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1.
Medicine (Baltimore) ; 100(15): e25461, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847653

RESUMEN

RATIONALE: Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) provides a safe and effective therapy for medically refractory essential tremor (ET). However, DBS may be risky in elderly patients and those with ischemic brain lesions. Gamma Knife radiosurgery (GKS) is a minimally invasive procedure, but bilateral thalamotomy is dangerous. PATIENT CONCERNS: We report a case of ventralis oralis anterior nucleus (Voa) DBS for dominant hand tremor plus Voa GKS for nondominant hand tremor in a very elderly patient with medically intractable ET. DIAGNOSIS: An 83-year-old right-handed woman visited our hospital with a medically intractable ET. Because of the ischemic lesion in the right basal ganglia, we decided to perform left unilateral DBS instead of bilateral DBS. INTERVENTION: We chose Voa as the target for DBS because, clinically, her tremor was mainly confined to her hands, and Voa had better intraoperative microelectrode recording results than Vim. OUTCOMES: After 2 years, her right-hand tremor remained in an improved state, but she still had severe tremor in her left hand. Therefore, we performed GKS targeting the right Voa. One year after surgery, the patient's hand tremor successfully improved without any complications. LESSONS: Salvage Voa GKS after unilateral Voa DBS is a valuable option for very elderly patients and patients with ischemic brain lesions. We suggest that Voa GKS thalamotomy is as useful and safe a surgical technique as Vim GKS for dystonic hand tremor. To the best of our knowledge, this is the first case report using salvage Voa as the only target for ET.


Asunto(s)
Estimulación Encefálica Profunda/métodos , Temblor Esencial/cirugía , Psicocirugía/métodos , Radiocirugia/métodos , Tálamo/cirugía , Anciano de 80 o más Años , Temblor Esencial/fisiopatología , Femenino , Lateralidad Funcional , Mano/fisiopatología , Humanos , Ilustración Médica , Resultado del Tratamiento , Núcleos Talámicos Ventrales
3.
Anticancer Res ; 41(3): 1445-1449, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33788736

RESUMEN

BACKGROUND: Limited brain metastasis is treated definitively with stereotactic radiosurgery when surgical resection is not indicated. Although this has historically been performed in a single fraction, multi-fraction approaches such as fraction radiosurgery (FSRS) and staged radiosurgery (SSRS) have been recently examined as alternative approaches for larger lesions to permit better tumor control without increased toxicity. CASE REPORT: We present the case of a patient who developed symptomatic radionecrosis in two brain metastasis, 2.3 cm and 2.1 cm in size, which were treated with 18 Gy in one fraction, but no radionecrosis in a 3.3 cm lesion treated in two fractions of 15 Gy nor in two punctate lesions that were treated in one fraction of 20 Gy. Although she did not respond to steroids, she responded to bevacizumab symptomatically and on neuroimaging. CONCLUSION: Congruent with other recent studies, our report suggests that large brain metastasis should be considered for FSRS/SSRS.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Encéfalo/efectos de la radiación , Fraccionamiento de la Dosis de Radiación , Radiocirugia/métodos , Adulto , Antineoplásicos Inmunológicos/uso terapéutico , Bevacizumab/uso terapéutico , Encéfalo/efectos de los fármacos , Encéfalo/patología , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Femenino , Humanos , Necrosis/radioterapia , Resultado del Tratamiento
4.
Cancer Radiother ; 25(2): 119-125, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33676829

RESUMEN

PURPOSE: To evaluate the safety and efficacy of Cyberknife® (CK) for the treatment of primary or recurring thymic tumours. MATERIALS AND METHODS: We retrospectively reviewed 12 patients (16 tumour lesions) with primary or recurring thymic tumours who were treated with CK between March 2008 and October 2017. Their data was stored in prospectively collected database. Kaplan-Meier method was used to calculate survival curves. RESULTS: Five patients (41.7%), who had inoperable disease or refused surgery, were treated with CK initially, and 7 patients (58.3%) were treated with CK when they had recurrence diseases. The disease sites treated with CK were primary tumour site (5), regional lymph nodes (4), tumour bed (3), chest wall (2), pleura (1), and bone (1). The median target volume was 43.8 cm3 (range, 13.1-302.5cm3) for the 16 tumour lesions. The median follow-up time was 69.3 months (range, 9.7-124.8 months). The median survival time was 48.2 months, and the 5-year and 10-year OS rates were 68.2% and 45.5%, respectively. A high response rate for the tumour lesions irradiated with CK was obtained. Only one patient (8%) experienced in-field recurrence, and the 5-year local recurrence free survival was 90.9%. A case indicated that CK may induce the abscopal effect, which provides the potential to combine CK and immunotherapy. No severe radiation related toxicities were observed, and no treatment related death occurred. CONCLUSION: CK treatment resulted in good outcomes, particularly local control, with minimal side effects, in highly selected patients with primary and recurring thymic tumours. More studies with larger sample are needed.


Asunto(s)
Recurrencia Local de Neoplasia/radioterapia , Radiocirugia/métodos , Radioterapia Guiada por Imagen/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Timoma/radioterapia , Neoplasias del Timo/radioterapia , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundario , Irradiación Linfática , Masculino , Neoplasias del Mediastino/radioterapia , Neoplasias del Mediastino/secundario , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Radiocirugia/efectos adversos , Radioterapia Guiada por Imagen/efectos adversos , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Seguridad , Tasa de Supervivencia , Timoma/mortalidad , Timoma/patología , Timoma/secundario , Neoplasias del Timo/mortalidad , Neoplasias del Timo/patología , Factores de Tiempo
5.
Br J Radiol ; 94(1119): 20200433, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33586999

RESUMEN

OBJECTIVE: We aim to test the hypothesis that neurovascular bundle (NVB) displacement by rectal hydrogel spacer combined with NVB delineation as an organ at risk (OAR) is a feasible method for NVB-sparing stereotactic body radiotherapy. METHODS: Thirty-five men with low- and intermediate-risk prostate cancer who underwent rectal hydrogel spacer placement and pre-, post-spacer prostate MRI studies were treated with prostate SBRT (36.25 Gy in five fractions). A prostate radiologist contoured the NVB on both the pre- and post-spacer T2W MRI sequences that were then registered to the CT simulation scan for NVB-sparing radiation treatment planning. Three SBRT treatment plans were developed for each patient: (1) no NVB sparing, (2) NVB-sparing using pre-spacer MRI, and (3) NVB-sparing using post-spacer MRI. NVB dose constraints include maximum dose 36.25 Gy (100%), V34.4 Gy (95% of dose) <60%, V32Gy <70%, V28Gy <90%. RESULTS: Rectal hydrogel spacer placement shifted NVB contours an average of 3.1 ± 3.4 mm away from the prostate, resulting in a 10% decrease in NVB V34.4 Gy in non-NVB-sparing plans (p < 0.01). NVB-sparing treatment planning reduced the NVB V34.4 by 16% without the spacer (p < 0.01) and 25% with spacer (p < 0.001). NVB-sparing did not compromise PTV coverage and OAR endpoints. CONCLUSIONS: NVB-sparing SBRT with rectal hydrogel spacer significantly reduces the volume of NVB treated with high-dose radiation. Rectal spacer contributes to this effect through a dosimetrically meaningful displacement of the NVB that may significantly reduce RiED. These results suggest that NVB-sparing SBRT warrants further clinical evaluation. ADVANCES IN KNOWLEDGE: This is a feasibility study showing that the periprostatic NVBs can be spared high doses of radiation during prostate SBRT using a hydrogel spacer and nerve-sparing treatment planning.


Asunto(s)
Disfunción Eréctil/prevención & control , Hidrogeles/uso terapéutico , Neoplasias de la Próstata/radioterapia , Radiocirugia/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Anciano , Estudios de Factibilidad , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Órganos en Riesgo/diagnóstico por imagen , Próstata/diagnóstico por imagen , Neoplasias de la Próstata/diagnóstico por imagen , Dosificación Radioterapéutica , Recto/diagnóstico por imagen , Estudios Retrospectivos
6.
N Z Med J ; 134(1529): 45-56, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582707

RESUMEN

AIM: Stereotactic ablative radiotherapy (SABR) involves the delivery of high doses of precisely targeted radiation in a shorter time period than conventional radiotherapy. The aim of this study was to compare the outcomes of lung-based SABR in a New Zealand cohort to the global literature. METHODS: A single-institution retrospective analysis was performed on all patients who received lung-based SABR between May 2015 and September 2019 at Waikato Hospital, New Zealand. The study included both early stage lung cancer and lung oligometastases that measured less than 5cm. RESULTS: 102 patients received SABR to 116 lesions. Median follow-up was 19 months. The three-year rate of local control in the primary and metastatic cohorts was 85% and 82%, respectively. This reflects the three-year local control rate of 86% for primary lung cancer in the SPACE trial and the two-year local control rate of 81% for pulmonary oligometastases in a German study. Central primary lung cancer was associated with a higher risk of local recurrence (HR6.4 (1.3-31.5) p=0.02). The three-year progression-free survival rate in patients with early stage lung cancer and oligometastases was 56% and 26%, respectively. Maori patients with primary lung cancer had a significantly worse progression free survival (HR2.4 (1.1-5.1) p=0.03). There were no reported grade three toxicities. CONCLUSION: The use of lung-based SABR in a typical radiotherapy setting in New Zealand mirrors global outcomes.


Asunto(s)
Neoplasias Pulmonares/radioterapia , Radiocirugia/métodos , Anciano , Femenino , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Nueva Zelanda , Grupo de Ascendencia Oceánica , Radiocirugia/efectos adversos , Estudios Retrospectivos , Análisis de Supervivencia
7.
Cancer Radiother ; 25(2): 141-146, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33422416

RESUMEN

PURPOSE: The ultimate goal of stereotactic radiotherapy (SRT) of brain metastases (BM) is to avoid or postpone whole brain radiotherapy (WBRT). A nomogram based on multi-institutional data was developed by Gorovets, et al. to estimate the 6 and 12-months WBRT-free survival (WFS). The aim of the current retrospective study was to validate the nomogram in a cohort of postoperative BM patients treated with adjuvant SRT. MATERIAL AND METHODS: We reviewed the data of 68 patients treated between 2008-2017 with postoperative SRT for BM. The primary endpoint was the WFS. The receiver operating characteristic curve and area under the curve (AUC) were calculated for both 6- and 12-months time points. RESULTS: After a median follow-up of 64 months, the 1-year cumulative incidence of local and distant brain relapse rates were 15% [95% CI=8-26%] and 34% [95% CI=24-48%], respectively. At recurrence, repeated SRT or salvage WBRT were applied in 33% and 57% cases, respectively. The WFS rates at 6 and 12 months were 88% [95% CI=81-97%] and 67% [95% CI=56-81%], respectively. Using the Gorovets nomogram, the 6 months rates were overestimated while they were accurate at 12 months. AUC values were 0.47 and 0.62 for the 6- and 12-months respectively. Overall, Harrell's concordance index was 0.54. CONCLUSION: This nomogram-predicted well the 12 months WFS but its discriminative power was quite low. This underlines the limits of this kind of predictive tool and leads us to consider the use of big data analysis in the future.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundario , Irradiación Craneana , Nomogramas , Radiocirugia/métodos , Terapia Recuperativa/métodos , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Neoplasias Encefálicas/epidemiología , Neoplasias Encefálicas/cirugía , Intervalos de Confianza , Irradiación Craneana/estadística & datos numéricos , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Periodo Posoperatorio , Curva ROC , Radiocirugia/estadística & datos numéricos , Estudios Retrospectivos , Terapia Recuperativa/estadística & datos numéricos , Factores de Tiempo
8.
Cancer Radiother ; 25(2): 135-140, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33422419

RESUMEN

PURPOSE: To investigate the Gross Tumor Volumes (GTV) and its dosimetric impact of magnetic resonance imaging (MRI) assisted contouring for non-spinal metastasis treated with stereotactic ablative body radiotherapy (SABR). MATERIAL AND METHODS: Five observer contours on CT (GTVCT) and CT+MR (GTVCT+MR) were evaluated against expert team contours (GTVEC) for 14 selected cases. Dice Similarity Index (DSC) and Geographical Miss Index (GMI) quantify observer variation. We also analyze the maximum dose (Dmax) and dose received by 0.35cc (D0.35cc) of the spinal cord (SC) for GTVCT and GTVCT+MR, where optimization parameters and priorities were unchanged. Percent rank function is also evaluated for SC doses. RESULTS: The mean DSC and GMI scores for the CT-only dataset are 0.6974 and 0.2851 and for CT+MR dataset is 0.7764 and 0.1907 respectively. Statistically, significant results were found for mean GTV volumes between GTVEC versus GTVCT and GTVCT versus GTVCT+MR (P<0.001). Dosimetric analysis of Dmax and D0.35cc exceeded 84.2% and 88.5% of times its respective threshold doses for CT-only dataset, whereas for the CT+MR dataset, it exceeded only by 18% and 15.7% times. 'Percent rank' function analysis for SC doses also indicates the same. CONCLUSION: This study supports MRI fusion for GTV and OAR delineation for non-spinal metastasis. Our study showed that the dosimetric analysis is vital for observer variation studies and the addition of the MR data set is significant to improve the confidence of Stereotactic treatments.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/radioterapia , Imagen por Resonancia Magnética/métodos , Órganos en Riesgo/diagnóstico por imagen , Radiocirugia/métodos , Carga Tumoral , Algoritmos , Neoplasias Óseas/patología , Conjuntos de Datos como Asunto , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Radioterapia Guiada por Imagen/métodos , Estudios Retrospectivos , Columna Vertebral , Tomografía Computarizada por Rayos X/métodos
9.
Am J Clin Oncol ; 44(3): 126-130, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33405479

RESUMEN

BACKGROUND: Stereotactic body radiation therapy (SBRT) is increasingly used for patients with recurrent and or metastatic tumors. Sarcomas are generally considered not sensitive to radiotherapy and SBRT may allow for increased biological effectiveness. We report intermediate outcomes and toxicity for pediatric, adolescent, and young adult patients treated with SBRT to sites of recurrent and or metastatic sarcoma. PROCEDURE: We queried an Institutional Review Board-approved registry of patients treated with SBRT for metastases from pediatric sarcomas. Patients age 29 and below were assessed for local control, survival, and toxicity. RESULTS: Thirty-one patients with a total of 88 lesions met eligibility criteria. Median patient age was 17.9 years at treatment. Sixteen patients were treated with SBRT to >1 site of disease. The median dose was 30 Gy in 5 fractions. The median follow-up time was 7.4 months (range: 0.2 to 31.4 mo). Patients were heavily pretreated with systemic therapy. In 57 lesions with >3 months of radiographic follow-up, the 6-month and 12-month local control rates were 88.3%±4.5% and 83.4%±5.5%, respectively. Radiographic local failures were rare (6/57 in-field, 4/57 marginal). Only 1/88 treated lesions was associated with a radiation-related high-grade toxicity; late grade 3 intestinal obstruction in a re-irradiated field while on concurrent therapy (gemcitabine and docetaxel). No acute grade ≥3 toxicity was observed. CONCLUSIONS: SBRT was well tolerated in the majority of patients with favorable local control outcomes. Additional studies will be required to determine the optimal SBRT dose and fractionation, treatment volume, and appropriate concurrent therapies.


Asunto(s)
Radiocirugia/métodos , Sarcoma/radioterapia , Adolescente , Adulto , Niño , Preescolar , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Masculino , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/radioterapia , Traumatismos por Radiación/etiología , Radiocirugia/efectos adversos , Reirradiación , Sarcoma/mortalidad , Sarcoma/patología , Neoplasias de los Tejidos Blandos/mortalidad , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/radioterapia , Resultado del Tratamiento , Adulto Joven
10.
J Cancer Res Clin Oncol ; 147(5): 1307-1313, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33471186

RESUMEN

INTRODUCTION: Recently major efforts have been made to define the oligometastatic setting, but for head and neck cancer (HNC) limited data are available. We aimed to evaluate outcome of oligometastatic HNC treated with Stereotactic body radiotherapy (SBRT) as metastasis-directed therapy. MATERIALS AND METHODS: We analyzed patients treated with SBRT on a maximum of five oligometastases from HNC, in up to two organs. Concomitant treatment was allowed. End points were toxicity, local control of treated metastases (LC), progression-free survival (PFS) and overall survival (OS). RESULTS: 48 consecutive patients and 71 lesions were treated. With a follow-up of 20.2 months, most common primary tumors were larynx (29.2%) and salivary glands (29.2%), while common site of metastases was lung (59.1%). Median dose was 48 Gy (21-75) in 3-8 fractions. Treatment was well tolerated, with two patients reporting mild pain and nausea. LC rates at 1 and 2 years were 83.1% and 70.2%. Previous local therapy (HR 4.97; p = 0.002), oligoprogression (HR 4.07; p = 0.031) and untreated metastases (HR 4.19; p = 0.027) were associated with worse LC. PFS at 1 and 2 years were 42.2% and 20.0%. Increasing age (HR 1.03; p = 0.010), non-adenoid cystic carcinoma (HR 2.57; p = 0.034) and non-lung metastases (HR 2.20; p = 0.025) were associated with worse PFS. One- and 2-years OS were 81.0% and 67.1%. Worse performance status (HR 2.91; p = 0.049), non-salivary primary (HR 19.9; p = 0.005), non-lung metastases (HR 2.96; p = 0.040) were correlated with inferior OS. CONCLUSIONS: SBRT can be considered a safe metastasis-directed therapy in oligometastatic HNC. Efficacy of the treatment seems to be higher when administered upfront in the management of metastatic disease; however, selection of patients need to be improved due to the relevant risk of appearance of new metastatic site after SBRT.


Asunto(s)
Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Metástasis de la Neoplasia/patología , Metástasis de la Neoplasia/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pulmón/patología , Pulmón/efectos de la radiación , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Radiocirugia/métodos , Resultado del Tratamiento
11.
Br J Radiol ; 94(1119): 20201354, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33481637

RESUMEN

OBJECTIVES: This multicentric study was carried out to investigate the impact of small field output factors (OFs) inaccuracies on the calculated dose in volumetric arctherapy (VMAT) radiosurgery brain plans. METHODS: Nine centres, realised the same five VMAT plans with common planning rules and their specific clinical equipment Linac/treatment planning system commissioned with their OFs measured values (OFbaseline). In order to simulate OFs errors, two new OFs sets were generated for each centre by changing only the OFs values of the smallest field sizes (from 3.2 × 3.2 cm2 to 1 × 1 cm2) with well-defined amounts (positive and negative). Consequently, two virtual machines for each centre were recommissioned using the new OFs and the percentage dose differences ΔD (%) between the baseline plans and the same plans recalculated using the incremented (OFup) and decremented (OFdown) values were evaluated. The ΔD (%) were analysed in terms of planning target volume (PTV) coverage and organs at risk (OARs) sparing at selected dose/volume points. RESULTS: The plans recalculated with OFdown sets resulted in higher variation of doses than baseline within 1.6 and 3.4% to PTVs and OARs respectively; while the plans with OFup sets resulted in lower variation within 1.3% to both PTVs and OARs. Our analysis highlights that OFs variations affect calculated dose depending on the algorithm and on the delivery mode (field jaw/MLC-defined). The Monte Carlo (MC) algorithm resulted significantly more sensitive to OFs variations than all of the other algorithms. CONCLUSION: The aim of our study was to evaluate how small fields OFs inaccuracies can affect the dose calculation in VMAT brain radiosurgery treatments plans. It was observed that simulated OFs errors, return dosimetric calculation accuracies within the 3% between concurrent plans analysed in terms of percentage dose differences at selected dose/volume points of the PTV coverage and OARs sparing. ADVANCES IN KNOWLEDGE: First multicentre study involving different Planning/Linacs about undetectable errors in commissioning output factor for small fields.


Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/radioterapia , Radiocirugia/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia de Intensidad Modulada/métodos , Tomografía Computarizada por Rayos X/métodos , Encéfalo/diagnóstico por imagen , Simulación por Computador , Humanos , Dosificación Radioterapéutica , Reproducibilidad de los Resultados , Incertidumbre
12.
Anticancer Res ; 41(1): 279-288, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419822

RESUMEN

BACKGROUND/AIM: The problem of lack of standardisation in target delineation and herewith the variability of target contours in Gamma Knife radiosurgery is as severe as in linac-based radiotherapy in general. The first aim of this study was to quantify the contouring variability for a group of five radiosurgery targets and estimate their true-volume based on multiple delineations using the Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm. The second aim was to assess the robustness of the STAPLE method for the assessment of the true-volume, with respect to the number of contours available as input. PATIENTS AND METHODS: A multicentre analysis of the variability in contouring of five cases was performed. Twelve contours were provided for each case by experienced planners for Gamma Knife. To assess the robustness of the STAPLE method with respect to the number of contours used as input, sets of contours were randomly selected in the analysis. RESULTS: A high similarity was observed between the STAPLE generated true-volume and the 50%-agreement volume when all 12 available contours were used as input (90-100%). Lower similarity was observed with smaller sets of contours (10-70%). CONCLUSION: If a high number of input contours is available, the STAPLE method provides a valuable tool in the estimation of the true volume of a target based on multiple contours as well as the sensitivity and specificity for each input contour relative to the true volume of that structure. The robustness of the STAPLE method for rendering the true target volume depends on the number of contours provided as input and their variability with respect to shape, size and position.


Asunto(s)
Radiocirugia/métodos , Radiocirugia/normas , Algoritmos , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/radioterapia , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Imagen por Resonancia Magnética , Planificación de la Radioterapia Asistida por Computador , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
13.
Anticancer Res ; 41(1): 341-345, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419829

RESUMEN

BACKGROUND/AIM: The aim of this study was to identify patients at high risk of death from neurological cause because these patients may be appropriate candidates for intense brain-directed treatment, in contrast to patients with uncontrollable extracranial disease, inevitably leading to death. In this context, the LabBM score (endpoint: overall survival; five blood test results; often abnormal in patients with widespread disease) may be a relevant tool. PATIENTS AND METHODS: This was a retrospective single-institution analysis of 101 patients, managed with upfront brain irradiation. Associations between neurological death and different baseline and treatment parameters were assessed. RESULTS: A LabBM score of 0 (five normal blood test results) was present in 32% of patients. Neurological death was recorded in 27%. Seven parameters were associated with neurological death, including the LabBM score (univariate analyses). Three out of the seven were significantly associated with neurological death in the multi-nominal logistic regression analysis. The most important parameter was primary tumor type (colorectal or melanoma), with a hazard ratio of 14.3. Patients without liver metastases were also more likely to die from neurological causes. Finally, patients who did not receive additional systemic therapy were more likely to die from central nervous system progression. The median survival time was 3.9 months (entire cohort). When censoring patients who died from extracranial progression, the median time to neurological death was 17.4 months. CONCLUSION: The LabBM score was not suitable for prediction of neurological death, in contrast to three other parameters. Interestingly, additional systemic therapy reduced the risk of neurological death, possibly because several new agents have known antitumor activity in the brain.


Asunto(s)
Muerte Encefálica , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/radioterapia , Causas de Muerte , Terapia Combinada , Irradiación Craneana/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Radiocirugia/métodos , Radioterapia/métodos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
14.
J Cancer Res Clin Oncol ; 147(3): 793-802, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33484347

RESUMEN

PURPOSE: To perform a systematic review of the current level of evidence on post-operative management following brain metastasectomy (namely: adjuvant stereotactic radiosurgery, whole brain radiotherapy or observation), and to propose a GRADE-based dedicated recommendation to inform Radiation Oncologists' clinical practice. METHODS: A panel of expert Radiation Oncologists from the Italian Association of Radiotherapy and Clinical Oncology had defined the search question per the PICO methodology. Electronic databases were independently screened; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was adopted. The individual and pooled hazard ratios with 95% confidence intervals (CI), as well as the pooled risk ratio (RR) were calculated using a fixed- or random-effects model. RESULTS: Eight full-texts were retrieved: six retrospective studies and two randomized clinical trials. Outcomes of benefit and damage were analyzed for SRS + observation (PICO A) and SRS + WBRT. SRS allowed for increased rates of local control when compared to both observation and WBRT, while evidence was less conclusive for distant brain control, leptomeningeal disease control and overall survival. In the SRS, the incidence of severe radionecrosis was higher as compared to WBRT, despite neurocognitive deterioration rates were lower. Overall, SRS seems to favorably compare with observation and whole brain RT, despite the level of evidence for the recommendation was low and very low, respectively. CONCLUSION: Despite low level of evidence, the panel concluded that the risk/benefit ratio probably favors adjuvant SRS as compared to the observation and whole brain RT as adjuvant treatments following brain metastasectomy (5 votes/5 participants, 100% attendance).


Asunto(s)
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Irradiación Craneana/métodos , Humanos , Cuidados Posoperatorios/métodos , Radiocirugia/métodos , Radioterapia Ayuvante , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos
15.
Cancer Radiother ; 25(1): 92-102, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33390318

RESUMEN

PURPOSE: In literature, there are no guidelines on how to prescribe dose in the case of radiosurgery (SRS) or stereotactic irradiation of multiple and adjacent BM. Aim of this work is to furnish practical proposals of dosimetric methods for multiple neighboring BM, and to make a literature review about the SRS treatment of multiple BM, comparing radiotherapy techniques on the basis of different dosimetric parameters. MATERIALS AND METHODS: A theoretical proposal of dosimetric approaches to prescribe dose in case of multiple contiguous BM is done. A literature review between 2010 and 2020 was performed on MEDLINE and Cochrane databases according to the PRISMA methodology, with the following keywords dose prescription, radiosurgery, multiple BM. Papers not reporting dosimetric solutions to irradiate multiple BM were excluded. RESULTS: Only one article in the literature reports a practical modality of dose prescription for multiple adjacent BM. Thus, we proposed other five practical solutions to prescribe radiation dose in case of two or more neighboring BM, describing advantages and drawbacks of each method in terms of different dosimetric parameters. The literature review about dosimetric solutions to irradiate multiple BM led to 56 titles; 14 articles met the chosen criteria and we reported their results in terms of dosimetric indexes and low doses to the normal brain tissue. CONCLUSIONS: The six dosimetric approaches here described can be used by physicians for multiple contiguous BM, depending on the clinical situation. These methods may be applied in clinical studies to better evaluate their usefulness in practice.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Radiocirugia/métodos , Encéfalo/patología , Encéfalo/efectos de la radiación , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/secundario , Humanos , Necrosis , Traumatismos por Radiación/patología , Dosificación Radioterapéutica
16.
Br J Radiol ; 94(1119): 20200239, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33353402

RESUMEN

OBJECTIVE: This study aimed to assess the dosimetric effect of intestinal gas of stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) on target and critical organs for pancreatic cancer without online electron density correction (EDC). METHODS: Thirty pancreatic cancer patients who underwent online SMART were selected for this study. The treatment time of each stage and the total treatment time were recorded and analyzed. The concerned dose-volume parameters of target and organs-at-risk (OAR) were compared with and without an intestinal gas EDC using the Wilcoxon-signed rank test. Analysis items with p value < 0.05 were considered statistically significant. The relationships between dosimetric differences and intestinal gas volume variations were investigated using the Spearman test. RESULTS: The average treatment time was 82 min, and the average EDC time was 8 min, which accounted for 10% of the overall treatment time. There were no significant differences in CTV (GTV), PTV, bowel, stomach, duodenum, and skin (p > 0.05) with respect to dose volume parameters. For the Dmax of gastrointestinal organs (p = 0.03), the mean dose of the liver (p = 0.002) and kidneys (p = 0.03 and p = 0.04 for the left and right kidneys, respectively), there may be a risk of slight overestimation compared with EDC, and for the Dmax of the spinal cord (p = 0.02), there may be a risk of slight underestimation compared with EDC. A weak correlation for D95 in the PTV and D0.5 cc in the duodenum was observed. CONCLUSION: For patients with similar inter-fractional intestinal gas distribution, EDC had little dosimetric effects on the D0.5 cc of all GI organs and dose volume parameters of target in most plans. ADVANCES IN KNOWLEDGE: By omitting the EDC of intestinal gas, the online SMART treatment time can be shortened.


Asunto(s)
Imagen por Resonancia Magnética Intervencional/métodos , Órganos en Riesgo/efectos de la radiación , Neoplasias Pancreáticas/radioterapia , Radiocirugia/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Guiada por Imagen/métodos , Adulto , Anciano , Anciano de 80 o más Años , Electrones , Femenino , Humanos , Intestinos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Dosificación Radioterapéutica
17.
Clin Oncol (R Coll Radiol) ; 33(5): 283-291, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33341333

RESUMEN

AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Radiocirugia/mortalidad , Anciano , Anciano de 80 o más Años , Instituciones Oncológicas , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Tomografía Computarizada Cuatridimensional , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radiocirugia/métodos , Estudios Retrospectivos , Tasa de Supervivencia
19.
Br J Radiol ; 94(1117): 20200332, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32960652

RESUMEN

OBJECTIVES: Stereotactic radiotherapy (SBRT) is gaining popularity although its use in head and neck cancer (HNC) is not well defined. The primary objective was to review the published evidence regarding the use of stereotactic radiotherapy in HNC. METHODS: A literature search was performed by using MEDLINE and EMBASE databases for eligible studies from 2000 to 2019 and 26 relevant studies were identified. RESULTS: Literature demonstrates a heterogeneous use of this technique with regards to patient population, primary or salvage treatment, dose fractionation regimens, outcomes and follow-up protocols. Carotid blow out syndrome is a risk as with other forms of reirradiation but alternative treatment regimens may reduce this risk. CONCLUSION: At present there is a lack of evidence regarding SBRT as a primary treatment option for HNC and definitive answers regarding efficacy and tolerability cannot be provided but there is growing evidence that SBRT reirradiation regimens are safe and effective. In lieu of evidence from large Phase III trials, we define appropriate organ at risk constraints and prescription doses, with accurate plan summation approaches. Prospective randomised trials are warranted to validate improved treatment outcomes and acceptable treatment morbidity. ADVANCES IN KNOWLEDGE: This article provides a comprehensive review of evidence of use of stereotactic radiotherapy in HNC site (either as a primary treatment or as reirradiation). We also provide an evidence-based approach to the implementation and practical consideration of stereotactic radiotherapy in HNC.


Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Radiocirugia/métodos , Humanos
20.
Br J Radiol ; 94(1117): 20200848, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33095659

RESUMEN

OBJECTIVE: The main aim of the current analysis was to explore the hypothetical advantages using rectal spacer during 1.5T MR-guided and daily adapted prostate cancer stereotactic body radiotherapy (SBRT) compared to a no-rectal spacer hydrogel cohort of patients. METHODS: The SBRT-protocol consisted of a 35 Gy schedule delivered in 5 fractions. Herein, we present a dosimetric analysis between spacer and no-spacer patients. Furthermore, treatment tolerability and feasibility were preliminarily assessed according to clinicians-reported outcomes at the end of treatment and patient-reported outcomes measures (PROMs) in both arms. Toxicity and quality of life were assessed at baseline and after treatment using the Common Terminology Criteria for Adverse Events v. 5.0, International Prostatic Symptoms Score, ICIQ-SF, IIEF-5, and EORTC-QLQ-C30 and PR-25 questionnaires. RESULTS: 120 plans (pre- and daily adaptive SBRT planning) were analyzed in 20 patients (10 patients in spacer group and 10 patients in no-spacer group) treated using 1.5T MR-guided adaptive SBRT. Statistically significant dosimetric advantages were observed in favor of the spacer insertion, improving the planning target volume coverage in terms of V33.2Gy >95% and planning target volume 37.5 Gy <2% mainly during daily-adapted SBRT. Also, rectum V32, V28 and V18Gy and bladder V35Gy <1 cc were significantly reduced in the spacer cohort. Concerning the PROMS, all questionnaires showed no difference between the pre- and post-SBRT evaluation in both arms, excepting the physical functioning item of EORTC QLQ-C30 questionnaire that was declined in the no-spacer group. CONCLUSION: These preliminary results strongly suggest the adoption of perirectal spacer due to dosimetric advantages not only for rectal sparing but also for target coverage. Longer follow-up is required to validate the clinical impact in terms of clinicians-reported toxicity and PROMs. ADVANCES IN KNOWLEDGE: This the first experience reporting preliminary data concerning the potential dosimetric impact of rectal hydrogel spacer on MR-guided SBRT for prostate cancer.


Asunto(s)
Hidrogeles/uso terapéutico , Imagen por Resonancia Magnética/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/radioterapia , Radiocirugia/métodos , Recto/efectos de la radiación , Anciano , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Órganos en Riesgo/efectos de la radiación , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Próstata/diagnóstico por imagen , Radiología Intervencional/métodos , Radiocirugia/efectos adversos , Dosificación Radioterapéutica
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