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1.
Breast Cancer Res Treat ; 114(2): 307-13, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18389365

RESUMO

PURPOSE: Reirradiation of breast cancer locoregional recurrence (LRR) in the setting of prior post-mastectomy radiation poses a significant clinical challenge due to the high risk for severe toxicity. In an attempt to reduce these toxicities, we have developed pulsed reduced dose-rate radiotherapy (PRDR), a reirradiation technique in which a series of 0.2 Gy pulses separated by 3-min time intervals is delivered, creating an apparent dose rate of 0.0667 Gy/min. Here we describe our early experience with PRDR. PATIENTS AND METHODS: We reirradiated 17 patients with LRR breast cancer to the chest wall, axilla, or supraclavicular region using PRDR. The median prior radiation dose was 60 Gy. We delivered a median PRDR dose of 54 Gy (range 40-66 Gy) in 1.8-2.0 Gy per fraction. Eight patients received concomitant low dose capecitabine for radiosensitization. The median treatment volume was 2,084 cm(3) (range 843-7,881 cm(3)). RESULTS: At a median follow-up of 18 months (range 4-75 months) only 2 patients have had tumor failure in the treatment region. Estimated 2-year local control rate is 92%. Treatment was well tolerated with 4 patients experiencing grade 3 acute skin toxicity. Despite a median cumulative dose of 110 Gy (range 80-236 Gy), there has been only one grade 3 and one grade 4 late toxicity. CONCLUSIONS: With a median follow-up of 18 months, PRDR appears to be an effective method to reirradiate large volumes of previously irradiated tissue in selected patients with locoregional chest wall, axilla, and supraclavicular recurrences.


Assuntos
Braquiterapia , Neoplasias da Mama/radioterapia , Clavícula/efeitos da radiação , Linfonodos/efeitos da radiação , Recidiva Local de Neoplasia/radioterapia , Lesões por Radiação , Parede Torácica/efeitos da radiação , Adulto , Idoso , Axila , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Dosagem Radioterapêutica , Retratamento , Taxa de Sobrevida , Neoplasias Torácicas/patologia , Neoplasias Torácicas/radioterapia , Neoplasias Torácicas/cirurgia
2.
Int J Radiat Oncol Biol Phys ; 56(3): 697-703, 2003 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-12788175

RESUMO

BACKGROUND: Adjuvant postmastectomy radiotherapy (RT) decreases the risk of local recurrence of breast cancer and may increase overall survival (OS). METHODS AND MATERIALS: After mastectomy, 656 premenopausal Vietnamese and Chinese women with clinical Stage II-IIIA breast cancer, in a clinical trial of adjuvant surgical oophorectomy and tamoxifen, were treated with adjuvant RT according to the availability in the institution. The short-term disease recurrence and OS experience of these 656 women were analyzed using univariate and multivariate methods. RESULTS: The 193 patients who did not receive RT differed from the 463 who did in that they had larger tumors and more frequently Grade 3 tumors. With a median follow-up of 3.6 years, in univariate analysis, RT was associated with improved disease-free survival (DFS) (relative risk 0.66; 95% confidence interval 0.49-0.89; p = 0.007) and OS (relative risk 0.71; 95% confidence interval 0.50-1.00; p = 0.051). In multivariate analysis, the relative risk for DFS and OS associated with RT was 0.78 and 0.94, respectively (p = not significant for both). Kaplan-Meier estimates showed better 5-year DFS (72% vs. 59%; p = 0.006) and OS (78% vs. 70%; p = 0.05) rates with RT. CONCLUSION: In the absence of detailed CT planning capacity, adjuvant RT for premenopausal Vietnamese women was associated statistically with short-term improvement in DFS and OS in univariate, but not multivariate, analysis.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Adulto , Análise de Variância , Antineoplásicos Hormonais/uso terapêutico , Quimioterapia Adjuvante , China , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Mastectomia Radical Modificada , Ovariectomia , Pré-Menopausa , Radioterapia Adjuvante , Estudos Retrospectivos , Tamoxifeno/uso terapêutico , Vietnã
3.
Int J Radiat Oncol Biol Phys ; 79(3): 835-41, 2011 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-20472350

RESUMO

PURPOSE: Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. PATIENTS AND METHODS: A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5±189.4 cm3 according to T2-weighted magnetic resonance imaging and a 2-cm margin. RESULTS: For the initial or upgraded Grade 4 cohort (n=86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n=43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n=43; p=0.004 and HR=1.82 with a 95% CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16% of the patients were treated at first relapse (with 46% treated at the second relapse, 32% at the third or fourth relapse, and 4% at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. CONCLUSION: PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.


Assuntos
Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Adolescente , Adulto , Fatores Etários , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Criança , Fracionamento da Dose de Radiação , Feminino , Glioma/mortalidade , Glioma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Radioterapia/métodos , Retratamento , Análise de Sobrevida , Fatores de Tempo , Carga Tumoral , Adulto Jovem
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