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Noël G, Bou-Gharios J, Burckel H. Tumor reirradiation: Issues, challenges and perspectives for radiobiology. Cancer Radiother 2024:S1278-3218(24)00126-4. [PMID: 39327200 DOI: 10.1016/j.canrad.2024.08.002] [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: 05/27/2024] [Revised: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/28/2024]
Abstract
The radiobiology of tumor reirradiation is poorly understood. It pertains to tumors and their sensitivity at the time of relapse, encompassing primary tumors, metastases, or secondary cancers developed in or proximal to previously irradiated tissues. The ability to control the pathology depends, in part, on understanding this sensitivity. To date, literature data remains limited regarding changes in the radiosensitivity of tissues after initial irradiation, and most proposals are based on conjecture. The response of healthy tissues at the site of irradiation raises concerns about radio-induced complications. Cumulative dose is likely a major factor in this risk, thus using equivalent dose calculations might help reduce the risk of complications. However, the correlation between mathematical equivalence formulas and clinical effects of radiobiological origin is weak, and the lack of knowledge of the alpha/beta (α/β) ratio of healthy tissues remains an obstacle to the extensive use of these formulas. However, tissues exposed to recovery dose may have a tolerance to irradiation much higher than assumed, thus further biological work remains to be developed. Also, the functionality of previously irradiated tissues could be useful in selecting the most suitable irradiation beams. Finally, research on the genomics of irradiated healthy tissues could improve the prediction of side effects and personalize radiotherapy.
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Affiliation(s)
- Georges Noël
- Radiotherapy Department, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France; Faculté de médecine, université de Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France; Radiobiology Laboratory, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67000 Strasbourg, France; Laboratory of Engineering, Informatics and Imaging (ICube), Integrative Multimodal Imaging in Healthcare (Imis), UMR 7357, université de Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France.
| | - Jolie Bou-Gharios
- Radiobiology Laboratory, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67000 Strasbourg, France; Laboratory of Engineering, Informatics and Imaging (ICube), Integrative Multimodal Imaging in Healthcare (Imis), UMR 7357, université de Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France
| | - Hélène Burckel
- Radiobiology Laboratory, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67000 Strasbourg, France; Laboratory of Engineering, Informatics and Imaging (ICube), Integrative Multimodal Imaging in Healthcare (Imis), UMR 7357, université de Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France
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2
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Critelli P, Pezzulla D, Lillo S, Arpa D, Scricciolo M, Di Carlo C, Argenone A, Borzillo V, Marsella AR, Tamburo M, Di Franco R, Di Marzo A, Settineri N, Mondello S, Macchia G, Belgioia L, Cerrotta A, Pontoriero A. Outcomes and toxicity in re-irradiation of gynecologic cancer: Systematic review of the Italian association of radiation and clinical oncology (AIRO). Gynecol Oncol 2023; 179:33-41. [PMID: 37913639 DOI: 10.1016/j.ygyno.2023.10.016] [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: 05/29/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
AIMS The aim of this study was to provide a literature review on the efficacy and safety of reirradiation(re-I) of locoregional recurrences in gynecological malignancies. METHODS A computerized literature search was performed in 4 electronic databases (1993-2020). Random-effects models and a tendency towards high heterogeneity (Cochran Q chi-square test and the I2 statistic) were used. A meta-analysis technique over single and multi-arm studies was performed to determine the pooled acute and late toxicity rate ≥ G3, locoregional control (LC), and overall survival (OS). RESULTS Out of 178 articles, only 18 articles accounting for 820 patients (pts) met the inclusion criteria. Outcomes were evaluable for 522 patients. Subgroup analyses highlighted moderate to high heterogeneity among studies. BT (Brachytherapy) showed a 2y OS of 63% (95% CI, 55 to 71 p = 0,36) and 5y OS of 42% (95% CI, 35 to 50, p = 0,43) with 1y-2y-3y LC of 74 (95% CI, 62 to 75, p = 0.04)49% (95% CI, 40 to 58, p = 0.38) and 48% (95% CI, 39 to 58, p = 0,45) respectively. Chemotherapy does not improve SBRT outcomes: BT showed a G3- G4 toxicities rate was of26% (95% CI: 8-49%); studies on SBRT re-I showed a G3-G4 toxicity around of 20% if combined with CHT, and <10 when alone. CONCLUSION A large heterogeneity among studies was revealed, but showing promising results in terms of safety and feasibility. BT resulted the best kind of radiation therapy delivery in terms of clinical outcome and comparable to the SBRT technique in terms of toxicities.
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Affiliation(s)
- Paola Critelli
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy.
| | - Sara Lillo
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Donatella Arpa
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Clelia Di Carlo
- Department of Radiation Oncology, "G. D'Annunzio" University of Chieti, SS. Annunziata Hospital, Chieti, Italy
| | | | - Valentina Borzillo
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | | | | | - Rossella Di Franco
- Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | | | | | - Stefania Mondello
- Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, San Martino Teaching Hospital, Genova University (DISSAL), Genoa, Italy
| | - Annamaria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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3
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Saddozai UAK, Wang F, Khattak S, Akbar MU, Badar M, Khan NH, Zhang L, Zhu W, Xie L, Li Y, Ji X, Guo X. Define the Two Molecular Subtypes of Epithelioid Malignant Pleural Mesothelioma. Cells 2022; 11:cells11182924. [PMID: 36139498 PMCID: PMC9497219 DOI: 10.3390/cells11182924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a fatal disease of respiratory system. Despite the availability of invasive biomarkers with promising results, there are still significant diagnostic and therapeutic challenges in the treatment of MPM. One of three main mesothelioma cell types, epithelioid mesothelioma makes up approximately 70% of all mesothelioma cases. Different observational findings are under process, but the molecular heterogeneity and pathogenesis of epithelioid malignant pleural mesothelioma (eMPM) are still not well understood. Through molecular analysis, expression profiling data were used to determine the possibility and optimal number of eMPM molecular subtypes. Next, clinicopathological characteristics and different molecular pathways of each subtype were analyzed to prospect the clinical applications and advanced mechanisms of eMPM. In this study, we identified two distinct epithelioid malignant pleural mesothelioma subtypes with distinct gene expression patterns. Subtype I eMPMs were involved in steroid hormone biosynthesis, porphyrin and chlorophyll metabolism, and drug metabolism, while subtype II eMPMs were involved in rational metabolism, tyrosine metabolism, and chemical carcinogenesis pathways. Additionally, we identified potential subtype-specific therapeutic targets, including CCNE1, EPHA3, RNF43, ROS1, and RSPO2 for subtype I and CDKN2A and RET for subtype II. Considering the need for potent diagnostic and therapeutic biomarkers for eMPM, we are anticipating that our findings will help both in exploring underlying mechanisms in the development of eMPM and in designing targeted therapy for eMPM.
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Affiliation(s)
- Umair Ali Khan Saddozai
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Fengling Wang
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Saadullah Khattak
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Muhammad Usman Akbar
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan 29050, Pakistan
| | - Muhammad Badar
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan 29050, Pakistan
| | - Nazeer Hussain Khan
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Lu Zhang
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Wan Zhu
- Department of Anesthesia, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Longxiang Xie
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Yongqiang Li
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
| | - Xinying Ji
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
- Correspondence: (X.J.); (X.G.)
| | - Xiangqian Guo
- Department of Preventive Medicine, Institute of Bioinformatics Center, Henan Provincial Engineering Center for Tumor Molecular Medicine, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
- Correspondence: (X.J.); (X.G.)
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4
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Shen Z, Qu A, Jiang P, Jiang Y, Sun H, Wang J. Re-Irradiation for Recurrent Cervical Cancer: A State-of-the-Art Review. Curr Oncol 2022; 29:5262-5277. [PMID: 35892987 PMCID: PMC9331513 DOI: 10.3390/curroncol29080418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
The recurrence rate of cervical cancer after primary treatment can reach 60%, and a poor prognosis is reported in most cases. Treatment options for the recurrence of cervical cancer mainly depend on the prior treatment regimen and the location of recurrent lesions. Re-irradiation is still considered as a clinical challenge, owing to a high incidence of toxicity, especially in in-field recurrence within a short period of time. Recent advances in radiotherapy have preliminarily revealed encouraging outcomes of re-irradiation. Several centers have concentrasted on stereotactic body radiation therapy (SBRT) for the treatment of well-selected cases. Meanwhile, as the image-guiding techniques become more precise, a better dose profile can also be achieved in brachytherapy, including high-dose-rate interstitial brachytherapy (HDR-ISBT) and permanent radioactive seed implantation (PRSI). These treatment modalities have shown promising efficacy with a tolerable toxicity, providing further treatment options for recurrent cervical cancer. However, it is highly unlikely to draw a definite conclusion from all of those studies due to the large heterogeneity among them and the lack of large-scale prospective studies. This study mainly reviews and summarizes the progress of re-irradiation for recurrent cervical cancer in recent years, in order to provide potential treatment regimens for the management of re-irradiation.
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Pontoriero A, Iatì G, Cacciola A, Conti A, Brogna A, Siragusa C, Ferini G, Davì V, Tamburella C, Molino L, Cambareri D, Severo C, Parisi S, Settineri N, Ielo I, Pergolizzi S. Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost in Patients With Spinal Metastases. Technol Cancer Res Treat 2020; 19:1533033820904447. [PMID: 32336255 PMCID: PMC7225842 DOI: 10.1177/1533033820904447] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stereotactic body radiation therapy in patients with spine metastases maximizes local tumor control and preserves neurologic function. A novel approach could be the use of stereotactic body radiation therapy with simultaneous integrated boost delivering modality. The aim of the present study is to report our experience in the treatment of spine metastases using a frameless radiosurgery system delivering stereotactic body radiation therapy–simultaneous integrated boost technique. The primary endpoints were the pain control and the time to local progression; the secondary ones were the overall survival and toxicity. A total of 20 patients with spine metastases and 22 metastatic sites were treated in our center with stereotactic body radiation therapy–simultaneous integrated boost between December 2007 and July 2018. Stereotactic body radiation therapy–simultaneous integrated boost treatments were delivered doses of 8 to 10 Gy in 1 fraction to isodose line of 50%. The median follow-up was 35 months (range: 12-110). The median time to local progression for all patients was not reached and the actuarial 1-, 2-, and 3-years local free progression rate was 86.36%. In 17 of 20 patients, a complete pain remission was observed and 3 of 20 patients had a partial pain remission (complete pain remission + partial pain remission: 100%). The median overall survival was 38 months (range 12-83). None of the patients experienced neither radiation adverse events (grade 1-4) nor reported pain flair reaction. None of the patients included in our series experienced vertebral compression fracture. Spine radiosurgery with stereotactic body radiation therapy–simultaneous integrated boost is safe. The use of this modality in spine metastases patients provides an excellent local control.
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Affiliation(s)
| | - Giuseppe Iatì
- Radiation Oncology Unit, A.O.U. "G. Martino", Messina, Italy
| | - Alberto Cacciola
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Alfredo Conti
- Neurosurgery Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Anna Brogna
- Medical Physics Unit, A.O.U. "G. Martino", Messina, Italy
| | | | - Gianluca Ferini
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Valerio Davì
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Consuelo Tamburella
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Laura Molino
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Domenico Cambareri
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Cesare Severo
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Nicola Settineri
- Medical Physics of Radiation Oncology Unit, A.O. "Papardo", Messina, Italy
| | - Isidora Ielo
- Medical Physics Unit, A.O.U. "G. Martino", Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
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Zhang TW, Palma D, D'Souza D, Velker V, Mendez LC. Stereotactic Ablative Radiotherapy for Recurrent or Metastatic Gynecological Cancer: Extending Lives? Curr Treat Options Oncol 2020; 21:58. [PMID: 32533272 DOI: 10.1007/s11864-020-00748-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OPINION STATEMENT Recent phase II clinical trials suggest that stereotactic ablative radiation therapy (SABR) can potentially improve survival for patients with oligometastatic cancer. However, these studies have mostly enrolled primaries other than gynecologic malignancies. While level I evidence is limited, recent publications exploring the use of SABR for oligometastatic gynecologic cancers have indicated a potential role for this treatment in para-aortic lymph node recurrences, and in visceral and brain metastases. The use of SABR for recurrences in the pelvis presents a number of challenges as these patients have often received previous radiation treatment. In these settings, care must be taken to avoid trespassing normal tissue tolerance with SABR leading to toxicity, especially as the potential benefit of SABR in this setting is not based on high-level evidence. Although SABR is feasible and in general safe for oligometastatic gynecologic malignancies, insufficient data are available to indicate whether it is associated with improved survival. Clinical judgment that incorporates patient and tumor factors is needed to determine if SABR is appropriate for selecting patients. Future directions include combining SABR with novel systemic therapies, determining optimal sequencing of treatments, and generating more robust randomized data pertaining to the use of SABR for oligometastatic gynecologic cancers.
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Affiliation(s)
- Tina W Zhang
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - David Palma
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - David D'Souza
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - Vikram Velker
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 800 Commissioners Rd East, London, Ontario, N6A 5W9, Canada.
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Sturdza A, Viswanathan AN, Erickson B, Yashar C, Bruggeman A, Feddock J, Klopp A, Beriwal S, Gaffney D, Han K, Kamrava M. American Brachytherapy Society working group report on the patterns of care and a literature review of reirradiation for gynecologic cancers. Brachytherapy 2020; 19:127-138. [PMID: 31917178 DOI: 10.1016/j.brachy.2019.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Recurrences of previously irradiated gynecological malignancies are uncommon. Standardized management of these cases is not well established. We aim to provide an in-depth literature review and present current practice patterns among an international group of experienced practitioners in the reirradiation setting of gynecologic cancers. METHODS AND MATERIALS An extensive literature search was performed and 35 articles were selected based on preset criteria. A 20-question online survey of 10 experts regarding their retreatment practices was also conducted. RESULTS The reviewed publications include a diverse group of patients, multiple treatment techniques, a range of total doses, local control, overall survival, and toxicity outcomes. Overall, local control ranged from 44% to 88% over 1-5 years with OS in the range of 39.5-82% at 2-5 years. Late G3-4 toxicity varied very broadly from 0% to 42.9%, with most papers reporting serious toxicities greater than 15%. The most common reirradiation technique utilized was brachytherapy. Some low-dose-rate data suggest improved outcomes with doses >50 Gy. The high-dose-rate data are more varied with some studies suggesting improved local control with doses >40 Gy. In general, a longer time interval between the first and second course of radiation as well as recurrences <2-4 cm tend to have improved outcomes. CONCLUSIONS Reirradiation with brachytherapy results in relatively reasonable local control and toxicities for women with recurrent gynecologic cancers. The appropriate dose for each case needs to be individualized given the heterogeneity of cases. Multidisciplinary management is critical to develop individualized plans and to clearly communicate potential side effects and expected treatment outcomes. TAKE HOME MESSAGE Reirradiation with brachytherapy is an acceptable effective organ preserving approach for recurrent gynecologic cancers with a reasonable local control and toxicity profile. Each case requires multidisciplinary management to develop an individualized approach. Monitoring for potential long-term toxicities is essential.
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Affiliation(s)
- Alina Sturdza
- Department of Radiation Oncology and Radiation Biology, Medical University of Vienna, Comprehensive Cancer Center Vienna, Austria.
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego
| | - Andrew Bruggeman
- Department of Radiation Medicine and Applied Sciences, University of California San Diego
| | | | - Ann Klopp
- Department of Radiation Oncology, MD Anderson Cancer Center
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman cancer center
| | - David Gaffney
- Department of Radiation Oncology, University of Utah
| | - Kathy Han
- Department of Radiation Oncology, University of Toronto
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Cihan YB. Which is more effective in the treatment of gynaecological tumours: SBRT boost or brachytherapy boost? J OBSTET GYNAECOL 2019; 40:288-289. [PMID: 31584304 DOI: 10.1080/01443615.2019.1634020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yasemin Benderli Cihan
- Department of Radiation Oncology, Kayseri Education and Research Hospital, Kayseri, Turkey
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9
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Sadozye AH. Re-irradiation in Gynaecological Malignancies: A Review. Clin Oncol (R Coll Radiol) 2017; 30:110-115. [PMID: 29233573 DOI: 10.1016/j.clon.2017.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/25/2022]
Abstract
Re-irradiation in gynaecological malignancies has become an increasingly frequent consideration. This can be delivered in multiple settings, with the most common being a patient with a history of cervical cancer developing a new vaginal cancer or endometrial cancer with local recurrence after hysterectomy and adjuvant pelvic radiation. A systematic review of the literature has unearthed a handful of reports, most delivering brachytherapy, with a small number on both external beam radiotherapy and stereotactic ablative radiotherapy. A detailed review of these papers suggests that it is not possible to draw any firm conclusions or put forward guidelines for this challenging area of gynaecological oncology. Here the author has provided a brief account of each paper, followed by a discussion of the literature, aiming to outline some very broad principles for management. It is recommended that such patients be referred to centres that treat high volumes of gynaecological malignancies, as the experience of the treating oncologist may be the most important factor in the management of these patients.
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Affiliation(s)
- A H Sadozye
- Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, UK.
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10
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Matzenauer M, Vrána D, Vlachová Z, Aujesky R, Vrba R, Neoral C, Melichar B. Stereotactic radiotherapy in the treatment of local recurrences of esophageal cancer. Oncol Lett 2017; 13:1807-1810. [PMID: 28454327 DOI: 10.3892/ol.2017.5605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/10/2016] [Indexed: 01/03/2023] Open
Abstract
Esophageal cancer (EC) consists of tumors with a generally poor prognosis, and treatment options for patients with disease recurrence are extremely limited. Due to this poor patient prognosis, the possible treatment toxicity should be carefully balanced against its potential benefit and patient quality of life. Stereotactic body radiotherapy (SBRT) is a rapidly expanding novel technique combining a short treatment time together with high local efficacy and an acceptable toxicity profile. There are no publications thus far presenting data regarding the usage of SBRT utilizing a conventional linear accelerator in locally recurrent EC patients. In the present study, 2 patients with recurrent EC in the neck lymph nodes were treated by SBRT in the Department of Oncology, University Hospital Olomouc, Czech Republic. The treatment dose was 30 and 40 Gy in 5 daily fractions, with a prescribed dose to 65 and 81% isodose, for each patient respectively, utilizing a volumetric arc therapy technique, a 6-MV photon beam and an Elekta Synergy linear accelerator. The treatment was delivered without any unintentional treatment interruptions and without any treatment-related acute toxicity. The maximum dose in the patients was 45.9 and 49.2 Gy, respectively. The maximum doses for the surrounding major blood vessels were 35.4 and 45.7 Gy, respectively. Maximum doses to the trachea and the esophagus in the first patient were 32.6 and 27.0 Gy. In the second patient, these doses were not clinically significant. SBRT utilizing linear accelerators should be considered in patients with localized recurrent EC, offering the patients the chance for local control with minimal treatment toxicity.
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Affiliation(s)
- Marcel Matzenauer
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - David Vrána
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 779 00 Olomouc, Czech Republic.,Toxicogenomics Unit, National Institute of Public Health, 100 42 Prague, Czech Republic
| | - Zuzana Vlachová
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Rene Aujesky
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Radek Vrba
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Cestmir Neoral
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
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