Scobioala, Sergiu; Kittel, Christopher; Elsayad, Khaled; Kroeger, Kai; Oertel, Michael; Samhouri, Laith; Haverkamp, Uwe; Eich, Hans
2019 Radiation Oncology
doi: 10.1186/s13014-019-1353-6pmid: 31399115
Mayinger, Michael; Reibelt, Antonia; Borm, Kai; Ettl, Johannes; Wilkens, Jan; Combs, Stephanie Elisabeth; Oechsner, Markus; Duma, Marciana
2019 Radiation Oncology
doi: 10.1186/s13014-019-1380-3pmid: 31533742
Aula, Hanna; Skyttä, Tanja; Tuohinen, Suvi; Luukkaala, Tiina; Hämäläinen, Mari; Virtanen, Vesa; Raatikainen, Pekka; Moilanen, Eeva; Kellokumpu-Lehtinen, Pirkko-Liisa
2019 Radiation Oncology
doi: 10.1186/s13014-019-1366-1pmid: 31470867
Auerswald, Steffen; Schreml, Stephan; Meier, Robert; Blancke Soares, Alexandra; Niyazi, Maximilian; Marschner, Sebastian; Belka, Claus; Canis, Martin; Haubner, Frank
2019 Radiation Oncology
doi: 10.1186/s13014-019-1413-ypmid: 31711506
Valeriani, Maurizio; Marinelli, Luca; Macrini, Serena; Reverberi, Chiara; Aschelter, Anna; Sanctis, Vitaliana; Marchetti, Paolo; Tronnolone, Lidia; Osti, Mattia
2019 Radiation Oncology
doi: 10.1186/s13014-019-1414-xpmid: 31727093
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Some patients experience oligo-progression during androgen receptor targeted therapy (ARTT) treatments. This progression might not indicate a real systemic drug resistance, but a selective monoclonal resistance. With the aim to delay the start of new line treatments we treated oligo-progressive sites with radiotherapy.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>From June 2011 to Febrary 2019, 29 consecutive metastatic castration resistant prostate cancer (mCRPC) patients were submitted to radiotherapy for oligo-progression (1–3 sites) during ARTT for a total of 37 lesions treated. Thirty-one (83.8%) lesions were treated with conformal radiotherapy and 6 (16.2%) with stereotactic radiotherapy. After radiotherapy all patients continued ARTT.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Median OS (calculated from ARTT start) was 46,6 months (range 4.4–97.5 months), 2 and 3-year OS were 82.8 and 70.7%, respectively. Median PFS was 18,4 months (range 4.4–45.3 months), 2 and 3-year PFS were 38.3 and 8.5%, respectively. Median overall duration of ARTT treatment was 14.8 months (range 4.4–45.3 months) and median duration of ARTT after radiotherapy was 4.6 months (range 1–33.8 months). Patients submitted to radiotherapy > 6 months from the start of ARTT presented a better PFS (<jats:italic>p</jats:italic> < 0.001) and a trend toward a better OS (<jats:italic>p</jats:italic> = 0.101). None patient presented RT and drug related toxicities.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Radiotherapy of oligoprogressive sites may prolong the duration of disease control under ARTT in mCRPC patients with a possible delay in the start of new line treatment. Patients progressing within 6 months from the start of ARTT did not benefit from this approach. More studies are necessary to confirm our results and to evaluate other prognostic factor in order to select patients with high benefit from this approach.</jats:p> </jats:sec>
Hirashima, Hideaki; Nakamura, Mitsuhiro; Miyabe, Yuki; Mukumoto, Nobutaka; Ono, Tomohiro; Iramina, Hiraku; Mizowaki, Takashi
2019 Radiation Oncology
doi: 10.1186/s13014-019-1264-6pmid: 30971273
Machiels, Melanie; Montfoort, Maurits; Thuijs, Nikki; Berge Henegouwen, Mark; Alderliesten, Tanja; Meijer, Sybren; Hooft, Jeanin; Hulshof, Maarten
2019 Radiation Oncology
doi: 10.1186/s13014-019-1419-5pmid: 31801574
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Objective</jats:title> <jats:p>The microscopic tumor spread (MS) beyond the macroscopic tumor borders of esophageal tumors is crucial for determining the clinical target volume (CTV) in radiotherapy. The question arises whether current voluminous CTV margins of 3–5 cm around the macroscopic gross tumor volume (GTV) to account for MS are still accurate when fiducial markers are used for GTV determination. We aimed to pathologically validate the use of fiducial markers placed on the (echo)endoscopically determined tumor border (EDTB) as a surrogate for macroscopic tumor borders and to analyse the MS beyond EDTBs.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Thirty-three consecutive esophageal cancer patients treated with neo-adjuvant chemoradiotherapy after (echo)endoscopic fiducial marker implantation at cranial and caudal EDTB were included in this study. Fiducial marker positions were detected in the surgical specimens under CT guidance and demarcated with beads, and subsequently analysed for macroscopic tumor spread and MS beyond the demarcations. A logistic regression analysis was performed to determine predicting factors for MS beyond EDTB.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 60 EDTBs were examined in 32 patients. In 50% of patients no or only partial regression of tumor in response to therapy (≥Mandard 3) or higher was seen (i.e., residual tumor group) and included for MS analysis. None had macroscopic tumor spread beyond EDTBs. In the residual tumor group, only 20 and 21% of the cranial and caudal EDTBs were crossed with a maximum of 9 mm and 16 mm MS, respectively. This MS was corrected for each individual determined contraction rate (mean: 93%). Presence of MS beyond EDTB was significantly associated with initial tumor length (<jats:italic>p</jats:italic> = 0.028).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Our results validate the use of fiducial markers on EDTB as a surrogate for macroscopic tumor and indicate that CTV margins around the GTV to compensate for MS along the esophageal wall can be limited to 1–1.5 cm, when the GTV is determined with fiducial markers.</jats:p> </jats:sec>
Petras, Katarina G.; Rademaker, Alfred W.; Refaat, Tamer; Choi, Mehee; Thomas, Tarita O.; Pauloski, Barbara R.; Mittal, Bharat B.
2019 Radiation Oncology
doi: 10.1186/s13014-019-1247-7pmid: 30885235
Abstract Background Literature has shown a significant relationship between radiation dose to the larynx and swallowing disorders. We prospectively studied the dose-volume relationship for larynx substructures and aspiration. Methods Forty nine patients with stage III/IV head-and-neck (H&N) squamous cell carcinoma were prospectively enrolled in this IRB-approved, federally funded study. All patients received IMRT-based chemoradiation therapy (CRT) and were scheduled for videofluorography (VFG) prior to CRT and at 3, 6, 9, 12, and 24 months post-CRT. Twelve laryngeal substructures were contoured in each patient: thyroid cartilage, cricoid cartilage, total epiglottis, suprahyoid epiglottis, infrahyoid epiglottis, total larynx, supraglottic larynx, subglottic larynx, glottic larynx, arytenoids, aryepiglottic (AE) folds, and glossoepiglottic fold. After exclusions, 29 patients were included in the final analysis. Incidence of aspiration at 1 year following CRT was correlated with dose-volume data to laryngeal substructures using logistic regression. Results The median age was 54 years with 79% being non-smokers. Tumor sites included oropharynx (22), unknown primary (6), and hypopharynx (1). One year following CRT, 10/29 (34%) showed aspiration on VFG. Dose to the AE folds showed the highest correlation with aspiration at 12 months and was significant on multivariate analysis (p = 0.025). A mean dose cutpoint of 6500 cGy or higher to the AE folds was associated with an increased risk of aspiration at 1 year [positive likelihood ratio (+LR) 2.81, positive predictive value (PPV) 60%, negative predictive value (NPV) 92.9%, relative risk (RR) 8.4]. Conclusions In this analysis, mean dose to the AE folds was associated with an increased risk of aspiration at 1 year. However, these are hypothesis-generating data that require further research and validation in a larger patient subset.
Corradini, S.; Alongi, F.; Andratschke, N.; Belka, C.; Boldrini, L.; Cellini, F.; Debus, J.; Guckenberger, M.; Hörner-Rieber, J.; Lagerwaard, F.; Mazzola, R.; Palacios, M.; Philippens, M.; Raaijmakers, C.; Terhaard, C.; Valentini, V.; Niyazi, M.
2019 Radiation Oncology
doi: 10.1186/s13014-019-1308-ypmid: 31167658
Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites.
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