scholarly journals IMAT-IGRT Treatment with Simultaneous Integrated Boost as Dose Escalation for Patients with Cervical Cancer: A Single Institution, Prospective Pilot Study

2021 ◽  
Vol 27 ◽  
Author(s):  
Zoltán Lőcsei ◽  
Klára Sebestyén ◽  
Zsolt Sebestyén ◽  
Eszter Fehér ◽  
Dorottya Soltész ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Total Dose ◽  
Dose Escalation ◽  
Tumor Regression ◽  
Simultaneous Integrated Boost ◽  
Disease Stage ◽  
Mri Scan ◽  
Regression Rate ◽  
Integrated Boost

Purpose: The aim of this study was to introduce the simultaneous integrated boost (SIB) technique to assess the safety of replacement of the brachytherapy (BT) boost for ineligible patients with cervical cancer receiving radiochemotherapy (RCT).Methods: Fourteen patients were enrolled between 2015 and 2018. SIB was delivered using RapidArc technique at doses of 2.4 Gy per fraction during pelvic irradiation with 50.4/1.8 Gy in seven patients (to a total dose of 67.2 Gy) with limited volume disease. In 7 patients with a more advanced disease stage (>5 cm tumor, parametric invasion both sides), parametric boost therapy was added to the pelvic radiotherapy to a total dose of the macroscopic tumor of 79.2 Gy. All patients received simultaneous cisplatin-based chemotherapy for 5 cycles with a dosage of 40 mg/m2. We examined acute toxicity (CTCAE v4.1) and quality of life (EORTC QLQ30 and CX24). The tumor regression rate was evaluated with RECIST 1.1 after the first 3- to 4-months follow-up Magnetic Resonance Imaging (MRI) scan. We calculated the percentage of tumor regression rate and the local control during the follow-up period and evaluated the survival data.Results: Our patient data are presented at a median follow-up time of 24.5 months. During the treatment period, no grade 3 to 4 toxicity was observed. During the follow-up period, no late-onset toxicity was observed. The tumor regression rate at the first MRI scan was 95.31% on average. Disease free survival (DFS) during the median follow-up of 24 months was 98.6%.Conclusion: In patients with cervical cancer, the SIB technique is amenable as part of definitive RCT. Dose escalation with the SIB technique can be safely administered to cervical cancer patients during definitive RCT if BT is not feasible. However, further randomized clinical studies are needed to validate the method, so routine use of it cannot be recommended yet.

scholarly journals EP-1327: Clinical outcomes of dose escalation using simultaneous integrated boost in cervical cancer

2016 ◽  
Vol 119 ◽  
pp. S621-S622
Author(s):  
R. Verges Capdevila ◽  
A. Varo ◽  
M. Mañas ◽  
A. Giraldo ◽  
J. Giralt
Keyword(s):  
Cervical Cancer ◽  
Clinical Outcomes ◽  
Dose Escalation ◽  
Simultaneous Integrated Boost ◽  
Integrated Boost

scholarly journals Preoperative intensity-modulated chemoradiotherapy with simultaneous integrated boost in rectal cancer: five-year follow-up results of a phase II study

2021 ◽  
Vol 55 (4) ◽  
pp. 439-448
Author(s):  
Jasna But-Hadzic ◽  
Anja Meden Boltezar ◽  
Tina Skerl ◽  
Vesna Zadnik ◽  
Vaneja Velenik
Keyword(s):  
Rectal Cancer ◽  
Acute Toxicity ◽  
Phase Ii ◽  
Dose Escalation ◽  
Phase Ii Study ◽  
Locally Advanced ◽  
Simultaneous Integrated Boost ◽  
Intensity Modulated ◽  
Integrated Boost

Abstract Background We conducted a phase II study to investigate the feasibility and safety of preoperative radiochemo-therapy experimental fractionation, using intensity-modulated radiation therapy with simultaneous integrated boost (IMRT SIB) to shorten the overall treatment time without dose escalation in intermediate/locally advanced rectal cancer with the aim to improving treatment outcome. Patients and methods A total of 51 patients with operable stage II–III rectal carcinoma were included between January 2014 and January 2015. Fifty patients completed preoperative IMRT treatment with an elective dose of 41.8 Gy and simultaneously delivered 46.2 Gy to T2/T3 and 48.4 Gy to T4 tumour in 22 fractions, with concomitant capecitabine (825 mg/m2/12 h, including at weekends). Median follow-up was 70 months (range 11–80 m). Results Forty-seven patients completed treatment per protocol. Acute toxicity occurred in 2 (4%) patients. R0 resection was achieved in all but 1 and pathologic complete response (pCR) in 12 (25.5%) patients who had 5-year overall survival (OS), disease-free survival (DFS) and local control (LC) of 91.7%, 100% and 100%, respectively. The intention-to-treat analysis showed that the type of surgery significantly moderated OS and DFS, while total downstaging and pN were predictive for DFS only. For treatment per protocol 5-year OS, DFS and LC were 80.9% (95% confidence interval [CI] 69.7–92.1), 77.1% (95% CI 65.1–89.1) and 95.2% (95% CI 88.7–100), respectively. The proportion of patients with severe late (CTCAE G ≥ 3) gastrointestinal, urinary and sexual toxicity was 15%, 2% and 8% respectively, with one reported secondary carcinoma. Conclusions Preoperative IMRT-SIB without dose escalation was well tolerated, with a low acute toxicity profile, we achieved a high rate of pCR and showed encouraging 5-year OS, DFS and LC.

Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer

2018 ◽  
Vol 50 (4) ◽  
pp. 735-739 ◽  
Author(s):  
Abdullah Alsuhaibani ◽  
Ahmed Elashwah ◽  
Rana Mahmood ◽  
Alaa Abduljabbar ◽  
Samar Alhomoud ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Dose Escalation ◽  
Volumetric Modulated Arc Therapy ◽  
Simultaneous Integrated Boost ◽  
Arc Therapy ◽  
Integrated Boost

Efficacy and Safety of Carbon Ion Radiotherapy in Bone and Soft Tissue Sarcomas

2002 ◽  
Vol 20 (22) ◽  
pp. 4466-4471 ◽  
Author(s):  
Tadashi Kamada ◽  
Hirohiko Tsujii ◽  
Hiroshi Tsuji ◽  
Tsuyoshi Yanagi ◽  
Jun-etsu Mizoe ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Total Dose ◽  
Local Control ◽  
Dose Escalation ◽  
Soft Tissue Sarcomas ◽  
Carbon Ion Radiotherapy ◽  
Skin Reactions ◽  
Carbon Ion ◽  
Acute Skin Reactions

PURPOSE: To evaluate the tolerance for and effectiveness of carbon ion radiotherapy in patients with unresectable bone and soft tissue sarcomas. PATIENTS AND METHODS: We conducted a phase I/II dose escalation study of carbon ion radiotherapy. Fifty-seven patients with 64 sites of bone and soft tissue sarcomas not suited for resection received carbon ion radiotherapy. Tumors involved the spine or paraspinous soft tissues in 19 patients, pelvis in 32 patients, and extremities in six patients. The total dose ranged from 52.8 to 73.6 gray equivalent (GyE) and was administered in 16 fixed fractions over 4 weeks (3.3 to 4.6 GyE/fraction). The median tumor size was 559 cm3 (range, 20 to 2,290 cm3). The minimum follow-up was 18 months. RESULTS: Seven of 17 patients treated with the highest total dose of 73.6 GyE experienced Radiation Therapy Oncology Group grade 3 acute skin reactions. Dose escalation was then halted at this level. No other severe acute reactions (grade > 3) were observed in this series. The overall local control rates were 88% and 73% at 1 year and 3 years of follow-up, respectively. The median survival time was 31 months (range, 2 to 60 months), and the 1- and 3-year overall survival rates were 82% and 46%, respectively. CONCLUSION: Carbon ion radiotherapy seems to be a safe and effective modality in the management of bone and soft tissue sarcomas not eligible for surgical resection, providing good local control and offering a survival advantage without unacceptable morbidity.

scholarly journals Moderately Hypofractionated Intensity Modulated Radiotherapy (IMRT) With a Simultaneous Integrated Boost for Locally Advanced Head and Cancer – Do Modern Techniques Held Their Promise?

2021 ◽  
Author(s):  
Jörn Wichmann ◽  
Martin Durisin ◽  
Robert Michael Hermann ◽  
Roland Merten ◽  
Hans Christiansen
Keyword(s):  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Simultaneous Integrated Boost ◽  
Advanced Head ◽  
Intensity Modulated ◽  
Regional Control ◽  
Integrated Boost ◽  
Long Term Follow Up

Abstract PurposeIntensity-modulated-radiotherapy (IMRT) is still a standard of care for radiotherapy in locally advanced head and neck cancer (LA-HNSCC). Simultaneous-integrated-boost (SIB) and moderately hypofractionation offer an opportunity of individual dose painting and reduction of overall treatment time. We present retrospective data on toxicity and local-regional-control of a patient cohort with LA-HNSCC treated with an IMRT-SIB-concept in comparison to normofractionated 3D-conformal radiotherapy (3D-RT) after a long-term follow-up.MethodsBetween 2012 and 2014, n=67 patients with HNSCC (stages III/IV without distant metastases) were treated with IMRT-SIB either definitive (single/total doses: 2.2/66Gy, 2.08/62.4Gy, 1.8/54Gy in 30 fractions) or in the postoperative setting (2.08/62.4Gy, 1.92/57.6Gy, 1.8/54Gy). These patients' clinical course was matched (for gender, primary, and treatment concept) as part of a matched-pair-analysis with patients treated before mid-2012 with normofractionated 3D-CRT (definitive: 2Gy/50Gy followed by a sequential boost up to 70Gy; postoperative: 2Gy/60-64Gy). Chemotherapy/immunotherapy was given concomitantly in both groups in the definitive situation (postoperative dependent on risk factors). Primary endpoints were acute and late toxicity; secondary endpoint was loco-regional-control (LRC).Results67 patients treated with IMRT-SIB (n = 20 definitive, n = 47 adjuvant) were matched with 67 patients treated with 3D-RT. There were minor imbalances between the groups concerning non-matching-variables like extracapsular extension (ECE) and chemotherapy in IMRT-SIB.Significantly less toxicity was found in favor of IMRT-SIB concerning dysphagia, radiation dermatitis, xerostomia, fibrosis, and lymphoedema. After a median follow-up of 63 months, median LRC was not reached (IMRT-SIB) vs. 69.5m (3D-RT) (p=0.63).ConclusionThis moderately hypofractionated IMRT-SIB-concept showed to be feasible with less toxicity compared to conventional 3D-RT in this long-term follow-up observation.

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