Dermatofibrosarcoma protuberans (DFSP) is a rare and slowly growing tumor. Inadequate surgical resection is associated with a high recurrence rate. However, complete resection with wide margins in some cases may cause cosmetic or functional deficits. Previous studies suggest that adjuvant radiotherapy (RT) can effectively decrease the local recurrence rate. We report the case of a tumor in the right shoulder of a 25-year-old woman, in which the tumor was located adjacent to the skin and joint. She underwent wide excision of this tumor, and the pathologic findings of this tumor showed DFSP with close margins. She was subsequently administered intensity modulated radiation therapy (IMRT) of 46 Gy with 2 Gy per fraction for the tumor bed and wide margins followed by 14 Gy with 2 Gy per fraction for the tumor bed boost. She remained disease-free during the 3-year follow-up. This finding indicates that adjuvant RT is considered for patients with DFSP who have close margins or in whom wide surgical margins are not feasible.
{"title":"Adjuvant radiotherapy for dermatofibrosarcoma protuberans: a case report","authors":"Mingfu Hu, S. Kuo","doi":"10.21037/tro.2019.08.01","DOIUrl":"https://doi.org/10.21037/tro.2019.08.01","url":null,"abstract":"Dermatofibrosarcoma protuberans (DFSP) is a rare and slowly growing tumor. Inadequate surgical resection is associated with a high recurrence rate. However, complete resection with wide margins in some cases may cause cosmetic or functional deficits. Previous studies suggest that adjuvant radiotherapy (RT) can effectively decrease the local recurrence rate. We report the case of a tumor in the right shoulder of a 25-year-old woman, in which the tumor was located adjacent to the skin and joint. She underwent wide excision of this tumor, and the pathologic findings of this tumor showed DFSP with close margins. She was subsequently administered intensity modulated radiation therapy (IMRT) of 46 Gy with 2 Gy per fraction for the tumor bed and wide margins followed by 14 Gy with 2 Gy per fraction for the tumor bed boost. She remained disease-free during the 3-year follow-up. This finding indicates that adjuvant RT is considered for patients with DFSP who have close margins or in whom wide surgical margins are not feasible.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tro.2019.08.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48092459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yang-Hong Dai, Yu-Jen Chen, Chun-Shu Lin, Kuen‐Tze Lin, Wen-Yen Huang, Chang-Ming Chen, Yu-Fu Su, Chao-Yueh Fan, C. Lo, Yen-Fu Yang, C. Tsao, Ming-Yueh Liu, P. Shen, H. Chao, K. Chao
In early stage breast cancer, intraoperative radiation therapy (IORT) is a form of accelerated partial breast irradiation (APBI) that provides attractive therapeutic effects while shortening the overall treatment time and sparing the normal tissue radiation exposure. This technique has been used in Taiwan for several years in selected patients with breast cancer. However, some randomized trials pointed out that IORT is associated with higher rate of recurrence, therefore impeding its wider use as one of the standard managements in breast cancer. Also, despite its theoretical benefits for smaller tumor after surgery, the problem of recurrence warrants the necessity of strict and careful patient selection. The purpose of this article is to comprehensively review the updated consensus and current opinions on the use of IORT for early stage breast cancer.
{"title":"Review of current perspectives on low-energy X-ray intraoperative radiotherapy in early stage breast cancer","authors":"Yang-Hong Dai, Yu-Jen Chen, Chun-Shu Lin, Kuen‐Tze Lin, Wen-Yen Huang, Chang-Ming Chen, Yu-Fu Su, Chao-Yueh Fan, C. Lo, Yen-Fu Yang, C. Tsao, Ming-Yueh Liu, P. Shen, H. Chao, K. Chao","doi":"10.21037/tro.2019.01.03","DOIUrl":"https://doi.org/10.21037/tro.2019.01.03","url":null,"abstract":"In early stage breast cancer, intraoperative radiation therapy (IORT) is a form of accelerated partial breast irradiation (APBI) that provides attractive therapeutic effects while shortening the overall treatment time and sparing the normal tissue radiation exposure. This technique has been used in Taiwan for several years in selected patients with breast cancer. However, some randomized trials pointed out that IORT is associated with higher rate of recurrence, therefore impeding its wider use as one of the standard managements in breast cancer. Also, despite its theoretical benefits for smaller tumor after surgery, the problem of recurrence warrants the necessity of strict and careful patient selection. The purpose of this article is to comprehensively review the updated consensus and current opinions on the use of IORT for early stage breast cancer.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tro.2019.01.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45585853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients affected by intra-thoracic recurrences of primary or secondary lung malignancies after the first course of definitive radiotherapy (RT) have limited therapeutic options, and they are often treated with palliative intent. Re-irradiation with stereotactic radiotherapy (SRT) represents an appealing approach, due to the optimized dose distribution that allows for high-dose delivery with better sparing of organs at risk; however, toxicity still represents an issue, even with dose-fractionation risk-adapted approaches. This review aims to analyze clinical data and dosimetric parameters related to stereotactic re-irradiation, mainly focusing on the toxicity profile, whose risk often limits the adoption of this technique in clinical practice.
{"title":"Stereotactic radiotherapy in previously treated lung cancers—what are the risks?","authors":"A. Filippi, A. Lancia, M. Trovò","doi":"10.21037/TRO.2019.03.02","DOIUrl":"https://doi.org/10.21037/TRO.2019.03.02","url":null,"abstract":"Patients affected by intra-thoracic recurrences of primary or secondary lung malignancies after the first course of definitive radiotherapy (RT) have limited therapeutic options, and they are often treated with palliative intent. Re-irradiation with stereotactic radiotherapy (SRT) represents an appealing approach, due to the optimized dose distribution that allows for high-dose delivery with better sparing of organs at risk; however, toxicity still represents an issue, even with dose-fractionation risk-adapted approaches. This review aims to analyze clinical data and dosimetric parameters related to stereotactic re-irradiation, mainly focusing on the toxicity profile, whose risk often limits the adoption of this technique in clinical practice.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.03.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45392790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yun-Chih Chen, Jang-Chun Lin, Wei-Hsiu Liu, Sheng Huang, Y. Chou, Ming‐Hsien Li, J. Tsai
Background: Adjuvant chemoradiotherapy is viewedas a definitive treatment after resection of stomach cancer (SC). To protectnormal tissue, several highly conformal radiotherapy modalities evolved.Therefore, we aimed to compare dosimetric parameters of helical tomotherapy(TOMO), volumetric-modulated arc therapy (VMAT), and intensity-modulatedradiotherapy (IMRT) in the adjuvant treatment of SC in different locations. Methods: This retrospective study wasconducted from January 2013 to May 2017 and included 11 patients with gastriccancer receiving adjuvant chemoradiotherapy after total gastrectomy. Both IMRTand VMAT plans were generated on the Pinnacle treatment planning system andTOMO plans were generated using a helical tomotherapy system. Adjuvantradiotherapy was prescribed with a total radiation dose of 50.4 Gy in 28fractions. Results: In proximal SC, TOMO achieved asignificantly lower dose for the heart, total kidney, left kidney, and liverthan that of IMRT or VMAT (P<0.05). In middle/distal SC, lower total kidneymean dose and V20 were observed with TOMO compared with IMRT (P=0.010 and0.011, respectively) and VMAT (P=0.049; P=0.014). Conclusions: For the adjuvant treatment of gastriccancer, TOMO not only provided superior dose sparing for total kidney, leftkidney, liver V 20 and liver V 30 in patients with proximalgastric cancer but also significantly lowered the heart dose in proximal SCwhen compared to IMRT or VMAT plan.
{"title":"Comparing treatment plans for proximal and middle/distal stomach cancer: intensity-modulated radiotherapy, volumetric-modulated arc therapy, and tomotherapy","authors":"Yun-Chih Chen, Jang-Chun Lin, Wei-Hsiu Liu, Sheng Huang, Y. Chou, Ming‐Hsien Li, J. Tsai","doi":"10.21037/TRO.2018.12.05","DOIUrl":"https://doi.org/10.21037/TRO.2018.12.05","url":null,"abstract":"Background: Adjuvant chemoradiotherapy is viewedas a definitive treatment after resection of stomach cancer (SC). To protectnormal tissue, several highly conformal radiotherapy modalities evolved.Therefore, we aimed to compare dosimetric parameters of helical tomotherapy(TOMO), volumetric-modulated arc therapy (VMAT), and intensity-modulatedradiotherapy (IMRT) in the adjuvant treatment of SC in different locations. Methods: This retrospective study wasconducted from January 2013 to May 2017 and included 11 patients with gastriccancer receiving adjuvant chemoradiotherapy after total gastrectomy. Both IMRTand VMAT plans were generated on the Pinnacle treatment planning system andTOMO plans were generated using a helical tomotherapy system. Adjuvantradiotherapy was prescribed with a total radiation dose of 50.4 Gy in 28fractions. Results: In proximal SC, TOMO achieved asignificantly lower dose for the heart, total kidney, left kidney, and liverthan that of IMRT or VMAT (P<0.05). In middle/distal SC, lower total kidneymean dose and V20 were observed with TOMO compared with IMRT (P=0.010 and0.011, respectively) and VMAT (P=0.049; P=0.014). Conclusions: For the adjuvant treatment of gastriccancer, TOMO not only provided superior dose sparing for total kidney, leftkidney, liver V 20 and liver V 30 in patients with proximalgastric cancer but also significantly lowered the heart dose in proximal SCwhen compared to IMRT or VMAT plan.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2018.12.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49611778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Asher, P. Munoz-Schuffenegger, W. F. Neves-Junior, H. Carvalho, A. D. Pra, F. Moraes
Lung cancer is the most common cause of cancer-related death in the world with a disproportionally high burden of disease in low- and middle-income countries (LMICs). Stereotactic ablative radiotherapy (SABR) is the standard of care treatment for inoperable patients with early-stage non-small cell lung cancer (ES-NSCLC) and is currently being evaluated in several randomized control trials in the operable patient setting. SABR for ES-NSCLC has been widely implemented throughout high-income countries (HICs), yet its implementation in LMICs, where the burden of disease is highest, has been limited. The purpose of this report is to provide a practical outline for practitioners to implement SABR for ES-NSCLC while addressing potential barriers that may arise in LMICs. We ultimately aim to describe the essential infrastructure, patient selection, human resources, technical requirements, radiation therapy (RT) planning, RT delivery, patient follow up, quality assurance (QA), and cost considerations required to effectively and safely deliver SABR for ES-NSCLC.
{"title":"Practical considerations of lung stereotactic ablative radiotherapy in the developing world","authors":"D. Asher, P. Munoz-Schuffenegger, W. F. Neves-Junior, H. Carvalho, A. D. Pra, F. Moraes","doi":"10.21037/TRO.2018.12.10","DOIUrl":"https://doi.org/10.21037/TRO.2018.12.10","url":null,"abstract":"Lung cancer is the most common cause of cancer-related death in the world with a disproportionally high burden of disease in low- and middle-income countries (LMICs). Stereotactic ablative radiotherapy (SABR) is the standard of care treatment for inoperable patients with early-stage non-small cell lung cancer (ES-NSCLC) and is currently being evaluated in several randomized control trials in the operable patient setting. SABR for ES-NSCLC has been widely implemented throughout high-income countries (HICs), yet its implementation in LMICs, where the burden of disease is highest, has been limited. The purpose of this report is to provide a practical outline for practitioners to implement SABR for ES-NSCLC while addressing potential barriers that may arise in LMICs. We ultimately aim to describe the essential infrastructure, patient selection, human resources, technical requirements, radiation therapy (RT) planning, RT delivery, patient follow up, quality assurance (QA), and cost considerations required to effectively and safely deliver SABR for ES-NSCLC.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2018.12.10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46784628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stereotactic ablative radiation therapy (SABR) is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC) who are not fit for surgery or who refuse an operation. The available evidence suggests that SABR is effective in obtaining durable local control in operable patients as well, but whether it can currently be recommended as an alternative to surgery in this population is contentious because of the absence of high quality long-term prospective randomized survival data. Retrospective comparisons of SABR with surgery are available, but have been subject to bias from the confounding effect of operability. Previous attempts to prospectively compare SABR with surgery in a randomized fashion have been unsuccessful due to poor accrual. From these efforts, the randomized data from two of these prematurely closed trials were combined to explore the potential outcome if they had completed accrual, though the analyses were largely dismissed by the academic community. In this review, we give a critical overview of the available data in this context, and address key areas of controversy which include the questioned importance of pathologic staging of the mediastinum, the appropriate thresholds for empiric treatment of suspicious lung nodules without biopsy confirmation, and the challenges of post-treatment surveillance of the irradiated lung. We also address design considerations aimed at maximising enrolment into ongoing prospective phase III trials of SABR versus surgery.
{"title":"Stereotactic ablative radiation therapy for operable early-stage lung cancer—considerations and controversies","authors":"C. Daniels, D. Moghanaki, S. Siva","doi":"10.21037/TRO.2019.01.01","DOIUrl":"https://doi.org/10.21037/TRO.2019.01.01","url":null,"abstract":"Stereotactic ablative radiation therapy (SABR) is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC) who are not fit for surgery or who refuse an operation. The available evidence suggests that SABR is effective in obtaining durable local control in operable patients as well, but whether it can currently be recommended as an alternative to surgery in this population is contentious because of the absence of high quality long-term prospective randomized survival data. Retrospective comparisons of SABR with surgery are available, but have been subject to bias from the confounding effect of operability. Previous attempts to prospectively compare SABR with surgery in a randomized fashion have been unsuccessful due to poor accrual. From these efforts, the randomized data from two of these prematurely closed trials were combined to explore the potential outcome if they had completed accrual, though the analyses were largely dismissed by the academic community. In this review, we give a critical overview of the available data in this context, and address key areas of controversy which include the questioned importance of pathologic staging of the mediastinum, the appropriate thresholds for empiric treatment of suspicious lung nodules without biopsy confirmation, and the challenges of post-treatment surveillance of the irradiated lung. We also address design considerations aimed at maximising enrolment into ongoing prospective phase III trials of SABR versus surgery.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.01.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44599978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stereotactic ablative radiotherapy (SABR) is a radiotherapy technique for treating early-stage non-small cell lung cancer (NSCLC), and is characterized by high dose per fraction, few fractions, and image-guided precision. Multiple studies have consistently demonstrated high rates of local control and a low incidence of serious adverse events, making it an attractive option for patients who are medically unfit for surgery. Although a biopsy is recommended for confirmation of the diagnosis prior to treatment, it is not without its risks. Herein we review the necessity of a biopsy prior to SABR for a solitary pulmonary nodule (SPN) suspicious for early-stage NSCLC. We examine malignancy prediction tools for assessing SPNs and scenarios in which forgoing a biopsy could be reasonable.
{"title":"Certainty versus practicality: when is histologic proof needed prior to stereotactic ablative radiotherapy for solitary pulmonary nodules?","authors":"A. Arifin, A. Louie","doi":"10.21037/TRO.2019.01.02","DOIUrl":"https://doi.org/10.21037/TRO.2019.01.02","url":null,"abstract":"Stereotactic ablative radiotherapy (SABR) is a radiotherapy technique for treating early-stage non-small cell lung cancer (NSCLC), and is characterized by high dose per fraction, few fractions, and image-guided precision. Multiple studies have consistently demonstrated high rates of local control and a low incidence of serious adverse events, making it an attractive option for patients who are medically unfit for surgery. Although a biopsy is recommended for confirmation of the diagnosis prior to treatment, it is not without its risks. Herein we review the necessity of a biopsy prior to SABR for a solitary pulmonary nodule (SPN) suspicious for early-stage NSCLC. We examine malignancy prediction tools for assessing SPNs and scenarios in which forgoing a biopsy could be reasonable.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.01.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43905354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wei-Jun Wang, Kuan-Der Lee, Wei-Yu Chen, J. Chiou, Long-Sheng Lu
A 69-year-old man was diagnosed stage II anorectal malignant melanoma. He received radiotherapy which consisted of 25 Gy in 5 fractions to primary lesions and whole pelvis. He started pembrolizumab 3 weeks after the completion of radiotherapy. The treatment was complicated by CTCAE v4.0 grade 3 diarrhea. Ten weeks after radiotherapy, near total regression of the primary lesion as well as lymph nodes were found. The patient continued triweekly pembrolizumab and local recurrence was noted at 9 months after the initial diagnosis. Treating anorectal malignant melanoma with radiation assisted immunotherapy is worth considering and further study is warranted.
{"title":"Combining hypofractionated radiation therapy with immunotherapy for anorectal malignant melanoma: a case report","authors":"Wei-Jun Wang, Kuan-Der Lee, Wei-Yu Chen, J. Chiou, Long-Sheng Lu","doi":"10.21037/TRO.2018.12.09","DOIUrl":"https://doi.org/10.21037/TRO.2018.12.09","url":null,"abstract":"A 69-year-old man was diagnosed stage II anorectal malignant melanoma. He received radiotherapy which consisted of 25 Gy in 5 fractions to primary lesions and whole pelvis. He started pembrolizumab 3 weeks after the completion of radiotherapy. The treatment was complicated by CTCAE v4.0 grade 3 diarrhea. Ten weeks after radiotherapy, near total regression of the primary lesion as well as lymph nodes were found. The patient continued triweekly pembrolizumab and local recurrence was noted at 9 months after the initial diagnosis. Treating anorectal malignant melanoma with radiation assisted immunotherapy is worth considering and further study is warranted.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2018.12.09","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44461229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Significant improvements in outcomes for locally advanced and metastatic non-small cell lung cancer (NSCLC) have been seen with increased use of immune checkpoint inhibitors (ICIs), and their role in the treatment of early-stage NSCLC is a subject of active investigation. Mounting evidence from preclinical and clinical trials involving immunotherapy for NSCLC has demonstrated the importance of understanding the tumor microenvironment (TME) and the host anti-tumor response. Incorporation of radiation, specifically in hypofractionated regimens, may potentiate the anti-tumor response stimulated by ICIs and thereby improve the efficacy of immunotherapy for these patients. Additional studies are in progress to determine the optimal sequence, dose, fractionation, and duration of combination therapy.
{"title":"Is radiotherapy the missing link to enhancing the outcomes in non-small cell lung cancer patients treated with immunotherapy?","authors":"R. Dams, D. Raben, Percy Lee","doi":"10.21037/tro.2018.12.08","DOIUrl":"https://doi.org/10.21037/tro.2018.12.08","url":null,"abstract":"Significant improvements in outcomes for locally advanced and metastatic non-small cell lung cancer (NSCLC) have been seen with increased use of immune checkpoint inhibitors (ICIs), and their role in the treatment of early-stage NSCLC is a subject of active investigation. Mounting evidence from preclinical and clinical trials involving immunotherapy for NSCLC has demonstrated the importance of understanding the tumor microenvironment (TME) and the host anti-tumor response. Incorporation of radiation, specifically in hypofractionated regimens, may potentiate the anti-tumor response stimulated by ICIs and thereby improve the efficacy of immunotherapy for these patients. Additional studies are in progress to determine the optimal sequence, dose, fractionation, and duration of combination therapy.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44812398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skin toxicities, particularly in the inframammary fold areas are noted for patients receiving hypofractionated whole breast radiation therapy. In this study, a hybrid modulated beam technique was developed to tackle such a problem. The technique aimed to achieve significant dose improvements to the inframammary region while maintaining the robustness and treatment delivery efficiency similar to that of 3D conformal treatment delivery. The overall treatment time for the technique was about 6 minutes or less for a treatment session delivering a fractional dose of 266 cGy. As a result, clinical centers with a high volume of patients are most likely to benefit from implementing such a technique.
{"title":"Improving regional dose distribution while maintaining high delivery efficiency for hypofractionated whole breast radiotherapy","authors":"Lijun Ma, A. Hwang","doi":"10.21037/TRO.2018.11.01","DOIUrl":"https://doi.org/10.21037/TRO.2018.11.01","url":null,"abstract":"Skin toxicities, particularly in the inframammary fold areas are noted for patients receiving hypofractionated whole breast radiation therapy. In this study, a hybrid modulated beam technique was developed to tackle such a problem. The technique aimed to achieve significant dose improvements to the inframammary region while maintaining the robustness and treatment delivery efficiency similar to that of 3D conformal treatment delivery. The overall treatment time for the technique was about 6 minutes or less for a treatment session delivering a fractional dose of 266 cGy. As a result, clinical centers with a high volume of patients are most likely to benefit from implementing such a technique.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43319071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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