Results of complex treatment of patients with operable pancreatic head cancer using preoperative intra-arterial chemotherapy in combination with radiation therapy in multifractionation mode

The aim of this study was to assess the safety and efficacy of treating patients with operable pancreatic cancer after preoperative intra-arterial infusion of chemotherapy combined with conformal radiation therapy in a multi-fractionation mode. Patients (n = 40) were randomized into two groups: the main one – intra-arterial infusion of chemotherapy + radiation therapy + surgery (n = 20), and control – intra-arterial infusion of chemotherapy + surgery (n = 20). Neoadjuvant therapy consisted of intra-arterial infusion of chemotherapy (chemoembolization of a pancreatic head tumor with oxaliplatin 85 mg/m2) followed by intra-arterial chemo infusion with gemcitabine 1000 mg/m2. In the main group, radiation therapy was also carried out in two fractions per day, 2 Gy with an interval of 4–6 hours, 5 days a week, up to a total dose of 50 Gy. In the main group, the lower incidence of postoperative pancreatitis and the pancreatic fistulas were statistically confirmed, the incidence of grade 2 therapeutic pathomorphisis increased, as well as the median life expectancy.

Potential benefits of volumetric modulated arc therapy to reduce the incidence of ≥ grade 2 radiation pneumonitis in radiotherapy for locally advanced non-small cell lung cancer patients

Background The use of volumetric modulated arc therapy is gradually widespread for locally advanced non-small cell lung cancer. The purpose of this study was to identify the factors that caused ≥ grade 2 radiation pneumonitis and evaluate the impact of using volumetric modulated arc therapy on the incidence of ≥ grade 2 radiation pneumonitis by comparing three-dimensional conformal radiation therapy. Methods We retrospectively evaluated 124 patients who underwent radical radiotherapy for locally advanced non-small cell lung cancer in our institution between 2008 and 2019. The following variables were analysed to detect the factors that affected ≥ grade 2 radiation pneumonitis; age, sex, the presence of interstitial lung disease, pulmonary emphysema, tumour location, stage, PTV/lung volume, lung V20Gy, total dose, concurrent chemoradiotherapy, adjuvant immune checkpoint inhibitor, radiotherapy method. Radiation pneumonitis was evaluated using the common terminology criteria for adverse events (version 5.0). Results A total of 84 patients underwent three-dimensional conformal radiation therapy (3D-CRT group) and 40 patients underwent volumetric modulated arc therapy (VMAT group). The cumulative incidence of ≥ grade 2 radiation pneumonitis at 12 months was significantly lower in the VMAT group than in the 3D-CRT group (25% vs. 49.1%). The use of volumetric modulated arc therapy was a significant factor for ≥ grade 2 radiation pneumonitis (HR:0.32, 95% CI: 0.15–0.65, P = 0.0017) in addition to lung V20Gy (≥ 24%, HR:5.72 (95% CI: 2.87–11.4), P < 0.0001) and total dose (≥ 70 Gy, HR:2.64 (95% CI: 1.39–5.03), P = 0.0031) even after adjustment by multivariate analysis. Conclusions We identified factors associated with ≥ grade 2 radiation pneumonitis in radiotherapy for patients with locally advanced non-small cell lung cancer. Volumetric modulated arc therapy has potential benefits to reduce the risk of ≥ grade 2 radiation pneumonitis.

Radiation therapy services during the COVID-19 pandemic

Relevance: The outbreak of a new respiratory disease SARS CoV-2 (COVID-19), reported by China in December 2019, significantly impacted cancer treatment. However, modern radiotherapy techniques remain in use during the COVID-19 pandemics. They include intensive modulated radiation therapy (IMRT, VMAT), image-guided radiation therapy (IGRT), stereotactic radiosurgery, and radiotherapy (SRS and SRT). The research aimed to compare the techniques used and the throughput of the linear accelerator before and during the COVID-19 pandemics. Results: The results were measured during nine months of operation of Almaty Oncology Center before the pandemic (April-December 2019) and the similar period during the pandemic in 2020. The amount of high-tech radiotherapy services provided before and during the COVID-19 pandemic equaled to (amount of sessions/ number of patients): conformal (3D) radiotherapy – 6510/335 vs. 6005/286; IGRT – 9171/524 and 8977/551; IMRT and VMAT – 4208/190 vs. 5992/287. The share of more complex methods of radiation therapy (IMRT, VMAT) has increased from 39.3% of sessions before the COVID-19 pandemic to 49.9% during the pandemic. The number of SRS and SRT procedures performed/patients served has also increased from 14/6 to 47/13. The average amount of services per patient before and during the COVID-19 pandemic has changed as follows: conformal radiation therapy – from 19.4 sessions to 21.0, IMRT and VMAT – from 22.1 to 20.9, IGRT – from 17.5 to 16.3. Conclusion: During the COVID-19 pandemic, there was no decrease in the amount of radiotherapy services provided; the use of more high-tech radiotherapy techniques has increased 1.4 times.

Prostate cancer with a large cystic lesion: Case Report

Prostate cancer is one of the most common malignancies in the world; however, it is rarely observed with cysts. Although prostate cysts are mostly benign, malignancies should not be ignored. A 66-year-old male presented with complaints of urinary retention and frequency. Regarding the results of clinical and paraclinical examination, elevated prostate-specific antigen (PSA) with a large cystic lesion was suspected. Initially, transrectal ultrasound prostate biopsy (TRUS BX), drainage, and cyst sclerotherapy with alcohol was performed. Pathology results confirmed the intra ductal carcinoma of prostate. The Three-Dimensional Conformal Radiation Therapy (3D CRT) and androgen deprivation therapy (ADT( were initiated. It is worth mentioning that his symptoms have improved now. In cases in which prostate is accompanied by cysts with high PSA, prostate cancer should not be ignored, and according to the guidelines, biopsy should be performed as needed. In the investigations of the prostate cysts causes, cancers are among the differential diagnosis, and therefore, malignancy should be a concern in the prostate cysts cases.

Radiation therapy services during the COVID-19 pandemic

Relevance: The outbreak of a new respiratory disease SARS CoV-2 (COVID-19), reported by China in December 2019, significantly impacted cancer treatment. However, modern radiotherapy techniques remain in use during the COVID-19 pandemics. They include intensive modulated radiation therapy (IMRT, VMAT), image-guided radiation therapy (IGRT), stereotactic radiosurgery, and radiotherapy (SRS and SRT). The research aimed to compare the techniques used and the throughput of the linear accelerator before and during the COVID-19 pandemics. Results: The results were measured during nine months of operation of Almaty Oncology Center before the pandemic (April-December 2019) and the similar period during the pandemic in 2020. The amount of high-tech radiotherapy services provided before and during the COVID-19 pandemic equaled to (amount of sessions/ number of patients): conformal (3D) radiotherapy – 6510/335 vs. 6005/286; IGRT – 9171/524 and 8977/551; IMRT and VMAT – 4208/190 vs. 5992/287. The share of more complex methods of radiation therapy (IMRT, VMAT) has increased from 39.3% of sessions before the COVID-19 pandemic to 49.9% during the pandemic. The number of SRS and SRT procedures performed/patients served has also increased from 14/6 to 47/13. The average amount of services per patient before and during the COVID-19 pandemic has changed as follows: conformal radiation therapy – from 19.4 sessions to 21.0, IMRT and VMAT – from 22.1 to 20.9, IGRT – from 17.5 to 16.3. Conclusion: During the COVID-19 pandemic, there was no decrease in the amount of radiotherapy services; the use of more high-tech radiotherapy techniques has increased 1.4 times.

Predictors of heart and lung dose in left-sided breast cancer treated with VMAT relative to 3D-CRT: A retrospective study

Background Before generating radiotherapy plans for breast cancer patients, the choice of plan techniques (three-dimensional conformal radiation therapy (3D-CRT) and volumetric modulated arc therapy (VMAT)) should be made. This study investigated the performance of two geometric indices in aiding the choice of 3D-CRT and VMAT plans in women undergoing left-sided whole breast radiotherapy. Materials and methods 119 patients, previously treated with left-sided breast radiotherapy (61 3D-CRT treatments and 58 VMAT treatments) from a single institution, were retrospectively studied. Two geometric indices, which were cardiac junction (CJ) index and pulmonary junction (PJ) index, were defined and the relationship between these indices and dose of organs at risk (OARs) were evaluated. Two-tailed Student’s t-test was performed to compare patient characteristics between 3D-CRT and VMAT. Linear regressions were calculated to investigate the association between geometric indices and absorbed dose of heart and left lung, including mean dose of heart (MHD), V5, V30 of heart, and mean dose of left lung (MLLD), V5, V10, V20, V30, V40 of left lung. Results The CJ index was strongly correlated with the MHD in 3D-CRT group and VMAT group. The linear regression formulas were MHD = 4826.59 ×CJ Index+310.48 (R = 0.857, F = 163.77, P = 0.000) in 3D-CRT plans and MHD = 1789.29×CJ Index+437.50 (R = 0.45, F = 14.23, P = 0.000) in VMAT plans. The intersection of the two formulas was CJ index = 4.2% and MHD = 512.33 cGy. The PJ index demonstrated a strongly positive correlation with MLLD in 3D-CRT group and VMAT group as well. The linear regression formulas were MLLD = 2879.54×PJ Index+999.79 (R = 0.697, F = 55.86, P = 0.000) in 3D-CRT plans and MLLD = 1411.79×PJ Index+1091.88 (R = 0.676, F = 47.11, P = 0.000) in VMAT plans, the intersection of the two formulas was PJ index = 6.3% and MLLD = 1180.46 cGy. Conclusions CJ index and PJ index could be used as a practical tool to select 3D-CRT or VMAT before generating plans. We recommend that VMAT plan is preferable when CJ index is greater than 4.2% and/or PJ index is greater than 14.6%, while 3D-CRT plan is the first choice in the opposite.