scholarly journals Toxicity Reduction after Craniospinal Irradiation via Helical Tomotherapy in Patients with Medulloblastoma: A Unicentric Retrospective Analysis

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 501
Author(s):  
Anil Öztunali ◽  
Khaled Elsayad ◽  
Sergiu Scobioala ◽  
Mohammed Channaoui ◽  
Uwe Haverkamp ◽  
...  
Keyword(s):  
Helical Tomotherapy ◽  
Radiation Therapy Oncology Group ◽  
Survival Rates ◽  
Local Control Rate ◽  
Craniospinal Irradiation ◽  
Lower Grade ◽  
European Organization ◽  
Efficacious Treatment ◽  
Eortc Criteria ◽  
Reduced Rate

Objectives: Recent trials with craniospinal irradiation (CSI) via helical Tomotherapy (HT) demonstrated encouraging medulloblastoma results. In this study, we assess the toxicity profile of different radiation techniques and estimate survival rates. Materials and Methods: We reviewed the records of 46 patients who underwent irradiation for medulloblastoma between 1999 and 2019 (27 conventional radiotherapy technique (CRT) and 19 HT). Patient, tumor, and treatment characteristics, as well as treatment outcomes—local control rate (LCR), event-free survival (EFS), and overall survival (OS)—were reviewed. Acute and late adverse events (AEs) were evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results: In total, 43 courses of CSI and three local RT were administered to the 46 patients: 30 were male, the median age was 7 years (range 1–56). A median total RT dose of 55 Gy (range 44–68) and a median CSI dose of 35 Gy (range, 23.4–40) was delivered. During follow-up (median, 99 months), six patients (13%) developed recurrence. The EFS rate after 5 years was 84%. The overall OS rates after 5 and 10 years were 95% and 88%, respectively. There were no treatment-related deaths. Following HT, a trend towards lower grade 2/3 acute upper gastrointestinal (p = 0.07) and subacute CNS (p = 0.05) toxicity rates was detected compared to CRT-group. The risk of late CNS toxicities, mainly grade 2/3, was significantly lower following HT technique (p = 0.003). Conclusion: CSI via HT is an efficacious treatment modality in medulloblastoma patients. In all, we detected a reduced rate of several acute, subacute, and chronic toxicities following HT compared to CRT.

Concordance between RTOG and EORTC prognostic criteria in low-grade gliomas

2019 ◽  
Vol 15 (22) ◽  
pp. 2595-2601
Author(s):  
Enrico Franceschi ◽  
Antonella Mura ◽  
Giuseppe Lamberti ◽  
Dario De Biase ◽  
Alicia Tosoni ◽  
...  
Keyword(s):  
High Risk ◽  
Radiation Therapy Oncology Group ◽  
Low Risk ◽  
Molecular Characteristics ◽  
Low Grade ◽  
European Organization ◽  
Low Grade Gliomas ◽  
High Risk Patients ◽  
Eortc Criteria ◽  
Risk Patients

Aim: European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) criteria are used to choose treatment in low-grade gliomas. However, no data exist on their concordance. Methods: Low-grade glioma patients treated at our institution from 1998 to 2015 and assessable for both RTOG and EORTC criteria were included to analyze their concordance. Surgery extension, postsurgical treatments, molecular characteristics ( IDH mutation, MGMT methylation and 1p/19q codeletion) were recorded. Results: We included 99 patients. The concordance was low (50.5%; K = 0.127; p = 0.021) but for two subgroups: EORTC high-risk patients were also RTOG high-risk patients (concordance: 97.5%) and RTOG low-risk patients were also EORTC low-risk patients (concordance: 90.9%). Conclusion: The concordance between RTOG and EORTC criteria is low. Thus, clinical trials adopting different risk criteria are not comparable.

The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients

2016 ◽  
Vol 37 (7) ◽  
pp. 845-851 ◽  
Author(s):  
Marie-Paule Fernandez-Gerlinger ◽  
Anne-Sophie Jannot ◽  
Sophie Rigaudeau ◽  
Juliette Lambert ◽  
Odile Eloy ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Severe Infection ◽  
Hematologic Malignancies ◽  
Preventive Strategies ◽  
European Organization ◽  
Exact Test ◽  
Eortc Criteria ◽  
Neutropenic Patients ◽  
Chemotherapy Induced Neutropenia ◽  
The Impact

OBJECTIVEInvasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study.DESIGNRetrospective cohort studyMETHODSPatients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher’s exact test, and a multivariate analysis was performed to take into account potential confounding factors.RESULTSData from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00–0.84).CONCLUSIONIn this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies.Infect Control Hosp Epidemiol 2016;37:845–851

Effect of Radiotherapy After Breast-Conserving Treatment in Women With Breast Cancer and Germline BRCA1/2 Mutations

2000 ◽  
Vol 18 (19) ◽  
pp. 3360-3369 ◽  
Author(s):  
Lori J. Pierce ◽  
Myla Strawderman ◽  
Steven A. Narod ◽  
Ivo Oliviotto ◽  
Andrea Eisen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cellular Response ◽  
Breast Tissue ◽  
Early Stage ◽  
Subcutaneous Tissue ◽  
Conditional Logistic Regression ◽  
Radiation Therapy Oncology Group ◽  
Laboratory Data ◽  
Tumor Control ◽  
European Organization

PURPOSE: Recent laboratory data suggest a role for BRCA1/2 in the cellular response to DNA damage. There is a paucity of clinical data, however, examining the effect of radiotherapy (RT), which causes double-strand breaks, on breast tissue from BRCA1/2 mutation carriers. Thus the goals of this study were to compare rates of radiation-associated complications, in-breast tumor recurrence, and distant relapse in women with BRCA1/2 mutations treated with breast-conserving therapy (BCT) using RT with rates observed in sporadic disease. PATIENTS AND METHODS: Seventy-one women with a BRCA1/2 mutation and stage I or II breast cancer treated with BCT were matched 1:3 with 213 women with sporadic breast cancer. Conditional logistic regression models were used to compare matched cohorts for rates of complications and recurrence. RESULTS: Tumors from women in the genetic cohort were associated with high histologic (P = .0004) and nuclear (P = .009) grade and negative estrogen (P = .0001) and progesterone (P = .002) receptors compared with tumors from the sporadic cohort. Using Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity scoring, there were no significant differences in acute or chronic morbidity in skin, subcutaneous tissue, lung, or bone. The 5-year actuarial overall survival, relapse-free survival, and rates of tumor control in the treated breast for the patients in the genetic cohort were 86%, 78%, and 98%, respectively, compared with 91%, 80%, and 96%, respectively, for the sporadic cohort (P = not significant). CONCLUSION: There was no evidence of increased radiation sensitivity or sequelae in breast tissue heterozygous for a BRCA1/2 germline mutation compared with controls, and rates of tumor control in the breast and survival were comparable between BRCA1/2 carriers and controls at 5 years. Although additional follow-up is needed, these data may help in discussing treatment options in the management of early-stage hereditary breast cancer and should provide reassurance regarding the safety of administering RT to carriers of a germline BRCA1/2 mutation.

Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: the H6 twin randomized trials from the European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group.

1993 ◽  
Vol 11 (11) ◽  
pp. 2258-2272 ◽  
Author(s):  
P Carde ◽  
A Hagenbeek ◽  
M Hayat ◽  
M Monconduit ◽  
J Thomas ◽  
...  
Keyword(s):  
Early Stage ◽  
Survival Rates ◽  
Left Ventricular ◽  
Clinical Staging ◽  
Left Ventricular Ejection ◽  
Tumor Control ◽  
European Organization ◽  
Ventricular Ejection Fraction ◽  
Staging Laparotomy ◽  
Negative Laparotomy

PURPOSE To compare (1) clinical staging and irradiation alone versus staging laparotomy and treatment adaptation in patients with a favorable prognosis (H6F); (2) two combined modalities in patients with an unfavorable prognosis (H6U). PATIENTS AND METHODS The H6F trial (n = 262) consisted of randomization to clinical staging plus subtotal nodal irradiation (STNI) or to staging laparotomy plus treatment adaptation (adjuvant chemotherapy [CT] only in the 33% with negative laparotomy). The H6U trial (n = 316) consisted of no laparotomy, randomization to mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), and mantle irradiation. RESULTS In the H6F trial, 6-year freedom from progression (FFP) rates (78% v 83%; P = .27) were similar in clinical and laparotomy stagings, respectively. Survival rates were 93% and 89%, due to laparotomy-related deaths. In the H6U trial, the ABVD arm had superior results (6-year FFP rate, 88% v 76%; P = .01), but they were not significant for survival (91% v 85%; P = .22). CT discontinuation due to hematologic intolerance occurred more often with MOPP (14.5% v 7.3%). Decrease of the pulmonary vital capacity ([VC] < 70% of the theoretic value) was observed more frequently after ABVD than after MOPP (12% v 2%; P = .08), with two lethal pulmonary insufficiencies occurring in the ABVD arm. No modification of the isotopic left ventricular ejection fraction (LVEF) occurred. Gonadal toxicity was less in the ABVD arm. CONCLUSION Early-stage patients benefit from treatment adaptation to initial characteristics in terms of tumor control and late toxicities. Staging laparotomy before STNI may be deleted even in favorable patients at no cost to survival or FFP. In unfavorable patients, ABVD achieved better results than MOPP, at lower hematologic and gonadal cost. Therefore, despite its pulmonary toxicity, ABVD is the best choice to design improved CT regimens associated with mantle irradiation.

scholarly journals A retrospective cohort study of low-dose intensity-modulated radiotherapy for unresectable liver metastases

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989238
Author(s):  
Su Pei ◽  
Kaihua Chen ◽  
Yunli Yang ◽  
Long Chen ◽  
Xiaodong Zhu
Keyword(s):  
Liver Metastases ◽  
Survival Rates ◽  
Intensity Modulated Radiotherapy ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Local Control Rate ◽  
Intensity Modulated ◽  
Median Total Dose ◽  
Unresectable Liver Metastases ◽  
Grade 3

Objective To evaluate the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) for the treatment of unresectable liver metastases. Methods Twenty-five patients with unresectable liver metastases treated with IMRT were enrolled from January 2003 to September 2016. The median longest diameter of the lesions was 3.3 cm (range, 1.6–16.7 cm). The fraction dose ranged from 2 to 5.2 Gy, with a median total dose of 50 Gy (range, 30–60 Gy). Results The median follow-up was 9.2 months (range, 2.1–48.8 months). The overall survival rates at 1 and 2 years were 46.4% and 27.4%, respectively. The 1-year local control rate was 69.8%. The 1-year progression-free survival rate was 26.3%. One patient had grade 4 liver dysfunction. One case of grade 4 leukopenia and one case of grade 3 leukopenia occurred, and one case of grade 3 leukopenia and thrombocytopenia was observed. Conclusion IMRT may be a promising and safe treatment for unresectable liver metastases and can be used as a treatment option.

Daily setup uncertainty analysis for craniospinal irradiation using helical tomotherapy

2013 ◽  
Vol 3 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Rolina Al-Wassia ◽  
Houda Bahig ◽  
Emily Poon ◽  
William Parker ◽  
Carolyn Freeman
Keyword(s):  
Uncertainty Analysis ◽  
Helical Tomotherapy ◽  
Craniospinal Irradiation

Effect and safety of proton beam therapy for locally recurrent rectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 743-743
Author(s):  
Yusuke Ogi ◽  
Tomohiro Yamaguchi ◽  
Yusuke Kinugasa ◽  
Akio Shiomi ◽  
Hiroyasu Kagawa ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Proton Beam ◽  
Survival Rates ◽  
Proton Beam Therapy ◽  
Local Control Rate ◽  
Recurrent Rectal Cancer ◽  
Lateral Lymph Node ◽  
Free Survival ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

743 Background: The first choice of treatment for locally recurrent rectal cancer is surgical resection. However, the operation is often difficult with high perioperative risk. For surgically unfit cases, proton beam therapy (PBT) is proposed as the treatment option. However, its efficacy for locally recurrent rectal cancer remains unclear. Therefore, this study aimed to evaluate the efficacy and safety of PBT for locally recurrent rectal cancer. Methods: A total of 23 patients with locally recurrent rectal cancer who received PBT were retrospectively evaluated, from November 2005 to July 2014. Patients with single lesion, who refuse the radical surgical therapy, or who were considered unfit for the operation were included in this study. All patients were treated with 2.8Gy relative biological effectiveness (RBE)/fraction. Twenty-five irradiations were performed, with a total irradiation of 70Gy RBE. Unfit for operation criteria include invasion to the vertebra higher than the third sacrum or lateral lymph node recurrence after a lateral lymph node dissection. To assess the safety of PBT, adverse events were evaluated by using the Common Terminology Criteria for Adverse Effects (CTCAE version4.0). To assess the efficacy, the overall and relapse-free survival rates and local control rate were evaluated. Results: Sixteen patients were unfit for operation, and seven refused surgery. Three patients experienced Grade 3 late adverse events in the CTCAE (two ileum fistula and one urinary tract obstruction). The median follow-up time was 28.9 months. The 5-year overall and relapse-free survival rates were 47.6% and 20.2%, respectively. Fifteen patients (65.2%) showed distant metastasis or regrowth at the locally recurrent site. The 5-year local control rate was 39.0%. Ten patients (43.4%) showed regrowth at the proton beam irradiation site. Conclusions: PBT was relatively effective for locally recurrent rectal cancer with manageable adverse effects. Therefore, PBT may be considered as the therapeutic option for selected locally recurrent rectal cancer patients.

PO-0655 REDUCING HAEMATOLOGICAL TOXICITY FOR ADULT PATIENTS RECEIVING CRANIOSPINAL IRRADIATION WITH HELICAL TOMOTHERAPY

2012 ◽  
Vol 103 ◽  
pp. S256
Author(s):  
K. Petersson ◽  
M. Gebre-Medhin ◽  
C. Ceberg ◽  
P. Engström ◽  
T. Knöös ◽  
...  
Keyword(s):  
Helical Tomotherapy ◽  
Haematological Toxicity ◽  
Adult Patients ◽  
Craniospinal Irradiation
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