Intensity-modulated radiation therapy (imrt) for anal cancer: Results from a multi-institutional retrospective cohort study.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 523-523 ◽  
Author(s):  
Jason Andrew Call ◽  
Brendan M Prendergast ◽  
Lindsay G Jensen ◽  
Celine B Ord ◽  
Karyn A. Goodman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Anal Cancer ◽  
Local Control ◽  
Treatment Time ◽  
Intensity Modulated Radiation Therapy ◽  
Late Toxicity ◽  
Nodal Status ◽  
Institutional Setting ◽  
Severe Toxicity ◽  
T Stage

523 Background: This study was done to assess the toxicity and efficacy of IMRT for anal cancer in a multi-institutional setting. Methods: Records of 152 total patients (pts) were reviewed retrospectively. Data on disease control and toxicity were collected as well as pt and treatment characteristics. Acute (<6 months) and late (>=6 months) severe toxicity (grade >=3) were recorded at each institution. Four were excluded for either presence of metastatic disease (2) or stage TX (2). There was data for late toxicity on 120 pts. Results: T stage was T1 in 28, T2 in 79, T3 in 29 and T4 in 12 pts. N stage was N0 in 77, N1 in 40, N2 in 19 and N3 in 12 pts. The median age was 56 yrs and median follow-up was 26.8 months. Cumulative IMRT dose was 51.25 Gy (median) (range: 4.32-61.2 Gy) in a median of 28 fractions (2-34). Chemotherapy was given in all but 2 pts and the most common regimen was 5- fluorouracil plus mitomycin-C. The median total elapsed treatment time was 40 days. Local control at 3 yrs was 87% and was significantly worse for patients with T3-4 disease (79% vs 90% at 3 years; p=0.04). There was no correlation between dose and local control. Regional control, distant control and overall survival were 97%, 91%, and 87% at 3 yrs, respectively. Nodal status was associated with regional and distal control as well as overall survival (p<0.01 for each). The most common acute severe toxicity was hematologic (41%). Severe acute GI, skin or other toxicity was 11%, 20% and 1% respectively. There were two grade 5 toxicities (hematologic and GI). Severe late toxicity was limited to skin (1%) and GI (3%). Conclusions: IMRT resulted in excellent local control in this multi-institutional cohort of pts. Although T stage did predict for worse local control, most pts with T3-4 disease were controlled with IMRT. Nodal status predicts for regional and distal control as well as overall survival. Severe toxicity was acceptable with this technique.

Intensity-modulated radiation therapy (IMRT) for anal cancer: Results from a multi-institutional retrospective cohort study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14555-e14555
Author(s):  
Jason Andrew Call ◽  
Brendan M Prendergast ◽  
Lindsay G Jensen ◽  
Celine B Ord ◽  
Karyn A. Goodman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Anal Cancer ◽  
Local Control ◽  
Treatment Time ◽  
Intensity Modulated Radiation Therapy ◽  
Late Toxicity ◽  
Nodal Status ◽  
Institutional Setting ◽  
Severe Toxicity ◽  
T Stage

e14555 Background: This study was done to assess the toxicity and efficacy of IMRT for anal cancer in a multi-institutional setting. Methods: Records of 152 total patients (pts) were reviewed retrospectively. Data on disease control and toxicity were collected as well as pt and treatment characteristics. Acute (<6 months) and late (>6 months) severe toxicity (grade >3) were recorded at each institution. Four were excluded for either presence of metastatic disease (2) or stage TX (2). There was data for late toxicity on 120 pts. Results: T stage was T1 in 28, T2 in 79, T3 in 29 and T4 in 12 pts. N stage was N0 in 77, N1 in 40, N2 in 19 and N3 in 12 pts. The median age was 56 yrs and median follow-up was 26.8 months. Cumulative IMRT dose was 51.25 Gy (median) (range: 4.32-61.2 Gy) in a median of 28 fractions (2-34). Chemotherapy was given in all but 2 pts and the most common regimen was 5- fluorouracil plus mitomycin-C. The median total elapsed treatment time was 40 days. Local control at 3 yrs was 87% and was significantly worse for patients with T3-4 disease (79% vs 90% at 3 years; p=0.04). There was no correlation between dose and local control. Regional control, distant control and overall survival were 97%, 91%, and 87% at 3 yrs, respectively. Nodal status was associated with regional and distal control as well as overall survival (p<0.01 for each). The most common acute severe toxicity was hematologic (41%). Severe acute GI, skin or other toxicity was 11%, 20% and 1% respectively. There were two grade 5 toxicities (hematologic and GI). Severe late toxicity was limited to skin (1%) and GI (3%). Conclusions: IMRT resulted in excellent local control in this multi-institutional cohort of pts. Although T stage did predict for worse local control, most pts with T3-4 disease were controlled with IMRT. Nodal status predicts for regional and distal control as well as overall survival. Severe toxicity was acceptable with this technique.

Re-irradiation for intra-thoracic tumours and extra-thoracic breast cancer: dose accumulation, evaluation of efficacy and toxicity based on a literature review

2021 ◽  
Author(s):  
Dorota Gabrys ◽  
Roland Kulik ◽  
Agnieszka Namysł-Kaletka
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Local Control ◽  
Treatment Time ◽  
Late Toxicity ◽  
Breast Conserving Therapy ◽  
Published Data ◽  
Overall Treatment Time ◽  
Grade 3 ◽  
Early Toxicity

The improvement seen in the diagnostic procedures and treatment of thoracic tumours means that patients have an increased chance of longer overall survival. Nevertheless, we can still find those who have had a recurrence or developed a secondary cancer in the previously treated area. These patients require retreatment including re-irradiation. We have reviewed the published data on thoracic re-irradiation which shows that some specific healthy tissues can tolerate a significant dose of irradiation and these patients benefit from aggressive treatment, however, there is a risk of damage to normal tissue under these circumstances. We analysed the literature data on re-irradiation in the areas of vertebral bodies, spinal cord, breast, lung and oesophagus. We evaluated the doses of primary and secondary radiotherapy, the treatment techniques, as well as the local control and median or overall survival in patients treated with re-radiation. The longest OS is reported in the case of re-irradiation after second breast-conserving therapy where the 5 year OS range is 81 to 100% and is shorter in patients with loco-reginal re-irradiation where the 5-y OS range is 18 to 60%. 2 year OS in patients re-irradiated for lung cancer and oesophagus cancer range from 13 to 74% and 18 to 42%, respectively. Majority grade ≥3 toxicity after second breast-conserving therapy was fibrosis up to 35%. For loco-regional breast cancer recurrences, early toxicity occurred in up to 33% of patients resulting in mostly desquamation, while late toxicity was recorded in up to 23% of patients and were mostly ulcerations. Early grade ≥3 lung toxicity developed in up to 39% of patients and up to 20% of Grade five hemoptysis. The most frequently observed early toxicity grade ≥3 in oesophageal cancer was oesophagitis recorded in up to 57% of patients, followed by hematological complications which was recorded in up to 50% of patients. The most common late complications included dysphagia, recorded in up to 16.7% of patients. We have shown that thoracic re-irradiation is feasible and effective in achieving local control in some patients. Re-irradiation should be performed with maximum accuracy and care using the best available treatment methods with a highly conformal, image-guided approach. Due to tremendous technological progress in the field of radiotherapy, we can deliver radiation precisely, shorten the overall treatment time and potentially reduce treatment-related toxicities.

Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer

2006 ◽  
Vol 24 (30) ◽  
pp. 4833-4839 ◽  
Author(s):  
Robert Timmerman ◽  
Ronald McGarry ◽  
Constantin Yiannoutsos ◽  
Lech Papiez ◽  
Kathy Tudor ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Phase Ii ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
Stage I ◽  
Severe Toxicity ◽  
Stereotactic Body Radiation

PurposeSurgical resection is standard therapy in stage I non–small-cell lung cancer (NSCLC); however, many patients are inoperable due to comorbid diseases. Building on a previously reported phase I trial, we carried out a prospective phase II trial using stereotactic body radiation therapy (SBRT) in this population.Patients and MethodsEligible patients included clinically staged T1 or T2 (≤ 7 cm), N0, M0, biopsy-confirmed NSCLC. All patients had comorbid medical problems that precluded lobectomy. SBRT treatment dose was 60 to 66 Gy total in three fractions during 1 to 2 weeks.ResultsAll 70 patients enrolled completed therapy as planned and median follow-up was 17.5 months. The 3-month major response rate was 60%. Kaplan-Meier local control at 2 years was 95%. Altogether, 28 patients have died as a result of cancer (n = 5), treatment (n = 6), or comorbid illnesses (n = 17). Median overall survival was 32.6 months and 2-year overall survival was 54.7%. Grade 3 to 5 toxicity occurred in a total of 14 patients. Among patients experiencing toxicity, the median time to observation was 10.5 months. Patients treated for tumors in the peripheral lung had 2-year freedom from severe toxicity of 83% compared with only 54% for patients with central tumors.ConclusionHigh rates of local control are achieved with this SBRT regimen in medically inoperable patients with stage I NSCLC. Both local recurrence and toxicity occur late after this treatment. This regimen should not be used for patients with tumors near the central airways due to excessive toxicity.

scholarly journals Comparison of Simultaneous Integrated Boost and Late-course Boost Intensity-modulated Radiation Therapy in the Treatment of Esophageal Carcinoma

2021 ◽  
Author(s):  
Yu Xiao ◽  
Guobo Du ◽  
Jianping Hu ◽  
Tingting Wu ◽  
Xue Meng ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Esophageal Carcinoma ◽  
Local Control ◽  
Intensity Modulated Radiation Therapy ◽  
Simultaneous Integrated Boost ◽  
Entire Group ◽  
Target Area ◽  
Intensity Modulated ◽  
Integrated Boost

Abstract This paper aimed to analyze and compare the outcomes of esophageal carcinoma treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and late-course boost intensity-modulated radiation therapy (LCB-IMRT). The retrospective study was designed to analyze the clinical data of 274 esophageal cancer patients who received radical radiotherapy in the Oncology Department of our hospital, from January 2014 to December 2017. Propensity score matching analysis was used to balance the variable differences in the two groups. Survival, toxicities, and target dose were observed and compared between the two groups. Statistical analysis was performed using SPSS 24.0 software. P<0.05 judged to be statistically significant. 200 patients were finally included after propensity scores matching , The 1-, 3-, and 5-year overall survival and local control rates of the entire group were 80.5% vs. 67.6%, 38.2% vs. 31.3%，and 22.2% vs. 20.4%, respectively. The 1-, 3-, and 5-year overall survival rates of the SIB-IMRT and LCB-IMRT group were 85.0% vs. 76.0%, 41.8% vs. 34.5%, and 25.5% vs. 21.3%, respectively (P＞0.05). The 1-, 3-, and 5- year local control rates of the SIB-IMRT and LCB-IMRT group were 77.3% vs. 58.0%, 31.4% vs. 30.1%, and 20.0% vs. 20.7%, respectively (P＞0.05). The recent total effective rates of the SIB-IMRT and LCB-IMRT group were 96.0% vs. 92.0% (P＞0.05). There were statistically significant differences in the incidence of ≥2 grade acute radiation esophagitis and pneumonia between the two groups (P＜0.05). The does of lung V5, lung V10, lung Dmean, and spinal cord Dmax in the SIB-IMRT group were significantly lower than those in LCB-IMRT group (P＜0.05). Patients age, tumor location, tumor length, gross tumor target volume, N stage were independent prognostic factors of overall survival and local control. Compared with the LCB-IMRT group, the survival prognosis of the SIB-IMRT group has benefit trend, patients in the SIB-IMRT group received less radiation dose to the normal organs around the target area, and the toxicities effects of radiotherapy were lighter, which is more conducive to the protection of normal tissues around the target area.

Treatment of diatal rectal cancer with preoperative intensity-modulated radiation therapy (IMRT) combined with chemotherapy: Updated 5-year results of 42 patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14157-e14157
Author(s):  
Albert S. DeNittis ◽  
John Marks ◽  
Filip Troicki ◽  
Erik L. Zeger ◽  
George Nassif ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Local Control ◽  
Medical Center ◽  
Neoadjuvant Chemoradiotherapy ◽  
Intensity Modulated Radiation Therapy ◽  
Intensity Modulated ◽  
Distal Rectal Cancer

e14157 Background: Preoperative chemoradiotherapy is currently the standard of care for patients with distal rectal cancer. With Intensity Modulated Radiation Therapy (IMRT), more conformal doses of radiation can be delivered to tumor while sparing normal tissue. It is our intent to present updated data showing 5 year follow up on patients treated concurrently with chemotherapy and IMRT reporting on local control, overall survival, and toxicity. Methods: From April 2007 to February of 2012 a sequential retrospective study of 42 patients at Lankenau Medical Center were treated for distal rectal cancer using IMRT. Patients staged from T2N0M0 to T3N1M0 and all received 5580 cGy to the pelvis using a 9 field plan to tumor, involved and uninvolved lymph nodes. All but one patient received 5FU based chemotherapy and four patients also received oxaliplatin. All patients then went on to surgery 8 – 12 weeks following neoadjuvant therapy. Twenty six patients underwent transabdominal transanal mesorectal (TATA) resection, 9 patients underwent a transanal endoscopic microsurgery (TEM), and 1 patient had an open low anterior resection. 3 patients have yet to go to surgery. FOLFOX was given to 25 of 42 patients adjuvently. Patients were analyzed for local control (LC), median survival (MS), overall survival (OS), and toxicity. Results: The median follow-up was 35 months. Complete pathological response was achieved in 12 (30.7%) patients, partial response was achieved in 25 (64%) patients, and 2 had stable disease at the time of surgery. There were no patients with local failure and only six (14%) patients progressed with distant metastatic disease. OS at 5 years was 92.8% with a MS of 37 months. Toxicity was acceptable with eight patients with grade 1, 5 patients with grade 2, and 3 grade 3 diarrhea. There were 3 (7%) patients with grade 1 neutropenia. Three patients experienced disease related death. Conclusions: With 5 years of follow-up data, our experience has shown that neoadjuvant chemoradiotherapy using IMRT to treat advanced stage rectal cancer is well tolerated and effective. Still further follow-up and additional studies will be required to confirm our findings.

Does gap-free intensity modulated chemoradiation therapy provide a greater clinical benefit than 3D conformal chemoradiation in patients with anal cancer?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 584-584
Author(s):  
Claire Dewas-Vautravers ◽  
Philippe Maingon ◽  
Cecile Dalban ◽  
Aurelie Petitfils ◽  
Karine Peignaux-Casasnovas ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Treatment Time ◽  
Anal Carcinoma ◽  
Late Toxicity ◽  
Response To Treatment ◽  
Concomitant Chemotherapy ◽  
Free Survival ◽  
Intensity Modulated ◽  
3D Crt

584 Background: Chemoradiation is the standard treatment for anal cancer. The purpose of this study was to compare outcomes and toxicities in patients treated with either intensity-modulated radiation therapy (IMRT) or 3D conformal radiotherapy (3D-CRT). Methods: Between 2004 and 2011, the data of 51 patients treated with exclusive radiotherapy with or without concomitant chemotherapy for non-metastatic anal carcinoma were retrospectively analyzed. Thirty-nine patients (76.5%) had concomitant chemotherapy: capecitabine alone (1), MMC combined with 5FU or capecitabine (36), MMC and CDDP (4). Twenty-seven patients were treated with 3D-CRT and 24 patients with IMRT, with a median dose delivered to the tumor of 59.4Gy [30.6-66.6], whatever the radiotherapy technique (p= 0.99). The median follow-up was 40 months [26.4-51.6]. Results: Median duration of the treatment was 56 days [22-103] (59 versus 47 days with 3D-CRT and IMRT respectively, p= 0.0007). A gap was planned in 29 patients (57%), 23 with 3D-CRT and 6 with IMRT (p< 0.0001). Treatment was stopped for toxicity in 9 patients (17.6%), 4 with 3D-CRT and 5 with IMRT (p= 0.48). There was no difference between the two groups for response to treatment (p= 0.46). Two-year overall survival (OS), locoregional relapse-free survival (LRS) and colostomy-free survival (CFS) rates were 88.5%, 63% and 60.3%, respectively for the IMRT group and 81%, 76.5% and 81.1% for the 3D-CRT group (all NS). Ten patients (37%) in 3D-CRT and 11 patients (45.8%) in IMRT (p= 0.524) had grade 3 (G3) acute toxicity. No grade 4 (G4) toxicity occurred. Conclusions: Our study suggests that further investigations concerning the use of IMRT to treat cancer of the anus are warranted. IMRT makes it possible to reduce treatment time, notably by abandoning the gap, but with no impact on the prognosis. Nonetheless, a longer follow-up is essential to determine whether or not IMRT has an impact on late toxicity, local control and survival compared with conventional 3D-CRT.

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 Prolonged Overall Treatment Time Negatively Affects the Outcomes of Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Weighted, Single-Center Analysis

2020 ◽  
Author(s):  
TOSHIKI IKAWA ◽  
Takahiro Tabuchi ◽  
Koji Konishi ◽  
Masahiro Morimoto ◽  
Takero Hirata ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Local Control ◽  
Treatment Time ◽  
Early Stage ◽  
Small Cell ◽  
Tumor Control ◽  
Small Cell Lung ◽  
Overall Treatment Time ◽  
Early Stage Nsclc

Abstract BackgroundPrevious studies have reported conflicting results for the effect of overall treatment time (OTT) on tumor control with stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). To examine this effect, we conducted a propensity score-weighted, retrospective, observational study at a single institution.MethodsWe analyzed the data of 200 patients with early-stage NSCLC who underwent SBRT (48 Gy in 4 fractions) at our institution between January 2007 and October 2013. Patients were grouped into consecutive (OTT = 4–5 days, n = 116) or non-consecutive treatment groups (OTT = 6–10 days, n = 84). The outcomes of interest were local control and overall survival. The Cox regression model was used with propensity score and inverse probability of treatment weighting.ResultsThe median OTTs in the consecutive and non-consecutive groups were 4 and 6 days, respectively. The 5-year local control and overall survival rates in the consecutive group vs. non-consecutive group were 86.3% vs. 77.2% and 55.5% vs. 51.8%, respectively. After propensity score-weighting, consecutive SBRT was associated with positive local control (adjusted hazard ratio 0.30, 95% confidence interval 0.14–0.65; p=0.002) and overall survival benefits (adjusted hazard ratio 0.56, 95% confidence interval 0.34–0.91; p=0.019). ConclusionsProlonged OTT negatively affected the outcomes of patients with early-stage NSCLC treated with SBRT. To our knowledge, this is the first study to show that in patients with early-stage NSCLC treated with the same dose-fractionation regimen, consecutive SBRT has a more beneficial effect on tumor control than does non-consecutive SBRT.

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.

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