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Moraes FY, Gouveia AG, Marta GN, da Silva MF, Hamamura AC, Tsakiridis T, Yan M, Viani GA. Meta-Analysis of STereotactic body radiothERapy in non-spine BONE metastaseS (MASTER-BONES). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00002-6. [PMID: 38244875 DOI: 10.1016/j.ijrobp.2023.12.045] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/03/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE The efficacy and safety of stereotactic body radiation (SBRT) for patients with non-spine bone metastases (NSBM) remains in question. A systematic review and meta-analysis was performed to evaluate SBRT treatment outcomes in NSBM. METHODS AND MATERIALS Eligible studies were retrieved from Medline, Embase, Scielo, the Cochrane Library, and annual meeting proceedings until July 6, 2023. We adhered to the PRISMA and MOOSE guideline recommendations. Quantitative synthesis was performed using a random effects model. RESULTS Seven retrospective studies, with a total of 807 patients (1048 lesions) treated with stereotactic body radiation were included, with median follow-up ranging from 7.6-26.5 months. The most common stereotactic body radiation sites were pelvis (39.2%), ribs (25.8%), femur (16.7%), and humerus/shoulder region (8.7%). At 1-year, the LF and FR were 7% (95%CI 5.5-8.5%; I2=0, n= 75/1048), and 5.3% (95%CI 3-7.5%;I2=0, n= 65/1010). The 2-year cumulative LF incidence was 12.1% (95% CI: 10-15.5%). The OS and PFS at 1-year were 82% (95%CI 75-88%;I2=82%, n= 746/867), and 33.5%(95%CI 26-41%;I2=0%, n= 51/152), with a median of 20.2 months (95%CI: 10.9-49.1 months) and 8.3 months (95% CI: 6.3-10.3%) for OS and PFS, respectively. Meta-regression analysis revealed a significant relationship between planning target volume and fracture rate (p<0.05). Ribs 2.5% followed by the femur 1.9% (95%CI:0-6.1%) were the most common fracture sites. The occurrence of pain flare, fatigue and dermatitis were 7 %, 5.4 %, and 0.65 %, respectively. CONCLUSIONS Stereotactic body radiation proves both safety and efficacy for non-spine bone metastases and serious complications (grade 3) are infrequent. Careful consideration of target volume is crucial due to its link with a higher fracture risk.
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Affiliation(s)
- Fabio Ynoe Moraes
- Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Andre Guimaraes Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology - Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department, Hospital Sirio Libanês, São Paulo, Brazil
| | - Mauricio Fraga da Silva
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department, Santa Maria Federal University, Rio Grande do Sul, Brazil
| | - Ana Carolina Hamamura
- Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Theodoros Tsakiridis
- Department of Oncology - Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Michael Yan
- Radiation Medicine Program - Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gustavo Arruda Viani
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
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Zhu Y, Gribniak V, Ding C, Zhu H, Chen B. The Material Heterogeneity Effect on the Local Resistance of Pultruded GFRP Columns. Materials (Basel) 2023; 17:153. [PMID: 38204004 PMCID: PMC10779590 DOI: 10.3390/ma17010153] [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] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
Pultruded GFRP (glass fiber-reinforced polymer) materials are widely used in structural engineering because of their lightweight, corrosion immunity, and electromagnetic transparency. However, the design of load-bearing components facing substantial compressive stresses, e.g., columns, must be more stringent than steel structures due to excessive deformability, material heterogeneity, and vulnerability to stress concentration. This manuscript investigates the failure performance of locally produced GFRP materials, focusing on the material heterogeneity effect on the mechanical resistance of a support joint of a pultruded tubular GFRP column. This experimental campaign employs relatively short rectangular profile fragments to isolate the support behavior and verify a simplified numerical finite element model, which neglects the nonlinearity of GFRP material. This work determines the material failure mechanisms behind the mechanical performance of pultruded profiles subjected to longitudinal compression for various column lengths.
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Affiliation(s)
- Yongcheng Zhu
- Department of Steel and Composite Structures, Vilnius Gediminas Technical University (VILNIUS TECH), Sauletekio Av. 11, LT-10223 Vilnius, Lithuania;
- Department of Civil Engineering, Yancheng Institute of Technology, 1st Xiwangdadao Road, Yancheng 224051, China; (H.Z.); (B.C.)
| | - Viktor Gribniak
- Department of Steel and Composite Structures, Vilnius Gediminas Technical University (VILNIUS TECH), Sauletekio Av. 11, LT-10223 Vilnius, Lithuania;
| | - Chaofeng Ding
- Changzhou Institute of Building Science Group Co., Ltd., 288 Changjiang Middle Road, Changzhou 213002, China;
| | - Hua Zhu
- Department of Civil Engineering, Yancheng Institute of Technology, 1st Xiwangdadao Road, Yancheng 224051, China; (H.Z.); (B.C.)
| | - Baiqi Chen
- Department of Civil Engineering, Yancheng Institute of Technology, 1st Xiwangdadao Road, Yancheng 224051, China; (H.Z.); (B.C.)
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Yang Z, Wang C, Wang Y, Lafata KJ, Zhang H, Ackerson BG, Kelsey C, Tong B, Yin FF. Development of a multi-feature-combined model: proof-of-concept with application to local failure prediction of post-SBRT or surgery early-stage NSCLC patients. Front Oncol 2023; 13:1185771. [PMID: 37781201 PMCID: PMC10534017 DOI: 10.3389/fonc.2023.1185771] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To develop a Multi-Feature-Combined (MFC) model for proof-of-concept in predicting local failure (LR) in NSCLC patients after surgery or SBRT using pre-treatment CT images. This MFC model combines handcrafted radiomic features, deep radiomic features, and patient demographic information in an integrated machine learning workflow. Methods The MFC model comprised three key steps. (1) Extraction of 92 handcrafted radiomic features from the GTV segmented on pre-treatment CT images. (2) Extraction of 512 deep radiomic features from pre-trained U-Net encoder. (3) The extracted handcrafted radiomic features, deep radiomic features, along with 4 patient demographic information (i.e., gender, age, tumor volume, and Charlson comorbidity index), were concatenated as a multi-dimensional input to the classifiers for LR prediction. Two NSCLC patient cohorts from our institution were investigated: (1) the surgery cohort includes 83 patients with segmentectomy or wedge resection (7 LR), and (2) the SBRT cohort includes 84 patients with lung SBRT (9 LR). The MFC model was developed and evaluated independently for both cohorts, and was subsequently compared against the prediction models based on only handcrafted radiomic features (R models), patient demographic information (PI models), and deep learning modeling (DL models). ROC with AUC was adopted to evaluate model performance with leave-one-out cross-validation (LOOCV) and 100-fold Monte Carlo random validation (MCRV). The t-test was performed to identify the statistically significant differences. Results In LOOCV, the AUC range (surgery/SBRT) of the MFC model was 0.858-0.895/0.868-0.913, which was higher than the three other models: 0.356-0.480/0.322-0.650 for PI models, 0.559-0.618/0.639-0.682 for R models, and 0.809/0.843 for DL models. In 100-fold MCRV, the MFC model again showed the highest AUC results (surgery/SBRT): 0.742-0.825/0.888-0.920, which were significantly higher than PI models: 0.464-0.564/0.538-0.628, R models: 0.557-0.652/0.551-0.732, and DL models: 0.702/0.791. Conclusion We successfully developed an MFC model that combines feature information from multiple sources for proof-of-concept prediction of LR in patients with surgical and SBRT early-stage NSCLC. Initial results suggested that incorporating pre-treatment patient information from multiple sources improves the ability to predict the risk of local failure.
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Affiliation(s)
- Zhenyu Yang
- Department of Radiation Oncology, Duke University, Durham, NC, United States
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
- Medical Physics Graduate Program, Duke University, Durham, NC, United States
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Yuqi Wang
- Medical Physics Graduate Program, Duke University, Durham, NC, United States
| | - Kyle J. Lafata
- Department of Radiation Oncology, Duke University, Durham, NC, United States
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States
- Department of Radiology, Duke University, Durham, NC, United States
| | - Haozhao Zhang
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Bradley G. Ackerson
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Christopher Kelsey
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Betty Tong
- Department of Surgery, Duke University, Durham, NC, United States
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University, Durham, NC, United States
- Medical Physics Graduate Program, Duke Kunshan University, Kunshan, Jiangsu, China
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Yanagita T, Hikichi T, Nakamura J, Hashimoto M, Kato T, Suzuki R, Sugimoto M, Sato Y, Irie H, Takagi T, Kobayakawa M, Ohira H. Novel Photodynamic Therapy for Esophageal Squamous Cell Carcinoma following Radiotherapy. Life (Basel) 2023; 13:1276. [PMID: 37374059 DOI: 10.3390/life13061276] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Radiotherapy (RT) or chemoradiotherapy (CRT) are frequently selected as treatments for esophageal squamous cell carcinoma (ESCC). However, salvage treatment remains challenging when endoscopic resection is not indicated for residual or recurrent ESCC following RT or CRT. Recently, owing to the emergence of second-generation photodynamic therapy (PDT) using talaporfin sodium, PDT can be performed with less phototoxicity and therefore has regained popularity in the treatment of ESCC. In this study, the effectiveness and safety of second-generation PDT in patients with residual or recurrent ESCC following RT or CRT were examined. Local complete response (L-CR) rates, procedure-related adverse events, and prognosis were evaluated. In 12 patients with 20 ESCC lesions, the L-CR rates were 95.0%. Perforation, postoperative bleeding, and photosensitivity were not observed. Esophageal stricture following PDT developed in one patient, but this could be addressed using balloon dilation. During a median follow-up period of 12 (range, 3-42) months, the 3-year cause-specific survival rate was 85.7%. Even in patients with a Charlson comorbidity index score ≥ 3, the 2-year overall survival rates were 100%. In conclusion, PDT was an efficacious and a safe salvage treatment in patients with local residual or recurrent ESCC following RT or CRT.
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Affiliation(s)
- Takumi Yanagita
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
- Medical Research Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Farneti A, Bottero M, Faiella A, Giannarelli D, Bertini L, Landoni V, Vici P, D’Urso P, Sanguineti G. The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy. Cancers (Basel) 2023; 15:cancers15041246. [PMID: 36831588 PMCID: PMC9954112 DOI: 10.3390/cancers15041246] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND To investigate the predictive role of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) findings before salvage radiotherapy after radical prostatectomy (RP). METHODS This retrospective study selected patients with biochemical failure (BF) after RP restaged with DCE-MRI. Patients underwent sRT in 30 fractions delivering 66-69 Gy and 73.5 Gy to the prostatic fossa and to the local failure as per DCE-MRI, respectively. Pelvic nodes were treated to 54 Gy in selected patients. The endpoint was BF after sRT. RESULTS In total, 236 patients were analyzed and 146 (61.9%) had presumed local failure at DCE-MRI: 54.8%, 23.8% and 21.4% were found at the vesico-urethral anastomosis (VUA), the bladder neck and the retro-vesical space, respectively. The presence of a local failure at DCE-MRI halved the risk of BF; VUA-only location and lesion volume were independently correlated with survival without evidence of biochemical failure (bNED) at multivariable analysis. For patients with VUA-only disease up to 0.4 cc, the 4-year-bNED was 94.6% (95%CI: 80.2-98.6%) as opposed to 80.9% (95%CI: 71.6-87.4%) and 73.7% (95%CI: 63.1-81.8%) for other lesions and no macrodisease, respectively. CONCLUSIONS DCE-MRI at restaging for BF after RP provides predictive and therapeutic information. Patients with small lesions at the VUA have an excellent prognosis after sRT.
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Affiliation(s)
- Alessia Farneti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Marta Bottero
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Adriana Faiella
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Diana Giannarelli
- Biostatistics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Luca Bertini
- Radiology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Valeria Landoni
- Physics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Pasqualina D’Urso
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence:
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Kim K, Cho J, Moon JH, Kim EH, Yoon HI. Radiation Therapy for Recurrent or Residual Pituitary Macroadenoma Invading Extrasellar Structures. Yonsei Med J 2022; 63:1059-1068. [PMID: 36444541 PMCID: PMC9760886 DOI: 10.3349/ymj.2022.0323] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy of radiation therapy (RT) for recurrent or residual pituitary macroadenoma (PMA) invading extrasellar regions. MATERIALS AND METHODS Patients from 2000 to 2020 who received RT with conventional fractionation for recurrent or residual PMA were included. The patients were divided according to the type of tumor [functioning (fx) or non-fx] and the aim of RT (salvage RT alone, immediate postoperative RT, delayed postoperative RT). Local and biochemical failure-free rates (FFR) were calculated using the Kaplan-Meier method. RESULTS With a median follow up of 82 months (IQR; 42-132 months), 36 patients treated with conventional RT (total 45-54 Gy in 1.8 or 2 Gy per fraction) for recurrent or residual PMA were analyzed. The 10-year local FFRs after RT for non-fx and fx tumor were 100% and 74.4%, respectively (p=0.047). In the immediate postoperative RT group, the 10-year local FFR was 100%, which was higher than the 90% FFR for salvage RT alone or 80% FFR for the delayed postoperative RT group (overall p=0.043, immediate vs. salvage; p=0.312, immediate vs. delayed; p=0.072). The local FFR was compared according to size of tumor with a cut-off value of 4 cm, and there was no significant difference (10-year local FFR 100% vs. 84.7% for >4 cm vs. <4 cm, p=0.320). The extents of extrasellar region invasion were not predictive of local failure after RT. We found no grade ≥3 acute toxicities or newly developed visual impairments as a late toxicity of RT. CONCLUSION Conventional RT is safe and effective for the local control of recurrent or residual PMA. Our data suggest that immediate postoperative RT can be beneficial in recurrent or residual PMA, although further studies to evaluate risk factors of treatment failure in terms of treatment and disease characteristics are required.
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Affiliation(s)
- Kangpyo Kim
- Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Pituitary Tumor Center, Severance Hospital, Seoul, Korea
| | - Eui-Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Pituitary Tumor Center, Severance Hospital, Seoul, Korea.
| | - Hong In Yoon
- Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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Madani I, Sahgal A, Erler D, Stish BJ, Olivier KR, Park SS, Eppinga WSC, Seravalli E, Redmond KJ, Cao Y, Siva S, Chang D, Nguyen TK, O'Neil M, Guckenberger M. STEREOTACTIC BODY RADIATION THERAPY FOR METASTASES IN LONG BONES. Int J Radiat Oncol Biol Phys 2022; 114:738-746. [PMID: 35850362 DOI: 10.1016/j.ijrobp.2022.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the cumulative incidence of fracture and local failure and associated risk factors after stereotactic body radiotherapy (SBRT) for long bone metastases. MATERIAL AND METHODS Data from 111 patients with 114 metastases in the femur, humerus and tibia treated with SBRT in 7 international centers between October 2011 and February 2021 were retrospectively reviewed and analyzed using a competing risk regression model. RESULTS The median follow-up was 21 months (range 6-91 months). All but one patient had a Karnofsky performance status ≥70. There were 84 femur (73.7%), 26 humerus (22.8%) and 4 tibia (3.5%) metastases from prostate (45 [39.5%]), breast (22 [19.3%]), lung (15 [13.2%]), kidney (13 [11.4%]) and other (19 [16.6%]) malignancies. Oligometastases accounted for 74.8% of metastases and 28.1% were osteolytic. The most common total doses were 30-50 Gy in 5 daily fractions (50.9%). Eight fractures (5 in the femur, 2 in the tibia and 1 in the humerus) were observed with a median time to fracture of 12 months (range 0.8-33 months). In 6/8 patients, fracture was not associated with local failure. The cumulative incidence of fracture was 3.5%, 6.1% and 9.8% at 1, 2 and 3 years, respectively. The cumulative incidence of local failure (9/110 metastases with imaging follow-up) was 5.7%, 7.2% and 13.5% at 1, 2 and 3 years, respectively. On multivariate analysis, extraosseous disease extension was significantly associated with fracture (P=0.001; subhazard ratio [SHR] 10.8; 95% CI 2.8-41.9) and local failure (P=0.02; SHR 7.9; 95% CI 1.4-44.7). CONCLUSION SBRT for metastases in long bones achieved high rates of durable local metastasis control without an increased risk of fracture. Similar to spine SBRT, patients with extraosseous disease extension are at higher risk of local failure and fracture.
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Affiliation(s)
- Indira Madani
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Darby Erler
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | - W S C Eppinga
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Kristin J Redmond
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Yilin Cao
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Chang
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Lang K, Baur M, Held T, Shafie RE, Moratin J, Freudlsperger C, Zaoui K, Bougatf N, Hoffmann J, Plinkert PK, Debus J, Adeberg S. Definitive radiotherapy for squamous cell carcinoma of the oral cavity: a single-institution experience. Radiol Oncol 2021; 55:467-73. [PMID: 34821134 DOI: 10.2478/raon-2021-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Surgery is standard of care for oral cavity cancer (OCC). We provide a single-institution experience using definitive radiotherapy (RT) with or without concurrent systemic therapy for primary unresectable OCC. Patients and methods We retrospectively examined 49 patients with non-metastatic primary unresectable OCC treated with definitive RT between 2000 and 2019. The majority of patients (63.3%) were treated with definitive chemoradiotherapy while 26.5% were given single-agent cetuximab weekly simultaneous to definitive RT. Five patients were treated with definitive RT alone because of limited disease and no nodal involvement. Results Median follow-up was 73 months (range, 6–236 months), median progression free survival (PFS) was 42 months (range, 2–157 months), median local disease-free survival (LDFS) was 44 months (range, 2–157 months) and median overall survival (OS) from the time of RT initiation was 52 months (range, 5–236 months). There were 65.3% locoregional failures, 84.4% local and 15.6% distant metastasis. The majority of patients with local failure presented with American Joint Committee on Cancer (AJCC) Stage III–IV disease (59.2%). The 5-year Kaplan-Meier estimates for OS (III–IV vs. I–II) was 22.8% vs. 54.2 % (p = 0.03, HR 2.090, 1.1–4.2). Patients who were treated with systemic therapy had a significant better 5-year overall survival compared to those with RT alone (43.9% vs. 23.1%, p = 0.05, 1.0–4.1). RT with doses less than 70 Gy (p = 0.046, HR 2.1 (1.0–4.5) was associated with worse overall survival. Mucositis was the most common ≥ grade 3 acute toxicity and occurred in 19 patients (39%). Incidences of chronic toxicities were loss of taste, trismus, osteoradionecrosis and xerostomia. Conclusions Definitive RT with or without concurrent systemic agents in patients with unresectable OCC resulted in an eloquent rate of locoregional control and good overall survival rates and is currently the best available treatment option in this patient collective.
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Crook J, Rodgers JP, Pisansky TM, Trabulsi EJ, Amin MB, Bice W, Morton G, Murtha AD, Vigneault E, Helou J, Michalski JM, Roach M, Beyer D, Jani AB, Horwitz EM, Raben A, Pugh S, Sandler H. Salvage Low Dose Rate Prostate Brachytherapy: Clinical Outcomes of a Phase II Trial for Local Recurrence after External Beam Radiotherapy (NRG Oncology/xxxx). Int J Radiat Oncol Biol Phys 2021; 112:1115-1122. [PMID: 34740768 DOI: 10.1016/j.ijrobp.2021.10.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We report efficacy of a prospective Phase II trial (YYYY) of salvage low dose rate (LDR) prostate brachytherapy (BT) for local failure (LF) after prior external beam radiotherapy (EBRT) with minimum 5- years' follow up. MATERIALS/METHODS Eligible patients had low/intermediate risk prostate cancer (PCa) prior to EBRT and biopsy-proven LF > 30 months after EBRT, with PSA < 10 ng/mL and no regional/distant disease. The primary endpoint, late GI/GU Adverse Events (AEs) (CTCAE V3.0 ≥ Grade 3) was 14%. With minimum 5-year follow up after salvage BT, secondary clinical outcomes including disease-free (DFS; includes death from any cause), disease-specific (DSS), and overall survival (OS) were estimated using the Kaplan-Meier method and modelled using Cox proportional hazards regression. Local tumor progression (LF), distant and biochemical failure (DF/BF) were estimated using cumulative incidence. Time to LF, DF and BF were modeled by cause-specific Cox proportional hazards regression. RESULTS From 05/2007 -01/2014, 20 centers registered 100 patients (92 analyzable). Median follow up is 6.7 years (range: 0.3-11.2); median age 70 years (range: 55-82); median prior EBRT dose 74 Gy (IQR: 70-76) at a median of 85 months prior(IQR: 60-119). Androgen deprivation was combined with salvage BT in 16%. 10-year OS is 70% (95% confidence interval [CI]: 58 -83). 19 patients died (5 PCa, 10 other, 4 unknown). 10-year failure rates are local 5% (95% CI:1-11), distant 19% (95% CI:10-29) and biochemical 46% (95% CI:34-57). DFS is 61% at 5 years; 33% at 10 years. No baseline characteristic was significantly associated with any clinical outcome. CONCLUSION This is the first prospective multicenter trial reporting outcomes of salvage LDR BT for LF after EBRT. Five-year freedom from BF is 68%, comparable to other salvage modalities. Although further LF is rare (5%), BF climbs to 46% by10-years.
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Affiliation(s)
- Juanita Crook
- BC Cancer Agency Centre for the Southern Interior, Kelowna, University of British Columbia, British Columbia, Canada.
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - Edouard J Trabulsi
- Sydney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahul B Amin
- The University of Tennessee Health Science Center, Memphis, Tennessee
| | - William Bice
- John Muir Health Systems California, Walnut Creek, California
| | - Gerard Morton
- Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Albert D Murtha
- Cross Cancer Institute, Alberta Health Services, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Vigneault
- L Hotel-Dieu de Quebec, Laval University, Quebec, Quebec, Canada
| | - Joelle Helou
- Princess Margaret Cancer Centre, University of Toronto Faculty of Medicine, University Health Network, Toronto, Ontario, Canada
| | | | - Mack Roach
- University of California San Francisco, San Francisco, California
| | - David Beyer
- Cancer Centers of Northern Arizona Healthcare, Flagstaff, Arizona
| | | | | | | | - Stephanie Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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10
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Devakumar D, Sunny G, Sasidharan BK, Bowen SR, Nadaraj A, Jeyseelan L, Mathew M, Irodi A, Isiah R, Pavamani S, John S, T Thomas HM. Framework for Machine Learning of CT and PET Radiomics to Predict Local Failure after Radiotherapy in Locally Advanced Head and Neck Cancers. J Med Phys 2021; 46:181-188. [PMID: 34703102 PMCID: PMC8491314 DOI: 10.4103/jmp.jmp_6_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/06/2023] Open
Abstract
Context: Cancer Radiomics is an emerging field in medical imaging and refers to the process of converting routine radiological images that are typically qualitatively interpreted to quantifiable descriptions of the tumor phenotypes and when combined with statistical analytics can improve the accuracy of clinical outcome prediction models. However, to understand the radiomic features and their correlation to molecular changes in the tumor, first, there is a need for the development of robust image analysis methods, software tools and statistical prediction models which is often limited in low- and middle-income countries (LMIC). Aims: The aim is to build a framework for machine learning of radiomic features of planning computed tomography (CT) and positron emission tomography (PET) using open source radiomics and data analytics platforms to make it widely accessible to clinical groups. The framework is tested in a small cohort to predict local disease failure following radiation treatment for head-and-neck cancer (HNC). The predictors were also compared with the existing Aerts HNC radiomics signature. Settings and Design: Retrospective analysis of patients with locally advanced HNC between 2017 and 2018 and 31 patients with both pre- and post-radiation CT and evaluation PET were selected. Subjects and Methods: Tumor volumes were delineated on baseline PET using the semi-automatic adaptive-threshold algorithm and propagated to CT; PyRadiomics features (total of 110 under shape/intensity/texture classes) were extracted. Two feature-selection methods were tested for model stability. Models were built based on least absolute shrinkage and selection operator-logistic and Ridge regression of the top pretreatment radiomic features and compared to Aerts' HNC-signature. Average model performance across all internal validation test folds was summarized by the area under the receiver operator curve (ROC). Results: Both feature selection methods selected CT features MCC (GLCM), SumEntropy (GLCM) and Sphericity (Shape) that could predict the binary failure status in the cross-validated group and achieved an AUC >0.7. However, models using Aerts' signature features (Energy, Compactness, GLRLM-GrayLevelNonUniformity and GrayLevelNonUniformity-HLH wavelet) could not achieve a clear separation between outcomes (AUC = 0.51–0.54). Conclusions: Radiomics pipeline included open-source workflows which makes it adoptable in LMIC countries. Additional independent validation of data is crucial for the implementation of radiomic models for clinical risk stratification.
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Affiliation(s)
- Devadhas Devakumar
- Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Goutham Sunny
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.,Department of Radiation Oncology, Baptist Cancer Centre, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | | | - Stephen R Bowen
- Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Ambily Nadaraj
- Department of Clinical Epidemiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Jeyseelan
- Department of Clinical Epidemiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manu Mathew
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Isiah
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Simon Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Subhashini John
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hannah Mary T Thomas
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
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11
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Wang H, Xue J, Qu T, Bernstein K, Chen T, Barbee D, Silverman JS, Kondziolka D. Predicting local failure of brain metastases after stereotactic radiosurgery with radiomics on planning MR images and dose maps. Med Phys 2021; 48:5522-5530. [PMID: 34287940 DOI: 10.1002/mp.15110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/21/2020] [Revised: 05/10/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Stereotactic radiosurgery (SRS) has become an important modality in the treatment of brain metastases. The purpose of this study is to investigate the potential of radiomic features from planning magnetic resonance (MR) images and dose maps to predict local failure after SRS for brain metastases. MATERIALS/METHODS Twenty-eight patients who received Gamma Knife (GK) radiosurgery for brain metastases were retrospectively reviewed in this IRB-approved study. 179 irradiated tumors included 42 that locally failed within one-year follow-up. Using SRS tumor volumes, radiomic features were calculated on T1-weighted contrast-enhanced MR images acquired for treatment planning and planned dose maps. 125 radiomic features regarding tumor shape, dose distribution, MR intensities and textures were extracted for each tumor. Logistic regression with automatic feature selection was built to predict tumor progression from local control after SRS. Feature selection and model evaluation using receiver operating characteristic (ROC) curves were performed in a nested cross validation (CV) scheme. The associations between selected radiomic features and treatment outcomes were statistically assessed by univariate analysis. RESULTS The logistic model with feature selection achieved ROC AUC of 0.82 ± 0.09 on 5-fold CV, providing 83% sensitivity and 70% specificity for predicting local failure. A total of 10 radiomic features including 1 shape feature, 6 MR images and 3 dose distribution features were selected. These features were significantly associated with treatment outcomes (p < 0.05). The model was validated on independent holdout data with an AUC of 0.78. CONCLUSIONS Radiomic features from planning MR images and dose maps provided prognostic information in SRS for brain metastases. A model built on the radiomic features shows promise for early prediction of tumor local failure after treatment, potentially aiding in personalized care for brain metastases.
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Affiliation(s)
- Hesheng Wang
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - Jinyu Xue
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - Tanxia Qu
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - Ting Chen
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - David Barbee
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - Joshua S Silverman
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA
| | - Douglas Kondziolka
- Department of Radiation Oncology, NYU Langone Medical Center, New York University, New York, New York, USA.,Department of Neurosurgery, NYU Langone Medical Center, New York University, New York, New York, USA
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12
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Kimura H, Yoshida M, Yabuuchi Y, Kakushima N, Yamamoto Y, Kawata N, Takizawa K, Kishida Y, Imai K, Ito S, Hotta K, Ishiwatari H, Matsubayashi H, Ono H. Long-term outcomes of salvage endoscopic submucosal dissection for local failure after chemoradiotherapy for esophageal squamous cell carcinoma. Jpn J Clin Oncol 2021; 51:1036-1043. [PMID: 33758950 DOI: 10.1093/jjco/hyab027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/09/2020] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Salvage endoscopic submucosal dissection is considered a minimally invasive treatment for local failure after chemoradiotherapy for esophageal squamous cell carcinoma. However, the long-term outcomes have not been fully evaluated. This study investigated the short-term and long-term outcomes of salvage endoscopic submucosal dissection. METHODS Patients who underwent endoscopic submucosal dissection for local recurrence or residual tumor after chemoradiotherapy from January 2006 to December 2017 were retrospectively investigated. Follow-up included endoscopic examination and computed tomography at least once every 6 months after salvage endoscopic submucosal dissection. Risk factors for disease recurrence after salvage endoscopic submucosal dissection were assessed using the Cox hazards model. RESULTS A total of 30 patients (33 cases of esophageal squamous cell carcinoma: local recurrence, n = 27; residual tumor, n = 6) were included. The median endoscopic submucosal dissection procedure time was 40 min (interquartile range [IQR], 33-58.5 min). En bloc resection was achieved in 31 (94%) of 33 esophageal squamous cell carcinoma cases. One patient with intraoperative perforation did not require surgical intervention and recovered with conservative treatment. A total of 16 patients (53%) had disease recurrence at a median follow-up of 51 months (IQR, 33-81 months). The 3-year overall, disease-specific, recurrence-free and local recurrence-free survival rates were 75%, 82%, 58% and 90%, respectively. The positive vertical margin, submucosal invasion in the endoscopic submucosal dissection specimen and piecemeal resection were significantly associated with disease recurrence after salvage endoscopic submucosal dissection. CONCLUSIONS Salvage endoscopic submucosal dissection is a feasible treatment for local failure after chemoradiotherapy for esophageal squamous cell carcinoma with acceptable long-term outcomes. However, for cases with positive vertical margins and submucosal invasion in the endoscopic submucosal dissection specimen, salvage endoscopic submucosal dissection outcomes were insufficient and additional treatment might be required.
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Affiliation(s)
- Hidenori Kimura
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Department of Gastroenterology & Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoichi Yamamoto
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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13
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Fausto A, Fanizzi A, Volterrani L, Mazzei FG, Calabrese C, Casella D, Marcasciano M, Massafra R, La Forgia D, Mazzei MA. Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position. Cancers (Basel) 2020; 12:cancers12092364. [PMID: 32825583 PMCID: PMC7564182 DOI: 10.3390/cancers12092364] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: To assess the feasibility, image quality and diagnostic value of contrast-enhanced breast magnetic resonance imaging (MRI) performed in a supine compared to a prone position. Methods: One hundred and fifty-one patients who had undergone a breast MRI in both the standard prone and supine position were evaluated retrospectively. Two 1.5 T MR scanners were used with the same image resolution, sequences and contrast medium in all examinations. The image quality and the number and dimensions of lesions were assessed by two expert radiologists in an independent and randomized fashion. Two different classification systems were used. Histopathology was the standard of reference. Results: Two hundred and forty MRIs from 120 patients were compared. The analysis revealed 134 MRIs with monofocal (U), 68 with multifocal (M) and 38 with multicentric (C) lesions. There was no difference between the image quality and number of lesions in the prone and supine examinations. A significant difference in the lesion extension was observed between the prone and supine position. No significant differences emerged in the classification of the lesions detected in the prone compared to the supine position. Conclusions: It is possible to perform breast MRI in a supine position with the same image quality, resolution and diagnostic value as in a prone position. In the prone position, the lesion dimensions are overestimated with a higher wash-in peak than in the supine position.
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Affiliation(s)
- Alfonso Fausto
- Department of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
- Correspondence: ; Tel.: +39-0577585287 or +39-3477601341
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; (L.V.); (M.A.M.)
| | - Francesco Giuseppe Mazzei
- Department of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | | | - Donato Casella
- Department of Oncologic and Reconstructive Breast Surgery, Azienda Ospedaliera Universitaria Senese, University Hospital of Siena, 53100 Siena, Italy;
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, “Spedali Riuniti” di Livorno, Breast Unit Integrata di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, 57100 Livorno, Italy;
| | - Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; (L.V.); (M.A.M.)
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14
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Lucas JT, Pappo AS. Optimal dosing of cyclophosphamide in rhabdomyosarcoma: It's complicated. Cancer 2019; 125:3107-3110. [PMID: 31174230 DOI: 10.1002/cncr.32205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/04/2019] [Indexed: 12/31/2022]
Affiliation(s)
- John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alberto S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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15
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Hasmat S, Ebrahimi A, Gao K, Low THH, Palme C, Gupta R, Clark J. Multifocal perineural invasion is a better prognosticator than depth of invasion in oral squamous cell carcinoma. Head Neck 2019; 41:3992-3999. [PMID: 31487105 DOI: 10.1002/hed.25940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 05/23/2019] [Revised: 07/24/2019] [Accepted: 08/15/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Prognostic significance of perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) characterized as unifocal and multifocal was compared to depth of invasion (DOI) and extranodal extension (ENE). MATERIALS AND METHODS Univariable and multivariable analyses of 861 consecutive patients with OSCC undergoing treatment between 1995 and 2018 were performed, with local failure (LF) and disease-specific mortality (DSS) as the primary endpoints. RESULTS After adjusting for other adverse histopathological factors and adjuvant therapy, multifocal PNI was associated with a greater risk of LF (P = .01) and DSS (P = 0.02) compared to DOI. The effect of multifocal PNI was comparable to the effect of nodal metastases without ENE (P = 0.02). LF and DSS were not improved by the administration of adjuvant radiotherapy within unifocal or multifocal PNI groups. CONCLUSION Multifocal PNI is associated with a greater risk of death in OSCC than DOI. Its effect is comparable to that of nodal metastases (without ENE).
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Affiliation(s)
- Shaheen Hasmat
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Medical School College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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16
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Factor O, Su W, Lazarev S, Miles B, Genden E, Sharma S, Gupta V, Misiukiewicz K, Bakst RL. Rapid in-field failures following adjuvant radiation for buccal squamous cell carcinoma. Laryngoscope 2019; 130:413-417. [PMID: 31021426 DOI: 10.1002/lary.27996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/21/2018] [Revised: 03/10/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma originating in the buccal mucosa and retromolar trigone (RMT) have historically poor outcomes. Difficulties in discriminating tumor origin often result in these subsites being combined in surgical and pathological reports. We aimed to determine if making this anatomical distinction has implications for treatment design and clinical outcomes. STUDY DESIGN Retrospective case series. METHODS We identified 27 tumors from either the buccal mucosa patients or RMT patients who underwent surgery followed by radiation. For patients who developed a local failure, we fused the pretreatment imaging, simulation computed tomography, and follow-up imaging to determine the location of failures relative to the radiation field. We calculated the 2-year locoregional control and 2-year disease-free survival. RESULTS The median time from surgery to radiation was 50 days (range, 32-133 days). The 2-year locoregional control for buccal mucosa versus RMT, respectively, were 35.9% versus 68.4% (P = .252). The 2-year disease-free survival rates were 32.7% versus 68.4%, respectively (P = .196). The median times to failure were 12.00 months (range, 4.9-115.0 months) versus 18.5 months (range, 4.5-61.0 months), respectively. All buccal mucosa failures occurred within the high-dose planning target volume, with a median dose of 60 Gy within the failure region. Following locoregional failure, 10 of the 12 patients have died, with a median time from local failure to death of 3.6 months (range, 1-17.6 months). CONCLUSIONS Squamous cell carcinomas of the buccal mucosa appear to have a poor prognosis characterized by rapid in-field failure. Therefore, differentiating tumor origin may be important for prognostication and treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 130:413-417, 2020.
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Affiliation(s)
- Oren Factor
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - William Su
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Krzysztof Misiukiewicz
- Department of Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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17
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Almarzouki H, Niazi T, Hier M, Mlynarek A, Lavoie I, Sultanem K. Local Failure Rate in Oropharyngeal Carcinoma Patients Treated with Intensity-modulated Radiotherapy Without High-dose Clinical Target Volume. Cureus 2018; 10:e2958. [PMID: 30214846 PMCID: PMC6132597 DOI: 10.7759/cureus.2958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose: Our purpose was to evaluate whether omitting high-dose clinical target volume radiation (CTV-HD) around the gross tumor volume (GTV) in patients with oropharyngeal squamous cell carcinoma (OSCC) treated with intensity-modulated radiotherapy (IMRT) was associated with increased local failure. Methods and materials: Patients diagnosed with stage I to stage IV OSCC between December 2004 and April 2017 were retrospectively reviewed. All patients were treated with radical radiotherapy using IMRT, with or without neoadjuvant or concurrent chemotherapy. In accordance with institution guidelines, CTV-HD was not used. Local failure was defined as disease persistence or reappearance at the primary tumor site. When primary failure was documented, the computed tomography/positron emission tomography (CT/PET) scan that showed primary failure was fused with the original treatment scan. Each recurrent tumor was contoured to evaluate the pattern of recurrence. Recurrences were categorized as in-field, marginal, or out-of-field if >95%, 20%-95%, or <20% of the recurrent tumor volume, respectively, was encompassed by the 95% high-dose prescription isodose line of the original treatment plan. We then determined whether omitting CTV-HD was associated with increased locoregional failure. Results: A total of 272 patients with OSCC were assessed. The median follow-up from initial treatment was 43 months (range: 3-194 months). Seven patients were lost to follow-up. The overall five-year survival rate was 87%. The three- and five-year disease-free survival rates were 86% and 83%, respectively. Forty-one patients had 53 treatment failures (16 were local, eight were regional, and 29 were distant; some patients had treatment failures in multiple locations). Fourteen (87.5%) of the local recurrences were in-field, one (6.25%) was marginal, and one (6.25%) was out-of-field. Conclusion: Our analysis of patients with oropharyngeal cancer suggests that local failure is mostly in-field and potentially due to radioresistance, rather than a marginal miss of the tumor. It suggests that omitting CTV-HD is feasible and safe.
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Affiliation(s)
| | - Tamim Niazi
- Oncology, Jewish General Hospital, Montreal, CAN
| | - Michael Hier
- Otolaryngology, Jewish General Hospital, McGill University, Montreal, CAN
| | - Alex Mlynarek
- Otolaryngology, Jewish General Hospital, McGill University, Montreal, CAN
| | - Isabelle Lavoie
- Radiation Oncology, McGill University/Jewish General Hospital, Montreal, CAN
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18
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Fan B, Fan P, Kong L, Sun X, Zhao S, Sun X, Fu Z, Zheng J, Ma L, Wang S, Hu M, Yu J. 18F-deoxyglucose positron emission tomography/computed tomography to predict local failure in esophageal squamous cell carcinoma. Oncotarget 2018; 8:34498-34506. [PMID: 28404900 PMCID: PMC5470985 DOI: 10.18632/oncotarget.15606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/15/2016] [Accepted: 01/04/2016] [Indexed: 01/24/2023] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) patients are at risk for local failure (LF) following treatment. Predicting tumor regions at high risk for local failure before radiotherapy may increase treatment efficacy by permitting an escalated radiation dose specifically to those regions critical for tumor control. Forty-one patients with non-resectable locally advanced ESCC underwent 18F-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging before concurrent chemoradiotherapy (CCRT). After CCRT, a second (failure) FDG PET/CT was performed in cases of relapse. Failure FDG PET/CT scans were fused to pre-treatment scans to identify tumor regions at high risk for LF. Within a median follow-up time of 26 months, 20 patients (48.8%) had LF. In 19 patients, the failure occurred within a pre-treatment high FDG uptake region; the failure occurred outside these regions in only one patient. Pre-treatment metabolic tumor volume (MTV) was independently associated with LF (P<0.001, HR 1.128, 95% CI: 1.061–1.198). LF was more likely in patients with MTVs ≥27 cm3. In initial PET/CT images, when 50% maximum standardized uptake value (SUVmax) was used as the threshold, delineated subvolumes overlapped LF regions. These results confirm that LF occurs most commonly within pre-treatment high FDG uptake regions.
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Affiliation(s)
- Bingjie Fan
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Pingping Fan
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Li Kong
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Xindong Sun
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Shuqiang Zhao
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China
| | - Xiaorong Sun
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China
| | - Zheng Fu
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China
| | - Jinsong Zheng
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China
| | - Li Ma
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Nuclear Medicine, Shandong Cancer Hospital and Institute, Jinan, China
| | - Shijiang Wang
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Man Hu
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Jinming Yu
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China.,Departments of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
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19
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Lockney NA, Yang TJ, Barron D, Gelb E, Gelblum DY, Yorke E, Shi W, Zhang Z, Rimner A, Wu AJ. PIK3CA mutation is associated with increased local failure in lung stereotactic body radiation therapy (SBRT). Clin Transl Radiat Oncol 2017; 7:91-93. [PMID: 29503876 PMCID: PMC5830173 DOI: 10.1016/j.ctro.2017.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 12/11/2022] Open
Abstract
Objectives Hyperactivation of the phosphatidylinositol-3-kinase (PI3K) pathway has been associated with radioresistance. It is unclear whether such mutations confer suboptimal local control for patients who receive lung stereotactic body radiation therapy (SBRT). Our objective was to examine whether mutations in the EGFR/AKT/PIK3CA signaling pathway are associated with local failure (LF) after lung SBRT. Methods We retrospectively reviewed 166 patients who underwent SBRT to primary or metastatic lung lesions from 2007-2015 for whom genetic testing data was available for EGFR, AKT, and PIK3CA genes. Association between clinical factors, including molecular mutation status, and LF was evaluated. Results Six patients (4%) had PIK3CA mutation, 36 patients (22%) had EGFR mutation, and one patient (0.6%) had AKT1 mutation. Median lesion size was 2.0 cm (range, 0.6-5.6 cm); median dose was 48Gy in 4 fractions (range, 30-70Gy in 3-10 fractions). Median follow-up for survivors was 27.3 months (range, 3.8-66.7 months). LF occurred in 16 patients (10%). On univariate analysis, PIK3CA mutation was associated with LF (HR 10.44 [95% CI 2.16-50.46], p=0.003), while tumor histology, tumor size, primary tumor site, BED and EGFR mutation were not. At one year, probability of LF in lesions with PIK3CA mutation was 20.0% vs. 2.9% in lesions without mutation (p<0.001 by log rank test). Conclusion Although the number of patients affected was small, PIK3CA mutation was significantly associated with higher risk of LF in patients undergoing lung SBRT. This association has not previously been reported for lung SBRT and indicates the need for further validation.
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Affiliation(s)
- Natalie A Lockney
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - David Barron
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Emily Gelb
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Weiji Shi
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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20
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Tinkle CL, Fernandez-Pineda I, Sykes A, Lu Z, Hua CH, Neel MD, Bahrami A, Shulkin BL, Kaste SC, Pappo A, Spunt SL, Krasin MJ. Nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) in pediatric and young adult patients: Results from a prospective study using limited-margin radiotherapy. Cancer 2017; 123:4419-4429. [PMID: 28759114 DOI: 10.1002/cncr.30793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 03/02/2017] [Revised: 04/14/2017] [Accepted: 04/25/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Indications for and delivery of adjuvant therapies for pediatric nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) have been derived largely from adult studies; therefore, significant concern remains regarding radiation exposure to normal tissue. The authors report long-term treatment outcomes and toxicities for pediatric and young adult patients with high-grade NRSTS who were treated on a prospective trial using limited-margin radiotherapy. METHODS Sixty-two patients (ages 3-22 years) with predominantly high-grade NRSTS requiring radiation were treated on a phase 2 institutional study of conformal external-beam radiotherapy and/or brachytherapy using a 1.5-cm to 2-cm anatomically constrained margin. The estimated cumulative incidence of local failure, Gray's method estimated cumulative incidence of local failure, Kaplan-Meier method estimated survival, competing-risk regression model determined predictors of disease outcome, and toxicity was reported according to CTCAE v2.0. RESULTS At a median follow-up of 5.1 years (range, 0.2-10.9 years), 9 patients had experienced local failure. The 5-year overall cumulative incidence of local failure was 14.8% (95% confidence interval [CI], 7.2%-25%), and all but 1 local failure occurred outside the highest-dose irradiation volume. The 5-year Kaplan-Meier estimates for event-free and overall survival were 49.3% (95% CI, 36.3%-61.1%) and 67.9% (95% CI, 54.2%-78.3%), respectively. Multivariable analysis indicated that younger age was the only independent predictor of local recurrence (P = .004). The 5-year cumulative incidence of grade 3 or 4 late toxicity was 15% (95% CI, 7.2%-25.3%). CONCLUSIONS The delivery of limited-margin radiotherapy using conformal external-beam radiotherapy or brachytherapy provides a high rate of local tumor control without an increase in marginal failures and with acceptable treatment-related morbidity. Cancer 2017;123:4419-29. © 2017 American Cancer Society.
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Affiliation(s)
- Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael D Neel
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University, Stanford, California
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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21
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Liu W, Patel SH, Harrington DP, Hu Y, Ding X, Shen J, Halyard MY, Schild SE, Wong WW, Ezzell GE, Bues M. Exploratory study of the association of volumetric modulated arc therapy (VMAT) plan robustness with local failure in head and neck cancer. J Appl Clin Med Phys 2017; 18:76-83. [PMID: 28503916 PMCID: PMC5500391 DOI: 10.1002/acm2.12099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/06/2016] [Revised: 03/02/2016] [Accepted: 03/30/2017] [Indexed: 12/25/2022] Open
Abstract
This work is to show which is more relevant to cause local failures (LFs) due to patient setup uncertainty between the planning target volume (PTV) underdosage and the potential target underdosage subject to patient setup uncertainties in head and neck (H&N) cancer treated with volumetric‐modulated arc therapy (VMAT). Thirteen LFs in 10 H&N patients treated by VMAT were analyzed. Measures have been taken to minimize the chances of insufficient target delineation for these patients and the patients were clinically determined to have LF based on the PET/CT scan results by an experienced radiologist and then reviewed by a second experienced radiation oncologist. Two methods were used to identify the possible locations of LF due to underdosage: (a) examining the standard VMAT plan, in which the underdosed volume in the nominal dose distribution (UVN) was generated by subtracting the volumes receiving the prescription doses from PTVs, and (b) plan robustness analysis, in which in addition to the nominal dose distribution, six perturbed dose distributions were created by translating the CT iso‐center in three cardinal directions by the PTV margin. The coldest dose distribution was represented by the minimum of the seven doses in each voxel. The underdosed volume in the coldest dose distribution (UVC) was generated by subtracting the volumes receiving the prescription doses in the coldest dose distribution from the volumes receiving the prescription doses in the nominal dose distribution. UVN and UVC were subsequently examined for spatial association with the locations of LF. The association was tested using the binominal distribution and the Fisher's exact test of independence. We found that of 13 LFs, 11 were associated with UVCs (P = 0.011), while three were associated with UVNs (P = 0.99). We concluded that the possible target underdosage due to patient setup uncertainties appeared to be a more relevant factor associated with LF in VMAT for H&N cancer than the compromised PTV coverage at least for the patients included in this study.
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Affiliation(s)
- Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | | | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Xiaoning Ding
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Jiajian Shen
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Michele Y Halyard
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Gary E Ezzell
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, 85054, USA
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22
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Vapiwala N, Hwang WT, Kushner CJ, Schnall MD, Freedman GM, Solin LJ. No impact of breast magnetic resonance imaging on 15-year outcomes in patients with ductal carcinoma in situ or early-stage invasive breast cancer managed with breast conservation therapy. Cancer 2016; 123:1324-1332. [PMID: 27984658 DOI: 10.1002/cncr.30479] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/25/2016] [Accepted: 11/07/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND For women undergoing breast conservation therapy (BCT), the added value of breast magnetic resonance imaging (MRI) at the time of initial diagnosis remains controversial. The current study was performed to determine long-term outcomes after BCT for women with and without pretreatment breast MRI. METHODS Between 1992 and 2001, a total of 755 women with ductal carcinoma in situ or early-stage invasive breast cancer underwent breast-conserving surgery (with axillary lymph node staging for invasive carcinoma) followed by definitive breast radiotherapy. Evaluation at the time of the initial diagnosis included conventional mammography in all subjects and breast MRI in 215 women (28%). Clinical, pathologic, and treatment characteristics were comparable for patients with and without breast MRI. Outcomes were determined using the Kaplan-Meier method and compared using the log-rank method. RESULTS At a median follow-up of 13.8 years, there were 49 local failures (15 women with and 34 women without breast MRI, respectively). The 15-year local failure rates were 8% for women with and 8% for women without MRI (P = .59). There also were no differences noted between women with and without breast MRI with regard to 15-year rates of overall survival (77% vs 71%; P = .24), freedom from distant metastases (86% vs 90%; P = .08), and contralateral breast cancer (10% vs 8%; P = .10). Multivariate analysis demonstrated no significant impact of breast MRI on local failure (P = .96). CONCLUSIONS Breast MRI during the initial evaluation for BCT appears to have no significant impact on 15-year rates for local control, overall survival, freedom from distant metastases, or contralateral breast cancer. The routine use of pretreatment breast MRI is not indicated for patients undergoing BCT. Cancer 2017;123:1324-1332. © 2016 American Cancer Society.
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Affiliation(s)
- Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn J Kushner
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary M Freedman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence J Solin
- Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania
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23
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Nakamura R, Omori T, Takeuchi H, Kawakubo H, Takahashi T, Wada N, Saikawa Y, Kitagawa Y. Salvage endoscopic resection as a treatment for locoregional failure or recurrence following chemoradiotherapy or radiotherapy for esophageal cancer. Oncol Lett 2016; 11:3631-3636. [PMID: 27284365 PMCID: PMC4887774 DOI: 10.3892/ol.2016.4478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/13/2015] [Accepted: 04/01/2016] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy (RT) or chemoradiotherapy (CRT) is a potentially curative, non-surgical treatment option for esophageal cancer, although the rate of local failure within the esophagus remains relatively high. Salvage esophagectomy is not regarded as a common treatment for esophageal cancer, since it is a high-risk surgery with a relatively high surgical mortality rate. Salvage endoscopic resection (ER) for local failure is used for treatment when esophageal cancer is localized and superficial. To evaluate to usefulness of salvage ER, the present study reviewed the clinicopathological records and follow-up data of 37 patients that underwent salvage ER for esophageal cancer, following initial treatment with RT or CRT. Salvage ER was conducted on a total of 78 lesions observed in the 37 patients. Since a thick epithelium and lack of normal vessels on the surface of the mucosa are characteristics of esophageal mucosa following RT or CRT, almost all the lesions were detected using iodine dyeing, and not by narrow band imaging. The growth rate of the detected lesions was relatively high, and early treatment was required. No particular complications occurred during the endoscopic treatment. A total of 11 patients survived for >5 years subsequent to initial endoscopic treatment. Only 4 patients succumbed to esophageal cancer. In conclusion, the present study demonstrated that salvage ER following CRT or RT for esophageal cancer is a minimally invasive, safe, adaptive and curative method for superficial lesions without distant metastases in patients with esophageal cancer with local failure following CRT or RT.
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Affiliation(s)
- Rieko Nakamura
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Tai Omori
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Tsunehiro Takahashi
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Yoshiro Saikawa
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan
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24
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Hughes RT, Black PJ, Page BR, Lucas JT, Qasem SA, Watabe K, Ruiz J, Laxton AW, Tatter SB, Debinski W, Chan MD. Local control of brain metastases after stereotactic radiosurgery: the impact of whole brain radiotherapy and treatment paradigm. J Radiosurg SBRT 2016; 4:89-96. [PMID: 29296433 PMCID: PMC5658880] [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] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/04/2015] [Indexed: 06/07/2023]
Abstract
PURPOSE We investigate clinical, pathologic, and treatment paradigm-related factors affecting local control of brain metastases after stereotactic radiosurgery (SRS) with or without whole brain radiotherapy (WBRT). METHODS AND MATERIALS Patients with brain metastases treated with SRS alone, before or after WBRT were considered to determine predictors of local failure (LF), time to failure and survival. RESULTS Among 137 patients, 411 brain metastases were analyzed. 23% of patients received SRS alone, 51% received WBRT prior to SRS, and 26% received SRS followed by WBRT. LF occurred in 125 metastases: 63% after SRS alone, 20% after WBRT then SRS, and 22% after SRS then WBRT. Median time to local failure was significantly less after SRS alone compared to WBRT then SRS (12.1 v. 22.7 months, p=0.003). Tumor volume was significantly associated with LF (HR:5.2, p<0.001, 95% CI:3.4-7.8). CONCLUSIONS WBRT+SRS results in reduced LF. Local control was not significantly different after SRS as salvage therapy versus upfront SRS.
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Affiliation(s)
- Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Paul J. Black
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Brandi R. Page
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - John T. Lucas
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Shadi A. Qasem
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Jimmy Ruiz
- Department of Internal Medicine-Hematology/Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Waldemar Debinski
- Brain Tumor Center of Excellence, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
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25
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Abstract
OPINION STATEMENT Local residual disease occurs in 7-13 % after primary treatment for nasopharyngeal carcinoma (NPC). To prevent tumor progression and/or distant metastasis, treatment is indicated. Biopsy is the "gold standard" for diagnosing residual disease. Because late histological regression frequently is seen after primary treatment for NPC, biopsy should be performed when imaging or endoscopy is suspicious at 10 weeks. Different modalities can be used in the treatment of local residual disease. Interestingly, the treatment of residual disease has better outcomes than treatment of recurrent disease. For early-stage disease (rT1-2), treatment results and survival rates are very good and comparable to patients who had a complete response after the first treatment. Surgery (endoscopic or open), brachytherapy (interstitial or intracavitary), external or stereotactic beam radiotherapy, or photodynamic therapy all have very good and comparable response rates. Choice should depend on the extension of disease, feasibility of the treatment, and doctor's and patient's preferences and experience, as well as the risks of the adverse events. For the more extended tumors, choice of treatment is more difficult, because complete response rates are poorer and severe side effects are not uncommon. The results of external beam reirradiation and stereotactic radiotherapy are better than brachytherapy for T3-4 tumors. Photodynamic therapy resulted in good palliative responses in a few patients with extensive disease. Also, chemotherapeutics or the Epstein-Barr virus targeted therapies can be used when curative intent treatment is not feasible anymore. However, their advantage in isolated local failure has not been well described yet. Because residual disease often is a problem in countries with a high incidence of NPC and limited radiotherapeutic and surgical facilities, it should be understood that most of the above mentioned therapeutic modalities (radiotherapy and surgery) will not be readily available. More research with controlled, randomized trials are needed to find realistic treatment options for residual disease.
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Affiliation(s)
- S. D. Stoker
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - J. N. A. van Diessen
- Department of Radiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - J. P. de Boer
- Department of Hemato-oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - B. Karakullukcu
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | - C. R. Leemans
- Department of otolaryngology/head and neck surgery, VU University Medical Center Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - I. B. Tan
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
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