Radiotherapy related skin toxicity (RAREST-01): Mepitel® film versus standard care in patients with locally advanced head-and-neck cancer.

BACKGROUND: The aim of the present trial is to investigate a new option of skin protection in order to reduce the rate of grade ≥ 2 skin toxicity in patients receiving radiotherapy alone or radiochemotherapy for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN). METHODS / DESIGN: This is a randomized, active-controlled, parallel-group multi-center trial that compares the following treatments of radiation dermatitis in patients with head-and-neck cancer: Mepitel® Film (Arm A) vs. standard care (Arm B). The primary aim of this trial is to investigate the rate of patients experiencing grade ≥ 2 radiation dermatitis (according to Common Toxicity Criteria for Adverse Events (CTCAE) Version 4.03) until 50 Gy of radiotherapy. Evaluation until 50 Gy of radiotherapy has been selected as the primary endpoint, since up to 50 Gy, the irradiated volume includes the primary tumor and the bilateral cervical and supraclavicular lymph nodes, and, therefore, is similar in all patients. After 50 Gy, irradiated volumes are very individual, depending on location and size of the primary tumor, involvement of lymph nodes, and the treatment approach (definitive vs. adjuvant). In addition, the following endpoints will be evaluated: Time to grade 2 radiation dermatitis until 50 Gy of radiotherapy, rate of patients experiencing grade ≥ 2 radiation dermatitis during radio(chemo)therapy, rate of patients experiencing grade ≥ 3 skin toxicity during radio(chemo)therapy, adverse events, quality of life, and dermatitis-related pain. Administration of Mepitel® Film will be considered to be clinically relevant, if the rate of grade ≥ 2 radiation dermatitis can be reduced from 85% to 65%. DISCUSSION: If administration of Mepitel® Film instead of standard care will be able to significantly reduce the rate of grade ≥ 2 radiation dermatitis, it could become the new standard of skin care in patients irradiated for SCCHN. TRIAL REGISTRATION: clinicaltrials.gov NCT03047174 . Registered on 26th of January, 2017. First patient included on 9th of May, 2017.

The prognostic impact of tumor cell expression of estrogen receptor-α, progesterone receptor, and androgen receptor in patients irradiated for nonsmall cell lung cancer.

BACKGROUND: The current study was performed to investigate the potential impact of tumor cell expression of estrogen receptor-α (ER-α), progesterone receptor (PR), and androgen receptor (AR) on the outcomes of patients who received radiotherapy (RT) for non-small cell lung cancer (NSCLC). METHODS: Tumor cell expression of ER-α, PR, and AR as well as 9 additional potential prognostic factors were retrospectively evaluated in 64 patients who underwent RT for AJCC stage II/III NSCLC. The endpoints investigated were locoregional control, metastases-free survival, and overall survival. The additional potential prognostic factors were age, gender, Karnofsky performance score, histology, T classification, N classification, surgery, smoking during RT, and hemoglobin levels during RT. Subgroup analyses were performed for women and men. RESULTS: On univariate analysis, locoregional control was not found to be associated with expression of PR or AR. ER-α expression demonstrated a strong trend toward worse locoregional control. On multivariate analysis, ER-α expression was found to be significantly associated with worse locoregional control (risk ratio [RR], 3.12; P = .035). On univariate analysis, metastases-free survival was not associated with expression of ER-α, PR, or AR. On univariate analysis, survival was found to be negatively associated with expression of ER-α (P = .003) but not with PR or AR expression. On multivariate analysis, ER-α expression maintained significance (RR, 2.73; P = .022). CONCLUSIONS: Tumor cell expression of ER-α was found to be a negative prognostic factor for treatment outcomes in both women and men. Expression of PR and AR was not associated with outcomes.

Prognostic impact of VEGF and VEGF receptor 1 (FLT1) expression in patients irradiated for stage II/III non-small cell lung cancer (NSCLC).

BACKGROUND AND PURPOSE: The prognostic value of the tumor expression of vascular endothelial growth factor (VEGF) and VEGF receptor 1 (FLT1) is still unclear. This study investigated the impact of tumor expression of VEGF and FLT1 on outcomes in 61 patients irradiated for stage II/III non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: The impact of tumor VEGF and FLT expression and twelve additional potential prognostic factors on locoregional control (LC), metastases-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These factors included age, gender, performance status, histology, histological grade, T-category, N-category, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin levels during radiotherapy. RESULTS: On univariate analysis, improved LC was associated with lower T-category (p = 0.046), lower N-category (p = 0.047), and not smoking during radiotherapy (p = 0.012). VEGF (p = 0.26) and FLT1 expression (p = 0.70) had no significant impact. On multivariate analysis, lower N-category (p = 0.037) maintained significance; not smoking during radiotherapy was almost significant (p = 0.052). On univariate analysis, improved MFS was associated with lower T-category (p = 0.034) and lower N-category (p = 0.027), and almost with hemoglobin >or= 12 g/dl during radiotherapy (p = 0.053). VEGF (p = 0.80) and FLT1 expression (p = 0.61) had no significant impact. On multivariate analysis, lower N-category (p = 0.040) maintained significance. On univariate analysis, improved OS was associated with lower T-category (p = 0.028), lower N-category (p = 0.003), not smoking during radiotherapy (p = 0.047), and hemoglobin levels >or= 12 g/dl during radiotherapy (p = 0.019). VEGF (p = 0.59) and FLT1 expression (p = 0.85) had no significant impact. On multivariate analysis, lower N-category (p = 0.011) maintained significance. CONCLUSION: Tumor expression of VEGF and FLT1 appear to have no significant impact on LC, MFS, or OS in patients irradiated for NSCLC.

Palliative radiotherapy to dominant symptomatic lesion in patients with hormone refractory prostate cancer (PRADO).

BACKGROUND: This study was conducted to investigate a new short-course radiotherapy regimen for patients with metastatic hormone refractory prostate cancer (HRPC) presenting with a dominant debilitating symptom. METHODS / DESIGN: This is an international, multi-center single arm prospective feasibility study that aims to include 34 patients with HRPC and a dominant debilitating symptom. The dominant symptomatic lesion will receive 4 × 5 Gy of high-precision radiotherapy, and the most aggressive part of the lesion 4 × 7 Gy using a simultaneous integrated boost technique. Based on advanced magnetic resonance imaging (MRI), an apparent diffusion coefficient (ADC) map will be calculated for the lesion using diffusion weighted imaging sequences. The dominant symptomatic lesion (GTV1) is drawn manually using the information from T2w-MRI and computed tomography scans. The most aggressive part of the dominant lesion (GTV2) is defined by using the ADC map. An auxiliary volume is created including only voxels in the GTV1 that presents with ADC values below 1200 × 10- 6 mm2/s. The most aggressive part is defined as voxels with an ADC value below the median ADC value. Primary endpoint is feasibility, i.e. proportion of patients who complete radiotherapy with ≥90% of the prescribed dose. Secondary endpoints include dominant symptom score, progression-free survival (freedom from symptoms), overall survival, acute toxicity, quality of life, change in ADC from baseline to end of treatment and 6 months following treatment. DISCUSSION: If this new radiotherapy regimen proves to be feasible, a prospective randomized phase II/III dose escalation study will be designed in order to improve the outcomes of palliative radiotherapy of symptomatic metastatic HRPC. STUDY STATUS: The study is ongoing and will be recruiting patients soon. TRIAL REGISTRATION: clinicaltrials.gov NCT03658434 . Initially registered on 30th of July, 2018.

A randomized trial (RAREST-01) comparing Mepitel® Film and standard care for prevention of radiation dermatitis in patients irradiated for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN).

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

Effect of smoking during radiotherapy, respiratory insufficiency, and hemoglobin levels on outcome in patients irradiated for non-small-cell lung cancer.

PURPOSE: To investigate the effect of smoking during radiotherapy (RT), respiratory insufficiency before RT, hemoglobin levels during RT, and additional factors on overall survival, locoregional control (LRC), and metastasis-free survival in non-small-cell lung cancer patients. METHODS AND MATERIALS: The following factors were investigated in 181 patients who underwent RT for non-small-cell lung cancer: age, gender, Karnofsky performance score, histologic type, grade, T/N stage, American Joint Committee on Cancer stage, surgery, chemotherapy, respiratory insufficiency before RT, pack-years, smoking during RT, and hemoglobin levels during RT. Additionally, in the 129 patients who did not undergo surgery, the effect of the equivalent dose in 2-Gy fractions (EQD2) (<60 Gy vs. 60 Gy vs. >60 Gy) on outcome was investigated. RESULTS: On multivariate analysis, improved overall survival was associated with a lower T stage (p = 0.004), lower N stage (p = 0.040), surgery (p = 0.010), and no respiratory insufficiency (p = 0.023). A Karnofsky performance score >70 achieved borderline significance (p = 0.056). Improved LRC was associated with a lower T stage (p = 0.007) and no smoking during RT (p = 0.029). Improved metastasis-free survival was associated with lower T stage (p < 0.001) and lower N stage (p < 0.001). In those patients who did not undergo surgery, an EQD2 of > or =60 Gy was associated with a better outcome than an EQD2 of <60 Gy. Furthermore, an EQD2 >60 Gy resulted in better LRC than did an EQD2 of < or =60 Gy. CONCLUSIONS: Smoking during RT had a significant effect on LRC, but we did not find that hemoglobin levels or respiratory insufficiency significantly affected LRC or metastasis-free survival in our patient population. Furthermore, our data suggest a dose-effect relationship in those patients who did not undergo surgery.

Fibroblast growth factor 2--a predictor of outcome for patients irradiated for stage II-III non-small-cell lung cancer.

PURPOSE: The prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients with non-small-cell lung cancer (NSCLC) is unclear. The present study investigated the effect of tumor cell expression of FGF-2 on the outcome of 60 patients irradiated for Stage II-III NSCLC. METHODS AND MATERIALS: The effect of FGF-2 expression and 13 additional factors on locoregional control (LRC), metastasis-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These additional factors included age, gender, Karnofsky performance status, histologic type, histologic grade, T and N category, American Joint Committee on Cancer stage, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin during radiotherapy. Locoregional failure was identified by endoscopy or computed tomography. Univariate analyses were performed with the Kaplan-Meier method and the Wilcoxon test and multivariate analyses with the Cox proportional hazard model. RESULTS: On univariate analysis, improved LRC was associated with surgery (p = .017), greater hemoglobin levels (p = .036), and FGF-2 negativity (p <.001). On multivariate analysis of LRC, surgery (relative risk [RR], 2.44; p = .037), and FGF-2 expression (RR, 5.06; p <.001) maintained significance. On univariate analysis, improved MFS was associated with squamous cell carcinoma (p = .020), greater hemoglobin levels (p = .007), and FGF-2 negativity (p = .001). On multivariate analysis of MFS, the hemoglobin levels (RR, 2.65; p = .019) and FGF-2 expression (RR, 3.05; p = .004) were significant. On univariate analysis, improved OS was associated with a lower N category (p = .048), greater hemoglobin levels (p <.001), and FGF-2 negativity (p <.001). On multivariate analysis of OS, greater hemoglobin levels (RR, 4.62; p = .002) and FGF-2 expression (RR, 3.25; p = .002) maintained significance. CONCLUSIONS: Tumor cell expression of FGF-2 appeared to be an independent negative predictor of LRC, MFS, and OS.

Prognostic impact of erythropoietin expression and erythropoietin receptor expression on locoregional control and survival of patients irradiated for stage II/III non-small-cell lung cancer.

PURPOSE: Prognostic factors can guide the physician in selecting the optimal treatment for an individual patient. This study investigates the prognostic value of erythropoietin (EPO) and EPO receptor (EPO-R) expression of tumor cells for locoregional control and survival in non-small-cell lung cancer (NSCLC) patients. METHODS AND MATERIALS: Fourteen factors were investigated in 62 patients irradiated for stage II/III NSCLC, as follows: age, gender, Karnofsky performance score (KPS), histology, grading, TNM/American Joint Committee on Cancer (AJCC) stage, surgery, chemotherapy, pack years (average number of packages of cigarettes smoked per day multiplied by the number of years smoked), smoking during radiotherapy, hemoglobin levels during radiotherapy, EPO expression, and EPO-R expression. Additionally, patients with tumors expressing both EPO and EPO-R were compared to those expressing either EPO or EPO-R and to those expressing neither EPO nor EPO-R. RESULTS: On univariate analysis, improved locoregional control was associated with AJCC stage II cancer (p < 0.048), surgery (p < 0.042), no smoking during radiotherapy (p = 0.024), and no EPO expression (p = 0.001). A trend was observed for a KPS of >70 (p = 0.08), an N stage of 0 to 1 (p = 0.07), and no EPO-R expression (p = 0.10). On multivariate analysis, AJCC stage II and no EPO expression remained significant. No smoking during radiotherapy was almost significant. On univariate analysis, improved survival was associated with N stage 0 to 1 (p = 0.009), surgery (p = 0.039), hemoglobin levels of ≥12 g/d (p = 0.016), and no EPO expression (p = 0.001). On multivariate analysis, N stage 0 to 1 and no EPO expression maintained significance. Hemoglobin levels of ≥12 g/d were almost significant. On subgroup analyses, patients with tumors expressing both EPO and EPO-R had worse outcomes than those expressing either EPO or EPO-R and those expressing neither EPO nor RPO-R. CONCLUSIONS: EPO expression of tumor cells was an independent prognostic factor for locoregional control and survival in patients irradiated for NSCLC. EPO-R expression showed a trend. Patients with tumors expressing both EPO and EPO-R have an unfavorable prognosis.