Background/purpose
To evaluate the impact of intensity-modulated radiotherapy (IMRT) with intra-prostate fiducial markers image-guided radiotherapy (IGRT) on the incidence of late urinary toxicity compared to 3D conformal radiotherapy (3DCRT) for patients with prostate cancer (PC).Methods and materials
We selected 733 consecutive patients with localized PC treated with dose-escalation radiotherapy between 2001 and 2014. Eligibility criteria were radiation dose >72.0 Gy, no pelvic RT and minimum follow-up 24 months. 438 patients were treated with 3DCRT and 295 with IMRT. Acute and late urinary complications were assessed using the EORTC/RTOG and CTCAEs v3.0 definition. The Cox regression model was used to compare grade ≥2 urinary toxicity between both techniques. The median follow-up was 75 months (range 24–204).Results
The median isocenter radiation dose was 78.7 Gy for 3DCRT and 80.7 Gy for IMRT/IGRT (p < 0.001). The 5-year incidence of late grade ≥2 urinary toxicity was 6.4% for IMRT and 10.8% for 3DCRT [hazard ratio (HR) 0.575, p = 0.056]. The corresponding 5-year estimates of late grade ≥2 hematuria were 2% for IMRT and 5.3% for 3DCRT (HR 0.296, p = 0.024). On multivariate analysis, the antecedent of prior transurethral resection of the prostate was also a strong predictor of a higher risk of urinary complications (HR 2.464, p = 0.002) and of hematuria (HR 5.196, p < 0.001).Conclusion
Compared with 3DCRT, high-dose IMRT/IGRT is associated with a lower rate of late urinary complications in spite of higher radiation dose.12.
Daniel J. Lee Daniel A. Barocas Zhiguo Zhao Li-Ching Huang Tatsuki Koyama Matthew J. Resnick Ralph Conwill Dan McCollum Matthew R. Cooperberg Michael Goodman Sheldon Greenfield Ann S. Hamilton Mia Hashibe Sherrie H. Kaplan Lisa E. Paddock Antoinette M. Stroup Xiao-Cheng Wu David F. Penson Karen E. Hoffman 《Practical radiation oncology》2018,8(5):307-316
Purpose
Quality measures represent the standards of appropriate treatment agreed upon by experts in the field and often supported by data. The extent to which providers in the community adhere to quality measures in radiation therapy (RT) is unknown.Methods and materials
The Comparative Effectiveness Analysis of Surgery and Radiation study enrolled men with clinically localized prostate cancer in 2011 and 2012. Patients completed surveys and medical records were reviewed. Patients were risk-stratified according to D’Amico classification criteria. Patterns of care and compliance with 8 quality measures as endorsed by national consortia as of 2011 were assessed.Results
Overall, 926 men underwent definitive RT (69% external beam radiation therapy [EBRT]), 17% brachytherapy (BT), and 14% combined EBRT and BT with considerable variation in radiation techniques across risk groups. Most men who received EBRT had dose-escalated EBRT (>75 Gy; 93%) delivered with conventional fractionation (<2 Gy; 95%), intensity modulated RT (76%), and image guided RT (85%). Most men treated with BT received I125 (77%). Overall, 73% of the men received EBRT that was compliant with the quality measures (dose-escalation, image-guidance, appropriate use of androgen deprivation therapy, and appropriate treatment target) but only 60% of men received BT that was compliant with quality measures (postimplant dosimetry and appropriate dose). African-American men (64%) and other minorities (62%) were less likely than white men (77%) to receive EBRT that was compliant with quality measures.Conclusions
Most men who received RT for localized prostate cancer were treated with an appropriately high dose and received image guidance and intensity modulated RT. However, compliance with some nationally recognized quality measures was relatively low and varied by race. There are significant opportunities to improve the delivery of RT and especially for men of a minority race. 相似文献13.
M. I. Martínez-Fernández J. L. Pérez Gracia I. Gil-Bazo R. Martínez-Monge 《Clinical & translational oncology》2016,18(7):743-747
Purpose
To investigate whether bone metastases-directed stereotactic body radiation therapy (SBRT) delays the emergence of castration resistance in patients with oligometastatic prostate cancer (OPC).Methods and material
OPC is usually managed with androgen deprivation therapy (ADT). Migration to castration-resistant prostate cancer will inevitably occur in the majority of these patients. There are several strategies aimed to delay the emergence of castration resistance including intermittent ADT, second generation antiandrogens (abiraterone, enzalutamide) or metastases-directed SBRT. The present report describes two cases of patients with OPC that received SBRT 24 Gy/3Rx to the solitary bony lesion after ADT failure.Results
Both cases showed complete and durable biochemical response for 13 and 17 months, respectively.Conclusions
SBRT can be used to delay the emergence of castration resistance and the need for systemic therapy when used after ADT failure.14.
Fernand Missohou 《Practical radiation oncology》2018,8(4):e224-e230
Purpose
Bowel is often the dose-limiting organ in curative pelvic irradiation because of radiation enteritis when dose exceeds 40 to 45 Gy. To limit radiation enteritis, a silicone tissue-expander prothesis (STEP) connected to a subcutaneous self-sealing valve was prospectively used in children undergoing pelvic or abdominal radiation therapy. This study reports the 15-year long-term outcomes of this prospective series.Methods and materials
Between 1987 and 2008, 29 children from 3 Paris institutions received pelvic radiation therapy after surgical placement of a STEP in the pelvis. The median prescribed dose was 50.4 Gy (44.1-55 Gy) using 5 daily fractions of 1.8 Gy per week, except for 1 patient receiving 4 fractions of 2.5 Gy per week. The median treatment duration was 40 days (29-49 days). After 2000, computed tomography (CT) conformal 3-dimensional radiation therapy was used, and 12 patients had CT simulation. Four had CT before and after insertion of the STEP, enabling us to compare pre- and postprosthesis insertion bowel dose-volume histograms. Acute and late toxicities were captured using the Radiation Therapy Oncology Group or the National Cancer Institute Common Terminology Criteria for Adverse Events 4.0 scale.Results
No patient experienced significant perioperative complications. Pre- and post-STEP insertion small bowel dose-volume histograms show significant reductions in small bowel: 51%, 45%, and 64%, respectively, in V10, V15, and V40 (Vx = irradiated volume by x Gy). Twenty-five patients (86%) completed their radiation therapy with no or minimal small bowel toxicity. One patient also treated with neutrons developed delayed grade 4 toxicities. The 15-year complication-free survival for those surviving was 70.3%.Conclusions
We report the long-term follow-up of STEP prosthesis insertion in children to reduce the small bowel volume in the radiation field. The acute and long-term tolerances were excellent. The STEP reduced the bowel dose over 40 Gy by 64%. 相似文献15.
Background and purpose
To evaluate the safety and efficacy of liver stereotactic body radiotherapy (SBRT), and examine potential factors impacting outcomes including prior liver-directed therapy.Materials and methods
Patients with ECOG 0–1, Child-Pugh Class A or B, and primary hepatocellular carcinoma (HCC) or liver metastases unsuitable for surgical resection or ablation were eligible for a prospective single arm trial. SBRT was delivered with a CyberKnife system to 45?Gy in 3 fractions with a predetermined dose de-escalation scheme. Adverse events, local control, and survival were assessed.Results
A total of 30 patients were enrolled. Eleven patients (37%) had HCC and 19 (63%) patients had liver metastases. Fourteen patients (47%) had prior liver-directed therapies including nine with liver resection, seven with trans-arterial chemoembolization, and six with radiofrequency ablation. Cumulative grade 2 and 3 acute toxicity occurred in 47% and 7% of patients, respectively. Similar rates of ≥grade 2 acute toxicity were observed between patients who had prior liver-directed treatments and those who did not. At a median follow-up of 12.7?months, 1-year local control and overall survival were 81% and 62%, respectively. Prior liver-directed therapy did not affect local control or survival.Conclusions
Liver SBRT is a safe and effective treatment even in the setting of prior liver-directed surgical and ablative therapies. 相似文献16.
Tobias R. Chapman Stephen R. Bowen Stephanie K. Schaub Rosanna H. Yeung Sharon W. Kwan James O. Park Lei Yu William P. Harris Guy E. Johnson Iris W. Liou Matthew J. Nyflot Smith Apisarnthanarax 《Practical radiation oncology》2018,8(3):157-166
Background
Our purpose was to define the most clinically relevant “nonclassic” radiation-induced liver disease (RILD) endpoints in cirrhotic patients receiving stereotactic body radiation therapy or proton beam therapy for primary liver cancer.Methods and materials
We retrospectively collected pretreatment, detailed toxicity (≤6 months posttreatment), and outcomes data from 48 patients. Deaths were examined for association with RILD. Univariate and multivariate Cox models defined significant predictors of overall survival (OS)/RILD-specific survival (RILD-SS).Results
With median follow-up of 13 months, 23 patients (48%) had an increase in Child-Pugh (CP) score (≥2, 25%) and 3 (6%) had ≥G3 transaminase elevation. Of 18 deaths, 6 were potentially ascribed to RILD. Univariate analysis showed that CP score increases of ≥1 and ≥2 and CP class change predicted OS, as did ≥G3 aspartate transaminase (AST) elevation and ≥1 Common Terminology Criteria for Adverse Events (CTCAE) AST toxicity grade change. On multivariate analysis, CP score increase of ≥2 and ≥1 CTCAE AST toxicity grade change were the strongest independent nonclassic RILD predictors of OS. For RILD-SS, CP score increases of ≥2, ≥grade 3 CTCAE alanine transaminase, and ≥grade 2 bilirubin elevations were predictive.Conclusions
Increased CP score ≥2 strongly predicts for both OS and RILD-SS and should be reported in future studies along with transaminase elevations, which are also predictive of outcomes. 相似文献17.
Pamela Samson Sana Rehman Aditya Juloori Todd DeWees Michael Roach Jeffrey Bradley Gregory M.M. Videtic Kevin Stephans Clifford Robinson 《Practical radiation oncology》2018,8(6):404-413
Purpose
Clinical concern remains regarding the relationship between consecutive (QD) versus nonconsecutive (QoD) lung stereotactic body radiation therapy (SBRT) treatment schedules and outcomes for clinical stage I non-small cell lung cancer (NSCLC). We examined a multi-institutional series of patients receiving 5-fraction lung SBRT to compare the local failure rates and overall survival between patients receiving QD versus QoD treatment.Methods and materials
Lung SBRT databases from 2 high-volume institutions were combined, and patients receiving 5-fraction SBRT for a solitary stage I NSCLC were identified. QD treatment was defined as completing SBRT in ≤7 days, whereas QoD treatment was defined as completing treatment in >7 days. To control for patient characteristics between the 2 institutions, a 1:1 propensity-matched analysis was performed. Multivariable logistic regression was performed to identify variables independently associated with local failure, and Cox proportional hazards modeling to identify variables independently associated with increased mortality.Results
From 2005 through 2016, 245 clinical stage I NSCLC patients receiving 5-fraction SBRT were identified. A total of 117 (47.8%) patients received QD treatment and 128 (52.2%) patients received QoD treatment. On propensity-matched analysis, no association was seen between QD treatment and local failure (odds ratio [OR] for QD treatment, 0.48; 95% confidence interval [CI], 0.12-1.99; P = .5). On multivariable logistic regression, central tumors were independently associated with increased likelihood of local recurrence (OR, 5.2; 95% CI, 1.11-24.2; P = .04). Kaplan-Meier analysis identified no difference in median overall survival between QD versus QoD treatments (38.0 vs 38.0 months, log-rank P = .7), respectively. QD treatment was not associated with an increased mortality hazard (hazard ratio, 1.08; 95% CI, 0.67-1.75; P = .75).Conclusions
This analysis demonstrated no association between QD versus QoD treatment scheduling and local control or overall survival for early-stage NSCLC. 相似文献18.
Yukinori Matsuo Takamasa Mitsuyoshi Takashi Shintani Yusuke Iizuka Takashi Mizowaki 《Journal of Geriatric Oncology》2018,9(6):589-593
Purpose
The purpose of the present study was to retrospectively evaluate impact of pre-treatment skeletal muscle mass (SMM) on overall survival and non-lung cancer mortality after stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC).Methods and Materials
One-hundred and eighty-six patients whose abdominal CT before the treatment was available were enrolled into this study. The patients were divided into two groups of SMM according to gender-specific thresholds for unilateral psoas area. Operability was judged by the treating physician or thoracic surgeon after discussion in a multi-disciplinary tumor board.Results
Patients with low SMM tended to be elderly and underweight in body mass index compared with the high SMM. Overall survival in patients with the low SMM tended to be worse than that in the high SMM (41.1% and 55.9% at 5?years, P?=?0.115). Cumulative incidence of non-lung cancer death was significantly worse in the low SMM (31.3% at 5?years compared with 9.7% in the high SMM, P?=?0.006). Multivariate analysis identified SMM and operability as significant factors for non-lung cancer mortality. Impact of SMM on lung cancer death was not significant. No difference in rate of severe treatment-related toxicity was observed between the SMM groups.Conclusion
Low SMM is a significant risk factor for non-lung cancer death, which might lead to worse overall survival, after SBRT for stage I NSCLC. However, the low SMM does not increase lung cancer death or severe treatment-related toxicity. 相似文献19.
Alfonso Gomez-Iturriaga Francisco Casquero Jose Ignacio Pijoan Pablo Minguez Jose Maria Espinosa Ana Irasarri Andrea Bueso Jon Cacicedo David Buchser Pedro Bilbao 《Radiotherapy and oncology》2018,126(2):278-282
Purpose
To evaluate the safety, tolerance and impact on health-related-quality-of-life (HRQoL) of the high-dose-rate brachytherapy of 19?Gy (BRT-HDR-19?Gy) single fraction in prostate cancer.Methods
From January 2014 to July 2016, 43 patients with low/intermediate risk were treated with BRT-HDR-19?Gy. The patients were monitored prospectively for toxicity and HRQoL.Results
The median age, initial PSA and the International Prostate Symptom Score (IPSS) were 71?years (55–78), 7.0?ng/mL (4.2–17.8) and 5 (0–14) respectively. 44% were low-risk and 56% intermediate-risk. Median CTV-V100 (where Vn is the fractional volume of the organ that receives n% of the prescribed dose) was 96.5%, Urethral-Dmax 106% and rectum-2?cc (the dose to 2?cc of rectal wall) 53%. After a median follow-up of 20?months (4–26), acute grade-2 genitourinary (GU) toxicity occurred in 4 patients (9%) and none presented acute gastrointestinal (GI) toxicity. Similarly, four patients (9%) presented late GU grade-2 toxicity. No grade-3 toxicity occurred.In terms of HRQoL, there was a statistically significant decline in Expanded Prostate Cancer Index Composite (EPIC) urinary urgency/obstructive domain at month 3 (p?=?0.047), and returned to baseline by month 6. Mean EPIC urinary incontinence, bowel, sexual and hormonal domains did not present significant post BRT-HDR-19?Gy changes.Patients rated their satisfaction at 6?months as “very-satisfied” (23%) or “extremely-satisfied” (77%).Conclusions
BRT-HDR-19?Gy demonstrates excellent results in terms of toxicity, tolerance, safety, patient satisfaction and HRQoL. 相似文献20.
Stefan S. Jeppesen Lars-Erik Matzen Carsten Brink Rasa Bliucukiene Søren Kasch Tine Schytte Charlotte Kristiansen Olfred Hansen 《Journal of Geriatric Oncology》2018,9(6):575-582