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1.
Br J Radiol ; 93(1107): 20190226, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31430202

RESUMO

Proton radiotherapy has clear dosimetric advantages over photon radiotherapy. In contrast to photons, which are absorbed exponentially, protons have a finite range dependent on the initial proton energy. Protons therefore do not deposit dose beyond the tumor, resulting in great conformality, and offers the promise of dose escalation to increase tumor control while minimizing toxicity. In this review, we discuss the rationale for using proton radiotherapy in the treatment of upper abdominal tumors-hepatocellular carcinomas, cholangiocarcinomas and pancreatic cancers. We also review the clinical outcomes and technical challenges of using proton radiotherapy for the treatment of these malignancies. Finally, we discuss the ongoing clinical trials implementing proton radiotherapy for the treatment of primary liver and pancreatic tumors.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Carcinoma Hepatocelular/radioterapia , Colangiocarcinoma/radioterapia , Neoplasias Hepáticas/radioterapia , Neoplasias Pancreáticas/radioterapia , Terapia com Prótons/métodos , Estudos de Viabilidade , Humanos , Neoplasias Pancreáticas/patologia , Estudos Prospectivos , Dosagem Radioterapêutica , Estudos Retrospectivos , Resultado do Tratamento
2.
Z Gastroenterol ; 57(11): 1304-1308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31739376

RESUMO

Selective internal radiation therapy (SIRT) is a therapeutic option for primary and metastatic liver tumors. Microspheres containing Yttrium 90, a beta-emitting radionuclide, are administered into the hepatic artery allowing selective internal radiation of a liver tumor. SIRT-related complications may appear due to migration of the radiation microspheres to organs distant from the tumor site. In order to prevent these complications, unintended non target embolization of Yttrium microspheres has to be avoided. However, data from external-beam radiation therapy (EBRT) suggests that the stomach/small bowel may actually be less radiosensitive than the liver. Gastric ulcers, a well-known SIRT-related complication, may therefore not only be caused by local radiation but also by unusual accumulation of microspheres in the submucosa and small vessel damage. We herein report a more than two- year-long persisting, highly symptomatic, non-neoplastic ulceration of the gastric antrum leading to pyloric stenosis caused by SIRT therapy with Yttrium 90 microspheres for the treatment of intrahepatic cholangiocellular carcinoma. The chronic courses of the ulcer disease together with the specific histological features highlight the pivotal role of radiation-induced small vessel damage in SIRT-induced adverse events.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/patologia , Colangiocarcinoma/radioterapia , Lesões por Radiação/diagnóstico , Úlcera Gástrica/etiologia , Radioisótopos de Ítrio/efeitos adversos , Ductos Biliares Intra-Hepáticos , Feminino , Artéria Hepática , Humanos , Microesferas , Pessoa de Meia-Idade , Úlcera Gástrica/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Radioisótopos de Ítrio/uso terapêutico
3.
Medicine (Baltimore) ; 98(31): e16673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374045

RESUMO

The aim of this study was to analyze dose-volume histogram (DVH) of the remnant liver for postoperative cholangiocarcinoma (CCA) patients, to find toxicity rates, and to confirm efficacy of postoperative radiation therapy (RT).Thirty-two postoperative CCA patients received partial liver resection and postoperative RT with curative intent. The "liver reduction rate" was calculated by contouring liver volume at computed tomography (CT) just before the surgery and at CT for planning the RT. To evaluate late toxicity, the radiation-induced hepatic toxicity (RIHT) was determined by the common terminology criteria for adverse events toxicity grade of bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, and albumin, and was defined from 3 months after RT until liver metastasis was revealed. The radiation-induced liver disease (RILD) was also evaluated.Tumor stages were distributed as follows: I: 1, II: 8, IIIA: 1, IIIB: 6, IIIC: 14, IVA: 2. Median prescribed total dose was 50 Gy. Median follow-up time was 27 months. Two-year overall survival (OS): 72.4%, disease-free survival: 47.7%, local control: 65.3%, and the median survival time was 40 months. The median "liver reduction rate" was 21%. The OS had statistically significant difference in nodal status (P = .032) and "liver reduction rate" >30% (P = .016). In the association between the ≥grade 2 RIHT and DVH, there were significantly differences in V30 and V40 (P = .041, P = .034), respectively. The grade ≥2 RIHT rates differ also significantly by sex (P = .008). Two patients (6.2%) were suspected of RILD.We suggest that RT for remnant liver should be considered the liver V30, V40 to prevent radiation-induced liver dysfunction.


Assuntos
Colangiocarcinoma/radioterapia , Hepatopatias/prevenção & controle , Neoplasias Hepáticas/radioterapia , Lesões por Radiação/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica , Colangiocarcinoma/tratamento farmacológico , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Cisplatino/uso terapêutico , Terapia Combinada , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Combinação de Medicamentos , Hepatectomia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Ácido Oxônico/uso terapêutico , Piridinas/uso terapêutico , Radiossensibilizantes/uso terapêutico , Dosagem Radioterapêutica , Radioterapia Adjuvante , Tegafur/uso terapêutico , Tomografia Computadorizada por Raios X
4.
Cancer Radiother ; 23(5): 385-394, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31300328

RESUMO

PURPOSE: The purpose of the study was to evaluate the outcomes of stereotactic radiation therapy for primary and secondary liver tumours in Jean-Perrin cancer centre (Clermont-Ferrand, France) in terms of efficacy and safety. MATERIALS AND METHODS: Between December 2013 and June 2016, 25 patients were included. Treatment was performed on a linear accelerator Novalis TX®. The prescription dose was 42 to 60Gy in three to five fractions. Local control at 1 year was evaluated with modified Response Evaluation Criteria in Solid Tumours (mRECIST) and RECIST criteria. Acute and late toxicity were evaluated with Common Terminology Criteria for Adverse Events (CTCAE) v4.0 criteria. RESULTS: Median follow-up was 10.5 months. Treatment tolerance was good with few side effects grade 3 or above, no acute toxicity and only one late toxicity. We have highlighted that hepatic artery haemorrhage was associated with the presence of a biliary prosthesis in contact with the artery (P=0.006) and in the irradiation field. There was no correlation with the dose delivered to the artery and hepatic artery haemorrhage. CONCLUSION: Stereotactic radiation therapy for liver tumours allows a good local control with few secondary effects. Caution should be exercised when treating patients with biliary prostheses in the vicinity of the target volume because there is a risk of haemorrhage of the hepatic artery in contact with the prosthesis.


Assuntos
Neoplasias Hepáticas/radioterapia , Hipofracionamento da Dose de Radiação , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinoma/radioterapia , Carcinoma/secundário , Carcinoma/terapia , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/terapia , Colangiocarcinoma/radioterapia , Colangiocarcinoma/terapia , Terapia Combinada , Intervalo Livre de Doença , Embolização Terapêutica , Feminino , Seguimentos , França/epidemiologia , Hemorragia/etiologia , Hepatectomia , Artéria Hepática/efeitos da radiação , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Polietileno/efeitos da radiação , Polímeros/efeitos da radiação , Lesões por Radiação/epidemiologia , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Stents
5.
Br J Radiol ; 92(1100): 20190285, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31145644

RESUMO

OBJECTIVE: To generate a map of local recurrences after pancreaticoduodenectomy (PD) for patients with distal extrahepatic cholangiocarcinoma (DEHC) and to evaluate the adequate target volume coverage encompassing the majority of local recurrences when the clinical target volume (CTV) for pancreatic cancer was applied. METHODS: We retrospectively reviewed the records of DEHC patients who underwent pancreaticoduodenectomy and had postoperative CT scans acquired between 1991 and 2015 available. The sites of local recurrence were delineated on individual CT scans, and then, mapping was manually performed onto template CT images. Coverage of each site of local recurrence was evaluated by applying the CTV defined according to Radiation Therapy Oncology Group (RTOG) consensus guidelines (CTVRTOG ) for target delineation in the postoperative treatment of pancreatic head cancer. RESULTS: Of the 99 patients, 36 patients had a total of 62 local relapses identifiable by postoperative CT scans; the relapses were the most frequent in the choledochojejunostomy (CJ) site, 11 sites (17.7%); para-aortic area, 10 sites (16.1%), superior mesenteric artery area, 10 sites (16.1%); and portal vein area, 9 sites (14.5%). 21 sites (33.9%) were not covered by the CTVRTOG, and the most common site of local recurrence outside the CTVRTOG was the CJ site. CONCLUSION: When mapping of local relapses was evaluated according to the CTVRTOG, the choledochojejunostomy site was identified as a high-risk area of local recurrence but was insufficiently covered within the CTVRTOG. These findings may help construct a target volume for postoperative radiotherapy in DEHC. ADVANCES IN KNOWLEDGE: Mapping local recurrences can aid in defining appropriate target volume for postoperative radiotherapy in DEHC.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Pancreaticoduodenectomia , Radioterapia Adjuvante , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/radioterapia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Colangiocarcinoma/radioterapia , Colangiocarcinoma/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Tech Vasc Interv Radiol ; 22(2): 81-86, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079715

RESUMO

While the most compelling levels of evidence for the use of Yttrium-90 (90Y) radioembolization are in patients with hepatocellular carcinoma and hepatic metastases from colorectal cancer, a growing body of literature supports its use in other primary and secondary hepatic malignancies. This includes intrahepatic cholangiocarcinoma, as well as hepatic metastases from neuroendocrine cancer, ocular melanoma, and breast cancer. While is it not feasible to conduct prospective, randomized trials for radioembolization in the setting of these malignancies due to the low overall prevalence of liver-only disease, numerous single-arm studies in the last several years make a compelling argument for its use in select situations. This clinical update summarizes those findings.


Assuntos
Neoplasias da Mama/radioterapia , Colangiocarcinoma/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Melanoma/radioterapia , Tumores Neuroendócrinos/radioterapia , Radioisótopos de Ítrio/uso terapêutico , Neoplasias da Mama/patologia , Colangiocarcinoma/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Melanoma/patologia , Microesferas , Tumores Neuroendócrinos/patologia , Radiografia Intervencionista
7.
Clin Nucl Med ; 44(7): e439-e441, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30985434

RESUMO

Ga-PSMA is a promising tracer for both staging and detection of biochemical recurrence in prostate cancer. Prostate-specific membrane antigen is also expressed in the endothelium of neovasculature of various solid malignancies possibly due to tumor-associated angiogenic factors and endothelial cell sprouting. We report a case of 75-year-old man with metastatic cholangiocarcinoma to liver and lymph nodes progressing on chemotherapy. Ga-PSMA PET/CT was performed to assess PSMA expression and showed additional bone and hepatic lesions compared with F-FDG PET/CT. Ga-PSMA expression in the metastatic cholangiocarcinoma potentially guides radionuclide legend therapy with α/ß-emitters especially after enervation of all approved therapeutic options.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Biomarcadores Tumorais/análise , Colangiocarcinoma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/radioterapia , Ácido Edético/análogos & derivados , Humanos , Masculino , Oligopeptídeos , Compostos Radiofarmacêuticos
8.
Radiother Oncol ; 132: 42-47, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30825968

RESUMO

PURPOSE: Non-resectable cholangiocarcinoma (CCC) is a significant therapeutic challenge because of bad prognosis. This study analyzed the outcome after SBRT for intra- and extrahepatic CCC. MATERIAL AND METHODS: Sixty-four patients with 82 CCC lesions from a retrospective multicenter database were analyzed. Available parameters were analyzed for local control (LC), overall survival (OS) and toxicity. RESULTS: Median follow-up time for patients alive was 35 months (range 7-91 months). Median overall survival (OS) time was 15 months; 2-year and 3-year OS rates were 32% and 21%. Median prescribed biological effective radiation dose (BED, α/ß = 10) was 67.2 Gy10 (range, 36-115 Gy10; SD: 20 Gy10) in median 8 fractions (range, 3-17; 95% CI: 3-12), median BEDmax was 91 Gy10. BED was the only prognostic factor for LC and OS. Patients receiving BEDmax >91 Gy10 had a median OS of 24 months vs. 13 months for those receiving lower doses (p = 0.008). LC rates at 12 and 24 months were 91% and 80% for BEDmax >91 Gy10 vs. 66% and 39% for lower doses (p = 0.009). Of note, tumor size and PTV were neither predictive nor prognostic for LC and OS. Treatment tolerance was good with 17% of grade 1 gastroduodenitis, 11% of grade 2-3 cholangitis and 4.7% of grade 3 gastrointestinal bleeding. CONCLUSION: This is the largest reported series on SBRT in cholangiocarcinoma. Overall survival and local control were significantly improved after higher doses (BED) and tolerance was excellent.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Ductos Biliares Intra-Hepáticos/patologia , Colangiocarcinoma/radioterapia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/mortalidade , Ductos Biliares Intra-Hepáticos/efeitos da radiação , Colangiocarcinoma/mortalidade , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
9.
J Vasc Interv Radiol ; 30(3): 293-297, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819468

RESUMO

PURPOSE: To analyze the cost-effectiveness of radioembolization in the treatment of intrahepatic cholangiocarcinoma (ICC) using the Surveillance, Epidemiology, and End Results (SEER) Medicare cancer database. MATERIALS AND METHODS: Cost as measured by total treatment-related reimbursement in patients diagnosed with ICC who received chemotherapy alone or chemotherapy and yttrium-90 radioembolization was assessed in the SEER Medicare cancer database (1999-2012). Survival analysis was performed, and incremental cost-effectiveness ratios were generated. RESULTS: The study included 585 patients. Average age at diagnosis was 71 years (standard deviation: 9.9), and 52% of patients were male. Twelve percent of patients received chemotherapy with radioembolization (n = 72), and 88% of patients (n = 513) received only chemotherapy. Median survival was 1043 days (95% confidence interval [CI]: 894-1244) for chemotherapy plus radioembolization and 811 days (95% CI: 705-925) for chemotherapy alone (P = .02). Patients who received combination therapy were slightly younger (71 vs 69 years, P = .03). No significant differences were observed between treatment groups in age at treatment, sex, race, or city size. Multivariable analysis showed a hazard ratio for progression for combination therapy versus chemotherapy alone of 0.76 (95% CI: 0.59-0.97, P = .029). The incremental cost-effectiveness ratio, a measure of cost of each added year of life, was $50,058.65 per year (quartiles: $11,454.63, $52,763.28). CONCLUSIONS: Combination therapy of ICC with chemotherapy and radioembolization is associated with higher median survival and can be a cost-effective treatment, with a median cost of $50,058.65 per additional year of survival.


Assuntos
Neoplasias dos Ductos Biliares/economia , Neoplasias dos Ductos Biliares/radioterapia , Quimiorradioterapia/economia , Colangiocarcinoma/economia , Colangiocarcinoma/radioterapia , Embolização Terapêutica/economia , Custos de Cuidados de Saúde , Medicare/economia , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/economia , Radioisótopos de Ítrio/administração & dosagem , Radioisótopos de Ítrio/economia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Neoplasias dos Ductos Biliares/patologia , Quimiorradioterapia/efeitos adversos , Colangiocarcinoma/patologia , Análise Custo-Benefício , Bases de Dados Factuais , Custos de Medicamentos , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Compostos Radiofarmacêuticos/efeitos adversos , Estudos Retrospectivos , Programa de SEER , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Radioisótopos de Ítrio/efeitos adversos
10.
Br J Radiol ; 92(1097): 20180688, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30673295

RESUMO

OBJECTIVE: Stereotactic body radiation therapy (SBRT) has been used in the treatment of cholangiocarcinoma (CC) but toxicity and clinical results of SBRT in CC are still limited and sparse. Therefore, the aim of this systematic review was to analyze the results of SBRT in the setting of advanced CC. METHODS: A systematic literature search was conducted on PubMed, Scopus, and Cochrane library using the PRISMA methodology. Studies including at least 10 patients with diagnosis of advanced CC regardless of tumor site and other treatments were included. The primary outcome was overall survival (OS) and secondary endpoints were local control (LC) and toxicity rates. The ROBINS-I risk of bias tool was used. RESULTS: 10 studies (231 patients) fulfilled the selection criteria and were included in this review. All but one study showed moderate to serious risk of bias. Median follow up was 15 months (range: 7.8-64.0 months). Pooled 1 year OS was 58.3% (95% CI: 50.2-66.1%) and pooled 2 year OS was 35.5% (95% CI: 22.1-50.1%). Pooled 1 year LC was 83.4%, (95% CI: 76.5-89.4%). The reported toxicities were acceptable and manageable with only one treatment-related death. CONCLUSION: The role of SBRT in CC is not yet supported by robust evidence in literature. However, within this limit, preliminary results seem almost comparable to the ones of standard chemotherapy or chemoradiation. ADVANCES IN KNOWLEDGE: SBRT seems effective in terms of LC with acceptable treatment-related toxicities. Therefore, SBRT can be considered a therapeutic option at least in selected patients with CC, possibly combined with adjuvant chemotherapy (CHT).


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/radioterapia , Radiocirurgia , Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias dos Ductos Biliares/mortalidade , Quimioterapia Adjuvante , Colangiocarcinoma/tratamento farmacológico , Colangiocarcinoma/mortalidade , Humanos , Radiocirurgia/efeitos adversos , Análise de Sobrevida
11.
Strahlenther Onkol ; 195(3): 246-253, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30353350

RESUMO

PURPOSE: To evaluate the feasibility and toxicity profile of repeated stereotactic body radiotherapy (SBRT) for recurrent primary or secondary liver tumors. METHODS: Consecutive patients with primary (hepatocellular carcinoma [HCC] or cholangiocarcinoma [CCC]) or secondary liver cancer (LM), with intrahepatic recurrence or progression after SBRT, underwent re-SBRT in 3 to 12 fractions with a median time of 15 (range 2-66) months between treatments. RESULTS: In all, 24 patients which were previously treated with SBRT (30 lesions) were retreated with SBRT for "in- and out-of-field" recurrences (2nd SBRT: n = 28, 3rd SBRT: n = 2). The median follow-up after re-irradiation was 14 months. The median prescribed dose for the first SBRT was 46.5 (range 33-66 Gy, EQD210 = 70.5) Gy and 48 (range 27-66 Gy, EQD210 = 71) Gy for the re-SBRT. The median mean liver dose (Dmean, liver) was 6 Gy (range 1-25, EQD22 = 7 Gy) for the first SBRT and 10 Gy (range 1-63 Gy, EQD22 = 9 Gy) for the re-SBRT. Of the 30 re-irradiated lesions 6 were re-irradiated in-field resulting in a median EQD22, maximum of 359 (range 120-500) Gy for both treatments, with an α/ß = 2 to account for liver parenchyma. Treatment was well tolerated. Two patients with stent placement before SBRT developed cholangitis 4 and 14 months after re-SBRT. There were no elevations of the serum liver parameters after re-SBRT. One patient developed a grade 3 gastrointestinal bleeding. There was no radiation induced liver disease (RILD) observed. CONCLUSIONS: Repeated liver SBRT is feasible, without excessive liver toxicity, when there is no considerable overlapping with pre-irradiated portions of the stomach or bowel and enough time for the liver to regenerate.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Carcinoma Hepatocelular/radioterapia , Colangiocarcinoma/radioterapia , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/radioterapia , Retratamento
12.
Rofo ; 191(1): 48-53, 2019 Jan.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-30308690

RESUMO

PURPOSE: To evaluate the safety and feasibility of sonographically-assisted catheter placement in interstitial high-dose-rate brachytherapy of abdominal malignancies. MATERIALS AND METHODS: In an initial cohort of 12 patients and 16 abdominal tumors (colorectal liver metastases n = 9; renal cell cancer n = 3; hepatocellular carcinoma n = 2; cholangiocellular carcinoma n = 2), initial puncture and catheter placement for CT-guided brachytherapy were performed under sonographic assistance when possible. The interventional procedure was prospectively recorded and in-patient data were collected. All data underwent descriptive statistics and comparative analysis by the Mann-Whitney test. RESULTS: In 12 out of 16 lesions (diameter 1.5 - 12.9 cm), initial puncture was successfully achieved under ultrasound guidance without utilization of CT fluoroscopy, yielding a significantly shorter mean total fluoroscopy time (14.5 vs. 105.5 s; p = 0.006). In 8 lesions visibility was rated better in ultrasound than in CT fluoroscopy (p = 0.2). No major or minor complications occurred within 30 days after treatment. CONCLUSION: Ultrasound-assisted catheter placement during interstitial CT-guided brachytherapy of abdominal tumors could improve catheter positioning and reduce radiation exposure for medical staff. KEY POINTS: Ultrasound-assisted catheter placement in CT-guided brachytherapy is safe and feasible. Ultrasound puncture may improve catheter positioning. Reduced CT fluoroscopy time can significantly help to minimize radiation exposure for medical staff. CITATION FORMAT: · Damm R, El-Sanosy S, Omari J et al. Ultrasound-assisted catheter placement in CT-guided HDR brachytherapy for the local ablation of abdominal malignancies: Initial experience. Fortschr Röntgenstr 2019; 191: 48 - 53.


Assuntos
Braquiterapia/métodos , Cateterismo/métodos , Neoplasias Renais/radioterapia , Neoplasias Hepáticas/radioterapia , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Idoso , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/radioterapia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/radioterapia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/radioterapia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/radioterapia , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Estudos Prospectivos
13.
Strahlenther Onkol ; 195(2): 93-102, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30206644

RESUMO

PURPOSE: Non-surgical treatment including stereotactic body radiation therapy (SBRT) have been used practically as alternative modalities for unresectable or recurrent cholangiocarcinoma (CC). We performed a systematic review and meta-analysis to examine the efficacy of SBRT for such patients. METHODS: Embase, PubMed, MEDLINE, and Cochrane library databases were searched systematically until October 2017. Primary endpoint was 1­year local control (LC) rate; 1­year overall survival (OS), response rates, and grade ≥3 toxicities were assessed as secondary endpoints. RESULTS: Eleven studies (226 patients) were included. The prescribed median SBRT dose was 45 (range 30-55) Gy in 3-5 fractions. The pooled 1­year LC rate was 81.8% (95% confidence interval [CI] 69.4-89.9%) in the studies using an equivalent dose in 2 Gy per fraction (EQD2) ≥71.3 Gy2 and 74.7% (95% CI 57.1-86.7%) in the studies using an EQD2 <71.3 Gy2. The median OS was 13.6 (range 10-35.5) months. The pooled 1­year OS rate was 53.8% (95% CI 44.9-62.5%) and the pooled 1­year LC rate was 78.6% (95% CI 69.0-85.8%). Most common toxicity was duodenal ulcer and gastric ulcer in available studies, with the acute incidence of grade ≥3 of less than 10% and the late incidence of 10-20%. CONCLUSIONS: SBRT was a feasible treatment option with respect to achieving a high LC for unresectable or recurrent CC. Gastrointestinal toxicity is acceptable, but remains an obstacle related to dose escalation.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/radioterapia , Recidiva Local de Neoplasia/radioterapia , Radiocirurgia/métodos , Neoplasias dos Ductos Biliares/mortalidade , Colangiocarcinoma/mortalidade , Estudos de Viabilidade , Humanos , Recidiva Local de Neoplasia/mortalidade , Dosagem Radioterapêutica , Taxa de Sobrevida , Resultado do Tratamento
15.
Semin Radiat Oncol ; 28(4): 267-276, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30309637

RESUMO

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) comprise the majority of primary liver cancers. Both HCC and ICC have characteristic imaging appearances on multiphase computed tomography (CT) and magnetic resonance imaging (MRI). Several locoregional therapies, including radiation therapy, are used to treat unresectable disease and residual or recurrent tumor. The tumor response following locoregional therapies has variable imaging manifestations. Focal liver reaction, the imaging changes of the liver following radiation treatment, should be recognized and not mistaken for tumor. We review the diagnostic imaging of HCC and ICC, imaging of tumor response to treatment, and imaging of the liver response to radiation.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/radioterapia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/radioterapia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Humanos
16.
Anticancer Res ; 38(10): 5843-5852, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30275209

RESUMO

BACKGROUND/AIM: Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose of this study was to evaluate the local tumor control (LTC) of CT-guided High-Dose-Rate-Brachytherapy (CT-HDRBT) for ablation of cholangiocarcinomas (CCA) ≥4 cm compared to smaller tumors. PATIENTS AND METHODS: Sixty-one patients (tumors: 142, interventions: 91) were treated from March 2008 to January 2017. LTC, progression-free survival (PFS) and overall survival (OS) after first CT-HDRBT were identified for two subgroups (A:<4 cm, B:≥4 cm) and the influence of coverage and target-dose were evaluated. Log-Rank- and Mann-Whitney-U-Tests were performed for statistical analyses with p-values <0.05 considered as significant. RESULTS: Better coverage was achieved for smaller tumors (A: 99.22-0.25%, B: 95.10-1.40%, p<0.001). LTC was better in subgroup A (A: 8, B: 6 months, p=0.006). Larger tumors (4-7 cm) with incomplete coverage showed the poorest LTC (p=0.032). There were no statistical significances in PFS (A: 5, B: 3 months, p=0.597) and OS (A:15.5; B:10.0 months, p=0.107). CONCLUSION: CT-HDRBT is sufficient in CCA ≥4 cm, if full coverage with therapeutic doses can be achieved.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Braquiterapia , Colangiocarcinoma/radioterapia , Radioisótopos de Irídio/uso terapêutico , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/patologia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Dosagem Radioterapêutica , Taxa de Sobrevida
17.
PLoS One ; 13(10): e0204013, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30304045

RESUMO

PURPOSE: To study the potential of (99m)Tc-Mebrofenin hepatobiliary scintigraphy (HBS) in identifying the short-term variations of liver function after stereotactic body radiotherapy (SBRT) for liver cancers. MATERIAL AND METHODS: We treated with SBRT 3 patients (pts) affected by a cholangiocarcinoma and 3 patient presenting liver metastases (3x15 Gy, 4 pts; 5x8 Gy, 1 pt; 6x5 Gy, 1 pt). All patients received HBS before and 3 months after SBRT, which were co-registered with the simulation CT-scan. Structures corresponding to isodoses from 10-90 Gy were created, with intervals of 10 Gy. Finally, the variations of the mean activity (MBq) in each isodose structure have been calculated. Then, a linear regression analysis was performed. RESULTS: We showed a linear reduction of the activity, significantly related to the delivered dose (p<0.01), and a reduction of the perfusion of 0.78% for each delivered Gy. The linear equation has predictive value of the loss of the function of 96% (R2 = 0.9605). CONCLUSIONS: HBS could improve treatment plans for liver SBRT, by allowing the identification of the liver function variations after SBRT and, potentially, the prediction of remnant liver function after SBRT. These preliminary results should be confirmed on long-term prospective data and larger population.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/radioterapia , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Cintilografia/métodos , Radiocirurgia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Humanos , Iminoácidos/administração & dosagem , Modelos Lineares , Testes de Função Hepática , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio/administração & dosagem , Projetos Piloto , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Cancer Med ; 7(10): 4880-4892, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30152073

RESUMO

PURPOSE: To evaluate the effect of escalated dose radiation therapy (EDR, defined as doses >50.4 Gy in 28 fractions [59.5 Gy BED]) on overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) of patients with unresectable extrahepatic cholangiocarcinoma (EHCC). METHODS: A consecutive cohort of 80 patients who underwent radiotherapy for unresectable EHCC from 2001 to 2015 was identified. Demographic, tumor, treatment, toxicity, and laboratory variables were collected. The maximal RT doses ranged from 30 to 75 Gy (median 50.4 Gy, at 1.8-4.5 Gy/fraction). Gross tumor volume (GTV) coverage by maximal dose in EDR group ranged from 38% to 100%. Kaplan-Meier method was used to estimate OS, FFLP, and FFDP. Univariate and multivariate Cox regression models were analyzed. RESULTS: After radiotherapy, median OS, FFLP, and FFDP were 18.7, 22.6, and 24.3 months, respectively. There was no significant difference in OS or FFLP between patients who received EDR to portions of the GTV and patients who did not. On multivariate analysis, bigger GTV, age, and ECOG performance status were independently associated with shorter OS. Local progression on chemotherapy prior to RT was independently associated with shorter FFLP. High baseline neutrophil/lymphocyte ratio (>5.3) was independently associated with shorter FFDP. Toxicity grades were similar in EDR and lower doses except lymphopenia which was higher in EDR (P = 0.053). CONCLUSIONS: EDR to selective portions of the GTV may not benefit patients with unresectable EHCC despite having acceptable toxicity. New methods to improve local control and survival for unresectable EHCC are needed.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Colangiocarcinoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Sobrevida , Resultado do Tratamento
20.
Strahlenther Onkol ; 194(11): 1017-1029, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30105451

RESUMO

PURPOSE: We investigated whether external beam radiotherapy (EBRT) could induce compensatory liver hypertrophy in liver cancers and assessed related clinical factors. METHODS: A total of 82 consecutive patients receiving EBRT for hepatocellular carcinoma (n = 77) or cholangiocarcinoma (n = 5) from April 2012 to June 2014 were recruited and divided into two subgroups according to tumor location in the right or left lobe. The left lateral and right lobes were considered as unirradiated volumes accordingly. Total liver volume (TLV), nontumor liver volume (NLV), left and right lobe whole volume (LLWV and RLWV, respectively), volume of liver irradiated < 30 Gy (V< 30 Gy), Child-Pugh (CPS) score, future liver remnant (FLR) ratio, and percentage of FLR hypertrophy from baseline (%FLR) were assessed. RESULTS: In the right lobe group, %FLR hypertrophy and LLWV increased significantly at all follow-ups (p < 0.001). %FLR hypertrophy steadily increased until the fourth follow-up. Multivariate analysis showed that the factor associated with maximum %FLR hypertrophy was tumor extent (upper or lower lobe vs. both lobes; p = 0.022). Post-RT treatments including transarterial chemoembolization or hepatic arterial infusion chemotherapy were associated with a CPS increase ≥ 2 (p = 0.002). Analysis of the RT only subgroup also showed a significant increase of %FLR until the fourth follow-up (p < 0.001). In the left lobe group, %FLR hypertrophy and RLWV showed no significant changes during follow-up. CONCLUSION: Significant compensatory hypertrophy of the liver was observed, with a steady increase of %FLR hypertrophy until the fourth follow-up (median: 396 days). Locally advanced tumors extending across the upper and lower right lobe were a significant factor for compensating hypertrophy after EBRT.


Assuntos
Neoplasias dos Ductos Biliares/radioterapia , Carcinoma Hepatocelular/radioterapia , Colangiocarcinoma/radioterapia , Neoplasias Hepáticas/radioterapia , Fígado/patologia , Fígado/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioembolização Terapêutica , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Seguimentos , Humanos , Infusões Intra-Arteriais , Falência Hepática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tamanho do Órgão/efeitos da radiação , Estudos Retrospectivos
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