scholarly journals Stereotactic body radiotherapy (SBRT) reirradiation for recurrent pancreas cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 451-451
Author(s):  
Rabia N Dagoglu ◽  
Mark Callery ◽  
James Moser ◽  
Jennifer F. Tseng ◽  
Tara Kent ◽  
...  
Keyword(s):  
Local Control ◽  
Systemic Therapy ◽  
Stereotactic Body Radiotherapy ◽  
Pancreas Cancer ◽  
Target Volume ◽  
Maximum Point ◽  
Prescription Dose ◽  
Locally Recurrent ◽  
Grade Iii

451 Background: After adjuvant or definitive radiation for pancreas cancer, there are limited conventional treatment options for recurrent pancreas cancer. We explored the role of (Stereotactic Body Radiotherapy) SBRT for reirradiation of recurrent pancreas cancer. Methods: Our institutional IRB approved database was retrospectively reviewed. All patients were deemed unresectable and treated with systemic therapy. Fiducial gold markers were used. CT simulation was performed with oral and IV contrast and patients were treated with respiratory motion tracking.The choice of fractionation was based on tumor volume, location of the tumor and prior radiation dose, interval between prior RT, adjacent normal tissue, patients’ performance status and co morbidities. The irradiation dose was prescribed to the isodose line covering at least 95% of the target volume. Maximum point dose to the gastric and duodenal walls was kept at or below prescription dose. Results: This study included 30 patients reirradiated for recurrent pancreas cancer at our center between September 2005 and September 2013. 17 males and 13 females were treated. The median age at the time of reirradiation was 67 years (range 44 to 88 years). Median follow-up was 11 months (4 to 24 months).The median target volume was 41.29cc. The median prescription dose was 25Gy (24-36 Gy) in a median of 5 fractions prescribed to a mean 78% isodose line. The median overall survival was 14 months. The 1 and 2 year local control was 78%. The worst toxicity included 3/30(10%) grade III acute toxicity for pain, bleeding and vomiting. There was 2/30 (7%) Grade III long-term bowel obstructions. Conclusions: Management of locally recurrent pancreatic cancer, particularly after prior radiation therapy, is challenging. We report the utility of SBRT for reirradiation of locally recurrent pancreas cancer after prior radiation, with reasonable local control, modest survival and acceptable toxicity. Future prospective studies are needed to define the role of SBRT reirradiation for local recurrences in the setting of systemic therapy.

scholarly journals CyberKnife and EDGE in stereotactic body radiotherapy for pancreas cancer: a comparison of plan quality

2020 ◽  
Author(s):  
Zhitao Dai ◽  
Li Ma ◽  
Tingting Cao ◽  
Lian Zhu ◽  
Man Zhao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stereotactic Body Radiotherapy ◽  
Normal Tissue ◽  
Pancreas Cancer ◽  
Target Volume ◽  
Conformity Index ◽  
Equivalent Uniform Dose ◽  
Dose Distributions ◽  
Dose Volume ◽  
Comprehensive Comparison

Abstract Purpose: To perform a comprehensive comparison of the different stereotactic body radiotherapy (SBRT) plans between the Varian EDGE and CyberKnife (CK) systems for pancreas cancer.Materials and methods: Fifteen patients with pancreas cancer were selected in this study. The median planning target volume (PTV) was 28.688cm 3 (5.736 to 49.246 cm 3 ). The SBRT plans for the EDGE and CK were generated in the Eclipse and Multiplan systems respectively with the same contouring and dose constrains for PTV and organ at risk (OAR). Dose distributions in PTV were evaluated in terms of coverage, conformity index (CI), new conformity index (nCI), homogeneity index (HI), and gradient index (GI). OARs, including spinal cord, bowel, stomach, duodenum and kidneys were statistically evaluated by different dose-volume metrics and equivalent uniform dose (EUD) . The volume covered by the different isodose lines (ISDL) ranging from 10% to 100% for normal tissue were also analyzed.Results: All SBRT plans for EDGE and CK met the clinical requirement for PTV and OARs. . For the PTV, the dosimetric metrics in EDGE plans were lower than that in CK, except that D 99 and GI were slightly higher. The EDGE plans with lower CI , nCI and HI were superior to offer the better conformity and homogeneity for PTV. For the normal tissue, the CK plans were better at OARs sparing. The radiobiological indices EUD of spinal cord, duodenum, stomach, and kidneys were lower for CK plans, except that liver were higher. The volumes of normal tissue covered by medium ISDLs (with range of 20%~70%) were lower for CK plans while that covered by high and low ISDLs were lower for EDGE plans.Conclusions: This study indicated that both EDGE and CK generated equivalent plan quality, and both systems can be considered as beneficial techniques for SBRT of pancreas cancer. EDGE plans offered the better conformity and homogeneity of dose distributions for PTV, while the CK plans could minimize the exposure of OARs.

scholarly journals Stereotactic body radiotherapy for patients with oligometastases from colorectal cancer: risk-adapted dose prescription with a maximum dose of 83–100 Gy in five fractions

2016 ◽  
Vol 57 (4) ◽  
pp. 400-405 ◽  
Author(s):  
Atsuya Takeda ◽  
Naoko Sanuki ◽  
Yuichiro Tsurugai ◽  
Yohei Oku ◽  
Yousuke Aoki
Keyword(s):  
Colorectal Cancer ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Pulmonary Metastases ◽  
Maximum Dose ◽  
Survival Rates ◽  
Target Volume ◽  
High Dose ◽  
Concurrent Administration

Abstract We previously reported that the local control of pulmonary metastases from colorectal cancer (CRC) following stereotactic body radiotherapy (SBRT) with moderate prescription dose was relatively worse. We investigated the treatment outcomes and toxicities of patients with oligometastases from CRC treated by SBRT using risk-adapted, very high- and convergent-dose regimens. Among patients referred for SBRT from August 2011 to January 2015, those patients were extracted who had liver or pulmonary metastases from CRC, and they were treated with a total dose of 50–60 Gy in five fractions prescribed to the 60% isodose line of the maximum dose covering the surface of the planning target volume. Concurrent administration of chemotherapy was not admitted during SBRT, while neoadjuvant or adjuvant chemotherapy was allowed. A total of 21 patients (12 liver, 9 lung) with 28 oligometastases were evaluated. The median follow-up duration was 27.5 months (range: 6.5–43.3 months). Four patients were treated with SBRT as a series of initial treatments, and 17 patients were treated after recurrent oligometastases. The local control rates at 1 and 2 years from the start of SBRT were 100%. The disease-free and actuarial overall survival rates were 62% and 55%, and 79% and 79%, respectively. No severe toxicities (≥grade 3) occurred during follow-up. The outcomes following high-dose SBRT were excellent. This treatment can provide an alternative to the surgical resection of oligometastases from CRC. Prospective studies are needed to validate the effectiveness of SBRT.

Primary Systemic Therapy in Operable Breast Cancer

2000 ◽  
Vol 18 (7) ◽  
pp. 1558-1569 ◽  
Author(s):  
Antonio C. Wolff ◽  
Nancy E. Davidson
Keyword(s):  
Breast Cancer ◽  
Clinical Trials ◽  
Local Control ◽  
Systemic Therapy ◽  
Potential Role ◽  
Operable Breast Cancer ◽  
Primary Systemic Therapy ◽  
Absolute Increase ◽  
Breast Conservation Treatment

PURPOSE: Laboratory studies suggest that primary systemic therapy (PST) could improve control of micrometastatic disease and impact on overall survival (OS). This article examines the rationale for and preclinical and clinical data of PST in operable breast cancer and the potential role of intermediate biomarkers as predictive and/or prognostic factors for response and survival. DESIGN AND METHOD: We conducted an extensive literative review (including MEDLINE) on preclinical studies, single-arm feasibility studies, large randomized single- and multi-institutional trials, and laboratory correlate studies of PST in breast cancer. RESULTS: Small trials in locally advanced disease showed high initial rates of response and local control. Six randomized clinical trials (RCTs) of PST for palpable, operable breast cancer have been reported since 1991 (from 204 to 1,523 patients each). These data clearly show a small but significant (less than 10%) absolute increase in the use of breast-conservation treatment (BCT) with similar rates of local control. Although one study showed better disease-free survival (DFS) and another showed better OS, most studies did not show any survival advantage of primary versus adjuvant systemic therapy. Thus far, pathologic complete response seems to be the best predictor of survival, but clinical response assessment correlates poorly with pathologic response. Pilot studies demonstrated feasibility of procuring tissue at diagnosis and after treatment for assays of potential intermediate biomarkers. Initial data suggest a potential correlation between markers of proliferation and apoptosis and in vivo chemotherapy sensitivity. CONCLUSION: Thus far, RCTs of PST versus standard adjuvant therapy have not shown any clear benefit for DFS or OS in early breast cancer. Ongoing trials should determine if specific subsets of patients at risk would benefit from additional systemic therapy and the potential role of intermediate biomarkers in identifying such women. Although PST results in a small increase in the rate of BCT with similar rates of local control, current PST strategies should not replace standard adjuvant approaches. Rather, they represent an acceptable alternative to women with palpable, operable tumors and an excellent arena for clinical trials.

scholarly journals Re-irradiation stereotactic body radiotherapy for spinal metastases: a multi-institutional outcome analysis

2016 ◽  
Vol 25 (5) ◽  
pp. 646-653 ◽  
Author(s):  
Ahmed Hashmi ◽  
Matthias Guckenberger ◽  
Ron Kersh ◽  
Peter C. Gerszten ◽  
Frederick Mantel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Total Dose ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Spinal Metastases ◽  
Target Volume ◽  
External Beam Radiation ◽  
Single Fraction ◽  
Kaplan Meier ◽  
Target Volumes

OBJECTIVE This study is a multi-institutional pooled analysis specific to imaging-based local control of spinal metastases in patients previously treated with conventional external beam radiation therapy (cEBRT) and then treated with re-irradiation stereotactic body radiotherapy (SBRT) to the spine as salvage therapy, the largest such study to date. METHODS The authors reviewed cases involving 215 patients with 247 spinal target volumes treated at 7 institutions. Overall survival was calculated on a patient basis, while local control was calculated based on the spinal target volume treated, both using the Kaplan-Meier method. Local control was defined as imaging-based progression within the SBRT target volume. Equivalent dose in 2-Gy fractions (EQD2) was calculated for the cEBRT and SBRT course using an α/β of 10 for tumor and 2 for both spinal cord and cauda equina. RESULTS The median total dose/number of fractions of the initial cEBRT was 30 Gy/10. The median SBRT total dose and number of fractions were 18 Gy and 1, respectively. Sixty percent of spinal target volumes were treated with single-fraction SBRT (median, 16.6 Gy and EQD2/10 = 36.8 Gy), and 40% with multiple-fraction SBRT (median 24 Gy in 3 fractions, EQD2/10 = 36 Gy). The median time interval from cEBRT to re-irradiation SBRT was 13.5 months, and the median duration of patient follow-up was 8.1 months. Kaplan-Meier estimates of 6- and 12-month overall survival rates were 64% and 48%, respectively; 13% of patients suffered a local failure, and the 6- and 12-month local control rates were 93% and 83%, respectively. Multivariate analysis identified Karnofsky Performance Status (KPS) < 70 as a significant prognostic factor for worse overall survival, and single-fraction SBRT as a significant predictive factor for better local control. There were no cases of radiation myelopathy, and the vertebral compression fracture rate was 4.5%. CONCLUSIONS Re-irradiation spine SBRT is effective in yielding imaging-based local control with a clinically acceptable safety profile. A randomized trial would be required to determine the optimal fractionation.

scholarly journals Re-Irradiation With Stereotactic Body Radiotherapy for In-Field Recurrence of Pancreatic Cancer After Prior Stereotactic Body Radiotherapy: Analysis of 24 Consecutive Cases

2021 ◽  
Vol 11 ◽  
Author(s):  
Yuxin Shen ◽  
Xiaofei Zhu ◽  
Fei Cao ◽  
Hongliang Xie ◽  
Xiaoping Ju ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Disease Control ◽  
Clinical Outcomes ◽  
Stereotactic Body Radiotherapy ◽  
Carbohydrate Antigen ◽  
Recurrent Pancreatic Cancer ◽  
Prescription Dose ◽  
Promising Treatment ◽  
Locally Recurrent ◽  
Mild Toxicity

Purpose/ObjectivesLocally recurrent pancreatic cancer is a therapeutic challenge, and aggressive approaches are needed to improve its clinical outcomes. Stereotactic body radiotherapy (SBRT) is a promising treatment for pancreatic cancer with an excellent local control and acceptable toxicity. However, the safety and efficacy of SBRT for in-field recurrence after initial SBRT remain unknown. The aim of the study was to investigate the feasibility of re-irradiation with SBRT for locally recurrent pancreatic cancer after prior definitive SBRT.Material/MethodsTwenty-four consecutive patients with pancreatic cancer received two courses of SBRT in our center between January 2014 and December 2016. The median prescription dose of the initial and second courses of SBRT was 35.5 Gy/5–7f and 32 Gy/5–8f, respectively. Clinical outcomes including overall survival (OS), disease control, and toxicity were evaluated after treatment.ResultsThe median interval between two courses of SBRT was 13 months (range: 6–29 months). From the first SBRT, the median OS of 18 patients with limited diseases was 26 months (95% CI: 19.1–32.95 months). The median OS of 12 patients without metastasis was 14 months (95% CI: 10.6–17.4 months) from re-irradiation of SBRT. The overall response rate and disease control rate were 50% and 13%, and 100% and 86.9% after each SBRT, respectively. Carbohydrate antigen 19-9 (CA19-9) levels declined dramatically after re-irradiation within 1 month (p = 0.002) and 3 months (p = 0.028). Twelve (75%) out of 16 patients had pain relief after re-irradiation. None of the patients experienced gastrointestinal toxicity.ConclusionsRe-irradiation with SBRT can provide favorable outcomes and effective analgesia with mild toxicity after prior SBRT for in-field recurrent pancreatic cancer, which might be feasible for locally relapsed pancreatic cancer.

scholarly journals Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy

2021 ◽  
Vol 91 (S2) ◽  
pp. 3-13
Author(s):  
B. Mark Smithers ◽  
Robyn P. M. Saw ◽  
David E. Gyorki ◽  
Richard C. W. Martin ◽  
Victoria Atkinson ◽  
...  
Keyword(s):  
New Zealand ◽  
Systemic Therapy ◽  
Advanced Melanoma ◽  
Adjuvant Systemic Therapy ◽  
Contemporary Management

scholarly journals NIMG-53. GLUTAMATE/GABA RATIO ON MRS IS ELEVATED IN PATIENTS WITH LOWER GRADE GLIOMAS AND SEIZURES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii159-ii160
Author(s):  
Roberta Rudà ◽  
Riccardo Pascuzzo ◽  
Francesca Mo ◽  
Alessia Pellerino ◽  
Peter B Barker ◽  
...  
Keyword(s):  
Tumor Location ◽  
Resonance Spectroscopy ◽  
Lower Grade ◽  
Lack Of Information ◽  
Baseline Evaluation ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND There is lack of information on the role of excitatory and inhibitory neurotransmitters in the development of seizures in patients with lower grade gliomas. Increase of glutamate and downregulation of GABA have been suggested in preclinical models and human surgical samples to be associated with brain tumor-related epilepsy. MATERIAL AND METHODS We prospectively investigated with the use of magnetic resonance spectroscopy (MRS) the differences in the ratio of metabolites (glutamate/GABA, glutamate/creatine and GABA/creatine) in the peritumoral areas between patients with or without seizures in a series of lower grade gliomas. Tumors were classified according to WHO Classification of 2016 as follows:11 grade II IDH mutated and 1p/19q codeleted; 3 grade III IDH mutated and 1p/19q codeleted; 6 grade II IDH mutated and 1p/19q intact; 1 grade III IDH mutated and 1p/19q intact; 1 grade II IDH wild-type. Patients received surgery alone or followed by temozolomide chemotherapy according to the presence of risk factors. RESULTS At baseline evaluation, maximum glutamate/GABA values were significantly higher (p=0.023) in the peritumoral area of patients with seizures (1.008 ± 0.368) with respect to those without seizures (0.691 ± 0.170). No other metabolites ratio showed significant differences between the two groups. Similar results were obtained when analyzing the metabolites ratio in the examinations during the follow-up. In the cohort of patients with seizures (n.14) variations of metabolite ratios were not associated with tumor location, 1p/19q codeletion, use of AEDs, concomitant chemotherapy or seizure characteristics (type, duration, frequency). CONCLUSIONS The study is ongoing with the aim of analyzing further the correlations between ratio of metabolites and status of the tumor (stable vs progressive).

scholarly journals Local control after stereotactic body radiotherapy of centrally located lung tumours

2021 ◽  
pp. 1-5
Author(s):  
A. A. Khalil ◽  
M. M. Knap ◽  
D. S. Møller ◽  
T. B. Nyeng ◽  
R. Kjeldsen ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Lung Tumours
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