Comparison of surgical intervention to Cyberknife® radiotherapy in the treatment of liver malignancies.

INTRODUCTION: Surgical resection is the method of choice in treating liver malignancies. In patients who are not suitable for radical surgical treatment, the radiotherapeutic system Cyberknife® is a viable treatment option. The aim of this study is to compare short- and long-term results of both treatment methods. METHODS: A retrospective analysis of prospectively collected data was performed, focused on patients undergoing treatment of liver malignancies either by surgical resection or by the Cyberknife® system from 2013 to 2016. Only patients treated using a single treatment method were included in the study. RESULTS: A total of 260 patients were analysed; 142 were treated by performing surgical resection and the remaining 118 using Cyberknife® radiotherapy. Median survival was 30.65 months for the surgical resection and 22.93 for the Cyberknife® therapy; median overall survival was 27.63 months. Three-year cumulative survival was 47.4% for the resection and 19.9% for radiotherapy. Kaplan-Meier analysis did not demonstrate a statistically significant difference in disease-specific survival between both groups (p=0.082, CI 95%). Results limited only to colorectal liver metastases showed a statistically significant difference in disease-specific survival (p=0.031, CI 95%). CONCLUSIONS: Results of this study show statistically indifferent overall disease-specific survival of both groups. However, the significant difference in 3-year survival still indicates a predominant position of surgery in the diagnostic and therapeutic management of patients with liver malignancies. Nevertheless, Cyberknife® radiotherapy may actually represent a viable treatment alternative, particularly in patients unable to undergo surgical resection, although a longer follow-up period is necessary to obtain more robust results.

[Intensity Modulated Hyperfractionated Accelerated Radiotherapy to Treat Advanced Head and Neck Cancer - Predictive Factors of Overall Survival]. / Hyperfrakcionovaná akcelerovaná radioterapie s modulovanou intenzitou u pokrocilých nádoru hlavy a krku - prediktivní faktory celkového prezití.

AIM: The aim of this study was to evaluate overall survival (OS) and prognostic factors in patients ineligible for chemotherapy who were treated with a hyperfractionated accelerated schedule with simultaneous integrated boost. MATERIAL AND METHODS: From May, 2008, to April, 2013, 122 patients with locally advanced nonmetastatic squamous laryngeal (14%), hypopharyngeal (30%), oropharyngeal (30%), and oral cavity (27%) cancer were treated at our institution. The median age, Karnofsky Performance Status (KPS), and gross tumor volume (GTV) of the patients were 63 years (range, 46-87 years), 80% (range, 50-100%), and 46 ml (range, 5-250 ml), resp. The median total dose of radiotherapy was 72.6 Gy (range, 62-77 Gy) at 1.4-1.5 Gy per fraction, and 55 Gy at 1.1 Gy per fraction was delivered for GTV (primary and lymphadenopathy) with a margin of 0.7 cm and regional lymphatic areas with a margin of 0.3 cm. The dose was delivered 2× a day, with a 6-8 hour interval between doses, via a 6 MeV linear accelerator. OS was estimated using the Kaplan-Meier method, and predictors of OS were analyzed using Cox proportional hazards regression. RESULTS: The median duration of the radiotherapy series was 37 days (range, 32-45 days). The incidence of grade 3 acute toxicity was 62% for mucosa (oral cavity and/or pharynx) and 0% for skin. Confluent mucositis cleared in all cases within 21 days. No grade 4 or 5 toxicities were recorded. PEG was introduced before treatment in 55 patients (45%). The 1-and 2-year OS was 65% and 32%, resp. KPS less than 80% (RR 2.4, 95% CI 1.3-4.2; p = 0.004), cancers other than oropharyngeal or laryngeal cancer (RR 2.0, 95% CI 1.1-3.5; p = 0.016), and capacity of high GTV (RR 1.006, 95% CI 1.001-1.011; p = 0.017) were found to be negative prognostic factors for OS. CONCLUSION: More than 30% of patients with poor prognosis survived for longer than 2 years. KPS before treatment was the strongest prognostic factor for better OS.Key words: head and neck cancer - radiotherapy dose fractionation - survival analysis - acceleration - hyperfractionation This work was supported by RVO-FNOs/2016 (HPV status as predictive and prognostic factor for primary and secondary head and neck cancer). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 9. 3. 2017Accepted: 19. 4. 2017.

[Stereotactic Body Radiotherapy of Prostate Cancer - Effectiveness and Toxicity]. / Stereotaktická radioterapie karcinomu prostaty - efektivita a toxicita.

BACKGROUND: Prostate cancer is the most prevalent cancer in males and its incidence is steadily increasing. Most cases of prostate cancer are diagnosed during the early asymptomatic period, in which case the prognosis is very good. Therapies differ widely in their efficacies and toxicities, and this is an important consideration when it comes to deciding which treatment is optimal for a particular patient. One treatment method for early stage prostate cancer is stereotactic body radiotherapy (SBRT). We present the first results obtained using this modality at our institution. PATIENTS AND METHODS: A total of 261 patients with low or intermediate risk prostate cancer were treated with SBRT between August 2010 and July 2012. Patients received a total dose of 36.25 Gy in five fractions of 7.25 Gy every other day. The toxicity of the treatment was evaluated according to RTOG criteria. For assessment of quality of life, patients filled out a modified EPIC questionnaire (Expanded Prostate Composite index). RESULTS: Overall survival (OS) in this study was 93.1%. Biochemical relapse free survival (bRFS) was 97.7%. As expected, OS and bRFS were worse in the group of patients with an intermediate risk of recurrence. Acute and chronic urinary and gastrointestinal RTOG toxicity was very low. Quality of life after treatment, as determined using the EPIC questionnaire, was slightly reduced immediately after treatment but returned to baseline or even improved during long term follow-up. CONCLUSION: SBRT is an effective therapeutic modality for early prostate cancer and has acceptable rates of acute and low late toxicity.Key words: prostate cancer - stereotactic body radiotherapy - quality of life The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 5. 1. 2017Accepted: 1. 2. 2017.

Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study.

BACKGROUND AND PURPOSE: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. METHODS AND MATERIALS: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV(tumor)) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV(uninvolved)) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. RESULTS: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was ≤ 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. CONCLUSION: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.