Radiation Oncology最新文献

Extramedullary hematopoiesis (EMH) is a compensatory response to chronic anemia, commonly observed in thalassemia. EMH can cause neurological complications such as spinal cord compression and paraparesis, as well as other site-specific compressive symptoms necessitating timely intervention. While medical management and surgery have been explored, radiation therapy (RT) remains a safe and effective alternative. This case series presents five patients with thalassemia who developed symptomatic EMH. All patients exhibited compressive symptoms, including lower limb weakness, sensory deficits, and abdominal pain. They were treated with conformal external beam RT using volumetric modulated arc therapy (VMAT) at doses ranging from 20 to 24 Gy in 10-12 fractions. Symptomatic relief was achieved within days of initiating radiation treatment, with near-complete neurological recovery by treatment completion. MRI follow-ups over 1-2 years demonstrated significant regression of EMH masses, and there was no recurrence of symptoms. Radiation was well tolerated and no treatment-related toxicities were observed. This study highlights the role of radiation treatment as a non-invasive and effective treatment modality for symptomatic EMH. The rapid clinical response and durable control observed in these cases reinforce its potential as a primary intervention, particularly in patients who are not responding and progressing on medical management. A dose range of 20-24 Gy in 10-12 fractions by modern radiation delivery techniques is recommended for the management of extramedullary hematopoietic masses.

Background: Bone metastases cause significant pain and functional limitation. Conventional external beam radiotherapy (EBRT) provides effective symptom relief, but local progression remains frequent. Stereotactic body radiotherapy (SBRT) offers improved local control but is often resource-intensive and associated with higher vertebral compression fracture (VCF) rates. Integrating a simultaneous gross tumour volume (GTV) boost within a conventional EBRT regimen may provide a feasible and safe alternative.

Methods: This is a prospective, multicentre, multinational, single-arm study enrolling 100 adults with painful bone metastases from solid tumours. Eligible patients receive 20 Gy in 5 fractions with a 5 Gy "stereotactic-lite" GTV boost (total 25 Gy) or 30 Gy in 10 fractions with a 6 Gy boost (total 36 Gy), delivered using intensity modulated radiotherapy or volumetric modulated arc therapy. The primary endpoints are feasibility (commencement of radiotherapy within 10 working days of computed tomography simulation in at least 80% of patients) and safety (incidence of Common Terminology Criteria for Adverse Events version 5.0 grade ≥ 2 acute toxicity within 3 months). Secondary endpoints include pain response, radiation site-specific progression-free survival, rates of VCF and long bone fracture, skeletal-related events, quality of life changes via EORTC QLQ-C30 and BM22, and overall survival.

Discussion: This protocol evaluates a hybrid EBRT approach with a simultaneous integrated boost as a practical strategy to enhance local tumour control and symptom relief without delaying palliation. If feasible and safe, this approach may bridge the gap between conventional EBRT and SBRT.

Trial registration: Australian and New Zealand Clinical Trial Registry (ACTRN12625000615482).

Background: Head and neck cancer (HNC), most of which are squamous cell carcinomas, is the seventh most common cancer worldwide. Radiotherapy is a standard treatment for HNC but may lead to late complications and severe complications like osteoradionecrosis (ORN) and impaired wound healing due to tissue hypoxia. Hyperbaric oxygen therapy (HBOT) has shown promise in ameliorating these late radiation effects. The purpose of this review is to summarize the extent of the literature on the effectiveness of HBOT in the treatment of late radiation tissue toxicity injuries (LRTTI) specifically in HNC patients.

Methods/material and methods: A systematic literature search was performed using PubMed, Embase, and the Cochrane Library on August 12, 2024, including studies published between 2004 and 2022. Studies that included HNC patients with LRTTI and treated with HBOT were selected. Articles were critically appraised using the Joanna Briggs Institute (JBI) checklists. Data on patient characteristics, HBOT treatment details, and main outcomes were extracted. Primary outcomes assessed included clinical changes, such as the Notani score, while secondary outcomes focused on patient-reported measures such as VAS and OHIP. Descriptive analysis, supported by statistical measures, was used to interpret the results.

Results: A total of 17 studies were reviewed, including 640 HNC patients with LRTTI who were treated with HBOT. In this systematic review, HBOT is presented in the included studies as a reliable and safe treatment for the treatment of LRTTI in HNC patients, with positive outcomes observed in 14 out of 17 studies. Specifically, almost all studies investigating ORN and oral health reported beneficial effects, with significant p-values in multiple cases. Overall, significant p-values were found in 11 studies, with a low incidence of adverse effects reported across the studies.

Conclusion: This review suggests that HBOT may be effective in the treatment of LRTTI in HNC patients. However, the supporting evidence is mainly derived from low quality studies with a high risk of bias, limited sample sizes, and inconsistent outcome measures. Additional high quality studies are needed to clarify the true clinical benefits and optimal use of HBOT.

Background: Advancements in cone beam computed tomography (CBCT)-guided radiotherapy (RT) platforms have created new frontiers in adaptive radiotherapy (ART). This report describes the novel application of single-fraction adaptive stereotactic body radiotherapy (SBRT) for a 66-year-old woman with lung adenocarcinoma for whom a conventional RT workflow was impractical due to advanced Parkinson's disease with uncontrolled tremors.

Case presentation: The patient presented with a 2.4 cm spiculated nodule in the left upper lobe (LUL) diagnosed as stage 1A3 lung adenocarcinoma. She declined surgery, and local radiation oncologists deemed SBRT unsafe due to her tremors. Our team proposed a direct-to-unit, single-visit SBRT treatment utilizing anesthesia for immobilization and the Ethos platform for online adaptation to day-of-treatment positioning. An initial treatment plan was generated offline using a diagnostic CT acquired near the patient's home. On the treatment day the patient was anesthetized and a custom foam mold created using a diagnostic CT was used for setup. An internal gross tumor volume (iGTV) was adjusted based on the CBCT of the treatment day. An adaptive plan improved target coverage by 5% without violating organ-at-risk constraints. The entire procedure from initial CBCT to treatment completion took 63 min. Post-treatment recalculations on a CBCT confirmed dosimetric accuracy.

Conclusions: This case illustrates the feasibility of direct-to-unit single-fraction CT-guided ART with high-quality CBCT imaging and anesthesia-facilitated immobilization. Our successful completion of this treatment establishes a procedure for future direct-to-unit ART in lung cancer, enhancing accessibility and reducing treatment time for a patient population for whom conventional RT is impractical.

Background: High-dose prescribed radiotherapy has been attempted to improve local control and restore portal vein in patients with hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombus (PVTT). The aim of this study was to evaluate feasibility of real-time tumor-tracking magnetic resonance imaging-guided radiotherapy (rtMRgRT) for PVTT in HCC. In addition, prognostic factors for overall survival (OS) and progression pattern after radiotherapy (RT) were analyzed.

Methods: We retrospectively reviewed the data of 34 patients who had unresectable HCC complicated with PVTT and who were treated with rtMRgRT using hypofractionated radiotherapy (HFRT) and stereotactic body radiation therapy (SBRT) between June 2019 and October 2023. HFRT was performed with a total of 50-60 Gy in 10 fractions, and SBRT was performed in a range of 36-50 Gy in 4-5 fractions. The median biologic effective dose with an a/b ratio of 10 was 100 Gy₁₀ (range: 68.4-100 Gy₁₀).

Results: Twenty-one patients (61.7%) had an objective response (complete response and partial response) to PVTT; the 1-year estimated local control rate was 77.7%. The median progression-free survival and OS were 5.2 and 10.6 months, respectively. The predominant initial pattern of progressive disease after RT was outfield intrahepatic progression (21/29 cases, 72.4%). RT responder (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.12-0.88; p = 0.026) and combined transarterial chemoembolization (TACE) within 1-month post-RT (HR, 0.24; 95% CI, 0.08-0.73; p = 0.012) were favorable prognostic factors for OS.

Conclusions: The rtMRgRT demonstrated feasibility in treatment of PVTT with favorable overall response and local control. Response to RT and combined TACE within a month post-RT were favorable prognostic factors for OS. Given the predominant patterns of disease progression after RT, timely management of HCC outside RT field may be crucial for enhancing the survival of patients with PVTT undergoing RT. The early combination of TACE within a month post-RT may be beneficial in this regard. Further prospective studies are needed to determine the optimal sequencing and timing for combining RT and other local therapies in patients with PVTT.

Purpose: Pelvic nodal irradiation is often used for high-risk prostate adenocarcinoma. A commonly used alternative to low dose rate (LDR) brachytherapy, a 3-fraction SBRT boost with fiducial tracking may allow for better coverage of extracapsular extension and macroscopic seminal vesicle invasion. This study evaluates the practical impact of prior pelvic nodal irradiation on fiducial tracking during a subsequent 3-fraction robotic stereotactic body radiation therapy (SBRT) boost for high-risk prostate cancer and compares these outcomes to a cohort of patients undergoing definitive 5-fraction SBRT.

Methods: In this institutional analysis, we prospectively collected fiducial tracking data for patients receiving a 3-fraction boost to the prostate and seminal vesicles after conventional nodal radiation. We also identified patients treated with 5-fraction SBRT with a low risk of nodal involvement. Monte Carlo estimates of the Fisher's Exact Test assessed fiducial tracking loss. Continuous variables within the 5- and 3-fraction cohorts were compared using the Mann-Whitney Test. Changes in fiducial tracking and their association with pre-treatment factors were analyzed through the Kruskal-Wallis test and Monte Carlo for tracking patterns, and Spearman Correlation Coefficient and Mann-Whitney Test for deviations in tracking over 5 fractions.

Results: A total of 405 patients were treated from April 2021 to September 2023 with: (1) 5-fraction SBRT (n = 309, 76%), and (2) 3-fraction boost after nodal irradiation (n = 96, 24%). There was no significant fiducial tracking loss over the three-fraction boost treatment regimen that proceeded nodal treatment (p = 0.63). However, there was a significant (p < 0.001) loss of fiducial tracking fidelity as demonstrated by progressive loss of one tracked fiducial over 5-fractions. There was significantly more volatility observed in the 5-fraction versus 3-fraction boost treatment (median volatility 2.4 vs. 0.0, p < 0.001). There were no significant associations between fiducial tracking, independently for 3- or 5-fractions, using either analysis method or volatility for ADT, time from fiducial placement to SBRT, CTV, and QOD vs. daily SBRT.

Conclusions: Pelvic nodal treatment does not affect the quantity/quality of fiducial tracking in 3-fraction treatments. However, 5-fraction treatments showed a progressive loss and increased volatility in fiducial tracking over time. No pre-treatment factors significantly influenced fiducial tracking changes in either cohort, though ADT use trended towards increased volatility in the 5-fraction group. With a minimum of 4 fiducials placed for treatment, the loss/volatility of a single fiducial had no clinical impact on the tracking system.