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Cuccia F, Franzese C, Badellino S, Borghetti P, Federico M, Marvaso G, Montesi G, Pontoriero A, Ferrera G, Alongi F, Scorsetti M. Stereotactic body radiotherapy for spinal oligometastases: a survey on patterns of practice on behalf of the Italian Association of Clinical Oncology and Radiotherapy (AIRO). Clin Exp Metastasis 2024:10.1007/s10585-024-10304-3. [PMID: 39088084 DOI: 10.1007/s10585-024-10304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The Study Group for the Biology and Treatment of the OligoMetastatic Disease on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) has conducted a national survey with the aim to depict the current patterns of practice of stereotactic body radiotherapy (SBRT) for spinal oligometastases. METHODS The Surveymonkey platform was used to send a 28-items questionnaire focused on demographic, clinical and technical aspects related to SBRT for spinal oligometastases. All the AIRO members were invited to fill the questionnaire. Data were then centralized to a single center for analysis and interpretation. RESULTS 53 radiation oncologists from 47 centers fulfilled the survey. A complete agreement was observed in proposing SBRT for spinal oligometastases, with the majority considering up to 3 concurrent spine oligometastases feasible for SBRT (73.5%), regardless of spine site (70%), vertebral segment (85%) and morphological features of the lesion (71.7%). Regarding dose prescription, fractionated regimens resulted as the preferred option, either in 3 (58.4%) or five sessions (34%), with a substantial agreement in applying a PTV-margin larger than 1 mm (almost 90% of participants), and ideally using both MRI and PET imaging to improve target volume and organs-at-risk delineation (67.9%). CONCLUSIONS This national italian survey illustrates the patterns of practice and the main issues for the indication of SBRT for spinal oligometastases. A substantial agreement in the numerical cut-off and vertebral segment involved for SBRT indication was reported, with a slight heterogeneity in terms of dose prescription and fractionation schemes.
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Affiliation(s)
- Francesco Cuccia
- Radiotherapy Unit, ARNAS Civico Hospital, Palermo, 90145, Italy.
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | | | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Italy
- University of Brescia, Brescia, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, ARNAS Civico Hospital, Milan, Italy
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Shyllon S, Penfold S, Dalfsen R, Kirkness E, Hug B, Rowshanfarzad P, Devlin P, Tang C, Le H, Gorayski P, Grogan G, Kearvell R, Ebert MA. Dosimetric comparison of proton therapy and CyberKnife in stereotactic body radiation therapy for liver cancers. Phys Eng Sci Med 2024:10.1007/s13246-024-01440-x. [PMID: 38809365 DOI: 10.1007/s13246-024-01440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
Stereotactic body radiation therapy (SBRT) has been increasingly used for the ablation of liver tumours. CyberKnife and proton beam therapy (PBT) are two advanced treatment technologies suitable to deliver SBRT with high dose conformity and steep dose gradients. However, there is very limited data comparing the dosimetric characteristics of CyberKnife to PBT for liver SBRT. PBT and CyberKnife plans were retrospectively generated using 4DCT datasets of ten patients who were previously treated for hepatocellular carcinoma (HCC, N = 5) and liver metastasis (N = 5). Dose volume histogram data was assessed and compared against selected criteria; given a dose prescription of 54 Gy in 3 fractions for liver metastases and 45 Gy in 3 fractions for HCC, with previously published consensus-based normal tissue dose constraints. Comparison of evaluation parameters showed a statistically significant difference for target volume coverage and liver, lungs and spinal cord (p < 0.05) dose, while chest wall and skin did not indicate a significant difference between the two modalities. A number of optimal normal tissue constraints was violated by both the CyberKnife and proton plans for the same patients due to proximity of tumour to chest wall. PBT resulted in greater organ sparing, the extent of which was mainly dependent on tumour location. Tumours located on the liver periphery experienced the largest increase in organ sparing. Organ sparing for CyberKnife was comparable with PBT for small target volumes.
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Affiliation(s)
- Samuel Shyllon
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Scott Penfold
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Physics, University of Adelaide, Adelaide, SA, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, SA, Australia
| | - Ray Dalfsen
- PT Product Engineering, Elekta, Adelaide, SA, Australia
| | - Elsebe Kirkness
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Ben Hug
- 5D Clinics, Claremont, WA, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia.
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA, Australia.
| | | | - Colin Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- 5D Clinics, Claremont, WA, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, SA, Australia
| | - Peter Gorayski
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, SA, Australia
| | - Garry Grogan
- Radiotherapy Physics, The Churchill Hospital, Headington, Oxford, UK
| | | | - Martin A Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- 5D Clinics, Claremont, WA, Australia
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA, Australia
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Shanker MD, Cavazos AP, Li J, Beckham TH, Yeboa DN, Wang C, McAleer MF, Briere TM, Amini B, Tatsui CE, North RY, Alvarez-Breckenridge CA, Cezayirli PC, Rhines LD, Ghia AJ, Bishop AJ. Definitive single fraction spine stereotactic radiosurgery for metastatic sarcoma: Simultaneous integrated boost is associated with high tumor control and low vertebral fracture risk. Radiother Oncol 2024; 193:110119. [PMID: 38311030 DOI: 10.1016/j.radonc.2024.110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Sarcoma spinal metastases (SSM) are particularly difficult to manage given their poor response rates to chemotherapy and inherent radioresistance. We evaluated outcomes in a cohort of patients with SSM uniformly treated using single-fraction simultaneous-integrated-boost (SIB) spine stereotactic radiosurgery (SSRS). MATERIALS AND METHODS A retrospective review was conducted at a single tertiary institution treated with SSRS for SSM between April 2007-April 2023. 16-24 Gy was delivered to the GTV and 16 Gy uniformly to the CTV. Kaplan-Meier analysis was conducted to assess time to progression of disease (PD) with proportionate hazards modelling used to determine hazard ratios (HR) and respective 95 % confidence intervals (CI). RESULTS 70 patients with 100 lesions underwent SSRS for SSM. Median follow-up was 19.3 months (IQR 7.7-27.8). Median age was 55 years (IQR42-63). Median GTV and CTVs were 14.5 cm3 (IQR 5-32) and 52.7 cm3 (IQR 29.5-87.5) respectively. Median GTV prescription dose and biologically equivalent dose (BED) [α/β = 10] was 24 Gy and 81.6 Gy respectively. 85 lesions received 24 Gy to the GTV. 27 % of patients had Bilsky 1b or greater disease. 16 of 100 lesions recurred representing a crude local failure rate of 16 % with a median time to failure of 10.4 months (IQR 5.7-18) in cases which failed locally. 1-year actuarial local control (LC) was 89 %. Median overall survival (OS) was 15.3 months (IQR 7.7-25) from SSRS. Every 1 Gy increase in GTV absolute minimum dose (DMin) across the range (5.8-25 Gy) was associated with a reduced risk of local failure (HR = 0.871 [95 % CI 0.782-0.97], p = 0.009). 9 % of patients developed vertebral compression fractures at a median of 13 months post SSRS (IQR 7-25). CONCLUSION This study represents one of the most homogenously treated and the largest cohorts of patients with SSM treated with single-fraction SSRS. Despite inherent radioresistance, SSRS confers durable and high rates of local control in SSM without unexpected long-term toxicity rates.
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Affiliation(s)
- Mihir D Shanker
- The University of Texas MD Anderson Cancer Centre, United States; The University of Queensland, Brisbane, Australia.
| | | | - Jing Li
- The University of Texas MD Anderson Cancer Centre, United States
| | - Thomas H Beckham
- The University of Texas MD Anderson Cancer Centre, United States
| | - Debra N Yeboa
- The University of Texas MD Anderson Cancer Centre, United States
| | - Chenyang Wang
- The University of Texas MD Anderson Cancer Centre, United States
| | | | | | - Behrang Amini
- The University of Texas MD Anderson Cancer Centre, United States
| | - Claudio E Tatsui
- The University of Texas MD Anderson Cancer Centre, United States
| | - Robert Y North
- The University of Texas MD Anderson Cancer Centre, United States
| | | | | | | | - Amol J Ghia
- The University of Texas MD Anderson Cancer Centre, United States
| | - Andrew J Bishop
- The University of Texas MD Anderson Cancer Centre, United States
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Ferini G, Zagardo V, Viola A, Aiello MM, Harikar MM, Venkataram T, Palmisciano P, Illari SI, Valenti V, Umana GE. Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review. Front Oncol 2023; 13:1146041. [PMID: 37441424 PMCID: PMC10335800 DOI: 10.3389/fonc.2023.1146041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/25/2023] [Indexed: 07/15/2023] Open
Abstract
Background The rarity of hand acrometastases hampers the consensus-building for their optimal management among the involved oncology professionals. In the current literature, demolitive surgery overcomes the use of palliative radiotherapy, which proved to be ineffective in more than 30% of cases treated with classic palliative dose schemes, carrying also a not negligible radiation-related adverse event rate. Against this background, stereotactic body radiation therapy (SBRT) could emerge as a well-balanced therapeutic option. Case summary Here we describe the methods and outcomes of a SBRT treatment of a painful and function-limiting hand acrometastasis in a patient with a history of stage IIIB lung adenocarcinoma. We delivered a total dose of 30 Gy in five daily fractions to a soft-tissue metastasis abutting the fifth metacarpal bone through the SBRT protocol generally used for intracranial treatments. A few weeks later, the patient reported a clinical complete response with acrometastasis and pain disappearance, function recovery, and no significant toxicity. The acrometastasis was the first sign of an atypical cancer progression. Conclusions SBRT for hand acrometastases is feasible and might have the best therapeutic profile among the currently available treatment options for this rare clinical scenario. Larger investigations are needed to confirm the present single-case experience.
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Affiliation(s)
- Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
| | - Valentina Zagardo
- Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
| | - Anna Viola
- Department of Radiation Oncology, Fondazione Istituto Oncologico del Mediterraneo (IOM), Viagrande, Italy
| | - Marco Maria Aiello
- Medical Oncology, University Hospital Policlinico San Marco, Catania, Italy
| | | | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Salvatore Ivan Illari
- Department of Radiation Oncology, Fondazione Istituto Oncologico del Mediterraneo (IOM), Viagrande, Italy
| | - Vito Valenti
- Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
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Liu X, Hu P, Zhai S, Liu X, Wang B, Zhou H, Liu X, Liu Z, Wei F. Surgery for metastatic spinal differentiated thyroid cancer: feasibility, outcome, and prognostic factors. Front Surg 2023; 10:1140150. [PMID: 37273828 PMCID: PMC10232895 DOI: 10.3389/fsurg.2023.1140150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Study design A retrospective cohort study. Objectives This study aims to report the surgical outcome of metastatic spinal differentiated thyroid cancer (MSDTC) and analyze the factors affecting the prognosis. Methods Thirty-five patients were recruited in our single institution who underwent spinal surgery and adjuvant therapies from 2009 to 2019. Two surgical procedures, total en-bloc spondylectomy and debulking surgery, were undertaken. Their clinical data, postoperative events, and survival data were collected and analyzed. Survival time and associated factors were further analyzed. Results The cohort had a median survival time of 60 months. The mean visual analog scale scores and the Karnofsky performance score improved postoperatively (p < 0.05). The patients' Frankel grade was elevated for cases with preoperative neurological deficits (p < 0.05). In 31 patients who underwent debulking surgery, 41.9% (n = 13) had local recurrences, and radiotherapy reduced the risk of local relapse (p < 0.05). Preoperative and postoperative Frankel grades and radioactive iodine (RAI) therapy were associated with the patients' survival in the univariate analysis (p < 0.05). Furthermore, a multivariate regression analysis showed the postoperative Frankel grade as an independent prognostic factor. Conclusion Pain, quality of life, and neurological status of patients can be effectively improved after surgery. Radiotherapy can reduce the risk of local recurrences, whereas RAI therapy has a limited effect on local and extraspinal tumor control. Neurological status was independently associated with the patients' survival.
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Affiliation(s)
- Xiajun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Department of Spinal Surgery, Baoji Municipal Central Hospital, Baoji, China
| | - Panpan Hu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Shuheng Zhai
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiao Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Ben Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Hua Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Feng Wei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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Nguyen EK, Ruschin M, Zhang B, Soliman H, Myrehaug S, Detsky J, Chen H, Sahgal A, Tseng CL. Stereotactic body radiotherapy for spine metastases: a review of 24 Gy in 2 daily fractions. J Neurooncol 2023; 163:15-27. [PMID: 37155133 DOI: 10.1007/s11060-023-04327-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) has proven to be a highly effective treatment for selected patients with spinal metastases. Randomized evidence shows improvements in complete pain response rates and local control with lower retreatment rates favoring SBRT, compared to conventional external beam radiotherapy (cEBRT). While there are several reported dose-fractionation schemes for spine SBRT, 24 Gy in 2 fractions has emerged with Level 1 evidence providing an excellent balance between minimizing treatment toxicity while respecting patient convenience and financial strain. METHODS We provide an overview of the 24 Gy in 2 SBRT fraction regimen for spine metastases, which was developed at the University of Toronto and tested in an international Phase 2/3 randomized controlled trial. RESULTS The literature summarizing global experience with 24 Gy in 2 SBRT fractions suggests 1-year local control rates ranging from 83-93.9%, and 1-year rates of vertebral compression fracture ranging from 5.4-22%. Reirradiation of spine metastases that failed prior cEBRT is also feasible with 24 Gy in 2 fractions, and 1-year local control rates range from 72-86%. Post-operative spine SBRT data are limited but do support the use of 24 Gy in 2 fractions with reported 1-year local control rates ranging from 70-84%. Typically, the rates of plexopathy, radiculopathy and myositis are under 5% in those series reporting mature follow up, with no cases of radiation myelopathy (RM) reported in the de novo setting when the spinal cord avoidance structure is limited to 17 Gy in 2 fractions. However, re-irradiation RM has been observed following 2 fraction SBRT. More recently, 2-fraction dose escalation with 28 Gy, with a higher dose constraint to the critical neural tissues, has been reported suggesting improved rates of local control. This regimen may be important in those patients with radioresistant histologies, high grade epidural disease, and/or paraspinal disease. CONCLUSION The dose-fractionation of 24 Gy in 2 fractions is well-supported by published literature and is an ideal starting point for centers looking to establish a spine SBRT program.
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Affiliation(s)
- Eric K Nguyen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Beibei Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Saha P, Raza M, Fragkakis A, Ajayi B, Bishop T, Bernard J, Miah A, Zaidi SH, Abdelhamid M, Minhas P, Lui DF. Case report: L5 tomita En bloc spondylectomy for oligometastatic liposarcoma with post adjuvant stereotactic ablative radiotherapy. Front Surg 2023; 10:1110580. [PMID: 36969765 PMCID: PMC10033756 DOI: 10.3389/fsurg.2023.1110580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/19/2023] [Indexed: 03/11/2023] Open
Abstract
IntroductionTomita En-bloc spondylectomy of L5 is one of the most challenging techniques in radical oncological spine surgery. A 42-year-old female was referred with lower back pain and L5 radiculopathy with a background of right shoulder liposarcoma excision. CT-PET confirmed a solitary L5 oligometastasis. MRI showed thecal sac indentation hence wasn't suitable for Stereotactic Ablative Radiotherapy (SABR) alone. The seeding nature of sarcoma prevents the indication of separation surgery hence excisional surgery is considered for radical curative treatment. This case report demonstrates dual-staged modified TES including the utilisation of novel techniques to allow for maximum radical oncological control in the era of SABR and lesser invasive surgery.MethodsFirst-stage: Carbonfibre pedicle screws planned from L2 to S2AI-Pelvis, aligned, to her patient-specific rods. Radiofrequency ablation of L5 pedicles prior to osteotomy was performed to prevent sarcoma cell seeding. Microscope-assisted thecal sac tumour separation and L5 nerve root dissection was performed. Novel surgical navigation of the ultrasonic bone-cutter assisted inferior L4 and superior S1 endplate osteotomies. Second-stage: Vascular-assisted retroperitoneal approach at L4–S1 was undertaken protecting the great vessels. Completion of osteotomies at L4 and S1 to En-bloc L5: (L4 inferior endplate, L4/5 disc, L5 body, L5/S1 disc and S1 superior endplate). Anterior reconstruction used an expandable PEEK cage obviating the need for a third posterior stage. Reinforced with a patient-specific carbon plate L4–S1 promontory.ResultsPatient rehabilitated well and was discharged after 42 days. Cyberknife of 30Gy in 5 fractions was delivered two months post-op. Despite left foot drop, she's walking independently 9 months post-op.ConclusionThese are challenging cases require a truly multi-disciplinary team approach. We share this technique for a dual stage TES and metal-free construct with post adjuvant SABR to achieve maximum local control in spinal oligometastatic disease. This case promotes our modified TES technique in the era of SABR and separation surgery in carefully selected cases.
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Affiliation(s)
- Priyanshu Saha
- School of Medicine, St George's, University of London, United Kingdom
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
- Correspondence: Priyanshu Saha
| | - Mohsen Raza
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Angelo Fragkakis
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Bisola Ajayi
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Timothy Bishop
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Jason Bernard
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Aisha Miah
- Department of Sarcoma, Royal Marsden NHS Foundation Trust, United Kingdom
| | - Shane H. Zaidi
- Department of Sarcoma, Royal Marsden NHS Foundation Trust, United Kingdom
| | - Mohamed Abdelhamid
- Department of Vascular Surgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Pawan Minhas
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Darren F. Lui
- Department of Complex Neurosurgery, St George's University Hospitals NHS Foundation Trust, United Kingdom
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Sherriff J, Abdul-Latif M, Tsang YM. Combining the Best of Both Worlds: The Role of Sequential Stereotactic Radiotherapy Boost for Spinal Metastases. Clin Oncol (R Coll Radiol) 2023; 35:323-325. [PMID: 36710152 DOI: 10.1016/j.clon.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Affiliation(s)
- J Sherriff
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Y M Tsang
- Radiation Medicine Programme, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Gales L, Mitrea D, Chivu B, Radu A, Bocai S, Stoica R, Dicianu A, Mitrica R, Trifanescu O, Anghel R, Serbanescu L. Risk of Myelopathy Following Second Local Treatment after Initial Irradiation of Spine Metastasis. Diagnostics (Basel) 2023; 13:diagnostics13020175. [PMID: 36672985 PMCID: PMC9857541 DOI: 10.3390/diagnostics13020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
Metastatic lesions of the spine occur in up to 40% of cancer patients and are a frequent source of pain and neurologic deficit due to cord compression. Palliative radiotherapy is the main first-intent local treatment in the form of single-fraction radiotherapy or fractionated courses. Reirradiation is a viable option for inoperable patients where spinal decompression is needed but with an increased risk of radiation-induced myelopathy (RM) and subsequent neurologic damage. This review summarizes reported data on local treatment options after initial irradiation in patients with relapsed spine metastasis and key dosimetric correlations between the risk of spinal cord injury and reirradiation technique, total dose, and time between treatments. The Linear Quadratic (LQ) model was used to convert all the published doses into biologically effective doses and normalize them to EQD2. For 3D radiotherapy, authors used cumulative doses from 55.2 Gy2/2 to 65.5 Gy2/2 EQD2 with no cases of RM mentioned. We found little evidence of RM after SBRT in the papers that met our criteria of inclusion, usually at the median reported dose to critical neural tissue around 93.5 Gy2/2. There is a lack of consistency in reporting the spinal cord dose, which leads to difficulty in pooling data.
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Affiliation(s)
- Laurentia Gales
- Department of Oncology, “Carol Davila” University of Medicine & Pharmacy, 020021 Bucharest, Romania
- Department of Oncology, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Diana Mitrea
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Bogdan Chivu
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Adrian Radu
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Silvia Bocai
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Remus Stoica
- Department of Radiotherapy, Centrul Oncologic Sanador, 010991 Bucharest, Romania
| | - Andrei Dicianu
- Department of Radiotherapy, Clinical Emergency County Hospital, 200642 Craiova, Romania
| | - Radu Mitrica
- Department of Oncology, “Carol Davila” University of Medicine & Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
- Correspondence: (R.M.); (O.T.); Tel.: +40-741964311 (R.M.); +40-745001224 (O.T.)
| | - Oana Trifanescu
- Department of Oncology, “Carol Davila” University of Medicine & Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
- Correspondence: (R.M.); (O.T.); Tel.: +40-741964311 (R.M.); +40-745001224 (O.T.)
| | - Rodica Anghel
- Department of Oncology, “Carol Davila” University of Medicine & Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
| | - Luiza Serbanescu
- Department of Oncology, “Carol Davila” University of Medicine & Pharmacy, 020021 Bucharest, Romania
- Department of Radiotherapy, “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
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10
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Advances in Radiation Oncology for Pancreatic Cancer: An Updated Review. Cancers (Basel) 2022; 14:cancers14235725. [PMID: 36497207 PMCID: PMC9736314 DOI: 10.3390/cancers14235725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
This review aims to summarize the recent advances in radiation oncology for pancreatic cancer. A systematic search of the MEDLINE/PubMed database and Clinicaltrials.gov was performed, focusing on studies published within the last 10 years. Our search queried "locally advanced pancreatic cancer [AND] stereotactic body radiation therapy (SBRT) [OR] hypofractionation [OR] magnetic resonance guidance radiation therapy (MRgRT) [OR] proton" and "borderline resectable pancreatic cancer [AND] neoadjuvant radiation" and was limited only to prospective and retrospective studies and metanalyses. For locally advanced pancreatic cancers (LAPC), retrospective evidence supports the notion of radiation dose escalation to improve overall survival (OS). Novel methods for increasing the dose to high risk areas while avoiding dose to organs at risk (OARs) include SBRT or ablative hypofractionation using a simultaneous integrated boost (SIB) technique, MRgRT, or charged particle therapy. The use of molecularly targeted agents with radiation to improve radiosensitization has also shown promise in several prospective studies. For resectable and borderline resectable pancreatic cancers (RPC and BRPC), several randomized trials are currently underway to study whether current neoadjuvant regimens using radiation may be improved with the use of the multi-drug regimen FOLFIRINOX or immune checkpoint inhibitors.
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11
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Ferini *G, Palmisciano P, Scalia G, Haider AS, Bin-Alamer O, Sagoo NS, Bozkurt I, Deora H, Priola SM, Aoun SG, Umana GE. The role of radiation therapy in the treatment of spine metastases from hepatocellular carcinoma: a systematic review and meta-analysis. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.8.focus2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE
Spine hepatocellular carcinoma (HCC) metastases severely worsen quality of life and prognosis, with the role of radiotherapy being controversial. The authors systematically reviewed the literature on radiotherapy for spine metastatic HCCs.
METHODS
The PubMed, Scopus, Web of Science, and Cochrane databases were searched according to the PRISMA guidelines to include studies of radiotherapy for spine metastatic HCCs. Outcomes, complications, and local control were analyzed with indirect random-effect meta-analyses.
RESULTS
The authors included 12 studies comprising 713 patients. The median time interval from diagnosis of HCC to spine metastases was 12 months (range 0–105 months). Most lesions were thoracic (35.9%) or lumbar (24.7%). Radiotherapy was delivered with conventional external-beam (67.3%) or stereotactic (31.7%) techniques. The median dose was 30.3 Gy (range 12.5–52 Gy) in a median of 5 fractions (range 1–20 fractions). The median biologically effective dose was 44.8 Gy10 (range 14.4–112.5 Gy10). Actuarial rates of postradiotherapy pain relief and radiological response were 87% (95% CI 84%–90%) and 70% (95% CI 65%–75%), respectively. Radiation-related adverse events and vertebral fractures had actuarial rates of 8% (95% CI 5%–11%) and 16% (95% CI 10%–23%), respectively, with fracture rates significantly higher after stereotactic radiotherapy (p = 0.033). Fifty-eight patients (27.6%) had local recurrences after a median of 6.8 months (range 0.1–59 months), with pooled local control rates of 61.6% at 6 months and 40.8% at 12 months, and there were no significant differences based on radiotherapy type (p = 0.068). The median survival was 6 months (range 0.1–62 months), with pooled rates of 52.5% at 6 months and 23.4% at 12 months.
CONCLUSIONS
Radiotherapy in spine metastatic HCCs shows favorable rates of pain relief, radiological responses, and local control. Rates of postradiotherapy vertebral fractures are higher after high-dose stereotactic radiotherapy.
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Affiliation(s)
- *Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Catania, Italy
| | | | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi," Catania, Italy
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, Texas
| | - Othman Bin-Alamer
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ismail Bozkurt
- Department of Neurosurgery, Cankiri State Hospital, Cankiri, Turkey
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Stefano M Priola
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
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12
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A Critical Overview of Predictors of Heart Sparing by Deep-Inspiration-Breath-Hold Irradiation in Left-Sided Breast Cancer Patients. Cancers (Basel) 2022; 14:cancers14143477. [PMID: 35884538 PMCID: PMC9319386 DOI: 10.3390/cancers14143477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 01/21/2023] Open
Abstract
Simple Summary Adjuvant radiotherapy could damage the heart in left-sided breast cancer patients. The deep-inspiration-breath-hold technique may limit the heart exposure to radiation. As non-beneficiaries exist, there is some need to do an upfront cost-effective selection. Some easy-to-use anatomical predictors may help insiders in the treatment decision. The awareness of such findings may improve the efficiency of practitioners’ workflows. Abstract Radiotherapy represents an essential part of the therapeutic algorithm for breast cancer patients after conservative surgery. The treatment of left-sided tumors has been associated with a non-negligible risk of developing late-onset cardiovascular disease. The cardiac risk perception has especially increased over the last years due to the prolongation of patients’ survival owing to the advent of new drugs and an ever earlier cancer detection through screening programs. Improvements in radiation delivery techniques could reduce the treatment-related heart toxicity. The deep-inspiration-breath-hold (DIBH) irradiation is one of the most advanced treatment approaches, which requires specific technical equipment and uses inspiration to displace the heart from the tangential radiation fields. However, not all patients benefit from its use. Moreover, DIBH irradiation needs patient compliance and accurate training. Therefore, such a technique may be unjustifiably cumbersome and time-consuming as well as unnecessarily expensive from a mere healthcare cost point of view. Hence the need to early select only the true beneficiaries while tailoring more effective heart-sparing techniques for the others and streamlining the workflow, especially in high-volume radiation oncology departments. In this literature overview, we collected some possible predictors of cardiac dose sparing in DIBH irradiation for left breast treatment in an effort to provide an easy-to-consult summary of simple instruments to insiders for identifying patients actually benefitting from this technique. We critically reviewed the reliability and weaknesses of each retrieved finding, aiming to inspire new insights and discussions on this much-debated topic.
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13
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The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective. Life (Basel) 2022; 12:life12040571. [PMID: 35455062 PMCID: PMC9032747 DOI: 10.3390/life12040571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 12/17/2022] Open
Abstract
Spine represents the most common site for metastatic disease involvement. Due to the close relationship between the spinal cord and critical structures, therapeutical management of metastatic spinal cord disease remains challenging. Spinal localization can lead to neurological sequelae, which can significantly affect the quality of life in patients with a limited life expectancy. The authors conducted a systematic literature review according to PRISMA guidelines in order to determine the impact of the most updated palliative care on spinal metastases. The initial literature search retrieved 2526 articles, manually screened based on detailed exclusion criteria. Finally, 65 studies met the inclusion criteria and were finally included in the systematic review. In the wide scenario of palliative care, nowadays, recent medical or surgical treatments represent valuable options for ameliorating pain and improving patients QoL in such this condition.
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14
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Ferini G, Castorina P, Valenti V, Illari SI, Sachpazidis I, Castorina L, Marrale M, Pergolizzi S. A Novel Radiotherapeutic Approach to Treat Bulky Metastases Even From Cutaneous Squamous Cell Carcinoma: Its Rationale and a Look at the Reliability of the Linear-Quadratic Model to Explain Its Radiobiological Effects. Front Oncol 2022; 12:809279. [PMID: 35280772 PMCID: PMC8904747 DOI: 10.3389/fonc.2022.809279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/26/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction Metastatic cutaneous squamous cell carcinoma (cSCC) is a very rare condition. The lack of definition of an oligometastatic subgroup means that there is no consensus for its treatment, unlike the mucosal head and neck counterpart. Like the latter, the cutaneous form is able to develop bulky tumor masses. When this happens, the classic care approach is just for palliative intent due to a likely unfavorable benefit–risk balance typical of aggressive treatments. Here we proposed a novel radiotherapy (RT) technique to treat bulky metastases from cSCC in the context of an overall limited tumor burden and tried to explain its clinical outcome by the currently available mathematical radiobiological and ad hoc developed models. Methods We treated a case of facial cSCC with three metastases: two of them by classic stereotactic RT and the other by lattice RT supported by metabolic imaging (18F-FDG PET) due to its excessively large dimensions. For the latter lesion, we compared four treatment plans with different RT techniques in order to define the best approach in terms of normal tissue complication probability (NTCP) and tumor control probability (TCP). Moreover, we developed an ad hoc mathematical radiobiological model that could fit better with the characteristics of heterogeneity of this bulky metastasis for which, indeed, a segmentation of normoxic, hypoxic, and necrotic subvolumes might have been assumed. Results We observed a clinical complete response in all three disease sites; the bulky metastasis actually regressed more rapidly than the other two treated by stereotactic RT. For the large lesion, NTCP predictions were good for all four different plans but even significantly better for the lattice RT plan. Neither the classic TCP nor the ad hoc developed radiobiological models could be totally adequate to explain the reported outcome. This finding might support a key role of the host immune system. Conclusions PET-guided lattice RT might be safe and effective for the treatment of bulky lesions from cSCC. There might be some need for complex mathematical radiobiological models that are able to take into account any immune system’s role in order to explain the possible mechanisms of the tumor response to radiation and the relevant key points to enhance it.
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Affiliation(s)
- Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | - Paolo Castorina
- Istituto Oncologico del Mediterraneo, Viagrande, Italy.,Faculty of Mathematics and Physics, Charles University, Prague, Czechia.,Istituto Nazionale Fisica Nucleare, Catania, Italy
| | - Vito Valenti
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | | | - Ilias Sachpazidis
- Department of Radiation Oncology, Division of Medical Physics, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Research & Development, Medical Innovation and Technology P. C., Mesolongi, Greece
| | - Luigi Castorina
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | - Maurizio Marrale
- Department of Physics and Chemistry, "Emilio Segrè" ATeN Center, University of Palermo, Palermo, Italy.,Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Catania, Catania, Italy
| | - Stefano Pergolizzi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, Messina, Italy
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15
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Parisi S, Ferini G, Cacciola A, Lillo S, Tamburella C, Santacaterina A, Bottari A, Brogna A, Ferrantelli G, Pontoriero A, Minutoli F, Pergolizzi S. A non-surgical COMBO-therapy approach for locally advanced unresectable pancreatic adenocarcinoma: preliminary results of a prospective study. LA RADIOLOGIA MEDICA 2022; 127:214-219. [PMID: 35034325 DOI: 10.1007/s11547-021-01441-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022]
Abstract
In this short report we present a series of thirteen patients with locally advanced, unresectable, pancreatic cancer treated with a COMBO-Therapy consisting of: STEP-1: induction chemotherapy; STEP-2: concomitant chemoradiotherapy; STEP-3: stereotactic body radiotherapy boost. After four weeks from the end of each step all patients had a re-staging and a surgical re-evaluation. All patients completed STEP-1 and STEP-2. STEP-3 has been successfully delivered to 8/13 patients with a median dose of 12 Gy (range 10-21 Gy) in 1-3 fractions. The median LC was 20 months (range 10-32) with a 2-year LC of 72.9%, and none of the patients developed G3 acute or late toxicities. The median OS was 21.5 months (range 12-34), and the 2-year OS was 53.9%; the median PFS was 17.5 months (range 10-27). Our non-surgical COMBO-Therapy has demonstrated a feasible profile with good tolerance. Further prospective protocols are needed to confirm our preliminary results.
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Affiliation(s)
- Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Alberto Cacciola
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sara Lillo
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Consuelo Tamburella
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Antonio Bottari
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Anna Brogna
- Unit of Medical Physics, University Hospital Policlinico "G. Martino", Messina, Italy
| | - Giacomo Ferrantelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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16
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Palmisciano P, Ferini G, Ogasawara C, Wahood W, Bin Alamer O, Gupta AD, Scalia G, Larsen AMG, Yu K, Umana GE, Cohen-Gadol AA, El Ahmadieh TY, Haider AS. Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes. Cancers (Basel) 2021; 14:94. [PMID: 35008259 PMCID: PMC8750198 DOI: 10.3390/cancers14010094] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. METHODS PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. RESULTS We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0-420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). CONCLUSIONS Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA;
| | - Waseem Wahood
- Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33328, USA;
| | - Othman Bin Alamer
- Department of Neurosurgery, King Abdullah International Medical Research Center, Riyadh 11451, Saudi Arabia;
| | - Aditya D. Gupta
- College of Medicine, Texas A&M University, Houston, TX 77030, USA; (A.D.G.); (A.S.H.)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95126 Catania, Italy;
| | - Alexandra M. G. Larsen
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Kenny Yu
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Giuseppe E. Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46077, USA;
| | - Tarek Y. El Ahmadieh
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Ali S. Haider
- College of Medicine, Texas A&M University, Houston, TX 77030, USA; (A.D.G.); (A.S.H.)
- Department of Neurosurgery, Anderson Cancer Center, The University of Texas M.D., Houston, TX 77030, USA
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17
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Ferini G, Viola A, Valenti V, Tripoli A, Molino L, Marchese VA, Illari SI, Rita Borzì G, Prestifilippo A, Umana GE, Martorana E, Mortellaro G, Ferrera G, Cacciola A, Lillo S, Pontoriero A, Pergolizzi S, Parisi S. Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life. Clin Transl Radiat Oncol 2021; 32:52-58. [PMID: 34926839 PMCID: PMC8649107 DOI: 10.1016/j.ctro.2021.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023] Open
Abstract
The main aim of MBM treatment is to palliate neurological symptoms and to maintain an adequate QoL. SRT could be the “new standard” over WBI in the management of MBM patients. Neurocognitive functions could deteriorate more after WBI than after SRT.
Aims To evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). Methods This multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). Discussion Several studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement that allows, in a context of a significant time saving, improved patient comfort and minimizing radiation dose to off-target brain, a selective treatment of MBM simultaneously, otherwise attackable only by WBI. The achievement of a local control rate comparable to that obtained with WBI remains the fundamental prerequisite. Trial registration NCT number: NCT04891471.
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Key Words
- 3D-CRT, 3Dimensional-ConformalRadioTherapy
- Autonomy in daily activities
- BSC, Best Supportive Care
- Brain metastases
- CRF, Case Report Form
- CT, Computerized Tomography
- CTV, Clinical Target Volume
- EORTC QLQ-C15-PAL, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care
- FSRT, Fractionated Stereotactic Radiation Therapy
- GTV, Gross Tumor Volume
- KPS, Karnofsky Performance Status
- LINAC, Linear Accelerator
- MBM, Multiple Brain Metastastes
- MRI, Magnetic Resonance Imaging
- MoCA, Montreal Cognitive Assessment
- NCCN, National Comprehensive Cancer Network
- Neurocognitive decay
- Neurocognitive performance
- Neurocognitive tests
- OAR, Organ At Risk
- OS, Overall Survival
- PTV, Planning Target Volume
- Palliative care
- QLQ-BN20, Quality of Life Questionnaire - Brain Neoplasm 20
- QoL, Quality of Life
- Quality of life
- RT, Radiation Therapy
- RTOG, Radiation Therapy Oncology Group
- Radiotherapy for multiple brain metastases
- SBI, Stereotactic Brain Irradiation
- SRS, Stereotactic RadioSurgery
- SRT, Stereotactic Radiation Therapy
- Stereotactic Brain RadioSurgery
- Stereotactic Brain Radiotherapy
- Supportive care in cancer patients
- VEGF, Vascular Endothelial Growth Factor
- Whole Brain Radiotherapy
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Affiliation(s)
| | - Anna Viola
- Fondazione IOM, Viagrande, I-95029 Catania, Italy
| | - Vito Valenti
- REM Radioterapia srl, Viagrande, I-95029 Catania, Italy
| | | | - Laura Molino
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | | | | | | | - Angela Prestifilippo
- Medical Oncology Unit, Mediterranean Institute of Oncology, Viagrande, I-95029 Catania, Italy
| | - Giuseppe Emmanuele Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, I-95125 Catania, Italy
| | | | - Gianluca Mortellaro
- Department of Radiation Oncology, ARNAS Ospedale Civico, I-90127 Palermo, Italy
| | - Giuseppe Ferrera
- Department of Radiation Oncology, ARNAS Ospedale Civico, I-90127 Palermo, Italy
| | - Alberto Cacciola
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Sara Lillo
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Antonio Pontoriero
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Stefano Pergolizzi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
| | - Silvana Parisi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali Università di Messina, I-98100 Messina, Italy
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Ferini G, Valenti V, Puliafito I, Illari SI, Marchese VA, Borzì GR. Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121379. [PMID: 34946324 PMCID: PMC8703259 DOI: 10.3390/medicina57121379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/25/2022]
Abstract
The peculiar and rare clinical condition below clearly requires a customized care approach in the context of personalized medicine. An 80-year-old female patient who was subjected in 2018 to surgical removal of a cutaneous Merkel cell carcinoma (MCC) nodule located on the posterior surface of the left thigh and to three subsequent palliative radiotherapy treatments developed a fourth relapse in October 2020, with fifteen nodular metastases located in the left thigh and leg. Since the overall macroscopic disease was still exclusively regionally located and microscopic spread was likely extended also to clinically negative skin of the thigh and leg, we performed an irradiation of the whole left lower extremity. For this purpose the total target (65.5 cm) was divided into three sub-volumes. Dose prescription was 30 Gy in 15 daily fractions. A sequential boost of 10 Gy in 5 daily fractions was planned for macroscopic nodules. Plans were calculated by means of volumetric modulated arc therapy (VMAT) with the field overlap technique. Thanks to this, we obtained a homogeneous dose distribution in the field junction region; avoidance structures were delineated in the central part of the thigh and leg with the aim of achieving an optimal superficial dose painting and to reduce bone exposure to radiation. This case study demonstrates that VMAT allows for a good dose coverage for circumferential cutaneous targets while sparing deeper organs at risk. A reproducible image-guided set-up is fundamental for an accurate and safe dose delivery. However, local treatments such as radiotherapy for very advanced MCC of the lower extremities might have limited impact due to the high probability of systemic progression, as illustrated in this case. Radiation is confirmed as being effective in preventing MCC nodule progression toward skin wounding.
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Affiliation(s)
- Gianluca Ferini
- REM Radioterapia srl, Via Penninazzo 11, I-95029 Viagrande, CT, Italy; (V.V.); (V.A.M.)
- Correspondence: ; Tel.: +39-095-78-94-581
| | - Vito Valenti
- REM Radioterapia srl, Via Penninazzo 11, I-95029 Viagrande, CT, Italy; (V.V.); (V.A.M.)
| | - Ivana Puliafito
- Medical Oncology Unit, Mediterranean Institute of Oncology, I-95029 Viagrande, CT, Italy;
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Radiotherapy in Current Neuro-Oncology: There Is Still Much to Reveal. Life (Basel) 2021; 11:life11121412. [PMID: 34947942 PMCID: PMC8706956 DOI: 10.3390/life11121412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 01/07/2023] Open
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Ferini G, Cacciola A, Parisi S, Lillo S, Molino L, Tamburella C, Davi V, Napoli I, Platania A, Settineri N, Iati G, Pontoriero A, Pergolizzi S, Santacaterina A. Curative Radiotherapy in Elderly Patients With Muscle Invasive Bladder Cancer: The Prognostic Role of Sarcopenia. In Vivo 2021; 35:571-578. [PMID: 33402511 DOI: 10.21873/invivo.12293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/07/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM To evaluate the impact of sarcopenia in muscle invasive bladder cancer (MIBC) elderly patients submitted to curative radiotherapy. PATIENTS AND METHODS Patients received radiotherapy between 2013 and 2018, and the skeletal muscle index was calculated to classify them as sarcopenic or non-sarcopenic. Primary endpoints were overall survival (OS), cancer specific survival (CSS), 90-day mortality and toxicity. RESULTS A total of 28 patients with a median age of 85 years met our inclusion criteria and 8 of them were sarcopenic. With a median prescribed dose of 61 Gy and a median follow-up of 24.5 months, OS rates in the sarcopenic and non-sarcopenic groups were 100% and 84.4% at 3 months, 57.1% and 56.6% at 12 months, 38.1% and 50.3% at 24 months and 38.1% and 33.5% at 48 months, respectively; the CSS rates were 100% and 94.1% at 3 months and 68.6% and 88.2% at 12, 24 and 48 months, respectively. The actuarial 90-day mortality rate was 17.9% for the whole cohort, and 20% and 12.5% for the non-sarcopenic and sarcopenic groups, respectively. The radio-induced toxicity was similar in both groups. CONCLUSION Sarcopenia cannot be considered a negative prognostic factor for MIBC elderly patients treated with external beam radiotherapy. Irradiation is therefore a feasible and effective choice for these patients, especially if unfit for surgery.
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Affiliation(s)
| | - Alberto Cacciola
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Silvana Parisi
- Fondazione Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Sara Lillo
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy;
| | - Laura Molino
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Consuelo Tamburella
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Valerio Davi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Ilenia Napoli
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | | | - Giuseppe Iati
- Radiation Oncology Unit, A.O.U. "G. Martino", Messina, Italy
| | | | - Stefano Pergolizzi
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.,Radiation Oncology Unit, A.O.U. "G. Martino", Messina, Italy
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