Purpose: To assess the feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) in patients with breast cancer.
Materials and methods: A total of 27 patients after breast-conserving surgery were included in this study. Patients were planned on a four-dimensional computerized tomogram, and contouring was done using RTOG guidelines. The dose was 34 Gy/10#/2 week to the breast and 40 Gy/10#/2 week to the tumor bed as SIB with volumetric modulated arc technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs-at-risk were calculated. Toxicities and cosmesis were assessed using RTOG/LENT/SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) were calculated with Kaplan-Meier curves.
Results: The mean age of the patients was 42 years. Left and right breast cancers were seen in 17 (63%) and 10 (37%) patients, respectively. The mean values of ipsilateral lung V16 and contralateral lung V5 were 16.01% and 3.74%, respectively. The mean heart doses from the left and right breast were 7.25 Gy and 4.37 Gy, respectively. The mean doses to the contralateral breast, oesophagus, and Dmax to brachial plexus were 2.64 Gy, 3.69 Gy, and 26.95 Gy, respectively. The mean value of thyroid V25 was 19.69%. Grade 1 and 2 acute skin toxicities were observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema, and induration were observed in 1 (3.7%), 2 (7.4%), and 4 (14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient. The median follow-up was 51 months (range, 12 to 61 months). At four years, breast induration, edema, and fibrosis were observed in 1 (3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred in 1 (3.7%) and 2 (7.4%) patients, respectively. DFS and OS at four years were 88% and 92%, respectively.
Conclusion: With this radiotherapy schedule, acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS, and OS were good.
{"title":"Accelerated hypofractionated breast radiotherapy with simultaneous integrated boost: a feasibility study.","authors":"Budhi Singh Yadav, Shipra Gupta, Divya Dahiya, Ankita Gupta, Arun Singh Oinam","doi":"10.3857/roj.2021.01053","DOIUrl":"https://doi.org/10.3857/roj.2021.01053","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) in patients with breast cancer.</p><p><strong>Materials and methods: </strong>A total of 27 patients after breast-conserving surgery were included in this study. Patients were planned on a four-dimensional computerized tomogram, and contouring was done using RTOG guidelines. The dose was 34 Gy/10#/2 week to the breast and 40 Gy/10#/2 week to the tumor bed as SIB with volumetric modulated arc technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs-at-risk were calculated. Toxicities and cosmesis were assessed using RTOG/LENT/SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) were calculated with Kaplan-Meier curves.</p><p><strong>Results: </strong>The mean age of the patients was 42 years. Left and right breast cancers were seen in 17 (63%) and 10 (37%) patients, respectively. The mean values of ipsilateral lung V16 and contralateral lung V5 were 16.01% and 3.74%, respectively. The mean heart doses from the left and right breast were 7.25 Gy and 4.37 Gy, respectively. The mean doses to the contralateral breast, oesophagus, and Dmax to brachial plexus were 2.64 Gy, 3.69 Gy, and 26.95 Gy, respectively. The mean value of thyroid V25 was 19.69%. Grade 1 and 2 acute skin toxicities were observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema, and induration were observed in 1 (3.7%), 2 (7.4%), and 4 (14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient. The median follow-up was 51 months (range, 12 to 61 months). At four years, breast induration, edema, and fibrosis were observed in 1 (3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred in 1 (3.7%) and 2 (7.4%) patients, respectively. DFS and OS at four years were 88% and 92%, respectively.</p><p><strong>Conclusion: </strong>With this radiotherapy schedule, acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS, and OS were good.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/fc/roj-2021-01053.PMC9262700.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: For patients with early breast cancer who undergo breast-conserving surgery, adjuvant whole breast irradiation (WBI) with simultaneous integrated boost (SIB) results in lower radiotherapy fractions. Published studies have shown that both conventional fraction with SIB (C-SIB) and hypofractionation with SIB (H-SIB) seem to be safe and feasible. In this study, we sought to compare the oncologic outcomes between C-SIB and H-SIB in early-stage breast cancer.
Materials and methods: Stage I-II breast cancer patients who received adjuvant WBI with SIB between January 2008 and December 2017 were retrospectively reviewed. The radiation dose in the C-SIB group was 50 Gy and 65 Gy in 25 daily fractions, while in the H-SIB group, it was 43.2 Gy and 52.8 Gy in 16 daily fractions to the whole breast and tumor bed, respectively.
Results: A total of 188 patients, 103 in the C-SIB group and 85 in the H-SIB group, were included. With a median follow-up time of 87 months, 7-year locoregional control of C-SIB was comparable to H-SIB (95.8% vs. 97.4%, p = 0.964). The 7-year distant metastasis-free survival rates of C-SIB and H-SIB were 89.9% and 95.9% (p = 0.111), while the 7-year disease-free survival rates were 84.2% and 95.4%, respectively (p = 0.176). In multivariate analysis, there was no significant prognostic factor associated with better overall survival.
Conclusion: H-SIB provided comparable locoregional control to C-SIB. With the advantage of a shorter radiotherapy course, H-SIB could be a favorable option for WBI in early-stage breast cancer.
目的:对于行保乳手术的早期乳腺癌患者，辅助全乳照射(WBI)同时综合增强(SIB)可降低放疗分数。已发表的研究表明，传统的SIB分流(C-SIB)和SIB分流(H-SIB)似乎都是安全可行的。在这项研究中，我们试图比较C-SIB和H-SIB在早期乳腺癌中的肿瘤预后。材料和方法:回顾性分析2008年1月至2017年12月期间接受SIB辅助WBI的I-II期乳腺癌患者。C-SIB组对整个乳房和肿瘤床的辐射剂量分别为50 Gy和65 Gy，分25个每日次;H-SIB组对整个乳房和肿瘤床的辐射剂量分别为43.2 Gy和52.8 Gy，分16个每日次。结果:共纳入188例患者，其中C-SIB组103例，H-SIB组85例。中位随访时间为87个月，7年C-SIB局部区域控制率与H-SIB相当(95.8% vs. 97.4%， p = 0.964)。C-SIB和H-SIB的7年无远处转移生存率分别为89.9%和95.9% (p = 0.111)， 7年无疾病生存率分别为84.2%和95.4% (p = 0.176)。在多变量分析中，没有明显的预后因素与更好的总生存相关。结论:H-SIB与C-SIB具有相当的局部控制作用。H-SIB具有较短放疗疗程的优势，可能是早期乳腺癌WBI的有利选择。
{"title":"Long-term oncological outcomes of hypofractionated versus conventional fractionated whole breast irradiation with simultaneous integrated boost in early-stage breast cancer.","authors":"Chawalit Lertbutsayanukul, Manida Pitak, Chonnipa Nantavithya","doi":"10.3857/roj.2021.00927","DOIUrl":"https://doi.org/10.3857/roj.2021.00927","url":null,"abstract":"<p><strong>Purpose: </strong>For patients with early breast cancer who undergo breast-conserving surgery, adjuvant whole breast irradiation (WBI) with simultaneous integrated boost (SIB) results in lower radiotherapy fractions. Published studies have shown that both conventional fraction with SIB (C-SIB) and hypofractionation with SIB (H-SIB) seem to be safe and feasible. In this study, we sought to compare the oncologic outcomes between C-SIB and H-SIB in early-stage breast cancer.</p><p><strong>Materials and methods: </strong>Stage I-II breast cancer patients who received adjuvant WBI with SIB between January 2008 and December 2017 were retrospectively reviewed. The radiation dose in the C-SIB group was 50 Gy and 65 Gy in 25 daily fractions, while in the H-SIB group, it was 43.2 Gy and 52.8 Gy in 16 daily fractions to the whole breast and tumor bed, respectively.</p><p><strong>Results: </strong>A total of 188 patients, 103 in the C-SIB group and 85 in the H-SIB group, were included. With a median follow-up time of 87 months, 7-year locoregional control of C-SIB was comparable to H-SIB (95.8% vs. 97.4%, p = 0.964). The 7-year distant metastasis-free survival rates of C-SIB and H-SIB were 89.9% and 95.9% (p = 0.111), while the 7-year disease-free survival rates were 84.2% and 95.4%, respectively (p = 0.176). In multivariate analysis, there was no significant prognostic factor associated with better overall survival.</p><p><strong>Conclusion: </strong>H-SIB provided comparable locoregional control to C-SIB. With the advantage of a shorter radiotherapy course, H-SIB could be a favorable option for WBI in early-stage breast cancer.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/53/roj-2021-00927.PMC9262705.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aims to assess the locoregional efficacy of postoperative vaginal brachytherapy (VBT) alone in patients undergoing surgical staging for early-stage high-intermediate-risk (HIR) and high-risk (HR) endometrial cancer.
Materials and methods: One hundred and four patients with early-stage HIR and HR endometrial cancer who underwent surgical staging were treated with adjuvant VBT alone. The patients with stage Ib, grade I-III, stage Ia, grade III, lower uterine segment involvement, and lymphovascular invasion (LVI) were included to study.
Results: The 5- and 10-year overall survival (OS) rates were 87% and 76%, respectively. The 5- and 10-year DFS rates were 86% and 86%, respectively. Among the patients, 92% had endometrioid adenocarcinoma, 2% had undifferentiated carcinoma, 2% had serous papillary carcinoma, and 4% had clear-cell carcinoma. Of the patients, 63% had stage Ib disease, while 37% had stage Ia disease. None of the patients had vaginal or pelvic lymph node recurrence, whereas two had para-aortic lymph node metastasis, one had surgical scar recurrence, one had para-aortic lymph node and brain metastasis, and one had lung metastasis. The presence of lymphatic invasion was found to be a statistically significant prognostic factor for increased distant metastasis rates (p = 0.020). Lymphatic invasion was also regarded as an independent prognostic factor for metastasis-free survival (p = 0.044).
Conclusion: Our study results suggest that postoperative VBT alone is an effective and safe treatment modality with low complication in patients undergoing surgical staging for HIR and HR endometrial cancer.
{"title":"Improving locoregional outcome in high-intermediate-risk and high-risk stage I endometrial cancer with surgical staging followed by brachytherapy.","authors":"Candan Demiroz Abakay, Sonay Arslan, Meral Kurt, Sibel Cetintas","doi":"10.3857/roj.2021.00864","DOIUrl":"https://doi.org/10.3857/roj.2021.00864","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess the locoregional efficacy of postoperative vaginal brachytherapy (VBT) alone in patients undergoing surgical staging for early-stage high-intermediate-risk (HIR) and high-risk (HR) endometrial cancer.</p><p><strong>Materials and methods: </strong>One hundred and four patients with early-stage HIR and HR endometrial cancer who underwent surgical staging were treated with adjuvant VBT alone. The patients with stage Ib, grade I-III, stage Ia, grade III, lower uterine segment involvement, and lymphovascular invasion (LVI) were included to study.</p><p><strong>Results: </strong>The 5- and 10-year overall survival (OS) rates were 87% and 76%, respectively. The 5- and 10-year DFS rates were 86% and 86%, respectively. Among the patients, 92% had endometrioid adenocarcinoma, 2% had undifferentiated carcinoma, 2% had serous papillary carcinoma, and 4% had clear-cell carcinoma. Of the patients, 63% had stage Ib disease, while 37% had stage Ia disease. None of the patients had vaginal or pelvic lymph node recurrence, whereas two had para-aortic lymph node metastasis, one had surgical scar recurrence, one had para-aortic lymph node and brain metastasis, and one had lung metastasis. The presence of lymphatic invasion was found to be a statistically significant prognostic factor for increased distant metastasis rates (p = 0.020). Lymphatic invasion was also regarded as an independent prognostic factor for metastasis-free survival (p = 0.044).</p><p><strong>Conclusion: </strong>Our study results suggest that postoperative VBT alone is an effective and safe treatment modality with low complication in patients undergoing surgical staging for HIR and HR endometrial cancer.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/12/roj-2021-00864.PMC9262699.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40477613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Cho, J. Jeong, T. Nam, Y. Joo, Sung-Bum Cho, Yong-Hyub Kim, Ju-Young Song, M. Yoon, S. Ahn, W. Chung
Purpose This study aimed to determine the correlation between protein induced by vitamin K absence or antagonist-II (PIVKA-II) and stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC). Materials and Methods Sixty-one patients received SBRT between 2015 and 2020 with a median dose of 48 Gy (range, 39 to 60 Gy) with a median of 4 fractions. Changes in tumor markers before and after SBRT were analyzed. Results The median follow-up period was 31 months (range, 12 to 64 months). The estimated 2-year in-field failure-free survival, progression-free survival (PFS), and overall survival rates were 82.0%, 39.3%, and 96.7%, respectively. Patients with decreased PIVKA-II levels through SBRT had significantly few in-field failures (p = 0.005). Patients with PIVKA-II levels of ≤25 mAU/mL after SBRT had significantly long PFS (p = 0.004). Conclusion PIVKA-II could be a useful surrogate marker for response or survival outcomes in patients with localized HCC receiving SBRT.
{"title":"PIVKA-II as a surrogate marker for prognosis in patients with localized hepatocellular carcinoma receiving stereotactic body radiotherapy","authors":"I. Cho, J. Jeong, T. Nam, Y. Joo, Sung-Bum Cho, Yong-Hyub Kim, Ju-Young Song, M. Yoon, S. Ahn, W. Chung","doi":"10.3857/roj.2021.00934","DOIUrl":"https://doi.org/10.3857/roj.2021.00934","url":null,"abstract":"Purpose This study aimed to determine the correlation between protein induced by vitamin K absence or antagonist-II (PIVKA-II) and stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC). Materials and Methods Sixty-one patients received SBRT between 2015 and 2020 with a median dose of 48 Gy (range, 39 to 60 Gy) with a median of 4 fractions. Changes in tumor markers before and after SBRT were analyzed. Results The median follow-up period was 31 months (range, 12 to 64 months). The estimated 2-year in-field failure-free survival, progression-free survival (PFS), and overall survival rates were 82.0%, 39.3%, and 96.7%, respectively. Patients with decreased PIVKA-II levels through SBRT had significantly few in-field failures (p = 0.005). Patients with PIVKA-II levels of ≤25 mAU/mL after SBRT had significantly long PFS (p = 0.004). Conclusion PIVKA-II could be a useful surrogate marker for response or survival outcomes in patients with localized HCC receiving SBRT.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76458114","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. Matani, S. Abel, A. Yu, S. Karlovits, R. Wegner
Purpose Meningiomas are tumors originating from arachnoid cap cells on the surface of the brain or spinal cord. Treatment differs by grade but can consist of observation, surgery, radiation therapy or both. We utilized the National Cancer Database (NCDB) to compare trends in the use stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) in the management of meningioma. Materials and Methods We queried the NCDB from 2004–2015 for meningioma patients (grade 1–3) treated with radiation therapy, either SRS or EBRT. Multivariable logistic regression was used to identify predictors of each treatment and to generate a propensity score. Propensity adjusted Kaplan-Meier survival curve analysis and multivariable Cox hazards ratios were used to identify predictors of survival. Results We identified 5,406 patients with meningioma meeting above criteria with 45%, 44%, and 11% having World Health Organization (WHO) grade 1, 2, and 3 disease, respectively. Median follow up was 43 months. Predictors for SRS were grade 1 disease, distance from treatment facility, and histology. The only predictor of EBRT was grade 3 disease. Treatment year, histology, race and female sex were associated with improved survival. Five- and 10-year survival rates were 89.2% versus 72.6% (p < 0.0001) and 80.3% versus 61.4% (p = 0.29) for SRS and EBRT respectively. After propensity matching 226 pairs were generated. For SRS, 5-year survival was not significantly improved at 88.2% compared with EBRT (p = 0.056). Conclusion In the present analysis, predictors of SRS utilization in management of meningioma include WHO grade 1 disease, distance from treatment facility and histology whereas conventional EBRT utilization was associated with grade 2 and 3 disease. Future studies need to be performed in order to optimize management of atypical and malignant meningioma.
{"title":"Trends in the use of radiation for meningioma across the United States","authors":"H. Matani, S. Abel, A. Yu, S. Karlovits, R. Wegner","doi":"10.3857/roj.2021.00563","DOIUrl":"https://doi.org/10.3857/roj.2021.00563","url":null,"abstract":"Purpose Meningiomas are tumors originating from arachnoid cap cells on the surface of the brain or spinal cord. Treatment differs by grade but can consist of observation, surgery, radiation therapy or both. We utilized the National Cancer Database (NCDB) to compare trends in the use stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) in the management of meningioma. Materials and Methods We queried the NCDB from 2004–2015 for meningioma patients (grade 1–3) treated with radiation therapy, either SRS or EBRT. Multivariable logistic regression was used to identify predictors of each treatment and to generate a propensity score. Propensity adjusted Kaplan-Meier survival curve analysis and multivariable Cox hazards ratios were used to identify predictors of survival. Results We identified 5,406 patients with meningioma meeting above criteria with 45%, 44%, and 11% having World Health Organization (WHO) grade 1, 2, and 3 disease, respectively. Median follow up was 43 months. Predictors for SRS were grade 1 disease, distance from treatment facility, and histology. The only predictor of EBRT was grade 3 disease. Treatment year, histology, race and female sex were associated with improved survival. Five- and 10-year survival rates were 89.2% versus 72.6% (p < 0.0001) and 80.3% versus 61.4% (p = 0.29) for SRS and EBRT respectively. After propensity matching 226 pairs were generated. For SRS, 5-year survival was not significantly improved at 88.2% compared with EBRT (p = 0.056). Conclusion In the present analysis, predictors of SRS utilization in management of meningioma include WHO grade 1 disease, distance from treatment facility and histology whereas conventional EBRT utilization was associated with grade 2 and 3 disease. Future studies need to be performed in order to optimize management of atypical and malignant meningioma.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82989887","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}
P. Sakyanun, Thirada Vongvanichvathana, P. Lertsanguansinchai
A 26-year-old female presented recurrent painful, carbuncles at both axillae for 10 years. It caused offensive odor and scar. Tissue diagnosis was chronic hidradenitis suppurativa. She was treated using antibiotics followed by multiple excisions with drainage but showed no improvement. Isotretinoin provided no benefit. She was socially isolated and experienced lower quality of life. Consequently, she was sent for radiation therapy. Computed tomography simulation was performed revealing an ulcer with deep chronic pus tracts at her axilla. Three-dimensional conformal radiation therapy was provided with 6 MV photon (7.5 Gy in 3 fractions) covering all ulcers and pus tracts. On the last day of radiation therapy, carbuncles and wounds at the left axilla exhibited much improvement without pus. Three months follow-up showed much improvement of the lesions. The skin was smoother without pus or odor. Radiation therapy was confirmed one treatment option for chronic hidradenitis suppurativa.
{"title":"Radiation therapy in chronic hidradenitis suppurativa: case report","authors":"P. Sakyanun, Thirada Vongvanichvathana, P. Lertsanguansinchai","doi":"10.3857/roj.2021.00570","DOIUrl":"https://doi.org/10.3857/roj.2021.00570","url":null,"abstract":"A 26-year-old female presented recurrent painful, carbuncles at both axillae for 10 years. It caused offensive odor and scar. Tissue diagnosis was chronic hidradenitis suppurativa. She was treated using antibiotics followed by multiple excisions with drainage but showed no improvement. Isotretinoin provided no benefit. She was socially isolated and experienced lower quality of life. Consequently, she was sent for radiation therapy. Computed tomography simulation was performed revealing an ulcer with deep chronic pus tracts at her axilla. Three-dimensional conformal radiation therapy was provided with 6 MV photon (7.5 Gy in 3 fractions) covering all ulcers and pus tracts. On the last day of radiation therapy, carbuncles and wounds at the left axilla exhibited much improvement without pus. Three months follow-up showed much improvement of the lesions. The skin was smoother without pus or odor. Radiation therapy was confirmed one treatment option for chronic hidradenitis suppurativa.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85439440","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}
Dowook Kim, J. Choi, K. Hong, H. Kang, I. Kim, J. Lee
Purpose Reports on results of radiation therapy (RT) for Kasabach-Merritt syndrome (KMS) are limited. We performed a retrospective study to evaluate the response rates and late complications and to determine the adequate RT dose for patients with KMS patients. Materials and Methods We studied 11 patients who received RT between October 1988 and September 2008 for KMS refractory to pharmacologic therapy. All patients had external hemangiomas and received the diagnosis of KMS within 12 months of birth. All 11 patients received steroids as the first-line therapy; eight patients additionally received interferon-α therapy, and one patient underwent surgery. Nine patients underwent single-course RT with a total dose of 4.5–8 Gy (1.5–2 Gy/fraction). Two patients received multiple courses of RT, with a cumulative total dose of 12 Gy (2 Gy/fraction) and 18 Gy (1.5 Gy/fraction), respectively. Results The median follow-up period was 156 months (interquartile range [IQR], 75 to 226 months). The median total dose of RT was 6 Gy, and all patients maintained complete remission until the last follow-up. An additional course of RT was performed for refractory cases or cases of local relapse after initial RT. Rapid platelet count increase after RT was seen in most patients, which returned to normalcy in a median of 20 days (IQR, 5 to 178 days). However, seven patients experienced radiation-related long-term complications. Conclusion Low-dose RT is effective and yields rapid response in patients with KMS. However, given growth-related late complications, RT should be carefully considered.
{"title":"Long-term outcomes of low-dose radiotherapy in Kasabach-Merritt syndrome","authors":"Dowook Kim, J. Choi, K. Hong, H. Kang, I. Kim, J. Lee","doi":"10.3857/roj.2021.00983","DOIUrl":"https://doi.org/10.3857/roj.2021.00983","url":null,"abstract":"Purpose Reports on results of radiation therapy (RT) for Kasabach-Merritt syndrome (KMS) are limited. We performed a retrospective study to evaluate the response rates and late complications and to determine the adequate RT dose for patients with KMS patients. Materials and Methods We studied 11 patients who received RT between October 1988 and September 2008 for KMS refractory to pharmacologic therapy. All patients had external hemangiomas and received the diagnosis of KMS within 12 months of birth. All 11 patients received steroids as the first-line therapy; eight patients additionally received interferon-α therapy, and one patient underwent surgery. Nine patients underwent single-course RT with a total dose of 4.5–8 Gy (1.5–2 Gy/fraction). Two patients received multiple courses of RT, with a cumulative total dose of 12 Gy (2 Gy/fraction) and 18 Gy (1.5 Gy/fraction), respectively. Results The median follow-up period was 156 months (interquartile range [IQR], 75 to 226 months). The median total dose of RT was 6 Gy, and all patients maintained complete remission until the last follow-up. An additional course of RT was performed for refractory cases or cases of local relapse after initial RT. Rapid platelet count increase after RT was seen in most patients, which returned to normalcy in a median of 20 days (IQR, 5 to 178 days). However, seven patients experienced radiation-related long-term complications. Conclusion Low-dose RT is effective and yields rapid response in patients with KMS. However, given growth-related late complications, RT should be carefully considered.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86104140","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 study aimed to identify the clinical parameters having the beneficial effect of postoperative radiotherapy (PORT) in pathologic N2 (pN2) non-small cell lung cancer (NSCLC) using the Surveillance, Epidemiology, and End Results (SEER) data. Materials and methods Among non-metastatic NSCLC patients in the SEER data, we included patients who diagnosed after 2002, who confirmed as pN2 after lobectomy or pneumonectomy, and who coded as underwent PORT or observation. Patients who survived less than 4 months of diagnosis were excluded in consideration of the perioperative mortality. After performing propensity score matching (PSM) on the selected patients, we compared PORT group with surgery alone group. We also performed exploratory subgroup analysis to find patients who could benefit from PORT. Results Among the selected 4,456 patients, 1,729 patients received PORT, and 2,727 patients did not. There was no survival benefit of PORT in all patients with pN2 disease (hazard ratio [HR] = 1.03, p = 0.5). In subgroup analyses, the patients with a positive lymph node (LN) ratio of 60%–80% showed the significant benefit of PORT (HR = 0.71, p = 0.002). Conclusion PORT did not show the significant survival benefit in patients with pN2 disease after correcting the confoundedness in the SEER data. However, a specific range of LN ratios can be a potential indicator maximizing the survival benefit of PORT.
目的本研究旨在通过监测、流行病学和最终结果(SEER)数据，确定对病理N2 (pN2)非小细胞肺癌(NSCLC)术后放疗(PORT)有利的临床参数。材料和方法在SEER数据中的非转移性NSCLC患者中，我们纳入了2002年以后诊断的患者，在肺叶切除术或全肺切除术后确诊为pN2的患者，以及编码为接受PORT或观察的患者。生存时间小于4个月的患者排除在围手术期死亡率考虑之外。在对选定的患者进行倾向评分匹配(PSM)后，我们将PORT组与单纯手术组进行比较。我们还进行了探索性亚组分析，以寻找可以从PORT获益的患者。结果4456例患者中，1729例患者接受了PORT治疗，2727例患者未接受PORT治疗。在所有pN2疾病患者中，PORT无生存获益(风险比[HR] = 1.03, p = 0.5)。在亚组分析中，淋巴结(LN)阳性比例为60%-80%的患者显示PORT的显著获益(HR = 0.71, p = 0.002)。结论在纠正了SEER数据中的混淆后，PORT并未显示pN2疾病患者的显著生存获益。然而，LN比率的特定范围可能是PORT生存效益最大化的潜在指标。
{"title":"Optimal positive lymph node ratio showing the benefit of postoperative radiotherapy in pathologic N2 non-small cell lung cancer: an exploratory study using the Surveillance, Epidemiology, and End Results data","authors":"Shiho Lee, Kyu Noh","doi":"10.3857/roj.2021.00969","DOIUrl":"https://doi.org/10.3857/roj.2021.00969","url":null,"abstract":"Purpose This study aimed to identify the clinical parameters having the beneficial effect of postoperative radiotherapy (PORT) in pathologic N2 (pN2) non-small cell lung cancer (NSCLC) using the Surveillance, Epidemiology, and End Results (SEER) data. Materials and methods Among non-metastatic NSCLC patients in the SEER data, we included patients who diagnosed after 2002, who confirmed as pN2 after lobectomy or pneumonectomy, and who coded as underwent PORT or observation. Patients who survived less than 4 months of diagnosis were excluded in consideration of the perioperative mortality. After performing propensity score matching (PSM) on the selected patients, we compared PORT group with surgery alone group. We also performed exploratory subgroup analysis to find patients who could benefit from PORT. Results Among the selected 4,456 patients, 1,729 patients received PORT, and 2,727 patients did not. There was no survival benefit of PORT in all patients with pN2 disease (hazard ratio [HR] = 1.03, p = 0.5). In subgroup analyses, the patients with a positive lymph node (LN) ratio of 60%–80% showed the significant benefit of PORT (HR = 0.71, p = 0.002). Conclusion PORT did not show the significant survival benefit in patients with pN2 disease after correcting the confoundedness in the SEER data. However, a specific range of LN ratios can be a potential indicator maximizing the survival benefit of PORT.","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72419701","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}
general understanding of the abscopal effect. As mentioned by the authors, while this phenomenon has been described for decades, the underlying molecular mechanisms allowing localized radiation to exert a disseminated anti-tumoral effect remains profoundly opaque. Although a multiplicity of pathways, effectors and mediators have been described, little work yielded results which could allow the clinical instrumentalization of this effect. In this review, the authors report the proposed unifying mechanism allowing distant effect of localized radiation therapy, which hinges on the activation of local CD T lymphocytes. These effector cells are exposed and primed to tumoral antigens and then exported to distant lesion sites, where they operate their cytolytic effect. The authors also mention that the generation of a large amount of de novo tumor antigens is responsible for robust immunogenicity, which is required to achieve potent activation of local leukocytes, as confirmed by others [2]. We do agree that tumor mutational burden (TMB) is usually considered as the primary predictor of neoantigen load, which is itself ontologically associated with tumoral immunoreactivity [3]. However, as underlined in pancreatic cancer [4] as well as other organ systems, distinct orthogonal signatures, like chemokine expression, can be used as robust, complementary proxies of the degree of tumoral T-cell infiltration and activation, even in the absence of high TMB or neoantigens. Alternatively, a variety of molecular signatures characteristic of T cell-inflamed phenotypes have been identified, with high T-cell infiltration generally predictive of good immunotherapeutic response. This, in turn, provides a plausibly robust prognosticator of response to immune checkpoint inhibitors [5]. In essence, it is suggested that tumoral immunogenicity, and response to immunotherapy, are not solely contingent on neoantigens and, by extension, TMB. Indeed, recent analysis of the phase 2 pan-cancer study (CA209-538) demonstrated no predictive value of TMB to response to combined PD-1/CTLA-4 (programmed cell death protein-1/cytotoxic T lymphocyte antigen-4) checkpoint inhibition [6]. Rather, tumor infiltration by competent lymphocytes, which appears to be associated with different immunobiologically relevant signatures, could be a complementary, powerful metric of predicted therapeutic sensitivity to both radio and immunotherapies. We agree with the authors that identifying lesions most likely to generate systemic response to loComment on “Abscopal effect in the radio and immunotherapy”
{"title":"Comment on “Abscopal effect in the radio and immunotherapy”","authors":"François Fabi","doi":"10.3857/roj.2022.00017","DOIUrl":"https://doi.org/10.3857/roj.2022.00017","url":null,"abstract":"general understanding of the abscopal effect. As mentioned by the authors, while this phenomenon has been described for decades, the underlying molecular mechanisms allowing localized radiation to exert a disseminated anti-tumoral effect remains profoundly opaque. Although a multiplicity of pathways, effectors and mediators have been described, little work yielded results which could allow the clinical instrumentalization of this effect. In this review, the authors report the proposed unifying mechanism allowing distant effect of localized radiation therapy, which hinges on the activation of local CD T lymphocytes. These effector cells are exposed and primed to tumoral antigens and then exported to distant lesion sites, where they operate their cytolytic effect. The authors also mention that the generation of a large amount of de novo tumor antigens is responsible for robust immunogenicity, which is required to achieve potent activation of local leukocytes, as confirmed by others [2]. We do agree that tumor mutational burden (TMB) is usually considered as the primary predictor of neoantigen load, which is itself ontologically associated with tumoral immunoreactivity [3]. However, as underlined in pancreatic cancer [4] as well as other organ systems, distinct orthogonal signatures, like chemokine expression, can be used as robust, complementary proxies of the degree of tumoral T-cell infiltration and activation, even in the absence of high TMB or neoantigens. Alternatively, a variety of molecular signatures characteristic of T cell-inflamed phenotypes have been identified, with high T-cell infiltration generally predictive of good immunotherapeutic response. This, in turn, provides a plausibly robust prognosticator of response to immune checkpoint inhibitors [5]. In essence, it is suggested that tumoral immunogenicity, and response to immunotherapy, are not solely contingent on neoantigens and, by extension, TMB. Indeed, recent analysis of the phase 2 pan-cancer study (CA209-538) demonstrated no predictive value of TMB to response to combined PD-1/CTLA-4 (programmed cell death protein-1/cytotoxic T lymphocyte antigen-4) checkpoint inhibition [6]. Rather, tumor infiltration by competent lymphocytes, which appears to be associated with different immunobiologically relevant signatures, could be a complementary, powerful metric of predicted therapeutic sensitivity to both radio and immunotherapies. We agree with the authors that identifying lesions most likely to generate systemic response to loComment on “Abscopal effect in the radio and immunotherapy”","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90292899","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: DNA polymerase β (Polβ) acts in the base excision repair (BER) pathway. Mutations in DNA polymerase β (Polβ) are associated with different cancers. A variant of Polβ with a 97 amino acid deletion (PolβΔ), in heterozygous conditions with wild-type Polβ, was identified in sporadic ovarian tumor samples. This study aims to evaluate the gamma radiation sensitivity of PolβΔ for possible target therapy in ovarian cancer treatment.
Materials and methods: PolβΔ cDNA was cloned in a GFP vector and transfected in PA1 cells. Stable cells (PA1PolβΔ) were treated with 60Co sourced gamma-ray (0-15 Gy) to investigate their radiation sensitivity. The affinity of PolβΔ with DNA evaluated by DNA protein in silico docking experiments.
Results: The result showed a statistically significant (p < 0.05) higher sensitivity towards radiation at different doses (0-15 Gy) and time-point (48-72 hours) for PA1PolβΔ cells in comparison with normal PA1 cells. Ten Gy of gamma radiation was found to be the optimal dose. Significantly more PA1PolβΔ cells were killed at this dose than PA1 cells after 48 hours of treatment via an apoptotic pathway. The in silico docking experiments revealed that PolβΔ has more substantial binding potential towards the dsDNA than wild-type Polβ, suggesting a possible failure of BER pathway that results in cell death.
Conclusion: Our study showed that the PA1PolβΔ cells were more susceptible than PA1 cells to gamma radiation. In the future, the potentiality of ionizing radiation to treat this type of cancer will be checked in animal models.
{"title":"PA1 cells containing a truncated DNA polymerase β protein are more sensitive to gamma radiation.","authors":"Anutosh Patra, Anish Nag, Anindita Chakraborty, Nandan Bhattacharyya","doi":"10.3857/roj.2021.00689","DOIUrl":"10.3857/roj.2021.00689","url":null,"abstract":"<p><strong>Purpose: </strong>DNA polymerase β (Polβ) acts in the base excision repair (BER) pathway. Mutations in DNA polymerase β (Polβ) are associated with different cancers. A variant of Polβ with a 97 amino acid deletion (PolβΔ), in heterozygous conditions with wild-type Polβ, was identified in sporadic ovarian tumor samples. This study aims to evaluate the gamma radiation sensitivity of PolβΔ for possible target therapy in ovarian cancer treatment.</p><p><strong>Materials and methods: </strong>PolβΔ cDNA was cloned in a GFP vector and transfected in PA1 cells. Stable cells (PA1PolβΔ) were treated with 60Co sourced gamma-ray (0-15 Gy) to investigate their radiation sensitivity. The affinity of PolβΔ with DNA evaluated by DNA protein in silico docking experiments.</p><p><strong>Results: </strong>The result showed a statistically significant (p < 0.05) higher sensitivity towards radiation at different doses (0-15 Gy) and time-point (48-72 hours) for PA1PolβΔ cells in comparison with normal PA1 cells. Ten Gy of gamma radiation was found to be the optimal dose. Significantly more PA1PolβΔ cells were killed at this dose than PA1 cells after 48 hours of treatment via an apoptotic pathway. The in silico docking experiments revealed that PolβΔ has more substantial binding potential towards the dsDNA than wild-type Polβ, suggesting a possible failure of BER pathway that results in cell death.</p><p><strong>Conclusion: </strong>Our study showed that the PA1PolβΔ cells were more susceptible than PA1 cells to gamma radiation. In the future, the potentiality of ionizing radiation to treat this type of cancer will be checked in animal models.</p>","PeriodicalId":46572,"journal":{"name":"Radiation Oncology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81528815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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