1
|
Carl G, Reitz D, Schönecker S, Pazos M, Freislederer P, Reiner M, Alongi F, Niyazi M, Ganswindt U, Belka C, Corradini S. Optical Surface Scanning for Patient Positioning in Radiation Therapy: A Prospective Analysis of 1902 Fractions. Technol Cancer Res Treat 2019; 17:1533033818806002. [PMID: 30453842 PMCID: PMC6243634 DOI: 10.1177/1533033818806002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose/Objective: Reproducible patient positioning remains one of the major challenges in modern radiation therapy. Recently, optical surface scanners have been introduced into clinical practice in addition to well-established positioning systems, such as room laser and skin marks. The aim of this prospective study was to evaluate setup errors of the optical surface scanner Catalyst HD (C-RAD AB) in different anatomic regions. Material/Methods: Between October 2016 and June 2017 a total of 1902 treatment sessions in 110 patients were evaluated. The workflow of this study included conventional setup procedures using laser-based positioning with skin marks and an additional registration of the 3-dimensional (3D) deviations detected by the Catalyst system. The deviations of the surface-based method were then compared to the corrections of cone beam computed tomography alignment which was considered as gold standard. A practical Catalyst setup error was calculated between the translational deviations of the surface scanner and the laser positioning. Two one-sided t tests for equivalence were used for statistical analysis. Results: Data analysis revealed total deviations of 0.09 mm ± 2.03 mm for the lateral axis, 0.07 mm ± 3.21 mm for the longitudinal axis, and 0.44 mm ± 3.08 mm vertical axis for the Catalyst system, compared to −0.06 ± 3.54 mm lateral, 0.53 ± 3.47 mm longitudinal, and 0.19 ± 3.49 mm vertical for the laser positioning compared to cone beam computed tomography. The lowest positional deviations were found in the cranial region, and larger deviations occurred in the thoracic and abdominal sites. A statistical comparison using 2 one-sided t tests showed a general concordance of the 2 methods (P ≤ 0.036), excluding the vertical direction of the abdominal region (P = 0.198). Conclusion: The optical surface scanner Catalyst HD is a reliable and feasible patient positioning system without any additional radiation exposure. From the head to the thoracic and abdominal region, a decrease in accuracy was observed within a comparable range for Catalyst and laser-assisted positioning.
Collapse
Affiliation(s)
- G Carl
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Authors have contributed equally to this study
| | - D Reitz
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,Authors have contributed equally to this study
| | - S Schönecker
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Pazos
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - P Freislederer
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Reiner
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - F Alongi
- 2 Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.,3 University of Brescia, Brescia, Italy
| | - M Niyazi
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - U Ganswindt
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,4 Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - C Belka
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - S Corradini
- 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
2
|
Gawish A, Chughtai AA, Eble MJ. Dosimetric and volumetric effects in clinical target volume and organs at risk during postprostatectomy radiotherapy. Strahlenther Onkol 2018; 195:383-392. [PMID: 30334066 DOI: 10.1007/s00066-018-1381-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the reproducibility of the dose-volume distribution of the initial simulation CT, generated using volumetric modulated arc therapy (VMAT) planning, during the radiotherapy of the prostatic bed based on weekly cone beam CTs (CBCT). METHODS Twenty-three patients, after radical prostatectomy were treated with adjuvant or salvage radiotherapy between July and December 2016 and considered for this evaluation. Weekly CBCT scans (n = 138) were imported into the treatment planning system, and the clinical tumor volume (CTV), the rectum and the bladder were contoured. The initially calculated dose distribution and the dose-volume histograms generated from weekly CBCTs were compared. The prostatic fossa dose coverage was assessed by the proportion of the CTV fully encompassed by the 95% and 98% isodose lines. Rectal and bladder volumes receiving 50, 60 and 65 Gy during the treatment were compared to the initial plan, with statistical significance determined using the one-sample t‑test. RESULTS Marked variations in the total organ volume of the rectum and the bladder were observed. The correlation between rectum volume and V50 was not significant (p = 0.487), while the bladder volume and V50 demonstrated a significant correlation. There was no correlation between urinary bladder volume and CTV. The change in rectal volume correlated significantly with CTV. The dose coverage (D98% and D95%) to the prostatic bed could be achieved for all patients due to the ventral shift in the volume differences of the rectum. CONCLUSION Weekly CBCTs can be considered as adequate verification tools to assess the interfractional variability of the CTV and organs at risk. The proven volume changes in the urinary bladder and the rectum do not compromise the final delivered dose in the CTV.
Collapse
Affiliation(s)
- Ahmed Gawish
- Department of Radiation Oncology, RWTH Aachen University, Pauwelsstraße 30, 52072, Aachen, Germany.
| | - Ahmed Ali Chughtai
- Department of Radiation Oncology, RWTH Aachen University, Pauwelsstraße 30, 52072, Aachen, Germany
| | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University, Pauwelsstraße 30, 52072, Aachen, Germany
| |
Collapse
|
3
|
Alongi F, Di Muzio N, Scorsetti M. Reirradiation: Hopes and Concerns of the Radiation Oncologist. TUMORI JOURNAL 2018; 96:792-3. [DOI: 10.1177/030089161009600527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Filippo Alongi
- Radioterapia e Radiochirurgia, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Nadia Di Muzio
- Radioterapia, Istituto Scientifico San Raffaele, Milan, Italy
| | - Marta Scorsetti
- Radioterapia e Radiochirurgia, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| |
Collapse
|
4
|
Alongi F, Russo G, Spinelli A, Borasi G, Scorsetti M, Gilardi MC, Messa C. Can magnetic resonance image-guided focused ultrasound surgery replace local oncology treatments? A review. TUMORI JOURNAL 2018; 97:259-64. [DOI: 10.1177/030089161109700301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance image-guided focused ultrasound surgery (MRgFUS) is an innovative technology in the new panorama of treatment using ultrasound. It combines two well-known and distinct methodologies: high-intensity focused ultrasound (HIFU) and a magnetic resonance imaging system (MRI). This review on MRgFUS is focused on the technical aspects and the current clinical applications in oncology. More precisely, the advantages/disadvantages of MRgFUS compared to other local approaches such as surgery and radiotherapy are discussed in detail.
Collapse
Affiliation(s)
- Filippo Alongi
- Radiotherapy and Radiosurgery, IRCCS Istituto Clinico Humanitas, Milan
| | - Giorgio Russo
- Institute for Molecular Bioimaging and Physiology (IBFM), National Council of Researches (CNR)
- Laboratorio di Tecnologie Oncologiche (LATO) and San Raffaele - G Giglio Foundation, Cefalù
| | - Antonio Spinelli
- Physics, IRCCS Scientific Institute San Raffaele, Milan; Physics-Radiotherapy, Negrar, Verona
| | - Giovanni Borasi
- Laboratorio di Tecnologie Oncologiche (LATO) and San Raffaele - G Giglio Foundation, Cefalù
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery, IRCCS Istituto Clinico Humanitas, Milan
| | - Maria Carla Gilardi
- Institute for Molecular Bioimaging and Physiology (IBFM), National Council of Researches (CNR)
- Laboratorio di Tecnologie Oncologiche (LATO) and San Raffaele - G Giglio Foundation, Cefalù
- Milano-Bicocca University, Milan
| | - Cristina Messa
- Institute for Molecular Bioimaging and Physiology (IBFM), National Council of Researches (CNR)
- Laboratorio di Tecnologie Oncologiche (LATO) and San Raffaele - G Giglio Foundation, Cefalù
- Milano-Bicocca University, Milan
- Nuclear Medicine Center, San Gerardo, Monza, Italy
| |
Collapse
|
5
|
Mazzola R, Aiello D, Ricchetti F, Alongi F. Induction chemotherapy for nasopharyngeal cancer: An eternally unfinished issue? Eur J Cancer 2017; 82:153-154. [PMID: 28689092 DOI: 10.1016/j.ejca.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/05/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Rosario Mazzola
- Radiation Oncology Division, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Dario Aiello
- Radiation Oncology Division, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy.
| | - Francesco Ricchetti
- Radiation Oncology Division, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Filippo Alongi
- Radiation Oncology Division, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy; University of Brescia, Brescia, Italy
| |
Collapse
|
6
|
Image-guided radiation therapy (IGRT): practical recommendations of Italian Association of Radiation Oncology (AIRO). Radiol Med 2016; 121:958-965. [DOI: 10.1007/s11547-016-0674-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 12/22/2022]
|
7
|
De Bari B, Alongi F, Mortellaro G, Mazzola R, Schiappacasse L, Guckenberger M. Spinal metastases: Is stereotactic body radiation therapy supported by evidences? Crit Rev Oncol Hematol 2016; 98:147-58. [DOI: 10.1016/j.critrevonc.2015.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022] Open
|
8
|
Giaj-Levra N, Ricchetti F, Alongi F. What is changing in radiotherapy for the treatment of locally advanced nonsmall cell lung cancer patients? A review. Cancer Invest 2016; 34:80-93. [PMID: 26810755 DOI: 10.3109/07357907.2015.1114121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiotherapy treatment continues to have a relevant impact in the treatment of nonsmall cell cancer (NSCLC). Use of concurrent chemotherapy and radiotherapy is considered the gold standard in the treatment of locally advanced NSCLC but clinical outcomes are not satisfactory. Introduction of new radiotherapy technology and chemotherapy regimens are under investigation in this setting with the goal to improve unsatisfactory results. We report how radiotherapy is changing in the treatment of locally advanced NSCLC.
Collapse
Affiliation(s)
- Niccoló Giaj-Levra
- a Radiation Oncology Department , Sacro Cuore-Don Calabria Hospital , Negrar-Verona , Italy
| | - Francesco Ricchetti
- a Radiation Oncology Department , Sacro Cuore-Don Calabria Hospital , Negrar-Verona , Italy
| | - Filippo Alongi
- a Radiation Oncology Department , Sacro Cuore-Don Calabria Hospital , Negrar-Verona , Italy
| |
Collapse
|
9
|
Arcangeli S, Zilli T, De Bari B, Alongi F. "Hit the primary": A paradigm shift in the treatment of metastatic prostate cancer? Crit Rev Oncol Hematol 2015; 97:231-7. [PMID: 26375435 DOI: 10.1016/j.critrevonc.2015.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 01/17/2023] Open
Abstract
Patients with metastatic prostate cancer (PC) represent a heterogeneous group with survival rates varying between 13 and 75 months. The current standard treatment in this setting is hormonal therapy, with or without docetaxel-based chemotherapy. In the era of individualized medicine, however, maximizing treatment options, especially in long-term surviving patients with limited disease burden, is of capital importance. Emerging data, mainly from retrospective surgical series, show survival benefits in men diagnosed with metastatic PC following definitive therapy for the prostate. Whether the irradiation of primary tumor in a metastatic disease might improve the therapeutic ratio in association with systemic treatments remains investigational. In this scenario, modern radiation therapy (RT) can play a significant role owing to its intrinsic capability to act as a more general immune response modifier, as well as to the potentially better toxicity profile compared to surgery. Preclinical data, clinical experience, and challenges in local treatment in de novo metastatic PC are reviewed and discussed.
Collapse
Affiliation(s)
- Stefano Arcangeli
- Radiation Oncology, San Camillo and Forlanini Hospital - Rome, Italy.
| | - Thomas Zilli
- Radiation Oncology Department, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) - Lausanne, Switzerland
| | - Filippo Alongi
- Radiation Oncology Department, Sacro Cuore - Don Calabria Hospital - Negrar, (Verona), Italy
| |
Collapse
|
10
|
Impact of weight loss in patients with head and neck carcinoma undergoing radiotherapy: is it an underestimated phenomenon? A radiation oncologist’s perspective. Eur J Clin Nutr 2015; 69:757-60. [DOI: 10.1038/ejcn.2015.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/22/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023]
|
11
|
De Bari B, Filippi AR, Mazzola R, Bonomo P, Trovò M, Livi L, Alongi F. Available evidence on re-irradiation with stereotactic ablative radiotherapy following high-dose previous thoracic radiotherapy for lung malignancies. Cancer Treat Rev 2015; 41:511-8. [PMID: 25913714 DOI: 10.1016/j.ctrv.2015.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/17/2015] [Accepted: 04/02/2015] [Indexed: 12/25/2022]
Abstract
Patients affected with intra-thoracic recurrences of primary or secondary lung malignancies after a first course of definitive radiotherapy have limited therapeutic options, and they are often treated with a palliative intent. Re-irradiation with stereotactic ablative radiotherapy (SABR) represents an appealing approach, due to the optimized dose distribution that allows for high-dose delivery with better sparing of organs at risk. This strategy has the goal of long-term control and even cure. Aim of this review is to report and discuss published data on re-irradiation with SABR in terms of efficacy and toxicity. Results indicate that thoracic re-irradiation may offer satisfactory disease control, however the data on outcome and toxicity are derived from low quality retrospective studies, and results should be cautiously interpreted. As SABR may be associated with serious toxicity, attention should be paid for an accurate patients' selection.
Collapse
Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Rosario Mazzola
- Radiation Oncology Department, University of Palermo, Palermo, Italy
| | | | - Marco Trovò
- Radiation Oncology Department, Centro di Riferimento Oncologico, Aviano, Italy
| | - Lorenzo Livi
- Radiation Oncology Department, University of Florence, Italy
| | - Filippo Alongi
- Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy
| |
Collapse
|
12
|
Bertolaccini L, Terzi A, Ricchetti F, Alongi F. Surgery or stereotactic ablative radiation therapy: how will be treated operable patients with early stage not small cell lung cancer in the next future? ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:25. [PMID: 25738145 DOI: 10.3978/j.issn.2305-5839.2015.01.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 11/14/2022]
Abstract
Lung neoplasm is the most influent cause of death for cancer. With the increasing of life expectancy in elderly patients and with the intensification of lung cancer screening by low-dose computed tomography, a further rise of the number of new non-small cell lung cancer (NSCLC) cases has been shown. Standard of care of early stage NSCLC patients is lobectomy but approximately 20% of them are not fit for surgery for comorbidities. Due to the high local control rates and the little adverse effects, stereotactic body radiation therapy (SBRT) also called stereotactic ablative radiation therapy (SABR), has rapidly replaced the conventional radiotherapy in not operable patients with stage I NSCLC. We review the evidence for use of SABR in medically inoperable patients with stage I NSCLC, and its possible extension of use to operable patients, from the perspectives of radiation oncologists and thoracic surgeons. Until the results of large randomized trials will be available, the multidisciplinary management, balancing during discussion the advantages/disadvantages of each treatment modality, could be the coming soon best approach for medically operable early-stage NSCLC. As a result, the minimally invasive thoracic surgery advantages and the SABR innovations will be translated into real clinical benefits.
Collapse
Affiliation(s)
- Luca Bertolaccini
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| | - Alberto Terzi
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| | - Francesco Ricchetti
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| | - Filippo Alongi
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| |
Collapse
|
13
|
De Bari B, Fiorentino A, Arcangeli S, Franco P, D'Angelillo RM, Alongi F. From radiobiology to technology: what is changing in radiotherapy for prostate cancer. Expert Rev Anticancer Ther 2014; 14:553-64. [DOI: 10.1586/14737140.2014.883282] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
14
|
Alongi F, De Bari B, Campostrini F, Arcangeli S, Matei DV, Lopci E, Petralia G, Bellomi M, Chiti A, Magrini SM, Scorsetti M, Orecchia R, Jereczek-Fossa BA. Salvage therapy of intraprostatic failure after radical external-beam radiotherapy for prostate cancer: A review. Crit Rev Oncol Hematol 2013; 88:550-63. [DOI: 10.1016/j.critrevonc.2013.07.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 05/20/2013] [Accepted: 07/17/2013] [Indexed: 01/29/2023] Open
|
15
|
The role of re-irradiation of secondary and recurrent head and neck carcinomas. Is it a potentially curative treatment? A practical approach. Cancer Treat Rev 2013; 40:178-89. [PMID: 23993769 DOI: 10.1016/j.ctrv.2013.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/18/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
Despite aggressive efforts to cure head and neck cancer patients, including altered fractionation and the addition of chemotherapy to radiation, locoregional recurrence remains a serious issue to face in clinical practice. Indeed, recurrent and second primary tumors occurring in previously irradiated area are common clinical challenge. Whenever possible, patients are advised to undergo salvage surgery. Nevertheless, few patients are suitable candidates for curative resection. In such cases, chemotherapy alone has traditionally been considered, with a poor response rate. It has been questioned whether re-irradiation toxicity outweighs the potential benefits, considering that the median survival of re-irradiated patients marginally exceeds the benefits observed with chemotherapy alone. However, full-dose re-irradiation is a viable treatment option, offering long-term survival for selected patients. Moreover, several prognostic factors should be considered for patients undergoing re-irradiation, such as basic patient characteristics, performance status, the location and extension of recurrent disease, patient co-morbidities, current speech and swallowing function, the interval from the initial radiation therapy to recurrence, previously received doses by critical structures and prior treatment toxicity. Nevertheless, several questions remain unanswered. The purpose of this review is to evaluate the major issues in the field of re-irradiation regarding the current evidence. Therefore, the major selection criteria and new treatment strategies are discussed to define the ideal candidates to undergo re-irradiation and describe a practical approach to these patients. Given the limited evidence in this field, the optimal treatment of recurrent and second primary cancers remains to be defined. Future prospective study of this approach is warranted.
Collapse
|
16
|
Alongi F, De Bari B, Franco P, Ciammella P, Chekrine T, Livi L, Jereczek-Fossa BA, Filippi AR. The PROCAINA (PROstate CAncer INdication Attitudes) Project (Part I): a survey among Italian radiation oncologists on postoperative radiotherapy in prostate cancer. Radiol Med 2013; 118:660-78. [PMID: 23358818 DOI: 10.1007/s11547-012-0913-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/20/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Radiotherapy (RT) has an established role in the postoperative treatment of prostate cancer patients with extracapsular extension, positive surgical margins or a detectable post-operative prostate-specific antigen (PSA). Despite the large number of patients treated with postoperative RT, some issues about optimal technique, doses, volumes, timing and association with androgen deprivation are still subject of debate. The aim of this survey was to determine the patterns of choice of Italian radiation oncologists in two different clinical cases of postoperative prostate cancer patients. STUDY DESIGN During the 2010 National Congress of the Italian Association of Radiation Oncology (AIRO), four clinical cases were presented to the attending radiation oncologists. Two of them were cases of postoperative prostate cancer, differing in T stage of the primary tumour according to the TNM classification, preoperative staging procedures, preoperative PSA (iPSA), Gleason score of biopsies and definitive pathological specimen after surgery and postoperative PSA. For each clinical case, the radiation oncologists were asked to: (a) give indication to new pre-treatment procedures for staging; b) give indication to postoperative treatment; (c) to define specifically, where indicated, the total dose, type of fractionation, treatment volumes, type of technique, type of image-guided setup control; (d) indicate whether adjuvant hormonal therapy should be prescribed; (e) define criteria that mostly influenced the prescription. A descriptive statistical analysis was then performed. RESULTS A total of 300 questionnaires were distributed amongst radiation oncologists attending the congress; 128 were completed and considered for this analysis (41%). Some important differences were shown in prescribing and performing postoperative radiotherapy, and some significant differences with international guidelines and data available from the literature were also reviewed and discussed. CONCLUSIONS Despite the results of clinical trials, significant differences still exist among Italian radiation oncologists in deciding postoperative treatment in prostate cancer patients. These patients probably deserve a more uniform approach based on updated, detailed and evidence-based recommendations.
Collapse
Affiliation(s)
- F Alongi
- Radiotherapy and Radiosurgery Department, Istituto Clinico Humanitas, Humanitas Cancer Center, Rozzano, MI, Italy
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer. Strahlenther Onkol 2012; 188:990-6. [DOI: 10.1007/s00066-012-0171-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/13/2012] [Indexed: 12/20/2022]
|
18
|
Alongi F, Clerici E, Pentimalli S, Mancosu P, Scorsetti M. Initial experience of hypofractionated radiation retreatment with true beam and flattening filter free beam in selected case reports of recurrent nasopharyngeal carcinoma. Rep Pract Oncol Radiother 2012; 17:262-8. [PMID: 24669306 DOI: 10.1016/j.rpor.2012.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 04/30/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022] Open
Abstract
AIM To show our preliminary experience in using TrueBeam with RapidArc technology and FFF beam for stereotactic re-irradiation of nasopharyngeal carcinoma. BACKGROUND Thanks to new advanced techniques, as well as intensity modulated radiation therapy, it is possible to approach head and neck recurrences in selected patients. Volumetric Modulated Arc Therapy (VMAT) in its RapidArc(®) format, permits to reduce significantly the time to deliver complex intensity modulated plans, allowing to treat hypofractionated regimes within a few minutes. With TrueBeam it is possible to perform photon beams without usage of the flattening filter. It seems possible to expect a reduction of out-of-field dose when flattening filter free (FFF) beams are used. While research into the physics domain for FFF beams is increasing, there are very few clinical data where FFF beams are applied in clinical practice. MATERIALS AND METHODS We present here the cases of 4 patients with local or regional recurrence of nasopharyngeal carcinoma. All patients were treated using TrueBeam with RapidArc technology and FFF beam for stereotactic hypofractionated re-irradiation. RESULTS All patients concluded SBRT and showed good tolerability. During follow-up, complete response at imaging evaluation (PET and/or MRI) for all treated patients was documented. CONCLUSIONS Our preliminary experience using TrueBeam with RapidArc technology and FFF beam for stereotactic hypofractionated re-irradiation of nasopharyngeal carcinoma was safe and effective in all 4 treated patients. Longer follow-up and a larger population of study is needed to confirm these promising results.
Collapse
Affiliation(s)
- Filippo Alongi
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Sara Pentimalli
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| |
Collapse
|
19
|
Alongi F, Scorsetti M. Hypofractionation in Current Clinical Practice: A Flash Forward to the near Future of Radiation Oncology? TUMORI JOURNAL 2012; 98:395-7. [DOI: 10.1177/030089161209800320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Filippo Alongi
- Radiotherapy and Radiosurgery, Humanitas Cancer
Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery, Humanitas Cancer
Center, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| |
Collapse
|
20
|
Wang YS, Wang YY, Jiang P, Ma JJ, Qu Z, Wang XL, Li JT, Jia XF. Short-term outcomes of CyberKnife therapy for advanced high-risk tumors: A report of 160 cases. Exp Ther Med 2012; 3:725-727. [PMID: 22969959 DOI: 10.3892/etm.2012.451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/01/2011] [Indexed: 11/05/2022] Open
Abstract
The objective of the present study was to evaluate short-term outcomes of CyberKnife therapy in patients with advanced high-risk tumors. A total of 201 target areas from 341 advanced high-risk tumor lesions in 160 patients were treated with CyberKnife. A prescribed dose of 18-60 Gy to the gross tumor volume was delivered in 1-6 fractions to complete the entire treatment in 1 week. Radiographic studies and clinical examinations were performed at 1- to 3-month follow-up intervals, and the results were compared to outcomes of 160 similar advanced high-risk tumor patients who were treated by conformal radiotherapy (CRT). After CyberKnife therapy, the short-term improvement in the quality of life was significant according to radiographic study, radioimmunoassay and ZPS scores of these patients. The total rates of objective efficacy and alleviation of ascities were as high as 66.88 and 67.90%. The short-term outcomes in our series of patients with advanced high-risk tumors treated with CyberKnife appeared to be better compared to conventional CRT. CyberKnife may be an option for patients with incurable advanced high-risk tumors, although further studies of the long-term outcomes are required to confirm the validity.
Collapse
Affiliation(s)
- Yi-Shan Wang
- Center for Tumor Treatment, The People's Liberation Army 107th Hospital, Shandong 264002, P.R. China
| | | | | | | | | | | | | | | |
Collapse
|