1
|
de Camargo AV, de Mattos MD, Kawasaki MK, Gomes DNS, Borges ABB, Vazquez VDL, Araujo RLC. Treatment of patients with multiple brain metastases by isolated radiosurgery: Toxicity and survival. World J Clin Oncol 2023; 14:400-408. [PMID: 37970107 PMCID: PMC10631349 DOI: 10.5306/wjco.v14.i10.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Radiosurgery for multiple brain metastases has been more reported recently without using whole-brain radiotherapy. Nevertheless, the sparsity of the data still claims more information about toxicity and survival and their association with both dosimetric and geometric aspects of this treatment. AIM To assess the toxicity and survival outcome of radiosurgery in patients with multiple (four or more lesions) brain metastases. METHODS In a single institution, data were collected retrospectively from patients who underwent radiosurgery to treat brain metastases from diverse primary sites. Patients with 4-21 brain metastases were treated with a single fraction with a dose of 18 Gy or 20 Gy. The clinical variables collected were relevant to toxicity, survival, treatment response, planning, and dosimetric variables. The Spearman's rank correlation coefficients, Mann-Whitney test, Kruskal-Wallis test, and Log-rank test were used according to the type of variable and outcomes. RESULTS From August 2017 to February 2020, 55 patients were evaluated. Headache was the most common complaint (38.2%). The median overall survival (OS) for patients with karnofsky performance status (KPS) > 70 was 8.9 mo, and this was 3.6 mo for those with KPS ≤ 70 (P = 0.047). Patients with treated lesions had a median progression-free survival of 7.6 mo. There were no differences in OS (19.7 vs 9.5 mo) or progression-free survival (10.6 vs 6.3 mo) based on prior irradiation. There was no correlation found between reported toxicities and planning, dosimetric, and geometric variables, implying that no additional significant toxicity risks appear to be added to the treatment of multiple (four or more) lesions. CONCLUSION No associations were found between the evaluated toxicities and the planning dosimetric parameters, and no differences in survival rates were detected based on previous treatment status.
Collapse
Affiliation(s)
| | | | - Murilo Kenji Kawasaki
- Department of Radiotherapy, Barretos Cancer Hospital, São Paulo, Barretos 14784-400, Brazil
| | | | | | | | - Raphael L C Araujo
- Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
- IEP, Barretos Cancer Hospital, São Paulo, Barretos 14784-400, Brazil
| |
Collapse
|
2
|
Marta GN, Moraes FY, de Oliveira Franco RC, de Andrade Carvalho H, Gouveia AG, de Lima Gössling GC, de Jesus RG, Ferraris G, Schuffenegger PM, Bardales GS, Chacón MAP, Murillo R, Sánchez LEM, Gamarra-Cabezas E, Rosa AA, da Silva MF, de Mattos MD, Morais DCR, de Castro DG, Dal Pra A, Amêndola BE, Barros JM, Lara TM, Isa N, de la Mata Moya D, Hidalgo I, Velilla DG, Loayza LEA, Montenegro FG, Sanchez Chacin NO, Werutsky G, Viani GA. Moderately hypofractionated post-operative radiation therapy for breast cancer: preferences amongst radiation oncologists from countries in Latin America and the Caribbean. Rep Pract Oncol Radiother 2023; 28:340-351. [PMID: 37795395 PMCID: PMC10547413 DOI: 10.5603/rpor.a2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023] Open
Abstract
Background The safety and effectiveness of moderately hypofractionated post-operative radiation therapy for breast cancer were demonstrated by several trials. This study aimed to evaluate the current patterns of practice and prescription preference about moderately hypofractionated post-operative radiation therapy to assess possible aspects that affect the decision-making process regarding the use of fractionation in breast cancer patients in Latin America and the Caribbean (LAC). We also aimed to identify factors that can restrain the utilization of moderately hypofractionated post-operative radiation therapy for breast cancer. Materials an methods Radiation oncologists from LAC were invited to contribute to this study. A 38-question survey was used to evaluate their opinions. Results A total of 173 radiation oncologists from 13 countries answered the questionnaire. The majority of respondents (84.9%) preferred moderately hypofractionated post-operative radiation therapy as their first choice in cases of whole breast irradiation. Whole breast plus regional nodal irradiation, post-mastectomy (chest wall and regional nodal irradiation) without reconstruction, and post-mastectomy (chest wall and regional node irradiation) with reconstruction hypofractionated post-operative radiation therapy was preferred by 72.2% 71.1%, and 53.7% of respondents, respectively. Breast cancer stage, and flap-based breast reconstruction were the factors associated with absolute contraindications for the use of hypofractionated schedules. Conclusion Even though moderately hypofractionated post-operative radiation therapy for breast cancer is considered a new standard to the vast majority of the patients, its unrestricted application in clinical practice across LAC still faces reluctance.
Collapse
Affiliation(s)
- Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Latin American Cooperative Oncology Group (LACOG), Brazil
| | - Fabio Y. Moraes
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Oncology, Division of Radiation Oncology, Queen’s University — Kingston Health Science Centre, Kingston, ON, Canada
| | | | - Heloísa de Andrade Carvalho
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Radiology and Oncology — Radiotherapy Division — Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Guimaraes Gouveia
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, Hamilton, ON, Canada
| | | | | | | | - Pablo Munoz Schuffenegger
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Radiation Oncology Unit, Department of Hematology — Oncology, Pontificia Universidad Catolica de Chile, Chile
| | | | | | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogota, Colombia
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Luis Ernesto Moreno Sánchez
- Instituto Nacional del Cáncer Rosa De Tavares (INCART), Savia Care Centro Avanzado de Radioterapia, Centro Gamma Knife Dominicano, Dominican Republic
| | - Elizabeth Gamarra-Cabezas
- Departamento de Radio-Oncología, Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”
- Sociedad de Lucha Contra el Cáncer (SOLCA), Guayaquil, Ecuador
| | - Arthur Accioly Rosa
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Oncoclinicas Salvador — Hospital Santa Izabel
| | - Maurício Fraga da Silva
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Santa Maria Federal University, Santa Maria, RS, Brazil
- Clínica de Radioterapia de Santa Maria, RS, Brazil
| | | | - Diego Chaves Rezende Morais
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Oncoclinicas Recife and Hospital Santa Águeda, Brazil
| | - Douglas Guedes de Castro
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Radiation Oncology, A.C. Camargo Cancer Center, Brazil
| | - Alan Dal Pra
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Radiation Oncology, University of Miami Miller School of Medicine, United States
| | | | - José Máximo Barros
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Departamento de Radio-Oncología, Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”
- Centro de Radioterapia del Hospital Universitario Austral, Argentina
| | - Tomas Merino Lara
- Department of Hematology Oncology, school of Medicine, Pontificia Universidad Catolica de Chile, Chile
| | | | - Dolores de la Mata Moya
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Cancer Center — ABC Medical Center, Mexico
| | - Iván Hidalgo
- Centro Javeriano de Oncología — Hospital Universitario San Ignacio, Colombia
| | | | | | | | | | | | - Gustavo Arruda Viani
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Ribeirão Preto Medical School, Department of Medical Imagings, Hematology and Oncology of University of São Paulo (FMRP-USP), Brazil
| |
Collapse
|
3
|
de Souza Viana L, de Aguiar Silva FC, Andrade Dos Anjos Jacome A, Calheiros Campelo Maia D, Duarte de Mattos M, Arthur Jacinto A, Elias Mamere A, Boldrini Junior D, de Castro Capuzzo R, Roberto Santos C, Lopes Carvalho A. Efficacy and safety of a cisplatin and paclitaxel induction regimen followed by chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E970-80. [PMID: 26031625 DOI: 10.1002/hed.24137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/14/2015] [Accepted: 05/21/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this phase II trial was to evaluate the tolerability, safety, and efficacy of a non-5-fluorouracil (5-FU)-based induction chemotherapy followed by chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS Sixty patients with stage III to IV HNSCC were treated with induction paclitaxel and cisplatin (TP; paclitaxel 175 mg/m(2) and cisplatin 80 mg/m(2) , 3 cycles) followed by CRT (cisplatin 100 mg/m(2) ; D1, 22, and 43 of radiotherapy). RESULTS Fifty-six patients (93.3%) completed 3 cycles of induction TP (no treatment-related deaths), 52 (86.7%) completed definitive CRT per protocol (adverse event [AE] grade ≥2 in 53.3%). The overall response rate after induction TP was 82.5% for patients with resectable disease and 55.5% for unresectable disease (p = .023), and complete response (CR) rate after CRT was 70.0% for patients with resectable disease and 30.0% for unresectable disease (p = .005). CONCLUSION Induction TP followed by cisplatin based-CRT was well-tolerated, safe, and had high overall response rate in selected patients with locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E970-E980, 2016.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Augusto Elias Mamere
- Department of Radiotherapy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | - Carlos Roberto Santos
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Andre Lopes Carvalho
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| |
Collapse
|