Palliative whole brain radiation therapy (WBRT) for brain metastases (BM) revisited: The patient population in the modern era is different from the original patient cohort of the RTOG WBRT clinical trials

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1544-1544 ◽  
Author(s):  
S. RushM. Savetsky ◽  
A. Vinokur ◽  
N. Mehta
Keyword(s):  
Clinical Trials ◽  
Radiation Therapy ◽  
Surgical Resection ◽  
Systemic Therapy ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Whole Brain Radiation ◽  
Oncology Practice ◽  
The Impact ◽  
Modern Era

1544 Background: RTOG trials in the 1970’s established WBRT (3000 cGy/10 fractions) as an effective palliative tool for symptomatic BM. This was in the era before CT/ MRI and effective systemic therapy. Inclusion criteria was based on clinical symptoms, and studies such as EEG and arteriography though not required. This study was undertaken to determine if pts. in the modern era are similar to those aforementioned, since it may not be appropriate to use accelerated WBRT (aWBRT) in these pts. based on the RTOG guidelines if the cohorts are different. (Other issues such as delayed cognitive dysfunction, alopecia and the impact of and integration with systemic therapy are pertinent to the application and prescription of aWBRT, but not the focus of this study). Methods: A retrospective chart review of 414 consecutive pts. with BM treated with radiation therapy in a single practice from 1990 through 2004 form the basis of this study. There were 256 females and 158 males. Lung cancer was the most common primary site (249/60%) and breast cancer next (75/18%). 121 pts (29%) had a single brain metastsis. 66 symptomatic patients underwent surgical resection of a brain metastasis prior to WBRT. The use of CT or MRI was determined. Results: Of the 414 pts, 105 were asymptomatic (25%). An additonal 66 pts. were rendered asymptomatic with surgical resection. Therefore, a total of 171 (40%) pts. were asymptomatic. All pts underwent imaging with CT (132) or MRI (282). Conclusions: Many pts. with BM seen in a modern radiation oncology practice are different from those in the RTOG series’ in which pts. were designated to receive aWBRT. 1. A notable proportion (40%) of a large number of pts. treated since 1990 for BM was asymptomatic vs. none of the pts. in the RTOG trials. 2. All pts. in this series underwent direct imaging vs. none in the RTOG series’. The systematic prescription of aWBRT for all pts. with BM as dictated by RTOG studies in the 1970’s may not be appropriate and alternative strategies and clinical trials are warranted. No significant financial relationships to disclose.

scholarly journals Improved clinical symptoms and mortality among patients with severe or critical COVID-19 after convalescent plasma transfusion

Blood ◽  
2020 ◽  
Vol 136 (6) ◽  
pp. 755-759 ◽  
Author(s):  
Xinyi Xia ◽  
Kening Li ◽  
Lingxiang Wu ◽  
Zhihua Wang ◽  
Mengyan Zhu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Benefit ◽  
Clinical Symptoms ◽  
Case Series ◽  
Plasma Transfusion ◽  
Controlled Clinical Trials ◽  
Early Administration ◽  
The Impact

Two case series examining the impact of convalescent plasma on patients with COVID-19 suggest some clinical benefit from early administration and modest impact on parameters of inflammation. Further assessment of the impact of this intervention awaits controlled clinical trials.

scholarly journals The use of radiation in the elderly

2007 ◽  
Vol 10 (1) ◽  
pp. 1-3 ◽  
Author(s):  
L. A. Schnaper ◽  
K. S. Hughes
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Radiation Therapy ◽  
Randomized Trial ◽  
Postmenopausal Women ◽  
Older Women ◽  
Systemic Therapy ◽  
Elderly Women ◽  
The Elderly

Despite the fact that breast cancer is predominantly a disease of postmenopausal women, there have been no uniform recommendations for both locoregional and systemic therapy for women over 70. Until recently, older women have been excluded from clinical trials. This study is the first randomized trial that addresses the use of radiation therapy following lumpectomy in a favorable cohort of elderly women.

Optimal timing of surgical resection after radiation therapy in locally advanced rectal adenocarcinoma: An analysis of the National Cancer Database (NCDB).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 510-510 ◽  
Author(s):  
Ciara R Huntington ◽  
Danielle Boselli ◽  
Joshua S. Hill ◽  
Jonathan C. Salo
Keyword(s):  
Radiation Therapy ◽  
Surgical Resection ◽  
Cox Model ◽  
Locally Advanced ◽  
Rectal Adenocarcinoma ◽  
Pathologic Response ◽  
Complete Pathologic Response ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Impact

510 Background: In treatment of rectal adenocarcinoma, an increased time delay (TD) of 6-12 weeks from the end of radiation therapy to surgery may increase the rate of complete pathologic response (pCR), but the optimal TD with respect to survival has not been established. This study evaluates the impact of TD on overall mortality. Methods: The NCDB was queried for patients with adenocarcinoma of the rectum and no evidence of metastasis at diagnosis, who underwent preoperative chemoradiation followed by radical surgical resection. Standard statistical methods were employed for descriptive statistics and Cox model development. Results: The study included 6805 patients, predominantly Caucasian (87.2%) and males (63.9%) who generally were treated with low anterior resection (57.3%), colonanal reanastomosis (8.4%), or abdominoperineal resection (28.4%), and had median survival of 66.6 months. The effects of age, surgical margins (-/+), comorbidity index, time to discharge after surgery, TMN pathologic staging, surgical volume, and patient income significantly impacted mortality after radiation and surgery (p<0.05 for all values). There was a significant relationship between TD and pCR (p=.0002). At TD less than 30 days, 4.0% of patients achieved pCR, while 9.3% of patients have achieved pCR by 75 days. In TD of greater than 75 days, the rate of pCR decreased. Overall, 6.8% of patients (n=461) achieved pCR. Using a refined cox model, a TD of more than 60 days was associated with 20% greater risk of mortality (95% CI 1.068 – 1.367). This effect became more pronounced with increasing TD; a TD of greater than 75 days was associated with 28% (95% CI 1.06-1.55) increased risk of mortality, while patients with TD less than 60 days saw a survival benefit. Conclusions: Though an interval up to 75 days between radiation and surgery may achieve higher rates of complete pathologic response, delay of more than 60 days from radiation to surgical resection and subsequent systemic chemotherapy decreases overall survival in patients with rectal cancer.

Characterization of Underrepresented Populations in Modern Era Radiation Therapy Clinical Trials

2020 ◽  
Vol 108 (3) ◽  
pp. S98
Author(s):  
E.H. Bero ◽  
L. Rein ◽  
A. Banerjee ◽  
M.W. Straza ◽  
C.A.F. Lawton ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Radiation Therapy ◽  
Underrepresented Populations ◽  
Modern Era

scholarly journals Adjuvant volumetric modulated arc therapy compared to 3D conformal radiation therapy for newly diagnosed soft tissue sarcoma of the extremities: outcome and toxicity evaluation

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190252 ◽  
Author(s):  
Lucia Di Brina ◽  
Antonella Fogliata ◽  
Pierina Navarria ◽  
Giuseppe D'Agostino ◽  
Ciro Franzese ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Total Dose ◽  
Surgical Resection ◽  
Local Control ◽  
Volumetric Modulated Arc Therapy ◽  
Conformal Radiation Therapy ◽  
Arc Therapy ◽  
The Impact

Objective: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities. Methods: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3. Results: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60–70 Gy;25–35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013). Conclusion: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging. Advances in knowledge: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.

Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

2021 ◽  
Author(s):  
Michael A Vogelbaum ◽  
Paul D Brown ◽  
Hans Messersmith ◽  
Priscilla K Brastianos ◽  
Stuart Burri ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Systemic Therapy ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Local Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract Purpose To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors. Methods ASCO convened an Expert Panel and conducted a systematic review of the literature. Results Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base. Recommendations Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non–small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status ≤ 50 or Karnofsky Performance Status &lt; 70 with no systemic therapy options do not derive benefit from radiation therapy. Additional information is available at www.asco.org/neurooncology-guidelines.

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