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Galunic Bilic L, Santek F, Mitrovic Z, Basic-Kinda S, Dujmovic D, Vodanovic M, Mandac Smoljanovic I, Ostojic Kolonic S, Galunic Cicak R, Aurer I. Long-Term Results of IFRT vs. ISRT in Infradiaphragmal Fields in Aggressive Non-Hodgkins's Lymphoma Patients-A Single Centre Experience. Cancers (Basel) 2024; 16:649. [PMID: 38339400 PMCID: PMC10854861 DOI: 10.3390/cancers16030649] [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: 10/12/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: This study aimed to examine the difference in efficacy and toxicity of involved-field (IFRT) and involved-site radiotherapy (ISRT) fields in infradiaphragmal aggressive non-Hodgkin lymphoma patients. (2) Methods: In total, 140 patients with infradiaphragmal lymphoma treated between 2003 and 2020 were retrospectively evaluated. There were 69 patients (49%) treated with IFRT, and 71 (51%) patients treated with ISRT. The median dose in the IFRT group was 36 Gy, (range 4-50.4 Gy), and in the ISRT group, it was 30 Gy (range 4-48 Gy). (3) Results: The median follow-up in the IFRT group was 133 months (95% CI 109-158), and in the ISRT group, it was 48 months (95% CI 39-57). In the IFRT group, locoregional control was 67%, and in the ISRT group, 73%. The 2- and 5-year overall survival (OS) in the IFRT and ISRT groups were 79% and 69% vs. 80% and 70%, respectively (p = 0.711). The 2- and 5-year event-free survival (EFS) in the IFRT and ISRT groups were 73% and 68% vs. 77% and 70%, respectively (p = 0.575). Acute side effects occurred in 43 (31%) patients, which is more frequent in the IFRT group, 34 (39%) patients, than in the ISRT group, 9 (13%) patients, p > 0.01. Late toxicities occurred more often in the IFRT group of patients, (10/53) 19%, than in the ISRT group of patients, (2/37) 5%, (p = 0.026). (4) Conclusions: By reducing the radiotherapy volume and the doses in the treatment of infradiaphragmatic fields, treatment with significantly fewer acute and long-term side effects is possible. At the same time, efficiency and local disease control are not compromised.
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Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Ruzica Galunic Cicak
- Department of Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Igor Aurer
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
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Hoffmann L, Ehmsen ML, Hansen J, Hansen R, Knap MM, Mortensen HR, Poulsen PR, Ravkilde T, Rose HK, Schmidt HH, Worm ES, Møller DS. Repeated deep-inspiration breath-hold CT scans at planning underestimate the actual motion between breath-holds at treatment for lung cancer and lymphoma patients. Radiother Oncol 2023; 188:109887. [PMID: 37659663 DOI: 10.1016/j.radonc.2023.109887] [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: 06/25/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE/OBJECTIVE Deep-inspiration breath-hold (DIBH) during radiotherapy may reduce dose to the lungs and heart compared to treatment in free breathing. However, intra-fractional target shifts between several breath-holds may decrease target coverage. We compared target shifts between four DIBHs at the planning-CT session with those measured on CBCT-scans obtained pre- and post-DIBH treatments. MATERIAL/METHODS Twenty-nine lung cancer and nine lymphoma patients were treated in DIBH. An external gating block was used as surrogate for the DIBH-level with a window of 2 mm. Four DIBH CT-scans were acquired: one for planning (CTDIBH3) and three additional (CTDIBH1,2,4) to assess the intra-DIBH target shifts at scanning by registration to CTDIBH3. During treatment, pre-treatment (CBCTpre) and post-treatment (CBCTpost) scans were acquired. For each pair of CBCTpre/post, the target intra-DIBH shift was determined. For lung cancer, tumour (GTV-Tlung) and lymph nodes (GTV-Nlung) were analysed separately. Group mean (GM), systematic and random errors, and GM for the absolute maximum shifts (GMmax) were calculated for the shifts between CTDIBH1,2,3,4 and between CBCTpre/post. RESULTS For GTV-Tlung, GMmax was larger at CBCT than CT in all directions. GMmax in cranio-caudal direction was 3.3 mm (CT)and 6.1 mm (CBCT). The standard deviations of the shifts in the left-right and cranio-caudal directions were larger at CBCT than CT. For GTV-Nlung and CTVlymphoma, no difference was found in GMmax or SD. CONCLUSION Intra-DIBH shifts at planning-CT session are generally smaller than intra-DIBH shifts observed at CBCTpre/post and therefore underestimate the intra-fractional DIBH uncertainty during treatment. Lung tumours show larger intra-fractional variations than lymph nodes and lymphoma targets.
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Affiliation(s)
- Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - M L Ehmsen
- Danish Center for Proton Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - J Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - M M Knap
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H R Mortensen
- Danish Center for Proton Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - P R Poulsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Proton Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - T Ravkilde
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H K Rose
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H H Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - E S Worm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - D S Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Perrone S, Lopedote P, Levis M, Di Rocco A, Smith SD. Management of relapsed or refractory large B-cell lymphoma in patients ineligible for CAR-T cell therapy. Expert Rev Hematol 2022; 15:215-232. [PMID: 35184664 DOI: 10.1080/17474086.2022.2044778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chimeric antigen receptor T (CAR-T) therapy has revolutionized the treatment of relapsed/refractory large B-cell lymphoma (LBCL). However, patients who are excluded or have no access to CAR-T represent a challenge for clinicians and have generally a dismal outcome. The landscape for this category of patients is constantly evolving: new agents have been approved in the last 2-3 years, alone or in combination, and novel treatment modalities are under investigations. AREAS COVERED Thereafter, we reviewed the currently available therapeutic strategies: conventional chemotherapy, Antibody-drug conjugate ADC (mainly polatuzumab and loncastuxumab), bispecific antibodies (CD19/CD3 and focus on novel CD20/CD3 Abs), immunomodulatory drugs (covering tafasitamab and lenalidomide, checkpoint inhibitors mainly in PMBL), small molecules (selinexor, BTK and PI3K inhibitors), and the role of radiotherapy. EXPERT OPINION Navigating this scenario, will uncover new challenges, including identifying an ideal sequence for these therapies, the most effective combinations, and search for consistent predictive factors to help selecting the appropriate population of LBCL patients. At present, supporting clinical research for CAR-T ineligible patients, a new and challenging group, must remain a major focus that is complementary to advances in CAR T-cell therapy.
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Affiliation(s)
- Salvatore Perrone
- Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, Latina, Italy
| | - Paolo Lopedote
- Internal Medicine, St Elizabeth's Medical Center, Boston University, Boston, U.S
| | - Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stephen Douglas Smith
- Division of Medical Oncology, Department of Internal Medicine, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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Illidge T, Mikhaeel NG, Specht L, Yahalom J. Lymphoma: advances in imaging and radiotherapy - introductory editorial. Br J Radiol 2021; 94:20219005. [PMID: 34677091 DOI: 10.1259/bjr.20219005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tim Illidge
- Manchester NIHR Biomedical Research Centre, University of Manchester, Christie Hospital, Manchester, United Kingdom
| | - N George Mikhaeel
- Guy's & St Thomas' NHS Foundation Trust and King's College University, London, United Kingdom
| | - Lena Specht
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joachim Yahalom
- Memorial Sloan Kettering Cancer Center, New York, United States
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