Reports of Practical Oncology and Radiotherapy最新文献

Background: Surface guided radiation therapy (SGRT) for patient positioning and motion management during radiation therapy is used on ~40% of US linear accelerators. Postural Video™ (PV), an augmented reality tool for SGRT, is showing a live patient video feed against an outline of the intended treatment position, at patient setup and intrafraction monitoring. A study was performed to assess any potential additional values of SGRT with PV, versus SGRT alone.

Materials and methods: Two radiation therapy centers, comparable across patient numbers, case mix, treatment times and staff experience, were selected to compare performance difference in SGRT with/without PV, focused on productivity. Site A used SGRT alone for patient setup, while Site B used SGRT with PV. Both sites were proficient in the use of SGRT prior to the study. 250 treatment delivery fractions per site were analyzed, evaluating average patient setup time, average wait time and frequency of repeated radiographic imaging. A qualitative survey completed information of PV impact on setup quality, access, and efficiency.

Results: Average time saving per patient by introducing PV is 28.8% plus additional 60 sec time saving in patient wait time. Repeated radiographic imaging was reduced by 63% (p < 0.05). Qualitative ratings and open comments supported PV being included in standard SGRT.

Conclusions: The scope of this work was to evaluate a feature under economic considerations. This data demonstrates an increase in quality, safety, accuracy and efficiency of patient setup with PV, and allows us to make an objective, business-focused assessment of the investment in PV.

Background: Majority of lung cancer patients are presented with metastatic disease. However, cutaneous metastasis (CM) from lung carcinoma is a rare entity with very few case reports published in the Indian background. Moreover, outcome in these patients is dismal and no standard therapeutic approaches are there. Thus, a long-term analysis from a single institute in this infrequent occurrence holds scientific importance. The purpose of this study was to describe the clinico-demographic profile of patients having CM with lung primary and also to evaluate the survival outcomes in these patients.

Materials and methods: This was a retro-prospective study conducted over 5-year time period in an academic institute of India. Records of all histopathologically confirmed lung cancer patients were reviewed and patients having biopsy-proven CM were included in this analysis. Permission from Institutional Ethics Committee and informed consent from all the patients were taken. Data of these patients were collected and analysed using standard statistical software.

Results: Total of 25 cases of biopsy-proven CM were found in the stipulated time period. Mean age of patients was 57.6 years with high male predominance. Anterior chest wall was the most common site of skin involvement and squamous cell carcinoma was the most common primary histopathology. Overall, median survival was 4.9 months.

Conclusion: Once CM developed, survival of lung carcinoma patients become dismal. Goal of the treatment will be to palliate and to improve quality of life in these patients. Understanding the clinical pattern and demographic profile of these patients will guide a standard treatment approach.

Background: The aim of study was to evaluate the oncological results of stereotactic body radiotherapy (SBRT) in de-novo oligometastatic (dOM) disease.

Materials and methods: Patients who underwent SBRT for dOM disease in Radiation Oncology Clinic of XXX Hospitals were analyzed retrospectively. The endpoints of the study were overall survival (OS) and disease free survival (DFS).

Results: 84 patients with treated between 08.06.2019-15.11.2022 were analyzed. The median follow up was 26 (range 6-219) months. dOM subgroups were as follows: 37 (44.0%) synchronous dOM (sdOM); 31 (37%) metachronous oligorecurrence (mdOR) and 16 (19.0%) metachronous oligoprogression (mdOP). Grade 1 acute side effects (ASE) were observed in only 1 patient and no grade ≥ 2 a ASE were observed. Progression was observed in 45 (53.6%) of the patients. The median DFS was 8 (range 1-32) mo, 1y DFS was 44.5%; 2y DFS was 26.2%. Significantly higher DFS was obtained in mdOR than sdOM and mdOP [p = 0.020; hazard ratio (HR): 1.6; 95% confidence interval (CI): 0.75-3.68%]. The relationship between response assessment after SBRT and DFS was significant (p < 0.001; HR: 4.8; 95% CI: 1.9-12.2). Twenty-nine (34.5%) patients were ex and 55 (65.5%) were alive. 1y OS was 75.6%; 2y OS -61.2%; 3y OS -57.4% and the median OS value has not yet been reached. Lower OS was observed in sdOM compared to mdOP and mdOR (p = 0.035, HR: 0.45; 95% CI: 0.21-0.96). The relationship between response assessment after SBRT and OS was significant (p = 0.017; HR: 6.6; 95% CI: 1.7-25.7).

Conclusion: Higher DFS was observed in mdOR patients and lower OS was observed in sdOM patients. SBRT response in dOM patients may be a prognostic factor for DFS and OS.

Background: This prospective single institutional study was conducted to compare the efficacy of the two different neoadjuvant chemotherapy (NACT) regimens in human epidermal growth factor receptor 2 (Her2neu) overexpressing non metastatic breast cancer.

Materials and methods: Patients randomly assigned into two arms in a 1:1 ratio. Arm A received NACT containing docetaxel, doxorubicin, and cyclophosphamide (TAC) regimen. Arm B received NACT containing docetaxel, carboplatin, and trastuzumab (TCH) regimen. Patients underwent surgical intervention following completion of 6 cycles of NACT. Postoperative histopathological reports were compared in terms of pathological response.

Results: 122 patients (Arm A = 61; Arm B = 61) analysed. The mean breast tumor size was 7.724 cm and 7.896 cm in Arm A and Arm B, respectively, at diagnosis and clinical staging. After 6 cycles of NACT, the mean breast tumor size in Arm A and Arm B was 3.495 cm and 3.711 cm, respectively. The Arm A and Arm B exhibited 22.9% and 40.9% of pathological complete response (pCR), respectively, with statistically significant difference (p = 0.033). All patients experienced varying degrees of bone marrow suppression. Grade 2 or 3 chemotherapy induced nausea and vomiting was 37.7% and 23% in Arm A and Arm B, respectively, without statistically significant difference (p = 0.076). 14.8% and 4.9% of patients exhibited febrile neutropenia in Arm A and Arm B, respectively, without statistically significant differences (p = 0.067).

Conclusion: TCH exhibited greater pCR with tolerable adverse reactions in Her2neu overexpressing breast cancer compared to TAC regimen as NACT. Therefore, TCH regimen should be considered for node positive Her2neu overexpressing breast cancer.

Background: The objective was to evaluate clinical outcomes and toxicity of patients with cervical cancer treated by radiotherapy with dose escalation in involved lymph nodes based on positron emission tomography/computed tomography (PET/CT) staging.

Materials and methods: Retrospective cohort study involving locally advanced cervical neoplasms treated with definitive radiotherapy. Volumetric modulated arc therapy (VMAT), image-guided radiotherapy (IGRT), and registration of PET/CT were employed in all. Involved lymph nodes were given higher doses simultaneously.

Results: Between February 2012 and September 2023, there were 37 patients, with median age of 48 (range 27-91) years. Almost 70% were stages III/IVA. Two-thirds were given retroperitoneal irradiation. The mean delivered doses to primary tumor and to involved lymph nodes were, respectively, 52.5 Gy, and 62.5 Gy. The 10-year rates of overall survival, event-free survival, local-recurrence-free survival, and metastasis-free survival were, respectively, 76%, 50%, 91%, and 82%. There were 13 and 2 cases of gastrointestinal toxicity grades II and III, respectively. Grades II and III of genitourinary toxicity were seen respectively in 7 and 3 patients. On univariate analysis, age was related to local recurrence-free survival (LRFS); standard uptake values (SUV) was related to event-free survival (EFS); lymph node dose was related to overall survival (OS), and EFS; primary tumor dose was directly related to EFS, albeit inversely to the likelihood of grade > II gastrointestinal toxicity. Retroperitoneal irradiation improved LRFS, and rates of grade > II gastrointestinal toxicity. On multivariate analysis, SUV remained an independent predictor of EFS; lymph node dose was an independent predictor of OS, and age was an independent predictor of lymph node recurrence.

Conclusion: Dose escalation radiotherapy (RT) based on PET/CT for cervical cancer may be feasible and safe. Further robust study results are needed.

Background: Daily bolus positioning implies a high degree of variability, which can affect the dose distribution within the planning target volume (PTV) and the organs at risk (OAR). We carried out a retrospective study to evaluate bolus positioning in patients with breast cancer.

Materials and methods: We evaluated 7 cases with left and 5 cases with right chest-wall with comprehensive nodal region irradiation in which bolus material was used to obtain better skin surface coverage. The bolus positioning on the daily cone-beam computed tomography (CBCT) images was compared to the reference image from the treatment planning system. Deviations from the reference position of the bolus were categorized as positive shifts (PosS) or negative shifts (NegS), depending on the material's overlapping with its planned position. Subsequently, a second plan was calculated using the information from the CBCT images for comparison with the original treatment plan. We performed a statistical and dosimetric analysis on the results.

Results: For both the 95% dose coverage for the PTV for the chest wall and for the lymph node regions, about 2% variation between initial and recalculated plans was seen, with a shift of the hotspots' position in some cases. The average mean heart dose was 4.1 ± 0.3 Gy, whereas the values for PosS and NegS mean heart doses were 3.8 ± 0.4 Gy and 4.0 ± 0.6 Gy, respectively. In contrast to the original values for the ipsilateral lung V5 (57.1 ± 12.9%), V20 (30.2 ± 2.7%), and Dmean (15.0 ± 1.7 Gy), the values for PosS were 56.1 ± 4.2% for V5:, 30.1 ± 3.3% for V20, and 14.9 ± 1.2 Gy for Dmean while for NegS we obtained 56.9 ± 8.9% for V5, 30.0 ± 2.3% for V20, and 15.2 ± 1.8 Gy for Dmean.

Conclusion: We observed dosimetric differences between the initial and given treatment plans depending on the position of the bolus for all cases, indifferent of the shift direction. Although the differences were not statistically significant, we identified a few specific instances where the variations might cause uncertainties regarding doses to the organs at risk (OAR). We suggest therefore that strategies for correct daily reproducibility of the bolus need to be implemented on a departmental level.

Background: The current study aims to evaluate the use of dose-volume histogram (DVH) metrics as part of a comprehensive pre-treatment quality assurance (PSQA) protocol for RapidArc treatment delivery.

Materials and methods: A total of ninety patients were included in this study, with the patient population divided into four groups: Brain (n = 15), Head and Neck (H & N) (n = 30), Thorax (n = 15), and Pelvis (n = 30) RapidArc plans. The delivered dose was assessed using the Octavius 4D 1500 detector array and the Verisoft DVH application, focusing on DVH-related errors pertaining to targets and organ-at-risk (OARs). Additionally, three-dimensional local and global gamma passing rates were analyzed in the axial, coronal, and sagittal planes using various gamma criteria, including 3 mm/3%, 3 mm/2%, 2 mm/3%, and 2 mm/2%.

Results: All treatment plans met the action level requirement, achieving a gamma acceptance rate exceeding 95% with a 3%/3 mm criterion. Among the anatomical planes, the transverse plane consistently exhibited the highest passing rates for various global gamma criteria across all treatment sites. Local gamma analysis revealed that the coronal plane had the highest passing rates for thorax and pelvis sites compared to other planes. DVH analysis indicated that doses to target volumes remained within specified tolerances for all cases. The most significant OAR dose discrepancies were observed in the H&N region.

Conclusion: Integrating DVH metrics into the RapidArc PSQA protocol can yield clinically significant results closely aligned with the gamma index. It was observed that a single action-level approach cannot be universally applied to DVH metrics across different anatomical sites.

Myelodysplastic syndrome (MDS) is a hematologic disorder characterized by ineffective blood cell production leading to cytopenias and a propensity for progression to acute myeloid leukemia (AML). In this study, we aimed to assess the prevalence of MDS in the United States population using data from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis revealed that the highest prevalence of MDS was observed in the over 85 age group, with an overall prevalence rate of 0.02%. Furthermore, our findings indicated that the White race had the highest prevalence rate compared to other racial groups. However, it should be noted that the SEER database, most likely due to sampling biases, has a potential underestimation of minority populations, but SEER and the US population are statistically similar enough for comparison. These results suggest a need for further research on the underlying factors contributing to the prevalence of MDS in the United States population; factors such as genetic, environmental, comorbidities, and racial disparities should be explored. Early diagnosis and treatment of MDS are crucial for improving outcomes for patients with this condition.

Background: This study performs an analysis of clinical and epidemiological characteristics of Ukrainian patients with breast cancer (BC) who presented to a regional cancer center in western Poland in 2022.

Materials and methods: Date and country of BC diagnosis, age at diagnosis, age at first visit to the Greater Poland Cancer Centre (GPCC), and clinical staging were collected from hospital records. Multidisciplinary team (MDT) data for all BC cases reviewed at the GPCC in 2022 served as a comparison for the study population.

Results: All 106 patients presented to the GPCC after the outbreak of the full-scale war in Ukraine in February 2022. The year of BC diagnosis ranged from 1993 to 2022. Median age at diagnosis was 47. The majority of cases were diagnosed (76%) and treated (76%) in Ukraine. Treatment at the GPCC was performed for 65% of cases - mostly continued oncological care for patients initially treated in Ukraine. Moreover, the majority of cases treated in Ukraine (55%) have received continued treatment at the GPCC. Cases with stage II BC were most numerous (36%), followed by stage IV BC (26%) and stage III BC (21%). Only 15% of cases were diagnosed with stage I BC and 1% with stage 0 BC.

Conclusions: The study population was characterized by relatively young age at diagnosis and advanced disease when compared with MDT data. Cases initially treated in Ukraine that required continued oncological care constituted the majority of all cases treated at the GPCC.

Soft tissue metastasis in esophageal cancer is a very rare entity. A 76-year-old man was referred for a week's history of dysphagia. Upper gastrointestinal endoscopy was performed, and biopsies were consistent with an adenocarcinoma of the lower esophagus. The patient was free of metastasis on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). The patient was treated with pre-operative chemoradiation, followed by surgery. Intravenous carboplatin [area under the curve of 2 mg/mL/min (AUC2)] and intravenous paclitaxel 50 mg/m² with concurrent radiotherapy (RT) (45 Gy delivered in 25 fractions of 1.8 Gy per fraction) were introduced from May 31^st, 2021, to July 2^nd, 2021. Lewis-Santy subtotal esophagectomy was performed, and pathology revealed a ypT3 ypN0 (0/26) L0 V1 Pn1 G3 R0. Adjuvant nivolumab was introduced for a total of 12 months. After five months of nivolumab, the patient complained of a painful left shoulder subcutaneous tumefaction in routine evaluation. Biopsy of the deltoid muscle demonstrated a poorly differentiated adenocarcinoma consistent with esophageal metastasis. Additional skeletal muscle (one) and bone metastases (two) were revealed on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). After multidisciplinary team approach, palliative radiation therapy to all metastases, denosumab and FOLFOX were introduced. Despite initial excellent clinical outcomes, patient presented avascular necrosis of left femoral head managed by surgery but died after post-operative complications. To the best of our knowledge, it is the first reported case with rare soft-tissue metastasis occurring during adjuvant nivolumab in esophageal cancer.