Reports of Practical Oncology and Radiotherapy最新文献

Background: Anemia has a significant clinical impact on cancer patients: it is related to an important decline in performance status (PS) and quality of life (QoL), with progressive worsening of cognitive function and energy-activity levels.

Materials and methods: To evaluate the effectiveness of Sucrosomial^® oral iron formulation to prevent moderate and severe anemia, we retrospectively recorded data from our database from February 2023 to December 2023 of patients affected by solid tumors, performing long-course radiochemotherapy (RTC) together with preventive Sucrosomial^® iron supplementation twice per day (Arm A = 35 patients) or other supplementations, delivered just as needed (Arm B = 35 patients).

Results: In arm A, at baseline, the median hemoglobin (Hb) value was 12.4 g/dL. After 15 days, 30 days and 60 days, median Hb values were, respectively, 12.2 g/dL, 11.8 g/dL, and 11.6 g/dL. In arm B, at baseline, the median Hb value was 12.30 g/dL. After 15 days, 30 days and 60 days, Hb values were, respectively, 11.7 g/dL, 11.2 g/dL, and 11.2 g/dL. Regarding the difference in QoL between the two treatment groups, in Arm A a consistent stability in FACT-An questionnaire scores was noted. Conversely, in Arm B, a slow but constant increase in FACT-An scores was observed.

Conclusions: Sucrosomial^® oral iron formulation seems to be efficient in preventing moderate and severe anemia during long-course randomized controlled trial (RCT) in cancer patients, while also offering notable advantages in terms of quality of life and healthcare costs.

Hypofractionation is a radiotherapy regimen that uses fewer fractions with higher doses with respect to conventional regimen. It can reduce overall treatment time and costs. Preoperative accelerated hypofractionated radiotherapy (PHYPORT) is a new approach in which radiation therapy is delivered in fewer, larger doses over a shorter period of time before surgery and it can be used to shrink tumours before surgical removal in some cancers. The choice of hypofractionated radiotherapy depends on the type of tumour, its localization and total target volume. Also, it is important to assess the potential benefits and risks of higher radiation doses. PHYPORT could be a more convenient and cost-effective option, but its effectiveness is unclear. This review assesses the use of PHYPORT in cancer treatment.

Background: The study aim was to evaluate the usefulness of tomotherapy megavoltage computed tomography (MVCT) as "slow" CT for both positioning and contouring lung tumors.

Materials and methods: Cranio-caudal motion of a pulmonary lesion was simulated by using a QUASAR phantom for different breathing periods (2-10 s) and cycles (sine and cosine-fourth-power). Coronal and sagittal MVCT reconstructions were analyzed, and Dice similarity coefficients were obtained to compare the expected motion-encompassing volumes with the segmented volumes.

Results: Despite motion artifacts in axial slices, the coronal and sagittal midplanes allowed delineation of the internal treatment volume, except when the breathing period was equal to the acquisition time (5 s). In that case, an aliasing artifact prevented applying proper delimitation. The highest similarity coefficient (> 0.9) was obtained for the lowest CT spacing (2 mm) and the shortest breathing period.

Conclusions: For periodic breath patterns, Tomotherapy MVCT can be used for positioning and cranio-caudal length contour delineation of lung tumors in motion.

Background: Magnetic resonance-guided adaptive stereotactic radiotherapy (MRgRT) represents an innovative approach in radiation oncology, combining real-time MR imaging with treatment delivery systems. This systematic literature review evaluates the efficacy, safety, and technical aspects of MRgRT in prostate cancer treatment compared to conventional radiotherapy approaches.

Materials and methods: A systematic search was conducted across PubMed, Embase, and Scopus databases following PRISMA guidelines. Randomized clinical trials, prospective cohort studies, and relevant retrospective studies published through 2024, evaluating MRgRT in primary or recurrent prostate cancer treatment, were included. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized trials and ROBINS-I tool for non-randomized studies. Data regarding acute and late toxicity, biochemical control, and technical aspects of treatment were analyzed through qualitative synthesis.

Results: The pivotal MIRAGE randomized trial (n = 156) demonstrated significant toxicity reduction in the MRgRT group compared to CT-guided radiotherapy (grade ≥ 2 GU toxicity: 24.4% vs. 43.4%, p = 0.01; grade ≥ 2 GI toxicity: 0% vs. 10%, p = 0.003). MRgRT technology enables safe reduction of clinical target volume (CTV)-PTV margins to 2-3 mm. Studies on ultra-hypofractionated regimens (including 5-fraction 37.5 Gy and 2-fraction 26 Gy) demonstrated promising safety profiles. Implementation of adaptive strategies (ATP and ATS) enables dose distribution optimization based on daily patient anatomy.

Conclusions: MRgRT represents a breakthrough technology in prostate cancer radiotherapy, enabling significant reduction in treatment toxicity while maintaining high precision in dose delivery. Results of ultra-hypofractionated regimens are particularly promising. Further studies are needed to evaluate long-term treatment outcomes and cost-effectiveness of this method.

Background: It is known that ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) makes a significant contribution to other diagnostic methods in determining the response to treatment after neoadjuvant chemoradiotherapy (NCRT). The study aimed to determine whether the tumor maximum standardized uptake values (SUVmax) on ¹⁸F-FDG PET/CT is predictive of overall survival (OS) in patients with rectal cancer after neoadjuvant treatment and to investigate whether the rate of change in SUVmax has a prognostic value.

Materials and methods: This retrospective study included 64 rectal cancer patients who underwent ¹⁸F-FDG PET/CT imaging, first for staging and then to assess response to neoadjuvant radiotherapy (NRT). SUVmax1 before and SUVmax2 after treatment were measured from the volume of interest (VOI). To determine the predictive value of ¹⁸F-FDG PET/CT SUVmax parameters for death, the area under the curve (AUC) and cut-off values were calculated using Receiver Operator Characteristic (ROC) analysis. Kaplan-Meier analysis was used to evaluate the effect of SUVmax cut of value on OS.

Results: Twenty-five (39%) patients were female and 39 (61%) were male. The median follow-up period was 37.5 months. The mean SUVmax1 and SUVmax2 values were 20.1 ± 9.5 and 7.6 ± 4.8, respectively. OS significantly differed when 8.5 was used as a cut-off for SUVmax2 (p = 006). ¹⁸F-FDG PET/CT metabolic tumor parameters had no significant predictive value for progression-free survival (PFS).

Conclusion: According to the results of our study, SUVmax2 after neoadjuvant treatment had a significant predictive value for OS in patients with recurrent cancer.

Background: This study evaluates practices and preferences in treating intact brain metastases with stereotactic-radiosurgery (SRS) among members of the SEOR-SRS_SBRT working group, focusing on clinical protocols, equipment usage, and treatment parameters.

Materials and methods: A survey conducted via Google Forms targeted 149 group members, with responses collected from one representative per institution between April and May 2024. Respondents included radiation oncologists from Mexico, Argentina, Portugal, and Spain, and data analysis covered demographics, equipment, treatment protocols, immobilization techniques, dose schedules, image-guided radiation therapy (IGRT), and prescription criteria.

Results: Out of 149 members, 28 institutions responded. Most participants (64.5%) had over 10 years of experience. Single-fraction-SRS was practiced by 64.5%, while fractionated SRS-SRT was used by 96.8%. Linear accelerators (C-Linac) were the primary equipment (86.7%). Specific protocols for brain metastases were reported by 80%. SRS was preferred for 1-3 metastases (93.3%), while whole-brain radiation therapy (WBRT) was used for > 10 metastases (70%). Considering the type of stereotactic localization, frameless systems were employed in 69% while rigid-frames were used in 31% of cases. The most common immobilization technique was a reinforced mask (50%). Planning computed tomography (CT)/magnetic resonance imaging (MRI) slice thickness ≤ 2 mm was standard, and automatic registration was applied in 69%. Doses of 21-23 Gy were common for lesions < 1 cm, while < 20 Gy was typical for 2-3 cm lesions. Margins for single-fraction SRS were 1 mm in 50% of cases. IGRT verification used cone-beam CT (64.5%) and surface-guided radiation therapy (35.5%).

Conclusion: The findings reveal variability in SRS practice, particularly in immobilization, dose prescriptions, and IGRT methods, emphasizing the need for standardized guidelines to optimize patient outcomes and adapt treatments to institutional resources and patient-specific factors.

This study evaluated the benefits of the ExacTrac system for non-coplanar beams in brain stereotactic radiotherapy (SRT) by comparing pre- and post-X-ray verification (XV) positioning data. Data from 62 patients undergoing brain SRT were analyzed, focusing on 151 non-coplanar beams. Patient positioning involved initial infrared marker alignment, followed by ExacTrac kV x-ray acquisition and 6D robotic couch adjustments. Patient positioning was corrected within a tolerance of 0.5 mm and 0.5° for translation and rotation, respectively. Pre and post-XV positioning data were compared at each planned couch angle. Results showed that 54% of non-coplanar beams had positioning errors exceeding the specified tolerances on the pre-XV. Significant differences were observed in translational and rotational corrections between pre- and post-XV positioning at each planned couch angle. These results demonstrate that XV at any each planned couch angle using the ExacTrac system significantly improves patient positioning accuracy in brain SRT.

Background: Patients submitted to breast conservative surgery (BCS) with whole breast irradiation at the initial disease that experience an isolated ipsilateral breast tumor recurrence, face mastectomy, as the standard treatment. Selected cases may derive good outcomes from repeat BCS and irradiation with partial breast irradiation (PBI) which limits the volume of tissue reducing the risk of increased toxicity. We report our experience with external PBI for locally recurrent breast cancer.

Materials and methods: We queried our department's re-RT database for breast cancer treated with external beam radiation therapy (EBRT) from 2017-2021. We reviewed the electronic record for each case with PBI. Demographic, disease characteristics, primary RT/re-RT details and toxicity were collected. Local recurrence-free survival (LR-FS), distant recurrence-free survival (DR-FS) and overall survival (OS) were estimated using the Kaplan-Meier method.

Results: Eleven women were reviewed. Mean (standard deviation; SD) age was 54 (38-76) years and Eastern Cooperative Oncology Group (ECOG) Performance Status was 0-1 (100%) with median follow-up from recurrence of 41 months (27-62 months). All presented T1-2 recurrent lesions. Tumors were clinically node negative and no patients had evidence of metastatic disease before undergoing BCS. For the re-RT course, all received PBI with 40 Gy/2,67 Gy daily. Cosmesis results were good. Eight experienced grade 1 erythema and 2 grade 1 pigmentation with 1 pruritus. Major late effects were fibrosis. There were no grade 3 or higher late reactions. At 3 years, 9 patients remained free from LR, 10 from DR, and 9 were alive.

Conclusion: In our cohort, a second BCS followed by re-RT with hypofractionation EBRT showed acceptable toxicity and early promising results, though longer follow-up is needed.

Background: There is limited evidence on the optimal management of vaginal vault recurrence (VVR) in patients with gynecological cancers. Real time bi-plane trans-rectal ultrasound (BTRUS) guidance with prostate perineal template with grid (PPTG) can ensure optimal placement of brachytherapy (BT) applicators for conformal high dose rate interstitial brachytherapy (HDRIBT) dose delivery.

Materials and methods: The clinical outcome and HDRIBT dosimetric data of six patients with histologically confirmed recurrent or persistent carcinoma of the endometrium (3) and cervix (3) who underwent definitive PPTG based BTRUS-HDRIBT between 2019 and 2023 were retrospectively analysed. The local control (LC) and progression free survival (PFS) for five out of six patients with VVR were analysed by the Kaplan-Meier method using RStudio ver.2023.12.0+369 software. Dose volume uniformity index (DVUI) and dose volume conformity index (DVCI) were used to assess the HDRIBT plan quality.

Results: The prescribed dose (PD) was 6 to 10 Gy. The two year LC rate and PFS for five patients are 100% [95% confidence interval (CI): 100%, 100%] and 80% (95% CI: 52%, 100%) respectively. Optimal mean DVUI (range 0.74-0.98) and mean DVCI (1.00) was achieved. At median follow up of 19 months, 3 patients are alive and free of disease. Most common toxicity is grade 1 hematuria.

Conclusion: PPTG based BTRUS-HDRIBT for VVR allows real time tumor visualization for optimal applicator insertion to deliver highly conformal tumoricidal dose and maximize LC rate. Radiation oncologists dealing with prostate HDRIBT already possess this skill and this "dying art" can be readily transferable to female genital tract tumors.