Precision Radiation Oncology最新文献

Objective: To investigate the prognostic value of pretreatment squamous cell carcinoma antigen (SCC Ag) levels for treatment failure prediction in patients with cervical cancer.

Methods: A quantity of 985 patients satisfying the eligibility criteria were included, with a median follow-up duration of 63.7 months. The optimal cutoff value for pretreatment SCC Ag levels was verified by the receiver operating characteristic (ROC) curve. Five-year disease-free survival (DFS), overall survival (OS), and local control (LC) rates were evaluated utilizing the Kaplan-Meier method. Log-rank test and Cox proportional hazards model was implemented to recognize independent prognostic predictors.

Results: The optimal pretreatment SCC Ag cutoff value was 8.85 ng/mL. Patients with pretreatment SCC Ag levels ≥ 8.85 ng/mL presented significantly inferior 5-year DFS (63.8% vs. 81.8%), OS (71.7% vs. 88.7%), and LC (80.5% vs. 91.0%) compared to those with levels < 8.85 ng/mL (all p < 0.001). The results of the multivariate analysis indicated that the pretreatment SCC Ag level was an independent predictor of treatment failure (HR,1.772; 95% CI, 1.366 to 2.299; p < 0.001).

Conclusion: Pretreatment SCC Ag is an effective prognostic factor in patients with cervical cancer undergoing definitive radiotherapy, with a ROC-identified cutoff value of 8.85 ng/mL and elevated SCC Ag indicates unfavorable outcomes.

Objective: To compare volumetric modulated arc therapy (VMAT) with simultaneous tumor bed boost (dpSIB-VMAT) to the whole breast and regional nodal irradiation (RNI) against standard three-dimensional conformal radiotherapy plus RNI with sequential tumor bed boost (3D-CRT-seqB).

Methods: Thirty patients who underwent breast cancer surgery (BCS) with axillary lymph node dissection (ALND) were enrolled. Two plans were generated for each case: (1) dpSIB-VMAT, and (2) 3D-CRT-seqB plans. Planning target volume (PTV)-Breast and PTV-Nodes were prescribed at a dose of 50 Gy in 25 fractions in both plans. PTV-Boost was prescribed at a dose of 60 Gy in 25 fractions simultaneously in the dpSIB-VMAT plans, whereas it was planned sequentially in the 3D-CRT-seqB plans at 10 Gy in 5 fractions. Dosimetric parameters were compared between the two plans.

Results: Both plans achieved the target coverage. D_mean of the heart was lower with dpSIB-VMAT in left-sided cases (7.17 ± 0.66 Gy vs. 10.12 ± 2.91 Gy; t = 4.02; p = 0.001). Ipsilateral mean lung dose (15.87 ± 1.40 Gy vs. 19.82 ± 3.20 Gy; t = 6.30; p<0.001) was significantly lower but mean doses of the contralateral breast (4.30 ± 1.76 Gy vs. 1.48 ± 0.76 Gy; t = -7.84; p<0.001), contralateral lung (3.86 ± 1.21 Gy vs. 0.96 ± 0.25 Gy; t = -13.13; p<0.001) and esophagus (13.11 ± 2.63 Gy vs. 10.32 ± 3.56 Gy; t = -6.65; p<0.001) were relatively higher with dpSIB-VMAT.

Conclusion: Dosimetrically, dpSIB-VMAT reduced doses to the ipsilateral lung and heart (in left breast but not right breast cases) compared to 3D-CRT-seqB plans for adequate target coverage.

Objective: A newly developed Gafchromic^TM EBT4 film model was released recently. According to the vendor-stated specifications, this new model maintains major features of its more recent predecessor, EBT3, but has a great improvement in the signal-to-noise ratio (SNR). The purpose of this study was to fully characterize the EBT4 model by testing its dose response dependence on beam energy using clinical photon and electron beams and validating its improvement in SNR.

Methods: In the beam energy dependence experiments, 6 MV and 15 MV photon beams, 6 MeV, 12 MeV and 20 MeV electron beams, 120 kVp and two 250 kVp x-ray beams (with different half-layer values) were selected, representing different clinical beam energies and radiation types. In the noise and SNR analyses, only the 6 MV photon beam was selected as the representative to compare between EBT4 and EBT3 models.

Results: The energy dependence test results showed that there was a slight difference (<2% at most dose levels) in the dose response among the clinical MV photons and MeV electrons. However, a large deviation (>10%) in the dose response was found for the 120 kVp x-ray beam. For the two 250 kVp x-ray beams, the difference in the dose response was moderate (<5%), but not negligible. The noise and SNR results showed a reduced noise and strengthened SNR in EBT4.

Conclusion: We conclude that the EBT4 film has a minimal energy dependence for MV photon and MeV electron beams but has a notable energy dependence for kilovoltage x-ray beams, and the vendor-stated features of the reduced noise and improved SNR in EBT4 are validated.

Objective: The role of prophylactic cranial irradiation (PCI) in treating extensive-stage small-cell lung cancer (ES-SCLC) has been controversial. This study aimed to comprehensively analyze the efficacy of PCI for the treatment of ES-SCLC under active brain magnetic resonance imaging (MRI) surveillance.

Methods: Patients with ES-SCLC with no brain metastases (BM) confirmed by MRI at the time of diagnosis who responded well to first-line chemoimmunotherapy at three general hospitals were retrospectively included. Overall survival (OS), progression-free survival (PFS), and cumulative incidence of BM were compared between patients who underwent PCI and those who did not.

Results: In total, 66 consecutive patients treated between March 2019 and December 2021 were included in our dataset. Seventeen patients underwent PCI (PCI group) and 49 patients did not (non-PCI group). In comparison with the non-PCI group, PCI did not provide OS (median OS: 18.53 vs. 17.35 months, p = 0.28) or PFS (median PFS: 8.61 vs. 7.56 months, p = 0.41) benefits. When death was counted as a competing risk, the difference in the cumulative incidence rate of BM was not statistically significant (1-year: 12.79% vs. 38.09%; p = 0.14).

Conclusion: Compared to active MRI surveillance, first-line chemoimmunotherapy followed by PCI did not improve the prognosis of patients with ES-SCLC. Further studies are warranted to evaluate the therapeutic effects of PCI following chemoimmunotherapy.

Objective: Radiation-induced skin injury (RISI) remains a serious concern during radiotherapy. IL-10 is considered as an immune suppressive cytokine by inhibiting the secretion of the proinflammatory cytokines in cells. The aim of this study was to evaluate the protective role of Erb (IL10) 2 against ionizing radiation.

Methods: We fused Interleukin 10 (IL-10) dimer onto an anti-epidermal growth factor receptor antibody Cetuximab (Erbitux) to form a new bispecific protein Erb-(IL10)2. The protective effect and biological activity of Erb-(IL10)2 was measured in model of RISI.

Results: Under the condition of 20 Gy irradiation, surviving cells in the IR group decreased significantly compared with the non-IR group (p = 0.0021). The survival rates of HaCaT (p = 0.0038) and WS1 (p = 0.0003) cells were significantly increased after IL-10 treatment. The apoptosis rates of HaCaT (p = 0.0048) and WS1 (p = 0.0074) cells in the IL-10 group were significantly lower compared to the NC group. Under 20 Gy irradiation conditions, IL-10 fusion protein reduced the level of reactive oxygen in HaCaT (p = 0.0046) and WS1 (p<0.0001) cells compared to the control group. Relatively normal granular mitochondrial morphology was observed in the IL-10 group after 20 Gy X-ray irradiation compared with the NC group. Ater 35 Gy electron radiation, the levels of reactive oxygen species in the skin tissue of C57/B6 mice injected with IL-10 fusion protein were significantly lower than those in the PBS group (p = 0.001). Compared with the PBS group and the other IL-10 groups, the group treated with 0.2 mg/kg IL-10 showed a significant decrease in MDA level (p = 0.0024). Compared with the PBS group, the thickness of the stratum corneum in groups treated with 0.05, 0.1 and 0.2 mg/kg IL-10 decreased, and the skin appendages were well-preserved. In the group treated with 0.2 mg/kg IL-10, the skin tissue structure was still relatively intact, and the masson staining area was smaller than that of the PBS group.

Conclusion: IL-10 plays a role in inhibiting radioactive fibrosis in radioactive skin injury. IL-10 has a protective effect on skin cell damage after ionizing radiation irradiation both in vitro and in vivo. Moreover, IL-10 plays a role in inhibiting radioactive fibrosis in radioactive skin injury.

Cervical cancer, the fourth most common cancer among females in the world, ranks the second in China. In advanced disease, metastases may be commonly present in the lungs, bones, liver and lymph nodes or elsewhere, but uncommon to the skin. In this report, a 63-year-old woman was diagnosed as stage IVB cervical squamous cell cancer in January 2021. The patient was scheduled for concurrent chemoradiotherapy; however, a metastatic lesion of skin was proved by biopsy during the process of treatment. She died 1 month after confirmed skin metastases. Cutaneous metastasis of cervical cancer may predict the mix of lymphatic and hematogenous metastasis and the rapid fatal termination.

Objective: This study aimed to investigate the effect of different postoperative radiotherapy doses on the prognosis of patients with esophageal squamous cell carcinoma (ESCC).

Methods: A total of 199 patients (aged 18-75 years) with locally advanced ESCC who underwent esophagectomy and postoperative radiotherapy/chemoradiotherapy at the Fujian Cancer Hospital between July 2008 and January 2018 were included. Based on the postoperative radiotherapy dose, the patients were divided into a low-dose group (50-50.4 Gy; median dose 50 Gy) and a high-dose group (>50.4 Gy; median dose 60 Gy). Neoadjuvant and adjuvant chemotherapy regimens included PF (fluorouracil and cisplatin) and TP (paclitaxel and cisplatin) regimens. Patients were followed-up every 3 months in the first 2 years after surgery, every 6 months for the next 3 years, and then subsequently once a year. The primary endpoints were overall survival (OS) and progression-free survival (PFS) rates. The propensity-score matching (PSM) method was applied to identify a 1:1, well-balanced matched cohort with 33 patients in each group for survival comparison.

Results: Among the 199 patients enrolled in this study, 144 and 55 were in the low-dose and high-dose groups, respectively. Univariate and multivariate analyses showed that pathological N classification, vascular tumor emboli, and postoperative radiotherapy dose were independent prognostic factors for both OS and PFS, all p < 0.05. Before PSM, the OS and the PFS of the low-dose group were significantly longer than those of the high-dose group, both p < 0.05. After PSM, better OS and PFS rates were observed in the low-dose group, both p < 0.05. The results showed that patients with pathological stages N0-2 or N3, negative surgical margins, and no vascular tumor emboli could obtain a significant benefit in both OS and PFS after treatment with a low dose of postoperative radiotherapy (50-50.4 Gy). In the subgroup with positive surgical margins, treatment with a low dose of postoperative radiotherapy offered a non-significant survival benefit compared to treatment with a high dose of postoperative radiotherapy.

Conclusions: Our study revealed that for patients with ESCC, the low-dose group (50-50.4 Gy) had a significantly higher OS and PFS than the high-dose group (>50.4 Gy). It was suggested that 50-50.4 Gy might be the recommended postoperative radiotherapy dose for ESCC patients.

Radiomics is a rapidly evolving field of research that extracts and analyzes quantitative features within medical images. Those features are termed as radiomic features that can characterize a tumor in a comprehensive and quantitative manner with regard to its internal structure and heterogeneity. Radiomic features can be used, alone or in combination with demographic, histological, genomic, or proteomic data, for predicting prognosis or treatment response. Immunotherapy, or immune-oncology, is the study of cancer treatment by taking advantage of the body's immune system to prevent, control, and eliminate cancer. In this review, we first provide a brief introduction to both radiomics and immune-oncology in lung cancer. Then, we discuss the need for developing immune-oncology biomarkers, and the advantages of radiomics in identifying biomarkers related to immunotherapy. We also discuss potential areas in and out of tumors, such as the intra-tumoral hypoxic region and tumor microenvironment, where radiomic markers might be extracted, as well as a potential application of radiomic biomarkers in clinical lung cancer management. Finally, we present radiation and immune modulation in non-small cell lung cancer, clinical trials and their design to incorporate radiomic biomarkers, and radiomics-guided precision radiation therapy.

Objective: The efficacy and safety of definitive chemoradiotherapy (dCRT) for elderly patients with unresectable esophageal cancer (EC) are not yet fully understood. We conducted this study to evaluate the outcome and toxicity in elder patients (65 years and over) of unresectable EC treated with dCRT. Methods: From four Georgian cancer centers with a radiation oncology department, we identified 44 elderly patients with EC suitable according to the study criteria. Overall survival (OS) was estimated from the beginning of treatment and toxicity scored using CTCAE 5.0 criteria. Results: The median age of patients was 70.0 years (range 65-83 years), with male predominance (77.3%) and 59% of patients were with Eastern Cooperative Oncology Group (ECOG) performance status 1. Because of significant dysphagia (grade 3-4) nine patients underwent intervention (stenting or gastrostomy) before dCRT. More than two-thirds of patients were squamous cell histological type (77.3%). Localization of tumors was equally distributed between the middle and lower parts of the esophagus (38.6%) and in 26 patients (59.1%) tumor length was more than 5 cm. The majority of patients had stage III disease (61.4%). Median survival was 16.0 months (95% confidence interval [CI] 0-35.9). OS at 12 and 24 months was 53.7% and 43.6%, respectively. Fifteen patients (34%) were alive from 2.1 to 5.4 years after treatment. A statistically significant difference (p = 0.011) in median OS was found between patients who received full (not reached) versus overall survival (OS) was 9.0 months in patients who received nonfull dose of radiotherapy (RT) (95% CI 2.79-15.2). Additional analysis between age subgroups revealed that elder subgroup patients (>75 years) had the highest OS, compared to younger (65-70 years) and intermediate groups (71-75 years) (p = 0.001). The most common adverse events were grade 3-4 leukopenia (43.2%), anemia (29.5%), and esophagitis (27.3%). Conclusion: The results of our study support the feasibility and efficacy of dCRT for unresectable EC in carefully selected elderly patients. Survival was correlated to complete dose of RT and therefore accurate selection of patients is crucial for better long-term survival. Our study showed that chronological age alone does not reflect a patient's ability to tolerate dCRT. Toxicity of dCRT is always a very important issue and patient selection must be very cautious in geriatric patients, although dCRT might benefit highly selected patients.