PO-1176 Duration of acute esophageal toxicity in RT-CHT for NSCLC with different fractionation schedules

Chemoradiotherapy (CRT) is extensively used prior to surgery for rectal cancer to provide significantly better local control, but the radiotherapy (RT), as the other component of CRT, has been subject to less interest than the drug component in recent years. With considerable developments in RT, the use of advanced techniques, such as intensity-modulated radiotherapy (IMRT) in rectal cancer, is garnering more attention nowadays. The radiation dose can be better conformed to the target volumes with possibilities for synchronous integrated boost without increased complications in normal tissue. Hopefully, both local recurrence and toxicities can be further reduced. Although those seem to be of interest, many issues remain unresolved. There is no international consensus regarding the radiation schedule for preoperative RT for rectal cancer. Moreover, an enormous disparity exists regarding the RT delivery. With the advent of IMRT, variations will likely increase. Moreover, time to surgery is also quite variable, as it depends upon the indication for RT/CRT in the clinical practices. In this review, we discuss the options and problems related to both the dose–time fractionation schedule and time to surgery; furthermore, it addresses the research questions that need answering in the future.

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Prostate SBRT: Comparison the Efficacy and Toxicity of Two Different Dose Fractionation Schedules

Frontiers in Oncology ◽

10.3389/fonc.2020.00936 ◽

2020 ◽

Vol 10 ◽

Author(s):

Donald Blake Fuller ◽

John Naitoh ◽

Reza Shirazi ◽

Tami Crabtree ◽

George Mardirossian

Keyword(s):

Dose Fractionation ◽

Fractionation Schedules

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Radical accelerated radiotherapy for non-small cell lung cancer (NSCLC): A 5-year retrospective review of two dose fractionation schedules

Radiotherapy and Oncology ◽

10.1016/j.radonc.2019.08.025 ◽

2020 ◽

Vol 143 ◽

pp. 37-43 ◽

Cited By ~ 2

Author(s):

Stephen D. Robinson ◽

Bilal A. Tahir ◽

Katherine A.R. Absalom ◽

Amila Lankathilake ◽

Tathagata Das ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Retrospective Review ◽

Small Cell ◽

Dose Fractionation ◽

Small Cell Lung ◽

Accelerated Radiotherapy ◽

Fractionation Schedules

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Palliation or Prolongation? The Impact of a Peer-Review Intervention on Shortening Radiotherapy Schedules for Bone Metastases

Journal of Oncology Practice ◽

10.1200/jop.18.00042 ◽

2018 ◽

Vol 14 (8) ◽

pp. e513-e516 ◽

Cited By ~ 4

Author(s):

Gary V. Walker ◽

Shervin M. Shirvani ◽

Yerko Borghero ◽

Matthew D. Callister ◽

Daniel D. Chamberlain ◽

...

Keyword(s):

Bone Metastases ◽

Peer Review ◽

Palliative Treatment ◽

Peer Review Process ◽

Daily Practice ◽

The United States ◽

Similar Efficacy ◽

National Guidelines ◽

The Impact ◽

Fractionation Schedules

Purpose: Shorter fractionation radiation regimens for palliation of bone metastases result in lower financial and social costs for patients and their caregivers and have similar efficacy as longer fractionation schedules, although practice patterns in the United States show poor adoption. We investigated whether prospective peer review can increase use of shorter fractionation schedules. Methods: In June 2016, our practice mandated peer review of total dose and fractionation for all patients receiving palliative treatment during our weekly chart rounds. We used descriptive statistics and Fisher’s exact test to compare lengths of treatment of uncomplicated bone metastases before and after implementation of the peer review process. Results: Between July 2015 and December 2016, a total of 242 palliative treatment courses were delivered, including 105 courses before the peer review intervention and 137 after the intervention. We observed greater adoption of shorter fractionation regimens after the intervention. The use of 8 Gy in one fraction increased from 2.8% to 13.9% of cases postadoption. Likewise, the use of 20 Gy in five fractions increased from 25.7% to 32.8%. The use of 30 Gy in 10 fractions decreased from 55.2% to 47.4% ( P = .002), and the use of ≥ 11 fractions decreased from 16.2% before the intervention to 5.8% after ( P = .006). Conclusion: Prospective peer review of palliative regimens for bone metastases can lead to greater adoption of shorter palliative fractionation schedules in daily practice, in accordance with national guidelines. This simple intervention may therefore benefit patients and their caregivers as well as provide value to the health care system.

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Haemostatic radiotherapy for bleeding cancers of the upper gastrointestinal tract

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.10.579 ◽

2019 ◽

Vol 80 (10) ◽

pp. 579-583 ◽

Cited By ~ 1

Author(s):

Christopher Hughes ◽

Ganesh Radhakrishna

Keyword(s):

Case Reports ◽

Meta Analysis ◽

Performance Status ◽

Palliative Radiotherapy ◽

Convincing Evidence ◽

Gastrointestinal Malignancies ◽

Phase 2 Trial ◽

Fractionation Schedule ◽

Fractionation Schedules ◽

Upper Gastrointestinal

Bleeding can cause significant morbidity in patients with upper gastrointestinal malignancies. Palliative radiotherapy can palliate bleeding effectively across numerous cancer sites such as the lung and rectum. The data available regarding the role in bleeding from upper gastrointestinal cancers are limited to a single meta-analysis, a phase 2 trial, eleven retrospective cohorts and two case reports, with the majority focusing on gastric cancer. From the data available radiotherapy appears to be a well-tolerated, effective haemostatic agent that should be considered in all patients with bleeding from an upper gastrointestinal malignancy. Questions remain regarding the radiobiology of haemostasis and the optimum fractionation schedule. There is no convincing evidence that protracted higher dose regimens provide additional benefit. Commonly used fractionation schedules use 1, 5 or 10 fractions. Short fractionation schedules have been used in patients with deteriorating performance status.

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