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Abdus-Salam AA, Olabumuyi AA, Jimoh MA, Folorunso SA, Orekoya AA. The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit. Radiat Oncol J 2020; 38:151-161. [PMID: 33012142 PMCID: PMC7533403 DOI: 10.3857/roj.2020.00178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 01/28/2023] Open
Abstract
Inflammatory musculoskeletal conditions are a common group of diseases among the elderly, worldwide. They are characterized by articular degenerative changes accompanied with often debilitating pain. Treatments often involve life-long analgesic therapy or joint replacement in extreme cases. The aim of this current review is to look at the role of radiation treatment with the hope of further study into the effectiveness of radiation treatment in reducing pain, eliminate or reduce the need for life-long analgesic therapy and thereby avoiding the analgesics’ side effects. Extensive literature search was done on PubMed and other available data base and the findings are presented and discussed. Literature showed that many countries in Europe, especially Germany use radiation routinely for the treatment of many degenerative disorders including osteoarthritis with good results and few side effects. A pilot study is therefore recommended with a view to establish the effectiveness or otherwise of this treatment method in patients.
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Affiliation(s)
| | | | - Mutiu Alani Jimoh
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
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Calabrese EJ, Dhawan G, Kapoor R, Kozumbo WJ. Radiotherapy treatment of human inflammatory diseases and conditions: Optimal dose. Hum Exp Toxicol 2019; 38:888-898. [DOI: 10.1177/0960327119846925] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During the early part of the past century, hundreds of clinical studies involving more than 37,000 patients were conducted that showed radiotherapy (RT) to be a successful and safe alternative to drug therapy for the treatment of many diverse inflammatory conditions and diseases (e.g. tendonitis, bursitis, arthritis, and serious inflammatory lung conditions). Data from these studies were collected and analyzed with the intent of estimating an optimal dosing range for RT that would induce an efficacious treatment response. RT was reported to be frequently effective after only a single treatment, with a rapid (within 24 h) and often long-lasting (from months to years) relief from symptoms. Over a two-decade span from the 1920s to the 1940s, the therapeutic responses to a single RT treatment consistently improved as the dosing for multiple ailments decreased over time to between 30 roentgen (r) and 100 r. These findings are significant and in agreement with a number of contemporary reports from Germany where RT has been commonly and successfully employed in treating ailments with an inflammatory origin. A proposed mechanism by which RT mitigates inflammation and facilitates healing is via the polarization of macrophages to an anti-inflammatory or M2 phenotype.
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Affiliation(s)
- EJ Calabrese
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - G Dhawan
- Mass Venture Center, Research Compliance, University of Massachusetts, Hadley, MA, USA
| | - R Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
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Orecchia R, Jereczek-Fossa BA, Rondi E, Bossi-Zanetti I, Meaglia I, Luraschi R, Leonardi MC, Rotmensz N, Botteri E, Fodor C, Cecconi A, Morra A, Lazzari R, Ferrari A, Cattani F, Galimberti V, Luini A, Veronesi P, Zurrida S, Magrini S, Doerr W, Humble N, Trott KR, Ottolenghi A, Smyth V, Veronesi U. Second Malignancies following Breast Cancer Treatment: A Case-Control Study Based on the Peridose Methodology. ALLEGRO Project (Task 5.4). TUMORI JOURNAL 2018; 98:715-21. [DOI: 10.1177/030089161209800607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims and background To calculate peripheral radiation dose to the second primary site in patients who have developed a second malignancy after breast cancer radiotherapy (index cases) and to compare it with dose in the analogous anatomical site in radiotherapy-treated breast cancer patients who did not experience a second malignancy (controls). To evaluate the feasibility of Peridose-software peripheral dose calculation in retrospective case-control studies. Material and study design A case-control study on 12,630 patients who underwent adjuvant breast radiotherapy was performed. Minimum 5-year follow-up was required. Each index case was matched with 5 controls by 1) year of birth, 2) year of radiotherapy and 3) follow-up duration. Peridose-software was used to calculate peripheral dose. Results 195 second cancers were registered (0.019% of all patients treated with adjuvant irradiation). Several methodological limitations of the Peridose calculation were encountered including impossibility to calculate the peripheral dose in the patients treated with intraoperative or external electron beam radiotherapy, in case of second tumors located at <15 cm from the radiotherapy field etc. Moreover, Peridose requires full radiotherapy data and the distance between radiotherapy field and second primary site. Due to these intrinsic limitations, only 6 index cases were eligible for dose calculation. Calculated doses at the second cancer site in index cases and in an analogous site in controls ranged between 7.5 and 145 cGy. The mean index-control dose difference was −3.15 cGy (range, −15.8 cGy and +2.7 cGy). Conclusions The calculated peripheral doses were low and the index-control differences were small. However, the small number of eligible patients precludes a reliable analysis of a potential dose-response relationship. Large patient series followed for a long period and further improvement in the methodology of the peripheral dose calculation are necessary in order to overcome the methodological challenges of the study.
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Affiliation(s)
- Roberto Orecchia
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Barbara A Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Elena Rondi
- Department of Medical Physics, European Institute of Oncology, Milan
| | - Isa Bossi-Zanetti
- Department of Radiation Oncology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Ilaria Meaglia
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Rosa Luraschi
- Department of Medical Physics, European Institute of Oncology, Milan
| | | | - Nicole Rotmensz
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - Edoardo Botteri
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Agnese Cecconi
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Roberta Lazzari
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Annamaria Ferrari
- Department of Radiation Oncology, European Institute of Oncology, Milan
| | - Federica Cattani
- Department of Medical Physics, European Institute of Oncology, Milan
| | | | - Alberto Luini
- Department of Senology, European Institute of Oncology, Milan
| | - Paolo Veronesi
- Department of Senology, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Stefano Zurrida
- Department of Senology, European Institute of Oncology, Milan
- University of Milan, Milan
| | | | - Wolfgang Doerr
- Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Klinik für Strahlentherapie und Radioonkologie, Dresden, Germany
- Dept of Radiation Oncology & Christian Doppler Laboratory for Medical Radiation Research in Radiooncology, Medical University, Vienna, Austria
| | - Nicole Humble
- Department of Radiation Oncology, University Hospital, Ulm, Germany
| | - Klaus R Trott
- University College of London, Cancer Institute, London, UK
- Physics Dept, University of Pavia, Pavia, Italy
| | | | - Vere Smyth
- Physics Dept, University of Pavia, Pavia, Italy
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[Interprofessional collaboration of physicians and respiratory therapists : It is easier as a team]. Med Klin Intensivmed Notfmed 2016; 112:62-63. [PMID: 28011987 DOI: 10.1007/s00063-016-0250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cakir A, Akgun Z, Fayda M, Agaoglu F. Comparison of three dimensional conformal radiation therapy, intensity modulated radiation therapy and volumetric modulated arc therapy for low radiation exposure of normal tissue in patients with prostate cancer. Asian Pac J Cancer Prev 2016; 16:3365-70. [PMID: 25921146 DOI: 10.7314/apjcp.2015.16.8.3365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Radiotherapy has an important role in the treatment of prostate cancer. Three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques are all applied for this purpose. However, the risk of secondary radiation-induced bladder cancer is significantly elevated in irradiated patients compared surgery-only or watchful waiting groups. There are also reports of risk of secondary cancer with low doses to normal tissues. This study was designed to compare received volumes of low doses among 3D-CRT, IMRT and VMAT techniques for prostate patients. Ten prostate cancer patients were selected retrospectively for this planning study. Treatment plans were generated using 3D-CRT, IMRT and VMAT techniques. Conformity index (CI), homogenity index (HI), receiving 5 Gy of the volume (V5%), receiving 2 Gy of the volume (V2%), receiving 1 Gy of the volume (V1%) and monitor units (MUs) were compared. This study confirms that VMAT has slightly better CI while thev olume of low doses was higher. VMAT had lower MUs than IMRT. 3D-CRT had the lowest MU, CI and HI. If target coverage and normal tissue sparing are comparable between different treatment techniques, the risk of second malignancy should be a important factor in the selection of treatment.
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Affiliation(s)
- Aydin Cakir
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey E-mail :
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Specht HM, Neff T, Reuschel W, Wagner FM, Kampfer S, Wilkens JJ, Petry W, Combs SE. Paving the Road for Modern Particle Therapy - What Can We Learn from the Experience Gained with Fast Neutron Therapy in Munich? Front Oncol 2015; 5:262. [PMID: 26640777 PMCID: PMC4661227 DOI: 10.3389/fonc.2015.00262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/11/2015] [Indexed: 12/17/2022] Open
Abstract
While neutron therapy was a highly topical subject in the 70s and 80s, today there are only a few remaining facilities offering fast neutron therapy (FNT). Nevertheless, up to today more than 30,000 patients were treated with neutron therapy. For some indications like salivary gland tumors and malignant melanoma, there is clinical evidence that the addition of FNT leads to superior local control compared to photon treatment alone. FNT was available in Munich from 1985 until 2000 at the Reactor Neutron Therapy (RENT) facility. Patient treatment continued at the new research reactor FRM II in 2007 under improved treatment conditions, and today it can still be offered to selected patients as an individual treatment option. As there is a growing interest in high-linear energy transfer (LET) therapy with new hadron therapy centers emerging around the globe, the clinical data generated by neutron therapy might help to develop biologically driven treatment planning algorithms. Also FNT might experience its resurgence as a combinational partner of modern immunotherapies.
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Affiliation(s)
- Hanno M Specht
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Teresa Neff
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Waltraud Reuschel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Franz M Wagner
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz II (FRM II), Technische Universität München , Garching , Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Munich , Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Munich , Germany ; Institute of Innovative Radiotherapy (iRT), Department of Radiation Science, Helmholtz Zentrum München , Oberschleißheim , Germany
| | - Winfried Petry
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz II (FRM II), Technische Universität München , Garching , Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München , Munich , Germany ; Institute of Innovative Radiotherapy (iRT), Department of Radiation Science, Helmholtz Zentrum München , Oberschleißheim , Germany
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Ottolenghi A, Smyth V, Trott K. Assessment of cancer risk from neutron exposure – The ANDANTE project. RADIAT MEAS 2013. [DOI: 10.1016/j.radmeas.2012.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Multhoff G, Trott KR. [Screening of gene polymorphisms does not improve predictability of radiation toxicity]. Strahlenther Onkol 2013; 189:91-2. [PMID: 23111471 DOI: 10.1007/s00066-012-0250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- G Multhoff
- Klinik und Poliklinik für Strahlentherapie und Radiologischer Onkologie, Klinikum rechts der Isar, TU München, München, Deutschland.
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Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiother Oncol 2013; 106:42-9. [PMID: 23395067 DOI: 10.1016/j.radonc.2013.01.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/09/2013] [Accepted: 01/09/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE To analyze the long-term risk of second primary solid non-breast cancer in a national population-based cohort of 46,176 patients treated for early breast cancer between 1982 and 2007. PATIENTS AND METHODS All patients studied were treated according to the national guidelines of the Danish Breast Cancer Cooperative Group. The risk of second primary cancers was estimated by Standardised incidence ratios (SIRs) and multivariate Cox regression models were used to estimate adjusted hazard ratios (HR) among irradiated women compared to non-irradiated. All irradiated patients were treated on linear accelerators. Second cancers were a priori categorized into two groups; radiotherapy-associated- (oesophagus, lung, heart/mediastinum, pleura, bones, and connective tissue) and non-radiotherapy-associated sites (all other cancers). RESULTS 2358 second cancers had occurred during the follow-up. For the radiotherapy-associated sites the HR among irradiated women was 1.34 (95% CI 1.11-1.61) with significantly increased HRs for the time periods of 10-14 years (HR 1.55; 95% CI 1.08-2.24) and ≥ 15 years after treatment (HR 1.79; 95% CI 1.14-2.81). There was no increased risk for the non-radiotherapy-associated sites (HR 1.04; 95% CI 0.94-1.1). The estimated attributable risk related to radiotherapy for the radiotherapy-associated sites translates into one radiation-induced second cancer in every 200 women treated with radiotherapy. CONCLUSIONS Radiotherapy treated breast cancer patients have a small but significantly excess risk of second cancers.
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Predicting outcomes in radiation oncology--multifactorial decision support systems. Nat Rev Clin Oncol 2012; 10:27-40. [PMID: 23165123 DOI: 10.1038/nrclinonc.2012.196] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the emergence of individualized medicine and the increasing amount and complexity of available medical data, a growing need exists for the development of clinical decision-support systems based on prediction models of treatment outcome. In radiation oncology, these models combine both predictive and prognostic data factors from clinical, imaging, molecular and other sources to achieve the highest accuracy to predict tumour response and follow-up event rates. In this Review, we provide an overview of the factors that are correlated with outcome-including survival, recurrence patterns and toxicity-in radiation oncology and discuss the methodology behind the development of prediction models, which is a multistage process. Even after initial development and clinical introduction, a truly useful predictive model will be continuously re-evaluated on different patient datasets from different regions to ensure its population-specific strength. In the future, validated decision-support systems will be fully integrated in the clinic, with data and knowledge being shared in a standardized, instant and global manner.
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Abstract
Recent advances in radiotherapy have enabled the use of different types of particles, such as protons and heavy ions, as well as refinements to the treatment of tumours with standard sources (photons). However, the risk of second cancers arising in long-term survivors continues to be a problem. The long-term risks from treatments such as particle therapy have not yet been determined and are unlikely to become apparent for many years. Therefore, there is a need to develop risk assessments based on our current knowledge of radiation-induced carcinogenesis.
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Affiliation(s)
- Wayne D Newhauser
- MD Anderson Cancer Center Radiation Oncology, 1515 Holcombe Boulevard Houston, Texas 77030-4009, USA.
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