Management of single pulmonary metastases from colorectal cancer:State of the art

Colorectal cancer(CRC)is one of the most common causes of death from cancer.Lung seeding occurs in approximately 10%of patients surgically treated for primary CRC with radical intent:the lung is the most common site of metastases after the liver.While surgical treatment of liver metastases is widely accepted to affect long-term outcomes,more controversial and not standardized is the therapy for CRC patients developing lung metastases.Experience suggests the potential curative role of pulmonary metastasectomy,especially in oligometastatic disease.However,the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined.This review focused on the uncommon scenario of single pulmonary metastases from CRC.We explored pertinent literature and provide an overview of the epidemiology,clinical characteristics and imaging of single pulmonary metastases from CRC.Additionally,we identified the best available evidence for overall management.In particular,we analyzed the role and results of locoregional approaches(surgery,radiotherapy or ablative procedures)and their integration with systemic therapy.

Robotic radiosurgery in pancreatic cancer: A systematic review

AIM: To present a systematic review of techniques and clinical results.METHODS: A systematic review of published literature was performed. Only studies reporting patient outcome after radiosurgery(single fraction) delivered with robotic devices [i.e.,robotic radiosurgery(RRS)] have been analyzed.RESULTS: A total of 96 patients from 5 studies were included. The studies are characterized by small series and different methods in terms of dose,target definition,combination with chemotherapy and/or standard fractionated radiotherapy and evaluation modalities. Preliminary results are positive in terms of tumor response(ORR = 56%) and local control of the tumor(crude rate of local progressions: 19.5%).Results for median overall survival(11.4 mo) seem comparable with the ones of prolonged chemoradiation(range: 8.6-13.0 mo). However,gastrointestinal toxicity seems to be the main limitation of RRS,especially at the duodenal level.CONCLUSION: RRS allows for local treatment in a shortened time(1 fraction) compared to traditional treatments(about 1 mo),providing the possibility for an easy integration with systemic therapies. Preliminary results did not show any outcome differences compared to standard chemoradiation. Thus,further efforts to reduce gastrointestinal toxicity are strongly needed.

Immunosuppressive treatment and radiotherapy in kidney transplant patients:A systematic review

BACKGROUND Immunosuppression(IS)therapy may contribute to cancer development.Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections,in immunosuppression-related diseases,and in patients undergoing radiotherapy.The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.METHODS The literature search was based on three electronic databases(Pubmed,Scopus,and Web of Science)using selected keywords linked through the"AND"and"OR"Boolean operators to build specific strings for each electronic search engine.Two researchers independently screened the citations,and disagreement was resolved by discussion or through the intervention of a third author.The review was conducted and reported according to the PRISMA statement.Extracted data were narratively synthesized,and,where possible,frequencies,percentages,and ranges were calculated.RESULTS The literature search resulted in 147 citations.After abstracts screening,21 records were selected for full-text evaluation.Fifteen of these were excluded,leaving six papers considered suitable for analysis.There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors,as opposed to continuing maintenance IS,improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy.Only few retrospective studies on small cancer patient cohorts are available in this setting,but without comparison of different immunosuppression treatments.Even where immunosuppression therapy was described,patient survival seemed to be correlated only with cancer stage and type.CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.

Hypofractionated and Low Dose Radiotherapy Combined with Temozolomide in Naive Unresectable Glioblastoma:A Pilot Study

Background/Aim: To assess safety of hypo-fractionated radiotherapy( HyRT) followed by low dose radiation therapy( LD-FRT) plus Temozolomide( TMZ) in naive unresectable Glioblastoma. Methods: Patients( ECOG < 2,age > 18) undergone to biopsy or with gross residual tumor after surgery were enrolled. HyRT( 30 Gy in ten fraction) plus TMZ was administered. From the second adjuvant cycle of TMZ,patients received LD-FRT( 0. 40 Gy twice daily over 5 days,every 28 days) for two cycles. The primary endpoints were safety and toxicity. Moreover we analyzed response,overall survival( OS) and progression-free survival( PFS). Results: Twenty patients were enrolled. Median dose of LD-FRT was 12 Gy. All toxicities were reversible. Four out of 20 patients had Partial Response( PR)and 6 experienced a stable disease( SD). Median OS and PFS were 14 and 11 months,respectively.Conclusions: HyRT followed by LD-FRT plus TMZ is safe and shows good clinical outcomes. A new study is ongoing.

Optimizing the Dose Distribution in Stereotactic Body Radiotherapy with Standard Multileaf Collimator(MLC) ： A Planning Study

导读：体部立体定向放射治疗（SBRT）可实现靶区剂量的集中、精准和生物有效性，同时避开重要的正常器官。它在当今放疗世界扮演着越来越重要的地位。为了得到更好的剂量优化，目前有很多关于定位、处方剂量技术的研究，运用IMRT可实现SBRT的剂量优化，但各个放疗中心的结果却不尽相同，尚未完全统一。