BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent ...BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.展开更多
Objective This study aims to quantify the uncertainties of CyberKnife Synchrony fiducial tracking for liver stereotactic body radiation therapy(SBRT)cases,and evaluate the required planning target volume(PTV)margins.M...Objective This study aims to quantify the uncertainties of CyberKnife Synchrony fiducial tracking for liver stereotactic body radiation therapy(SBRT)cases,and evaluate the required planning target volume(PTV)margins.Methods A total of 11 liver tumor patients with a total of 57 fractions,who underwent SBRT with synchronous fiducial tracking,were enrolled for the present study.The correlation/prediction model error,geometric error,and beam targeting error were quantified to determine the patient-level and fraction-level individual composite treatment uncertainties.The composite uncertainties and multiple margin recipes were compared for scenarios with and without rotation correction during treatment.Results The correlation model error-related uncertainty was 4.3±1.8,1.4±0.5 and 1.8±0.7 mm in the superior-inferior(SI),left-right,and anterior-posterior directions,respectively.These were the primary contributors among all uncertainty sources.The geometric error significantly increased for treatments without rotation correction.The fraction-level composite uncertainties had a long tail distribution.Furthermore,the generally used 5-mm isotropic margin covered all uncertainties in the left-right and anterior-posterior directions,and only 75%of uncertainties in the SI direction.In order to cover 90%of uncertainties in the SI direction,an 8-mm margin would be needed.For scenarios without rotation correction,additional safety margins should be added,especially in the superior-inferior and anterior-posterior directions.Conclusion The present study revealed that the correlation model error contributes to most of the uncertainties in the results.Most patients/fractions can be covered by a 5-mm margin.Patients with large treatment uncertainties might need a patient-specific margin.展开更多
Objective The combination of stereotactic body radiation therapy(SBRT)and immune checkpoint inhibitors(ICIs)is actively being explored in advanced non-small-cell lung cancer(NSCLC)patients.However,little is known abou...Objective The combination of stereotactic body radiation therapy(SBRT)and immune checkpoint inhibitors(ICIs)is actively being explored in advanced non-small-cell lung cancer(NSCLC)patients.However,little is known about the optimal fractionation and radiotherapy target lesions in this scenario.This study investigated the effect of SBRT on diverse organ lesions and radiotherapy dose fractionation regimens on the prognosis of advanced NSCLC patients receiving ICIs.Methods The medical records of advanced NSCLC patients consecutively treated with ICIs and SBRT were retrospectively reviewed at our institution from Dec.2015 to Sep.2021.Patients were grouped according to radiation sites.Progression-free survival(PFS)and overall survival(OS)were recorded using the Kaplan-Meier method and compared between different treatment groups using the log-rank(Mantel-Cox)test.Results A total of 124 advanced NSCLC patients receiving ICIs combined with SBRT were identified in this study.Radiation sites included lung lesions(lung group,n=43),bone metastases(bone group,n=24),and brain metastases(brain group,n=57).Compared with the brain group,the mean PFS(mPFS)in the lung group was significantly prolonged by 13.3 months(8.5 months vs.21.8 months,HR=0.51,95%CI:0.28–0.92,P=0.0195),and that in the bone group prolonged by 9.5 months with a 43%reduction in the risk of disease progression(8.5 months vs.18.0 months,HR=0.57,95%CI:0.29–1.13,P=0.1095).The mPFS in the lung group was prolonged by 3.8 months as compared with that in the bone group.The mean OS(mOS)in the lung and bone groups was longer than that of the brain group,and the risk of death decreased by up to 60%in the lung and bone groups as compared with that of the brain group.When SBRT was concurrently given with ICIs,the mPFS in the lung and brain groups were significantly longer than that of the bone group(29.6 months vs.16.5 months vs.12.1 months).When SBRT with 8–12 Gy per fraction was combined with ICIs,the mPFS in the lung group was significantly prolonged as compared with that of the bone and brain groups(25.4 months vs.15.2 months vs.12.0 months).Among patients receiving SBRT on lung lesions and brain metastases,the mPFS in the concurrent group was longer than that of the SBRT→ICIs group(29.6 months vs.11.4 months,P=0.0003 and 12.1 months vs.8.9 months,P=0.2559).Among patients receiving SBRT with<8 Gy and 8–12 Gy per fraction,the mPFS in the concurrent group was also longer than that of the SBRT→ICIs group(20.1 months vs.5.3 months,P=0.0033 and 24.0 months vs.13.4 months,P=0.1311).The disease control rates of the lung,bone,and brain groups were 90.7%,83.3%,and 70.1%,respectively.Conclusion The study demonstrated that the addition of SBRT on lung lesions versus bone and brain metastases to ICIs improved the prognosis in advanced NSCLC patients.This improvement was related to the sequence of radiotherapy combined with ICIs and the radiotherapy fractionation regimens.Dose fractionation regimens of 8–12 Gy per fraction and lung lesions as radiotherapy targets might be the appropriate choice for advanced NSCLC patients receiving ICIs combined with SBRT.展开更多
Objective:To carry out dosimetric comparison between volumetric modulated arc therapy(VMAT)and intensity-modulated radiation therapy(IMRT)in cervical cancer.Methods:50 postoperative cervical cancer patients were inclu...Objective:To carry out dosimetric comparison between volumetric modulated arc therapy(VMAT)and intensity-modulated radiation therapy(IMRT)in cervical cancer.Methods:50 postoperative cervical cancer patients were included in this study.The patients were admitted for treatment from January 2021 to January 2022.VMAT and IMRT plans were designed for each patient to analyze the dose distribution in the target area of the two treatment techniques.Results:Comparing the monitor unit for single treatment(638.21±116.21 MU)and time of single treatment(143.21±23.14 s)in the observation group and the monitor unit for single treatment(932.14±74.11 MU)and time of single treatment(223.14±17.26 s)in the control group,there was significant difference(P<0.05);there was also significant difference(P<0.05)between the normal tissue(bladder and rectum)of the observation group and that(bladder and rectum)of the control group.Conclusion:VMAT is more effective in cervical cancer,and it has a certain protective effect on normal tissues in patients and can reduce the radiation dose.展开更多
Cancers, malignant melanoma and sarcomas of the skin represent the most common group of malignancies in humans. The main treatment method of almost all skin cancers and subcutaneous tissue tumours is surgery, which co...Cancers, malignant melanoma and sarcomas of the skin represent the most common group of malignancies in humans. The main treatment method of almost all skin cancers and subcutaneous tissue tumours is surgery, which consists of complete removal of a neoplastic lesion, with an adequate margin of healthy tissue. Radiotherapy plays an adjuvant role in this process, meaning complementing of the surgical procedure. This study compared four methods of irradiation treatment of cancer located in the skin or in subcutaneous tissues: contact brachytherapy, conventional orthovoltage therapy, electron beam conformal teleradiotherapy and IMRT dynamically shaped photonic beams conformal teleradiotherapy. In order to compare the methods and techniques of surface radiotherapy, following specific objectives were formulated. At the beginning in order to compare the scopes of the absorbed doses at different tissue depths, an analysis of parameters describing particular beams or radiation source has been performed—the curves for the absorbed-dose depth drop-offs. Doses distribution in tissue-like phantoms stimulating homogeneous cuboidal tissue block has been determined. A quality comparison of dose distribution in 2D and 3D treatment planning system for contact brachytherapy application has been made. The dose distribution for electron beam in the system has been determined. Conformal plannings for electron beam treatment, contact brachytherapy applicator treatment and 4 photon beams treatment optimized in IMRT technology have been performed. Dose distribution has been performed for the irradiated female patient within the well chest—the target included the recurrence area in the post-operative scar. The radiation therapy with X-rays has actually been completely eliminated from skin cancer and subcutaneous tissue radiotherapy by the electrons generated in linear accelerators, contact brachytherapy HDR and by high-energy photons used in conformal techniques, ex. IMRT. It is because the residual dose beyond the target is the highest for single X-ray beam. Although in brachytherapy HDR a rapid dose drop-off is observed, 5 cm from its normalization level for the target the residual radiation remains at the level of several percent. So, both X-rays beam radiation and brachytherapy in skin cancer treatment is connected with the administration of the dose with a high gradient in the health tissues. The dose distribution for photon conformal techniques IMRT or for electron radiation looks different. There with the dose normalization at the level of 90% or 85% we deal with the dose layer, the division does not exceed 15% of heterogeneity.展开更多
Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three m...Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.展开更多
Health-related quality-of-life (HRQOL) after a radical prostatectomy (RP) or extemal beam radiation therapy (EBRT) has not been studied in conjunction with oncological outcomes in relation to disease risk strati...Health-related quality-of-life (HRQOL) after a radical prostatectomy (RP) or extemal beam radiation therapy (EBRT) has not been studied in conjunction with oncological outcomes in relation to disease risk stratification. Moreover, the long-term outcomes of these treatment approaches have not been studied. We retrospectively analyzed oncological outcomes between consecutive patients receiving RP (n = 86) and EBRT (n = 76) for localized prostate cancer. HRQOL and functional outcomes could be assessed in 62 RP (79%) and 54 EBRT (79%) patients over a 3-year follow-up period (median: 41 months) using the Medical Outcomes Study Short Form-36 (SF-36) and the University of Califomia Los Angeles Prostate Cancer Index (UCLA PCI). The 5-year biochemical progression-free survival did not differ between the RP and EBRT groups for low-risk (74.6% vs. 75.0%, P = 0.931) and intermediate-risk (61.3% vs. 71.1%, P = 0.691) patients. For high-risk patients, progression-free survival was lower in the RP group (45.1%) than in the EBRT group (79.7%) (P = 0.002). The general HRQOL was comparable between the two groups. Regarding functional outcomes, the RP group reported lower scores on urinary function and less urinary bother and sexual bother than the EBRT group (P 〈 0.001, P 〈 0.05 and P 〈 0.001, respectively). With risk stratification, the low- and intermediate-risk patients in the RP group reported poorer urinary function than patients in the EBRT group (P 〈 0.001 for each). The sexual function of the high-risk patients in the EBRT group was better than that of the same risk RP patients (P 〈 0.001). Biochemical recurrence was not associated with the UCLA PCI score in either group. In conclusion, low- to intermediate-risk patients treated with an RP may report relatively decreased urinary function during long-term follow-up. The patient's HRQOL after treatment did not depend on biochemical recurrence.展开更多
BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect a...BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect and abscopal effect response following carbon-ion irradiation for recurrent thymic carcinoma.CASE SUMMARY A 44-year-old female presented with shortness of breath.Eleven years prior,she was diagnosed with athymic tumor located in the anterosuperior mediastinum.She underwent extensive tumor resection,and the postoperative pathologic diagnosis was thymic carcinoma.She was administered 50 Gy/25 Fx of postoperative radiation.In 2019,she was diagnosed with a recurrence of thymic carcinoma,with multiple recurrent nodules and masses in the left thoracic chest and peritoneal cavity,the largest of which was in the diaphragm pleura proximal to the pericardium,with a size of 6.7 cm×5.3 cm×4.8 cm.She received carbonion radiotherapy.After carbon-ion radiotherapy treatment,the treated masses and the untreated masses were observed to have noticeably shrunk on the day of carbon-ion radiotherapy completion and on follow-up imaging.We followed the CARE Guidelines for consensus-based clinical case reporting guideline development and completed the CARE Checklist of information to report this case.CONCLUSION This report is the first of obvious abscopal and bystander effects following carbonion irradiation in a human patient,and further research is needed to better elucidate the mechanisms of bystander and abscopal effects.展开更多
Objective This study explains the application number and funding rate of oncology projects undertaken by the National Natural Science Foundation of China(NSFC),with focus on tumor radiotherapy-related research over th...Objective This study explains the application number and funding rate of oncology projects undertaken by the National Natural Science Foundation of China(NSFC),with focus on tumor radiotherapy-related research over the past 11 years.Methods A stratified analysis was carried out on the application and funding status of tumor radiotherapy studies in different NSFC project categories,different research areas,and different tumor types.Research areas that required specific focus,such as immunology-related radiotherapy,multimodality imaging and radiomics,and post-radiotherapy organ injury,were separately analyzed.Results The status and development trends of various related research fields were studied,and the research results were presented with the support of the NSFC,in order to provide reference for future applications and funding allocations.Conclusion The number of applications for funding increases every year.Although the total number of funded projects has also increased every year,the funding rate has decreased year by year.Projects on radiotherapy and immunization have been at the forefront in recent years,and the funding rate for these projects increases yearly.展开更多
BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for wait...BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor growth.Transarterial chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in LT.However,it remains unclear if one of those treatment options is superior.The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.METHODS In this multicenter retrospective study,27 patients who received liver transplantation for HCC were analyzed.Patients received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver transplantation.Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies.Statistical analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U tests.RESULTS Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and SBRT.There were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor lesions.Strikingly,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.展开更多
Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide.A multimodality treatment approach may be utilized for optimal management of patients with combina...Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide.A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery,radiation therapy(RT)and systemic treatment.RT composes an integral part of breast conserving treatment,and is typically used after breast conserving surgery to improve local control.Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery.Adaptive radiation therapy(ART)is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation.In the context of breast cancer,ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed.Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation.Herein,we provide a concise review of ART for breast cancer in light of the literature.展开更多
The European Organization for Research on Treatment of Cancer Research published a consensus statement to establish the key criteria to define oligometastatic disease(OMD).According to those criteria,all lesions(both ...The European Organization for Research on Treatment of Cancer Research published a consensus statement to establish the key criteria to define oligometastatic disease(OMD).According to those criteria,all lesions(both primary and metastatic)should be amenable to radical intent treatment with acceptable toxicity.Several retrospective studies have shown that adding local ablative therapy to the treatment of OMD improves outcomes;however,due to the diverse selection criteria and treatment strategies used in those studies,it is difficult to compare directly results to draw definitive conclusions.In recent years,prospective phase II trials,such as the SABR-COMET and"Oligomez"trials,have shown that stereotactic body radiation therapy(SBRT)improves outcomes in patients with OMD.More recently,interim results of the randomised phase 3 SINDAS trial were reported at the annual meeting of the American Society of Clinical Oncology 2020 demonstrating that upfront SBRT added to systemic treatment with tyrosine kinase inhibitors yielded a significant benefit in both progression-free survival and overall survival in patients with epidermal growth factor receptor-mutant oligometastatic non-small cell lung cancer.In the present editorial,we review the definition and historical context of advanced non-small cell lung cancer with OMD.In addition,we review the scientific evidence for local ablative therapy and SBRT and discuss the results of recently published prospective studies.We also discuss in depth the results of the SINDAS study,including the strengths and weaknesses of the study and the barriers to extrapolating these results to routine clinical practice.展开更多
BACKGROUND Although stereotactic body radiation therapy(SBRT)is increasingly used,its application has not yet been regulated by the main international guidelines,leaving the decision to multidisciplinary teams.AIM To ...BACKGROUND Although stereotactic body radiation therapy(SBRT)is increasingly used,its application has not yet been regulated by the main international guidelines,leaving the decision to multidisciplinary teams.AIM To assess magnetic resonance imaging(MRI)features of hepatocellular carcinoma(HCC)treated with SBRT,highlighting the efficacy of the treatment and the main aspects of the lesion before and after the procedure.METHODS As part of a retrospective study,49 patients who underwent SBRT for HCC between January 2013 and November 2019 were recruited.Each patient under went a pre-treatment MRI examination with a hepatospecific contrast agent and a similar followup examination within 6 mo of therapy.In addition,22 patients underwent a second follow-up examination after the first 6 mo.The following characteristics were analysed:Features analysed compared to pre-treatment MRI examination,presence or absence of infield and outfield progression,ring-like enhancement,signal hyperintensity in T2-weighted sequences in the perilesional parenchyma,capsular retraction,and"band"signal hypointensity in T1-weighted gradient echo fat saturated sequences obtained during hepatobiliary excretion.RESULTS Signal hyperintensity in the T2-weighted sequences showed a statistically significant reduction in the number of lesions at the post-SBRT first control(P=0.0006).Signal hyperintensity in diffusionweighted imaging-weighted sequences was decreased at MRI first control(P<0.0001).A statistically significant increase of apparent diffusion coefficient values from a median of 1.01 to 1.38 at the first post-control was found(P<0.0001).Capsular retraction was increased at the late evaluation(P=0.006).Band-like signal hypointensity in the hepatobiliary phase was present in 94%at the late control(P=0.006).The study of the risk of outfield progression vs infield progression revealed a hazard ratio of 9.CONCLUSION The efficacy of SBRT should be evaluated not in the first 6 mo,but at least 9 mo post-SBRT,when infield progression persists at very low rates while the risk of outfield progression increases significantly.展开更多
Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely ...Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely follow prescriptions. Poor adherence to radiation therapy is associated with low survival and high mortality rates. This study therefore sought to investigate the levels of adherence and factors influencing adherence to radiation therapy among cervical cancer patients being treated at Cancer Diseases Hospital. Methods: A cross-sectional analytical study design was used, 142 patients were selected from the outpatient department using a fishbowl sampling method. A structured interview schedule was used to collect data. Data was entered and analyzed using SPSS, the binary logistic regression analysis was used to predict levels of adherence to treatment and to identify factors associated with adherence to RT among cervical cancer patients. Results: The findings showed that 93% of the participants adhered to radiation therapy while 7% did not adhere to treatment. Majority of the patients 77.1% had experienced side effects of radiation therapy. About 28% of patients had severe psychological distress. By using binary logistic regression, there was a statistically significant association between adherence and perceived quality of health care services (p = 0.001). The analysis showed that patients who perceived poor quality of health care services were 0.005 (99.5%) times less likely to adhere to radiation therapy. The other independent variables were not statistically significant despite being associated with adherence among cervical cancer patients. Conclusions and Recommendations: The findings showed that patients who perceived good quality of health care services had higher chances of adherence compared to those who perceived poor quality of health care services. There is therefore a need for quality service provision which could include good maintenance of radiation machines. Furthermore, there is a need to develop guidelines for follow-up in case of any disease outbreak to avoid interference with patients’ treatment schedules and appointments for reviews.展开更多
To study the clinical significance of the morphological and volume changes in cervical cancer during an ongoing course of radiation therapy (RT) using MR imaging. Methods: Serial MR imaging examinations were performed...To study the clinical significance of the morphological and volume changes in cervical cancer during an ongoing course of radiation therapy (RT) using MR imaging. Methods: Serial MR imaging examinations were performed in 60 advanced cervical cancer patients. MR imaging was obtained at the start of RT, at 20-25 Gy (2-2.5 weeks of RT), at 45-50 Gy (4-5 weeks of RT), and 1-2 month post-RT. Tumor morphology was classified qualitatively as well-defined (round/oval with a well-demarcated smooth margin) vs. lobulated vs. irregular and tumor volume was assessed in each serial MR examination independently by ROI volumetry and diameter volumetry. ROI volumetry was traced on the computer workstation with a trackball in each sagittal T2-weighted image and calculated by the summation of all tumor areas in each slice and multiplication by the slice profile. Diameter volumetry was to measure the largest three orthogonal tumor diameters in each orthogonal measurement plane and calculate as an ellipsoid formula (V=d1 x d2 x d3 x p/6). Serial tumor volume was compared between the two measurement methods. Results: The proportion of lobulated and irregular tumors increased early during RT and declined lately post-RT (68% pre-RT, 80% at 2-2.5 weeks of RT, 72% at 4-5 weeks of RT, 33% post-RT). Accordingly, ROI volumetry and diameter volumetry correlated well pre-RT (r1=0.89) and post-RT (r4=0.80), but poorly during RT (r2 = 0.17 at 2-2.5 weeks of RT, r3 = 0.69 at 4-5 weeks of RT). Conclusions: Cervical cancers regress in a non-uniform fashion during RT and undergo increasingly irregular shrinkage. Measurement with ROI volumetry techniques, which can optimally measure irregular volumes, provides better assessment of radiation response during treatment than diameter volumetry.展开更多
The aim of this mini-review is to compare and contrast the pros and cons of short-course and long-course neoadjuvant chemoradiation therapy regimens for stageⅡ&Ⅲrectal adenocarcinoma.Multiple trials have demonst...The aim of this mini-review is to compare and contrast the pros and cons of short-course and long-course neoadjuvant chemoradiation therapy regimens for stageⅡ&Ⅲrectal adenocarcinoma.Multiple trials have demonstrated the equal efficacy and safety of short-course and long-course radiation therapy as a part of neoadjuvant regimens.Published data also shows that total neoadjuvant therapy could be more successful than neoadjuvant chemoradiation followed by adjuvant chemotherapy.This review points out future research directions for patients with locally advanced rectal adenocarcinoma such as comparing total neoadjuvant therapy that contains a short-course of radiation therapy to the standard of care,and evaluating how the sequence of short-course radiation therapy and chemotherapy in the total neoadjuvant therapy impacts the pathological complete response(pCR)rate,local control,and survival outcomes.展开更多
BACKGROUND There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm(IPMN),who are surgically intolerant and require less invasive treatment options,which are limited.In the ...BACKGROUND There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm(IPMN),who are surgically intolerant and require less invasive treatment options,which are limited.In the present study,we report a case of IPMN presenting with acute recurrent pancreatitis(ARP),in which radiation therapy effectively prevented further attacks of ARP and reduced tumor volume.CASE SUMMARY An 83-year-old man was referred to our hospital with an asymptomatic incidental pancreatic cyst.Endoscopic ultrasound imaging and magnetic resonance cholangiopancreatography revealed a multiloculated tumor in the head of the pancreas,with dilated pancreatic ducts and mural nodules.The patient was diagnosed with mixed-type IPMN,and five years later,he developed ARP.Several endoscopic pancreatic ductal balloon dilatations failed to prevent further ARP attacks.Surgery was considered clinically inappropriate because of his old age and comorbidities.He was referred to our department for radiation therapy targeted at those lesions causing intraductal hypertension and radiation was administered at a dose of 50 Gy.An magnetic resonance imaging scan taken ten weeks after treatment revealed a decrease in tumor size and improvement of pancreatic duct dilatation.Fourteen months later,he remains symptom-free from ARP.CONCLUSION This case highlights the important role of radiation therapy in mitigating the signs and symptoms of ARP in patients with inoperable IPMN.展开更多
Whole breast external beam radiotherapy is an effective adjuvant treatment for early breast cancer, and was a key factor in the move from mastectomy to breast-conserving surgery for women with low-risk disease. The lo...Whole breast external beam radiotherapy is an effective adjuvant treatment for early breast cancer, and was a key factor in the move from mastectomy to breast-conserving surgery for women with low-risk disease. The logical development from partial surgical removal of the breast is partial breast radiotherapy. Several methods of delivery have been investigated, but as yet none has been widely accepted.展开更多
Radiation therapy(RT)is a treatment option for head and neck cancer(HNC),but 2%of RT patients may experience damage to the jawbone,resulting in osteoradionecrosis(ORN).The ORN can manifest years after RT exposure.Chan...Radiation therapy(RT)is a treatment option for head and neck cancer(HNC),but 2%of RT patients may experience damage to the jawbone,resulting in osteoradionecrosis(ORN).The ORN can manifest years after RT exposure.Changes in the local microchemical bone quality prior to the clinical manifestation of ORN could play a key role in ORN pathogenesis.Chemical bone quality can be analyzed using Fourier transform infrared spectroscopy(FTIR),that is applied to examine the effects of cancer,chemotherapy,and RT on the quality of human man-dibular bone.Cortical mandibular bone samples were harvested from dental implant beds of 23 individuals,i.e.,patients with surgically and radiotherapeutically treated HNC(RT-HNC,n=7),surgically and radiochemotherapeutically treated HNC(CH-RT-HNC,n=3),only surgically treated HNC(SRG-HNC,n=4),and healthy controls(n=9).Infrared spectra were acquired from two representative regions of interest in cortical mandibular bone.Spectral parameters,i.e.,mineral-to-matrix ratio(MM),carbonate-to-matrix ratio(CM),carbonate-to-phosphate ratio(CP),collagen maturity(cross-linking),crystallinity,acid phosphate substitu-tion(APS),and advanced glycation end products(AGEs),were analyzed for each sample.Amide I region of the CH-RT-HNC group differed from the control group in cluster analysis(p=0.02).Apart from a minor variation trend in collagen maturity(p=0.07),there were no other signif-icant differences between the groups.Thus,the effect of radiochemotherapy on mandibular bone composition should be further investigated.In future trials,this study design is potential when the effects of the cancer burden and different HNC treatment modalities on jawbone composition are studied,in order to reveal ORN pathogenesis.展开更多
Objective:Serum prostate specific antigen(PSA)is commonly used to evaluate treatment response after definitive radiation therapy(RT).However,PSA levels can temporarily rise without a clear reason,termed“PSA bounce”,...Objective:Serum prostate specific antigen(PSA)is commonly used to evaluate treatment response after definitive radiation therapy(RT).However,PSA levels can temporarily rise without a clear reason,termed“PSA bounce”,and often engender great anxiety for both patients and physicians.The present study aimed to determine the prevalence and factors that predict“PSA bounce”after intensity-modulated radiation therapy(IMRT),and the relevance to biochemical failure and cancer recurrence in an Asian population.Methods:We retrospectively reviewed 206 patients who received IMRT for prostate cancer from 2004 to 2012 in the National Cancer Centre Singapore.These patients were followed up with regular PSA monitoring.We defined“PSA bounce”as a rise of 0.1 ng/mL,followed by two consecutive falls.Patients with biochemical failure(PSA nadir t 2 ng/mL)were further evaluated for cancer recurrence.Results:Sixty-one patients(29.6%)experienced“PSA bounce”,at a median time of 16 months and lasted for 12 months.Age remained the most consistent predictor of the incidence,duration and extent of“PSA bounce”.Other contributory factors included baseline PSA,Gleason score and PSA nadir.Hormonal therapy and prostate volume did not affect this phenomenon.Sixteen patients(7.8%)developed biochemical recurrence,at median time of 32 months,of which 11 were confirmed to have metastatic disease.The median follow-up time was 71 months.展开更多
基金Supported by The Science and Technology Plan Project of Guangzhou,No.202102010171National Natural Science Foundation。
文摘BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.
基金This project was supported by the National Key R&D Program of China(No.2016YFC105300).
文摘Objective This study aims to quantify the uncertainties of CyberKnife Synchrony fiducial tracking for liver stereotactic body radiation therapy(SBRT)cases,and evaluate the required planning target volume(PTV)margins.Methods A total of 11 liver tumor patients with a total of 57 fractions,who underwent SBRT with synchronous fiducial tracking,were enrolled for the present study.The correlation/prediction model error,geometric error,and beam targeting error were quantified to determine the patient-level and fraction-level individual composite treatment uncertainties.The composite uncertainties and multiple margin recipes were compared for scenarios with and without rotation correction during treatment.Results The correlation model error-related uncertainty was 4.3±1.8,1.4±0.5 and 1.8±0.7 mm in the superior-inferior(SI),left-right,and anterior-posterior directions,respectively.These were the primary contributors among all uncertainty sources.The geometric error significantly increased for treatments without rotation correction.The fraction-level composite uncertainties had a long tail distribution.Furthermore,the generally used 5-mm isotropic margin covered all uncertainties in the left-right and anterior-posterior directions,and only 75%of uncertainties in the SI direction.In order to cover 90%of uncertainties in the SI direction,an 8-mm margin would be needed.For scenarios without rotation correction,additional safety margins should be added,especially in the superior-inferior and anterior-posterior directions.Conclusion The present study revealed that the correlation model error contributes to most of the uncertainties in the results.Most patients/fractions can be covered by a 5-mm margin.Patients with large treatment uncertainties might need a patient-specific margin.
文摘Objective The combination of stereotactic body radiation therapy(SBRT)and immune checkpoint inhibitors(ICIs)is actively being explored in advanced non-small-cell lung cancer(NSCLC)patients.However,little is known about the optimal fractionation and radiotherapy target lesions in this scenario.This study investigated the effect of SBRT on diverse organ lesions and radiotherapy dose fractionation regimens on the prognosis of advanced NSCLC patients receiving ICIs.Methods The medical records of advanced NSCLC patients consecutively treated with ICIs and SBRT were retrospectively reviewed at our institution from Dec.2015 to Sep.2021.Patients were grouped according to radiation sites.Progression-free survival(PFS)and overall survival(OS)were recorded using the Kaplan-Meier method and compared between different treatment groups using the log-rank(Mantel-Cox)test.Results A total of 124 advanced NSCLC patients receiving ICIs combined with SBRT were identified in this study.Radiation sites included lung lesions(lung group,n=43),bone metastases(bone group,n=24),and brain metastases(brain group,n=57).Compared with the brain group,the mean PFS(mPFS)in the lung group was significantly prolonged by 13.3 months(8.5 months vs.21.8 months,HR=0.51,95%CI:0.28–0.92,P=0.0195),and that in the bone group prolonged by 9.5 months with a 43%reduction in the risk of disease progression(8.5 months vs.18.0 months,HR=0.57,95%CI:0.29–1.13,P=0.1095).The mPFS in the lung group was prolonged by 3.8 months as compared with that in the bone group.The mean OS(mOS)in the lung and bone groups was longer than that of the brain group,and the risk of death decreased by up to 60%in the lung and bone groups as compared with that of the brain group.When SBRT was concurrently given with ICIs,the mPFS in the lung and brain groups were significantly longer than that of the bone group(29.6 months vs.16.5 months vs.12.1 months).When SBRT with 8–12 Gy per fraction was combined with ICIs,the mPFS in the lung group was significantly prolonged as compared with that of the bone and brain groups(25.4 months vs.15.2 months vs.12.0 months).Among patients receiving SBRT on lung lesions and brain metastases,the mPFS in the concurrent group was longer than that of the SBRT→ICIs group(29.6 months vs.11.4 months,P=0.0003 and 12.1 months vs.8.9 months,P=0.2559).Among patients receiving SBRT with<8 Gy and 8–12 Gy per fraction,the mPFS in the concurrent group was also longer than that of the SBRT→ICIs group(20.1 months vs.5.3 months,P=0.0033 and 24.0 months vs.13.4 months,P=0.1311).The disease control rates of the lung,bone,and brain groups were 90.7%,83.3%,and 70.1%,respectively.Conclusion The study demonstrated that the addition of SBRT on lung lesions versus bone and brain metastases to ICIs improved the prognosis in advanced NSCLC patients.This improvement was related to the sequence of radiotherapy combined with ICIs and the radiotherapy fractionation regimens.Dose fractionation regimens of 8–12 Gy per fraction and lung lesions as radiotherapy targets might be the appropriate choice for advanced NSCLC patients receiving ICIs combined with SBRT.
文摘Objective:To carry out dosimetric comparison between volumetric modulated arc therapy(VMAT)and intensity-modulated radiation therapy(IMRT)in cervical cancer.Methods:50 postoperative cervical cancer patients were included in this study.The patients were admitted for treatment from January 2021 to January 2022.VMAT and IMRT plans were designed for each patient to analyze the dose distribution in the target area of the two treatment techniques.Results:Comparing the monitor unit for single treatment(638.21±116.21 MU)and time of single treatment(143.21±23.14 s)in the observation group and the monitor unit for single treatment(932.14±74.11 MU)and time of single treatment(223.14±17.26 s)in the control group,there was significant difference(P<0.05);there was also significant difference(P<0.05)between the normal tissue(bladder and rectum)of the observation group and that(bladder and rectum)of the control group.Conclusion:VMAT is more effective in cervical cancer,and it has a certain protective effect on normal tissues in patients and can reduce the radiation dose.
文摘Cancers, malignant melanoma and sarcomas of the skin represent the most common group of malignancies in humans. The main treatment method of almost all skin cancers and subcutaneous tissue tumours is surgery, which consists of complete removal of a neoplastic lesion, with an adequate margin of healthy tissue. Radiotherapy plays an adjuvant role in this process, meaning complementing of the surgical procedure. This study compared four methods of irradiation treatment of cancer located in the skin or in subcutaneous tissues: contact brachytherapy, conventional orthovoltage therapy, electron beam conformal teleradiotherapy and IMRT dynamically shaped photonic beams conformal teleradiotherapy. In order to compare the methods and techniques of surface radiotherapy, following specific objectives were formulated. At the beginning in order to compare the scopes of the absorbed doses at different tissue depths, an analysis of parameters describing particular beams or radiation source has been performed—the curves for the absorbed-dose depth drop-offs. Doses distribution in tissue-like phantoms stimulating homogeneous cuboidal tissue block has been determined. A quality comparison of dose distribution in 2D and 3D treatment planning system for contact brachytherapy application has been made. The dose distribution for electron beam in the system has been determined. Conformal plannings for electron beam treatment, contact brachytherapy applicator treatment and 4 photon beams treatment optimized in IMRT technology have been performed. Dose distribution has been performed for the irradiated female patient within the well chest—the target included the recurrence area in the post-operative scar. The radiation therapy with X-rays has actually been completely eliminated from skin cancer and subcutaneous tissue radiotherapy by the electrons generated in linear accelerators, contact brachytherapy HDR and by high-energy photons used in conformal techniques, ex. IMRT. It is because the residual dose beyond the target is the highest for single X-ray beam. Although in brachytherapy HDR a rapid dose drop-off is observed, 5 cm from its normalization level for the target the residual radiation remains at the level of several percent. So, both X-rays beam radiation and brachytherapy in skin cancer treatment is connected with the administration of the dose with a high gradient in the health tissues. The dose distribution for photon conformal techniques IMRT or for electron radiation looks different. There with the dose normalization at the level of 90% or 85% we deal with the dose layer, the division does not exceed 15% of heterogeneity.
基金supported by the National Natural Science Foundation of China,No.81060182the Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2012211B34the Key Technology Research and Development and Major Program of Xinjiang Uygur Autonomous Region,No.200833116
文摘Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.
文摘Health-related quality-of-life (HRQOL) after a radical prostatectomy (RP) or extemal beam radiation therapy (EBRT) has not been studied in conjunction with oncological outcomes in relation to disease risk stratification. Moreover, the long-term outcomes of these treatment approaches have not been studied. We retrospectively analyzed oncological outcomes between consecutive patients receiving RP (n = 86) and EBRT (n = 76) for localized prostate cancer. HRQOL and functional outcomes could be assessed in 62 RP (79%) and 54 EBRT (79%) patients over a 3-year follow-up period (median: 41 months) using the Medical Outcomes Study Short Form-36 (SF-36) and the University of Califomia Los Angeles Prostate Cancer Index (UCLA PCI). The 5-year biochemical progression-free survival did not differ between the RP and EBRT groups for low-risk (74.6% vs. 75.0%, P = 0.931) and intermediate-risk (61.3% vs. 71.1%, P = 0.691) patients. For high-risk patients, progression-free survival was lower in the RP group (45.1%) than in the EBRT group (79.7%) (P = 0.002). The general HRQOL was comparable between the two groups. Regarding functional outcomes, the RP group reported lower scores on urinary function and less urinary bother and sexual bother than the EBRT group (P 〈 0.001, P 〈 0.05 and P 〈 0.001, respectively). With risk stratification, the low- and intermediate-risk patients in the RP group reported poorer urinary function than patients in the EBRT group (P 〈 0.001 for each). The sexual function of the high-risk patients in the EBRT group was better than that of the same risk RP patients (P 〈 0.001). Biochemical recurrence was not associated with the UCLA PCI score in either group. In conclusion, low- to intermediate-risk patients treated with an RP may report relatively decreased urinary function during long-term follow-up. The patient's HRQOL after treatment did not depend on biochemical recurrence.
基金Supported by Key R&D Plan of Science and Technology Program of Gansu Province,China,No.19YF3FH001.
文摘BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect and abscopal effect response following carbon-ion irradiation for recurrent thymic carcinoma.CASE SUMMARY A 44-year-old female presented with shortness of breath.Eleven years prior,she was diagnosed with athymic tumor located in the anterosuperior mediastinum.She underwent extensive tumor resection,and the postoperative pathologic diagnosis was thymic carcinoma.She was administered 50 Gy/25 Fx of postoperative radiation.In 2019,she was diagnosed with a recurrence of thymic carcinoma,with multiple recurrent nodules and masses in the left thoracic chest and peritoneal cavity,the largest of which was in the diaphragm pleura proximal to the pericardium,with a size of 6.7 cm×5.3 cm×4.8 cm.She received carbonion radiotherapy.After carbon-ion radiotherapy treatment,the treated masses and the untreated masses were observed to have noticeably shrunk on the day of carbon-ion radiotherapy completion and on follow-up imaging.We followed the CARE Guidelines for consensus-based clinical case reporting guideline development and completed the CARE Checklist of information to report this case.CONCLUSION This report is the first of obvious abscopal and bystander effects following carbonion irradiation in a human patient,and further research is needed to better elucidate the mechanisms of bystander and abscopal effects.
文摘Objective This study explains the application number and funding rate of oncology projects undertaken by the National Natural Science Foundation of China(NSFC),with focus on tumor radiotherapy-related research over the past 11 years.Methods A stratified analysis was carried out on the application and funding status of tumor radiotherapy studies in different NSFC project categories,different research areas,and different tumor types.Research areas that required specific focus,such as immunology-related radiotherapy,multimodality imaging and radiomics,and post-radiotherapy organ injury,were separately analyzed.Results The status and development trends of various related research fields were studied,and the research results were presented with the support of the NSFC,in order to provide reference for future applications and funding allocations.Conclusion The number of applications for funding increases every year.Although the total number of funded projects has also increased every year,the funding rate has decreased year by year.Projects on radiotherapy and immunization have been at the forefront in recent years,and the funding rate for these projects increases yearly.
文摘BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor growth.Transarterial chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in LT.However,it remains unclear if one of those treatment options is superior.The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.METHODS In this multicenter retrospective study,27 patients who received liver transplantation for HCC were analyzed.Patients received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver transplantation.Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies.Statistical analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U tests.RESULTS Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and SBRT.There were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor lesions.Strikingly,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.
文摘Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide.A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery,radiation therapy(RT)and systemic treatment.RT composes an integral part of breast conserving treatment,and is typically used after breast conserving surgery to improve local control.Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery.Adaptive radiation therapy(ART)is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation.In the context of breast cancer,ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed.Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation.Herein,we provide a concise review of ART for breast cancer in light of the literature.
文摘The European Organization for Research on Treatment of Cancer Research published a consensus statement to establish the key criteria to define oligometastatic disease(OMD).According to those criteria,all lesions(both primary and metastatic)should be amenable to radical intent treatment with acceptable toxicity.Several retrospective studies have shown that adding local ablative therapy to the treatment of OMD improves outcomes;however,due to the diverse selection criteria and treatment strategies used in those studies,it is difficult to compare directly results to draw definitive conclusions.In recent years,prospective phase II trials,such as the SABR-COMET and"Oligomez"trials,have shown that stereotactic body radiation therapy(SBRT)improves outcomes in patients with OMD.More recently,interim results of the randomised phase 3 SINDAS trial were reported at the annual meeting of the American Society of Clinical Oncology 2020 demonstrating that upfront SBRT added to systemic treatment with tyrosine kinase inhibitors yielded a significant benefit in both progression-free survival and overall survival in patients with epidermal growth factor receptor-mutant oligometastatic non-small cell lung cancer.In the present editorial,we review the definition and historical context of advanced non-small cell lung cancer with OMD.In addition,we review the scientific evidence for local ablative therapy and SBRT and discuss the results of recently published prospective studies.We also discuss in depth the results of the SINDAS study,including the strengths and weaknesses of the study and the barriers to extrapolating these results to routine clinical practice.
文摘BACKGROUND Although stereotactic body radiation therapy(SBRT)is increasingly used,its application has not yet been regulated by the main international guidelines,leaving the decision to multidisciplinary teams.AIM To assess magnetic resonance imaging(MRI)features of hepatocellular carcinoma(HCC)treated with SBRT,highlighting the efficacy of the treatment and the main aspects of the lesion before and after the procedure.METHODS As part of a retrospective study,49 patients who underwent SBRT for HCC between January 2013 and November 2019 were recruited.Each patient under went a pre-treatment MRI examination with a hepatospecific contrast agent and a similar followup examination within 6 mo of therapy.In addition,22 patients underwent a second follow-up examination after the first 6 mo.The following characteristics were analysed:Features analysed compared to pre-treatment MRI examination,presence or absence of infield and outfield progression,ring-like enhancement,signal hyperintensity in T2-weighted sequences in the perilesional parenchyma,capsular retraction,and"band"signal hypointensity in T1-weighted gradient echo fat saturated sequences obtained during hepatobiliary excretion.RESULTS Signal hyperintensity in the T2-weighted sequences showed a statistically significant reduction in the number of lesions at the post-SBRT first control(P=0.0006).Signal hyperintensity in diffusionweighted imaging-weighted sequences was decreased at MRI first control(P<0.0001).A statistically significant increase of apparent diffusion coefficient values from a median of 1.01 to 1.38 at the first post-control was found(P<0.0001).Capsular retraction was increased at the late evaluation(P=0.006).Band-like signal hypointensity in the hepatobiliary phase was present in 94%at the late control(P=0.006).The study of the risk of outfield progression vs infield progression revealed a hazard ratio of 9.CONCLUSION The efficacy of SBRT should be evaluated not in the first 6 mo,but at least 9 mo post-SBRT,when infield progression persists at very low rates while the risk of outfield progression increases significantly.
文摘Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely follow prescriptions. Poor adherence to radiation therapy is associated with low survival and high mortality rates. This study therefore sought to investigate the levels of adherence and factors influencing adherence to radiation therapy among cervical cancer patients being treated at Cancer Diseases Hospital. Methods: A cross-sectional analytical study design was used, 142 patients were selected from the outpatient department using a fishbowl sampling method. A structured interview schedule was used to collect data. Data was entered and analyzed using SPSS, the binary logistic regression analysis was used to predict levels of adherence to treatment and to identify factors associated with adherence to RT among cervical cancer patients. Results: The findings showed that 93% of the participants adhered to radiation therapy while 7% did not adhere to treatment. Majority of the patients 77.1% had experienced side effects of radiation therapy. About 28% of patients had severe psychological distress. By using binary logistic regression, there was a statistically significant association between adherence and perceived quality of health care services (p = 0.001). The analysis showed that patients who perceived poor quality of health care services were 0.005 (99.5%) times less likely to adhere to radiation therapy. The other independent variables were not statistically significant despite being associated with adherence among cervical cancer patients. Conclusions and Recommendations: The findings showed that patients who perceived good quality of health care services had higher chances of adherence compared to those who perceived poor quality of health care services. There is therefore a need for quality service provision which could include good maintenance of radiation machines. Furthermore, there is a need to develop guidelines for follow-up in case of any disease outbreak to avoid interference with patients’ treatment schedules and appointments for reviews.
文摘To study the clinical significance of the morphological and volume changes in cervical cancer during an ongoing course of radiation therapy (RT) using MR imaging. Methods: Serial MR imaging examinations were performed in 60 advanced cervical cancer patients. MR imaging was obtained at the start of RT, at 20-25 Gy (2-2.5 weeks of RT), at 45-50 Gy (4-5 weeks of RT), and 1-2 month post-RT. Tumor morphology was classified qualitatively as well-defined (round/oval with a well-demarcated smooth margin) vs. lobulated vs. irregular and tumor volume was assessed in each serial MR examination independently by ROI volumetry and diameter volumetry. ROI volumetry was traced on the computer workstation with a trackball in each sagittal T2-weighted image and calculated by the summation of all tumor areas in each slice and multiplication by the slice profile. Diameter volumetry was to measure the largest three orthogonal tumor diameters in each orthogonal measurement plane and calculate as an ellipsoid formula (V=d1 x d2 x d3 x p/6). Serial tumor volume was compared between the two measurement methods. Results: The proportion of lobulated and irregular tumors increased early during RT and declined lately post-RT (68% pre-RT, 80% at 2-2.5 weeks of RT, 72% at 4-5 weeks of RT, 33% post-RT). Accordingly, ROI volumetry and diameter volumetry correlated well pre-RT (r1=0.89) and post-RT (r4=0.80), but poorly during RT (r2 = 0.17 at 2-2.5 weeks of RT, r3 = 0.69 at 4-5 weeks of RT). Conclusions: Cervical cancers regress in a non-uniform fashion during RT and undergo increasingly irregular shrinkage. Measurement with ROI volumetry techniques, which can optimally measure irregular volumes, provides better assessment of radiation response during treatment than diameter volumetry.
文摘The aim of this mini-review is to compare and contrast the pros and cons of short-course and long-course neoadjuvant chemoradiation therapy regimens for stageⅡ&Ⅲrectal adenocarcinoma.Multiple trials have demonstrated the equal efficacy and safety of short-course and long-course radiation therapy as a part of neoadjuvant regimens.Published data also shows that total neoadjuvant therapy could be more successful than neoadjuvant chemoradiation followed by adjuvant chemotherapy.This review points out future research directions for patients with locally advanced rectal adenocarcinoma such as comparing total neoadjuvant therapy that contains a short-course of radiation therapy to the standard of care,and evaluating how the sequence of short-course radiation therapy and chemotherapy in the total neoadjuvant therapy impacts the pathological complete response(pCR)rate,local control,and survival outcomes.
文摘BACKGROUND There has been an increasing number of elderly patients with intraductal papillary mucinous neoplasm(IPMN),who are surgically intolerant and require less invasive treatment options,which are limited.In the present study,we report a case of IPMN presenting with acute recurrent pancreatitis(ARP),in which radiation therapy effectively prevented further attacks of ARP and reduced tumor volume.CASE SUMMARY An 83-year-old man was referred to our hospital with an asymptomatic incidental pancreatic cyst.Endoscopic ultrasound imaging and magnetic resonance cholangiopancreatography revealed a multiloculated tumor in the head of the pancreas,with dilated pancreatic ducts and mural nodules.The patient was diagnosed with mixed-type IPMN,and five years later,he developed ARP.Several endoscopic pancreatic ductal balloon dilatations failed to prevent further ARP attacks.Surgery was considered clinically inappropriate because of his old age and comorbidities.He was referred to our department for radiation therapy targeted at those lesions causing intraductal hypertension and radiation was administered at a dose of 50 Gy.An magnetic resonance imaging scan taken ten weeks after treatment revealed a decrease in tumor size and improvement of pancreatic duct dilatation.Fourteen months later,he remains symptom-free from ARP.CONCLUSION This case highlights the important role of radiation therapy in mitigating the signs and symptoms of ARP in patients with inoperable IPMN.
文摘Whole breast external beam radiotherapy is an effective adjuvant treatment for early breast cancer, and was a key factor in the move from mastectomy to breast-conserving surgery for women with low-risk disease. The logical development from partial surgical removal of the breast is partial breast radiotherapy. Several methods of delivery have been investigated, but as yet none has been widely accepted.
文摘Radiation therapy(RT)is a treatment option for head and neck cancer(HNC),but 2%of RT patients may experience damage to the jawbone,resulting in osteoradionecrosis(ORN).The ORN can manifest years after RT exposure.Changes in the local microchemical bone quality prior to the clinical manifestation of ORN could play a key role in ORN pathogenesis.Chemical bone quality can be analyzed using Fourier transform infrared spectroscopy(FTIR),that is applied to examine the effects of cancer,chemotherapy,and RT on the quality of human man-dibular bone.Cortical mandibular bone samples were harvested from dental implant beds of 23 individuals,i.e.,patients with surgically and radiotherapeutically treated HNC(RT-HNC,n=7),surgically and radiochemotherapeutically treated HNC(CH-RT-HNC,n=3),only surgically treated HNC(SRG-HNC,n=4),and healthy controls(n=9).Infrared spectra were acquired from two representative regions of interest in cortical mandibular bone.Spectral parameters,i.e.,mineral-to-matrix ratio(MM),carbonate-to-matrix ratio(CM),carbonate-to-phosphate ratio(CP),collagen maturity(cross-linking),crystallinity,acid phosphate substitu-tion(APS),and advanced glycation end products(AGEs),were analyzed for each sample.Amide I region of the CH-RT-HNC group differed from the control group in cluster analysis(p=0.02).Apart from a minor variation trend in collagen maturity(p=0.07),there were no other signif-icant differences between the groups.Thus,the effect of radiochemotherapy on mandibular bone composition should be further investigated.In future trials,this study design is potential when the effects of the cancer burden and different HNC treatment modalities on jawbone composition are studied,in order to reveal ORN pathogenesis.
文摘Objective:Serum prostate specific antigen(PSA)is commonly used to evaluate treatment response after definitive radiation therapy(RT).However,PSA levels can temporarily rise without a clear reason,termed“PSA bounce”,and often engender great anxiety for both patients and physicians.The present study aimed to determine the prevalence and factors that predict“PSA bounce”after intensity-modulated radiation therapy(IMRT),and the relevance to biochemical failure and cancer recurrence in an Asian population.Methods:We retrospectively reviewed 206 patients who received IMRT for prostate cancer from 2004 to 2012 in the National Cancer Centre Singapore.These patients were followed up with regular PSA monitoring.We defined“PSA bounce”as a rise of 0.1 ng/mL,followed by two consecutive falls.Patients with biochemical failure(PSA nadir t 2 ng/mL)were further evaluated for cancer recurrence.Results:Sixty-one patients(29.6%)experienced“PSA bounce”,at a median time of 16 months and lasted for 12 months.Age remained the most consistent predictor of the incidence,duration and extent of“PSA bounce”.Other contributory factors included baseline PSA,Gleason score and PSA nadir.Hormonal therapy and prostate volume did not affect this phenomenon.Sixteen patients(7.8%)developed biochemical recurrence,at median time of 32 months,of which 11 were confirmed to have metastatic disease.The median follow-up time was 71 months.