scholarly journals Adaptive Dose Escalated Radiotherapy in Oropharyngeal Cancers: A Treatment Planning Feasibility Study

2021 ◽  
Author(s):  
Laura Grocutt ◽  
Claire Paterson ◽  
Ronan M Valentine
Keyword(s):  
At Risk ◽  
Feasibility Study ◽  
Poor Prognosis ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Unmet Need ◽  
Group I ◽  
Dose Levels ◽  
Patients With Poor Prognosis

Abstract Background: A significant proportion of patients with poor prognosis squamous cell cancer of the oropharynx relapse loco-regionally despite radical (chemo)radiotherapy. If a predictive biomarker for disease control can be identified during treatment then individualised and adaptive treatment strategies may be employed. The aim of this study is to assess the feasibility of adaptive and dose-escalated RT to the gross tumour volume without increasing surrounding planning target volume doses and maintaining clinically acceptable organs at risk doses.Materials and methods: Twenty representative patients with poor prognosis locally advanced OPSCC who were known to have relapsed post RT, were re-planned retrospectively using Eclipse TPS v15.5, RapidPlanTM and multi-criteria optimisation. In our centre, areas of gross disease (PTV65) are treated with 65Gy in 30# while areas at risk of containing microscopic disease (PTV54) are treated synchronously to 54Gy in 30#. The original clinical plans were re-optimised to act as controls (Group I). These plans were split into two plans of 15# each, with the latter 15# used to escalate the dose to the GTV to 73Gy (Group II) and 82Gy (Group III). Plan sums were created for the total 30# to record plan evaluation parameters along with assessments of plan deliverability.Results: For all groups, the dose coverage at D98% and D50% for the PTVs were comparable. As expected, the D2% dose levels for PTV65 increased. All dose levels associated with PTV54 remained largely unaffected by the dose escalation regimens. Conformity indices for PTV65 and PTVAll reveal comparable conformity across all three groups. Despite the GTV being escalated by 12.3% and 26.2% in groups II and III, the volume of GTV receiving > 84 Gy was considerably less than 1.75 cc. While OAR doses increased for the escalated groups, these increases were not clinically significant. Conclusion: This planning feasibility study exploring RapidPlanTM combined with multi-criteria optimisation has demonstrated that doses to the GTV may be escalated without increasing PTV or OAR doses considerably, suggesting an interventional clinical trial using this approach would be feasible. Given loco-regional control remains an unmet need, response-adaptive dose-escalated RT has the potential to improve outcomes for poor-prognosis patients.

Allogeneic Transplant in Patients with Poor Prognosis B-Chronic Lymphocytic Leukemia (B-CLL): Comparative Study between Myeloablative(M) and Non-Myeloablative(NM) Conditioning Regimen.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2306-2306 ◽  
Author(s):  
M.D. Caballero ◽  
J.A. García-Marco ◽  
R. Martino ◽  
J. Esteve ◽  
M.V. Mateos ◽  
...  
Keyword(s):  
At Risk ◽  
Poor Prognosis ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Lymphocytic Leukemia ◽  
Allogeneic Transplant ◽  
Peripheral Blood Stem Cells ◽  
Group A ◽  
Group B ◽  
Patients With Poor Prognosis

Abstract Sustained complete remissions (CR) have been reached with allogeneic transplant in patients with poor prognosis B-CLL; however, mortality rates are high (20–50%); in order to reduced TRM, NM conditioning are widely used in haematological malignancies; however it is not clear if the use of NM regimens can maintain the efficacy reducing the toxicity. IN this report we performed a retrospective comparison between 30 patients (group A) who have received myeloablative conditioning consisted of TBI plus Cy in 23 pts (74%), TBI, Cy plus VP-16 in 6 pts (19%) and BuCy in 1 patient and 31 patients (Group B) who have received a NM transplant. Conditioning regimens in Group B included: Fludarabine plus Melphalan, 20 pts (64%), Fludarabine, Busulphan and ATG, 5 pts (16%), Fludarabine, TBI and ATG, 4 pts (13%) and Fludarabine plus TBI, 1 patient. All patients received peripheral blood stem cells from a HLA related identical donor. T-cell depletion was performed in 14 patients of the group A. Median age at transplant was significantly higher in the group B patients (53 versus 45, respectively) (p<0,005); no differences were observed in terms of status at transplant and n° of previous chemotherapy lines as well in the risk of graft versus host disease (GVHD) and transplant related mortality (TRM) (See Table, below). With a median follow-up of 71 and 36 months for groups A and B respectively,Overall Survival and Event Free Survival are similar for both groups (53% versus 64% and 60% versus 68%, respectively). Although patients in the NM transplant group were older toxicity was similar in both groups; moreover a similar efficacy has been observed suggesting the clear role of graft versus tumour effect in B-CLL probably more important that the type ofconditining. Table 1 GROUP A Myeloablative Group B Non-myeloablative p Number of previuous chemotherapy lines 2 (1-6) 2 (1-8) NS Acute GVHD 15/30 (48%) 20/31 (64%) NS Grade II-IV 11/30 (35%) 12 /31(38%) NS Chronic GVHD 12/26pts at risk (46%) 18/27 pts at risk (66%) NS Extense 8 pts (30%) 9 pts (33%) NS TRM 7/30 (23%) 7/31 (22%) NS

scholarly journals CMET-31. WHOLE BRAIN RADIOTHERAPY VERSUS STEREOTACTIC RADIOSURGERY IN POOR-PROGNOSIS PATIENTS WITH 1 – 10 BRAIN METASTASES: A RANDOMIZED FEASIBILITY STUDY

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi58-vi58
Author(s):  
Alan Nichol ◽  
Srinivas Raman ◽  
Benjamin Mou ◽  
Fred Hsu ◽  
Boris Valev ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Median Survival ◽  
Feasibility Study ◽  
Systemic Therapy ◽  
Poor Prognosis ◽  
Whole Brain Radiotherapy ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Patients With Poor Prognosis

Abstract BACKGROUND The clinical advantage of stereotactic radiosurgery (SRS) over whole brain radiotherapy (WBRT) in patients with brain metastases and poor prognosis is controversial. To investigate the feasibility of a phase III clinical trial in a population of patients with poor prognosis, we conducted a randomized feasibility study of WBRT versus SRS. METHODS Patients with Karnofsky performance status (KPS) ≥ 70, life expectancy of 3–6 months, based on both Diagnosis-Specific Graded Prognostic Assessments and attending oncologist opinion, and 1– 10 brain metastases with a diameter ≤ 4 cm were enrolled at six Canadian cancer centers. Patients were randomly assigned to WBRT (20 Gy in 5 fractions) or SRS (15 Gy in 1 fraction). The primary endpoint was the rate of accrual. A secondary endpoint was the ratio of screened subjects to accrued subjects. This trial is registered with ClinicalTrials.gov (NCT02220491). RESULTS Between January 2015 and November 2017, 210 were screened to enroll 22 patients (9.5 screened/participant) and 20 patients were randomized. The accrual rate was 0.63 patients / month. The most common reasons for exclusion were: estimated median survival outside 3–6 months (n = 40), baseline KPS below 70 (n = 28), and > 10 brain metastases (n = 28). The median survival was 7.0 months. The overall survival was 9.5 months (n = 11) for patients who had subsequent systemic therapy, compared to 3.7 months (n = 9) in patients who had none. In both arms, the cumulative incidence of retreatment with brain radiotherapy was 40%. CONCLUSIONS Accrual was slow and the median survival was longer than expected, but a randomized trial evaluating WBRT vs SRS in patients with poor prognosis would likely be feasible by enrolling only patients with no remaining systemic therapy options.

Management of Patients with Poor-Prognosis Nonseminomatous Germ Cell Cancer

Oncology ◽  
1990 ◽  
Vol 47 (3) ◽  
pp. 234-240 ◽  
Author(s):  
S.D. Fosså ◽  
G. Sœtter ◽  
N. Aass ◽  
S. Ous ◽  
A.E. Stenwig ◽  
...  
Keyword(s):  
Germ Cell ◽  
Poor Prognosis ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Patients With Poor Prognosis

Information-Seeking on the Internet

Crisis ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Vinod Singaravelu ◽  
Anne Stewart ◽  
Joanna Adams ◽  
Sue Simkin ◽  
Keith Hawton
Keyword(s):  
At Risk ◽  
Young People ◽  
Information Seeking ◽  
Significant Proportion ◽  
The Internet ◽  
Search Terms ◽  
Specific Advice ◽  
Restriction Sites ◽  
Self Harm ◽  
Negative Tone

Abstract. Background: The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. Aims: We aimed to identify and analyze websites potentially accessed by these young people. Method: Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. Results: In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. Conclusion: Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.

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