METHOD OF ASSESSMENT OF RADIOTHERAPEUTIC INTERVAL IN RADIATION THERAPY FOR CANCER CONSIDERING DOSE FRACTIONATION REGIMEN

Breast cancer remains the most common malignant neoplasm in women. According to the current standards, radiation therapy is one of the most important components of the multi-disciplinary treatment. The efficacy of the postoperative radiotherapy in both the traditional fractionation regimen and in the hypofractionation mode is not questioned. Contrary to the conventional fractionation, hypofractionation implies an increase in the daily dose and a reduction in the total treatment time. This approach helps reduce the treatment costs in patients with breast cancer while maintaining a high treatment efficacy and quality of life.The aim of the study was to analyze the economic efficiency of the dose hypofractionation as compared to the traditional mode of dose fractionation during postoperative radiation therapy in patients with breast cancer.Materials and methods. The study included 220 patients with breast cancer who received a combined treatment. Of these, 120 patients (study group) received hypofractionated radiotherapy (40.5 Gy in 15 fractions) whereas 100 patients of the control group were treated by the conventional therapy of 50 Gy in 25 fractions. Patients of the both groups were comparable by stages of the disease, systemic treatment, age and molecular type of tumor. The cost of treatment was calculated from the price list of this research center.Results. The present economic analysis showed that the method of hypofractionation was more (30% on average) cost-efficient than the conventional regimen while both modalities produced similar rates of total and relapse-free survival. We were then able to identify the main items in the list of medical services that contributed to the estimated difference in the treatment costs. Reducing the number of examinations and the treatment duration help reduce the expenditure of this medical organization.Сonclusion. Hypofractionation of postoperative radiotherapy in patients with breast cancer allows one to reduce the treatment costs as compared to the conventional fractionation regimen. The funds saved by optimizing the costs of postoperative radiation can be directed to the development of additional means of cancer treatment.

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A review on radiation induced nausea and vomiting: “Current management strategies and prominence of radio sensitizers”

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211011539 ◽

2021 ◽

pp. 107815522110115

Author(s):

Meenu Vijayan ◽

Sherin Joseph ◽

Emmanuel James ◽

Debnarayan Dutta

Keyword(s):

Radiation Therapy ◽

Cell Damage ◽

Genetic Material ◽

High Energy ◽

Concurrent Chemotherapy ◽

Nausea And Vomiting ◽

Dose Fractionation ◽

Psychological State ◽

Related Factors ◽

Radiation Induced

Radiations dissipated are high energy waves used mostly as treatment intervention in controlling the unwanted multiplication of cell. About 60%–65% of cancer treatment requires radiation therapy and 40%–80% of radiation therapy causes RINV which are true troublemakers. Radiation therapy (RT) is targeted therapy mostly used to treat early stages of tumour and prevent their reoccurrence. They mainly destroy the genetic material (DNA) of cancerous cells to avoid their unwanted growth and division. The RINV affects the management and quality of life of patients which further reduces the patient outcome. RINV depends on RT related factors (dose, fractionation, irradiation volume, RT techniques) and patient related factors like (gender, health conditions, age, concurrent chemotherapy, psychological state, and tumour stage). RT is an active area of research and there is only limited progress in tackling the RINV crisis. Advanced technological methods are adopted that led to better understanding of total lethal doses. Radiation therapy also affects the immunity system that leads to radiation induced immune responses and inflammation. Radio sensitizers are used to sensitize the tumour cells to radiations that further prevent the normal cell damage from radiation exposure. There is a need for future studies and researches to re-evaluate the data available from previous trials in RINV to make better effective antiemetic regimen. The article focuses on radiation therapy induced nausea and vomiting along with their mechanism of action and treatment strategies in order to have a remarkable patient care.

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Exceeding Radiation Dose to Volume Parameters for the Proximal Airways with Stereotactic Body Radiation Therapy Is More Likely for Ultracentral Lung Tumors and Associated with Worse Outcome

Cancers ◽

10.3390/cancers13143463 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3463

Author(s):

Mark Farrugia ◽

Sung Jun Ma ◽

Mark Hennon ◽

Chukwumere Nwogu ◽

Elisabeth Dexter ◽

...

Keyword(s):

Radiation Therapy ◽

Propensity Score ◽

Stereotactic Body Radiation Therapy ◽

Performance Status ◽

Bronchial Tree ◽

Lung Tumors ◽

Gender Performance ◽

Dose Fractionation ◽

Stereotactic Body Radiation ◽

History Of

The preferred radiotherapeutic approach for central (CLT) and ultracentral (UCLT) lung tumors is unclear. We assessed the toxicity and outcomes of patients with CLT and UCLT who underwent definitive five-fraction stereotactic body radiation therapy (SBRT). We reviewed the charts of patients with either CLT or UCLT managed with SBRT from June 2010–April 2019. CLT were defined as gross tumor volume (GTV) within 2 cm of either the proximal bronchial tree, trachea, mediastinum, aorta, or spinal cord. UCLT were defined as GTV abutting any of these structures. Propensity score matching was performed for gender, performance status, and history of prior lung cancer. Within this cohort of 83 patients, 43 (51.8%) patients had UCLT. The median patient age was 73.1 years with a median follow up of 29.9 months. The two most common dose fractionation schemes were 5000 cGy (44.6%) and 5500 cGy (42.2%) in five fractions. Multivariate analysis revealed UCLT to be associated with worse overall survival (OS) (HR = 1.9, p = 0.02) but not time to progression (TTP). Using propensity score match pairing, UCLT correlated with reduced non-cancer associated survival (p = 0.049) and OS (p = 0.03), but not TTP. Within the matched cohort, dosimetric study found exceeding a D4cc of 18 Gy to either the proximal bronchus (HR = 3.9, p = 0.007) or trachea (HR = 4.0, p = 0.02) was correlated with worse non-cancer associated survival. In patients undergoing five fraction SBRT, UCLT location was associated with worse non-cancer associated survival and OS, which could be secondary to excessive D4cc dose to the proximal airways.

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Radiobiological Evaluation of Dosimetric Plans for Stereotactic Radiotherapy for Prostate Cancer According to Fractionation Regimen

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2019-100-5-263-269 ◽

2019 ◽

Vol 100 (5) ◽

pp. 263-269

Author(s):

E. S. Sukhikh ◽

I. N. Sheyno ◽

L. G. Sukhikh ◽

A. V. Taletskiy ◽

A. V. Vertinskiy ◽

...

Keyword(s):

Radiation Therapy ◽

Total Dose ◽

Rectal Wall ◽

Tumor Control ◽

Anterior Rectal Wall ◽

Tumor Control Probability ◽

Equivalent Uniform Dose ◽

Dose Volume Histograms ◽

Dose Volume ◽

Fractionation Regimen

Objective. To determine the most effective irradiation regimen (total dose and dose per fraction) for hypofractionated treatment for prostate carcinomas according the TCP/NTCP radiobiological criteria.Material and methods. Using the tomographic information of five patients with low-risk prostate adenocarcinoma as an example, the authors devised dosimetric radiation therapy plans using the volumetric modulated arc therapy (VMAT) procedure. They considered the range of total doses of 33.5 to 38 Gy administered in 4 and 5 fractions. Based on the equivalent uniform dose concept proposed by A. Niemierko and on the computed differential dose volume histograms, the investigators modeled local tumor control probability (TCP) values, by taking into account the uncertainties of main radiobiological parameters, and estimated normal tissue complication probabilities (NTCP) for the anterior rectal wall as the organ most at risk of irradiation. An effective dosimetric plan was selected according to the UTCP criterion and the probability of complication-free tumor control, i.e. TCP (1 – NTCP).Results. The results of modeling the UTCP criterion show that with a higher total dose, the TCP value increases and so does the NTCP value, therefore the optimal radiation therapy plans are to irradiate with a total dose of 34 Gy over 4 fractions or with a dose of 36–37 Gy over 5 fractions. The difference between the fractionation regimens is that the UTCP value is achieved with a higher TCP value over 4 fractions and with a lower load on the rectal wall over 5 fractions.Conclusion. The choice of a specific fractionation regimen should be determined from the calculated values of differential dose volume histograms for each patient, as well as from radiobiological criteria, such as TCP, NTCP and UTCP.

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Stereotactic Body Radiation Therapy in Multiple Organ Sites

Journal of Clinical Oncology ◽

10.1200/jco.2006.09.7469 ◽

2007 ◽

Vol 25 (8) ◽

pp. 947-952 ◽

Cited By ~ 307

Author(s):

Robert D. Timmerman ◽

Brian D. Kavanagh ◽

L. Chinsoo Cho ◽

Lech Papiez ◽

Lei Xing

Keyword(s):

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Advanced Technology ◽

Dose Fractionation ◽

Tumor Control ◽

High Dose ◽

Stereotactic Body Radiation ◽

Phase Ii Studies ◽

Prospective Phase ◽

Prospective Trials

Introduction Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver a potent ablative dose to deep-seated tumors in the lung, liver, spine, pancreas, kidney, and prostate. Methods SBRT involves constructing very compact high-dose volumes in and about the tumor. Tumor position must be accurately assessed throughout treatment, especially for tumors that move with respiration. Sophisticated image guidance and related treatment delivery technologies have developed to account for such motion and efficiently deliver high daily dose. All this serves to allow the delivery of ablative dose fractionation to the target capable of both disrupting tumor mitosis and cellular function. Results Prospective phase I dose-escalation trials have been carried out to reach potent tumoricidal dose levels capable of eradicating tumors with high likelihood. These studies indicate a clear dose-response relationship for tumor control with escalating dose of SBRT. Prospective phase II studies have been reported from several continents consistently showing very high levels of local tumor control. Although late toxicity requires further careful assessment, acute and subacute toxicities are generally acceptable. Patterns of toxicity, both clinical and radiographic, are distinct from those observed with conventionally fractionated radiotherapy as a result of the unique biologic response to ablative fractionation. Conclusion Prospective trials using SBRT have confirmed the efficacy of treatment in a variety of patient populations. Although mechanisms of ablative-dose injury remain elusive, ongoing prospective trials offer the hope of finding the ideal application for SBRT in the treatment arsenal.

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