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PURPOSE: We aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey. METHODS: A questionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. A list of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested. RESULTS: Of the 138 RO departments, 29 (21%) responded. The data received concerned 15 (52%) university, 10 (34%) public, and four (14%) private hospitals. A total of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves' ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients. CONCLUSION: The ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%.
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Fasciíte Plantar , Radioterapia (Especialidade) , Radiocirurgia , Humanos , Fasciíte Plantar/radioterapia , Inquéritos e Questionários , Turquia/epidemiologiaRESUMO
PURPOSE: The purpose of this multicenter retrospective study was to analyze the clinical and radiological effects of bevacizumab (BV) on radionecrosis (RN) that developed after stereotactic radiotherapy (SRT) for brain metastasis. METHODS: Forty patients with SRT related symptomatic brain RN treated in 10 radiation oncology centers were analyzed. The clinical response to BV treatment was categorized as follows: complete (no additional treatment required), partial (requiring either steroids or repeat BV), and unresponsive (requiring surgery). The radiological features of brain RN were analyzed in 10 patients whose serial MRI scans were available after corticosteroid and BV treatments. RESULTS: BV was used as a first line treatment in 11 (27.5%) and as a second line treatment in 29 (72.5%) of patients. The neurological symptoms regressed in 77.5% of patients after treatment with BV (45% complete response, 32.5% partial response). The median edema volume increased from 75.9 cc (range: 5.9-125.8 cc) at RN to 113.65 cc (range: 1.5-382.1 cc) after use of corticosteroids, representing a rate of 39.8% increase (p = 0.074). However, after BV treatment the median volume of edema decreased to 19.5 cc (range: 0-163.3 cc) which represents a difference of 62.2% (p = 0.041) from RN. CONCLUSION: The use of BV caused clinical response rate of 77.5% and a good radiological response in corticosteroid unresponsive patients. The role of BV should be further investigated in prospective studies.
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Bevacizumab , Neoplasias Encefálicas , Necrose , Lesões por Radiação , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/radioterapia , Imageamento por Ressonância Magnética , Necrose/etiologia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/tratamento farmacológico , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To investigate salvage treatment approaches and treatment outcomes in high-risk prostate cancer after radical prostatectomy (RP). METHODS: In this retrospective, multicenter study, 272 patients who underwent salvage radiotherapy (RT) ± androgen deprivation therapy (ADT) for recurrent prostate cancer after RP between 2007 and 2021 were analysed. Univariate analyses of time to biochemical and clinical relapse after salvage therapies were conducted using Kaplan-Meier plots and log-rank tests. Multivariate analyses were performed using a Cox proportional hazards model to determine the risk factors for disease relapse. RESULTS: Median age was 65 (48-82) years. All patients underwent salvage prostate bed RT. Pelvic lymphatic RT was performed in 66 patients (24.3%) and ADT was included in 158 (58.1%) patients. The median PSA value before RT was 0.35 ng/mL. The median follow-up time was 64 (12-180) months. 5-years bRFS, cRFS, and OS were 75.1%, 84.8%, and 94.9% respectively. In multivariate cox regression analysis; seminal vesicle invasion (HR 8.64, 95% CI 3.47-21.48, p < 0.001), pre-RT PSA higher than 0.14 ng/mL (HR 3.79, 95% CI 1.47-9.78, p = 0.006), and ≥ 2 positive pelvic lymph nodes (HR 2.50, 95% CI 1.11-5.62, p = 0.027) were found to be unfavorable prognostic factors for bRFS. CONCLUSION: Salvage RT ± ADT provided 5-years biochemical disease control in 75.1% of patients. Seminal vesicle invasion, ≥ 2 positive pelvic nodes and delayed administration of salvage RT (PSA levels higher than 0.14 ng/mL) were found to be adverse risk factors for relapse. Such factors should be taken into account during the decision process on salvage treatment.
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Neoplasias da Próstata , Masculino , Humanos , Idoso , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Próstata/patologia , Antígeno Prostático Específico , Glândulas Seminais/patologia , Estudos Retrospectivos , Antagonistas de Androgênios/uso terapêutico , Intervalo Livre de Doença , Recidiva Local de Neoplasia/cirurgia , Prostatectomia/efeitos adversos , Fatores de Risco , Terapia de SalvaçãoRESUMO
PURPOSE: Stereotactic body radiation therapy (SBRT) is an effective treatment modality for inoperable early-stage lung cancer or metastatic lung lesions. Post-SBRT, acute radiological lung changes sometimes mimic tumor progression, so over-investigation may be applied. We aimed to reveal the interobserver agreement among physicians regarding acute radiographic changes on CT of the thorax obtained shortly after SBRT MATERIALS AND METHODS: Radiologic images of 20 lesions treated with SBRT were evaluated for acute lung changes. Two physicians, one senior and one junior, from diagnostic radiology, radiation oncology, nuclear medicine, and chest disease departments reviewed these images. The final interpretations were categorized as stable, regression/consolidation, progressive disease, and SBRT-related changes. The evaluations of the physicians were compared with the experienced reference radiation oncologist. The gold standard was accepted as the reference physician's final score. Unweighted Cohen's kappa (κ) coefficient was used for assessing interobserver agreement between physicians. RESULTS: The evaluations of the physicians were compared with the reference radiation oncologist. The strongest coherence coefficient was found with the senior radiation oncologist (κ: 0.72). The kappa coefficients between the junior radiation oncologist, junior nuclear medicine physician, and the reference physician were 0.61 and 0.55, respectively. The disciplines with the lowest kappa coefficients were junior chest disease and senior radiologist, and the kappa values were 0.37 and 0.44, respectively. CONCLUSION: Disciplines dealing with lung cancer treatment may not be aware of the various radiologic changes after SBRT or inexperienced in interpreting them from recurrence. Therefore, physicians must have detailed radiotherapy information such as planning target volume (PTV), dose/fractionation, etc. In addition, final evaluations should be performed in the multidisciplinary team dealing with the treatment of the patient.
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Pulmão/efeitos da radiação , Variações Dependentes do Observador , Médicos/psicologia , Radiocirurgia , Tórax/efeitos da radiação , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Tomografia Computadorizada Quadridimensional , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Medicina Nuclear , Posicionamento do Paciente , Pneumologia , Radioterapia (Especialidade) , Radiologistas/psicologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Tórax/diagnóstico por imagemRESUMO
OBJECTIVE: Today, respiratory movement can be monitored and recorded with different methods during a simulation on a four-dimensional (4D) computed tomography (CT) device to be used in radiotherapy planning. A synchronized respiratory monitoring system (RPM) with an externally equipped device is one of these methods. Another method is to create 4D images of the patient's breathing phases without the need for extra equipment, with an anatomy-based software program integrated into the CT device. Our aim is to compare the RPM system and the software system (Deviceless) which are two different respiratory monitoring methods used in tracking moving targets during 4D-CT imaging and to assess their clinical usability. METHODS: Ten patients who underwent paraaortic nodal irradiation were enrolled. The simulation was performed using intravenous contrast material on a 4D-CT device with both respiratory monitoring methods. The right/left kidneys and renal arteries were chosen as references to evaluate abdominal organ movement. It was then manually contoured one by one on both sets of images. The images were compared volumetrically and geometrically after rigid reconstruction. The similarity between the contours was determined by the Dice index. Wilcoxon test was used for statistical comparisons. RESULTS: The motion of the kidneys in all three directions was found to be 0.0 cm in both methods. The shifts in the right/left renal arteries were submillimetric. The Dice index showed a high similarity in both kidney and renal artery contours. CONCLUSION: In our study, no difference was found between RPM and Deviceless systems used for tracking and detection of moving targets during simulation in 4D-CT. Both methods can be used safely for radiotherapy planning according to the available possibilities in the clinic.
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Due to the prolongation of a lifetime, more cancer patients with cardiac implantable electronic devices are treated by radiotherapy. However, radiation may cause permanent or temporary malfunctions on these devices, and new-generation devices are more sensitive to radiation. Besides, radiotherapy techniques and image guidance methods that may cause different interactions with the functions of the devices have been changed significantly recently. Here, we reported our clinical experience in a patient with a pacemaker who underwent radiotherapy with intensity-modulated radiation therapy (IMRT) due to gastric cancer and reviewed the literature.
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Bloqueio Atrioventricular/terapia , Carcinoma/terapia , Marca-Passo Artificial/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Neoplasias Gástricas/terapia , Bloqueio Atrioventricular/complicações , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/patologia , Fracionamento da Dose de Radiação , Evolução Fatal , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Adjuvante/métodos , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologiaRESUMO
Langerhans Cell Histiocytosis (LCH) is an uncommon benign bone tumour typically seen in children. LCH of bones in adults has been reported as solitary cases. The aim of the current study is to analyze different treatment approaches and the role of radiotherapy (RT) in adult LCH. Thirty patients from five Rare Network Cancer centers were included in this retrospective study. Median age was 30 years. The localization of tumours was skull bones in 12 (40%), lower extremity in 6 (20%), thoracic bones in 4 (133%), spine in 3 (10%), pelvis in 2 (6.7%) and multiple sites in 3 (10%) patients. Primary treatment was surgery in 1 (33%), surgery+ radiotherapy (RT) in 15 (50%), RT in 12 (40%), RT + CHT in 1 (33%) and corticosteroids in 1 (33%) patient. Median follow-up was 58 months. Complete remission was obtained in 21 (70%), partial remission in 4 (133%); 2 lesions were stable (6.7%) and progression was noted in 2 (6.7%) of the patients. Nine patients (30%) had recurrent disease. Recurrence rates were significantly lower in patients who were treated with surgery and RT (p < 0.003). Surgery plays a major role in the treatment of adult LCH of bones ; radiotherapy should be considered in the adjuvant setting and palliation.
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Doenças Ósseas/terapia , Histiocitose de Células de Langerhans/terapia , Adulto , Doenças Ósseas/diagnóstico , Doenças Ósseas/patologia , Feminino , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/patologia , Humanos , MasculinoRESUMO
BACKGROUND: Sexual dysfunction is an important side-effect after radiotherapy (RT) for prostate cancer (PCa). The aim of this study was to compare sexual functions of PCa patients before and after intensity-modulated RT and to analyze their correlation with penile bulb (PB) doses and patient characteristics. MATERIALS AND METHODS: Forty-two patients who underwent RT ± hormone therapy for PCa between 2010 and 2013 were analyzed. Sexual functions assessed by patient-reported questionnaire and physician reported scale before and 3 years after treatment. The effect of patients' age, prostate volume, testosterone levels, comorbidity, smoking status, tumor stage, RT technique, hormone therapy, and PB doses to sexual functions were investigated. RESULTS: After 3 years of RT, 64.3% of all patients had a lower erectile score; and 75% of patients who were previously potent (n = 24) had become impotent after treatment. However sexual desire still remained in 75.8% of patients who had desire before treatment (n = 33). Statistical analysis showed that two parameters were correlated with postradiotherapy impotency outcome; PB mean radiation dose (P = 0.033) and testosterone levels (P = 0.032). CONCLUSIONS: RT, despite modern techniques, affects the sexual function of PCa patients in varying degrees. Reducing radiation doses to penile structures may play a role in preventing erectile dysfunction.
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Disfunção Erétil/terapia , Neoplasias da Próstata/complicações , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Humanos , Masculino , Radioterapia de Intensidade Modulada/métodos , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess the prognostic factors and results of limb sparing surgery and postoperative radiotherapy (PORT) in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. METHODS: Between 1980-2007, 114 extremity-located STS treated with PORT were analyzed retrospectively. Tumors were mostly localized in the lower extremities (71,9%). The median radiotherapy (RT) dose was 60.9 Gy. Chemotherapy was administered to 37.7% of the patients. Tumor sizes were between 3-26 cm (median 7 cm). The three most frequent histological types included undifferentiated pleomorphic sarcoma (26.3%), liposarcoma (25.4%), and synovial sarcoma (13.2%). The median follow-up for all patients was 60 months, and 81 months for survivors. RESULTS: The 5- and 10-year local control (LC) rates were 77% and 70.4%, respectively; actuarial survival rates for 5 and 10 years were 71.8% and 69.1%, respectively. Increasing the dose above 60 Gy for all patients and the patients with positive margins demonstrated a clear benefit on 5-year LC (p=0.03 and p=0.04, respectively). Based on multivariate analysis, the addition of chemotherapy and RT dose were independent prognostic factors for LC. A recurrent presentation significantly affects the disease-free survival. CONCLUSIONS: PORT for STS of the extremities provides good long-term disease control with acceptable toxicity in a multidisciplinary approach. Level of evidence III, Retrospective study .
OBJETIVO: Avaliar os fatores prognósticos e os resultados da cirurgia poupadora de membro e radioterapia pós-operatória em pacientes com sarcomas de partes moles das extremidades. MÉTODOS: Entre 1980 e 2007, 114 sarcomas de partes moles localizados em extremidades tratados com cirurgia poupadora de membro e radioterapia pós-operatória foram analisados restrospectivamente. Os tumores localizavam-se principalmente na região mais baixa (71,9%). A dose média da radioterapia foi de 60,9 Gy. A quimioterapia foi usada em 37,7% dos pacientes. Os tamanhos do tumores estiveram entre 3 e 26 cm (mediana de 7 cm). Os três tipos histológicos mais frequentes foram, respectivamente, sarcoma pleomórfico indiferenciado (26,3%), lipossarcoma (25,4%) e sarcoma sinovial (13,2%). O tempo médio de acompanhamento para todos os pacientes foi de 60 meses e 81 meses para sobrevivente. RESULTADOS: As taxas de controle local para 5 e 10 anos foram de 77% e 70,4%, respectivamente, e as taxas de sobrevida foram de 71,8% e 69,1%. Aumentar a dose acima de 60 Gy para todos os pacientes e para aqueles com margens positivas demonstrou claro benefício no controle local de 5 anos (p = 0,03 e p = 0,04, respectivamente). Considerando a análise multivariada, a adição de quimioterapia e a dose de radioterapia foram fatores prognósticos independentes para controle local. Apresentação recorrente afetou significativamente a sobrevida livre da doença. CONCLUSÕES: A cirurgia poupadora de membro e radioterapia pós-operatória para sarcomas de partes moles das extremidades fornece bom controle da doença a longo prazo, com toxicidade aceitável na abordagem multidisciplinar. Nível de evidência III, Estudo retrospectivo.
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PURPOSE: To assess the outcomes and patterns of failure in solitary plasmacytoma (SP). METHODS AND MATERIALS: The data from 258 patients with bone (n = 206) or extramedullary (n = 52) SP without evidence of multiple myeloma (MM) were collected. A histopathologic diagnosis was obtained for all patients. Most (n = 214) of the patients received radiotherapy (RT) alone; 34 received chemotherapy and RT, and 8 surgery alone. The median radiation dose was 40 Gy. The median follow-up was 56 months (range 7-245). RESULTS: The median time to MM development was 21 months (range 2-135), with a 5-year probability of 45%. The 5-year overall survival, disease-free survival, and local control rate was 74%, 50%, and 86%, respectively. On multivariate analyses, the favorable factors were younger age and tumor size <4 cm for survival; younger age, extramedullary localization, and RT for disease-free survival; and small tumor and RT for local control. Bone localization was the only predictor of MM development. No dose-response relationship was found for doses >30 Gy, even for larger tumors. CONCLUSION: Progression to MM remains the main problem. Patients with extramedullary SP had the best outcomes, especially when treated with moderate-dose RT. Chemotherapy and/or novel therapies should be investigated for bone or bulky extramedullary SP.
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Neoplasias Ósseas/radioterapia , Plasmocitoma/radioterapia , Análise de Variância , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Plasmocitoma/mortalidade , Plasmocitoma/patologia , Dosagem Radioterapêutica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an aggressive tumor with an average five-year survival rate of less than 10% as cited by multiple case reports. We report a 48 year-old male patient with primary small cell neuroendocrine carcinoma of the bladder who was treated with TUR-T, adjuvant carboplatin-based chemotherapy and radiotherapy. The patient is free of disease at the end of 30 months with a normally functioning bladder.
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Carcinoma de Células Pequenas/terapia , Neoplasias da Bexiga Urinária/terapia , Carcinoma de Células Pequenas/patologia , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/patologiaRESUMO
BACKGROUND: Desmoid tumors are uncommon and benign mesenchymal neoplasms. The optimal treatment of patients with desmoid tumors is still controversial. Surgery is the primary treatment for locally invasive or recurrent desmoid tumors. Also, radiotherapy is a treatment option for patients at high risk for local failure such as those with positive margins or recurrent and unresectable tumors. AIMS: To report our institutional experience and long-term results of patients with desmoid tumors who received radiotherapy. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Between 1980 and 2009, 20 patients who received radiotherapy (RT) in our institution were analyzed. The majority of patients (80%) were referred with a recurrent tumor after previous surgery. Thirteen patients underwent marginal resection, 4 had wide local excision and 3 patients had only biopsy. Resection margin was positive in 15 (75%) patients. All patients received radiation therapy. The median prescribed dose was 60 Gy. Five patients received less than 54 Gy. RESULTS: The median follow-up time was 77.5 months (28-283 months). Nine patients developed local recurrence after RT. Seven local failures (78%) were in field. Time to local recurrence ranged from 3-165 months (median 33 months). The 2-5 year local control (LC) rates were 80% and 69%, respectively. On univariate analysis, the 5 year local control rate was significantly better in the patients treated with ≥54 Gy than in patients who received <54 Gy (p=0.023). The most common acute side effect was grade 1-2 skin toxicity. As a late side effect of radiotherapy, soft tissue fibrosis was detected in 10 patients and lymphangitis was seen in 1 patient. One patient developed radiation-induced sarcoma. CONCLUSION: According to our results, radiotherapy is especially effective in recurrent disease and provides a high local control rate in the patients received more than 54 Gy.
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PURPOSE: To assess the role of preoperative radiotherapy in patients with nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery and to compare the response of neoadjuvant therapies, local control, and survival with the literature results. METHODS AND MATERIALS: Forty-six patients with osteosarcoma of the limbs who were treated within a limb salvage protocol including preoperative radiotherapy and chemotherapy between 1987 and 2002, were retrospectively analyzed. Median age was 17 years (range, 14-66 years). Treatment was started with neoadjuvant chemotherapy. Cisplatin, epidoxorubicin, ifosfamide, and methotrexate were used in different combinations. Preoperative radiotherapy was applied, usually between the second and third cycle of chemotherapy. Radiotherapy was given (35 Gy in 10 fractions) to 44 patients. Two patients were treated with 46 Gy at 2 Gy/day. Definitive surgery was administered after the third course of chemotherapy. Chemotherapy was complete 6 courses postsurgery. RESULTS: Median follow-up time was 44 months (range, 2-154 months). Forty-four patients had limb-sparing surgery, whereas 2 had amputation. Tumor necrosis rate was >/=90% in 87% of the patients (Huvos Grade 3-4). Two patients had local failures, and 26 patients (56.5%) had distant metastases. The 5-year local control and overall survival rates were 97.5% and 48.4%, respectively. On univariate analysis, age =18 years, Huvos Grade 4, lower-extremity localization, and surgery within 1 month significantly survived better than the others. On multivariate analysis, Huvos grade (p = 0.01), age (p = 0.01), interval between neoadjuvant chemotherapy and surgery (p = 0.02), and extremity localization (p = 0.02) were significant prognostic factors for actuarial survival. Severe complication developed in 20% of the patients. CONCLUSION: Preoperative radiotherapy helps to increase the chance of extremity-sparing surgery with good local control and necrosis rate when combined with chemotherapy.
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Neoplasias Ósseas , Salvamento de Membro , Osteossarcoma , Adolescente , Adulto , Idoso , Amputação Cirúrgica , Análise de Variância , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Epirubicina/administração & dosagem , Extremidades , Humanos , Ifosfamida/administração & dosagem , Masculino , Mesna/administração & dosagem , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Osteossarcoma/tratamento farmacológico , Osteossarcoma/radioterapia , Osteossarcoma/cirurgia , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
ABSTRACT Objective: To assess the prognostic factors and results of limb sparing surgery and postoperative radiotherapy (PORT) in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. Methods: Between 1980-2007, 114 extremity-located STS treated with PORT were analyzed retrospectively. Tumors were mostly localized in the lower extremities (71,9%). The median radiotherapy (RT) dose was 60.9 Gy. Chemotherapy was administered to 37.7% of the patients. Tumor sizes were between 3-26 cm (median 7 cm). The three most frequent histological types included undifferentiated pleomorphic sarcoma (26.3%), liposarcoma (25.4%), and synovial sarcoma (13.2%). The median follow-up for all patients was 60 months, and 81 months for survivors. Results: The 5- and 10-year local control (LC) rates were 77% and 70.4%, respectively; actuarial survival rates for 5 and 10 years were 71.8% and 69.1%, respectively. Increasing the dose above 60 Gy for all patients and the patients with positive margins demonstrated a clear benefit on 5-year LC (p=0.03 and p=0.04, respectively). Based on multivariate analysis, the addition of chemotherapy and RT dose were independent prognostic factors for LC. A recurrent presentation significantly affects the disease-free survival. Conclusions: PORT for STS of the extremities provides good long-term disease control with acceptable toxicity in a multidisciplinary approach. Level of evidence III, Retrospective study.
RESUMO Objetivo: Avaliar os fatores prognósticos e os resultados da cirurgia poupadora de membro e radioterapia pós-operatória em pacientes com sarcomas de partes moles das extremidades. Métodos: Entre 1980 e 2007, 114 sarcomas de partes moles localizados em extremidades tratados com cirurgia poupadora de membro e radioterapia pós-operatória foram analisados restrospectivamente. Os tumores localizavam-se principalmente na região mais baixa (71,9%). A dose média da radioterapia foi de 60,9 Gy. A quimioterapia foi usada em 37,7% dos pacientes. Os tamanhos do tumores estiveram entre 3 e 26 cm (mediana de 7 cm). Os três tipos histológicos mais frequentes foram, respectivamente, sarcoma pleomórfico indiferenciado (26,3%), lipossarcoma (25,4%) e sarcoma sinovial (13,2%). O tempo médio de acompanhamento para todos os pacientes foi de 60 meses e 81 meses para sobrevivente. Resultados: As taxas de controle local para 5 e 10 anos foram de 77% e 70,4%, respectivamente, e as taxas de sobrevida foram de 71,8% e 69,1%. Aumentar a dose acima de 60 Gy para todos os pacientes e para aqueles com margens positivas demonstrou claro benefício no controle local de 5 anos (p = 0,03 e p = 0,04, respectivamente). Considerando a análise multivariada, a adição de quimioterapia e a dose de radioterapia foram fatores prognósticos independentes para controle local. Apresentação recorrente afetou significativamente a sobrevida livre da doença. Conclusões: A cirurgia poupadora de membro e radioterapia pós-operatória para sarcomas de partes moles das extremidades fornece bom controle da doença a longo prazo, com toxicidade aceitável na abordagem multidisciplinar. Nível de evidência III, Estudo retrospectivo.
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AIMS AND BACKGROUND: To assess the variations in actual doses delivered to the rectum and bladder in the course of postprostatectomy radiotherapy using kilovoltage-cone-beam computed tomography datasets acquired during image-guided radiotherapy. METHODS AND STUDY DESIGN: Twenty consecutive patients treated with intensity-modulated or intensity-modulated arc therapy to the prostate bed were retrospectively evaluated. Both the planning tomography and kilovoltage-cone-beam computed tomography were acquired with an empty rectum and a half-full bladder. Target localization was performed on the basis of soft tissue matching using cone-beam computed tomography scans before each treatment fraction. A total of 16 cone-beam computed tomography scans per patient (acquired at the first 5 fractions and twice weekly thereafter) were used for the assessments. The bladder and rectum were re-contoured offline on each cone-beam computed tomography scan by a single physician, and the delivered doses were recalculated. The variations in certain dose-volume parameters for the rectum and bladder (BD2cc, RD 2cc, V40%, V50%, V60%, V65%) were analyzed using the paired t test. RESULTS: Most of the dose volume variations for rectum and bladder were significantly higher than predicted (P <0.05) for the 320 kilovoltage-cone-beam computed tomography sets, except for the doses received by 2 cc of the bladder and V50 and V60 of the rectum. The dose-volume parameters of the bladder did not meet our criteria of V65 ≤25% and V40 ≤50% in 10% and 20% of the patients, respectively. None of the dose-volume histograms showed rectal V65 ≥17%; however, the rectal V40 ≤35% dose constraint was not met in 11 patients. For all patients, the ANOVA test revealed no significant difference between the variations. CONCLUSION: Actual doses delivered during treatment were found to be higher than predicted, but the majority of calculated bladder and rectal doses remained in the limits of our plan acceptance criteria. Interfraction variability of the rectum and bladder is a major concern in the postprostatectomy radiotherapy setting, even when patients are instructed about rectal and bladder preparation before the radiotherapy course. Image guidance with cone-beam computed tomography at each treatment fraction may offer a viable tool to account for interfraction variations of the rectum and bladder throughout the treatment course.
Assuntos
Neoplasias da Próstata/radioterapia , Reto/efeitos da radiação , Bexiga Urinária/efeitos da radiação , Terapia Combinada , Tomografia Computadorizada de Feixe Cônico , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prostatectomia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Reto/patologia , Bexiga Urinária/patologiaRESUMO
OBJECTIVE: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall. MATERIALS AND METHODS: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated. RESULTS: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Five- year local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively). CONCLUSIONS: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.
Assuntos
Recidiva Local de Neoplasia/radioterapia , Sarcoma/radioterapia , Neoplasias Torácicas/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Período Pós-Operatório , Cuidados Pré-Operatórios , Prognóstico , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias Torácicas/patologia , Neoplasias Torácicas/cirurgia , Adulto JovemRESUMO
BACKGROUND: To assess the long term clinical outcome of preoperative radiotherapy with or without chemotherapy followed by limb sparing surgery in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. MATERIALS AND METHODS: Sixty patients with locally advanced STS were retrospectively analyzed. The median tumor diameter was 12 cm. All patients were treated with preoperative radiotherapy delivered with two different fractionation schedules (35Gy/10fr or 46-50Gy/23-25fr). Neoadjuvant chemotherapy was added to 44 patients with large and/or high grade tumors. Surgery was performed 2-6 weeks after radiotherapy. Chemotherapy was completed up to 6 courses after surgery in patients who had good responses. RESULTS: Median follow-up time was 67 months (8-268 months). All of the patients had limb sparing surgery. The 5-year local control (LC), disease free (DFS) and overall survival (OSS) rates for all of the patients were 81%, 48.1% and 68.3% respectively. 5-year LC, DFS and cause specific survival (CSS) were 81.7%, 47%, 69.8%, and 80%, 60%, 60% in the chemoradiotherapy and radiotherapy groups, respectively. On univariate analysis, patients who were treated with hypofractionation experienced significantly superior LC, DFS and CSS rates with similar rates of late toxicity when compared with patients who were treated with conventional fractionation and statistical significance was retained on multivariate analysis. CONCLUSIONS: Treatment results are consistent with the literature. As neoadjuvant chemoradiotherapy provides effective LC and CSS with acceptable morbidity, it should be preferred for patients with large and borderline resectable STS.
Assuntos
Cuidados Pré-Operatórios , Sarcoma/tratamento farmacológico , Sarcoma/radioterapia , Adolescente , Adulto , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/uso terapêutico , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Doxorrubicina/uso terapêutico , Extremidades/patologia , Feminino , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/uso terapêutico , Masculino , Mesna/administração & dosagem , Mesna/uso terapêutico , Pessoa de Meia-Idade , Substâncias Protetoras/administração & dosagem , Substâncias Protetoras/uso terapêutico , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/cirurgia , Resultado do Tratamento , Turquia , Adulto JovemRESUMO
AIMS AND BACKGROUND: There is limited data regarding outcomes of Ewing's sarcoma family of tumors in adolescents and adults compared with the same tumors in childhood. The aim of the study was to analyze prognostic factors and treatment results in a cohort of adolescents and adults with non-metastatic skeletal Ewing's sarcoma family of tumors. METHODS AND STUDY DESIGN: From 1992-2008, 90 adolescents and adults with Ewing's sarcoma family of tumors of the bone were referred to our institution. Sixty-five (72%) non-metastatic patients with analyzable data and treated in our institution were retrospectively evaluated. All patients were treated with alternated chemotherapy regimens administered every 3 weeks. The local treatment modality was selected according to tumor and patient characteristics. RESULTS: The median age was 21 years (range, 13-50). Most patients (74%) were >17 years of age. Forty-six percent of the tumors were located in the extremities. Local therapy was surgery in 45 patients and radiotherapy alone in 19 patients. Twenty-one patients received preoperative and 13 patients postoperative radiotherapy. Median follow-up was 43 months (range, 7-167). The 5-year event-free and overall survival rates for all patients were 44% and 49%, respectively. On univariate survival analysis, event-free and overall survival were worse for patients >17 years of age, tumor size >8 cm in diameter, an axial location, positive surgical margins, and poor histopathological response (<90% necrosis). Age, tumor site and tumor size on event-free and overall survival remained significant on multivariate analysis. CONCLUSIONS: We identified age, tumor size, and tumor site as independent prognostic factors, in accord with the Western literature. These patients require novel treatment modalities.