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1.
Anticancer Res ; 40(1): 367-371, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892588

RESUMO

BACKGROUND/AIM: Individualization of treatment may improve the outcome of patients with bone metastases from breast cancer. To support physicians when selecting individualized programs for these patients, a simple instrument for predicting survival was created. PATIENTS AND METHODS: In 126 female patients with breast cancer irradiated for bone metastases, 11 characteristics were evaluated with respect to survival. RESULTS: On Cox regression analysis, Eastern Cooperative Oncology Group performance score (0-1 vs. ≥2; p=0.032) and visceral metastases (absence vs. presence; p=0.017) were independently associated with survival and incorporated into the scoring instrument. Three prognostic groups (0, 1 or 2 points) were designated with 12-month survival rates of 38%, 57% and 91%, and 24-month survival rates of 32%, 36% and 80%, respectively (p<0.001). CONCLUSION: This easy-to-use scoring instrument allows physicians to estimate the lifespan of patients irradiated for bone metastases from breast cancer and can facilitate individualization of their treatment.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Estimativa de Kaplan-Meier , Probabilidade , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico
2.
Anticancer Res ; 40(1): 287-291, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892578

RESUMO

BACKGROUND/AIM: Estimating survival is important for treatment personalization in patients with metastatic cancer. In this study, we aimed to develop a survival score for patients irradiated for bone metastases from colorectal cancer. PATIENTS AND METHODS: Eleven factors were retrospectively analyzed in 25 patients, including age, gender, Eastern Cooperative Oncology Group performance score, tumor site, time between diagnosis of colorectal cancer and irradiation, visceral or other bone metastases, type and number of irradiated sites, upfront surgery and previous systemic treatment. RESULTS: On multivariate analysis, performance score (p=0.005) and previous systemic treatment (p=0.007) were significantly associated with survival and used for the score. One point (performance score 0-1 or no previous systemic treatment) or 0 points (performance score ≥2 or previous systemic treatment) were assigned resulting in 0, 1 or 2 points. Six-month survival rates of these groups were 0%, 64% and 100%, respectively. CONCLUSION: This new survival score can support physicians during personalization of treatment for patients with bone metastases from colorectal cancer.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Colorretais/patologia , Idoso , Humanos , Estimativa de Kaplan-Meier , Prognóstico
3.
Artigo em Inglês | MEDLINE | ID: mdl-31987967

RESUMO

PURPOSE: We propose linear-energy-transfer (LET)-guided robust optimization in intensity-modulated proton therapy (IMPT) for head-and-neck (H&N) cancer. This method simultaneously considers LET and physical dose distributions of tumors and organs-at-risk (OARs) with uncertainties. METHOD: Fourteen H&N cancer patients were included in this retrospective study. Cord, brainstem, brain, and oral cavity were considered. Two algorithms: voxel-wise worst-case robust optimization (RO) and LET-guided robust optimization (LETRO) were used to generate IMPT plans for each patient. The latter method directly optimized LET distributions rather than indirectly as in previous methods. LET-volume histograms (LETVHs) were generated and high LET was redistributed from nearby OARs to tumors in a user-defined way via LET-volume constraints (LETVCs). Dose-volume histogram (DVH) indices, such as clinical target volume (CTV) D98% and D2%-D98%, cord Dmax, brainstem Dmax, brain Dmax, and oral cavity Dmean, were calculated. Plan robustness was quantified using the worst-case analysis method. LETVH indices analogous to DVH indices were used to characterize LET distributions. The Wilcoxon signed rank test was performed to measure statistical significance. RESULT: In the nominal scenario, LETRO provided higher LET distributions in CTV (unit: keV/µm) [CTV LET98%: 1.18 vs. 1.08, LETRO vs. RO, p=0.0031], while preserving comparable physical dose and plan robustness. LETRO achieved significantly reduced LET distributions in cord, brainstem, and oral cavity, compared with RO [cord LETmax: 7.20 vs. 8.20, p=0.0010; brainstem LETmax: 10.95 vs. 12.05, p=0.0007; oral cavity LETmean: 2.11 vs. 3.12, p=0.0052], and had comparable physical dose and plan robustness in all OARs. In the worst-case scenario, LETRO achieved significantly higher LETmean in CTV, reduced LETmax in brain, and comparable other LETVH indices [CTV LETmean: 3.26 vs. 3.35, p=0.0012; brain LETmax: 24.80 vs. 22.00, p=0.0016]. CONCLUSIONS: LETRO robustly optimized LET and physical dose distributions simultaneously. It redistributed high LET from OARs to targets with slightly modified physical dose and plan robustness.

4.
Am J Clin Oncol ; 43(2): 128-132, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31764021

RESUMO

OBJECTIVE: Radiation therapy (RT) is the primary treatment of intracranial metastasis (ICM) from lung cancer (LC). Radiation necrosis (RN) has been reported post-RT with an incidence of 5% to 24%. We reviewed the spectrum of imaging changes in patients treated with RT for ICM from LC in an effort to identify potential risk factors for RN. METHODS: We reviewed 63 patients with LC and ICM who received RT (radiosurgery [stereotactic radiosurgery] with/without whole brain radiation therapy) at our institution between 2013 and 2018. Data evaluated included demographics, tumor type, ICM burden and location, chemotherapy, surgery, and RT details as well as treatment choices and outcomes. RESULTS: Of the 63 patients, clinical and radiographic criteria for RN were noted in 24 (38%) as early as 2 months and as late as 5 years posttreatment. Six patients required surgical resection due to refractory symptoms revealing pathology-proven RN and occasionally tumor. Patients were significantly more likely to develop RN if they had surgical resection of an ICM (45.8% vs. 20.5%, P=0.05). No differences were found in location, size, or genetic profile of lesions. In total, 80% of patients received treatment for symptoms and/or radiographic change. This was generally a combination of steroids, bevacizumab, laser interstitial thermal treatment, or surgical resection. Most patients required >1 treatment modality. CONCLUSIONS: This review of outcomes of RT for ICM in LC demonstrates a higher rate of RN than previously reported in the literature in those having had a surgical resection plus stereotactic radiosurgery. Our observation of RN as late as 5 years post-RT for ICM necessitates clinician awareness.

5.
J Thorac Oncol ; 15(1): 110-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605793

RESUMO

INTRODUCTION: The Seneca Valley virus (NTX-010) is an oncolytic picornavirus with tropism for SCLC. This phase II double-blind, placebo-controlled trial evaluated NTX-010 in patients with extensive-stage (ES) SCLC after completion of first-line chemotherapy. METHODS: Patients with ES SCLC who did not progress after four or more cycles of platinum-based chemotherapy were randomized 1:1 to a single dose of NTX-010 or placebo within 12 weeks of chemotherapy. The primary end point was progression-free survival (PFS). A prespecified interim analysis for futility was performed after 40 events. Viral clearance and the development of neutralizing antibodies were followed. RESULTS: From January 15, 2010, to January 10, 2013, a total of 50 patients were randomized and received therapy on study (26 received NTX-010 and 24 received placebo). At the specified interim analysis, the median PFS was 1.7 months (95% confidence interval [CI]: 1.4-3.1 months) for the NTX-010 group versus 1.7 months (95% CI: 1.4-4.3 months) for the placebo group (hazard ratio = 1.03, p = 0.92), and the trial was terminated owing to futility. In the NTX-010 group, PFS was shorter in patients with detectable virus at days 7 and 14 versus in those in whom it was not detected after treatment (1.0 month [95% CI: 0.4-1.5 months] versus 1.8 months [95% CI: 1.3-5.5 months, p = 0.008] and 0.9 months [95% CI: 0.4-2.6 months] versus 1.3 months [95% CI: 1.0-5.3 months], respectively [p = 0.04]). CONCLUSIONS: Patients with ES SCLC did not benefit from NTX-010 treatment after chemotherapy with a platinum doublet. Persistence of NTX-010 in the blood 1 or 2 weeks after treatment was associated with a shorter PFS.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31812719

RESUMO

PURPOSE/OBJECTIVE: To investigate precision radiotherapy for metastatic spinal cord compression (MSCC) and compare it to conventional radiotherapy. METHODS AND MATERIALS: In a multi-center phase 2 study, 40 patients received 5Gyx5 of precision radiotherapy (38 volume modulated arc therapy, 2 intensity-modulated radiotherapy) for MSCC and were evaluated for local progression-free survival (LPFS), motor function, ambulatory status, sensory function, sphincter dysfunction, pain, distress, overall survival (OS) and toxicity. Maximum spinal cord dose was 101.5% (myelopathy risk <0.03%) of the prescription dose. Patients were compared to a historical control group conventionally irradiated with 4Gyx5 (propensity-score analysis). The equivalent dose in 2Gy-fractions of 5Gyx5 is similar to 3Gyx10, which results in better LPFS than 4Gyx5. It was assumed that 5Gyx5 is also superior to 4Gyx5 for LPFS. (ClinicalTrials.gov-identifier: XXX) RESULTS: Six-month rates of LPFS and OS were 95.0% and 42.6%, respectively. Improvement of motor function occurred in 24 patients (60%). Thirty-three patients (82.5%) were ambulatory following radiotherapy. Eight of 16 patients (50.0%) with sensory deficits improved. Pain and distress relief were reported by 61.9% and 54.2% of patients at 1 month following radiotherapy. Grade 3 toxicities occurred in one patient, grade 2 toxicities in another 3 patients. Of the control group, 664 patients qualified for the propensity-score analysis. 5Gyx5 was significantly superior to 4Gyx5 regarding LPFS (p=0.026), but not regarding motor function (p=0.51) or OS (p=0.82). CONCLUSIONS: Precision radiotherapy with 5Gyx5 was well tolerated and effective, and appeared superior to 4Gyx5 regarding LPFS. The retrospective nature of the historic control group, which may have led to a hidden selection bias, needs to be considered when interpreting the results.

7.
J Natl Compr Canc Netw ; 17(12): 1464-1472, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31805526

RESUMO

The NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC) address all aspects of management for NSCLC. These NCCN Guidelines Insights focus on recent updates in immunotherapy. For the 2020 update, all of the systemic therapy regimens have been categorized using a new preference stratification system; certain regimens are now recommended as "preferred interventions," whereas others are categorized as either "other recommended interventions" or "useful under certain circumstances."

8.
Neurooncol Pract ; 6(6): 484-489, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31832219

RESUMO

Background: Guidelines to provide recommendations about driving restrictions for patients with brain metastases are lacking. We aim to determine whether clinical neurologic examination is sufficient to predict suitability to drive in these patients by comparison with an occupational therapy driving assessment (OTDA). Methods: We prospectively evaluated the concordance between neurology assessment of suitability to drive (pass/fail) and OTDA in 41 individuals with brain metastases. Neuro-oncology evaluation included an interview and neurological examination. Participants subsequently underwent OTDA during which a battery of objective measures of visual, cognitive, and motor skills related to driving was administered. Results: The mean age of patients who failed OTDA was age 68.9 years vs 59.3 years in the group members who passed (P = .0046). The sensitivity of the neurology assessment to predict driving fitness compared with OTDA was 16.1% and the specificity 90%. The 31 patients who failed OTDA were more likely to fail Vision Coach, Montreal Cognitive Assessment, and Trail Making B tests. Conclusions: There was poor association between the assessment of suitability to drive by neurologists and the outcome of the OTDA in patients with brain metastases. Subtle deficits that may impair the ability to drive safely may not be evident on neurologic examination. The positive predictive value was high to predict OTDA failure. Age could be a factor affecting OTDA performance. The results raise questions about the choice of assessments in making recommendations about driving fitness in people with brain metastases. OTDA should be strongly considered in patients with brain metastases who wish to continue driving.

9.
J Clin Oncol ; : JCO1901162, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31841363

RESUMO

PURPOSE: RTOG 0617 compared standard-dose (SD; 60 Gy) versus high-dose (HD; 74 Gy) radiation with concurrent chemotherapy and determined the efficacy of cetuximab for stage III non-small-cell lung cancer (NSCLC). METHODS: The study used a 2 × 2 factorial design with radiation dose as 1 factor and cetuximab as the other, with a primary end point of overall survival (OS). RESULTS: Median follow-up was 5.1 years. There were 3 grade 5 adverse events (AEs) in the SD arm and 9 in the HD arm. Treatment-related grade ≥3 dysphagia and esophagitis occurred in 3.2% and 5.0% of patients in the SD arm v 12.1% and 17.4% in the HD arm, respectively (P = .0005 and < .0001). There was no difference in pulmonary toxicity, with grade ≥3 AEs in 20.6% and 19.3%. Median OS was 28.7 v 20.3 months (P = .0072) in the SD and HD arms, respectively, 5-year OS and progression-free survival (PFS) rates were 32.1% and 23% and 18.3% and 13% (P = .055), respectively. Factors associated with improved OS on multivariable analysis were standard radiation dose, tumor location, institution accrual volume, esophagitis/dysphagia, planning target volume and heart V5. The use of cetuximab conferred no survival benefit at the expense of increased toxicity. The prior signal of benefit in patients with higher H scores was no longer apparent. The progression rate within 1 month of treatment completion in the SD arm was 4.6%. For comparison purposes, the resultant 2-year OS and PFS rates allowing for that dropout rate were 59.6% and 30.7%, respectively, in the SD arms. CONCLUSION: A 60-Gy radiation dose with concurrent chemotherapy should remain the standard of care, with the OS rate being among the highest reported in the literature for stage III NSCLC. Cetuximab had no effect on OS. The 2-year OS rates in the control arm are similar to the PACIFIC trial.

10.
BMC Cancer ; 19(1): 1156, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779595

RESUMO

BACKGROUND: Personalized therapy for bone metastases should consider the patients' remaining lifespan. Estimation of survival can be facilitated with scoring tools. A new tool was developed, specifically designed to estimate 12-month survival. METHODS: In 445 patients irradiated for bone metastases, radiotherapy regimen plus 13 factors (age, gender, Karnofsky performance score (KPS), primary tumor type, interval between cancer diagnosis and RT of bone metastases, visceral metastases, other (non-irradiated) bone metastases, sites of bone metastases, number of irradiated sites, pathological fracture, fractionation of RT, pre-RT surgery, pre-RT administration of bisphosphonates/denosumab, pre-RT systemic anticancer treatment) were retrospectively analyzed for survival. Factors achieving significance (p < 0.05) or borderline significance (p < 0.055) on multivariate analysis were used for the scoring system. Twelve-month survival rates were divided by 10 (factor scores); factor scores were summed for each patient (patient scores). RESULTS: On multivariate analysis, survival was significantly associated with KPS (hazard ratio (HR) 1.91, p < 0.001) and primary tumor type (HR 1.12, p < 0.001); age achieved borderline significance (HR 1.14, p = 0.054). These factors were used for the scoring tool. Patient scores ranged from 8 to 17 points. Three groups were designated: 8-9 (A), 10-14 (B) and 15-17 (C) points. Twelve-month survival rates were 9, 38 and 72% (p < 0.001); median survival times were 3, 8 and 24 months. CONCLUSIONS: This new tool developed for patients irradiated for bone metastases at any site without spinal cord compression allows one to predict the survival of these patients and can aid physicians when assigning the treatment to individual patients.

11.
Technol Cancer Res Treat ; 18: 1533033819887182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31755362

RESUMO

PURPOSE: To describe and validate the dose calculation algorithm of an independent second-dose check software for spot scanning proton delivery systems with full width at half maximum between 5 and 14 mm and with a negligible spray component. METHODS: The analytical dose engine of our independent second-dose check software employs an altered pencil beam algorithm with 3 lateral Gaussian components. It was commissioned using Geant4 and validated by comparison to point dose measurements at several depths within spread-out Bragg peaks of varying ranges, modulations, and field sizes. Water equivalent distance was used to compensate for inhomogeneous geometry. Twelve patients representing different disease sites were selected for validation. Dose calculation results in water were compared to a fast Monte Carlo code and ionization chamber array measurements using dose planes and dose profiles as well as 2-dimensional-3-dimensional and 3-dimensional-3-dimensional γ-index analysis. Results in patient geometry were compared to Monte Carlo simulation using dose-volume histogram indices, 3-dimensional-3-dimensional γ-index analysis, and inpatient dose profiles. RESULTS: Dose engine model parameters were tuned to achieve 1.5% agreement with measured point doses. The in-water γ-index passing rates for the 12 patients using 3%/2 mm criteria were 99.5% ± 0.5% compared to Monte Carlo. The average inpatient γ-index analysis passing rate compared to Monte Carlo was 95.8% ± 2.9%. The average difference in mean dose to the clinical target volume between the dose engine and Monte Carlo was -0.4% ± 1.0%. For a typical plan, dose calculation time was 2 minutes on an inexpensive workstation. CONCLUSIONS: Following our commissioning process, the analytical dose engine was validated for all treatment sites except for the lung or for calculating dose-volume histogram indices involving point doses or critical structures immediately distal to target volumes. Monte Carlo simulations are recommended for these scenarios.

12.
Med Phys ; 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31758864

RESUMO

PURPOSE: The dose-averaged linear energy transfer (LETd ) for intensity-modulated proton therapy (IMPT) calculated by one-dimensional (1D) analytical models deviates from more accurate but time-consuming Monte Carlo (MC) simulations. We developed a fast hybrid three-dimensional (3D) analytical LETd calculation that is more accurate than 1D analytical model. METHODS: We used the Geant4 MC code to generate 3D LETd distributions of monoenergetic proton beams in water for all energies and used a customized error function to fit the LETd lateral profiles at various depths to the MC simulation. The 3D LETd calculation kernel was a lookup table of these fitted coefficients, and LETd was determined directly from spot energies and voxel coordinates during analytical dose calculations. We validated our new method by comparing the calculated LETd distributions to MC results using 3D Gamma index analysis with 3%/2 mm criteria in 12 patient geometries. The significance of the improvement in Gamma index analysis passing rates over the 1D analytical model was determined using the Wilcoxon rank-sum test. RESULTS: The passing rate of 3D Gamma analysis comparing LETd distributions from the hybrid 3D method and the 1D method to MC simulations was significantly improved from 94.0% ± 2.5% to 98.0% ± 1.0% (P = 0.0003). The typical time to calculate dose and LETd simultaneously using an Intel Xeon E5-2680 2.50 GHz workstation was approximately 2.5 min. CONCLUSION: Our new method significantly improved the LETd calculation accuracy compared to the 1D method while maintaining significantly shorter calculation time even comparing with the GPU-based fast MC code.

13.
Anticancer Res ; 39(11): 6217-6222, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704850

RESUMO

BACKGROUND/AIM: Elderly cancer patients are more prevalent and require special attention. This study focused on the outcome of elderly (≥65 years) rectal cancer patients treated with tri-modality therapy. PATIENTS AND METHODS: A total of 105 patients receiving neoadjuvant radio-chemotherapy and resection for locally advanced rectal cancers were retrospectively evaluated. Nine characteristics were analyzed for loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) including tumor location, gender, age, performance status, radiotherapy technique, primary tumor/lymph node categories, downstaging and histological grading. RESULTS: The 5-year rates of LRC, MFS and OS were 91%, 78% and 87%, respectively. Radio-chemotherapy was not completed in 12 patients (11%) due to toxicity; 18 patients (17%) experienced grade 3 toxicities. A total of 29 patients (28%) had surgical complications. On multivariate analyses, MFS was significantly associated with downstaging (p=0.003) and OS with lower histological grade (p=0.013). CONCLUSION: Tri-modality therapy resulted in promising outcomes and was tolerated reasonably well by elderly patients. Prognostic factors were identified that may help personalize future treatment.


Assuntos
Neoplasias Retais/terapia , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Capecitabina/administração & dosagem , Quimiorradioterapia Adjuvante/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Intervalo Livre de Doença , Feminino , Fluoruracila/administração & dosagem , Humanos , Avaliação de Estado de Karnofsky , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Oxaliplatina/administração & dosagem , Complicações Pós-Operatórias , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento
15.
Med Phys ; 46(11): 4755-4762, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31498885

RESUMO

PURPOSE: Approximate dose calculation methods were used in the nominal dose distribution and the perturbed dose distributions due to uncertainties in a commercial treatment planning system (CTPS) for robust optimization in intensity-modulated proton therapy (IMPT). We aimed to investigate whether the approximations influence plan quality, robustness, and interplay effect of the resulting IMPT plans for the treatment of locally advanced lung cancer patients. MATERIALS AND METHODS: Ten consecutively treated locally advanced nonsmall cell lung cancer (NSCLC) patients were selected. Two IMPT plans were created for each patient using our in-house developed TPS, named "Solo," and also the CTPS, EclipseTM (Varian Medical Systems, Palo Alto, CA, USA), respectively. The plans were designed to deliver prescription doses to internal target volumes (ITV) drawn by a physician on averaged four-dimensional computed tomography (4D-CT). Solo plans were imported back to CTPS, and recalculated in CTPS for fair comparison. Both plans were further verified for each patient by recalculating doses in the inhalation and exhalation phases to ensure that all plans met clinical requirements. Plan robustness was quantified on all phases using dose-volume-histograms (DVH) indices in the worst-case scenario. The interplay effect was evaluated for every plan using an in-house developed software, which randomized starting phases of each field per fraction and accumulated dose in the exhalation phase based on the patient's breathing motion pattern and the proton spot delivery in a time-dependent fashion. DVH indices were compared using Wilcoxon rank-sum test. RESULTS: Compared to the plans generated using CTPS on the averaged CT, Solo plans had significantly better target dose coverage and homogeneity (normalized by the prescription dose) in the worst-case scenario [ITV D95% : 98.04% vs 96.28%, Solo vs CTPS, P = 0.020; ITV D5% -D95% : 7.20% vs 9.03%, P = 0.049] while all DVH indices were comparable in the nominal scenario. On the inhalation phase, Solo plans had better target dose coverage and cord Dmax in the nominal scenario [ITV D95% : 99.36% vs 98.45%, Solo vs CTPS, P = 0.014; cord Dmax : 20.07 vs 23.71 Gy(RBE), P = 0.027] with better target coverage and cord Dmax in the worst-case scenario [ITV D95% : 97.89% vs 96.47%, Solo vs CTPS, P = 0.037; cord Dmax : 24.57 vs 28.14 Gy(RBE), P = 0.037]. On the exhalation phase, similar phenomena were observed in the nominal scenario [ITV D95% : 99.63% vs 98.87%, Solo vs CTPS, P = 0.037; cord Dmax : 19.67 vs 23.66 Gy(RBE), P = 0.039] and in the worst-case scenario [ITV D95% : 98.20% vs 96.74%, Solo vs CTPS, P = 0.027; cord Dmax : 23.47 vs 27.93 Gy(RBE), P = 0.027]. In terms of interplay effect, plans generated by Solo had significantly better target dose coverage and homogeneity, less hot spots, and lower esophageal Dmean , and cord Dmax [ITV D95% : 101.81% vs 98.68%, Solo vs CTPS, P = 0.002; ITV D5% -D95% : 2.94% vs 7.51%, P = 0.002; cord Dmax : 18.87 vs 22.29 Gy(RBE), P = 0.014]. CONCLUSIONS: Solo-generated IMPT plans provide improved cord sparing, better target robustness in all considered phases, and reduced interplay effect compared with CTPS. Consequently, the approximation methods currently used in commercial TPS programs may have space for improvement in generating optimal IMPT plans for patient cases with locally advanced lung cancer.

16.
Radiother Oncol ; 139: 79-82, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31431372

RESUMO

Mepitel® Film (MEP) and standard care (STD) were compared for radiation dermatitis in SCCHN patients. This trial was stopped prematurely since13/28 patients did not tolerate MEP. Grade ≥2 dermatitis: 34.8% (MEP) vs. 35.7% (STD) at 50 Gy, 65.2% vs. 59.3% at 60 Gy. MEP was unsatisfactorily tolerated and appeared not superior (NCT03047174).

18.
Int J Radiat Oncol Biol Phys ; 105(4): 760-764, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31415797

RESUMO

PURPOSE: To compare 4 Gy × 5 (1 week) to 3 Gy × 10 (2 weeks) in relieving pain and distress in patients with metastatic epidural spinal cord compression (MESCC). METHODS AND MATERIALS: The randomized SCORE-2 trial compared 4 Gy × 5 (n = 101) to 3 Gy × 10 (n = 102) for MESCC. In this additional analysis, these regimens were compared for their effect in relieving pain and distress. Distress was evaluated with the distress-thermometer (0 = no distress, 10 = extreme distress) and pain on a linear scale (0 = no pain, 10 = worst pain). Relief of distress was defined as decrease of ≥2 points; complete and partial pain relief were defined as achieving a score of 0 points and a decrease ≥2 points, respectively, without increase of analgesic use. This prospective secondary analysis of the SCORE-2 trial aimed to show that 4 Gy × 5 was not inferior to 3 Gy × 10 regarding distress and pain relief. Analyses were performed using the unconditional test of noninferiority for binomial differences based on restricted maximum likelihood estimates (noninferiority margin: -20%). Evaluations were performed before, directly after, and 1, 3, and 6 months after radiation therapy. (ClinicalTrials.gov: NCT02189473). RESULTS: At baseline, median distress scores were 8 (2-10) points in the 4 Gy × 5 group and 8 (2-10) points in the 3 Gy × 10 group. At 1 month, distress relief rates were 58.1% (43/74) and 62.7% (47/75) (difference: -4.6%; 95% confidence interval, -20.0% to +11.1%; P = .025). At baseline, median pain scores were 7 (2-10) and 7 (2-10) points, respectively. At 1 month, complete pain relief rates were 23.5% (16/68) versus 20.0% (14/70) (difference, +3.5%; 95% confidence interval, -10.4% to +17.5%; P < .001), and overall pain relief rates were 52.9% (36/68) versus 57.1% (40/70) (difference, -4.2%; 95% confidence interval, -20.5% to +12.3%; P = .029). Distress and pain relief rates after 4 Gy × 5 were largely comparable to 3 Gy × 10 at all time points. Associated 95% confidence intervals did not point toward any relevant differences. CONCLUSIONS: In patients with MESCC and poor to intermediate survival prognoses, 4 Gy × 5 appeared noninferior to 3 Gy × 10 regarding pain and distress relief.


Assuntos
Manejo da Dor/métodos , Medidas de Resultados Relatados pelo Paciente , Compressão da Medula Espinal/radioterapia , Neoplasias da Coluna Vertebral/radioterapia , Estresse Psicológico/terapia , Idoso , Feminino , Humanos , Masculino , Medição da Dor/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Qualidade de Vida , Dosagem Radioterapêutica , Compressão da Medula Espinal/complicações , Neoplasias da Coluna Vertebral/complicações , Fatores de Tempo
19.
Radiother Oncol ; 141: 56-61, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31445837

RESUMO

INTRODUCTION: There has been a long-standing debate regarding the efficacy of single fraction radiotherapy (SFRT) compared to multiple fraction radiotherapy (MFRT); many systematic reviews and meta-analyses have been conducted to resolve the debate and suggested SFRT is equally as effective as MFRT. Given the adequate amalgamated sample size that exists, it is difficult to appreciate the need for further RCTs. The aim of this paper was to conduct a cumulative meta-analysis to determine whether further trials will be of value to the meta-conclusion. This paper also assessed publication quality. METHODS: A total of 29 studies were used in our meta-analysis. Comprehensive Meta-Analysis (Version 3) by Biostat was used to conduct a cumulative meta-analysis. The Cochrane Risk of Bias assessment tool was employed to assess study quality of the included RCTs. Funnel plots were generated using Review Manager (RevMan 5.3) by Cochrane IMS, to visually assess for publication bias. RESULTS: All but one endpoint, overall response rates in assessable patients, maintained the same meta-conclusion over publication time; published studies did not change the amalgamated scientific conclusion of existing literature. Additional studies have simply confirmed pre-existing conclusions and refined the point estimate of the efficacy estimate. The majority of included studies have low risk of bias. CONCLUSION: In conclusion, the meta-conclusion has remained consistent over time - SFRT is equally as efficacious as MFRT. Recent studies have had little impact on the overall conclusion, and given the vast amount of resources to execute a randomized trial, future resources should not be used to repeat these studies, and can be better allocated to test other hypotheses.

20.
Anticancer Res ; 39(8): 4273-4277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366517

RESUMO

BACKGROUND/AIM: For treatment of brain metastases, a patient's survival prognosis should be considered. Existing survival scores appear complex and require complete tumor staging. For many patients, a faster and simpler tool would be helpful. PATIENTS AND METHODS: This retrospective study investigated the prognostic value of the number of pre-treatment symptoms plus eight other factors on survival of patients irradiated for brain metastases. Other factors included whole-brain radiotherapy (WBRT) regimen, age, gender, performance score, primary tumor type, number of brain metastases, extracranial metastases, and interval between cancer diagnosis and WBRT. RESULTS: The number of symptoms (p=0.002) and all other factors were significantly associated with survival on univariate analyses. On multivariate analysis, all factors but the number of symptoms (p=0.47) and primary tumor type (p=0.48) were significant. CONCLUSION: Since the number of symptoms was not an independent predictor of survival, it cannot replace existing scoring tools and may only serve for orientation.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias/radioterapia , Prognóstico , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Irradiação Craniana/efeitos adversos , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/classificação , Neoplasias/patologia
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