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1.
J Healthc Eng ; 2022: 4998997, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35422981

RESUMO

Background: This retrospective study aimed to evaluate the radiation dose delivered to dental structures in intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) without dental dose constraints, compare the dosimetry differences of dental structures between the two radiation techniques, and determine whether dental structures should be one of the organs at risk for IMRT and VMAT plans according to the dosimetric analysis. Materials and Methods: A total of 138 head and neck cancer patients (nasopharyngeal, oral cavity, pharyngeal, hypopharynx, and larynx), who underwent IMRT (69 patients) or VMAT (69 patients) from March 2016 to March 2021 in our hospital, were included to assess the dosimetry difference between two radiotherapy techniques for dental structures. Results: The radiation dose delivered by IMRT and the mean maximum doses delivered by VMAT to the maxillary teeth of nasopharyngeal cancer patients were significantly higher than the dose received by the mandibular teeth. In contrast, the mandibular teeth of oral cavity cancer, oropharynx cancer, and laryngeal cancer received higher radiation doses than maxillary teeth. Except for mandibular teeth of oral cancer patients, the molars received significantly high-dose radiation than premolars and/or incisors in both radiotherapy techniques. No significant difference was observed between IMRT and VMAT in the dosimetric comparison of dental structures, except that oral cavity cancer patients treated with VMAT received a significantly higher mean average dose than those treated with IMRT. When PTV included level Ib, the radiation doses of the mandibular teeth delivered by both radiotherapy techniques were significantly higher than that in PTV when level Ib was excluded. Conclusion: Without dental dose constraints, no major difference was observed between IMRT and VMAT plans in tooth dose distribution. We suggest that dental structures should be delineated as part of the organ at risk (OAR) when IMRT and VMAT are planned. Meanwhile, attention should be paid to dental structures that might have a high-dose area according to the specific tumor location.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Nasofaríngeas/etiologia , Órgãos em Risco , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
2.
Am J Clin Oncol ; 45(5): 190-195, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35446278

RESUMO

OBJECTIVES: In the era of dose-escalated prostate radiation therapy (RT), the use of androgen deprivation therapy (ADT) is undefined for intermediate-risk (IR) prostate cancer. There is growing concern of the risk of ADT to be detrimental to quality of life. This single-institution retrospective analysis aimed to evaluate outcomes of IR patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with or without concurrent/adjuvant short-term ADT. MATERIALS AND METHODS: Data was collected from 260 consecutive patients treated with dose-escalated IMRT with daily image-guided RT for newly diagnosed IR prostate cancer. Biochemical recurrence-free survival (BCRFS), distant metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were calculated using Kaplan-Meier methodology. RESULTS: Median follow-up was 93 months. A total of 181 patients had unfavorable IR disease, and 36.2% (N=94) received ADT, with median ADT duration of 6 months. Seven-year BCRFS was 94.1% vs. 86.2% (P=0.067), for ADT and no ADT, respectively, and no difference in distant metastasis-free survival or prostate cancer-specific survival was observed. ADT was associated with significantly worse 7-year OS (80.0% vs. 91.3%, P=0.010). Analysis of the unfavorable IR cohort alone, showed similar results; 7-year BCRFS and 7-year OS in patients who received ADT versus no ADT were 93.7% vs. 85.9% (P=0.093), and 79.0% vs. 90.6% (P=0.019), respectively. CONCLUSIONS: In our 15-year experience treating IR prostate cancer with dose-escalated IMRT with daily image-guided RT, short-term concurrent ADT was associated with a statistically significant worse OS. Additional studies are needed to determine if ADT is beneficial or detrimental for patients with IR prostate cancer treated with dose-escalated radiation.


Assuntos
Neoplasias da Próstata , Radioterapia de Intensidade Modulada , Antagonistas de Androgênios/uso terapêutico , Humanos , Masculino , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Qualidade de Vida , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos
3.
Nagoya J Med Sci ; 84(1): 180-184, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35392013

RESUMO

A 71-year-old man with stage IIB (Union for International Cancer Control, 8th edition) non-small cell lung cancer underwent intensity-modulated radiation therapy with a dose of 66 Gy administered in 33 fractions concomitant with carboplatin and paclitaxel therapy. On computed tomography after completion of radiation therapy, ground-glass opacity, which was larger on the contralateral side, was observed, but it was not observed in the high-dose area on the ipsilateral side. Although the adverse event theoretically shows dose dependency, it was finally diagnosed as radiation pneumonitis. The presence of an atypical distribution of radiation pneumonitis should be recognized to improve the diagnosis, and it is suggested that the relative volume of the normal contralateral lung receiving a dose of ≥5 Gy is a possible risk factor for radiation pneumonitis.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Pneumonite por Radiação , Radioterapia de Intensidade Modulada , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Pneumonite por Radiação/diagnóstico , Pneumonite por Radiação/tratamento farmacológico , Pneumonite por Radiação/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos
4.
Radiat Oncol ; 17(1): 70, 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35392934

RESUMO

OBJECTIVES: To quantify the pelvic bone marrow (PBM) fat content changes receiving different radiation doses of concurrent chemoradiotherapy for cervical cancer and to determine association with peripheral blood cell counts. METHODS: The data of 54 patients were prospectively collected. Patients underwent MRI iterative decomposition of water and fat with echo asymmetrical and least squares estimation (IDEAL IQ) scanning at RT-Pre, RT mid-point, RT end, and six months. The changes in proton density fat fraction (PDFF%) at 5-10 Gy, 10-15 Gy, 15-20 Gy, 20-30 Gy, 30-40 Gy, 40-50 Gy, and > 50 Gy doses were analyzed. Spearman's rank correlations were performed between peripheral blood cell counts versus the differences in PDFF% at different dose gradients before and after treatment. RESULTS: The lymphocytes (ALC) nadirs appeared at the midpoint of radiotherapy, which was only 27.6% of RT-Pre; the white blood cells (WBC), neutrophils (ANC), and platelets (PLT) nadirs appeared at the end of radiotherapy which was 52.4%, 65.1%, and 69.3% of RT-Pre, respectively. At RT mid-point and RT-end, PDFF% increased by 46.8% and 58.5%, respectively. Six months after radiotherapy, PDFF% decreased by 4.71% under 5-30 Gy compared to RT-end, while it still increased by 55.95% compared to RT-Pre. There was a significant positive correlation between PDFF% and ANC nadirs at 5-10 Gy (r = 0.62, P = 0.006), and correlation was observed between PDFF% and ALC nadirs at 5-10 Gy (r = 0.554, P = 0.017). CONCLUSION: MRI IDEAL IQ imaging is a non-invasive approach to evaluate and track the changes of PBM fat content with concurrent chemoradiotherapy for cervical cancer. The limitation of low-dose bone marrow irradiation volume in cervical cancer concurrent chemoradiotherapy should be paid more attention to.


Assuntos
Radioterapia de Intensidade Modulada , Neoplasias do Colo do Útero , Medula Óssea/diagnóstico por imagem , Medula Óssea/efeitos da radiação , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Feminino , Humanos , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia
5.
J Cancer Res Ther ; 18(1): 81-83, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35381766

RESUMO

Introduction: Dysphagia and xerostomia are the main sequelae of radiotherapy for head and neck cancer (HNC) and the main factors in reducing the longterm patient quality of life. Intensitymodulated radiotherapy (IMRT) uses advanced technology to focus the high radiation doses on the targets and avoid irradiation of noninvolved tissues. Material and Methods: During 2016-2017, 44 patients of locally advanced HNCs were treated with a curative intent with IMRT. They were in the age range of 65-75 years. The median age was 69 years. Thirtyfive patients were male and nine patients were female. Histopathologically, all had squamous cell carcinoma. Stage wise all were T3N2 or more. No concurrent chemotherapy was given. The Eastern Clinical Oncology Group criteria were used for grading the toxicities. Patients were assessed after 4 weeks of completion of treatment. Results and Conclusion: The incidence of mucositis was of Grade 1-2 in 37 patients. Moreover, patients experienced severe mucositis. Six patients had treatment interruptions due to mucositis. Xerostomia was Grade 1-2 in 42 patients and Grade 3 in 2 patients. Dysphagia was Grade 1-2 only. No hematological toxicity was seen. Patients having dysphagia during the treatment were given nasogastric feed. Response wise 14 patients achieved complete response, 28 patients had partial response, and 2 had stable disease. There was no treatmentrelated mortality.


Assuntos
Neoplasias de Cabeça e Pescoço , Radioterapia de Intensidade Modulada , Xerostomia , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Incidência , Masculino , Qualidade de Vida , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Xerostomia/epidemiologia , Xerostomia/etiologia
6.
J Cancer Res Ther ; 18(1): 84-88, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35381767

RESUMO

Purpose: Radiation dermatitis is most common and debilitating side effects of radiotherapy leading to treatment interruption, thereby compromising the local control, and effecting quality of life. With the invent of modern imaging and recent advances in megavoltage radiotherapy, radiation-related side effects have reduced. In this audit, we report the risk factors associated with Grade III dermatitis in modern centers. Materials and Methods: We analyzed 172 patients treated with volume modulated arc therapy (VMAT) and static field intensity-modulated radiotherapy (SFIMRT) at our center. All head and neck, breast, gynecological, GU malignancies, and sarcoma patients treated with a dose of >45 Gy from April 2018 to December 2019 were included in the study. On couch, treatment verification was done with cone-beam computer tomography (CBCT). Slice-by-slice verification of planning target volume (PTV) with CBCT was done in the first three fractions and weekly thereafter. Skin evaluation was done using CTCAE v. 5. Statistical analysis was done using SPSS v. 22. Results: Of the 172 patients treated with VMAT and SFIMRT, 15 patients (8.7%) had Grade III dermatitis. Grade III dermatitis was mostly seen in breast cancer followed by head-and-neck patients. More reactions were observed in patients with advanced stage disease. Treatment verification is important at the later course of treatment, especially in head-and-neck cases where the treatment volume is large and PTV may extend outside skin. Contributing factors of radiation dermatitis at modern radiotherapy center are gene mutation, use of concurrent chemoradiotherapy, and bolus. Conclusion: We hereby conclude that PTV mismatch in weekly treatment verification, genetic mutations, concurrent chemo-radiotherapy, use of thermoplastic mask, and bolus are the contributing factors for Grade III dermatitis in modern radiotherapy centers.


Assuntos
Radioterapia (Especialidade) , Radioterapia de Intensidade Modulada , Humanos , Qualidade de Vida , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos
7.
Pediatr Blood Cancer ; 69(6): e29689, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35373904

RESUMO

INTRODUCTION: Total body irradiation (TBI) is an important component of many conditioning regimens for hematopoietic stem cell transplantation (HSCT), most commonly used in pediatric and adolescent/young adult (AYA) patients. We aimed to evaluate outcomes and toxicities among pediatric and AYA patients treated with TBI utilizing volumetric modulated arc therapy total body irradiation (VMAT-TBI). METHODS: We reviewed pediatric and AYA patients treated with VMAT-TBI at our institution from 2019 to 2021. Data on patient and disease characteristics, treatment details, outcomes and toxicities were collected. Overall survival (OS) and relapse-free survival (RFS) were analyzed using the Kaplan-Meier method. RESULTS: Among 38 patients, 16 (42.1%) were treated with myeloablative regimens and 22 (57.9%) with nonmyeloablative regimens. Median age was 7.2 years (range: 1-27) and median follow-up was 8.7 months (range: 1-21). Lungs Dmean was 7.3 ± 0.3 Gy for myeloablative regimens (range: 6.8-7.8). Kidneys were spared to average mean dose of 71.4 ± 4.8% of prescription dose. Gonadal sparing was achieved for patients treated for nonmalignant diseases to Dmean of 0.7 ± 0.1 Gy. No patient experienced primary graft failure; one (2.6%) experienced secondary graft failure. The most common grade 1-2 acute toxicities were nausea (68.4%) and fatigue (55.3%). Mucositis was the most common grade 3-4 acute toxicity, affecting 39.5% of patients. There were no cases of pneumonitis or nephrotoxicity attributable to TBI. CONCLUSION: VMAT-TBI offers increased ability to spare organs at risk in pediatric and AYA patients undergoing HSCT, with a favorable acute/subacute toxicity profile and excellent disease control.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Radioterapia de Intensidade Modulada , Adolescente , Criança , Humanos , Recidiva Local de Neoplasia/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodos , Irradiação Corporal Total/métodos , Adulto Jovem
8.
Cancer Epidemiol Biomarkers Prev ; 31(5): 1119-1129, 2022 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-35391491

RESUMO

BACKGROUND: We aim at describing the incidence, potential predisposing factors, and progression of major radiotherapy-related neurologic complications (RRNC) in nasopharyngeal carcinoma (NPC)-endemic regions, especially southern China. METHODS: We performed a multicenter longitudinal retrospective study with clinical follow-ups in 22,302 patients with post-radiotherapy NPC between January 2003 and June 2017 covering three major residential areas. Epidemiology, potential predisposing/protective factors, clinicopathologic progression, and survival conditions of each RRNC were separately recorded and analyzed on the basis of their related clinical, radiologic, and laboratory parameters. RESULTS: 949 new cases of RRNCs occurred among the 22,302 patients with post-radiotherapy NPC during 101,714 person years' follow-up, which is equal to an incidence density rate of 9.3 new cases per 1000 person year. Radiation-induced cranial nerve palsy showed the highest incidence (2.68%, 597/22,302) with the earliest onset (median latency, 4.45 years) as well. Patients benefited from intensity-modulated radiotherapy (IMRT) over conventional radiotherapy (CRT) in both overall survival (median survival 13.2 years for IMRT vs. 8.3 years for CRT) and RRNC-free survival (except for epilepsy and cranial nerve palsy). Causes of death varied substantially between patients with or without RRNCs. CONCLUSIONS: Our study indicates a non-negligible incidence of RRNC spectrum in southern China in the past ten years. IMRT is one of the most significant protectors against development and progression of RRNCs. IMPACT: Our findings support the hypothesis that patients with NPC with preexisting predispositions would receive long-term benefits from IMRT and other dose-related modulations (like hyperfractionation and dose conformation).


Assuntos
Neoplasias Nasofaríngeas , Lesões por Radiação , Radioterapia de Intensidade Modulada , China/epidemiologia , Humanos , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/epidemiologia , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/epidemiologia , Lesões por Radiação/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos
9.
J Healthc Eng ; 2022: 9367919, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35313514

RESUMO

To examine the influences of bevacizumab combined with intensity-modulated radiation therapy (IMRT) on postoperative brain glioma, particularly its impact on coagulation function and cognitive function, the complete clinical data of 156 patients undergoing glioma surgery in the neurosurgery department of our hospital between March 2015 and October 2018 were retrospectively analyzed. All patients underwent glioma surgery and were then assigned to the observation group (Obs group, n = 79, received bevacizumab combined with IMRT) or the control group (Con group, n = 77, received IMRT without bevacizumab) for analysis during postoperative treatment. The patients' short-term efficacy was evaluated, and their serum markers and coagulation function were compared, as well as the cognitive function, the occurrence of adverse reactions during treatment, the Karnofsky performance status (KPS) score, and quality of life after treatment. Patients' survival was followed up within 2 years after surgery. The Obs group showed a notably higher clinical remission rate and clinical control rate (DCR) than the Con group after treatment. The Obs group showed notably lower levels of interleukin-2 (IL-2), vascular endothelial growth factor (VEGF), IL-6, and epidermal growth factor (EGF), experienced notably shorter prothrombin time (PT) and activated partial thromboplastin time (APTT), and showed higher fibrinogen (FIB) and D-dimer (D-D) levels than Con group. The Obs group showed notably better cognitive function, KPS score, and quality of life than the Con group, but no notable difference was observed between them in the incidence of adverse reactions (P > 0.0500). The survival rates in the Obs group were higher than in the Con group. For patients with glioma, postoperative bevacizumab combined with IMRT delivers substantially higher clinical efficacy by lowering serum marker levels and improving cognitive function without significantly affecting coagulation function.


Assuntos
Glioma , Radioterapia de Intensidade Modulada , Bevacizumab/uso terapêutico , Cognição , Glioma/tratamento farmacológico , Glioma/radioterapia , Glioma/cirurgia , Humanos , Qualidade de Vida , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/uso terapêutico
10.
Head Neck ; 44(5): 1213-1222, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35243719

RESUMO

BACKGROUND: Submandibular gland (SMG) transfer decreased radiation-associated xerostomia in the 2/3-dimensional radiotherapy era. We evaluated the dosimetric implications of SMG transfer on modern intensity modulated radiotherapy (IMRT) plans. METHODS: Eighteen oropharynx cancer patients underwent SMG transfer followed by IMRT; reoptimized plans using the baseline SMG location were generated. Mean salivary gland, oral cavity, and larynx doses were compared between clinical plans and reoptimized plans. RESULTS: No statistically significant difference in mean SMG dose (27.53 Gy vs. 29.61 Gy) or total salivary gland dose (26.12 Gy vs. 26.41 Gy) was observed with or without SMG transfer (all p > 0.05). Mean oral cavity and larynx doses were not statistically different. Neither tumor site, target volume crossing midline, stage, nor salivary gland volumes were associated with mean doses. CONCLUSIONS: Salivary gland doses were similar with or without SMG transfer. IMRT likely decreases the benefit of SMG transfer on the risk of radiation-associated xerostomia.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Radioterapia de Intensidade Modulada , Xerostomia , Humanos , Neoplasias Orofaríngeas/radioterapia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Glândula Submandibular , Xerostomia/etiologia , Xerostomia/prevenção & controle
11.
J Healthc Eng ; 2022: 2531671, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35310190

RESUMO

Aim: The paper aims to combine mathematical statistics to assess the effect of nutritional intervention in the population of nasopharyngeal cancer patients. Methodology. After following the inclusion and exclusion criteria, a total of 120 patients with nasopharyngeal carcinoma were selected. All patients are treated with intensity-modulated radiotherapy (IMRT). The nurse collects relevant clinical treatment data during the radiotherapy of the patient. After the patient's radiotherapy, the nurse remeasures the patient's nutritional status indicators. Three months after the completion of radiotherapy, the patient will be reexamined by MRI, and the radiotherapist will assess the patient's radiosensitivity based on the results of the MRI examination. All the blood biochemical indicators and body measurement indicators were also assessed and coordinated with nasopharyngeal carcinoma patients. This study performs multiple linear regression analysis on treatment-related factors that affect nutritional status during radiotherapy. Results: The experimental results showed that the side effects of radiotherapy are independent influencing factors of nutritional status. Radiotherapy damages the DNA of cells, so that cells cannot continue to divide and grow, and all cells in the treatment area were affected by radiation. The standard radiotherapy treatment is quite long, and the oral cavity, throat, and parotid gland, are all within the irradiation range. In addition to killing the tumor cells, the radiation can also cause certain damage to the surrounding tissues of the tumor. This article takes radiosensitivity as the dependent variable (insensitivity = 0; sensitivity = 1) and takes the nutritional index NI, age, gender, education level, marriage, smoking, chronic disease history, TNM staging, whether the chemotherapy steps are the same or not, GTVnx prescription dose, and the number of radiotherapies as independent variables. AMC, albumin, hemoglobin, serum prealbumin, and transferrin are all correlated with radiosensitivity, which is consistent with the results of most studies. The results of multivariate logistic regression analysis showed that nutritional index (NI) was correlated with the radiosensitivity of nasopharyngeal carcinoma. Conclusion: Finally, this paper concludes that nutritional intervention has a certain effect on the treatment of patients with nasopharyngeal carcinoma.


Assuntos
Carcinoma , Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Carcinoma/radioterapia , Humanos , Carcinoma Nasofaríngeo/etiologia , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
12.
Sci Rep ; 12(1): 4355, 2022 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-35288619

RESUMO

Cutaneous angiosarcomas is a rare cancer with poor prognoses. The common radiotherapy techniques that have been reported so far are two pairs of lateral X-ray and electron fields. However, it is quite difficult to irradiate scalp angiosarcomas (SAs) homogeneously with this technique. In this study, safety, effectiveness, and risk factors were assessed for localized SAs ≥ 5 cm treated with intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) with boluses. Sixty-eight angiosarcoma patients who had received radiotherapy in our institution between January 2007 and November 2020 were retrieved from our radiotherapy database. Of these patients, 27 localized SA patients were included in the retrospective analysis. The 2-year overall survival, local progression-free rate, and distant metastases-free survival were 41.8%, 48.4%, and 33.1%. All the patients experienced acute radiation dermatitis ≥ grade 2, with18 (66.7%) ≥ grade 3. No nodule lesion was a significant unfavorable predictive factor of acute radiation dermatitis ≥ grade 3. Tumor bleeding at the initiation of radiotherapy and tumor invasion to the face were significant predictive factors of overall survival, and tumor bleeding at the initiation of radiotherapy was also a significant predictive factor of local progression-free rate.


Assuntos
Dermatite , Hemangiossarcoma , Radioterapia de Intensidade Modulada , Dermatite/etiologia , Hemangiossarcoma/radioterapia , Humanos , Prognóstico , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Couro Cabeludo
13.
Pediatr Blood Cancer ; 69(5): e29600, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35234340

RESUMO

BACKGROUND: It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. PROCEDURE: Patients aged ≤21 years treated with IMRT between 1998 and 2009 and who survived ≥5 years after IMRT were included. SMN site in relation to isodose level (IDL) of IMRT was evaluated. Standardized incidence ratios (SIR) and excess absolute risks (EAR) were calculated. Cumulative incidences were estimated with death as a competing risk. RESULTS: Three-hundred twenty-five patients were included with median follow-up of 11.2 years from IMRT (interquartile range: 9.4-14.0) among patients alive at the end of follow-up. Two hundred (62%) patients had ≥10 years of follow-up and 284 (87%) patients were alive at the time of analysis. Fifteen patients developed SMNs (11 solid, four hematologic). Median time from IMRT to solid SMN was 11.0 years (range: 6.8-19.2) with 10- and 15-year cumulative incidences 1.8% (95% CI: 0.7-3.9) and 3.5% (95% CI: 1.4-7.5), respectively; SIR was 13.7 (95% CI: 6.9-24.6) and EAR was 2.8 per 1000 person-years (95% CI: 1.0-4.6). Eight solid SMNs developed within the IMRT field (100% IDL [n = 5], 80% IDL [n = 1], 50% IDL [n = 1], 40% IDL [n = 1]), one within the 70%-80% IDL of a conventional field, one was out-of-field, and one could not be determined. CONCLUSIONS: With median follow-up of >10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high-dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).


Assuntos
Sobreviventes de Câncer , Segunda Neoplasia Primária , Neoplasias , Radioterapia de Intensidade Modulada , Criança , Seguimentos , Humanos , Neoplasias/radioterapia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos
14.
Sci Rep ; 12(1): 4167, 2022 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-35264614

RESUMO

The aim of this study is to demonstrate the feasibility of a commercially available Auto-Planning module for the radiation therapy treatment planning for locally advanced nasopharyngeal carcinoma (NPC). 22 patients with locally advanced NPC were included in this study. For each patient, volumetric modulated arc therapy (VMAT) plans were generated both manually by an experienced physicist and automatically by the Auto-Planning module. The dose distribution, dosimetric parameters, monitor units and planning time were compared between automatic plans (APs) and manual plans (MPs). Meanwhile, the overall stage of disease was factored into the evaluation. The target dose coverage of APs was comparable to that of MPs. For the organs at risk (OARs) except spinal cord, the dose parameters of APs were superior to that of MPs. The Dmax and V50 of brainstem were statistically lower by 1.0 Gy and 1.32% respectively, while the Dmax of optic nerves and chiasm were also lower in the APs (p < 0.05). The APs provided a similar or superior quality to MPs in most cases, except for several patients with stage IV disease. The dose differences for most OARs were similar between the two types of plans regardless of stage while the APs provided better brainstem sparing for patients with stage III and improved the sparing of the parotid glands for stage IV patients. The total monitor units and planning time were significantly reduced in the APs. Auto-Planning is feasible for the VMAT treatment planning for locally advanced NPC.


Assuntos
Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Humanos , Carcinoma Nasofaríngeo/etiologia , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/patologia , Órgãos em Risco/patologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada/efeitos adversos
15.
Cancer Invest ; 40(5): 437-441, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35236196

RESUMO

The purpose of this study was to investigate the efficacy and feasibility of high-dose (72.6 Gy) planned adaptive intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) for 9 consecutive patients with synchronous oligometastatic pancreatic ductal adenocarcinoma (PDAC). The estimated 2-year overall survival rate was 66.7%, and the local progression-free survival at 2 years was 83.3%. No severe adverse events were observed. Planned adaptive dose-escalated IMRT-SIB has the potential to improve local control rate and prolong overall survival in patients with synchronous oligometastatic PDAC.


Assuntos
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Radioterapia de Intensidade Modulada , Carcinoma Ductal Pancreático/radioterapia , Humanos , Neoplasias Pancreáticas/radioterapia , Intervalo Livre de Progressão , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos
16.
Oncologist ; 27(1): 40-47, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-35305097

RESUMO

BACKGROUND: Although intensity-modulated radiation therapy (IMRT) is considered the standard of care for the treatment of squamous cell carcinoma of the anus (SCCA), few large series have reported oncologic outcomes and toxicities. In this retrospective report, we aim to describe outcomes and toxicities after IMRT-based chemoradiation (CRT) for the treatment of SCCA, evaluate the impact of dose escalation (>54 Gy), and compare concurrent fluoropyrimidine in combination with either mitomycin or with cisplatin as chemosensitizers. METHODS: Patients treated at The University of Texas MD Anderson Cancer Center between January 1, 2003 and December 31, 2018 with IMRT-based CRT were included. Median time to locoregional recurrence, time to colostomy, and overall survival were estimated using the Kaplan-Meier method. RESULTS: A total of 428 patients were included; median follow-up was 4.4 years. Three hundred and thirty-four patients (78.0%) were treated with concurrent cisplatin and fluoropyrimidine, and 160 (37.4%) with >54 Gy. Two- and 5-year freedom from locoregional failure, freedom from colostomy failure, and overall survival were 86.5% and 81.2%, respectively, 90.0% and 88.3%, respectively, and 93.6% and 85.8%, respectively. Neither dose escalation nor mitomycin-based concurrent chemotherapy resulted in improved outcomes. Mitomycin-based concurrent chemotherapy was associated with in approximately 2.5 times increased grade 3 or greater acute toxicity. Radiation dose >54 Gy was associated with approximately 2.6 times increased Grade 3 or greater chronic toxicity. CONCLUSIONS: Our results suggest IMRT-based CRT with concurrent fluoropyrimidine and cisplatin is a safe and feasible option for patient with SCCA and may cause less acute toxicity. The role for radiation dose escalation is unclear and requires further study.


Assuntos
Neoplasias do Ânus , Carcinoma de Células Escamosas , Radioterapia de Intensidade Modulada , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Ânus/tratamento farmacológico , Neoplasias do Ânus/radioterapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Cisplatino/efeitos adversos , Fluoruracila/efeitos adversos , Humanos , Mitomicina/efeitos adversos , Recidiva Local de Neoplasia/tratamento farmacológico , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
17.
Oncologist ; 27(1): e53-e63, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-35305100

RESUMO

OBJECTIVE: The objective of this study was to retrospectively explore the clinical implications of simultaneous intensity-modulated radiotherapy (IMRT) boost to the tumor bed in cervical cancer with full-thickness stromal invasion (FTSI). PATIENTS AND METHODS: Patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB and IIA cervical cancer with confirmed FTSI were included. Patients received pelvic IMRT from a dose of 50.4 Gy in 28 fractions with (or without) a simultaneous integrated boost (SIB) to 58.8 Gy in 28 fractions for the tumor bed. The progression-free survival (PFS), overall survival (OS), and pelvic-PFS (p-PFS) were analyzed using the Kaplan-Meier method, and independent prognostic factors were explored by Cox regression analyses. RESULTS: Patients without a tumor bed boost had a poor prognosis. The 5-year OS was 81.3% versus 58.3% and the 5-year PFS rates were 75.0% versus 57.6% (boost vs non-boost). The FIGO stage, pathology, adjuvant chemotherapy, and tumor bed boost were independent factors affecting both the 5-year OS and PFS. Subgroup analysis showed that the SIB group had a higher 5-year OS, PFS, and p-PFS for different stages, lymph node status, and risk groups than the non-SIB group. Recurrence occurred in 268 of 910 (29.5%) patients without SIB and 49 of 293 (16.7%) with SIB. Among patients with recurrence, 113 of 282 (40.1%) in the non-boost group compared with 14 of 51 (23.0%) patients in the boost group had a pelvic recurrence. Tumor bed boost resulted in an increase in the mean radiation dose to the intestine, rectum, and bladder, although there were no differences in the rates of acute and late toxicities between the 2 groups. CONCLUSION: Tumor bed boost by external beam radiotherapy (EBRT) is an effective and safe method for patients with FTSI and risk factors. Compared with the standard prophylactic radiation, tumor bed boost by EBRT was not associated with increased acute and late toxicities.


Assuntos
Radioterapia de Intensidade Modulada , Neoplasias do Colo do Útero , Quimioterapia Adjuvante , Feminino , Humanos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
18.
Radiat Oncol ; 17(1): 48, 2022 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-35248087

RESUMO

PURPOSE: To explore clinical and dosimetric predictors of acute hematologic toxicity (HT) in cervical cancer patients treated with concurrent chemotherapy and volumetric-modulated arc therapy (VMAT). METHODS AND MATERIALS: We retrospectively reviewed the clinical data of 184 cervical cancer patients who had concurrent chemotherapy and VMAT. Hematological parameters were collected during the treatment period. The total pelvic bone (TPB) was delineated retrospectively for dose-volume calculations. To compare the differences between two groups, the normality test findings were used to run a paired-samples t-test or Wilcoxon signed-rank test. Pearson's correlation analysis or Spearman's correlation was used to testing the correlation between the two variables. Binary logistic regression analysis was used to analyze associations between HT and possible risk factors. The receiver operating characteristic curve(ROC) was used to evaluate the best cut-off point for dosimetric planning constraints. RESULTS: The nadir of absolute monocyte count (AMC) was found to be positively correlated with the nadir of absolute white blood cells (WBC) count (r = 0.5378, 95% CI 0.4227-0.6357, P < 0.0001) and the nadir of absolute neutrophil count(ANC) (r = 0.5000, 95% CI 0.3794-0.6039, P < 0.0001). The AMC decreased and increased before the ANC and WBC. In multivariate logistic regression analysis, the chemotherapy regimens and the TPB_V20 were independent risk factors for developing grade ≥ 3 HT. The optimal TPB_V20 cut-off value identified by ROC curves and the Youden test was 71% (AUC = 0.788; 95% CI 0.722-0.845; P value < 0.001). CONCLUSIONS: The changing trend of AMC can be used as an effective predictor for the timing and severity of the ANC/WBC nadirs and prophylactic G-CSF administration. Maintain TPB_V20 < 71% and selecting single-agent cisplatin or carboplatin could significantly reduce grade ≥ 3 HT in cervical cancer patients undergoing concurrent chemoradiotherapy.


Assuntos
Quimiorradioterapia , Doenças Hematológicas/etiologia , Monócitos , Radioterapia de Intensidade Modulada/efeitos adversos , Neoplasias do Colo do Útero/sangue , Neoplasias do Colo do Útero/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Contagem de Leucócitos , Pessoa de Meia-Idade , Prognóstico , Radiometria , Dosagem Radioterapêutica , Estudos Retrospectivos
19.
Head Neck ; 44(5): 1114-1123, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35170140

RESUMO

BACKGROUND: The purpose of this study was to investigate the effect of hypothyroidism and thyroxine replacement therapy on the prognosis of nasopharyngeal carcinoma (NPC) patients. METHODS: The clinical data of 284 NPC patients, who received intensity-modulated radiation therapy (IMRT) between January 2011 and December 2016, were retrospectively analyzed. RESULTS: Hypothyroidism occurred in 38% of patients. Patients with hypothyroidism had significantly better disease-free survival (DFS) (p = 0.002) and relapse-free survival (RFS) (p = 0.008). Multivariate analysis showed that hypothyroidism was a positive independent prognostic factor (DFS and RFS). Among the patients with hypothyroidism, thyroxine replacement therapy did not yield inferior survival (DFS, RFS, all p > 0.05). CONCLUSIONS: The NPC patients with complete response are at risk of hypothyroidism, which is attributable to escalating dose. These patients experienced clinical hypothyroidism could be adequately treated with thyroid hormone replacement. Further investigation of the underlying biological mechanism and potential therapeutic implications are required.


Assuntos
Hipotireoidismo , Neoplasias Nasofaríngeas , Radioterapia de Intensidade Modulada , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Carcinoma Nasofaríngeo/patologia , Neoplasias Nasofaríngeas/patologia , Recidiva Local de Neoplasia/patologia , Prognóstico , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos
20.
Technol Health Care ; 30(S1): 37-46, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35124582

RESUMO

BACKGROUND: According to statistics of the Ministry of Health and Welfare in 2017, the second leading cause of death in Taiwan was lung cancer. OBJECTIVE: Routine treatment planning does not consider photoneutron dose equivalent (PNDE) of patient induced secondary radiation resulting from primary exposure of lung cancer. However, such treatment is potentially important for improving estimates of health risks. METHODS: This study used 10, 30, 50, 70, and 90 kg of polymethylmethacrylate (PMMA) phantoms as patient to measure PNDE varying anatomical area during lung cancer of intensity modulated radiotherapy (IMRT) treatment. Paired thermoluminescent dosimeters (TLD-600 and 700) were calibrated using university reactor neutrons. TLDs were inserted into phantom which was closely corresponded of the represented tissues or organs. RESULTS: Neutron doses (ND) of organ or tissue (N⁢DT) were determined in these phantoms using paired TLDs approach. The risks of incurring fatal secondary malignancies, maximum statistical and total errors were estimated. Evaluated PNDE ranged from 0.80 ± 0.12 to 0.56 ± 0.08 mSv/Gy for these phantoms. CONCLUSION: The estimated N⁢DT decreased with increasing distance that is from the central axis. Evaluated PNDE and N⁢D𝑠𝑘𝑖𝑛 for these phantoms were discussed. This investigation also identified secondary risks associated with PNDE relating to radiation protection.


Assuntos
Neoplasias Pulmonares , Radioterapia de Intensidade Modulada , Humanos , Neoplasias Pulmonares/radioterapia , Nêutrons , Imagens de Fantasmas , Polimetil Metacrilato , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos
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