Use of cardiac radiation therapy as bridging therapy to CAR-T for relapsed pediatric B-cell acute lymphoblastic leukemia.

The use of radiotherapy as bridging therapy to chimeric antigen receptor T-cell therapy (CAR-T) in pre-B acute lymphoblastic leukemia (B-ALL) has been minimally explored. Here, we present a boy with B-ALL who relapsed after allogeneic bone marrow transplant with disseminated disease, including significant symptomatic cardiovascular and gastrointestinal (GI) involvement. The cardiac and GI leukemic infiltrates were successfully treated with bridging radiation therapy (BRT) prior to CAR-T infusion. Using this approach, he successfully tolerated CAR-T with no evidence of disease or sequelae on 3-month follow-up. This is the first reported case of safe and effective delivery of cardiac BRT in B-ALL.

Does the Use of Volumetric Modulated Arc Therapy Reduce Gastrointestinal Symptoms after Pelvic Radiotherapy?

AIMS: Growing numbers of patients with cancer are surviving after treatment with pelvic radiotherapy. We evaluated the technique of volumetric modulated arc therapy (VMAT), which delivers a decreased dose to the organs at risk. We aimed to determine outcomes of this technique in terms of patient-reported acute toxicity and late effects and correlate the frequency of gastrointestinal symptoms with the volume of bowel receiving radiation dose. MATERIALS AND METHODS: Patients who were to receive VMAT for gynaecological malignancy completed patient-reported outcomes at baseline, the end of treatment, 8 weeks and 1 year. The rates of patient-reported toxicity were correlated with the volume of bowel irradiated. RESULTS: The frequencies of patient-reported gastrointestinal symptoms increased in the acute toxicity phase and tended to improve at 1 year, with the exception of faecal incontinence and rectal bleeding (P < 0.05). There was not a strong association between the volume of small bowel that was irradiated (P > 0.05 at all dose levels) and reported toxicity, suggesting that other factors are involved in the development of toxicity. CONCLUSION: Although VMAT decreases the dose delivered to the small bowel, this does not translate into a reduction in patient-reported toxicity.

Phase II study of a four-week hypofractionated external beam radiotherapy regimen for prostate cancer: report on acute toxicity.

PURPOSE: To evaluate the early side effects of a short course hypofractionated radiotherapy regimen in prostate cancer. MATERIALS AND METHODS: Three institutions (IRE, AZ VUB, GUH) included 36 patients with T1-T3N0M0 prostate cancer in a phase II study. Patients were treated with 56 Gy in 16 fractions over 4 weeks. Early side effects were scored using the RTOG/EORTC criteria and the international prostate symptom index (IPSI) weekly during treatment and 1 and 2 months afterwards. The results were compared with two control groups of patients previously treated with conventional fractionation at AZ VUB (238 patients) and GUH (114 patients). RESULTS: None of the patients experienced grade 3-4 toxicity. Grade 1-2 Gastro-intestinal (GI), grade 2 GI, grade 1-2 Genito-urinary (GU) and grade 2 GU toxicity occurred in 75%, 36%, 75% and 44% for the hypofractionation schedule. The corresponding figures were 25-44%, 6-29%, 47-53% and 16-44% for the control groups (p<0.01 for grade 1-2 GI and GU toxicity). Two months after treatment all GU and the majority of GI symptoms had resolved. The IPSI increased from (average +/-1 SD) 5.6+/-4 pre-treatment to 10.0+/-6 during week 2-4 and had normalized (5.2+/-4) two months after treatment. CONCLUSIONS: Though no grade 3-4 side effects were observed, the investigated schedule results in a marked increase of grade 1-2 early side effects as compared to a conventional regimen. Side effects resolved within two months post-treatment.

[Personal experience in clinical use of low power laser therapy]. / Wlasne doswiadczenia w klinicznym wykorzystaniu lasera niskoenergetycznego.

The results of our own clinical trials regarding therapeutical effects of low power lasers in the treatment of some diseases of motional system, skin and lesions of peripheral circulation were presented in the paper. The laser therapy was used in over 320 patients in period of last 3 years. The infra-red laser (wave-length 904 nm, mean power 4 mW) was used. The procedures were performed daily, for 5 days a week in 2 stages: the scan of sore region (3-min.) and the irradiation of trigger points (2-3 min. each). As a result of 10-25 procedures a significant clinical improvement in 65-90% patients was obtained. On the base of obtained results one can conclude that low-power laser therapy could make a useful supplementary method of treatment of overloading syndrome of motional system, postthrombotic syndrome, lymphatic edema and trophic lesions of skin.

[The correction of motor-tonic disorders of the gastrointestinal tract and of duodenogastric reflux with laser radiation]. / Korrektsiia motorno-tonicheskikh narushenii zheludochno-kishechnogo trakta i duodenogastral'nogo refliuksa lazernym izlucheniem.

Forty-five patients with duodenogastric reflux and defective gastroduodenal motor tonicity (gastroduodenal hypotonia, duodenal hypertension, gastric hypotonia in combination with duodenal hypertension) were exposed to He--Ne laser radiation. The impact was focused on the biologically active points G14, TR5, VC15, E21. The treatment resulted in normalization of the gastrointestinal pressure gradient, in discontinuance or reduction of duodenogastric reflux.

Whole-abdominal irradiation for the management of gastrointestinal and abdominal manifestations of agnogenic myeloid metaplasia.

A patient with a long-standing history of agnogenic myeloid metaplasia developed weight loss and ascites secondary to gastric/small bowel infiltration and peritoneal implants of myeloid tissue. Moderate doses of radiation were very effective in controlling her gastrointestinal symptoms. In contrast to previous reports, clinical improvement after irradiation was a slow, gradual process, requiring 5 months for complete resolution of the patient's ascites. Hematologic suppression may be profound and careful attention to the rate of change in leukocyte and platelet counts is necessary to avoid severe toxicity.

Endoscopic application of lasers in gastrointestinal disease.

Laser therapy in gastrointestinal disease offers ever-increasing possibilities for therapeutic endoscopy with the prospect of reducing hospitalization, morbidity and mortality in many conditions traditionally treated by conventional surgery, as well as the opportunity to provide worthwhile palliation for previously inoperable disorders.

[Gastrointestinal laser treatment]. / Gastrointestinal laserbehandling.

During the seven-year period from 1983 to 1990, 210 patients with gastrointestinal disorders were treated by laser at Aker Hospital. The main reason for the laser treatment was gastrointestinal bleeding, malignant tumour obstruction in oesophagus and rectum, and colorectal adenoma. This treatment has also been used in some patients with benign strictures and in 30 patients with perianal condylomata. In this paper we present the results of the treatment, and our experiences. We conclude that the use of laser has become an established alternative treatment for a number of gastrointestinal conditions.