Radiotherapy for tumors of the mediastinum - state of the art.

Mediastinal tumors encompass a diverse range of malignancies, originating within or spreading to the mediastinum. The administration of radiotherapy within the anatomical confines of the mediastinum presents unique challenges owing to the close proximity of critical organs, including the heart, lungs, esophagus, and spinal cord. However, recent progress in imaging techniques, treatment modalities, and our understanding of tumor biology has significantly contributed to the development of effective and safe therapeutic strategies for mediastinal diseases. This review article aims to explore the latest innovations in radiotherapy and their practical applications in the management of mediastinal tumors, with a primary focus on lymphomas, thymomas, and thymic carcinomas. By examining these advancements, we seek to provide valuable insights into the current state of the art in radiotherapy for mediastinal malignancies, ultimately fostering improved patient outcomes and clinical decision-making.

Physical activity, early first delivery and residence as parameters for breast cancer prevention: an observational study.

PURPOSE: To determine the impact of physical activity, obesity, history of maternity, residence and socioeconomic status on the prevention of breast cancer (BC). METHODS: We established a questionnaire in order to record several potential parameters associated with BC in women aged between 30 and 60 years. The parameters evaluated in the present study were physical activity (years and days per week), obesity, age of menarche, age of first delivery, breast feeding, family history of BC, vegetarian diet, residence and socioeconomic status. RESULTS: A total of 120 women who worked in administrative jobs in large hospitals in Athens entered the study. Eleven of them had a history of BC. The multivariate logistic regression analysis revealed as independent risk variables for BC the following: family history of BC (p<0.001), absence of physical activity (p<0.001), first delivery after 35 years (p=0.011) and residence in city center (p=0.036). CONCLUSION: According to our results, because women who have family history of BC, sedentary and delivery after 35 years have higher risk to develop BC, risk reduction methods for these groups may need to be identified and implemented. Further studies are needed for the confirmation of our results.

Review of the three-field techniques in breast cancer radiotherapy.

Breast cancer is often treated with radiotherapy (RT), with two opposing tangential fields. When indicated, supraclavicular lymph nodes have to be irradiated, and a third anterior field is applied. The junction region has the potential to be over or underdosed. To overcome this problem, many techniques have been proposed. A literature review of 3 Dimensional Conformal RT (3D CRT) and older 3-field techniques was carried out. Intensity Modulated RT (IMRT) techniques are also briefly discussed. Techniques are categorized, few characteristic examples are presented and a comparison is attempted. Three-field techniques can be divided in monoisocentric and two-isocentric. Two-isocentric techniques can be further divided in full field and half field techniques. Monoisocentric techniques show certain great advantages over two-isocentric techniques. However, they are not always applicable and they require extra caution as they are characterized by high dose gradient in the junction region. IMRT has been proved to give better dosimetric results. Three-field matching is a complicated procedure, with potential of over or undredosage in the junction region. Many techniques have been proposed, each with advantages and disadvantages. Among them, monoisocentric techniques, when carefully applied, are the ideal choice, provided IMRT facility is not available. Otherwise, a two-isocentric half beam technique is recommended.

Splenic irradiation as palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis: a multi-institutional experience.

PURPOSE: To evaluate the impact of splenic irradiation as a palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis. METHODS: Seventeen patients with chronic myelogenous leukemia and 3 with idiopathic polycythaemia presented with splenomegaly, splenic pain and anemia. Due to symptomatic splenomegaly, despite first-line treatment, the patients underwent splenic irradiation. Two patients received two different schedules of external radiotherapy (580 cGy in 5 fractions and 600 cGy in 6 fractions). Eight patients received 980 cGy in 14 fractions. Ten patients received two courses of 360 cGy in 6 fractions, 3 months apart. Median follow-up was 12 months post irradiation. RESULTS: The patients showed excellent response to treatment one month post-radiotherapy, while treatment was well tolerated without severe toxicity. The dimensions of the spleen decreased significantly. Pain-related Visual Analogue Score (VAS) regressed after completion of irradiation. During 12-month follow-up all patients maintained the benefit of radiotherapy. CONCLUSION: This study indicates that splenic irradiation could be a safe and effective palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis.

A hypofractionated radiotherapy schedule with 57.75Gy in 21 fractions for T1-2N0 prostate carcinoma: Analysis of late toxicity and efficacy.

PURPOSE: The primary endpoint was to assess the late toxicity of a hypofractionated radiotherapy schedule in relation to radiation parameters concerning the rectum and bladder. The second endpoint was to assess a composite of biochemical and clinical failure. METHODS: Sixty-four prospectively selected patients diagnosed with localized low risk prostate cancer, Gleason score (GS) <7, PSA <10, and T1-2N0, were treated with external 3- dimensional conformal radiotherapy (3D-CRT). Patients received 57.75 Gy in 21 daily fractions of 2.75 Gy/fraction. RESULTS: Late gastrointestinal (GI) toxicity was as follows: grade 0: 47 (73.4 %) patients, grade 1: 12 (19.2 %), grade 2: 4 (6.3%), and grade 3: 1 (1.6%). There was a significant correlation between D50, V70 and EORTC/RTOG late rectal toxicity score (p<0.001 and p=0.006, respectively). Grade 1 and 2 late bladder toxicity was seen in 4.7 and 1.6% of the patients, respectively. With a median follow up of 18 months no biochemical relapse was observed. CONCLUSION: The present study supports the use of hypofractionated radiation therapy which showed a high therapeutic ratio with acceptable toxicity and no biochemical relapse during follow-up.

Radiotherapy combined with daily escitalopram in patients with painful bone metastasis: clinical evaluation and quality of life measurements.

PURPOSE: To prospectively assess the efficacy of the selective serotonin inhibitor escitalopram on painful bone metastases, in combination with external beam irradiation. METHODS: Forty-three patients with cancer metastatic to bone and suffering from depression were treated with 3 Dimensional Conformal Radiotherapy (3DCRT) (30 Gy; 3 Gy/fraction, 5 days/week) combined with escitalopram (20 mg/day). Pain relief was evaluated with Wong/Baker Faces Pain Scale. The patients reported outcome using a RTOG-EORTC quality-of-life self-questionnaire (QLQ-C30 v3.0) and the status of depression according to Hamilton Scale (HAM-17). The assessment was performed at baseline and 6-8 weeks after radiotherapy. RESULTS: Patients treated with radiotherapy and escitalopram tended to show a good response to pain and improvement of their quality of life. CONCLUSIONS: Though our data concerned a rather small number of patients, addition of escitalopram to 3DCRT accomplished a high clinical benefit rate on neuropathic pain from bone metastasis.

Grade III Dermatitis in a Patient Treated With Paclitaxel and Radiotherapy: Case Report and Review of the Literature.

Taxanes, both paclitaxel and doxetaxel are the medication of the future in the management of solid tumors. In high risk breast cancer patients, the combination of concurrent paclitaxel and docetaxel chemotherapy with adjuvant radiotherapy is an attractive option to sequential treatment, with potential for enforcing both local and systemic control. This case report examines the tolerance of such treatment. A 54-year-old Greek woman without a relevant medical history, presented with clinical diagnosed breast cancer staged T4NxM0. Neo-adjuvant chemotherapy was initially administered, and paclitaxel was administered concurrently with radiotherapy in order to achieve local control. During the third cycle of paclitaxel the patient developed grade III dermatitis. The tumor showed a reduction in size by 70%, however, chronic cutaneous and subcutaneous changes have not been accessed. In conclusion, adjuvant breast cancer therapy with concurrent standard dose radiotherapy and paclitaxel (175 mg/m2) every three weeks, should be approached cautiously owing to paclitaxel induced dermatitis.