1
|
Selingerova I, Holikova K, Chodur T, Hynkova L, Pospisil P, Bulik M, Belanova R, Siffelova K, Kolouskova I, Slavik M, Burkon P, Hrstka R, Jancalek R, Sana J, Slampa P, Kazda T. Challenges with hippocampal MR spectroscopy as a surrogate for pre-radiotherapy assessment of neurocognitive impairment in patients with brain metastasis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 38623639 DOI: 10.5507/bp.2024.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
AIM Patients with multiple brain metastases (BM) benefit from hippocampal-avoiding whole brain radiotherapy (HA-WBRT), the challenging and less available form of WBRT. This study explores potential of pre-radiotherapy (pre-RT) hippocampal magnetic resonance spectroscopy (MRS) measuring hippocampal neuronal density as an imaging surrogate and predictive tool for assessing neurocognitive functions (NCF). METHODS 43 BM patients underwent pre-RT hippocampal MRS. N-acetyl aspartate (NAA) concentration, a marker for neuronal density (weighted by creatine (Cr) and choline (Cho) concentrations), and neurocognitive function (NCF) tests (HVLT and BVMT) performed by certified psychologists were evaluated. Clinical variables and NAA concentrations were correlated with pre-RT NCFs. RESULTS HVLT and BVMT subtests showed pre-RT deterioration except for BVMT recognition. Significantly better NCFs were observed in women in HVLT subsets. Significantly higher NAA/Cr + Cho was measured in women (median 0.63 vs. 0.55; P=0.048) in the left hippocampus (no difference in the right hippocampus). In men, a positive correlation (0.51, P=0.018) between total brain volume and HVLT-TR, between left hippocampal NAA/Cr + Cho and HVLT-R (0.45, P=0.063), and between right hippocampal NAA/Cr + Cho and BVMT-recognition (0.49, P=0.054) was observed. In women, a borderline significant negative correlation was observed between left hippocampal NAA/Cr + Cho and BVMT-TR (-0.43, P=0.076) and between right NAA/Cr + Cho and HVLT-DR (-0.42, P=0.051). CONCLUSION Borderline statistically significant correlations were observed with speculative interpretation underlying the challenges of hippocampal MRS as a surrogate for neurocognitive impairment. Further studies need to be done to ascertain the opportunities for imaging predictors of benefit from memory sparing radiotherapy.
Collapse
Affiliation(s)
- Iveta Selingerova
- Research Center for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Klara Holikova
- Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Chodur
- Unit of Clinical Psychology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ludmila Hynkova
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Pospisil
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Bulik
- Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Renata Belanova
- Department of Radiology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Kamila Siffelova
- Unit of Clinical Psychology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ivana Kolouskova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Slavik
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Burkon
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hrstka
- Research Center for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Sana
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kazda
- Research Center for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
2
|
Nguyen Van D, Duong Van N, Le Van Q, Ngo Thanh T, Ta Van T. External-Beam Radiotherapy Alone Management of Primary CNS Lymphoplasmacytic Lymphoma: A Vietnamese Case Report and Literature Review. J Blood Med 2021; 12:769-774. [PMID: 34456597 PMCID: PMC8387585 DOI: 10.2147/jbm.s326165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Primary central nervous system (CNS) lymphoma is an uncommon non-Hodgkin disease limited to the CNS, and most cases are diffuse large B-cell lymphomas. Other pathologies, including lymphoplasmacytic lymphoma (LPL), are exceedingly rare and poorly understood. The clinical presentation of primary CNS LPL is diverse. It depends on the original site and the tumor’s extension. There is currently no consensus on a treatment strategy for this uncommon manifestation. To our knowledge, no previously published case was successfully treated with radiation therapy alone. Case Presentation We present here a case of primary CNS LPL. A 46-year-old, previously healthy woman was presented with a worsening headache and lower extremity numbness. Multifocal enhanced masses were detected in an MRI with biopsy results consistent with LPL. A complete staging workup was performed with no evidence of systemic disease. The patient received external-beam radiotherapy alone and had a complete remission. After 2 years of follow-up, she remains disease-free. Conclusion Radiation alone is a promising treatment option for primary CNS lymphoplasmacytic lymphoma.
Collapse
Affiliation(s)
- Dang Nguyen Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam.,Department of Head and Neck Radiation Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Nghia Duong Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Le Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Ngo Thanh
- Department of Head and Neck Radiation Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - To Ta Van
- Center of Pathology and Molecular Biology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| |
Collapse
|
3
|
Ahn MJ, Lee K, Lee KH, Kim JW, Kim IY, Bae WK. Combination of anti-PD-1 therapy and stereotactic radiosurgery for a gastric cancer patient with brain metastasis: a case report. BMC Cancer 2018; 18:173. [PMID: 29433469 PMCID: PMC5809881 DOI: 10.1186/s12885-017-3906-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/11/2017] [Indexed: 01/22/2023] Open
Abstract
Background Brain metastases from gastric cancer are difficult to treat and their prognosis is poor. Despite various possible treatments, the survival rate of such patients is still unsatisfactory; therefore, new treatment modalities or combinations of therapies need to be explored. Case presentation We herein discuss a case of a 38-year-old man initially diagnosed with a gastric cancer brain metastasis. At first, only stereotactic radiosurgery (SRS) was performed, but it was not effective. After the brain and systemic metastases progressed, SRS and anti-PD-1 therapy were administered in combination, and the brain and intra-abdominal metastatic lesions responded satisfactorily. Conclusion The combination of anti-PD-1 therapy and SRS could be effective against gastric cancer with brain metastases.
Collapse
Affiliation(s)
- Min-Joo Ahn
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju, 501-757, South Korea
| | - Kanghan Lee
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju, 501-757, South Korea
| | - Kyung Hwa Lee
- Departments of Pathology, Chonnam National University Medical School, Gwangju, 501-757, South Korea
| | - Jin Woong Kim
- Departments of Radiology, Chonnam National University Medical School, Gwangju, 501-757, South Korea
| | - In-Young Kim
- Departments of Neurosurgery, Chonnam National University Medical School, Gwangju, 501-757, South Korea. .,Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, 519-809, South Korea.
| | - Woo Kyun Bae
- Departments of Internal Medicine, Chonnam National University Medical School, Gwangju, 501-757, South Korea. .,Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, 519-809, South Korea.
| |
Collapse
|
4
|
Kazda T, Vrzal M, Prochazka T, Dvoracek P, Burkon P, Pospisil P, Dziacky A, Nikl T, Jancalek R, Slampa P, Lakomy R. Left hippocampus sparing whole brain radiotherapy (WBRT): A planning study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:397-402. [DOI: 10.5507/bp.2017.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/20/2017] [Indexed: 12/21/2022] Open
|
5
|
El-Hamamsy M, Elwakil H, Saad AS, Shawki MA. A Randomized Controlled Open-Label Pilot Study of Simvastatin Addition to Whole-Brain Radiation Therapy in Patients With Brain Metastases. Oncol Res 2017; 24:521-528. [PMID: 28281972 PMCID: PMC7838650 DOI: 10.3727/096504016x14719078133528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Statins have been reported to have a potential radiosensitizing effect that has not been evaluated in clinical trials. The aim of this study was to evaluate the efficacy and safety of simvastatin in addition to whole-brain radiation therapy (WBRT) in patients with brain metastases (BM). A prospective randomized, controlled, open-label pilot study was conducted on 50 Egyptian patients with BM who were randomly assigned to receive 30-Gy WBRT (control group: 25 patients) or 30 Gy WBRT + simvastatin 80 mg/day for the WBRT period (simvastatin group: 25 patients). The primary outcome was radiological response at 4 weeks after WBRT. Secondary outcomes were 1-year progression-free survival (PFS), 1-year overall survival (OS), and health-related quality of life (HRQL) that was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and its brain module (BN-20), at baseline, after WBRT, and 4 weeks after WBRT. The addition of simvastatin was tolerated. Twenty-one patients were not evaluated for radiological response because of death (n = 16), noncompliance to follow-up (n = 4), and clinical deterioration (n = 1). Response rates were 60% and 78.6% (p = 0.427), 1-year PFS rates were 5.2% and 17.7% (p = 0.392), and 1-year OS rates were 12% and 8% (p = 0.880) for the control group and simvastatin group, respectively. Nonsignificant differences were found between the two arms regarding HRQL scales. The addition of simvastatin 80 mg/day did not improve the clinical outcomes of patients with BM receiving WBRT.
Collapse
Affiliation(s)
- Manal El-Hamamsy
- Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | | | | |
Collapse
|
6
|
Pospisil P, Kazda T, Bulik M, Dobiaskova M, Burkon P, Hynkova L, Slampa P, Jancalek R. Hippocampal proton MR spectroscopy as a novel approach in the assessment of radiation injury and the correlation to neurocognitive function impairment: initial experiences. Radiat Oncol 2015; 10:211. [PMID: 26474857 PMCID: PMC4609038 DOI: 10.1186/s13014-015-0518-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hippocampus is considered as the main radiosensitive brain structure responsible for postradiotherapy cognitive decline. We prospectively assessed correlation of memory change to hippocampal N-acetylaspartate (h-tNAA) concentration, a neuronal density and viability marker, by (1)H-MR spectroscopy focused on the hippocampus. METHODS Patients with brain metastases underwent whole brain radiotherapy (WBRT) to a dose of 30 Gy in ten fractions daily. Pre-radiotherapy (1)H-MR spectroscopy focused on the h-tNAA concentration and memory testing was performed. Memory was evaluated by Auditory Verbal Learning Test (AVLT) and Brief Visuospatial Memory Test-Revised (BVMT-R). Total recall, recognition and delayed recall were reported. The both investigation procedures were repeated 4 months after WBRT and the h-tNAA and memory changes were correlated. RESULTS Of the 20 patients, ten passed whole protocol. The h-tNAA concentration significantly decreased from pre-WBRT 8.9, 8.86 and 8.88 [mM] in the right, left and both hippocampi to 7.16, 7.65 and 7.4 after WBRT, respectively. In the memory tests a significant decrease was observed in AVLT total-recall, BVMT-R total-recall and BVMT-R delayed-recall. Weak to moderate correlations were observed between left h-tNAA and AVLT recognition and all BVMT-R subtests and between the right h-tNAA and AVLT total-recall. CONCLUSIONS A significant decrease in h-tNAA after WBRT was proven by (1)H-MR spectroscopy as a feasible method for the in vivo investigation of radiation injury. Continuing patient recruitment focusing on other cognitive tests and metabolites is needed.
Collapse
Affiliation(s)
- Petr Pospisil
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53, Brno, Czech Republic.
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53, Brno, Czech Republic. .,International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
| | - Martin Bulik
- International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic. .,Department of Diagnostic Imaging, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Diagnostic Imaging, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
| | - Marie Dobiaskova
- International Clinical Research Center, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic. .,Department of Clinical Psychology, St. Anne's University Hospital Brno, Pekarska 53, Brno, Czech Republic.
| | - Petr Burkon
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53, Brno, Czech Republic.
| | - Ludmila Hynkova
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53, Brno, Czech Republic.
| | - Pavel Slampa
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53, Brno, Czech Republic.
| | - Radim Jancalek
- Department of Neurosurgery - St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,Department of Neurosurgery, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
| |
Collapse
|
7
|
[Mnesic disorders caused by left temporal gliomas]. Rev Neurol (Paris) 2015; 171:382-9. [PMID: 25847397 DOI: 10.1016/j.neurol.2015.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/30/2014] [Accepted: 02/13/2015] [Indexed: 11/20/2022]
Abstract
Episodic memory disorders are frequent in patients with temporal lesion. Verbal or visuo-spatial memory disorders depend on the location and the lateralization of the lesion. These disorders are well described in temporal epilepsy but rarely in population with cerebral tumor and especially not specifically focus on temporal glioma. The purpose of this study was to describe neuropsychological examination in patient with temporal glioma in the database of the regional memory centre of Besançon. Four patients were identified (all right-handed and with a left temporal glioma). Verbal episodic memory impairment and auditory-verbal short-term memory impairment were observed. One patient had also visual memory disorders. Therefore, further investigations showed an associated Alzheimer's disease. This finding modified the clinical management of this patient. Extensive neuropsychological assessment should be systematic initially to seek an associated pathology, especially in elderly patients, if the cognitive profile is unusual, during the follow-up to better understand cognitive evolution and the effect of therapies on cognition.
Collapse
|
8
|
Gao Y, Gao F, Ma JL, Zhao DL. Palliative whole-brain radiotherapy and health- related quality of life for patients with brain metastasis in cancer. Neuropsychiatr Dis Treat 2015; 11:2185-90. [PMID: 26346192 PMCID: PMC4552255 DOI: 10.2147/ndt.s87109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the use of palliative whole-brain radiotherapy (WBRT) in the treatment of brain metastases (BMs) and to evaluate the health-related quality of life (HRQOL) of these patients. MATERIALS AND METHODS We conducted a retrospective study of 46 patients with BMs who were treated with WBRT at the First Affiliated Hospital of Xi'an Jiaotong University between January 2013 and January 2015. External beam radiotherapy techniques were used to deliver 40 Gy in 20 fractions or 30 Gy in ten fractions with a 10 MV photon beam from a linear accelerator to the whole brain. Data were stored and analyzed using SPSS version 17.0. RESULTS Of the 46 patients, the survival time of patients in our study was 10.8±0.55 months: 11.8±0.46 months in patients with WBRT, 11.75±1.00 in patients with WBRT + chemotherapy, and 3±0.79 months in patients with supportive care, respectively (P<0.01). The HRQOL scores of all the patients were 70±1.16 (before therapy) and 76.83±1.04 (after therapy) (P<0.01). The HRQOL scores of the patients with WBRT were 72.23±0.88 (before therapy) and 78.49±0.87 (after therapy) (P<0.01). There was no central nervous system toxicity; only two (4.3%) patients were found to have BM hemorrhage. Radiation necrosis happened in one patient (2.2%). CONCLUSION Effective treatment options for patients with BMs are important. WBRT was evaluated to ensure survival outcomes and QOL were enhanced after therapy for patients with BMs.
Collapse
Affiliation(s)
- Ying Gao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Fei Gao
- Department of Neurology, First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Jin-Lu Ma
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Dong-Li Zhao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| |
Collapse
|
9
|
Kraszkiewicz M, Wydmanski J. Brain metastases from stomach cancer - The role of different treatment modalities and efficacy of palliative radiotherapy. Rep Pract Oncol Radiother 2014; 20:32-7. [PMID: 25535582 DOI: 10.1016/j.rpor.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/17/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
AIM To evaluate different treatment modalities, sequences, and prognostic factors in patients with brain metastases from stomach cancer. BACKGROUND Brain metastases from gastric cancer are rare and late manifestation of the disease, occurring in less than 1% of gastric cancer patients. The prognosis is poor and median overall survival is 1.3-2.4 months. The standard treatment scheme has not yet been described. Most studies present small sample sizes. The choice of treatment scheme is individually based on performance status, number, location and size of metastases, the status of primary tumor and the presence of other metastases. MATERIALS AND METHODS Sixteen patients diagnosed with brain metastases from gastric cancer in Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch. Patients, mostly men (69%) aged 51-75 years, (median 68.5 years). Thirteen (81.25%) had treatment of primary tumor before diagnosis of brain metastases. Primary metastatic gastric cancer was diagnosed in 6 patients (37.5%), in 3 cases (18.75%) brain was the site of those metastases. Treatment schemes were individually based. RESULTS We identified prognostic factors influencing OS: performance status, number of brain metastases, type of treatment. Median OS was 2.8 months. Median time to brain metastases was 12.3 months and it was shorter in patients with pretreatment metastases to other organs. Patients treated with combined treatment had median survival of 12.3 months. CONCLUSIONS Aggressive treatment schemes are needed to improve the outcome. Prognostic factors such as performance status, number of metastases, dissemination to other organs are helpful in considering the best treatment options.
Collapse
Affiliation(s)
- Malgorzata Kraszkiewicz
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, ul. Wybrzeże AK 15, 44-101 Gliwice, Poland
| | - Jerzy Wydmanski
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, ul. Wybrzeże AK 15, 44-101 Gliwice, Poland
| |
Collapse
|
10
|
Gawkowska-Suwińska M, Blamek S, Heyda A, Boguszewicz L, Cichoń A, Zarudzki L, Nowicka E, Behrendt K, Smolska-Ciszewska B, Plewicki G, Zajusz A, Tarnawski R. Tolerability and toxicity of prophylactic cranial irradiation in patients with non-small cell lung cancer - Results of a phase II study (with estimation of hematological toxicity, pituitary function and magnetic resonance spectra changes). Rep Pract Oncol Radiother 2014; 19:361-8. [PMID: 25337408 DOI: 10.1016/j.rpor.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/06/2014] [Accepted: 05/29/2014] [Indexed: 11/25/2022] Open
Abstract
AIM To evaluate the tolerability and toxicity of PCI in patients with NSCLC. BACKGROUND Prophylactic cranial irradiation (PCI) is a standard treatment for patients with small cell lung cancer. There are data showing a decreasing ratio of brain metastases after PCI for non-small cell lung cancer (NSCLC-non small cell lung cancer) patients but, so far, there is no evidence for increasing overall survival. The main concern in this setting is the tolerance and toxicity of the treatment. MATERIALS AND METHODS From 1999 to 2007, 50 patients with NSCLC treated with radical intent underwent PCI (30 Gy in 15 fractions). Mean follow-up was 2.8 years. The tolerability and hematological toxicity were evaluated in all patients, a part of participants had done neuropsychological tests, magnetic resonance imaging with (1)H nuclear magnetic resonance spectra, and estimation of pituitary function. RESULTS During follow-up, 20 patients developed distant metastases, 4-brain metastases. Fourteen (30%) patients had acute side effects: (headache, nausea, erythema of the skin). The symptoms did not require treatment breaks. Six patients complained of late side effects (vertigo, nausea, anxiety, lower extremity weakness, deterioration of hearing and olfactory hyperesthesia). Hematological complications were not observed. Testosterone levels tended to decrease (p = 0.062). Visual-motor function deteriorated after treatment (p < 0.059). Performance IQ decreased (p < 0.025) and the difference between performance IQ and verbal IQ increased (p < 0.011). Degenerative periventricular vascular changes were observed in two patients. Analysis of the spectroscopic data showed metabolic but reversible alterations after PCI. CONCLUSION PCI in the current series was well tolerated and associated with a relatively low toxicity.
Collapse
Affiliation(s)
| | - Sławomir Blamek
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Alicja Heyda
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Lukasz Boguszewicz
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Anna Cichoń
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Lukasz Zarudzki
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Elżbieta Nowicka
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Katarzyna Behrendt
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Beata Smolska-Ciszewska
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Grzegorz Plewicki
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Aleksander Zajusz
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Rafał Tarnawski
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| |
Collapse
|
11
|
Skórska M, Piotrowski T, Kaźmierska J, Adamska K. A dosimetric comparison of IMRT versus helical tomotherapy for brain tumors. Phys Med 2014; 30:497-502. [PMID: 24613513 DOI: 10.1016/j.ejmp.2014.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Helical tomotherapy (HT) can deliver highly conformal, uniform doses to the target volume. However, HT can only be delivered in a coplanar mode. The purpose of this study was to perform a dosimetric comparison of HT versus coplanar (cIMRT) and non-coplanar (n-cIMRT) beam arrangements on a conventional linear accelerator in a diverse group of brain tumors. MATERIALS AND METHODS A total of 45 treatment plans were calculated retrospectively for 15 cases. For each case, 3 different delivery techniques (n-cIMRT, cIMRT and HT) were used. The treatment plans were compared using the parameters of the target coverage (conformity index; CI) and homogeneity (HI) for the planning target volume (PTV) and the maximum and mean doses for organs at risk (OARs). RESULTS Median HI and CI were the best for HT plans and the worst for cIMRT. The largest reduction of maximum dose for lenses and mean dose for both eyes was achieved for n-cIMRT plans. Mean dose for chiasm and the ipsilateral optic nerve were the lowest for HT. The contralateral optic nerve was most spared with n-cIMRT. For D1% in the brain stem, there was no significant difference between HT and the IMRT plans. CONCLUSIONS Both HT and n-cIMRT are capable of producing conformal and homogeneous treatment plans with a good sparing of OARs. However, due to the non-coplanar capabilities of IMRT, n-cIMRT led to a superior dose reduction to the lenses.
Collapse
Affiliation(s)
- M Skórska
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland.
| | - T Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland; Department of Electroradiology, University of Medical Sciences, Poznan, Poland
| | - J Kaźmierska
- Department of Electroradiology, University of Medical Sciences, Poznan, Poland; Department of Radiotherapy II, Greater Poland Cancer Centre, Poznan, Poland
| | - K Adamska
- Second Radiotherapy Ward, Greater Poland Cancer Centre, Poznan, Poland
| |
Collapse
|