Individualized 3D Reconstruction of Normal Tissue Dose for Patients With Long-term Follow-up: A Step Toward Understanding Dose Risk for Late Toxicity

2012 ◽  
Vol 84 (4) ◽  
pp. e557-e563 ◽  
Author(s):  
Angela Ng ◽  
Kristy K. Brock ◽  
Michael B. Sharpe ◽  
Joanne L. Moseley ◽  
Tim Craig ◽  
...  
Keyword(s):  
3D Reconstruction ◽  
Normal Tissue ◽  
Late Toxicity ◽  
Tissue Dose ◽  
Long Term Follow Up

Late toxicity of brachytherapy after female genital tract tumors treated during childhood: Prospective evaluation with a long-term follow-up

2015 ◽  
Vol 117 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Antonin Levy ◽  
Helene Martelli ◽  
Chiraz Fayech ◽  
Veronique Minard-Colin ◽  
Isabelle Dumas ◽  
...  
Keyword(s):  
Genital Tract ◽  
Female Genital Tract ◽  
Late Toxicity ◽  
Prospective Evaluation ◽  
Long Term Follow Up ◽  
Female Genital

scholarly journals Normal Tissue Dose Constraints for Multiple Lung Stereotactic Radiotherapy Treatments

2020 ◽  
pp. 1-4
Author(s):  
Beshar Allos ◽  
H. Howard ◽  
Beshar Allos ◽  
D. Stange ◽  
J. Bhogal ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Normal Tissue ◽  
Current Evidence ◽  
Normal Lung ◽  
Lung Lesions ◽  
Multiple Lesions ◽  
Tissue Dose ◽  
Dose Constraints

Introduction: The role and use of stereotactic radiotherapy (SABR) is evolving rapidly. A key article by Hanna et al. (2017) provides an excellent overview of current evidence and suggestion of sensible dose constraints. Given the topical nature of this discussion we present a short retrospective analysis of treating multiple lung SABR patients at our centre. Method: We retrospectively analysed toxicity, both early (within 3 months of SABR) and late, and normal tissue dose constraints on all patients who had multiple lung lesions treated with SABR (using volumetric modulated arc therapy (VMAT) technique) at our tertiary centre over a 25-month period from April 2016 until May 2018. Results: We have treated 78 lung lesions in 37 patients with a combination of synchronous lung cancer primaries and lung metastases diagnoses. Median follow-up was 9 months. Almost all patients received treatment on the same day for multiple lesions. We report no grade 3 toxicities in any patient nor any unexpected side effects. 5 patients (14.7%) developed grade 2 pneumonitis. In all 5 patients, lung V12.5 was >20% (range 20.8-32.2%), yet only 1 patient exceeded acceptable lung V20 constraints. Regarding long-term toxicity, 66.6% of patients reported no treatment-related effects. Of 9 patients with long-term toxicity, 8 exceeded V12.5 constraint of <15%, indeed of these 5 were >20%. Lung V20 levels were acceptable for the majority of these. Local control of treated lesions at median follow-up in all comers was 86.2%. Discussion: Our findings show that multiple lung SABR is tolerable, safe with minimal long-term toxicity and acceptable early toxicity. Defining normal lung V12.5 of <15% (optimal) and <20% (acceptable) will significantly reduce the risk of pneumonitis and longer-term toxicity, proving itself more predictive than lung V20 levels for toxicity. Additionally, treating multiple lesions concurrently appears to bare no extra risk to patients.

scholarly journals Incidence of therapy-related myeloid neoplasia after initial therapy for chronic lymphocytic leukemia with fludarabine-cyclophosphamide versus fludarabine: long-term follow-up of US Intergroup Study E2997

Blood ◽  
2011 ◽  
Vol 118 (13) ◽  
pp. 3525-3527 ◽  
Author(s):  
Mitchell R. Smith ◽  
Donna Neuberg ◽  
Ian W. Flinn ◽  
Michael R. Grever ◽  
Hillard M. Lazarus ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Late Toxicity ◽  
Initial Therapy ◽  
Lymphocytic Leukemia ◽  
Long Term Follow Up ◽  
After Cancer ◽  
Myeloid Neoplasia ◽  
Additional Therapy

Abstract Chemotherapy-related myeloid neoplasia (t-MN) is a significant late toxicity concern after cancer therapy. In the randomized intergroup phase 3 E2997 trial, initial therapy of chronic lymphocytic leukemia with fludarabine plus cyclophosphamide (FC) compared with fludarabine alone yielded higher complete and overall response rates and longer progression-free, but not overall, survival. Here, we report t-MN incidence in 278 patients enrolled in E2997 with a median 6.4-year follow-up. Thirteen cases (4.7%) of t-MN occurred at a median of 5 years from initial therapy for chronic lymphocytic leukemia, 9 after FC and 4 after fludarabine alone. By cumulative incidence methodology, rates of t-MN at 7 years were 8.2% after FC and 4.6% after fludarabine alone (P = .09). Seven of the 9 cases of t-MN after FC occurred without additional therapy. Abnormalities involving chromosomes 5 or 7 were found in 10 cases, which suggests alkylator involvement. These data suggest that FC may induce more t-MN than fludarabine alone.

Randomized trial of thoracic radiotherapy with or without concurrent daily low-dose carboplatin in elderly patients with locally advanced non-small cell lung cancer (NSCLC): Long-term follow-up of Japan Clinical Oncology Group (JCOG) Study JCOG0301.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8532-8532 ◽  
Author(s):  
Shinji Atagi ◽  
Junki Mizusawa ◽  
Satoshi Ishikura ◽  
Toshiaki Takahashi ◽  
Hiroaki Okamoto ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Late Toxicity ◽  
Initial Report ◽  
Locally Advanced Nsclc ◽  
Long Term Follow Up ◽  
Grade 3

8532 Background: In the phase III JCOG0301 trial, concurrent chemoradiotherapy (CRT) was compared with radiotherapy (RT), demonstrating clinically significant survival benefits in elderly patients with locally advanced NSCLC after a median follow-up of 19.4 months. However, the long-term patterns and cumulative incidences of toxicity associated with CRT and RT are poorly understood for elderly patients. We report long-term survival data and late toxicities after a minimum follow-up of 6.4 years. Methods: Eligible patients were older than 70 years and had unresectable stage III NSCLC. They were randomly assigned to RT alone (RT arm: irradiation with 60 Gy in 30 fractions) or CRT (CRT arm: the same RT with additional concurrent use of carboplatin 30 mg/m2 per fraction up to the first 20 fractions). The primary endpoint was overall survival (OS). Prognosis and adverse events data were collected beyond those in the initial report of this trial. Kaplan-Meier survival curves and 3- and 5-year survival proportions were calculated. Late toxicities were defined as occurring later than 90 days after RT initiation. Results: From September 2003 to May 2010, 200 patients (RT arm, n = 100; CRT arm, n = 100) were enrolled. Consistent with the initial report, the CRT arm had better OS than the RT arm (HR = 0.743, 95% CI = 0.552 – 0.998, one-sided p = 0.0239 by stratified log-rank test). In the RT and CRT arms, median OS was 16.5 and 21.7 months, 3-year survival was 16.3% and 34.3%, and 5-year survival was 9.2% and 15.2%, respectively. %Grade 3/4 late toxicities were 7.4% (heart 2.1%, lung 5.3%) in the RT arm (n = 94) and 7.5% (esophagus 1.1%, lung 6.5%) in the CRT arm (n = 93). No additional cases of late toxicity (Grade 3/4) were seen since the initial report. There were 7 treatment-related deaths, all of which were recorded in the initial report: 4 (4.0%) in the RT arm and 3 (3.0%) in the CRT arm. Conclusions: Long-term follow-up confirms the survival benefits of CRT for elderly patients with locally advanced NSCLC. There was no observed increase in late toxicity with CRT, as compared with RT alone. Clinical trial information: 00132665.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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