What Did the Pandemic Teach Us About Palliative Radiation in Head and Neck Cancer?

Aim: To assess the feasibility and efficacy of palliative radiotherapy dose regimens for patients with locally advanced head and neck cancer. Methods: Fifty patients of previously untreated, inoperable, stage IVA and IVB squamous cell carcinoma of the head and neck, deemed unfit for radical treatment, were included in the study from May 2020 to June 2020. Two palliative radiotherapy regimens were used. First was a single fraction radiation with 8 Gy for patients with limited life expectancy and poor performance status, which was repeated after 4 weeks in case of good symptom relief. The second regimen was used for patients with good performance status and consisted of fractionated radiation with 30 Gy in 10 fractions over 2 weeks, which was followed by supplementary radiation with 25 Gy in 10 fractions over 2 weeks in patients with good symptomatic response at 2 weeks. Symptoms were assessed at baseline and at the end of 4 weeks after treatment completion using the numerical rating score. Patients were followed up for a median of 4.5 months and assessed for symptom control and overall survival. Results: Forty-eight patients completed treatment and were included for analysis. Of the 24 patients who received single fraction radiation, 13 (54.2%) were given the second dose. Improvement in pain and dysphagia were reported in 57.9% and 60% patients, respectively. A total of 55.5% noted decrease in size of the neck node. Twenty-four patients received fractionated radiation and 15 (62.5%) were given the second course after 2 weeks. Relief in pain and dysphagia was reported in 68.2% and 63.6% patients, respectively. There were no grade 3/4 toxicities. Symptom control lasted for at least 3 months in 30% of the patients who received single fraction radiation and 54.2% of the patients who received fractionated radiation. The estimated 6-month overall survival of the entire cohort was 51.4%. Conclusion: Judicious use of palliative radiation in advanced incurable head and neck cancers provides effective and durable symptom relief and should be used after careful consideration of patient prognosis, logistics of treatment, and goals of care.

Fractionated Radiation Exposure Enhances DNA Repair Capacity to Amplify Radioresistance of Cancer Cells

Fractionated radiotherapy is widely used in cancer therapy for its advantages in the preservation of normal tissues, but may amplify radioresistance of cancer cells. To understand whether and how fractionated radiation exposure amplifies radioresistance, HCT-8 human colon cancer cells and MCF-7 human breast cancer cells were received a total dose of 5 Gy X-ray irradiation by a single exposure or fractionated exposures (1 Gy/day for 5 consecutive days), respectively. We then examined the radioresistance of cells. Underwent an additional exposing to 2 Gy, cells received fractionated exposures showed significantly better cell proliferation and clonogenic ability than cells received a single exposure. Compared to the intact cells without radiation exposure, the expression of γ-H2AX, pATM and PARP was significantly enhanced in only these cells received fractionated exposures. However, the expression of cyclin D1 and cyclin E1 was enhanced in only these HCT-8 cells received a single exposure. Otherwise, the expression of SOD1, SOD2 and caspase 3 was not significantly changed in both cells received either a single exposure or fractionated exposures. Fractionated radiation exposure amplifies radioresistance of cancer cells, predominantly by enhancing DNA repair capacity.

Stem Cell Migration: A Possible Mechanism for the Tissue-Sparing Effect of Spatially Fractionated Radiation

Stem cell responses in tissues after exposure to radiation are of significance for maintaining tissue functions. From the point of view of stem cell characteristics, this article seeks to illustrate some contributions of microbeam research to spatially fractionated radiotherapy (SFRT), such as grid radiotherapy and microbeam radiotherapy. Although the tissue-sparing response after SFRT was first reported more than a century ago, current radiation dose–volume metrics are still unable to accurately predict such tissue-level changes in response to spatially fractionated radiation fields. However, microbeam approaches could contribute to uncovering the mechanisms of tissue response, significantly improving the outcomes of SFRT and reducing its adverse effects. Studies with microbeams have shown that the testicular tissue-sparing effect for maintaining spermatogenesis after exposure to spatially fractionated radiation depends on biological parameters, such as the radiation dose distribution at the microscale level for tissue-specific stem cells and the microenvironment, or niche. This indicates that stem cell survival, migration, and repopulation are involved in the tissue-level changes during or after SFRT. The illustration of microbeam applications in this article focuses on the stem cell migration as a possible mechanism of the tissue-sparing effect for preserving functionality.

Comparison of stereotactic body radiation therapy versus fractionated radiation therapy for primary liver cancer with portal vein tumor thrombus

Background To compare the clinical outcomes of stereotactic body radiation therapy (SBRT) and fractionated radiation therapy (FRT) for primary liver cancer with portal vein tumor thrombus (PVTT). Methods This retrospective study included 36 patients who underwent SBRT and 36 patients who underwent FRT from August 2016 to June 2018. Patients were evaluated for short-term efficacy, long-term efficacy, AEs, and quality of life before and after treatment. Results With a median follow-up of 28.8 months (26–36 months), 27 patients survived in the SBRT group while 19 patients survived in the FRT group. The survival rate in the SBRT group was statistically higher than that of the FRT group after 6 months (80.56% vs. 58.33%; P = 0.041), 12 months (77.78% vs. 55.56%; P = 0.046) and 24 months 75.00% vs. 52.78%; P = 0.049). The median whole survival time of the SBRT group was 13.3 months (95% CI 12.83–13.97), which was statistically longer than 9.8 months in the FRT group (95% CI 8.83–10.97, P < 0.05) based on the Kaplan–Meier method. The SBRT group had better survival quality and fewer adverse events than the FRT group. Conclusion SBRT had better clinical outcomes than FRT for primary liver cancer with PVTT.

Extended Hypofractionated Cancer Radiation Therapy Against Aged and Non-aged Breast Carcinomas Patients

We led an investigation to decide if hypo fractionated 35-days timetable of entire breast radiation is pretty much as viable. Women who bearing obtrusive breast carcinoma had gone through breast monitoring a medical procedure and resection edges were clean and partially lymph hubs were negatively approached with haphazardly relegated to get entire bosom illumination either at a control portion of 50 Gy in 15 divisions over a time of 45 days or at a portion of 45.5 Gy in 12 parts over a time of 22 days (the hypo fractionated-radiation bunch). The repetition at 36 months were 7.2% among the 301 ladies allocated to standard illumination as contrasted and 7.6% among the 312 ladies allocated to the hypo fractionated routine. At 36 months, 69.5% of ladies in the benchmark group as contrasted and 71.2% of the ladies in the hypo fractionated-radiation bunch had a decent or astounding restorative result. 3 years after therapy, sped up, hypo fractionated entire breast illumination was not sub-par compared to standard radiation therapy in ladies who had gone through breast preserving a medical procedure for obtrusive bosom malignant growth with clear careful edges what's more, negative axillary hubs. The ideal fractionation plan for entire bosom light after bosom rationing medical procedure is obscure.