Safety and outcomes of volumetric modulated arc therapy in the treatment of patients with inoperable lung cancer.

Background: Published data on the effects and toxicities of volumetric modulated arc therapy (VMAT) in the management of inoperable lung cancer are scarce. Materials and methods: The clinical outcomes and pulmonary toxicities of 134 patients with consecutive inoperable lung cancer who underwent VMAT from March 2011 to September 2016 were retrospectively reviewed. The dosimetric and characteristic factors associated with acute radiation pneumonitis (RP) and pulmonary fibrosis were evaluated with univariate and multivariate analysis. Results: The average prescription doses to these 134 patients were 57.07±6.27 Gy (range 52-64 Gy). The overall median follow-up time was 18.6 months (range, 2-45 mo), with a median follow-up time for the surviving patients of 20 months (range, 7-45 mo). The 2-year progression-free survival (PFS) and overall survival (OS) for all patients were 18.2% and 38.4%, with a median PFS and OS of 7.6 months and 18.6 months, respectively. The percent of patients with grade III/higher RP and pulmonary fibrosis were 10.5% and 9.0%, respectively. V13 (p=0.02) and age (p=0.02) were independently associated with acute RP according to multivariate analysis. The constraints for lung dosimetric metrics V10,V13,V20 and V30 were approximately 49%,41%,26% and 17% in VMAT treatment of lung cancer to limit the RP rate < 10%. Conclusion: VMAT can be delivered safely with acceptable acute and late toxicities for lung cancer patients. Lung dosimetric metrics were valuable in predicting acute RP. A lung V13 constraint of 40% was helpful to limit the RP rate < 10% in VMAT treatment of lung cancer patients.

Association of lung and heart dose with survival in patients with non-small cell lung cancer underwent volumetric modulated arc therapy.

BACKGROUND: Controversial conclusions had been reported in studies trying to confirm the impact of heart dose on overall survival (OS) reported in RTOG 0167 for non-small cell lung cancer (NSCLC) patients who underwent radiotherapy (RT). The purpose of this study is to investigate the association of lung and heart dosimetric parameters with OS in NSCLC patients treated by volumetric modulated arc therapy (VMAT). METHODS: Inoperable NSCLC patients treated by VMAT from March 2012 to December 2015 were retrospectively reviewed. OS and progression-free survival (PFS) were estimated with the Kaplan-Meier method. Univariate and multivariate analyses were conducted with Cox proportional hazards model. Multivariate model building was conducted using stepwise regression for variables with p-value smaller than 0.2 in the univariate analysis. RESULTS: There were 130 NSCLC patients enrolled in this study with a median age of 63 years (range from 34 to 82 y). The median prescription dose for these patients was 56 Gy (range 40-70 Gy) with a mean heart and lung dose of 14.8±8.5 Gy and 13.6±4.4 Gy, respectively. The rates of patients with above grade III radiation pneumonitis (RP) and fibrosis were 8.5% and 8.5%, respectively. The 2-year PFS and OS of these patients were 15.2% and 39.8%, with a median PFS and OS of 7.2 and 18.8 months, respectively. RP was correlated with OS (p=0.048) and lung V20 was associated with PFS (p=0.04) according to the univariate analysis. Multivariate analysis demonstrated that RP (HR 1.39, 95%CI 1.010-1.909, p=0.043) and heart V15 (HR 1.02, 95%CI 1.006-1.025 p=0.002) were progression factors of OS, and no factor was associated with PFS. CONCLUSIONS: RP and heart V15 were associated with OS for patients with stage III NSCLC who underwent VMAT. Heart and lung dosimetric parameters were highly correlated with each other, sparing of heart and lung should be considered equally during the treatment planning.

The effect of the primary tumor location on the survival of colorectal cancer patients after radical surgery.

Background and Objectives: Colorectal cancer is one of the most common cancers and the leading cause of cancer-related death worldwide. The impact of the primary tumor location on the prognosis of patients with colorectal cancer has long been a concern, but studies have led to conflicting conclusions. Methods: In total, 465 colorectal cancer patients who received radical surgery were reviewed in this study. Enrolled patients were divided into two groups according to the tumor location. Disease-free survival (DFS) and overall survival (OS) were analyzed via the Kaplan-Meier method. A Cox regression model was employed to evaluate the independent prognostic factors for DFS and OS. Results: The right colorectal cancer (RCC) and left colorectal cancer (LCC) groups comprised 202 and 140 patients, respectively. Univariate and multivariate analyses revealed that the tumor location and TNM stage were independent predictors of DFS and OS. Subgroup analyses by stage demonstrated that there were significant differences in DFS and OS between patients with stage II and III RCC and LCC, but not for those with stage I colorectal cancer. Conclusions: Patients with stage II and III LCC had better survival than those with RCC. However, this improvement in DFS and OS was not observed in patients with stage I colorectal cancer.

Induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus volumetric modulated arc therapy alone in the treatment of stage II-IVB nasopharyngeal carcinoma patients: a retrospective controlled study.

BACKGROUND: In the era of intensity-modulated radiotherapy (IMRT), the role of additional concurrent chemotherapy (CC) to radiotherapy (RT) after induction chemotherapy (IC) compared to IC followed by RT alone remains unclear for stage II-IVB nasopharyngeal carcinoma (NPC) patients. The aim of this study was to evaluate the efficacy and toxicities of IC/RT and IC/CCRT in the treatment of NPC with volumetric modulated arc therapy (VMAT). METHODS: From January 2012 to March 2016, a total of 217 NPC patients were retrospectively assessed. Of the 217 patients, 139 patients received IC followed by VMAT alone and 78 patients received IC plus CCRT. Overall survival (OS), progression-free survival (PFS) and toxicities were assessed. RESULTS: The 5-year OS, PFS rates were 57.5%, 41.8% and 47.8%, 38.4% for the IC/RT and IC/CCRT arms, respectively, without significant difference in survival between the two groups (both p > 0.05). Multivariate analysis indicated that treatment modality (IC/RT vs. IC/CCRT) was not an independent prognostic factor for OS or PFS. Grade 3-4 leukopenia/neutropenia (3.60% vs. 20.51%, p < 0.001), gastrointestinal disorder (nausea/vomiting/diarrhea, 2.16% vs. 41.03%, p < 0.001), mucositis (29.50% vs. 47.44%, p = 0.01) and xerostomia (34.53% vs. 48.72%, p = 0.04) were more frequent in the IC/ CCRT arm than in the IC/RT arm during VMAT. CONCLUSIONS: No significant difference in OS and PFS was observed between IC plus VMAT alone and IC/CCRT in the treatment of stage II-IVB NPC patients, however, more side effects were observed in the IC/CCRT arm.

A type II first branchial cleft cyst masquerading as an infected parotid Warthin's tumor.

The diagnosis of a parotid mass usually depends on thorough history taking and physical examination. Diagnostic modalities, including ultrasonographic examinations, computed tomography and magnetic resonance images, may also provide substantial information but their accuracy for diagnosis is sometimes questionable, especially in differentiating some rare neoplasms. First branchial cleft cysts (FBCCs) are rare causes of parotid swelling and comprise less than 1% of all branchial anomalies. They are frequently misdiagnosed due to their rarity and unfamiliar clinical signs and symptoms. We present a case of type II FBCC masquerading as an infected parotid Warthin's tumor. We also review the clinical signs and symptoms of FBCCs in order to remind clinicians that this rare branchial anomaly can mimic an infected Warthin's tumor and may be seated in the deep lobe of the parotid gland. By making an accurate pre-operative diagnosis of type II FBCC, we can minimize surgical morbidity and avoid incomplete resection and possible recurrence.