Intensity modulated conformal radiotherapy of a jugulo-tympanic paraganglioma

Jugulo-tympanic paragangliomas are rare benign tumors arising from the neuroectodermal cells of the tympanic cavity and the dome of the jugular vein. Surgical resection has long been the first-line treatment. However, when this is not possible, radiotherapy remains a therapeutic alternative allowing local control with less morbidity. We report the case of a patient with an unresectable tympano-jugular paraganglioma, the symptomalagy was dominted by chronic headaches and right sided hypoacousie, and the treatment consisted of external radiation therapy with a total dose of 50 Gy in 25 fractions, one fraction per day, 2 Gy per fraction using the IMRT technique. The evolution was good with disappearance of clinical symptomatology, significant local control with less toxicity.

Rectal plasmablastic lymphoma in Ebstein Barr virus positive and human immunodeficiency virus negative subject after external radiation therapy for prostatic cancer

Plasmablastic lymphoma (PBL) represents a rare and aggressive subtype of diffuse large B cells lymphoma (DLBCL) most associated with the human immunodeficiency virus (HIV). Prognosis remains poor despite various treatment approaches. We describe an evolution at six months of HIV negative PBL and Ebstein Barr virus (EBV) positive PBL with chemotherapy. Role of radiotherapy is still unclear.

Dose Calculation Algorithms for External Radiation Therapy: An Overview for Practitioners

Radiation therapy (RT) is a constantly evolving therapeutic technique; improvements are continuously being introduced for both methodological and practical aspects. Among the features that have undergone a huge evolution in recent decades, dose calculation algorithms are still rapidly changing. This process is propelled by the awareness that the agreement between the delivered and calculated doses is of paramount relevance in RT, since it could largely affect clinical outcomes. The aim of this work is to provide an overall picture of the main dose calculation algorithms currently used in RT, summarizing their underlying physical models and mathematical bases, and highlighting their strengths and weaknesses, referring to the most recent studies on algorithm comparisons. This handy guide is meant to provide a clear and concise overview of the topic, which will prove useful in helping clinical medical physicists to perform their responsibilities more effectively and efficiently, increasing patient benefits and improving the overall quality of the management of radiation treatment.

A Study to Assess Effect of Information Booklet on Knowledge Regarding Side Effect Management in the Patients of Head and Neck Cancer Undergoing External Radiation Therapy in Selected Hospital

Objectives: - To evaluate the effectiveness of informational booklet regarding side effects management in patient undergoing external radiation therapy. Methods: Quasi experimental pre test post test design was used in the study at radiation therapy department in cancer institute. 35 patients of head and neck cancer undergoing external radiation therapy received information booklet regarding side effect management of external radiation therapy in their first week of treatment. Knowledge regarding side effect management of external radiation therapy was assessed one week later. Results: - In pre test there was 51.1% patients with poor knowledge, 48.6% had average knowledge and no one had good knowledge whereas the post test scores are increased by 85.7% with good knowledge, 14.3% had average knowledge and no one had poor knowledge. There is significant difference of knowledge score between pre and post test as P<0.0001 i.e. knowledge score significantly increased after administering information booklet. Sociodemographic variable age, gender, educational status, family income & type of treatment were found to have no association with knowledge score regarding management of side effects. Conclusion: - Radiation therapy is one of the important treatments for cancer but can also cause side effects. These Side effects of radiation therapy are very common and can affect the quality of life of the cancer patients. There was significant impact of information booklet on knowledge regarding side effects management of radiation therapy among head and neck cancer patients. Hence using information booklet as an education material can be helpful in teaching patients self care behaviours, prevent the side effects of radiation therapy and improve the quality of life. Key words: Information booklet, external radiation therapy, head and neck cancer, side effect management.

Osteonecrosis of the jaw: a rare but possible side effect in thyroid cancer patients treated with tyrosine-kinase inhibitors and bisphosphonates

Osteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no history of external radiation therapy in the craniofacial region. Although in phase 3 trials of tyrosine kinase inhibitors (TKIs) used in thyroid cancer (TC) the ONJ was not reported among the most common side effects, several papers reported the association between ONJ and TKIs, both when they are used alone and in combination with a bisphosphonate. The appearance of an ONJ in a patient with metastatic radio-iodine refractory differentiated TC, treated with zoledronic acid and sorafenib, has put us in front of an important clinical challenge: when a ONJ occurred during TKIs treatment, it really worsens the patients’ quality of life. We should consider that in the case of ONJ a TKI discontinuation becomes necessary, and this could lead to a progression of neoplastic disease. The most important aim of this review is to aware the endocrinologists/oncologists dealing with TC to pay attention to this possible side effect of BPS and TKIs, especially when they are used in association. To significantly reduced the risk of ONJ, both preventive measures before initiating not only antiresorptive therapy but also antiangiogenic agents, and regular dental examinations during the treatment should always be proposed.

Phase 1 dose-escalation trial using convection-enhanced delivery of radiolabeled monoclonal antibody for diffuse intrinsic pontine glioma following external radiation therapy.

2010 Background: The prognosis of diffuse intrinsic pontine glioma (DIPG) is dire with a median overall survival less than one-year. 124I-omburtamab is a radiolabeled monoclonal antibody that targets B7-H3 epitope. We evaluated the safety of administering escalating doses and volumes of 124I-omburtamab via convection-enhanced delivery (CED) in children with DIPG. Methods: MSKCC 11-011 trial is a standard 3+3 phase 1, open-label, dose escalation study in patients with non-progressive DIPG. CED of 124I-omburtamab was performed between 4-14 weeks post-external radiation therapy. Nine dose levels of a single injection of 124I-omburtamab (Y-mAbs Therapeutics, USA) (range 0.25 to 8.0 mCi; and volume of infusion (Vi) from 250 to 8,000 µl) have been evaluated so far. Patients were assessed weekly for 30 days. Results: 46 children were evaluable for primary and secondary endpoints. The median age at enrolment was 6.5 years (range 2-17). Two patients have experienced AEs CTCAE grade 3 that were categorized as dose limiting toxicities (DLTs), which led to inclusion of three more patients at both the 4 and 6 mCi dose levels. Eight patients have reported transient AEs of grade 3 considered related to 124I-omburtamab. The acute grade 3 AEs were generally indicative of nervous system effects due to volume intolerance or radiation injury, and included hemiparesis (n = 3), dysarthria (n = 3), ataxia (n = 3), dysphagia (n = 2), muscular weakness (n = 2) and gait disturbance (n = 1). There were no related AEs CTCAE grade 4 or 5. Estimations of distribution volumes based on T2-weighted imaging were linearly related to volume with a mean volume of distribution/volume of infusion ratio (Vd/Vi) between 3 and 3.5. The mean ratio of lesion-to-whole body absorbed dose was ̃1000. Median overall survival from diagnosis across all cohorts was 14.8 months (n = 46, 95% CI 11.5, 16.8) and the survival rate estimates (with 95% confidence intervals) at 1, 2, 3 and 5 years were 0.63 (0.46;0.76); 0.13 (0.05;0.26); 0.08 (0.02;0.19); and 0.04 (0.00;0.16), respectively. Four patients have survived > 3 years; two remain alive at 46 and 96 months and two have died at 43 and 53 months, both with CNS disease outside of the treatment field and one with extra-CNS metastases. Conclusions: 124I-omburtamab via CED into the brain stem of children with DIPG and previously irradiated provides a possibility for improved treatment of DIPG. A dose of 8mCi and an infusion volume of 8,000 µl is considered safe and may provide a distribution volume large enough to cover tumor volumes up to 20 cm3. The median overall survival of all patients included in the trial appears to be increased with 3-4 months compared to historical control data from consortia trials. A phase 2 trial aiming at investigating the efficacy of radiolabeled omburtamab administered via CED is being planned. Clinical trial information: NCT01502917.

Utilization of nanotechnology in targeted radionuclide cancer therapy: monotherapy, combined therapy and radiosensitization

The rapid progress of nanomedicine field has a great influence on the different tumor therapeutic trends. It achieves a potential targeting of the therapeutic agent to the tumor site with neglectable exposure of the normal tissue. In nuclear medicine, nanocarriers have been employed for targeted delivery of therapeutic radioisotopes to the malignant tissues. This systemic radiotherapy is employed to overcome the external radiation therapy drawbacks. This review overviews studies concerned with investigation of different nanoparticles as promising carriers for targeted radiotherapy. It discusses the employment of different nanovehicles for achievement of the synergistic effect of targeted radiotherapy with other tumor therapeutic modalities such as hyperthermia and photodynamic therapy. Radiosensitization utilizing different nanosensitizer loaded nanoparticles has also been discussed briefly as one of the nanomedicine approach in radiotherapy.

Endothelium changes of peritumoral zone capillaries after brain glioblastoma adjuvant radiation therapy

Introduction. Despite the treatment methods’ improvement, the brain glioblastoma (GB) patient survival remains at the level of 12–14 months. In this regard, it is very relevant to optimize the choice of the treat-ment of recurrent GB, including using stereotactic radiosurgery (SRS). Materials and methods. Comparative analysis of the endothelial cells in the capillaries of blood vessels of the brain peritumoral zone (PZ) before (1 group – 32 capillaries) and 12 – 14 months after (2 group – 75 capillaries) adjuvant external radiation therapy (AERT) was performed using transmission electron micros-copy (TEM). Results. Apoptosis of endotheliocytes was observed in the capillaries of the brain PZ from 2 group much more often than from 1 group (60% and 12.6% of capillaries, respectively, p<0.001). Capillary death and thrombosis occurred in 4% and 1.4% of 2 group capillaries. An important finding was that only 69.3 of capillaries from 2 group revealed thickening of the basement membrane (BM), and 26.9% of them also revealed its peak deformation. Conclusion. 12–14 months after AERT, the brain PZ remains ischemic due to apoptosis of the capillary endothelium, thickening and peak deformation of the BM. The detected signs of revascularization of the brain PZ after previously performed AERT suggest that it is possible to consider SRS as a method of treat-ment for recurrent brain GB. Keywords: brain glioblastoma, peritumoral zone, endotheliocyte apoptosis, thickening of the basement membrane, stereotactic radiosurgery, glioblastoma relapse

Morphological substantiation of radiomodification of preoperative radiotherapy in patients with advanced endometrial cancer

Relevance. Endometrial cancer ranks first among oncogynecological diseases, however, 5-year survival can be achieved only in 67,7 % of patients, while 22,4 % of patients die during this period from the con­tinuation of the tumor process. Therefore, improving the complex therapy of patients with EC is very important. Purpose of the study. to investigate therapeutic pathomorphosis in pa­tients with advanced endometrial cancer with neoadjuvantchemoradiation therapy. Materials and methods. In order to study radiation pathomorphosis, 26 patients with ER T1-3N0-1M0-1 were examined. Group I consisted of 11 patients with a preoperative course of external radiation therapy SOD 30 Gywithout radiomodification, II – 15 patients with a preoperative course of external radiation therapy SOD 30 Gywith radiomodification. Results and its discussion. When conducting a comparative assessment of radiation pathomorphism in patients of the study groups, it was found that when using the preoperative course of TFD on Gy 30 with radiomodi­fication, a significant decrease in the mitotic index occurs. There is also a tendency to an increase in the degree of tumor regression, the number of pathological mitoses and stromal reactions during the preoperative course of TFD on 30 Gywith radiomodification. Conclusions. It was found that radiation therapy with EС with radiomodi­fication gives a more positive effect and regression of more than 50,0 % of the tumor volume, a decrease in its biological potential. The volume of the damaged tumor was 58,0 %, and the volume of the residual tumor was 42,0 %, that is, most of the tumor mass underwent regression.