Inter-Fraction Analysis of One Week Hypo-Fractionation of Deep Inspiration Breath Hold (DIBH) Technique for Left Sided Breast Cancer Radiation Treatment

The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatment sessions for the left sided breast patients were observed and recorded. Measurements of routine set-up variation for 24 patients were performed by matching the cone beam computed tomography (CBCT) and the planning computed tomography (CT). Scans of all five fractions per patient were used to quantify the setup variations with standard deviation (SD) in all the three directions (anterior posterior, left right, and superior inferior). The patients DIBH comfort and knowledge was also evaluated. The average translational errors for the anterior posterior (AP, z), left-right (LR, x), and Superior-inferior (SI, y) directions were 0.40 cm, 0.40 cm, and 0.40 cm, respectively. The translation variation of the three directions showed statistical significance (P < 0.05). On comfort and knowledge investigation, among all participants, 80% moderately agreed that the therapist’s instructions for operating the deep inspiration breath hold (DIBH) technique were easy to understand, and 63.33% indicated that their comfort with the DIBH technique was neutral or average. The inter-fraction variations in patients with left-sided breast cancer were qualitatively analyzed. Significant shifts between CBCT and planning CT images were observed. The daily treatment verification could assist accurate dose delivery.

Quality of Life in Men Treated for Early Prostate Cancer: A Prospective Patient Preference Cohort Study

Objectives: In 1997, a study was launched to investigate the treatment of early prostate cancer. Using a patient preference design, health-related quality-of-life (HRQOL) and disease specific HRQOL was assessed prospectively to compare men undergoing radical prostatectomy (RP), hypo-fractionated conformal radiotherapy (CRT) or brachytherapy (BT). Methods: Patients with localised prostate cancer were counselled by a urological surgeon, clinical oncologist and specialist uro-oncology nurse. Patients received treatment according to individual preference. 430 men chose and received RP (n = 217), CRT (n = 161) and BT (n = 52). 354 (82%) completed pre-treatment RAND 36-Item Short-Form Health survey version-2 (SF36v2) and University of California, Los Angeles Prostate cancer index (UCLA-PCI) questionnaires. HRQOL score changes from baseline to 24 months were compared using Kruskall-Wallis test. Results: Pre-treatment, the CRT cohort scored lower for physical function (p = 0.0029) and general health perception (p = 0.0021). The BT cohort reported better baseline scores for urinary function (p = 0.0291), urinary bother (p = 0.0030), sexual function (p = 0.0009) and bowel bother (p = 0.0063). At 24 months, bowel function was similar for CRT and BT but both modalities were worse than RP (p = 0.0010). Urinary continence deteriorated most following RP (p < 0.0001) but BT had worse urinary bother (p = 0.0153). Sexual function deteriorated most following RP and BT (p < 0.0005). Percentages of patients achieving erections adequate for sexual activity (from baseline to 24 months) were 66% to 29% for RP, 62% to 49% for CRT and 88% to 65% for BT. Conclusion: This data demonstrates significant differences in disease specific quality-of-life between RP, CRT and BT and should be available for men with early prostate cancer making treatment decisions.

Stereotactic body radiation therapy favors long-term overall survival in patients with lung metastases： five-year experience of a single-institution

Background Metastatic lung cancer is one of the most common oncologic problems. This study aimed to evaluate the long-term clinical outcome of stereotactic body radiation therapy （SBRT） for metastatic lung tumors. Methods We retrospectively reviewed the 71 patients with lung metastases, who had 172 lesions treated with SBRT from January 2000 to December 2006. All patients were unfit or failed after surgery and/or chemotherapy. The median total dose was 48 Gy （range, 30-60） in 4 （range, 2-12） fractions. The median size of the irradiated lesions was 2.1 cm （range, 0.9-7.9 cm）. Results All but two patients received follow up. The median follow-up time was 24.7 months （range, 2.9-114.4 months）. The median follow-up time for living patients was 86.8 months （range, 58.1-114.4 months）. The 1-, 3-, 5-year local control and overall survival rates were 88.8%, 75.4%, 75.4% and 78.9%, 40.8%, 25.2%. Multivariate analysis showed that the absence of extrapulmonary metastases （P=-0.024; hazard ratio （HR）, 1.894; 95% confidence interval （C/）, 1.086-3.303） and disease-free interval 〈12 months （P=0.014; HR, 0.511; 95% Cl, 0.299-0.873） were independent prognostic factors. No grade 3 or more acute and late toxicities occurred. Only one patient developed a non-symptomatic rib fracture. Conclusion SBRT could be an alternative treatment to surgery for subsets of patients with lung metastases with favorable long-term survival and tolerable complications.