High linear energy transfer (LET) radiation therapy in recurrent, metastatic, or unresectable rectal adenocarcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 612-612
Author(s):  
P. Paximadis ◽  
D. Elliott ◽  
A. F. Shields ◽  
P. A. Philip ◽  
D. W. Weaver ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Normal Tissue ◽  
Rectal Adenocarcinoma ◽  
Late Toxicity ◽  
Neutron Radiation ◽  
Neutron Dose ◽  
Mixed Beam ◽  
Photon Dose ◽  
High Let

612 Background: The purpose of this study was to retrospectively analyze the outcomes of patients with recurrent, metastatic, or unresectable rectal adenocarcinoma treated with mixed beam photon and high LET radiotherapy. Methods: Between 1995 and 2005, the high LET database was queried to identify patients with rectal adenocarcinoma. Local control and overall survival (OS) were calculated using the Kaplan-Meier method. Acute and chronic toxicities were graded using the common terminology criteria for adverse events (CTCAE) v4.0 grading system. Biological equivalent dose (BED) was calculated for tumor and normal tissue of both the photon dose and neutron dose for 10 patients. Results: 11 patients with recurrent, metastatic, or unresectable rectal adenocarcinoma were identified as being treated with mixed photon-neutron radiation. The median age of patients in the study was 58 (range: 38-79). There were 8 male patients and 3 female patients. Median follow-up was 6 months (range: 4-76 months). Patients received a median photon dose of 40Gy (range: 26-50.4Gy) and a median neutron dose of 8nGy (range: 6-10nGy). Seven patients received radiation given concurrently with 5-FU. The median OS was 16 months (range: 4-76 months), with 1 and 2-year OS of 56% and 22%, respectively. Local control was achieved in 9 of 11 (82%) patients. Local progression occurring in two patients occurred at 5 months after completion of RT. The median tumor BED in patients achieving local control was 72.5 Gy (range: 57.1-83.5 Gy). There was a nonsignificant difference in median normal tissue BED of patients with grade 3-4 late toxicity of 104.8 Gy (range: 81.1-115.1 Gy), compared with 95.3Gy (range: 89.0-104.6 Gy) for those patients with grade 1-2 late toxicity. Conclusions: Our experience demonstrates that treatment of unresectable rectal tumors with mixed photon-neutron achieved excellent local control. With the added capabilities of intensity modulated neutron radiation therapy (IMNRT), the incidence of treatment-related morbidity may be improved while taking advantage of the superior tumor control that high-LET radiation can impart. No significant financial relationships to disclose.

Clinical Proton Radiation Therapy Research at the Francis H. Burr Proton Therapy Center

2007 ◽  
Vol 6 (4_suppl) ◽  
pp. 61-66 ◽  
Author(s):  
Thomas F. DeLaney
Keyword(s):  
Clinical Trials ◽  
Radiation Therapy ◽  
Clinical Research ◽  
Local Control ◽  
Proton Therapy ◽  
Dose Escalation ◽  
Normal Tissue ◽  
Late Toxicity ◽  
Proton Radiation ◽  
Therapy Center

The Francis H. Burr Proton Therapy Center has a 230 MeV cyclotron from which proton beams are directed to two isocentric gantries, a stereotactic intracranial beam line, and an eye line. Because of improved physical dose distribution, proton radiotherapy allows dose escalation to improve local tumor control in anatomic sites and histologies where local control is suboptimal with photons. The improved dose localization also reduces normal-tissue doses with an anticipated reduction in acute and late toxicity. Clinical treatment protocols, developed to exploit the dosimetric advantages of protons over photons, have been grouped into two broad categories. In the first, dose is escalated for anatomic sites where local control with conventional radiation doses has been suboptimal. In the second, normal-tissue sparing with protons is designed to minimize acute and late toxicity. Treatment of patients on clinical research protocols has been encouraged. Patient treatments began on the first gantry in November 2001; on the eye line in April 2002; on the second gantry in May 2002; and on the stereotactic intracranial line in August 2006. The facility currently treats 60 patients per day, including up to six children daily under anesthesia. Dose-escalation studies have been completed for early stage prostate cancer (in conjunction with Loma Linda University) and sarcomas of the cervical spine/base of skull and thoracolumbosacral spine. Protocols are in progress or development for carcinoma of the nasopharynx, paranasal sinus carcinoma, non-small-cell lung carcinoma, locally advanced carcinoma of the prostate, hepatocellular carcinoma, and pancreatic cancer. Studies evaluating the use of protons for morbidity reduction include protocols for craniospinal irradiation in conjunction with systemic chemotherapy for medulloblastoma, retinoblastoma, pediatric rhabdomyosarcoma, other pediatric sarcomas, and accelerated, hypofractionated partial breast irradiation for T1N0 breast carcinomas. For pediatric patients, protons have also been accepted as an alternative to photons for children enrolled in Children's Oncology Group (COG) protocols. Treatment of patients on these studies has often required the development of new treatment techniques ( i.e., matching abutting fields for craniospinal irradiation), respiratory gating, and development of appropriate clinical infrastructure support ( i.e., increase in availability of pediatric anesthesia) to allow appropriate treatment. In addition, a clinical research infrastructure for protocol development and data management is required. Results to date indicate that proton radiation therapy offers several potential treatment advantages to patients that can be studied in the setting of clinical trials. Patients' willingness to enter these clinical trials seems to be quite high; accrual to selected studies has been favorable.

scholarly journals Outcomes after Radiation Therapy for HIV Positive Patients with Invasive Cervical Cancer

2018 ◽  
Vol 7 (1) ◽  
pp. 12 ◽  
Author(s):  
Victoire Molinier ◽  
Florence Huguet ◽  
Marcos Ballester ◽  
Marina Karmochkine ◽  
Christophe Hennequin ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Local Control ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Late Toxicity ◽  
Hiv Positive ◽  
Grade 3 ◽  
Overall Survival Rates

Objective: To assess tolerance, local control, and survival outcomes for HIV (human immunodeficiency virus) positive patients with locally advanced cervical cancer (CC) treated with external beam radiation therapy (EBRT) and/or brachytherapy from an Assistance Publique - Hôpitaux de Paris (APHP) retrospective cohort.Methods: Between 2000 and 2014, 28 HIV positive patients presenting with a non-metastatic CC were treated in one of the five APHP radiation therapy centers. Fifteen patients (54%) underwent primary surgery. Twenty-four patients (88%) received EBRT, with concurrent chemotherapy in 22 cases, and 68% received brachytherapy.Results: The median follow-up was 58 months. At 5 years, local control (LCR) and overall survival rates (OS) were 56% and 46.5% respectively. A grade 3-4 acute toxicity (mainly hematological toxicity) was reported in 18 patients (64%). In univariate analysis, total irradiation dose (p=0.03) and cisplatin-based chemotherapy (p=0.005) were predictive of acute toxicity. A grade 3-4 late toxicity (mainly gastro-intestinal and renal) was observed in 7 patients (25%). In univariate analysis, HIV stage at diagnosis (p=0.02) and an initial CD4 count <200/mm3 (p=0.03) were predictive factors of late toxicity.Conclusion: In this study including HIV positive patients with CC, local control and overall survival rates seemed to be lower than those reported in the literature for non-HIV patients. We also reported an increase in acute and late toxicity, mainly hematological, underlying the fundamental role of immunosuppression in tolerance to radiation therapy.

scholarly journals Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

2018 ◽  
Vol 3 (3) ◽  
pp. 339-345 ◽  
Author(s):  
Adil S. Akthar ◽  
Anthony C. Wong ◽  
Akash D. Parekh ◽  
Greg Hubert ◽  
Christina H. Son ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Normal Tissue ◽  
Intensity Modulated Radiation Therapy ◽  
Late Toxicity ◽  
Intensity Modulated ◽  
Normal Tissue Sparing ◽  
Tissue Sparing

scholarly journals Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5928
Author(s):  
Sofiane Allali ◽  
Youlia Kirova
Keyword(s):  
Radiation Therapy ◽  
Acute Toxicity ◽  
Local Control ◽  
Background Radiation ◽  
Treatment Time ◽  
Tumour Response ◽  
Late Toxicity ◽  
Partial Breast Irradiation ◽  
Sequential Boost ◽  
Equivalent Efficacy

Background: Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods used to manage, prevent, and quantify this toxicity. Method: More than 1753 articles were identified using the various search terms. We selected 53 articles to answer the questions addressed in this study according to criteria set in advance. Result: The literature reports lower acute toxicity with IMRT compared to 3DCRT, but no significant differences in terms of late toxicities. Partial breast irradiation appears to be less effective in terms of local control with a higher rate of late toxicity. Intra operative radiation therapy appears to provide good results in terms of both local control and late toxicity. The hypofractionation has equivalent efficacy and safety to the normofractionated regimen, but with lower rates of radiodermatitis and fibrosis. The adddition of a boost, particularly a sequential boost, increases the risk of fibrosis and radiodermatitis during treatment. Conclusion: The development of IMRT has significantly reduced acute toxicity and has improved tolerability during treatment. Modified fractionation has reduced treatment time, as well as adverse effects.

scholarly journals Radiation-Induced Fibrotic Tumor Microenvironment Regulates Anti-Tumor Immune Response

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5232
Author(s):  
Jae-Kyung Nam ◽  
Ji-Hee Kim ◽  
Min-Sik Park ◽  
Eun Ho Kim ◽  
Joon Kim ◽  
...  
Keyword(s):  
Immune Response ◽  
Radiation Therapy ◽  
Cytotoxic T Cells ◽  
Neutron Radiation ◽  
X Rays ◽  
Mesenchymal Transition ◽  
X Ray ◽  
High Let ◽  
Tumor Environment ◽  
Endothelial To Mesenchymal Transition

High linear energy transfer (LET) radiation, such as neutron radiation, is considered more effective for the treatment of cancer than low LET radiation, such as X-rays. We previously reported that X-ray irradiation induced endothelial-to-mesenchymal transition (EndMT) and profibrotic changes, which contributed to the radioresistance of tumors. However, this effect was attenuated in tumors of endothelial-specific Trp53-knockout mice. Herein, we report that compared to X-ray irradiation, neutron radiation therapy reduced collagen deposition and suppressed EndMT in tumors. In addition to the fewer fibrotic changes, more cluster of differentiation (CD8)-positive cytotoxic T cells were observed in neutron-irradiated regrowing tumors than in X-ray-irradiated tumors. Furthermore, lower programmed death-ligand 1 (PD-L1) expression was noted in the former. Endothelial-specific Trp53 deletion suppressed fibrotic changes within the tumor environment following both X-ray and neutron radiation therapy. In particular, the upregulation in PD-L1 expression after X-ray radiation therapy was significantly dampened. Our findings suggest that compared to low LET radiation therapy, high LET radiation therapy can efficiently suppress profibrotic changes and enhance the anti-tumor immune response, resulting in delayed tumor regrowth.

The use of primary radiation for ocular adnexal MALTomas.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18502-e18502
Author(s):  
Wesley Alan Russell ◽  
David Gessert ◽  
Jack A. Cohen ◽  
Jonathan B. Rubenstein ◽  
Arnold M. Herskovic ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Progressive Disease ◽  
Late Toxicity ◽  
Initial Therapy ◽  
Phase Iii ◽  
Primary Radiation ◽  
Distant Failure ◽  
Treatment Information ◽  
Unclear Etiology

e18502 Background: Ocular adnexal mucosal associated lymphoid tissue lymphomas (MALTomas) are rare with no phase III trials to guide treatment. Typical management has been primary radiation therapy. This retrospective series aims to report the experience of a single institution and add to the current literature. Methods: Using our electronic medical record systems and available paper charts, we identified patients with MALTomas of the lacrimal gland or sac, conjunctiva, and posterior orbital structures. Records were reviewed to determine pathology, staging, treatment information, local and distant control, salvage treatments, and late toxicity. Results: Sixteen patients with ocular adnexal MALTomas had local radiation between 1992 and 2011 for primary or recurrent disease. 50% had lymphoma in the conjunctiva, 25% in the lacrimal sac/gland, and 25% in the posterior orbit. 75% had stage IAE disease, 6% had stage IIAE, and 19% had a positive bone marrow biopsy. One patient received chemotherapy as part of his initial therapy. The median radiation dose was 30 Gy (25.5-36 Gy) delivered with electrons (31%) or photons (69%). After a median follow-up of 34.78 months, two patients had residual/progressive disease, two had contralateral recurrence, and 1 had a distant failure, for local control of 87.5% and overall disease control of 68.75%. Recurrence/progression occurred at a median of 35.45 months. Two patients with residual/progressive disease and one with a contralateral recurrence were followed, successfully salvaged, and are NED. Fourteen patients are still alive and there were no disease-related/toxicity deaths. Seven patients developed cataracts in the treated eye, 2 had radiation retinopathy, 2 had permanent dry eye syndrome, and 1 had severe keratopathy requiring enucleation. Six patients (3.75%) had worsening visual acuity of unclear etiology. Conclusions: Primary radiation therapy for ocular adnexal MALTomas with a median dose of 30 Gy led to excellent local control. Those patients who did recur were successfully salvaged. Radiation was generally well-tolerated with expected cataractogenesis given the dose required to achieve local control with only one patient developing severe keratopathy after receiving the highest dose in this series.

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