Reports of Practical Oncology and Radiotherapy最新文献

The aim of the study was to conduct an integrative review on intraoral stents for head and neck radiotherapy using 3D technology. For data collection, the words were used: "intraoral stent", "oral cancer" and "3D", with their combination performed using the Boolean operator AND. Only articles in English were selected from the PubMed and LILACS databases. The search process was conducted between August and October 2024. Eight articles were found, of which seven met the established inclusion criteria. The articles demonstrate that the use of 3D technology optimizes the fabrication time of intraoral stents, directs isodose distribution to the treated area while preserving adjacent healthy tissues, and reduces side effects during the irradiation period. Evident advances in the literature regarding the innovation in the production of intraoral stents, such as 3D printing, have demonstrated effectiveness and benefits in this treatment modality.

In recent years, we have observed a significant increase in the number of radical prostatectomies (RP) performed in patients at very high risk of prostate cancer. This group of patients is very heterogeneous due to the presence of multiple risk factors for recurrence, which makes decisions regarding the use of salvage radiotherapy (RT) very challenging. On the one hand, there is a subgroup of patients who can only be observed. For a more advanced subgroup of patients postoperative RT alone is effective treatment. For patients with very aggressive biology characteristics RT should be combined with systemic therapy. Unfortunately, we still do not have ideal tools to precisely assign individual patients to these subgroups. Clinicopathological factors are very helpful in this regard. So, introduction of modern molecular diagnostics, i.e., positron emission tomography (PET) using a radiotracer that binds to prostate-specific membrane antigen (PET-PSMA), allowed for a change in the general strategy for salvage RT. Information from PET scans included in the RT plan allow for increasing the effectiveness of RT. Another method for personalizing RT planning is the use of genomic testing. To date, the most clinically validated method allows for the identification of a subgroup of patients in whom combined treatment [androgen deprivation therapy (ADT) + RT] yields the greatest clinical benefits. Improvement in RT outcomes is associated with the introduction of technologically advanced RT methods, such as adaptive RT (ART), which provides the opportunity for a precise delivery of dose to a tumour bed. Another very promising development involves new predictive tests for RT which are based on genomic analysis of cancer tissue.

Background: In this study we aimed to analyse the late cardiac effects in patients with left sided breast cancer treated with hypofractionated radiotherapy.

Materials and methods: Between January 1990 to December 2005, patients treated for left side breast cancer who had received radiotherapy at least 10 years earlier were included in this study. Radiotherapy dose was 35-40 Gy/15-16#/3 weeks. These patients underwent echocardiography, stress myocardial perfusion scintigraphy (MPS) to look for any myocardial perfusion defect (MPD). MPD extent was defined as not significant, mild, moderate and large if it was < 5%, 5-10%, > 10-20% and > 20%, whereas severity was defined as mild moderate and severe, respectively.

Results: A total of 87 patients underwent stress myoperfusion scan (MPS). MPDs were observed in 31 (36%) patients. MPDs were not significant, mild and moderate in 5 (6%), 25 (28%) and 1 (1%) patients, respectively. In majority of patients [30 (97%)], MPDs were observed in the apex and apical anterior segment of the left ventricle myocardium. MPD intensity was mild, mild to moderate and moderate in 21 (68%), 4 (13%) and 6 (19%) patients, respectively. MPDs were reversible, partially reversible, minimally reversible and fixed in 22 (71%), 3 (10%) 1 (3%) and 5 (16%) patients, respectively. Central lung distance (CLD) ≥ 2.5 cm was a significant factor for MPDs (p = 0.027). Left ventricular ejection fraction deterioration was observed in 2 (6%) patients only. Coronary events occurred in 4 (4.5%) patients.

Conclusions: In patients with left sided breast radiotherapy majority of MPDs were mild. Moderate and fixed MPDs were associated with CLD ≥ 2.5 cm. Left ventricular functional deterioration was observed in few patients only.

Diffuse midline gliomas (DMGs) with H3K27M alterations are rare, aggressive, World Health Organization (WHO) grade 4 tumors arising in midline central nervous system (CNS) structures, characterized by a lysine-to-methionine substitution at histone H3K27, which disrupts epigenetic regulation via global loss of H3K27 trimethylation. The pineal gland is an exceptionally uncommon site of origin. We report the first case of a synaptophysin-positive, H3K27M-altered DMG in the pineal gland of a 7-year-old female, characterized by hypercellularity, moderate atypia, high mitotic activity, and a Ki-67 index of 30%. Immunohistochemistry confirmed positivity for glial markers: glial fibrillary acidic protein (GFAP), oligodendrocyte transcription factor 2 (Olig2), loss of hypotrimethylation of lysine 27 on histone H3 (H3K27me3), and synaptophysin expression, an unusual feature for DMGs. Methylation profiling established the diagnosis. A systematic review identified seven cases of pineal H3K27M-altered DMG (age ranged from 7 to 65 years, with three pediatric and four adult) revealing notable immunohistochemical heterogeneity, limited molecular data (only our case had available methylation profiling) and a synaptophysin expression limited to our pediatric case. Sparse clinical outcome data precluded robust prognostic comparisons. These findings underscore the biological heterogeneity and diagnostic challenges of pineal DMGs and underscore the necessity of comprehensive molecular and immunohistochemical assessments to optimize diagnosis and guide emerging targeted therapies.

Background: A hybrid solitary dynamic portal radiotherapy (h-SDPRT) technique for complex chest-wall and regional nodal irradiation was clinically implemented on the Monaco treatment planning system (TPS) by effectively adapting the Eclipse-based h-SDPRT method with minimal amendments to align with Monaco-specific technical constraints while maintaining consistent and reproducible dosimetric outcomes.

Materials and methods: This technique was evaluated on ten left-sided post-mastectomy radiotherapy (PMRT) patients, delivering 80-85% of the prescribed dose through asymmetric static open field apertures with the Elekta Agility multileaf collimator (MLC), and the remaining 15-20% via a unidirectional solitary dynamic field with differential blocks, composed of 10-15 MLC control points (4-5% of the dose per segment).

Results: The h-SDPRT plans demonstrated excellent dose coverage to the chest-wall target (D₉₉ ≥ 96.3 ± 0.2%) and regional nodes (D₉₉ ≥ 96.4 ± 0.8%), optimal conformity (1.5 ± 0.1), and superior homogeneity (0.104 ± 0.01), while effectively sparing critical organs-at-risk (OAR) viz., ipsilateral lung (V₂₀ ≤ 26.7 ± 2.0% and D_mean: 14.3 ± 5.7 Gy) and heart (V₂₅ ≤ 6.4 ± 3.8% and D_mean: 6.1 ± 1.6 Gy), with complete sparing of contralateral lung (V₅ ≤ 0.1 ± 0.2% and D_mean: 1.3 ± 0.3 Gy) and breast (V₅ ≤ 1.5 ± 1.0% and D_mean: 1.6 ± 0.2 Gy). Gamma evaluation (γ) showed > 95% pixels passing the standard 3% dose difference and 3 mm distance-to-agreement γ criteria, with results closely aligning with Eclipse TPS data.

Conclusions: The h-SDPRT technique minimizes the risk of "geometrical miss" and reduces delivery uncertainties associated with irregular or thin chest-wall with comprehensive nodal irradiation. By combining dominant static portals with simplified unidirectional dynamic field sequencing strategy, this approach provides a feasible and effective solution for PMRT.

Background: Magnesium (Mg) deficiency may promote tumor growth and metastasis, hence the need to monitor and possibly normalize its level during treatment is emphasized. Therefore, our study aimed to assess the effect of a six-week adjuvant chemotherapy on serum Mg and calcium (Ca)/Mg ratio in patients with breast cancer.

Materials and methods: The study included a group of 80 women with breast cancer who were qualified for adjuvant chemotherapy in the AC regimen (doxorubicin and cyclophosphamide). Serum magnesium and calcium levels were determined spectrophotometrically. Serum high-sensitivity C-reactive protein (hs-CRP) was measured using enzyme-linked immunosorbent assay (ELISA).

Results: In the postoperative period, decreased serum magnesium and increased Ca/Mg ratio were observed in breast cancer women compared to healthy controls. After six weeks of AC chemotherapy, magnesium levels increased significantly, reaching a lower reference value. The same trend was noticed for the Ca/Mg ratio, which increased slightly but remained higher than in the control group. In patients with higher values of hs-CRP after treatment, decreased serum magnesium level was observed.

Conclusions: Our study showed that the postoperative period is associated with magnesium deficiency in breast cancer patients. However, AC chemotherapy tends to normalize its concentration. During treatment, low magnesium concentration was associated with increased hs-CRP levels. This finding confirms that magnesium deficiency may induce inflammation, which has been implicated in tumor growth and metastasis. However, further research is needed to explain the role of magnesium in tumor development clearly.

Background: Head and neck cancer is one of the most common cancers in India, with tobacco chewing being the predominant form of tobacco consumption. We aimed to assess the impact of superficial gland sparing on xerostomia.

Materials and methods: Patients with histopathological diagnosis of head and neck cancer treated with curative intent radiotherapy with intensity-modulated radiotherapy (IMRT) to a dose of 60-70 Gy in 30-35 fractions with or without chemotherapy from June 2017 to March 2020 were included in the study. The superficial and deep lobes of the parotid were contoured retrospectively. The physician-reported Radiation Therapy Oncology Group (RTOG) xerostomia toxicity grades at two years were retrieved from records.

Results: One hundred seventy-four patients were included in the study. Tobacco chewing was the most common form of use, followed by smoking. Tobacco chewers had significantly smaller mean parotid (53cc vs. 60cc, p = 0.02) and mean submandibular gland volumes (6 cc vs. 14 cc, p < 0.001) as compared to smokers. Bilateral or contralateral parotid sparing (mean dose < 26 Gy) was achieved in 62.7%, bilateral or contralateral superficial lobe in 27.6% and no sparing in 9.8% of patients. The xerostomia was similar in smokers and chewers (p = 0.95). Patients with bilateral or contralateral superficial lobe sparing had lower grade II/III xerostomia rates than the no-sparing group (p = 0.038).

Conclusions: Tobacco chewers have smaller volumes of salivary glands. Contralateral or bilateral superficial parotid sparing translated into better xerostomia scores at two years.

Background: Melanoma is an aggressive malignancy with high metastatic potential, often requiring systemic treatment with immune checkpoint inhibitors (CHI) in advanced stages. While CHI has significantly improved outcomes, its combination with local radiotherapy - particularly brachytherapy (BT) - may further enhance therapeutic efficacy by promoting immunogenic tumor cell death. BT enables precise delivery of high radiation doses, providing rapid symptom relief and potentially triggering local and systemic immune responses. This case series presents the first known clinical experience with noninvasive contact high-dose-rate brachytherapy (HDR-BT) combined with CHI in patients with metastatic melanoma treated in a palliative setting.

Materials and methods: We retrospectively analyzed four patients with stage IV melanoma and symptomatic subcutaneous metastases, all receiving ongoing CHI (nivolumab or pembrolizumab). Each underwent a single HDR-BT session (5-7 Gy) using a Freiburg Flap applicator. The primary goal was symptom relief. Treatment response was assessed clinically and radiologically, focusing on local control, response of non-irradiated lesions, progression-free survival (PFS), and overall survival (OS).

Results: All patients experienced rapid clinical improvement and significant regression of the irradiated lesion, with minimal (Grade 0-1) acute skin toxicity. In two cases, complete remission of treated sites was achieved. One patient demonstrated long-term remission in both subcutaneous and visceral metastases. Median PFS was 3.4 months (range: 1.5-15.0), and OS ranged from 8.5 to 22 months.

Conclusions: Single-fraction contact HDR-BT in combination with CHI appears to be a safe and effective palliative strategy for metastatic melanoma, offering fast local control, minimal toxicity, and potential systemic immune benefits.

Background: In managing the progression of diseases, particularly cancer, Markov decision processes (MDP) and dynamic therapy regimes are gaining prominence. Despite this, cancer treatments often negatively impact patients' quality of life, leading many to abandon effective, accessible, and affordable therapies.

Materials and methods: This paper introduces a novel MDP-based mathematical framework for optimizing multi-therapy treatment schedules in malignancy therapy. Through practical illustrations, we demonstrate the utility and applicability of the proposed framework. Our approach integrates both patient utility and the physician's net benefit function, accounting for treatment options and survival probabilities across diverse clinical profiles. The system state in our MDP model is defined by tumor progression and normal tissue side effects, while the response field encompasses treatment outcomes categorized into recurrence, tumor regression, and healthy tissue safety. At each decision stage, the physician assesses the patient's condition and selects the optimal treatment strategy to maximize the final reward, determined by the patient's health at the end state.

Results/conclusions: This framework offers a holistic approach to improving overall treatment outcomes while recognizing the importance of preserving patients' quality of life.

Clinical governance (CG) is an emerging framework that ensures accountability for delivering safe, effective, and continuously improving healthcare services. Originally introduced in the United Kingdom in the late 1990s as part of reforms in the National Health Service, CG draws upon principles of corporate governance to establish system-wide oversight of clinical quality, safety, and accountability. CG provides an overarching organisational framework encompassing leadership structures, clinical effectiveness, risk management, audits, professional development, and patient engagement. In radiation oncology, CG plays a critical role in enhancing treatment safety and quality by standardising protocols, conducting regular audits and peer reviews, implementing risk management strategies, and supporting continuous education for multidisciplinary teams. It also ensures accountability through transparent reporting to regulators, collaboration with patient groups, and commitment to evidence-based practice. Ethical principles - beneficence, non-maleficence, autonomy, and justice - are central to CG and provide the foundation for maintaining professional standards of care. Despite the increasing use of the term clinical governance, it is often only poorly understood. In the present review, we define the concept of clinical governance and discuss its role in healthcare, with a particular focus on the field of radiation oncology.