scholarly journals Retrospective analysis of acute and late gastrointestinal and hematological toxicities with extended field radiation in gynaecological malignancies: A single institution data

2016 ◽  
Author(s):  
Chaitanya Medichelme ◽  
Shagun Juneja ◽  
Anirudh Punnakal ◽  
Charu Garg ◽  
Indu Bansal ◽  
...  
Keyword(s):  
Volumetric Modulated Arc Therapy ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
Planning System ◽  
Hematological Toxicity ◽  
Ct Simulation ◽  
Field Radiation ◽  
Extended Field ◽  
Gynaecological Malignancies ◽  
Grade 3

Purpose: The aim of this study is to report a preliminary analysis of our clinical experience with extended field pelvic (conformal) radiation, with or without concurrent chemotherapy, in gynaecological malignancies. Materials and Methods: 27 women with gynaecological malignancies (17 with Carcinoma Cervix and 10 with Carcinoma Endometrium) were treated between November 2009 and October 2015 with Extended Field abdomino-pelvic radiation. All patients were treated with conformal radiation (Intensity Modulated Radiotherpy or Volumetric Modulated Arc Therapy). All patients underwent CT Simulation followed by target and OAR delineation as per RTOG guidelines. Dose prescriped was 45-50 Gy in 1.8 Gy per fraction and boost to gross node upto 54-56 Gy. Planning was done on Eclipse Planning system, and treatment was delivered on 6 MV linac. Concurrent chemotherapy was given when indicated. All toxicities were scored according to Common Terminology Criteria for Adverse Events (CTCAE v 4.03). Dosimetric parameters were correlated with toxicities. Results: Median follow up was 9.5 months (Range 0-52 months). 14 (51.8%) patients developed Grade 1 and 2 acute hematological toxicity and 1 (0.04%) developed Grade 3 toxicity. 10 (37%) patients developed Grade 1 and 2 acute gastrointestinal toxicity and 1 (0.04%) developed grade 4 toxicity. 3 (11.12%) patients had late toxicity in the form of prolonged leucopenia, SAIO, and Irritable Bowel Syndrome. 1 patient did not complete her treatment due to persistent leucopenia (Grade 3). Conclusion: Extended field Radiation in Gynaecological malignancies is a reasonably well tolerated procedure when treated with IMRT or VMAT, with acceptable toxicity profile.

Survival and toxicity with intensity modulated radiation therapy (IMRT) and chemotherapy for esophageal carcinoma, with or without surgery.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 125-125
Author(s):  
Kristin Kowalchik ◽  
Elizabeth Johnson ◽  
George P. Kim ◽  
C. Daniel Smith ◽  
Siyong Kim ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Acute Toxicity ◽  
Esophageal Carcinoma ◽  
Locally Advanced ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
Conformal Radiation Therapy ◽  
Trimodality Therapy ◽  
Grade 3 ◽  
3D Crt

125 Background: Treatment for locally advanced esophageal carcinoma is radiation and chemotherapy, with or without surgery. Radiation has traditionally been delivered with 3D conformal radiation therapy (3D CRT). This study evaluates late toxicity in patients treated with IMRT as well as early outcomes and acute toxicity. Methods: This is a retrospective review of 32 patients with esophageal carcinoma treated with IMRT at Mayo Clinic Florida from 2008 -2012. Pathology includes squamous cell and adenocarcinomas. Tumor sites include middle and lower thoracic and GE junction. Clinical stages are TX-T3, N0-3, M0-1. All patients received at least one cycle of concurrent chemotherapy. IMRT dose was 50.4 Gy in 28 fractions prescribed to a target volume including the tumor and regional lymphatics. IMRT plans utilized coplaner beams in a 7-9 beam arrangement or volumetric modulated arc therapy. Results: Median follow-up is 8.9 months (range 2.4-23.0) for all patients and 13.1 months (range 2.8-23.0 months) in surviving patients. Median patient age is 69 (range 46-87). Trimodality treatment was completed in 20 patients (62.5%). Surgery was either an open or minimally invasive esophagogastrectomy. The incidence of grade 3 or greater late toxicity at 1 year was 48% in surgery patients and 26% in non-surgery patients. The most common grade 3 or higher toxicity was esophageal strictures in 25%. The incidence of any grade 3 or greater acute toxicity was 65% in the surgery patients and 75% in the non-surgery patients. Overall survival (OS) for all patients at 18 months is 57% (CI 37-86%) and progression-free survival (PFS) is 60% (36-99%). OS and PFS for trimodality therapy at 12 months is 83% (66-100%) and 81% (63-100%) respectively and for bimodality therapy is 34% (12-93%) and 70% (33-100%) respectively. Conclusions: Increased late toxicity occurs in surgery patients, and increased acute toxicity in non-surgery patients. Lower survival in non-surgery patients may be due to early progression, morbidities which preclude surgery or improved survival with surgery. Overall, IMRT is a feasible treatment modality, which may be equally efficacious to 3D CRT for the treatment of esophageal carcinoma.

NTENSITY-MODULATED RADIATION THERAPY WITH CONCURRENT CHEMOTHERAPY FOR NASOPHARYNGEAL CARCINOMA

2018 ◽  
Vol 8 (6) ◽  
pp. 105-113
Author(s):  
Tin Vo Nguyen ◽  
Tuong Pham Nguyen ◽  
Thanh Dang
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Radiation Therapy Oncology Group ◽  
Nasopharyngeal Cancer ◽  
Tumour Response ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
European Organization ◽  
Intensity Modulated ◽  
Grade 3

Purpose: To evaluate tumour response, acute and late toxicity in nasopharyngeal cancer (NPC) patients treated with intensity modulated radiotherapy (IMRT) with cisplatin chemotherapy. Materials and Methods: 33 NPC patients, received IMRT concurrently with four to six cycles of cisplatin (30 mg/m2/day) every six weeks between May 2016 and July 2018, were evaluated prospectively. The doses to the planning target volumes of primary tumor and involved lymph nodes, uninvolved regional nodal areas were 70 Gy and 50 Gy respectively. All patients were evaluated for tumour and node response using response evaluation criteria in solid tumour (RECIST) criteri, acute and late toxicities according to CTCAE version 3.0 (common terminology criteria for adverse events), RTOG/EORTC (Toxicity criteria of the Radiation Therapy Oncology Group/the European Organization for Research and Treatment of Cancer). Results: At three months after chemoradiation, 81.8% and 18.2% of patients achieved complete and partial response, respectively. Grade 3 acute toxicities were oral mucositis (6.1%), dermatitis (3%). Grade 3 late toxicities were xerostomia 2/33(6.1%). There was no grade 3 to grade 4 neck fibrosis and trismus, none of the patients developed mandibular bone necrosis. Conclusion:Cisplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. Key words: intensity-modulated radiation therapy, Concurrent chemotherapy and radiation therapy, nasopharyngeal carcinoma

A phase II trial of lithium, bevacizumab, temozolomide, and radiation for newly diagnosed glioblastomas (GBM).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e13033-e13033
Author(s):  
Ashwatha Narayana ◽  
Moses M Tam ◽  
Deborah Beth Gruber ◽  
John Golfinos ◽  
Erik Parker ◽  
...  
Keyword(s):  
Phase Ii ◽  
Residual Disease ◽  
Progression Free Survival ◽  
Median Number ◽  
Hematological Toxicity ◽  
Newly Diagnosed ◽  
Goal Level ◽  
Field Radiation ◽  
Grade 3 ◽  
Involved Field

e13033 Background: Invasion is a dominant escape mechanism following angiogenic blockade in glioblastomas (GBM). Lithium has shown anti-invasive activity in glioma cells by inhibiting Glycogen Synthetase Kinase -3. This phase II study evaluated the safety and efficacy of using lithium and bevacizumab (BEV) in newly diagnosed GBM. Methods: From 2010 through 2012, 20 GBM patients with residual disease after surgery were treated with involved-field radiation therapy to 5940 cGy and concomitant temozolomide (TMZ) (75 mg/m2 daily for 42 days) along with BEV (10 mg/kg every 2 weeks), starting 29 days after surgery. This was followed by six 28-day cycles of TMZ (150 mg/m2 on days 1-7, BEV (10 mg/kg) on days 8 and 22, and lithium 300 mg BID. Lithium was increased every 7 days up to 600 mg BID with a serum lithium goal level of 0.8 to 1.2 mEq/L. Results: The median follow-up was 9.9 months (range 1.9-24.5). Fourteen patients (70.0%) received at least one dose of lithium and three patients completed the entire course of therapy. The median number of BEV infusion was 9 (range 2-19). Five patients discontinued trial due to skin sensitivity (n = 2), pulmonary embolism (n = 1), infection (n = 1), and hematological toxicity (n=1). Two patients experienced dose limiting lithium toxicity which included drowsiness (n = 1) and tremor (n = 1). No patients experienced grade 3/4 intra-cranial hemorrhage. The median progression free survival (PFS) was 9.3 months. The 12-month PFS and OS were 31.9% and 59.3% respectively. For the 14 patients who received lithium, the 12-month PFS and OS were 42.9% and 69.2% respectively. Conclusions: The strategy of targeting angiogenesis and invasion simultaneously in newly diagnosed GBM is effective and feasible. Clinical trial information: NCT01105702.

Concomitant cisplatin and extended field radiation therapy in patients with cervical and endometrial cancer

2002 ◽  
Vol 12 (5) ◽  
pp. 459-464 ◽  
Author(s):  
B. M. Sood ◽  
P. F. Timmins ◽  
G. R. Gorla ◽  
M. Garg ◽  
P. S. Anderson ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Exploratory Laparotomy ◽  
Lymph Node Sampling ◽  
Treatment Morbidity ◽  
Field Radiation ◽  
Extended Field ◽  
Grade 3 ◽  
Delay Of Treatment ◽  
Radiation Treatments

The purpose of this study is to evaluate the toxicity and safety of concomitant cisplatin (CDDP) and extended field radiation therapy (EFRT) in patients with cervical cancer (CxCA) and endometrial cancer (EnCA). Twenty-five patients were analyzed retrospectively for treatment-related morbidity from 1989 to 1998. Fourteen patients had CxCA and 11 patients had EnCA. Eighteen patients (72%) had surgery prior to radiotherapy and chemotherapy. EFRT was delivered by a four-field technique to the pelvis and para-aortic regions. CDDP at 100 mg/m2 was given over 5 days during 1st and 4th week of EFRT. EFRT dose for EnCA and CxCA was 45 Gy. Toxicity was analyzed using the RTOG toxicity criteria.Twenty-four (96%) of the 25 patients completed the prescribed therapy. Of the 14 patients with CxCA, three (21%) had no toxicity, three (21%) had grade 1–2, and eight (58%) had grade 3–4 hematologic toxicities. Overall six (24%) had grade 3–4 acute gastrointestinal toxicities, three (21%) of these patients were treated for cervix cancer and three (27%) patients were treated for endometrial cancer. The worst (Grade 3–4) toxicities in 15 patients occurred after the 4th week of radiotherapy. In six of 25 (24%) patients radiation treatments had to be delayed due to toxicities. The median delay of treatment was 10.5 days (range 7–31 days). Of the six patients who had grade 3–4 acute gastrointestinal toxicities, four (66%) had undergone exploratory laparotomy and lymph node sampling prior to start of chemoradiation.We conclude that concomitant EFRT and CDDP appears to be safe with moderate but manageable toxicity. Toxicity is most severe after the 4th week of treatment. Morbidity may be worse in patients with prior laparotomy.

scholarly journals Predictive Value of Dosimetric Parameters and Absolute Monocyte Count (AMC) for Acute Hematologic Toxicity in Cervical Cancer Patients Undergoing Concurrent Chemotherapy and Volumetric-Modulated Arc Therapy (VMAT)

2021 ◽  
Author(s):  
Xiaoyong Xiang ◽  
Zhen Ding ◽  
Qi Zeng ◽  
Lingling Feng ◽  
Chunyan Qiu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Hematologic Toxicity ◽  
Monocyte Count ◽  
Arc Therapy ◽  
Grade 3

Abstract Purpose: To identify clinical/dosimetric predictors of acute hematologic toxicity (HT) in cervical cancer patients undergoing concurrent chemotherapy and volumetric-modulated arc therapy (VMAT).Methods and Materials: We retrospectively analyzed 184 cervical cancer patients receiving concurrent chemotherapy and VMAT. Hematological parameters were collected during the treatment period. The total pelvic bone(TPB) was retrospectively delineated for each patient, and the volume of TPB receiving 10, 20, 30, 40, and 50 Gy (V10, V20, V30, V40, and V50, respectively) was calculated. We assessed the correlations between variables by the Spearman rank correlation test and compared the differences between groups by the Wilcoxon signed-rank test. Binary logistic regression analysis was used to analyze associations between HT and clinical/dosimetric parameters. The receiver operating characteristic curve(ROC) was used to determine the best cut-off values for dosimetric planning constraints.Results: The nadir of absolute monocyte count (AMC) was positively correlated with the nadir of absolute white blood cells (WBC) count (r＝0.5378, 95%CI ＝ 0.4227 to 0.6357, P<0.0001) and the nadir of absolute neutrophil count(ANC) (r＝0.5000，95%CI ＝ 0.3794 to 0.6039, P<0.0001). The decrease and increase of AMC usually occurred before the ANC and WBC. In multivariate logistic regression analysis, the chemotherapy regimen and the TPB_V20 were independent risk factors for developing Grade ≥3 hematologic toxicity. The optimal TPB_V20 cut-off value identified by ROC curves followed by Youden test was 71% (AUC = 0.788; 95%CI, 0.722–0.845; p-value＜0.001).Conclusions: The changing trend of AMC can be used as an effective predictor for the timing and severity of the ANC/WBC nadirs. Maintain TPB_V20 < 71 % and selecting single-agent cisplatin or carboplatin could significantly reduce Grade ≥3 HT in cervical cancer patients undergoing concurrent chemoradiotherapy.

Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers

2017 ◽  
Vol 16 (4) ◽  
pp. 423-430
Author(s):  
Kannan Perisamy ◽  
Ashutosh Mukherji ◽  
Saravanan Kandasamy ◽  
K. Sathyanarayan Reddy
Keyword(s):  
Radiation Therapy ◽  
Treatment Time ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Large Field ◽  
Concomitant Boost ◽  
Arc Therapy ◽  
Grade 3 ◽  
Boost Radiation

AbstractIntroductionVolumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.Materials and methodsIn this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.ResultsAll patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.ConclusionVMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.

Extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy for cervical cancer with para-aortic lymph nodes metastasis

2018 ◽  
Vol 49 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Xiaoliang Liu ◽  
Weiping Wang ◽  
Qingyu Meng ◽  
Fuquang Zhang ◽  
Ke Hu
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Field Intensity ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Intensity Modulated ◽  
Genitourinary Toxicity ◽  
Extended Field ◽  
Grade 3

Abstract Objective This study was conducted to evaluate the efficacy and toxicity of extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy in patients with cervical cancer with positive para-aortic lymph nodes (PALN). Methods From September 2007 to December 2014, a total of 59 patients who had cervical cancer with para-aortic lymph node metastasis were treated with concurrent chemoradiotherapy at our institution. A dose of 45–50.4 Gy in 25–28 fractions with extended-field intensity-modulated radiation therapy was prescribed to planning target volume, and a dose of 30–36 Gy in 5–6 fractions was prescribed to Point A with high-dose-rate brachytherapy. A concurrent first-line cisplatin-based chemotherapy regimen was used. Results The median duration of follow-up was 32.1 months (range, 3.2–103.7 months). The 2- and 3-year overall survival, disease-free survival and local control rates were 69.0 and 52.8%, 45.0 and 41.3% and 83.4 and 81.0%, respectively. Distant metastasis was the major pattern of treatment failure, which occurred in 26 patients (44.1%). The incidence of Grade 3 or greater acute hematologic, gastrointestinal and genitourinary toxicity was 50.9, 1.7 and 3.4%, respectively. Only one patient had both Grade 3 late gastrointestinal and genitourinary toxicity. Conclusions The study found that extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy was safe and effective in patients who had cervical cancer with positive PALN.

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