Reports of Practical Oncology and Radiotherapy最新文献

Background: The study aimed to overview radiopharmaceuticals used for the nuclear medicine (NM) imaging of prostate cancer (Pca) since the first mentions in the literature up to recent reports, with the special focus on positron emission tomography-computed tomography (PET-CT) radiotracers.

Materials and methods: We found over 3500 articles discussing the role of PET-CT in Pca patients' management published within 1990-2023. We summarized the past and present interests of the Authors when the Pca diagnostic imaging and the use of radiotracers in Pca diagnosis are considered. Eventually, we have compared the radiotracers' introduction in the literature with the United States (U.S.) Food and Drug Administration (FDA) approval timeline.

Results: The most mentions by the Authors were made of the following PET-CT study compounds: 2-[¹⁸F]fluoroethyl-choline ([¹⁸F]FECh), gallium-⁶⁸-labelled prostate-specific membrane antigen using peptide-11, ([⁶⁸Ga]Ga-PSMA-11), carbon-¹¹-labelled acetic acid ([¹¹C]acetate), and the anti-1-amino-3-[¹⁸F]-fluorocyclobutane-1-carboxylic acid (anti-3-[¹⁸F]FACBC, Axumin®), as well as the non-tumour-specific 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG). The most recent studies analysis showed an increasing interest of the Authors not only in a relatively new Pca-specific [⁶⁸Ga]Ga-PSMA-11, but also in a widely used non-specific [¹⁸F]FDG.

Conclusions: The literature analysis results lead to the conclusion that Pca remains a constant focus of the NM drug development with particularly high interest in PET-CT-dedicated radiotracers.

Background: Treatment with sole ultra-low dose rate brachytherapy (uLDR-BT) for unfavorable intermediate risk factor (IUR) group prostate cancer patients is not recommended by guidelines due to the lack of strong evidence of its effectiveness. However, there were numerous patients treated with good results with this method in older trials. Purpose of this work was to retrospectively asses effectiveness of uLDR-BT in IUR group treated in our department.

Materials and methods: We performed retrospective analysis of 39 IUR prostate cancer patients treated in our department with uLDR-BT between 2015-2019. All Patients had confirmed prostate cancer in biopsy and had local staging assessed with digital rectal examination and either transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI) before treatment. Treatment was performed using ¹²⁵I seeds, and the dose prescribed to the clinical target volume was 145 Gy. After treatment, all patients were followed in our outpatient ambulatory one month after the procedure and every 3-6 months later on. Toxicity was assessed using the International Prostate Symptom Score (IPSS) and Radiation Therapy Oncology Group (RTOG) scales.

Results: The median follow-up was 56,3 months [interquartile range (IQR): 36.9-73.4]. The mean nadir prostate-specific antigen (PSA) was 0.20 ng/mL (range 0.001-1.7). The actuarial 5-year biochemical failure-free survival (BFFS) was 87.02%. There was no statistically significant difference in BFFS between groups with antigen deprivation therapy (ADT) and without (p = 0.439). Analysis also showed no impact on BFFS of each intermediate group risk factors: initial PSA (iPSA) (p = 0.595). Gleason (p = 0.671) and Tumor stage (p = 0.694). There were no statistically significant differences in BFFS depending on number of those factors (p = 0.330).

Conclusion: The uLDR-BT may be an effective option for selected IUR prostate cancer patients.

Background: Radiation dermatitis (RD) or skin toxicity is one of the most common acute side effects of radiation in head and neck cancer patients. This study aims to correlate the pattern of volumetric-modulated arc therapy (VMAT) dose distribution to the skin with the grades of RD.

Materials and methods: 80 plans of histopathologically proven squamous cell carcinoma head and neck patients already treated with definitive concurrent chemoradiation [66-70 Gy in 33-35# or 66 Gy in 30# in simultaneous integrated boost (SIB), with concurrent Cisplatin 100 mg/m² 3 weekly] at our institution between November 2022 and November 2023 were retrieved from our digital archives. For each plan, 1 ring structure was created 3mm below the external skin surface, and the parameters V₄₀, V₅₀, V₆₀ and D_max were collected from the same. These parameters were correlated with grades of RD as per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. The statistical analysis was done using MedCalc software version 22.021.

Results: The incidence of G2/G3 RD was 52.5%, and its incidence was significantly correlated with all of the four parameters. Statistically significant (p < 0.001) dosimetric predictive accuracy was provided by 71.66 cc, 29.98 cc and 7.624 cc of the 3mm skin ring V_40, V₅₀ and V₆₀, respectively.

Conclusion: The dose distribution pattern to a skin layer stationed 3mm below the surface may help predict the development of severe RD in head and neck cancer patients receiving concurrent chemoradiation.

Background: The purpose of this study is to determine the effect of the type of I-125 radioactive source on dose distribution in the planning process of ultra-low dose rate (uLDR) prostate brachytherapy.

Material and methods: 7 patients who had undergone brachytherapy in our center were included in the study. Dose in five geometrical points were analyzed for 12 types of implants that are available on the market. The plans were originally calculated for S17plus implant model (Eckert & Ziegler Medical). Point dose calculations were performed using RadCalc (LAP) software.

Results: The differences in doses for individual points were significant. The largest differences were observed at the point located in the center of the patients' urethra and between BestMedical 2301 (highest doses for each point) and IsoStar (lowest doses) implants.

Conclusions: The choice of implant manufacturer strongly influences what dose distribution will be obtained for the prostate. It is possible to obtain satisfactory plans that meet the dosimetric criteria for each type of implant, but the positioning of each source will vary significantly.

Background: Recurrent high-grade gliomas present a therapeutic challenge. Repeat surgery, re-irradiation, and systemic therapy have been explored, with re-irradiation requiring precise tumor relapse delineation and advanced dosimetric techniques. This study aims to evaluate the effectiveness and tolerability of re-irradiation using Hypofractionated Stereotactic Radiation (HFSRT) schedules.

Materials and methods: In a retrospective analysis from 2011 to 2021, 52 adult patients with recurrent high-grade gliomas were examined, including 42.3% with glioblastoma, 32.5% with grade 3 gliomas, and 25% with grade 2 gliomas as initial diagnosis. All received prior radiotherapy at doses ranging from 54-60 Gy, with a median time to tumor relapse of 19.8 months. Salvage surgery was performed in 42.3% of cases, with a median interval of 22.45 months between radiation courses. Re-irradiation doses were 30 Gy in 5 fractions for 54% and 40 Gy in 10 fractions for 46%. Concurrent systemic treatments included temozolomide (30.8%), nevacizumab (27%), or none (35%).

Results: In-field and out-field tumor progression occurred in 65.4% and 25% of patients, with median times to local and distant progression of 5.17 and 4.57 months. Median overall survival (OS) from re-irradiation was 12 months. Univariate analysis showed a trend favoring 30 Gy in 5 fractions for disease progression-free survival (DPFS). Treatment was generally well-tolerated, with only 5.7% experiencing acute Grade-3 toxicity, and symptomatic radionecrosis occurred in 2 patients.

Conclusion: Re-irradiation using HFSRT for recurrent high-grade gliomas is viable and well-tolerated, demonstrating survival rates comparable to existing literature. These findings underscore the potential of HFSRT in managing recurrent high-grade gliomas.

Background: The onset of the coronavirus disease 2019 (COVID-19) outbreak caused major interruptions to the entire healthcare network affecting referral, diagnosis and treatment pathways with the potential to affect cancer treatment outcomes. In Ireland a national lockdown was initiated in March 2020 involving a stay-at-home order with a limitation on travel, social interactions and closure of schools, universities and childcare facilities. We designed a retrospective study comparing treatment outcomes for patients with oropharyngeal cancer treated before and during the COVID pandemic.

Materials and methods: All patients receiving radical radiotherapy for oropharyngeal cancer pre-COVID (July 17 - July 18) and during COVID (Mar 20 - Mar 21) were included. Patient and disease characteristics, diagnostic timelines, treatment delays and disease outcomes were extracted from the patient record. Disease free survival and overall survival were calculated for both groups.

Results: 159 oropharynx patients were included, 76 in the pre-COVID group (Group 1) and 83 in the pandemic group (Group 2). When comparing Group 1 and 2, respectively: There were no differences in human papilloma virus (HPV) status (74% vs. 71% p = 0.795) or Tumour-Node-Metastasis (TNM) overall stage [American Joint Committee on Cancer (AJCC) ed. 8]: (Stage 1: 25% vs. 45.8%, Stage 2: 28.9% vs. 18.1%, Stage 3: 21% vs. 15.7%, Stage 4: 25% vs. 20.5%, p = 0.268). Use of moderate hypofractionated regime increased during the pandemic (2.6% to 10.8%) and one patient omitted chemotherapy due to COVID-related reasons. There was no change in overall treatment times between groups with COVID-related sepsis accounting for one significant delay and one death during treatment. Overall survival at 2 years via Kaplan-Meier analysis; Group 1 cumulative proportion surviving at 2 years was 77% [95% confidence interval (CI): 67-86%] vs. 85% in Group 2 (95% CI: 77-93%, p = 0.35). The disease free survival at 2 years was 69% in Group 1 (95% CI: 59-80%) vs. 76% in Group 2 (95% CI: 67-85%, p = 0.567).

Conclusion: In spite of challenges related to the COVID-19 pandemic, we have demonstrated that oropharyngeal cancer patients treatment standards and outcomes were maintained. We did not demonstrate any significant difference in overall survival and disease free survival at 2 years when compared to a similar group prior to the pandemic.

Background: In small cell lung cancer (SCLC), limiting the radiation dose in the hippocampus area during preventive cranial irradiation (PCI) can reduce nerve injury and cognitive decline. This study was done to compare changes in cognitive functions between hippocampal-protected (3D-H) and non-hippocampal-protected (3D) patients during PCI.

Materials and methods: the study group included 113 patients with SCLC qualified to PCI divided in two subgroups: 3D-H (n = 74) and 3D (n = 39). Two diagnostic and screening tests, Mini-Mental State Examination (MMSE) Short Scale and Montreal Cognitive Assessment (MoCA) Scale, have been applied before the start of irradiation, immediately after and 3 months after PCI.

Results: The doses delivered to the volume of the left and right hippocampus were similar and amounted to 12.00 Gy and 12.05 Gy, respectively. There were no differences between 3D-H and 3D groups in the MoCA and MMSE tests at any time point. In both groups the values in MoCA and MMSE scales differed between time points I, II and III. The patients in the 3D-H group were less likely than patients in 3D group to experience significant cognitive decline on the MoCA scale (p = 0.003), but not on the MMSE scale (p = 0.103).

Conclusions: Following PCI, SCLC patients experience significant cognitive decline, even when the radiation dose in the hippocampal area is reduced. This trend continues for at least 3 months following the PCI. In hippocampal-protected patients significant cognitive decline assessed on the MoCA scale is less common than in non-hippocampal-protected patients.

Gastrointestinal (GI) cancer patients undergoing surgery are particularly vulnerable to malnutrition, which can significantly impact surgical outcomes. Prehabilitation interventions encompassing nutritional, physical, and psychosocial support have gained attention for their potential to mitigate these risks. However, the efficacy of multidisciplinary prehabilitation programs in this context remains underexplored. This narrative review synthesizes existing literature to evaluate the effectiveness of prehabilitation interventions in improving outcomes for GI cancer patients undergoing surgery. Drawing on a comprehensive analysis of available evidence, the review examines the integration of nutritional, physical, and psychosocial interventions and explores the implications for clinical practice and future research. The review highlights the importance of standardized protocols and interdisciplinary collaboration in optimizing prehabilitation programs for GI cancer patients. It identifies gaps in current research, particularly regarding the synergistic effects of integrating various intervention modalities and the role of innovative strategies such as immunonutrition. Moreover, the review underscores the need for larger studies to assess the effectiveness of multimodal prehabilitation approaches and establish standardized outcome measures. In conclusion, despite advancements in understanding the importance of prehabilitation, significant gaps persist in the literature, warranting further research to refine prehabilitation protocols and improve perioperative outcomes for GI cancer patients. By addressing these research gaps and fostering interdisciplinary partnerships, future studies have the potential to enhance the effectiveness of prehabilitation interventions and optimize perioperative care in this population.

Background: Angiogenesis is mediated by endothelial progenitor cells (EPCs) derived from bone-marrow. In this prospective study, we tried to investigate the clinical utility of circulating EPCs in lung cancer (LC) patients.

Materials and methods: Flow cytometry technique was used to assess circulating EPCs according to the immuno-phenotype CD45^- CD34⁺ CD133⁺ CD146⁺ mononuclear cells. Sixty patients and 30 controls were included in this prospective study.

Results: The mean of baseline EPC numbers was significantly higher in LC patients than in controls (p =0.003). Pretreatment EPC values were significantly correlated with primary tumor size (p = 0.05) and tumor response (p = 0.04). Receiver operating characteristics (ROC) curves were plotted to discriminate EPC numbers between patients and controls. Using ROC analysis, the optimal cutoff value was 125 cells/mL with a sensitivity and a specificity for baseline EPCs of 76.7% and 63.3%, respectively. According to this cutoff value, basal EPC values were significantly correlated with primary tumor size (p = 0.047) and response to chemotherapy (p = 0.034). High EPC levels were significantly associated with longer progression-free survival (PFS) and overall survival (OS) duration (p = 0.0043 and p = 0.02, respectively).

Conclusion: Increased baseline EPC values seem to be a useful biomarker for the prediction of prognosis and tumor response in LC patients. Furthermore, high EPC levels at diagnosis might be an indicator of tumor growth and longer survival in LC patients.