S. Novikov, Petr Krivorotko, Zhanna Bryantseva, I. Akulova, A. Emelyanov, V. Mortada, Olga Ponomareva, P. Krzhivitskiy, Sergey Kanaev
Purpose: We evaluate various approaches to target volume definition and boost delivery in patients with complete response to neoadjuvant systemic therapy (NST) who were treated by radiotherapy without a surgery. Materials and Methods: A pathological complete response (pCR) was diagnosed in 21 of 27 patients included in “surgery de-escalation” prospective observation study. Clips were placed in the primary tumor volume (PrTV) before NST and during the vacuum aspiration biopsy. Twenty patients with pCR underwent the whole breast irradiation and a boost to the PrTV. High-dose rate brachytherapy (HDRB) was the basic technique for boost delivery. Finally, we identified the value of fused images (computed tomography [CT] before NST with simulation CT), clips and their combination for an accurate boost delivery.Results: A complete overlap between PrTV on pre-treatment CT with the localization of the clips on simulation CT was mentioned in 10, partial mismatch in three patients. In 12 of these 13 women, HDRB was successfully used for the boost delivery. In five cases we mentioned a marked discrepancy between the PrTV on fused images and the topography of the clips. In other two women we did not find clips on simulation CT. The fused images in five of these seven patients showed anatomical landmarks (scar, fibrosis) used for identification of the gross tumor volume. In all 20 women with pCR (average follow-up of 16.6 months), there were no locoregional recurrences.Conclusion: Combination of the clips with fusion of pre-NST and simulation CTs is important for an accurate boost delivery.
{"title":"Different approaches to target volume definition and boost delivery in surgery de-escalation clinical trial in breast cancer patients with pathological complete response","authors":"S. Novikov, Petr Krivorotko, Zhanna Bryantseva, I. Akulova, A. Emelyanov, V. Mortada, Olga Ponomareva, P. Krzhivitskiy, Sergey Kanaev","doi":"10.3857/roj.2023.00528","DOIUrl":"https://doi.org/10.3857/roj.2023.00528","url":null,"abstract":"Purpose: We evaluate various approaches to target volume definition and boost delivery in patients with complete response to neoadjuvant systemic therapy (NST) who were treated by radiotherapy without a surgery. Materials and Methods: A pathological complete response (pCR) was diagnosed in 21 of 27 patients included in “surgery de-escalation” prospective observation study. Clips were placed in the primary tumor volume (PrTV) before NST and during the vacuum aspiration biopsy. Twenty patients with pCR underwent the whole breast irradiation and a boost to the PrTV. High-dose rate brachytherapy (HDRB) was the basic technique for boost delivery. Finally, we identified the value of fused images (computed tomography [CT] before NST with simulation CT), clips and their combination for an accurate boost delivery.Results: A complete overlap between PrTV on pre-treatment CT with the localization of the clips on simulation CT was mentioned in 10, partial mismatch in three patients. In 12 of these 13 women, HDRB was successfully used for the boost delivery. In five cases we mentioned a marked discrepancy between the PrTV on fused images and the topography of the clips. In other two women we did not find clips on simulation CT. The fused images in five of these seven patients showed anatomical landmarks (scar, fibrosis) used for identification of the gross tumor volume. In all 20 women with pCR (average follow-up of 16.6 months), there were no locoregional recurrences.Conclusion: Combination of the clips with fusion of pre-NST and simulation CTs is important for an accurate boost delivery.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":" 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiotherapy (RT) is the main local treatment for limited-stage small-cell lung cancer (LS-SCLC). No-tably, SCLC is extremely sensitive to radiotherapy. Turrisi et al. [1] demonstrated the oncological benefit of high radiation doses by showing the survival benefit of a 45 Gy/1.5 Gy bid protocol compared to the conventional 45 Gy in 25 fractions treatment. Recently, Faivre-Finn et al. [2] reported that treatment with 66 Gy in 33 fractions could achieve a survival similar to that of the bid regimen. Ref-erencing the literature on non-small cell lung cancer (NSCLC), dose-escalation beyond 60–66 Gy is not always successful and has the potential to increase toxicity [3
{"title":"Proton beam therapy as a promising option for high-risk limited stage small cell lung cancer: revealing potential of future novel agents","authors":"C. H. Rim","doi":"10.3857/roj.2023.01004","DOIUrl":"https://doi.org/10.3857/roj.2023.01004","url":null,"abstract":"Radiotherapy (RT) is the main local treatment for limited-stage small-cell lung cancer (LS-SCLC). No-tably, SCLC is extremely sensitive to radiotherapy. Turrisi et al. [1] demonstrated the oncological benefit of high radiation doses by showing the survival benefit of a 45 Gy/1.5 Gy bid protocol compared to the conventional 45 Gy in 25 fractions treatment. Recently, Faivre-Finn et al. [2] reported that treatment with 66 Gy in 33 fractions could achieve a survival similar to that of the bid regimen. Ref-erencing the literature on non-small cell lung cancer (NSCLC), dose-escalation beyond 60–66 Gy is not always successful and has the potential to increase toxicity [3","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"10 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Choi, B. Jeong, Hojin Jeong, I. Ha, Bong-Hoi Choi, K. Kang
mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.
颈部 LN 水平 II 需要 5 毫米，颈部 LN 水平 III 需要 5 毫米，颈部 LN 水平 IV 需要 3 毫米，以包括每个 LN 水平的所有移动。在使用咬合阻滞的患者中，原发肿瘤体积和转移 LN 体积的变化与明显的移动有关。
{"title":"Target movement according to cervical lymph node level in head and neck cancer and its clinical significance","authors":"H. Choi, B. Jeong, Hojin Jeong, I. Ha, Bong-Hoi Choi, K. Kang","doi":"10.3857/roj.2023.00787","DOIUrl":"https://doi.org/10.3857/roj.2023.00787","url":null,"abstract":"mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"80 22","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138957982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyunseok Lee, D. Oh, Y. Ahn, Hongryull Pyo, Kyungmi Yang, J. Noh
lower mean lung dose (4.4 Gy vs. 7.6 Gy vs. 10.9 Gy, respectively; p < 0.001), lower mean heart dose (5.4 Gy vs. 10.0 Gy vs. 13.1 Gy, respectively; p = 0.003), and lower mean esophageal dose than patients in the 3D-CRT and IMRT groups (6.3 Gy vs. 9.8 Gy vs. 13.5 Gy, respectively; p = 0.011). Twenty patients (19.8%) showed disease recurrence, and seven patients (6.9%) died. The differences in the survival rates between RT groups were not statistically significant. Conclusion: In patients with TET who underwent adjuvant RT, PBT resulted in a lower dose of exposure to adjacent organs at risk. Survival outcomes for patients in PBT group were not significantly different from those in other groups.
与 3D-CRT 组和 IMRT 组患者相比，3D-CRT 组患者的平均肺部剂量（分别为 4.4 Gy vs. 7.6 Gy vs. 10.9 Gy；p < 0.001）、平均心脏剂量（分别为 5.4 Gy vs. 10.0 Gy vs. 13.1 Gy；p = 0.003）和平均食管剂量（分别为 6.3 Gy vs. 9.8 Gy vs. 13.5 Gy；p = 0.011）更低。20名患者（19.8%）出现疾病复发，7名患者（6.9%）死亡。不同 RT 组的存活率差异无统计学意义。结论在接受辅助 RT 的 TET 患者中，PBT 对邻近危险器官的照射剂量较低。PBT组患者的存活率与其他组没有明显差异。
{"title":"Comparison of radiotherapy techniques in patients with thymic epithelial tumor who underwent postoperative radiotherapy","authors":"Hyunseok Lee, D. Oh, Y. Ahn, Hongryull Pyo, Kyungmi Yang, J. Noh","doi":"10.3857/roj.2023.00360","DOIUrl":"https://doi.org/10.3857/roj.2023.00360","url":null,"abstract":"lower mean lung dose (4.4 Gy vs. 7.6 Gy vs. 10.9 Gy, respectively; p < 0.001), lower mean heart dose (5.4 Gy vs. 10.0 Gy vs. 13.1 Gy, respectively; p = 0.003), and lower mean esophageal dose than patients in the 3D-CRT and IMRT groups (6.3 Gy vs. 9.8 Gy vs. 13.5 Gy, respectively; p = 0.011). Twenty patients (19.8%) showed disease recurrence, and seven patients (6.9%) died. The differences in the survival rates between RT groups were not statistically significant. Conclusion: In patients with TET who underwent adjuvant RT, PBT resulted in a lower dose of exposure to adjacent organs at risk. Survival outcomes for patients in PBT group were not significantly different from those in other groups.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"25 12","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sang Hoon Seo, Hongryull Pyo, Yong Chan Ahn, D. Oh, Kyungmi Yang, Nalee Kim, Jong-Mu Sun, Sehhoon Park, H. Jung, Se-Hoon Lee, J. Ahn, Myung-Ju Ahn, J. Noh
and radiation-related toxicities in LS-SCLC. PBT may be a valuable therapeutic modality in patients with poor pulmonary function or extensive disease burden owing to its lung-sparing ability.
{"title":"Pulmonary function and toxicities of proton versus photon for limited-stage small cell lung cancer","authors":"Sang Hoon Seo, Hongryull Pyo, Yong Chan Ahn, D. Oh, Kyungmi Yang, Nalee Kim, Jong-Mu Sun, Sehhoon Park, H. Jung, Se-Hoon Lee, J. Ahn, Myung-Ju Ahn, J. Noh","doi":"10.3857/roj.2023.00773","DOIUrl":"https://doi.org/10.3857/roj.2023.00773","url":null,"abstract":"and radiation-related toxicities in LS-SCLC. PBT may be a valuable therapeutic modality in patients with poor pulmonary function or extensive disease burden owing to its lung-sparing ability.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"30 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138596485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CyberKnife-based stereotactic radiosurgery or fractionated stereotactic radiotherapy in older patients with brain metastases from non-small cell lung cancer","authors":"Jeongshim Lee, H. Kim, Woo Chul Kim","doi":"10.3857/roj.2023.00563","DOIUrl":"https://doi.org/10.3857/roj.2023.00563","url":null,"abstract":"clinical results of CyberKnife","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"35 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139224037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anitha Mandava, V. Koppula, Meghana Kandati, K. V. V. N. Raju
{"title":"Synchronous radiation-induced enterovesical and enterocervical fistulas in carcinoma of the uterine cervix","authors":"Anitha Mandava, V. Koppula, Meghana Kandati, K. V. V. N. Raju","doi":"10.3857/roj.2023.00500","DOIUrl":"https://doi.org/10.3857/roj.2023.00500","url":null,"abstract":"","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"14 1-4 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139234408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose This systematic review aims to assess and summarize the clinical values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameter changes as early biomarkers of tumor responses following radiation therapy (RT) in patients with spinal metastases. Materials and Methods A systematic search was conducted on five electronic databases: PubMed, Scopus, Science Direct, Cochrane, and Embase. Studies were included if they mentioned DCE-MRI parameter changes before and after RT in patients with spinal metastases with a correlation to tumor responses based on clinical and imaging criteria. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess study quality. Results This systematic review included seven studies involving 107 patients. All seven studies evaluated the transfer constant (Ktrans), six studies evaluated the plasma volume fraction (Vp), three studies evaluated the extravascular extracellular space volume fraction, and two studies evaluated the rate constant. There were variations in the type of primary cancer, RT techniques used, post-treatment scan time, and median follow-up time. Despite the variations, however, the collected evidence generally suggested that significant differences could be detected in DCE-MRI parameters between before and after RT, which might reflect treatment success or failures in long-term follow-up. Responders showed higher reduction and lower values of Ktrans and Vp after RT. DCE-MRI parameters showed changes and detectable recurrences significantly earlier (up to 6 months) than conventional MRI with favorable diagnostic values. Conclusion The results of this systematic review suggested that DCE-MRI parameter changes in patients with spinal metastases could be a promising tool for treatment-response assessment following RT. Lower values and higher reduction of Ktrans and Vp after treatment demonstrated good prediction of local control. Compared to conventional MRI, DCE-MRI showed more rapid changes and earlier prediction of treatment failure. Keywords: Multiparametric magnetic resonance imaging, Spine, Neoplasm metastasis, Radiotherapy
{"title":"Dynamic contrast-enhanced magnetic resonance imaging parameter changes as an early biomarker of tumor responses following radiation therapy in patients with spinal metastases: a systematic review","authors":"Rahmad Mulyadi, Pungky Permata Putri, Handoko Handoko, Ramdinal Aviesena Zairinal, Joedo Prihartono","doi":"10.3857/roj.2023.00290","DOIUrl":"https://doi.org/10.3857/roj.2023.00290","url":null,"abstract":"Purpose This systematic review aims to assess and summarize the clinical values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameter changes as early biomarkers of tumor responses following radiation therapy (RT) in patients with spinal metastases. Materials and Methods A systematic search was conducted on five electronic databases: PubMed, Scopus, Science Direct, Cochrane, and Embase. Studies were included if they mentioned DCE-MRI parameter changes before and after RT in patients with spinal metastases with a correlation to tumor responses based on clinical and imaging criteria. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess study quality. Results This systematic review included seven studies involving 107 patients. All seven studies evaluated the transfer constant (Ktrans), six studies evaluated the plasma volume fraction (Vp), three studies evaluated the extravascular extracellular space volume fraction, and two studies evaluated the rate constant. There were variations in the type of primary cancer, RT techniques used, post-treatment scan time, and median follow-up time. Despite the variations, however, the collected evidence generally suggested that significant differences could be detected in DCE-MRI parameters between before and after RT, which might reflect treatment success or failures in long-term follow-up. Responders showed higher reduction and lower values of Ktrans and Vp after RT. DCE-MRI parameters showed changes and detectable recurrences significantly earlier (up to 6 months) than conventional MRI with favorable diagnostic values. Conclusion The results of this systematic review suggested that DCE-MRI parameter changes in patients with spinal metastases could be a promising tool for treatment-response assessment following RT. Lower values and higher reduction of Ktrans and Vp after treatment demonstrated good prediction of local control. Compared to conventional MRI, DCE-MRI showed more rapid changes and earlier prediction of treatment failure. Keywords: Multiparametric magnetic resonance imaging, Spine, Neoplasm metastasis, Radiotherapy","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"22 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136234525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arkaja Tripathy, Sandeep Muzumder, Nirmala Srikantia, Ajay Babu, MG John Sebastian, Avinash H. Udayashankar, Ganesha Dev Vashishta, John Michael Raj
Purpose The study evaluates accelerated hypofractionated radiotherapy (AHRT) compared to conventional fractionation radiotherapy (CFRT) in patients with locally advanced head and neck cancer (LAHNC) receiving definitive chemoradiation therapy. Materials and Methods The study includes a retrospective cohort analysis of 120 patients. CFRT arm (n = 65) received 2 Gy per fraction to a dose of 70 Gy over 7 weeks in a three-volume approach, whereas the AHRT arm (n = 55) received 2.2 Gy per fraction to a dose of 66 Gy in 6 weeks with a two-volume approach. The primary outcome was overall survival (OS). Results With a median follow-up of 18.9 months, 23 patients died in the AHRT arm, and 45 deaths in the CFRT arm. The median OS was 23.4 and 37.63 months in the CFRT and AHRT arms, respectively (hazard ratio [HR] = 0.709; 95% confidence interval [CI], 0.425â1.18; p = 0.189). The median time to loco-regional control was 33.3 months in the CFRT arm and was not reached in the patient group receiving AHRT (HR = 0.558; 95% CI, 0.30â1.03; p = 0.065). The median progression-free survival was 15.9 months in the CFRT arm and 26.9 months in the AFRT arm (HR = 0.801; 95% CI, 0.49â1.28; p = 0.357). Out of 11 acute toxic deaths, eight were in the CFRT arm. Conclusion The study showed a trend towards benefit in terms of locoregional control in the AHRT arm and similar OS. A longer follow-up of patients receiving AHRT is required to assess the benefit. Keywords: Radiotherapy, Altered fractionation, Survival, Locoregional neoplasm recurrence
{"title":"A comparison of conventional and accelerated hypofractionated radiotherapy in definitive chemoradiation for locally advanced head and neck carcinoma: a retrospective cohort study","authors":"Arkaja Tripathy, Sandeep Muzumder, Nirmala Srikantia, Ajay Babu, MG John Sebastian, Avinash H. Udayashankar, Ganesha Dev Vashishta, John Michael Raj","doi":"10.3857/roj.2023.00248","DOIUrl":"https://doi.org/10.3857/roj.2023.00248","url":null,"abstract":"Purpose The study evaluates accelerated hypofractionated radiotherapy (AHRT) compared to conventional fractionation radiotherapy (CFRT) in patients with locally advanced head and neck cancer (LAHNC) receiving definitive chemoradiation therapy. Materials and Methods The study includes a retrospective cohort analysis of 120 patients. CFRT arm (n = 65) received 2 Gy per fraction to a dose of 70 Gy over 7 weeks in a three-volume approach, whereas the AHRT arm (n = 55) received 2.2 Gy per fraction to a dose of 66 Gy in 6 weeks with a two-volume approach. The primary outcome was overall survival (OS). Results With a median follow-up of 18.9 months, 23 patients died in the AHRT arm, and 45 deaths in the CFRT arm. The median OS was 23.4 and 37.63 months in the CFRT and AHRT arms, respectively (hazard ratio [HR] = 0.709; 95% confidence interval [CI], 0.425â1.18; p = 0.189). The median time to loco-regional control was 33.3 months in the CFRT arm and was not reached in the patient group receiving AHRT (HR = 0.558; 95% CI, 0.30â1.03; p = 0.065). The median progression-free survival was 15.9 months in the CFRT arm and 26.9 months in the AFRT arm (HR = 0.801; 95% CI, 0.49â1.28; p = 0.357). Out of 11 acute toxic deaths, eight were in the CFRT arm. Conclusion The study showed a trend towards benefit in terms of locoregional control in the AHRT arm and similar OS. A longer follow-up of patients receiving AHRT is required to assess the benefit. Keywords: Radiotherapy, Altered fractionation, Survival, Locoregional neoplasm recurrence","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135667731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose The standard treatment of non-Hodgkin lymphoma (NHL) comprises combined modality treatment, radiotherapy (RT), and chemotherapy with rituximab which has significantly improved both disease-free survival (DFS) and overall survival (OS). However, there is no uniformity in radiation dose usage in these patients. In this retrospective study, we compared lower radiation dose with higher in patients with aggressive NHL. Materials and Methods From 2007 to 2017, treatment records of all high-grade NHL or diffuse large B-cell lymphoma and non-central nervous system NHL were included. We compared response rates, OS and DFS of patients who received â¤30 Gy RT to those with >30 Gy. Univariate and multivariate analyses were done to determine factors affecting prognosis, i.e., age, sex, stage, International Prognostic Index (IPI), adding rituximab, and radiation dose. Results A total of 184 NHL patients treated with combined modality or radiation alone having complete follow-up details were analyzed. At median follow-up of 66.8 months, 5-year OS was 72.8% in high-dose group versus 69.9% in low-dose group (p = 0.772) and 5-year DFS 64.7% versus 64.1% (p = 0.871). Patients having early-stage disease receiving low dose and those with advanced disease treated with >30 Gy had better OS and DFS though not statistically significant. Adding rituximab was associated with significantly better OS and DFS irrespective of radiation dose delivered. High IPI score and omitting rituximab were the only factors that significantly worsened both OS and DFS. Acute radiation toxicities were comparable in both groups (p = 0.82). Among late toxicities, no patient developed a second malignancy and 5% died due to cardiovascular complications (p = 0.595) though only two patients (1.1%) had received thoracic radiation. Conclusion The two groups had comparable response rates, acute toxicities, DFS and OS. This study suggests that RT dose reduction may be possible in high-grade NHL without compromising the DFS and OS. Keywords: Non-Hodgkin lymphoma, Radiotherapy, Late effects, Radiation dose de-escalation
{"title":"Radiotherapy dose de-escalation in patients with high grade non-Hodgkin lymphoma in a real-world clinical practice","authors":"Budhi Singh Yadav, Treshita Dey","doi":"10.3857/roj.2023.00339","DOIUrl":"https://doi.org/10.3857/roj.2023.00339","url":null,"abstract":"Purpose The standard treatment of non-Hodgkin lymphoma (NHL) comprises combined modality treatment, radiotherapy (RT), and chemotherapy with rituximab which has significantly improved both disease-free survival (DFS) and overall survival (OS). However, there is no uniformity in radiation dose usage in these patients. In this retrospective study, we compared lower radiation dose with higher in patients with aggressive NHL. Materials and Methods From 2007 to 2017, treatment records of all high-grade NHL or diffuse large B-cell lymphoma and non-central nervous system NHL were included. We compared response rates, OS and DFS of patients who received â¤30 Gy RT to those with >30 Gy. Univariate and multivariate analyses were done to determine factors affecting prognosis, i.e., age, sex, stage, International Prognostic Index (IPI), adding rituximab, and radiation dose. Results A total of 184 NHL patients treated with combined modality or radiation alone having complete follow-up details were analyzed. At median follow-up of 66.8 months, 5-year OS was 72.8% in high-dose group versus 69.9% in low-dose group (p = 0.772) and 5-year DFS 64.7% versus 64.1% (p = 0.871). Patients having early-stage disease receiving low dose and those with advanced disease treated with >30 Gy had better OS and DFS though not statistically significant. Adding rituximab was associated with significantly better OS and DFS irrespective of radiation dose delivered. High IPI score and omitting rituximab were the only factors that significantly worsened both OS and DFS. Acute radiation toxicities were comparable in both groups (p = 0.82). Among late toxicities, no patient developed a second malignancy and 5% died due to cardiovascular complications (p = 0.595) though only two patients (1.1%) had received thoracic radiation. Conclusion The two groups had comparable response rates, acute toxicities, DFS and OS. This study suggests that RT dose reduction may be possible in high-grade NHL without compromising the DFS and OS. Keywords: Non-Hodgkin lymphoma, Radiotherapy, Late effects, Radiation dose de-escalation","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135770461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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