scholarly journals Early Clinical Outcomes, Patterns of Failure, and Acute Haematologic Toxicity of Image-Guided Volumetric Modulated Arc Therapy (IG-VMAT) in the Definitive Treatment of Locally Advanced Carcinoma Cervix

2018 ◽  
Vol 12 ◽  
pp. 117955491878399
Author(s):  
Irfan Ahmad ◽  
Kundan Singh Chufal ◽  
Irfan Bashir ◽  
Chandi Prasad Bhatt ◽  
Ram Bajpai ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Locally Advanced ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Definitive Treatment ◽  
Failure Patterns ◽  
Image Guided ◽  
Arc Therapy

Purpose: To evaluate clinical outcomes and failure patterns in patients with locally advanced cervical cancer (LACC) treated definitively using image-guided volumetric-modulated arc therapy (IG-VMAT). Methods and materials: This retrospective review included 18 consecutively treated patients with LACC. Treatment consisted of IG-VMAT and concurrent chemotherapy followed by intracavitary radiotherapy. The primary end points were overall survival (OS) and disease-free survival (DFS). Acute haematologic toxicity was evaluated using Radiation Therapy Oncology Group (RTOG) criteria. Results: A total of 16 patients were either stage IIB or IIIB and the median follow-up was 30.5 months (interquartile range: 13-36.25 months). The 2-year DFS was 63.3% (95% confidence interval [CI]: 52.8%-72.4%) and 2-year OS was 72.2% (95% CI: 62.1%-80.5%). There were 7 treatment failures, predominantly in-field. Acute haematologic toxicity was low. Conclusions: IG-VMAT is associated with favourable outcomes for patients with LACC.

Comparison between hypo-fractionated dose-escalated volumetric modulated arc therapy and conventional concurrent chemo-radiation in locally advanced head and neck cancer: a pilot study

2019 ◽  
Vol 19 (2) ◽  
pp. 132-138
Author(s):  
Ehab Saad ◽  
Riham Hani Radwan ◽  
Eman Abdel Hadi
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Comparable Efficacy ◽  
Advanced Head ◽  
Arc Therapy ◽  
To Receive

AbstractObjective:In the treatment of locally advanced head and neck cancer (LA-HNC), both dose escalation and hypo-fractionation can improve tumour control rates with uncertain role of addition of concurrent chemotherapy. We aimed at developing a new radiotherapy protocol for patients not eligible to receive the standard concurrent chemo-radiation therapy (CCRT) with little toxicity profile.Methods:A total of 63 LA-HNC patients were randomised to receive either: 70 Gy in 35 fx in 7 weeks concurrently with cisplatin 100 mg/m2 every 3 weeks for 3 doses (Arm A) or 74 Gy in 33 fx in 6·5 weeks (Arm B). Volumetric modulated arc therapy plans were created for both treatment arms. We compared the local control (LC), progression-free survival (PFS), overall survival (OS) and acute and late toxicity between the two arms.Results:A total of 33 patients were in Arm A versus 30 patients in Arm B with median follow-up 24·2 months. No significant differences in LC, PFS and OS between the two arms. Complete remission occurred in 54·5 and 63·3% of patients in Arms A and B, respectively. All toxicities were significantly less in Arm B than Arm A.Conclusion:Slightly dose-escalated hypo-fractionated regimen is safe and feasible and has comparable efficacy and less acute and late side effects than conventional dose CCRT with avoidance of chemotherapy-related toxicities in LA-HNC patients.

scholarly journals Clinical outcomes of hypofractionated image-guided multifocal irradiation using volumetric-modulated arc therapy for brain metastases

2018 ◽  
Vol 60 (1) ◽  
pp. 134-141 ◽  
Author(s):  
Shunsuke Furutani ◽  
Hitoshi Ikushima ◽  
Motoharu Sasaki ◽  
Chisato Tonoiso ◽  
Ayaka Takahashi ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Clinical Outcomes ◽  
Volumetric Modulated Arc Therapy ◽  
Image Guided ◽  
Arc Therapy

Neoadjuvant volumetric modulated arc therapy in rectal cancer and the correlation of pathological response with diffusion-weighted MRI and apoptotic markers

2018 ◽  
Vol 104 (4) ◽  
pp. 266-272 ◽  
Author(s):  
Necla Gurdal ◽  
Merdan Fayda ◽  
Nijat Alishev ◽  
Baris Bakir ◽  
Didem Tastekin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Pathologic Complete Response ◽  
Concurrent Chemotherapy ◽  
Pathological Response ◽  
Dna Integrity ◽  
Apoptotic Markers ◽  
Diffusion Weighted ◽  
Arc Therapy

Purpose: In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. Methods: The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy. Before and after the neoadjuvant treatment, apoptotic markers including the nucleosomes and cell-free DNA fragments in the serum samples were examined; DNA integrity was assessed by amplifying the ACTB gene; and the ADC measurements on the DW-MRI were analyzed. Results: No patients had acute or chronic grade III-IV toxicity. Pathologic complete response (pCR) was achieved in 8 patients (27%), while in 10 patients (33%) near-complete pathological response was obtained. Posttreatment ADC was significantly higher in patients with pCR compared with the others (1.28 vs. 1.10, p = 0.017). ROC curve analysis showed that posttreatment ADC values had a sensitivity of 75% and a specificity of 77.3% for distinguishing the patients with pCR from other responders. On the other hand, posttreatment DNA integrity values were revealed lower than the pretreatment values (p = 0.36). Also, the results revealed an insignificant increase in the posttreatment serum level of nucleosomes (p = 0.72). Conclusions: Neoadjuvant SIB-VMAT with concurrent chemotherapy was proved to be a feasible treatment regimen in LARC with tolerable side effects, and improved local control rate and pCR rate.

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.

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