Analysis of the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy

Objective:To explore the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy.Methods: A total of 84 patients who were admitted in our hospital after modified radical mastectomy were included in the study and divided into the conventional radiotherapy group (n=42) and the three-dimensional conformal radiotherapy group (n=42) according to different radiotherapy methods. The patients in the conventional radiotherapy group were given conventional radiotherapy of chest wall and clavicular field, while the patients in the three-dimensional conformal radiotherapy group were given three-dimensional conformal radiotherapy. The serum tumor markers and peripheral blood T lymphocyte subsets 6-8 weeks after treatment in the two groups were detected. The clinical efficacy, and toxic and side effects in the two groups were evaluated.Results: The serum CA15-3, CA125, CEA, and CK19 levels after treatment in the two groups were significantly reduced when compared with before treatment, CD3+,CD4+, and CD4+/CD8+ were significantly elevated, while CD8+ was significantly reduced when compared with before treatment, but the comparison of the above indicators between the two groups was not statistically significant. The occurrence rate of radioactive skin damage and pneumonia after treatment in the conventional radiotherapy group was significantly higher than that in the three-dimensional conformal radiotherapy group. Conclusions:The two kinds of radiotherapy schemes have an equal efficacy, but the toxic and side effects of three-dimensional conformal radiotherapy are significantly lower than those by the conventional radiotherapy, with a certain advantage.

Effect of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy on clinical outcomes in patients with glioblastoma multiforme

Background Few studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy （IMRT） and three-dimensional conformal radiotherapy （3D-CRT） in the treatment of glioblastoma multiforme （GBM）.This study aimed to determine whether IMRT improves clinical outcomes compared with 3D-CRT in patients with GBM.Methods The records of 54 patients with newly-diagnosed GBM from July 2009 to December 2010 were reviewed.The patients underwent postoperative IMRT or 3D-CRT with concurrent and adjuvant temozolomide.Kaplan-Meier method and log rank test were used to estimate differences of patients＇ survival.Results The median follow-up was 13 months.Of the 54 patients,fifty （92.6%） completed the combined modality treatment.The 1-year overall survival rate （OS） was 79.6%.The pattern of failure was predominantly local.A comparative analysis revealed that no statistical difference was observed between the IMRT group （n=21） and the 3D-CRT group （n=33） for 1-year OS （89.6% vs.75.8%,P=0.795）,or 1-year progression-free survival （PFS） （61.0% vs.45.5%,P=0.867）.In dosimetric comparison,IMRT seemed to allow better sparing of organs at risk than 3D-CRT did （P=0.050,P=0.055）.However,there was no significant difference for toxicities of irradiation between the IMRT group and the 3D-CRT group.Conclusions Our preliminary results suggested that delivering standard radiation doses by IMRT is unlikely to improve local control or overall survival for GBM compared with 3D-CRT.Given this lack of survival benefit and increased costs of IMRT,the utilization of IMRT treatment for GBM needs to be carefully rationalized.

Adjuvant radiotherapy in central hepatocellular carcinoma after narrow-margin hepatectomy:A 10-year real-world evidence

Objective:A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma(HCC)after narrow-margin hepatectomy(<1 cm).This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.Methods:Patients with central HCC after narrow-margin hepatectomy(<1 cm)were prospectively assigned to adjuvant radiotherapy group and control group.Patients'outcome,adverse events,long-term recurrence and survival rates were investigated.Results:The 1-,5-,and 10-year recurrence-free survival(RFS)rates were 81.0%,43.9%,and 38.7%,respectively in adjuvant radiotherapy group and 71.7%,35.8%,and 24.2%,respectively in control group(log-rank test,P=0.09).The 1-,5-,and 10-year overall survival(OS)rates were 96.6%,54.7%,and 42.8%,respectively in adjuvant radiotherapy group and 90.2%,55.1%,and 30.0%,respectively in control group(log-rank test,P=0.20).The 1-,5-,and 10-year RFS rates for patients with small HCC(≤5 cm)were 91.1%,51.6%,and 48.4%,respectively in adjuvant radiotherapy group and 80.0%,36.6%,and 26.6%,respectively in control group(log-rank test,P=0.03).Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatment in comparison to patients in control group(log-rank test,P=0.05).Conclusions:Our updated results showed a sustained clinical benefit on reducing recurrence,improving longterm survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy.Long-term survival data also indicated that hepatectomy is an optimal treatment for selected patients with central HCC.

Helical tomotherapy and volumetric modulated arc therapy:New therapeutic arms in the breast cancer radiotherapy

AIM To analyse clinical and dosimetric results of helical tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in complex adjuvant breast and nodes irradiation.METHODS Seventy-three patients were included(31 HT and 42 VMAT). Dose were 63.8 Gy(HT) and 63.2 Gy(VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes(SCN) and internal mammary chain(IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort(7 mm vs 5 mm).RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC:96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5%(HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2%(VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1%(HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9%(VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy(HT) and 4.6 ± 0.9 Gy(VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.CONCLUSION HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.

The Effect of Absorbed Dose to Organs at Risk Following Craniospinal Irradiation Using Different Radiotherapy Techniques

Introduction: In medulloblastoma patients craniospinal irradiation is an important element the treatment. Our study aimed to evaluate the effect of absorbed dose to organs at risk using the hybrid intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) for craniospinal irradiation (CSI) in average risk medulloblastoma patients. Materials and Methods: In this study, thirteen medulloblastoma patients were included. The prescribed total dose to the planning target volume (PTV) was 23, 40 Gy in 13 fractions. Two radiotherapy techniques, three dimensional conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (IMRT) were used to treat these patients. The coverage of the Target was evaluated using the D mean, D95%, D2%, D98% and V95%. Other parameters were also compared such as Integral dose (ID), Homogeneity index (HI) and doses to the organs at risk (OARs). Results: There was no significant difference in the mean dose received by the PTV-Brain or the dose received by 95% and 98% of PTV volume using the two techniques. For PTV-Spine, the percentage volume receiving 95% of the total dose increased significantly in the hybrid IMRT technique compared to the conformal technique. So, hybrid IMRT plan achieved the best coverage for PTV spine. Lower dose for OAR was delivered by 3DCRT, except the heart and thyroid, hybrid IMRT achieved better sparing. All plans resulted in the same dose homogeneity index (DHI) for PTV-Brain. For PTV-Spine, hybrid IMRT technique achieved better dose homogeneity compared to 3DCRT technique (1.09 vs. 1.12;p > 0.05). Conclusions: hybrid IMRT technique can be realized on conformal technique because it achieved better dose coverage for the (PTV) and organ at risk (OAR). 3DCRT reduced mean dose to most OARS, except the heart and thyroid. Therefore, the hybrid IMRT technique may be a CSI treatment alternative to 3DCRT.