Reports of Practical Oncology and Radiotherapy最新文献

Background: Nivolumab and ipilimumab combination is recommended as a first-line treatment for metastatic renal cell carcinoma (mRCC) in patients without life-threatening symptoms. This study aims to assess the efficacy and safety of this treatment regimen administered in the one-day chemotherapy unit of a district hospital.

Materials and methods: We conducted a retrospective study involving 36 patients diagnosed with mRCC who had received combined immunotherapy at the Department of Chemotherapy, District Hospital in Sucha Beskidzka, Poland. We evaluated treatment response and adverse events (AEs). Laboratory parameters were recorded, and we calculated neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), and lymphocyte-monocyte ratios (LMR) at baseline, after 3 months of treatment, and prior to disease progression.

Results: After a median follow-up of 11 months (7.5-17.5 months), the median overall survival was not reached (NR, 6.7-NR), while the median progression-free survival was 11.5 months (6.7-NR). The objective response rate was 30.6% (n = 11), and the disease-control rate was 66.7% (n = 24). Hemoglobin and eosinophil levels varied at three checkpoints, without differences in NLR, PLR, and LMR. AEs of any grade were observed in 23 patients (63.9%) with a median onset time of 3 months (2-4 months), and serious AEs in 13.8% of patients (n = 5).

Conclusions: Our analysis suggests that the combination of nivolumab and ipilimumab for mRCC has an acceptable toxicity profile and can be effectively managed in a district hospital's outpatient clinic. This approach requires close patient monitoring and collaboration with other hospital departments to ensure patient safety and treatment efficacy.

Background: It is estimated that 60% of new rectal cancer cases will be diagnosed in patients ≥ 65 years old. The geriatric patient is heterogeneous and underrepresented in clinical trials, and oncologic therapies are often tailored with little evidence. We describe a cohort of patients diagnosed with locally advanced rectal cancer in geriatric and non-geriatric patients.

Materials and methods: Retrospective and descriptive analysis of 137 patients, 44 (32.1%) ≥ 75 years old and 93 (67.9%) ≤ 75 years old, with diagnosis of locally advanced rectal cancer. All patients received neoadjuvant chemoradiotherapy (nCRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy.

Results: Mean age was 79.5 for ≥ 75 years and 62.7 for ≤ 75 years, tumor location was: upper rectum (16.1% and 11.3%), middle rectum (60.2% and 47.7%) and lower rectum (23.7% and 41%), using the Eastern Cooperative Oncology Group (ECOG) 0: 74.1% and 81.8%, ECOG 1: 25.9% and 18.2%. Pathological complete response was 21.5% and 22.7%, partial response, 57% and 59% and no response, 21.5% and 18.3%, respectively. Tumor shrinkage in both groups after neoadjuvant treatment was 34.5% and 35.46%. Local recurrence was 2.2% and 3.2% and distance recurrence, 11.3% and 8.6%, respectively.

Conclusion: The study shows similar outcomes in both groups following radical treatment, with similar rates of pathological complete response. However, it has notable limitations, including a small sample size and the absence of a comprehensive geriatric assessment. To enhance these findings, future research should involve larger patient cohorts with comparative analysis and clinical trials specifically focused on the geriatric population.

Background: As coronavirus disease 19 (COVID-19) run unabated across the globe, its potential survival detrimental effects on lung function may be potentiated by systemic therapy and/or radiotherapy. Limiting lung exposure to high radiation dose in addition to sparing the heart may be critical for left-sided breast cancer patients. Deep inspiration breath-hold allows heart sparing. However, a minority of patients cannot hold breath for radiotherapy. We aim to evaluate whether a prone setup can be advantageous in these patients.

Materials and methods: Left breast cancer patients who had dual supine and prone planning, both in free-breathing, were retrospectively identified. A multiple-structures penalty score was computed from the mean absolute dose deviation (MADD) to heart, lungs, breasts, and tumor bed for each supine and prone plan. Dosimetric advantage of prone was assessed by the reduction of penalty score compared with supine. Patients' characteristics effect on the reduction of penalty was analyzed using robust linear regression.

Results: The prone vs. supine MADD for 27 patients demonstrated significant sparing for the ipsilateral lung and was 0.6 vs. 3 Gy, respectively, without differences regarding heart and target volumes. The average penalty ± standard deviation was 0.90 ± 0.28 Gy prone, vs. 1.13 ± 0.38 Gy supine, p = 0.024. Overall, 70.4% (19/27) patients had a reduction of penalty with prone setup, as compared with 29.6% (8/27) supine, p = 0.0065. Pre-dosimetry characteristics could not predict the reduction of penalty.

Conclusion: Prone conferred substantial lung sparing without dose-deterioration to other structures, providing a significant advantage as compared with supine free-breathing radiotherapy in left-breast cancer patients.

Background: This study intends to analyze the feasibility and the outcomes of stereotactic body radiotherapy (SBRT) as a salvage treatment for lung cancer after primary surgery and compare them with the results of SBRT as the first treatment option.

Materials and methods: Retrospective analysis of early-stage non-small cell lung cancer (NSCLC) treated with SBRT, either as a primary treatment or as salvage treatment after primary surgery.

Results: From January 2017 to January 2022, 68 patients were analyzed. 80% were 65 years-old or above. Seven (10%) underwent SBRT as a salvage treatment after primary surgery. Most lesions treated with primary SBRT were peripheral (n = 33; 54.1%), opposed to the salvage group, where 71.4% were central lesions (n = 5). Patients who had previous surgery presented with lower forced expiratory volume in 1 second (FEV1) (p = 0.006). Median time between surgery and salvage SBRT was 35.4 months. Median follow-up was 29.3 months; median overall survival (OS) at 2 years and 3 years was, respectively, 73.5% and 67.6% (median 52.5 months), with no difference between groups. Median local, regional, and distant progression free survivals were not reached. Local control was 94.1% at 2 years and 92.6% at 3 years. Only 5 (8.2%) patients presented late grade 3-4 pneumonitis, and one, grade 5 (fatal), all in the primary SBRT group.

Conclusion: SBRT as salvage after primary surgery is feasible and seems to be safe. Outcomes are expected to be equivalent to those of the patients submitted to primary SBRT.

Background: Aspirin, a non-steroidal anti-inflammatory drug and platelet inhibitor, has been shown to reduce cancer incidence, lower metastatic rates and improve survival in certain cancer types. However, data on the effect of aspirin on prognosis in pancreatic ductal adenocarcinoma (PDAC) are limited. Therefore, we conducted a retrospective, single-center study to evaluate the impact of aspirin use on disease characteristics and survival in PDAC patients.

Materials and methods: The study analyzed data from all consecutively treated PDAC patients over a 6-year period. Operability, Tumor-Node-Metastasis (TNM) stage, and survival endpoints were compared between patients who had used aspirin for 2 or more years prior to their diagnosis (ASA ≥ 2) and those who did not (ASA 0).

Results: A total of 182 patients were included. In the ASA ≥ 2 group, significantly fewer patients had metastatic disease at diagnosis, and a significantly larger proportion presented in the operable stages, compared to the ASA 0 group. No significant differences were observed between the two groups in the T or N stages, overall survival, disease-free survival, or time to progression-free survival.

Conclusions: Although long-term aspirin use did not influence survival endpoints, it was associated with a significantly lower probability of demonstrable distant metastases at diagnosis and a higher rate of resectable disease. This finding warrants further research to explore new therapeutic approaches for the treatment of PDAC.

Background: The aim of this study is to investigate the beam width and beam profile of kilovoltage cone beam computed tomography (kV CBCT) using different measurement techniques on an O-ring linear accelerator. The effect of the imaging beam on the dosimetric parameters was analysed.

Materials and methods: The uncertainty of field size adjustment, the dependence of beam width on field size, and the effect of deflection from the isocenter on the beam profile were investigated by ionization chamber detector matrices. The 2D beam profile of the CBCT was analysed by relative ionization chamber measurements.

Results: The average setup uncertainties of the field sizes were 0.3 mm ± 0.02 mm. The dependence of beam width on field size investigation revealed that the largest discrepancies occurred for small field sizes, which are important in determining computed tomography dose index (CTDI) values of the kV CBCT. The beam width deviation between measured and vendor-based data was larger than 1 mm below 40 mm field of view. The pelvis protocol demonstrated the smallest CTDI value difference of 2.3%, yet presented the largest effective dose deviation of 0.12 mSv.

Conclusions: The measured CTDI coefficients were higher than predicted by the manufacturer for all cases. The currently internationally recommended CTDI measurement protocols for CBCT contain no reference to the determination of the beam width as a basic element of the calculations. Based on our measurement results, the beam width parameters affect CTDI: therefore, it would be advisable to apply this type of correction.

Background: Still controversial is the optimal radiotherapy (RT) schedule for high-risk patients after mastectomy or breast conserving surgery (BCS). An alternative to conventional RT schedules is hypo-fractionation (HF) (40.5 Gy or 42.67 Gy in 15-16 fractions). The present observational, retrospective study assessed acute and late toxicities after hypo-fractionation targeting the chest wall/breast and regional lymph nodes, compared with a cohort that had received conventional fractionation. The aim was to establish the safety of hypo-fractionation in wide-field irradiation.

Materials and methods: This study enrolled 80 patients (median age 63 years; range 34-83) who underwent either BCS (9) or mastectomy (71) as well as axillary lymph node dissection. The RT schedule was 40.05 Gy in 15 fractions over 3 weeks. A simultaneous integrated boost (SIB) (49.5 Gy in 15 fractions) was delivered to the tumour bed in 9 patients who received whole breast irradiation (WBI). Acute and late toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE v4.02) and compared with outcomes in 51 patients after conventionally fractionated RT to the chest wall/breast and regional nodes. Median follow-up was 16 months (range 2.7-33.8 months).

Results: All patients completed RT with no toxicity-related interruption. No patient developed any cardiac or pulmonary toxicity or ≥ grade 3 acute skin and oesophageal toxicity. Late G1 skin toxicity occurred in 9/75 patients who were eligible for analysis. No patient developed ≥ G2 late toxicity. The incidences of acute toxicity, skin rash and dysphagia were significantly lower after HF (p < 0.001 and 0.040, respectively). No significant differences emerged in late edema and skin toxicity.

Conclusions: The efficacy and safety of hypofractionated regimens were confirmed in real-life settings. Present evidence supports the use of HFRT as standard treatment, providing patients with the advantages of shorter treatment times and reduced healthcare costs.

Background: The application of total body irradiation (TBI), using intensity-modulated techniques with dynamic arcs, creates overlap at the treatment arc boundaries, which can lead to dosimetric variations. Therefore, this research aimed to evaluate the dose distributions in the overlap regions of the arcs used in total body irradiation in pediatric patients.

Material and methods: This dosimetric evaluation was conducted on a CIRS 715-TY0710 pediatric body simulator, where a treatment plan with three isocenters was designed, generating two 4 cm overlap regions along the line connecting the isocenters. The plan was verified using the gamma criteria of 3%/3mm and 5%/5mm with the Octavius 4D software.

Results and conclusions: The planning results showed 98.2% dose coverage over 95% of the planning target volume (PTV) with adequate tolerance for risk organs. Regarding the gamma analysis, the acceptance rate was greater than 95% at the treatment isocenters with criteria of 3%/3 mm and 5%/5 mm. However, there is a decrease in the approved points in the overlap zone when evaluated with a 3%/3 mm criterion, while maintaining an approval percentage above 95% when evaluated with a 5%/5 mm criterion.

The goal of this study was to evaluate the current literature covering the topic of 3D-printed radiotherapy boluses in the context of fabrication methods, materials, and clinical outcomes. This systematic review followed the PRISMA 2020 guidelines. Data were extracted for authors, publication details, application type, printing technique and materials, study type, radiation type, reported outcomes and implementation difficulties. The search yielded 161 articles, 52 of which met the inclusion criteria. Publications on 3D printing for customized boluses have increased since 2014, with the most articles from the United States (21%). Most studies (80.8%) focused on manufacturing custom boluses and testing 3D printing materials, whereas 19.2% explored creating molds for boluses. CT scans were the primary method for defining the bolus area (88.6%). The publications included three study types: dosimetric evaluations, evaluations with anthropomorphic phantoms, and clinical case studies. Fused Deposition Modeling (FDM) was the most common printing technique (88.1%), with Polylactic Acid (PLA) being the most frequently used material (57.1%). Challenges included ensuring proper fit, assessing material properties, and managing printing time. The outcomes of this review suggest that 3D printing technology holds significant promise for improving radiotherapy by creating custom-fit boluses. 3D-printed boluses demonstrated notable advantages, such as improved dose distribution, better bolus conformity, and reduced setup times. However, several limitations have been identified, including considerable variability in study designs, making it challenging to draw generalized conclusions. Some studies had small sample sizes or did not clearly report methodological details. Addressing these issues will help to optimize technology's implementation.