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Fang P, Pinnix CC, Wu SY, Lee HC, Patel KK, Saini N, Becnel MR, Kaufman G, Thomas SK, Orlowski RZ, Amini B, Lin P, Dabaja BS, Gunther JR. Management and Outcomes of Patients with Refractory Solitary Plasmacytoma after Treatment with Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 119:193-199. [PMID: 38070713 DOI: 10.1016/j.ijrobp.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Radiation therapy (RT) is the standard treatment for solitary plasmacytoma (SP); however, the optimal management of RT-refractory SPs is unknown. We examined outcomes after early systemic therapy, surgical resection, or observation for patients with RT-refractory disease and assessed the potential impact of treatment selection on disease outcomes. METHODS AND MATERIALS We retrospectively reviewed patients with SP treated with definitive radiation and evaluated at a single institution with persistent disease on imaging or biopsy. Descriptive statistics were used to characterize patient and disease characteristics and treatment outcomes. RESULTS Of 102 total SP patients, 17 (17%) were RT-refractory. The median RT dose was 45 Gy, and median follow-up was 71 months from end of RT. Fifteen patients had additional treatment for refractory disease at a median time of 9.5 months after RT, with the following subsequent interventions: surgical resection (n = 4), additional RT (n = 2), systemic therapy without evidence of multiple myeloma (MM; n = 4), systemic therapy for progression to MM (n = 5), and observation (n = 2). Of 4 patients treated with surgical resection, 3 progressed to MM 22 to 43 months after diagnosis. Of 2 patients treated with additional RT, neither responded, and both had pathologic confirmation of residual disease after the second course. Four patients treated with systemic therapy without MM all had complete responses on positron emission tomography and no subsequent MM progression. Eight patients were initially observed after RT for ≥12 months (n = 8) or ≥24 months (n = 6). Of the 2 patients in continued observation, both had stable/unchanged avidity after radiation treatment for 12 and 22 months and ultimately had a slow decrease of disease avidity over multiple years. CONCLUSIONS Patients with RT-refractory SPs can achieve good local control with alternative therapies, such as surgery or systemic therapy, if needed. Additional RT does not seem to be effective. Given the known high rates of progression from SP to MM, close observation of asymptomatic persistent disease until disease progression is likely sufficient in most cases.
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Affiliation(s)
- Penny Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan Y Wu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hans C Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina K Patel
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melody R Becnel
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory Kaufman
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheeba K Thomas
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Z Orlowski
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Behrang Amini
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pei Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Yigit E, Gultekin M, Aydin B, Kutluk T, Yuce Sari S, Ekinci S, Orhan D, Yildiz F. A Single-center Experience of Radiotherapy in Pediatric Ewing Sarcoma/Primitive Neuroectodermal Tumor of the Chest Wall. J Pediatr Hematol Oncol 2024; 46:197-205. [PMID: 38572993 DOI: 10.1097/mph.0000000000002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/13/2024] [Indexed: 04/05/2024]
Abstract
AIM To evaluate the treatment results, prognostic parameters, and treatment-related toxicity in patients with Ewing sarcoma (ES)/primitive neuroectodermal tumor (PNET) of the chest wall who underwent surgery, chemotherapy, and radiotherapy (RT) in a tertiary referral center. METHODS The data of 24 patients under 18 years of age with a histologic diagnosis of ES/PNET in the chest wall that received RT in our department between February 2003 and July 2020 were retrospectively evaluated. RT was applied to the primary site±whole involved chest wall and to the whole lung in patients with lung metastasis. RESULTS The median age was 8.5 years (range: 1.5 to 17 y), 15 (63%) patients were female and 9 were male (37%). The tumor localization was extrathoracic in 18 (75%) and intrathoracic in 6 (25%) patients. Mediastinal lymph node and distant metastasis (DM) was present in 5 (21%) and 4 (16%) cases at diagnosis, respectively. The median follow-up after RT was 47 months (range: 11 to 162 mo). The 2-year and 5-year overall survival, event-free survival, local recurrence-free survival, and pleural recurrence-free survival were 83% and 48%, 48% and 42%, 74% and 48%, and 61% and 52%, respectively. The overall local control rate was 83% and the pleural control rate was 67%. RT was well tolerated, with 1 case of grade 3 acute dermatitis and 1 case of grade 3 subacute radiation pneumonitis. Late toxicity was observed in 3 (13%) cases. CONCLUSION Long-term survival can be achieved with extended-field RT even in patients with ES/PNET of the chest wall with DM. The low toxicity rates allow us to draw the conclusion that RT with modern techniques is an effective and safe treatment modality for these patients.
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Affiliation(s)
| | | | | | | | | | | | - Diclehan Orhan
- Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Chan AW, Simone CB, van der Linden Y, Hoskin P, Detsky J, Choi JI, Lee SF, Wong HC, Martin EJ, Raman S, Rades D, Rembielak A, Kazmierska J, Vassiliou V, Alcorn S, Bonomo P, Oldenburger E. Prophylactic Radiation Therapy for High-Risk Asymptomatic Bone Metastases: A New Standard of Care or Need for More Data? J Clin Oncol 2024; 42:1326-1327. [PMID: 38320224 DOI: 10.1200/jco.23.02391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Adrian Wai Chan
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Charles B Simone
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Yvette van der Linden
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Peter Hoskin
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Jay Detsky
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - J Isabelle Choi
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - S F Lee
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Henry Cy Wong
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Emily J Martin
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Dirk Rades
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Agata Rembielak
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Joanna Kazmierska
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Vassilios Vassiliou
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Sara Alcorn
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Pierluigi Bonomo
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Eva Oldenburger
- Adrian Wai Chan, MBBS, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; Charles B. Simone II, MD, Department of Radiation Oncology, New York Proton Center, New York, NY; Yvette van der Linden, MD, PhD, Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands, Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands; Peter Hoskin, MD, Mount Vernon Cancer Centre, Northwood, United Kingdom, Division of Cancer Sciences, University of Manchester, United Kingdom; Jay Detsky, MD, PhD, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, the University of Toronto, Toronto, Canada; J. Isabelle Choi, MD, Department of Radiation Oncology, New York Proton Center, New York, NY, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; S.F. Lee, MD, , Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore; Henry CY Wong, MBBS, Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong S.A.R., China, Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hospital Authority, Hong Kong S.A.R., China; Henry CY Wong, MBBS, Department of Medicine, UCLA Health, Los Angeles, CA; Srinivas Raman, MD, Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada; Dirk Rades, MD, Department of Radiation Oncology, University of Lübeck, Germany; Agata Rembielak, MD, PhD, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Joanna Kazmierska, MD, PhD, Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland, Electroradiology Department, University of Medical Sciences, Poznan, Poland; Vassilios Vassiliou, MD, PhD, Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Strovolos, Cyprus; Sara Alcorn, MD, PhD, Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN; Pierluigi Bonomo, MD, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; and Eva Oldenburger, MD, Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
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Campbell SR. "Bone Voyage:" Perfecting the Solo Act of Radiation Therapy for Older Patients With Unresectable Osteosarcoma. Int J Radiat Oncol Biol Phys 2024; 118:1163. [PMID: 38492966 DOI: 10.1016/j.ijrobp.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 03/18/2024]
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Liatsou I, Fu Y, Li Z, Hasan M, Guo X, Yu J, Piccolo J, Cartee A, Wang H, Du Y, Bryan J, Gabrielson K, Kraitchman DL, Sgouros G. Therapeutic efficacy of an alpha-particle emitter labeled anti-GD2 humanized antibody against osteosarcoma-a proof of concept study. Eur J Nucl Med Mol Imaging 2024; 51:1409-1420. [PMID: 38108831 DOI: 10.1007/s00259-023-06528-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Current treatments for osteosarcoma (OS) have a poor prognosis, particularly for patients with metastasis and recurrence, underscoring an urgent need for new targeted therapies to improve survival. Targeted alpha-particle therapy selectively delivers cytotoxic payloads to tumors with radiolabeled molecules that recognize tumor-associated antigens. We have recently demonstrated the potential of an FDA approved, humanized anti-GD2 antibody, hu3F8, as a targeted delivery vector for radiopharmaceutical imaging of OS. The current study aims to advance this system for alpha-particle therapy of OS. METHODS The hu3F8 antibody was radiolabeled with actinium-225, and the safety and therapeutic efficacy of the [225Ac]Ac-DOTA-hu3F8 were evaluated in both orthotopic murine xenografts of OS and spontaneously occurring OS in canines. RESULTS Significant antitumor activity was proven in both cases, leading to improved overall survival. In the murine xenograft's case, tumor growth was delayed by 16-18 days compared to the untreated cohort as demonstrated by bioluminescence imaging. The results were further validated with magnetic resonance imaging at 33 days after treatment, and microcomputed tomography and planar microradiography post-mortem. Histological evaluations revealed radiation-induced renal toxicity, manifested as epithelial cell karyomegaly and suggestive polyploidy in the kidneys, suggesting rapid recovery of renal function after radiation damage. Treatment of the two canine patients delayed the progression of metastatic spread, with an overall survival time of 211 and 437 days and survival beyond documented metastasis of 111 and 84 days, respectively. CONCLUSION This study highlights the potential of hu3F8-based alpha-particle therapy as a promising treatment strategy for OS.
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Affiliation(s)
- Ioanna Liatsou
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Yingli Fu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhi Li
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahmud Hasan
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xin Guo
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jing Yu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Piccolo
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison Cartee
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hao Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yong Du
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Kathleen Gabrielson
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara L Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Sgouros
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jennings JW. Combined Complementary Local Therapies for Pain Palliation and Local Control of a Pelvic Osteosarcoma. Int J Radiat Oncol Biol Phys 2024; 118:1161-1162. [PMID: 38492963 DOI: 10.1016/j.ijrobp.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 03/18/2024]
Affiliation(s)
- Jack W Jennings
- Department of Radiology, Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Akakura K, Uemura H, Kawakami S, Yokomizo A, Nakamura M, Nishimura K, Komori T, Ledesma DA. Metastatic castration resistant prostate cancer patients' experience with Radium-223 treatment in Japan. Future Oncol 2024; 20:781-798. [PMID: 38275149 DOI: 10.2217/fon-2023-0870] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Aim: We aimed to determine Japanese metastatic castration resistant prostate cancer (CRPC) patients' Ra-223 treatment experience. Patients & methods: Patients answered the Cancer Therapy Satisfaction Questionnaire (CTSQ domains: Satisfaction with Therapy [SWT], Expectations of Therapy [ET], Feelings about Side Effects [FSE]), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and the FACT-Bone Pain (FACT-BP) Questionnaire at baseline, during (vists 3 and 5) and after treatment (end of observation; EOO). Results: Data from 72 patients were included. Baseline median CTSQ scores SWT: 66.1 (IQR19.7), ET: 75.0 (IQR45), and FSE 68.8 (IQR 34.4) were unchanged during vists 3 and 5, but the SWT (-3.57 [IQR17.9]) and ET (-5.0 [IQR30]) decreased while FSE was unchanged (0.0 [IQR31.25]) at EOO. The median MAX-PC (18.0 [IQR 49]) score was unchanged (0.0, IQR 6) while the median FACT BP (54.0 [IQR13]) score decreased by -1.0 (IQR 8) at EOO. Conclusion: Japanese metastatic castration resistant prostate cancer patients' experience is stable during Ra-223 treatment.
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Affiliation(s)
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Satoru Kawakami
- Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Chiao EJ, Harris J. By Your Powers Combined: Treating Pelvic Osteosarcoma With Combination Radiation and Thermoablation. Int J Radiat Oncol Biol Phys 2024; 118:1159-1160. [PMID: 38492962 DOI: 10.1016/j.ijrobp.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 03/18/2024]
Affiliation(s)
- Elaine J Chiao
- Department of Radiation Oncology, University of California Irvine, School of Medicine, Irvine, California
| | - Jeremy Harris
- Department of Radiation Oncology, University of California Irvine, School of Medicine, Irvine, California.
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Daugherty EC, Zhang Y, Xiao Z, Mascia AE, Sertorio M, Woo J, McCann C, Russell KJ, Sharma RA, Khuntia D, Bradley JD, Simone CB, Breneman JC, Perentesis JP. FLASH radiotherapy for the treatment of symptomatic bone metastases in the thorax (FAST-02): protocol for a prospective study of a novel radiotherapy approach. Radiat Oncol 2024; 19:34. [PMID: 38475815 PMCID: PMC10935811 DOI: 10.1186/s13014-024-02419-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND FLASH therapy is a treatment technique in which radiation is delivered at ultra-high dose rates (≥ 40 Gy/s). The first-in-human FAST-01 clinical trial demonstrated the clinical feasibility of proton FLASH in the treatment of extremity bone metastases. The objectives of this investigation are to assess the toxicities of treatment and pain relief in study participants with painful thoracic bone metastases treated with FLASH radiotherapy, as well as workflow metrics in a clinical setting. METHODS This single-arm clinical trial is being conducted under an FDA investigational device exemption (IDE) approved for 10 patients with 1-3 painful bone metastases in the thorax, excluding bone metastases in the spine. Treatment will be 8 Gy in a single fraction administered at ≥ 40 Gy/s on a FLASH-enabled proton therapy system delivering a single transmission proton beam. Primary study endpoints are efficacy (pain relief) and safety. Patient questionnaires evaluating pain flare at the treatment site will be completed for 10 consecutive days post-RT. Pain response and adverse events (AEs) will be evaluated on the day of treatment and on day 7, day 15, months 1, 2, 3, 6, 9, and 12, and every 6 months thereafter. The outcomes for clinical workflow feasibility are the occurrence of any device issues as well as time on the treatment table. DISCUSSION This prospective clinical trial will provide clinical data for evaluating the efficacy and safety of proton FLASH for palliation of bony metastases in the thorax. Positive findings will support the further exploration of FLASH radiation for other clinical indications including patient populations treated with curative intent. REGISTRATION ClinicalTrials.gov NCT05524064.
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Affiliation(s)
- E C Daugherty
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Y Zhang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
- Cancer and Blood Disease Institute , Cincinnati Children's Hospital , Cincinnati, OH, USA
| | - Z Xiao
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
- Cancer and Blood Disease Institute , Cincinnati Children's Hospital , Cincinnati, OH, USA
| | - A E Mascia
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
- Cancer and Blood Disease Institute , Cincinnati Children's Hospital , Cincinnati, OH, USA
| | - M Sertorio
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - J Woo
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | - C McCann
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | - K J Russell
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | - R A Sharma
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | - D Khuntia
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | - J D Bradley
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - C B Simone
- Department of Radiation Oncology, New York Proton Center , New York, NY, USA
| | - J C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - J P Perentesis
- Cancer and Blood Disease Institute , Cincinnati Children's Hospital , Cincinnati, OH, USA.
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10
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Pijeira MSO, Gomes-da-Silva NC, Ricci-Junior E, Alencar LMR, İlem-Özdemir D, Cavalcanti ADS, Machado DE, Perini JA, Santos-Oliveira R. Micellar solution of [ 223Ra]RaCl 2: Reaching renal excretion, potent efficacy in osteoblastic osteosarcoma in PDX model, biochemistry alterations and pharmacokinetics. Int J Pharm 2024; 652:123765. [PMID: 38195032 DOI: 10.1016/j.ijpharm.2023.123765] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/27/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
Despite the successful use of the radiopharmaceutical radium-223 dichloride ([223Ra]RaCl2) for targeted alpha therapy of castration-resistant prostate cancer patients with bone metastases, some short-term side effects, such as diarrhea and vomiting, have been documented, causing patient discomfort. Hence, we prepared a nanosized micellar solution of [223Ra]RaCl2 and evaluated its biodistribution, pharmacokinetics, and induced biochemical changes in healthy mice up to 96 h after intraperitoneal administration as an alternative to overcome the previous limitations. In addition, we evaluated the bone specificity of micellar [223Ra]RaCl2 in patient-derived xenografts in the osteosarcoma model. The biodistribution studies revealed the high bone-targeting properties of the micellar [223Ra]RaCl2. Interestingly, the liver uptake remained significantly low (%ID/g = 0.1-0.02) from 24 to 96 h after administration. In addition, the micellar [223Ra]RaCl2 exhibited a significantly higher uptake in left (%ID/g = 0.85-0.23) and right (%ID/g = 0.76-0.24) kidneys than in small (%ID/g = 0.43-0.06) and large intestines (%ID/g = 0.24-0.09) over time, suggesting its excretion pathway is primarily through the kidneys into the urine, in contrast to the non-micellar [223Ra]RaCl2. The micellar [223Ra]RaCl2 also had low distribution volume (0.055 ± 0.003 L) and longer elimination half-life (28 ± 12 days). This nanosystem was unable to change the enzymatic activities of alanine aminotransferase, aspartate aminotransferase, gamma GT, glucose, and liquiform lipase in the treated mice. Finally, microscopic examination of the animals' osteosarcoma tumors treated with micellar [223Ra]RaCl2 indicated regression of the tumor, with large areas of necrosis. In contrast, in the control group, we observed tumor cellularity and cell anaplasia, mitotic figures and formation of neoplastic extracellular bone matrix, which are typical features of osteosarcoma. Therefore, our findings demonstrated the efficiency and safety of nanosized micellar formulations to minimize the gastrointestinal excretion pathway of the clinical radiopharmaceutical [223Ra]RaCl2, in addition to promoting regression of the osteosarcoma. Further studies must be performed to assess dose-response outcomes and organ/tissue dosimetry for clinical translation.
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Affiliation(s)
- Martha Sahylí Ortega Pijeira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro 21941906, Brazil
| | - Natália Cristina Gomes-da-Silva
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro 21941906, Brazil
| | - Eduardo Ricci-Junior
- School of Pharmacy, DEFARMED, Rio de Janeiro Federal University, Rio de Janeiro 21941900, Brazil
| | | | - Derya İlem-Özdemir
- School of Pharmacy, Department of Radiopharmacy, Ege University, 35040 Bornova, Izmir, Turkey
| | - Amanda Dos Santos Cavalcanti
- Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil; State University of Rio de Janeiro, Research Laboratory of Pharmaceutical Sciences, Rio de Janeiro 23070200, Brazil
| | - Daniel Escorsim Machado
- State University of Rio de Janeiro, Research Laboratory of Pharmaceutical Sciences, Rio de Janeiro 23070200, Brazil
| | - Jamila Alessandra Perini
- State University of Rio de Janeiro, Research Laboratory of Pharmaceutical Sciences, Rio de Janeiro 23070200, Brazil
| | - Ralph Santos-Oliveira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro 21941906, Brazil; State University of Rio de Janeiro, Laboratory of Radiopharmacy and Nanoradiopharmaceuticals, Rio de Janeiro 23070200, Brazil.
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11
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Jeon SH, Jang BS, Kim DY, Kim JH, Shin EC, Kim IA. Dynamic Responses of Circulating T Cells After Stereotactic Body Radiation Therapy for Bone Metastasis in Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2024; 118:790-800. [PMID: 37802227 DOI: 10.1016/j.ijrobp.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Preclinical studies have shown that radiation therapy modulates antitumor immune responses. However, circulating T-cell responses after radiation therapy in patients with cancer have been poorly characterized. This study aims to explore the changes in circulating T cells after stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS Peripheral blood samples of 30 patients with breast cancer who underwent SBRT for bone metastasis were analyzed using multicolor flow cytometry. Phenotypes of PD-1+ CD8+ T cells and regulatory T (TREG) cells were examined. Additionally, plasma protein levels were analyzed using a bead-based immunoassay. RESULTS Circulating PD-1+ CD8+ T cells, which are enriched for tumor-specific clonotypes, were activated at 1 week after SBRT. However, circulating TREG cells were also activated after SBRT; this pattern was also evident among effector Foxp3hiCD45RA- TREG cells. We observed no difference in T-cell responses according to the fraction size and number. Notably, activation of TREG cells was more prominent in patients who experienced greater activation of PD-1+ CD8+ T cells. Plasma level changes in TGF-β1, soluble CTLA-4, and soluble 4-1BB at 1 week after SBRT were associated with PD-1+ CD8+ T-cell responses. Activation of TREG cells at 1 week after SBRT was associated with worse progression-free survival. Clinical factors including molecular subtype were not associated with the T-cell responses. CONCLUSIONS SBRT induced activation of both potentially tumor-specific CD8+ T cells and TREG cells, which were tightly associated with each other. These results may support the use of TREG cell-modulating strategies with SBRT to improve the antitumor immune response.
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Affiliation(s)
- Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Yun Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eui-Cheol Shin
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea; The Center for Viral Immunology, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon, Republic of Korea.
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Medical Science Research Institute, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Tumor Biology and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea; Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea.
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12
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Guhlich M, Rieken S. [Prophylactic Radiation Therapy Versus Standard of Care for Patients With High-Risk Asymptomatic Bone Metastases]. Strahlenther Onkol 2024; 200:253-254. [PMID: 38180495 PMCID: PMC10876712 DOI: 10.1007/s00066-023-02195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Manuel Guhlich
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Stefan Rieken
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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13
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Dyer MR, Jing Z, Duncan K, Godbe J, Shokeen M. Advancements in the development of radiopharmaceuticals for nuclear medicine applications in the treatment of bone metastases. Nucl Med Biol 2024; 130-131:108879. [PMID: 38340369 DOI: 10.1016/j.nucmedbio.2024.108879] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Bone metastases are a painful and complex condition that overwhelmingly impacts the prognosis and quality of life of cancer patients. Over the years, nuclear medicine has made remarkable progress in the diagnosis and management of bone metastases. This review aims to provide a comprehensive overview of the recent advancements in nuclear medicine for the diagnosis and management of bone metastases. Furthermore, the review explores the role of targeted radiopharmaceuticals in nuclear medicine for bone metastases, focusing on radiolabeled molecules that are designed to selectively target biomarkers associated with bone metastases, including osteocytes, osteoblasts, and metastatic cells. The applications of radionuclide-based therapies, such as strontium-89 (Sr-89) and radium-223 (Ra-223), are also discussed. This review also highlights the potential of theranostic approaches for bone metastases, enabling personalized treatment strategies based on individual patient characteristics. Importantly, the clinical applications and outcomes of nuclear medicine in osseous metastatic disease are discussed. This includes the assessment of treatment response, predictive and prognostic value of imaging biomarkers, and the impact of nuclear medicine on patient management and outcomes. The review identifies current challenges and future perspectives on the role of nuclear medicine in treating bone metastases. It addresses limitations in imaging resolution, radiotracer availability, radiation safety, and the need for standardized protocols. The review concludes by emphasizing the need for further research and advancements in imaging technology, radiopharmaceutical development, and integration of nuclear medicine with other treatment modalities. In summary, advancements in nuclear medicine have significantly improved the diagnosis and management of osseous metastatic disease and future developements in the integration of innovative imaging modalities, targeted radiopharmaceuticals, radionuclide production, theranostic approaches, and advanced image analysis techniques hold great promise in improving patient outcomes and enhancing personalized care for individuals with bone metastases.
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Affiliation(s)
- Michael R Dyer
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Zhenghan Jing
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathleen Duncan
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacqueline Godbe
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Monica Shokeen
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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14
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Saylor PJ, Kozin SV, Matsui A, Goldberg SI, Aoki S, Shigeta K, Mamessier E, Smith MR, Michaelson MD, Lee RJ, Duda DG. The radiopharmaceutical radium-223 has immunomodulatory effects in patients and facilitates anti-programmed death receptor-1 therapy in murine models of bone metastatic prostate cancer. Radiother Oncol 2024; 192:110091. [PMID: 38224917 PMCID: PMC10905770 DOI: 10.1016/j.radonc.2024.110091] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND & PURPOSE Radium-223 (Ra223) improves survival in metastatic prostate cancer (mPC), but its impact on systemic immunity is unclear, and biomarkers of response are lacking. We examined markers of immunomodulatory activity during standard clinical Ra223 and studied the impact of Ra223 on response to immune checkpoint inhibition (ICI) in preclinical models. MATERIALS & METHODS We conducted a single-arm biomarker study of Ra223 in 22 bone mPC patients. We measured circulating immune cell subsets and a panel of cytokines before and during Ra223 therapy and correlated them with overall survival (OS). Using two murine mPC models-orthotopic PtenSmad4-null and TRAMP-C1 grafts in syngeneic immunocompetent mice-we tested the efficacy of combining Ra223 with ICI. RESULTS Above-median level of IL-6 at baseline was associated with a median OS of 358 versus 947 days for below levels; p = 0.044, from the log-rank test. Baseline PlGF and PSA inversely correlated with OS (p = 0.018 and p = 0.037, respectively, from the Cox model). Ra223 treatment was associated with a mild decrease in some peripheral immune cell populations and a shift in the proportion of MDSCs from granulocytic to myeloid. In mice, Ra223 increased the proliferation of CD8+ and CD4+ helper T cells without leading to CD8+ T cell exhaustion in the mPC lesions. In one of the models, combining Ra223 and anti-PD-1 antibody significantly prolonged survival, which correlated with increased CD8+ T cell infiltration in tumor tissue. CONCLUSION The inflammatory cytokine IL-6 and the angiogenic biomarker PlGF at baseline were promising outcome biomarkers after standard Ra223 treatment. In mouse models, Ra223 increased intratumoral CD8+ T cell infiltration and proliferation and could improve OS when combined with anti-PD-1 ICI.
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Affiliation(s)
- Philip J Saylor
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Sergey V Kozin
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aya Matsui
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Saveli I Goldberg
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shuichi Aoki
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kohei Shigeta
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Emilie Mamessier
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthew R Smith
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Dror Michaelson
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard J Lee
- MGH Cancer Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Dan G Duda
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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15
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Bindels BJJ, Mercier C, Gal R, Verlaan JJ, Verhoeff JJC, Dirix P, Ost P, Kasperts N, van der Linden YM, Verkooijen HM, van der Velden JM. Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2355409. [PMID: 38345820 PMCID: PMC10862159 DOI: 10.1001/jamanetworkopen.2023.55409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Conventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported. Objective To compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain. Data Sources A structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT. Study Selection Comparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases. Data Extraction and Synthesis Two independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures Overall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study's definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis. Results There were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results. Conclusions and Relevance In this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.
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Affiliation(s)
- Bas J. J. Bindels
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carole Mercier
- Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium
- Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Roxanne Gal
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium
- Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Nicolien Kasperts
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvette M. van der Linden
- Department of Radiation Oncology and Centre of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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16
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Benabdallah N, Lu P, Abou DS, Zhang H, Ulmert D, Hobbs RF, Gay HA, Simons BW, Saeed MA, Rogers BE, Jha AK, Tai YC, Malone CD, Ippolito JE, Michalski J, Jennings JW, Baumann BC, Pachynski RK, Thorek DLJ. Beyond Average: α-Particle Distribution and Dose Heterogeneity in Bone Metastatic Prostate Cancer. J Nucl Med 2024; 65:245-251. [PMID: 38124163 PMCID: PMC10858382 DOI: 10.2967/jnumed.123.266571] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Indexed: 12/23/2023] Open
Abstract
α-particle emitters are emerging as a potent modality for disseminated cancer therapy because of their high linear energy transfer and localized absorbed dose profile. Despite great interest and pharmaceutical development, there is scant information on the distribution of these agents at the scale of the α-particle pathlength. We sought to determine the distribution of clinically approved [223Ra]RaCl2 in bone metastatic castration-resistant prostate cancer at this resolution, for the first time to our knowledge, to inform activity distribution and dose at the near-cell scale. Methods: Biopsy specimens and blood were collected from 7 patients 24 h after administration. 223Ra activity in each sample was recorded, and the microstructure of biopsy specimens was analyzed by micro-CT. Quantitative autoradiography and histopathology were segmented and registered with an automated procedure. Activity distributions by tissue compartment and dosimetry calculations based on the MIRD formalism were performed. Results: We revealed the activity distribution differences across and within patient samples at the macro- and microscopic scales. Microdistribution analysis confirmed localized high-activity regions in a background of low-activity tissue. We evaluated heterogeneous α-particle emission distribution concentrated at bone-tissue interfaces and calculated spatially nonuniform absorbed-dose profiles. Conclusion: Primary patient data of radiopharmaceutical therapy distribution at the small scale revealed that 223Ra uptake is nonuniform. Dose estimates present both opportunities and challenges to enhance patient outcomes and are a first step toward personalized treatment approaches and improved understanding of α-particle radiopharmaceutical therapies.
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Affiliation(s)
- Nadia Benabdallah
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Peng Lu
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Diane S Abou
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Hanwen Zhang
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - David Ulmert
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Robert F Hobbs
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brian W Simons
- Center for Comparative Medicine, Baylor University, Houston, Texas
| | - Muhammad A Saeed
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Buck E Rogers
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Abhinav K Jha
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Yuan-Chuan Tai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Radiation Oncology, Springfield Clinic, Springfield, Illinois; and
| | - Russell K Pachynski
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Daniel L J Thorek
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri;
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Oncologic Imaging Program, Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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17
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Redmond KM, Turner PG, Cole A, Jain S, Prise KM, O'Sullivan JM. A potential biomarker of radiosensitivity in metastatic hormone sensitive prostate cancer patients treated with combination external beam radiotherapy and radium-223. Radiother Oncol 2024; 191:110063. [PMID: 38135185 DOI: 10.1016/j.radonc.2023.110063] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The ADRRAD trial reported the safety and feasibility of the combination of external beam radiotherapy and radium-223 in the treatment of de novo bone metastatic prostate. This study aimed to determine if any biomarkers predictive of response to these treatments could be identified. EXPERIMENTAL DESIGN 30 patients with newly diagnosed bone metastatic hormone sensitive prostate cancer were recruited to the ADRRAD trial. Blood samples were taken pre-treatment, before cycles 2 to 6 of radium-223, and 8 weeks and 6 months after treatment. Mononuclear cells were isolated and DNA damage was assessed at all timepoints. RESULTS DNA damage was increased in all patients during treatment, with bigger increases in foci observed in patients who relapsed late compared to those who relapsed early. Increases in DNA damage during the radium-223 only cycles of treatment were specifically related to response in these patients. Analysis of hematology counts also showed bigger decreases in red blood cell and hemoglobin counts in patients who experienced later biochemical relapse. CONCLUSIONS While some patients responded to this combination treatment, others relapsed within one year of treatment initiation. This study identifies a biomarker based approach that may be useful in predicting which patients will respond to treatment, by monitoring both increases in DNA damage above baseline levels in circulating lymphocytes and decreases in red blood cell and hemoglobin counts during treatment.
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Affiliation(s)
- K M Redmond
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom.
| | - P G Turner
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - A Cole
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - S Jain
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - K M Prise
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom
| | - J M O'Sullivan
- The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, United Kingdom; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Faghihi Moghaddam F, Bakhshandeh M, Mofid B, Sahinbas H, Faeghi F, Mirzaei H, Rakhsha A, Yousefi Kashi AS, Sadeghi R, Mahdavi A. Clinical effectiveness of combined whole body hyperthermia and external beam radiation therapy (EBRT) versus EBRT alone in patients with painful bony metastases: A phase III clinical trial study. J Therm Biol 2024; 120:103804. [PMID: 38460451 DOI: 10.1016/j.jtherbio.2024.103804] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To evaluate the response rate, pain relief duration, and time it took for pain to decline or resolve after radiation therapy (RT) with or without fever-range Whole Body Hyperthermia (WBH) in bony metastatic patients with mainly primary tumor of prostate and breast cancer leading to bone pain. MATERIALS & METHODS Bony metastatic patients with pain score ≥4 on the Brief Pain Inventory (BPI) underwent RT of 30 Gy in 10 fractions in combination with WBH with nursing care under medical supervision versus RT-alone. WBH application time was 3-4 h in three fractions with at least 48-h intervals. All patients were stratified primary site, breast or prostate cancer vs others, BPI score, and exclusion criteria. The primary endpoint was complete response (CR) (BPI equal to zero with no increase of analgesics) within two months of follow-up. RESULTS Based on this study, the RT-alone group showed the worst pain. The study was terminated after the enrollment of a total of 61 patients, 5 years after the first enrollment (April 2016 to February 2021). Finally, the CR rate in RT + WBH revealed the most significant difference with RT-alone, 47.4% versus 5.3% respectively within 2 months post-treatment (P-value <0.05). The time of complete pain relief was 10 days for RT + WBH, while the endpoint was not reached during the RT-alone arm. Pain progression or stable disease was observed in half of the patients in RT-alone group within 4 weeks after treatment. However, this score was near zero in RT + WBHT patients in two months post-treatment. CONCLUSIONS WBH plus RT showed significant increases in pain relief and shorter response time in comparison with RT-alone for patients with bone metastatic lesions.
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Affiliation(s)
- Fahimeh Faghihi Moghaddam
- Biomedical Engineering and Medical Physics Department, Faculty of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hüseyin Sahinbas
- Institute for Hyperthermia Research, Partner of the Marien Hospital Herne, Hospital of the RuhrUniversity, Bochum, Germany
| | - Fariborz Faeghi
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mirzaei
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Rakhsha
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Shahram Yousefi Kashi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Sadeghi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahdavi
- Department of Radiology, Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Marshall SK, Taweesap M, Saelim B, Pachana V, Benlateh N, Sangangam S, Bumrungsin A, Kholo-asae H, Wongtechanon I. Cytotoxicity Enhancement in Osteosarcoma with Multifunctional I-131 Radiotherapeutic Nanoparticles: In Vitro Three-Dimensional Spheroid Model and Release Kinetics Modeling. Molecules 2024; 29:630. [PMID: 38338373 PMCID: PMC10856476 DOI: 10.3390/molecules29030630] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
This novel radiolabeled chitosan nanoparticle, facilitated with curcumin, increased doxorubicin cytotoxicity and radiosensitivity to MG-63 osteosarcoma cells in a three-dimensional model. Delivery of the anti-epidermal growth factor receptor (EGFR) targeted carboxymethyl chitosan nanoparticles, directly labeled with Na131I (ICED-N), achieved deep tumor penetration in a three-dimensional model. Of three kinetic models, the Higuchi model more closely matched the experimental curve and release profiles. The anti-EGFR targeting resulted in a 513-fold greater targeting efficacy to MG-63 (EGFR+) cells than the control fibroblast (EGFR-) cells. The curcumin-enhanced ICED-N (4 × 0.925 MBq) fractionated-dose regime achieved an 18.3-fold increase in cell cytotoxicity compared to the single-dose (1 × 3.70 MBq) doxorubicin-loaded nanoparticle, and a 13.6-fold increase in cell cytotoxicity compared to the single-dose Na131I nanoparticle. Moreover, the ICED-N fractionated dose increased cells in the G2/M phase 8.78-fold, indicating the cell cycle arrest in the G2/M phase is associated with DNA fragmentation, and the intracellular damage is unable to be repaired. Overall, the results indicate that the fractionated dose was more efficacious than a single dose, and curcumin substantially increased doxorubicin cytotoxicity and amplified osteosarcoma cell radiosensitivity to Na131I.
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Affiliation(s)
- Suphalak Khamruang Marshall
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Molecular Imaging and Cyclotron Center, Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Maneerat Taweesap
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Boonyisa Saelim
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Verachai Pachana
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Nadeeya Benlateh
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Sireetorn Sangangam
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Achiraya Bumrungsin
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Haswanee Kholo-asae
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Issaree Wongtechanon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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20
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Bianchi SP, Faccenda V, Pacifico P, Parma G, Saufi S, Ferrario F, Belmonte M, Sala L, De Ponti E, Panizza D, Arcangeli S. Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study. Med Oncol 2023; 41:13. [PMID: 38079079 DOI: 10.1007/s12032-023-02238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/11/2023] [Accepted: 11/04/2023] [Indexed: 12/18/2023]
Abstract
This study aimed at evaluating the efficacy of different radiotherapy (RT) fractionation regimens in managing uncomplicated painful bone metastases (BM) and identifying predictive factors for pain control. Patients with 1 to 4 symptomatic BM from any primary solid tumors and a life expectancy exceeding 3 months were included in the study and received palliative RT, with SBRT restricted in the context of oligometastatic disease or in patients with good prognosis. Pain analysis using the Brief Pain Inventory (BPI) tool was conducted at baseline, 1 and 3 months after RT. Analgesic intake was recorded as morphine-equivalent doses (OME). Pain response was assessed using the International Consensus on Palliative Radiotherapy Endpoint (ICPRE). Multivariate logistic regression analyzed patient-related, tumor-related, and treatment-related factors predicting BM pain control at 3 months post-RT. From Feb 2022 to Feb 2023, 44 patients with 65 symptomatic BM were investigated. Breast (32%) and lung (24%) tumors were the most common primary tumors. Treatment plans included 3DCRT (60%) and VMAT (40%), with a median biological effective dose for tumors (BED) of 29 Gy [14-108]. All patients completed the 3-month follow-up. Pain response rates were 62% at 1 month and 60% at 3 months. Responders had better PS ECOG scores (67%; P = 0.008) and received active systemic therapies (67%: P = 0.036). Non-responders had lower pretreatment BPI (mean: 13.7 vs. 58.2; P = 0.032), with significantly higher values after 1 month (mean: 9.1 vs. 5.3, P = 0.033). Baseline BPI (OR: 1.17; 95% CI: 1.032-1.327; P = 0.014) and BPI at 1 month (OR: 0.83; 95% CI: 0.698-0.976; P = 0.025) were independent predictors of pain response at 3 months. Our findings show that palliative RT ensured short-term pain control in patients with BM, regardless of tumor type and dose-fractionation regimen. A larger sample size and a longer follow-up could potentially identify which patients are likely to benefit most from RT, and which fractionation might be indicated for achieving a durable pain relief. A multidisciplinary approach is paramount to provide a better care to BM patients.
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Affiliation(s)
- Sofia Paola Bianchi
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Pietro Pacifico
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Gaia Parma
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Sara Saufi
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Federica Ferrario
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Maria Belmonte
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Luca Sala
- Clinical Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Elena De Ponti
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Denis Panizza
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Medical Physics Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
- Radiation Oncology Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
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21
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Oshima A, Yoshida D, Hiruma T, Washimi K, Okubo Y, Sato H. Intraoperative extracorporeal irradiation for giant sarcoma-infiltrated calvarium: a case report. Br J Neurosurg 2023; 37:1742-1745. [PMID: 33645360 DOI: 10.1080/02688697.2021.1888875] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
Large bone defects that occur after resection of calvarial tumours are commonly remedied using titanium meshes or bone prostheses. However, these methods have several problems. While intraoperative extracorporeal radiotherapy for bone flaps could avoid these problems, there have been only a few reports wherein meningiomas were treated with 120 Gy irradiation. Moreover, no reports are available on calvarial metastasis of sarcoma, and the therapeutic radiation dose remains uncertain. Here, we report a case of giant calvarial metastasis of myxoid liposarcoma treated with intraoperative extracorporeal radiotherapy at a dose of 50 Gy. The treatment resulted in successful tumour control followed by favourable bone reconstruction.
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Affiliation(s)
- Akito Oshima
- Department of Neurosurgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daisaku Yoshida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Toru Hiruma
- Department of Musculoskeletal Tumour Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hidemitsu Sato
- Department of Neurosurgery, Kanagawa Cancer Center, Yokohama, Japan
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22
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Yang J, Jiang H, Fu Q, Qin H, Li Y, Liu M. Blue light photobiomodulation induced apoptosis by increasing ROS level and regulating SOCS3 and PTEN/PI3K/AKT pathway in osteosarcoma cells. J Photochem Photobiol B 2023; 249:112814. [PMID: 37956614 DOI: 10.1016/j.jphotobiol.2023.112814] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
Blue light photobiomodulation (PBM) has attracted great attention in diminishing proliferation and inducing death of cancer cells recently. Osteosarcoma (OS) primarily occurring in children and adolescents, the limitations of drug resistance and limb salvage make it urgent to develop and identify new adjuvant therapeutic strategies. In this work, we attempted to research the anticancer effects and biological mechanisms of blue light PBM in human OS MG63 cells. The effects of various blue light parameters on MG63 cells indicated that suppressed cell proliferation and cell migration, induced cell apoptosis which are experimentally assessed using multiple assays including CCK, LDH, wound healing assay and Hoechst staining. Concurrently, the increases of ROS level and the inhibition of PI3K and AKT expression were identified under high-dose blue light PBM in MG63 cells. Meanwhile, SOCS3 is a major inducible anti-tumor molecule, we also found that blue light LED substantially promoted its expression. Thus, this study proposed that bule light PBM may be a hopeful therapeutic approach in OS clinical treatment in the future.
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Affiliation(s)
- Jiali Yang
- School of information science and technology, Fudan University, 2005th Songhu Road, Shanghai 200438, China
| | - Hui Jiang
- Academy for Engineering and Technology, Fudan University, 220th Handan Road, Shanghai 200433, China
| | - Qiqi Fu
- School of information science and technology, Fudan University, 2005th Songhu Road, Shanghai 200438, China
| | - Haokuan Qin
- Academy for Engineering and Technology, Fudan University, 220th Handan Road, Shanghai 200433, China
| | - Yinghua Li
- Shanghai Fifth People's Hospital, Fudan University, 801th Heqing Road, Shanghai 200240, China
| | - Muqing Liu
- School of information science and technology, Fudan University, 2005th Songhu Road, Shanghai 200438, China; Zhongshan Fudan Joint Innovation Center, 6th Xiangxing Road, Zhongshan 28403, China.
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23
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Santoni M, Massari F, Takeshita H, Tapia JC, Dionese M, Pichler R, Rizzo M, Lam ET, Grande E, Kemp R, Molina-Cerrillo J, Calabrò F, Tural D, Küronya Z, Kucharz J, Fiala O, Seront E, Kopp RM, Abahssain H, Kopecky J, Martignetti A, Kanesvaran R, Zakopoulou R, Ansari J, Landmesser J, Mollica V, Porta C, Bellmunt J, Salah S, Santini D. Bone targeting agents, but not radiation therapy, improves survival in patients with bone metastases from advanced urothelial carcinoma receiving pembrolizumab: results from the ARON-2 study. Clin Exp Med 2023; 23:5413-5422. [PMID: 37917218 DOI: 10.1007/s10238-023-01235-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
The ARON-2 study (NCT05290038) aimed to assess the real-world efficacy of pembrolizumab in patients recurred or progressed after platinum-based chemotherapy. This retrospective analysis reports the outcomes of urothelial carcinoma (UC) patients with bone metastases (BM). Medical records of patients with documented metastatic UC treated by pembrolizumab as second-line therapy were reviewed from60 institutions in 20 countries. Patients were assessed for Overall Response Rate (ORR), Progression-Free Survival (PFS), and Overall Survival (OS). Univariate and multivariate analyses were used to explore the association of variables of interest with OS and PFS. 881 patients were included; of them, 263 (30%) presented BM. Median follow-up time was 22.7 months. Patients with BM showed both shorter median OS (5.9 months vs 13.1 months, p < 0.001) and PFS (3.5 months, vs 7.3 months, p < 0.001) compared to patients without BM. Patients who received bone targeted agents (BTAs) showed a significantly longer median OS (8.5 months vs 4.6 months, p = 0.003) and PFS (6.1 months vs 3.2 months, p = 0.003), while no survival benefits were observed among patients who received radiation therapy for BM during pembrolizumab treatment compared to those who did not. In multivariate analysis, performance status, concomitant liver metastases, and the lack of use of BTAs were significantly associated with worse OS and PFS. Bone involvement in UC patients treated with pembrolizumab predicts inferior survival. Poor performance status and liver metastases may further worsen outcomes, while the use of BTAs is associated with improved outcomes.
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Affiliation(s)
- Matteo Santoni
- Oncology Unit, Macerata Hospital, via Santa Lucia 2, 62100, Macerata, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni - 15, Bologna, Italy
| | - Hideki Takeshita
- Department of Urology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Jose Carlos Tapia
- Department of Medical Oncology, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creui Sant Pau, Barcelona, Spain
| | - Michele Dionese
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, 35128, Padua, Italy
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mimma Rizzo
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Elaine T Lam
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Robert Kemp
- Southampton Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | | | - Fabio Calabrò
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Deniz Tural
- Department of Medical Oncology, Bakirköy Dr.SadiKonuk Training and Research Hospital, Zuhuratbaba District, TevfikSaglam St. No: 11, Bakirkoy, Istanbul, Turkey
| | - Zsófia Küronya
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ondrej Fiala
- Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alejSvobody 76, Pilsen, Czech Republic
| | - Emmanuel Seront
- Department of Medical Oncology, Centre Hospitalier de Jolimont, Haine Saint Paul, La Louvière, Belgium
| | - Ray Manneh Kopp
- Clinical Oncology, Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia
| | - Halima Abahssain
- Medicine and Pharmacy Faculty, National Institute of Oncology, Medical Oncology Unit, Mohamed V University, Rabat, Morocco
| | - Jindrich Kopecky
- Department of Clinical Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Angelo Martignetti
- Dipartimento oncologico usl sud-est toscana-area senese, Località Campostaggia s.n.c., 53036, Poggibonsi, Italy
| | | | - Roubini Zakopoulou
- 2nd Propaedeutic Department of Internal Medicine, School of Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jawaher Ansari
- Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni - 15, Bologna, Italy.
| | - Camillo Porta
- Chair of Oncology, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Joaquim Bellmunt
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Samer Salah
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Daniele Santini
- UOC Oncologia A, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
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Killock D. Irradiation of asymptomatic bone metastases improves outcomes. Nat Rev Clin Oncol 2023; 20:817. [PMID: 37803132 DOI: 10.1038/s41571-023-00828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
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25
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Wada Y, Kumagai S, Shinozaki T, Murata T, Okuyama E, Takagi N, Mori N. Treatment outcomes of radiotherapy for malignant psoas syndrome: A single-center retrospective study. J Med Imaging Radiat Sci 2023; 54:595-602. [PMID: 37481374 DOI: 10.1016/j.jmir.2023.07.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION The efficacy of radiotherapy for symptomatic relief of malignant psoas syndrome (MPS) remains unknown because there are limited publications with high level evidence, including analyses with sufficient number of cases, clinical trials, and systematic reviews about radiotherapy for MPS. We aimed to investigate the characteristics of and symptom relief rates in patients treated with radiotherapy for MPS in palliative intent. METHODS In this single-center retrospective study, we analyzed data of 22 consecutive patients treated with radiotherapy for MPS at our institution in Japan between 2012 and 2022. We recorded patient characteristics, including primary site, invasion pattern, recognition of MPS by the attending physician, radiation regimen, biological effective dose with α/β = 10 Gy (BED10), and adverse events. Since no objective evaluation index for palliative radiotherapy for non-bone metastases has been established, we modified and used an International Consensus on Palliative Radiotherapy Endpoint, which was originally used for bone metastases, to evaluate symptom relief in the present retrospective study. "Response" was defined as symptom relief described in medical records or the use of analgesic medications reduced by ≥25% within 3 months post-initiation of radiotherapy. RESULTS Genitourinary organs (41%) were the most common primary-tumor sites. MPS was caused by metastasis in the iliopsoas muscle in 14 patients (64%) and by direct invasion of the primary tumor in eight patients (36%). Since the optimal radiation dose for MPS has not been established, the radiation dose varied from low dose, which are used in palliative radiotherapy for painful bone metastases, to high dose with conventional fraction using 1.8 to 2 Gy per fraction, with a median BED10 of 48 Gy (range, 10.6-79.2 Gy). Fifteen patients (68%) achieved a response. No acute nor late adverse events of grade 2 or higher, according to Common Terminology Criteria for Adverse Events version 5.0, were reported during the observation period. CONCLUSION Radiotherapy for symptomatic MPS might be an effective treatment option with a high response rate (68%) and minimal adverse events. Since the present study is a retrospective study with small number of cases, a prospective study with a larger sample size is required.
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Affiliation(s)
- Yuki Wada
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan.
| | - Satoshi Kumagai
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tetsugaku Shinozaki
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshiki Murata
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Eriko Okuyama
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Noriko Takagi
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
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26
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Wong HCY, Chan AW, Johnstone P, Simone CB, Navarro-Domenech I, Hoskin P, Johnstone C, Recht A, Menten J, van der Linden YM, van der Velden JM, Nguyen QN, Lutz S, Andratschke N, Wilmann J, Kazmierska J, Spalek M, Lim F, Yu HM, Perez B, Marta GN, Vassiliou V, Lee SF, Bonomo P, Rembielak A, Chow E, Oldenburger E, Raman S. A critical appraisal of the four systematic reviews and meta-analysis on stereotactic body radiation therapy versus external beam radiotherapy for painful bone metastases and where we go from here. Ann Palliat Med 2023; 12:1318-1330. [PMID: 37303218 DOI: 10.21037/apm-23-218] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Radiotherapy is an important treatment modality for pain control in patients with bone metastases. Stereotactic body radiation therapy (SBRT), which allows delivering a much higher dose per fraction while sparing critical structures compared to conventional external beam radiotherapy (cEBRT), has become more widely used, especially in the oligometastatic setting. Randomized controlled trials (RCTs) comparing the pain response rate of SBRT and cEBRT for bone metastases have shown conflicting results, as have four recent systematic reviews with meta-analyses of these trials. Possible reasons for the different outcomes between these reviews include differences in methodology, which trials were included, and the endpoints examined and how they were defined. We suggest ways to improve analysis of these RCTs, particularly performing an individual patient-level meta-analysis since the trials included heterogeneous populations. The results of such studies will help guide future investigations needed to validate patient selection criteria, optimize SBRT dose schedules, include additional endpoints (such as the time to onset of pain response, durability of pain response, quality of life (QOL), and side effects of SBRT), and better assess the cost-effectiveness and trade-offs of SBRT compared to cEBRT. An international Delphi consensus to guide selection of optimal candidates for SBRT is warranted before more prospective data is available.
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Affiliation(s)
- Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Peter Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | | | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, The University of Manchester, UK
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johan Menten
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Yvette M van der Linden
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Lutz
- Eastern Woods Radiation Oncology, Blanchard Valley Health Organization, Findlay, OH, USA
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Wilmann
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joanna Kazmierska
- Radiotherapy Department II, Greater Poland Cancer Centre, Poznan, Poland; Department of Electroradiology, Poznań University of Medical Sciences, Poznan, Poland
| | - Mateusz Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Fiona Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - H Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brad Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China; Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Pierluigi Bonomo
- Department of Oncology, Azienda, Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Shiba S, Kawashima M, Okamoto M, Ohno T. Dose Distribution Degradation of Carbon-ion Radiotherapy Caused by Tumor Cell-specific Relative Biological Effectiveness of Osteosarcoma: A Simulation Study Using In Vitro Experimental Results. Anticancer Res 2023; 43:4873-4878. [PMID: 37909964 DOI: 10.21873/anticanres.16684] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Dose distributions of carbon-ion radiotherapy (C-ion RT) have been created with the relative biological effectiveness (RBE) of human salivary gland cells (HSG). However, no dose distributions have been created using various tumor cell-specific RBE values. Hence, we conducted in vitro experiments to determine the RBE of human osteosarcoma cells (U2OS) and used this RBE value (RBEU2OS) to calculate the dose distribution for C-ion RT. MATERIALS AND METHODS To obtain RBE values for various linear energy transfer (LET) levels, we exposed U2OS cells to different doses of X-rays and varying doses and LET levels of C-ion beams (13, 30, 50, and 70 keV/μm). Subsequently, we converted the RBE of HSG (RBEHSG) to RBEU2OS in the treatment planning system and reconstructed the dose distribution for a typical osteosarcoma case. We performed a dose-volume histogram (DVH) analysis, evaluating the percentage of the minimum dose that covered 98%, 50%, and 2% (D98%, D50%, and D2%, respectively), as well as the homogeneity index [HI; calculated as (D2%-D98%)/D50%]. RESULTS The RBEU2OS values for C-ion beams with LET of 13, 30, 50, and 70 keV/μm were 1.77, 2.25, 2.72, and 4.50, respectively. When comparing DVH parameters with the planning target volume, we observed the following values: D98%, D50%, D2%, and HI for RBEHSG were 64.1, 70.1, 72.4 Gy (RBE), and 0.12, respectively. For RBEU2OS, these values were 86.2, 95.0, 107.9 Gy (RBE), and 0.23, respectively. CONCLUSION We utilized RBEU2OS to calculate the dose distribution of carbon ion radiotherapy, revealing potential degradation in dose distribution and particularly worsening of the HI.
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Affiliation(s)
- Shintaro Shiba
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Japan;
- Radiological Research Division, Shonan Research Institute of Innovative Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Motohiro Kawashima
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Sartor O. Radium-223 and bone metastatic disease: still more to learn. JNCI Cancer Spectr 2023; 7:pkad083. [PMID: 37952210 PMCID: PMC10640878 DOI: 10.1093/jncics/pkad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Oliver Sartor
- Department of Medical Oncology and Radiology, Mayo Clinic, Rochester, MN, USA
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Parker C, Tunariu N, Tovey H, Alonzi R, Blackledge MD, Cook GJR, Chua S, Du Y, Hafeez S, Murray I, Padhani AR, Staffurth J, Tree A, Stidwill H, Finch J, Curcean A, Chatfield P, Perry S, Koh DM, Hall E. Radium-223 in metastatic castration-resistant prostate cancer: whole-body diffusion-weighted magnetic resonance imaging scanning to assess response. JNCI Cancer Spectr 2023; 7:pkad077. [PMID: 37788117 PMCID: PMC10640884 DOI: 10.1093/jncics/pkad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Radium-223 is a bone-seeking, ɑ-emitting radionuclide used to treat men with bone metastases from castration-resistant prostate cancer. Sclerotic bone lesions cannot be evaluated using Response Evaluation Criteria in Solid Tumors. Therefore, imaging response biomarkers are needed. METHODS We conducted a phase 2 randomized trial to assess disease response to radium-223. Men with metastatic castration-resistant prostate cancer and bone metastases were randomly allocated to 55 or 88 kBq/kg radium-223 every 4 weeks for 6 cycles. Whole-body diffusion-weighted magnetic resonance imaging (DWI) was performed at baseline, at cycles 2 and 4, and after treatment. The primary endpoint was defined as a 30% increase in global median apparent diffusion coefficient. RESULTS Disease response on DWI was seen in 14 of 36 evaluable patients (39%; 95% confidence interval = 23% to 56%), with marked interpatient and intrapatient heterogeneity of response. There was an association between prostate-specific antigen response and MRI response (odds ratio = 18.5, 95% confidence interval = 1.32 to 258, P = .013). Mean administered activity of radium-223 per cycle was not associated with global MRI response (P = .216) but was associated with DWI response using a 5-target-lesion evaluation (P = .007). In 26 of 36 (72%) patients, new bone metastases, not present at baseline, were seen on DWI scans during radium-223 treatment. CONCLUSIONS DWI is useful for assessment of disease response in bone. Response to radium-223 is heterogeneous, both between patients and between different metastases in the same patient. New bone metastases appear during radium-223 treatment.The REASURE trial is registered under ISRCTN17805587.
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Affiliation(s)
- Chris Parker
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Holly Tovey
- The Institute of Cancer Research, London, UK
| | | | | | - Gary J R Cook
- Cancer Imaging Department and King’s College London and Guy’s and St Thomas’ PET Centre, King’s College London, London, UK
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Yong Du
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Shaista Hafeez
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Iain Murray
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Alison Tree
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | | | | | - Andra Curcean
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | | | | | - Dow-Mu Koh
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Emma Hall
- The Institute of Cancer Research, London, UK
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30
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Kim N, Kim H, Park W, Cho WK, Kim TG, Im YH, Ahn JS, Park YH, Kim JY. Impact of high dose radiotherapy for breast tumor in locoregionally uncontrolled stage IV breast cancer: a need for a risk-stratified approach. Radiat Oncol 2023; 18:168. [PMID: 37821947 PMCID: PMC10566115 DOI: 10.1186/s13014-023-02357-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
AIM Patients with locoregionally uncontrolled breast tumors are frequently referred for breast palliative radiotherapy (PRT) to mitigate symptoms. We analyzed the outcomes following breast PRT to optimize PRT according to risk groups. METHODS We reviewed 133 patients who underwent breast PRT. A median total dose of 45 Gy was prescribed with an equivalent dose in 2 Gy fractions (EQD2, α/β = 3.5) of 53 Gy. The Cox proportional hazards model was used to analyze the prognostic factors of local control (LC). RESULTS Most (90.2%) had polymetastatic disease (> 5 lesions), and 48.9% had bone metastasis. With a median follow-up of 17.2 months, the 2-year LC and overall survival (OS) rates were 49.4%, and 48.3%, respectively. Multivariable analyses demonstrated progressive or mixed responses outside the breast and > 2 lines of previous therapy as adverse features for clinical outcomes. Group 1 (0 risk factors) showed favorable 2-year LC and OS of 63.9%, and 72.8%, respectively, whereas group 3 (2 risk factors) showed the worst outcomes of 0%, and 6.8%, respectively. Breast PRT with EQD2 ≥ 63 Gy showed a significant benefit in LC for group 1 and marginal benefit (p = 0.055) for group 2, but no improvement for group 3 (p = 0.300). CONCLUSION Breast PRT showed favorable LC outcomes in patients with stable disease outside the breast and treated with ≤ 2 lines of systemic treatment. Our findings warrant future clinical trials investigating the role of higher than palliative dose and early intervention of PRT in stage IV patients.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young-Hyuck Im
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hee Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Tornyi I, Árkosy P, Horváth I, Furka A. A new perspective on the proper timing of radiotherapy during CDK4/6 inhibitor therapy in patients with "bone-only" metastatic breast cancer. Pathol Oncol Res 2023; 29:1611369. [PMID: 37886029 PMCID: PMC10598277 DOI: 10.3389/pore.2023.1611369] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
The vast majority of hormone positive and HER2 negative advanced breast cancers can be controlled well by endocrine therapy combined with the groundbreaking use of CDK4/6 inhibitors in the metastatic first-line setting. Approximately 50%-60% of these patients have "bone-only" metastatic disease. In oligometastatic cases or if a certain number of uncontrolled lesions develop during the aforementioned therapy, ablative radiotherapy can be delivered or, in symptomatic cases, urgent irradiation is needed with palliative intent. To achieve the most effective results, parallel with good quality of life, the timing of radiotherapy must be determined precisely, taking into account that different cell cycles are involved during different treatment modalities; therefore, optimization of treatment schedules ensures longer and safer post-progression overall survival. The key question is whether the two treatment modalities are safe concurrently or whether they should be administered separately, and if so, what is the optimal sequence and why? This manuscript aims to answer this important question, with a focus on quality of life. Existing publications focus on safety and toxicity profiles, and efficacy is detailed only tangentially and minimally.
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Affiliation(s)
- Ilona Tornyi
- Department of Pulmonology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Árkosy
- Department of Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Horváth
- Department of Pulmonology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Furka
- Department of Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, Miskolc, Hungary
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32
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Vidal M, Cárdenas-Perilla R, Delgado A, Morón S, Londoño Blair JL, Vega I, Correa Ochoa JJ, Rojas J. Prognostic biomarkers in the use of radium-223 in patients with metastatic castration-resistent prostate cancer. Rev Esp Med Nucl Imagen Mol 2023; 42:310-318. [PMID: 37419250 DOI: 10.1016/j.remnie.2023.06.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES This study aimed to establish basal biomarkers in patients with bone metastatic castration-resistant prostate cancer (mCRPC) treated with 223Ra to predict better overall survival (OS), and assess hematologic toxicity and treatment response. MATERIALS AND METHODS This was a retrospective multicenter study including 151 patients with mCRPC between 2013 and 2020. OS was assessed according to basal hemoglobin (Hb), prostate-specific antigen (PSA), and alkaline phosphatase (AP) values, the World Health Organization pain scale, the Eastern Cooperative Oncology Group (ECOG) performance status scale, the number of metastatic lesions on bone scintigraphy (BS), and the use of protective bone agents and the dose received. The grade of hematological toxicities was evaluated as well as treatment response based on changes in AP and pre- and post-treatment pain. RESULTS The median OS was 24 months (95% confidence interval 16.5-31). The OS in 70% of patients who received complete (5-6 doses) versus incomplete (1-4 doses) 223Ra treatment was 34.9 vs. 5.8 months, respectively, being longer in patients with lower PSA and AP values, Hb >13 g/dl, lesser bone metastasis on bone scan and with an ECOG 0-1. 52/151 patients (34%) died during follow-up. Pain reduced in nearly 70% of patients and 66% presented a reduction in AP values. Half of the patients presented mild and 5 % severe hematological adverse effects. CONCLUSIONS mCRPC patients treated with 223Ra with Hb values >13 g/mL, an ECOG 0-1, low AP values, PSA < 20 ng/mL and lesser bone metastasis on BS presented a better OS with an adequate safety profile.
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Affiliation(s)
- M Vidal
- Departamento de Medicina Nuclear, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - R Cárdenas-Perilla
- Departamento de Medicina Nuclear, Clínica Imbanaco-Grupo Quironsalud, Cali, Colombia; Grupo de Investigaciones y Educación, Clínica de Occidente, Cali, Colombia
| | - A Delgado
- Departamento de Medicina Nuclear, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - S Morón
- Departamento de Medicina Nuclear, Medicina Nuclear SAS, Valledupar, Colombia
| | - J L Londoño Blair
- Departamento de Medicina Nuclear, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - I Vega
- Departamento de Medicina Nuclear, Clínica Las Américas AUNA, Medellín, Colombia
| | - J J Correa Ochoa
- Departamento de Urología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - J Rojas
- Departamento de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá, Colombia
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Locquet MA, Brahmi M, Blay JY, Dutour A. Radiotherapy in bone sarcoma: the quest for better treatment option. BMC Cancer 2023; 23:742. [PMID: 37563551 PMCID: PMC10416357 DOI: 10.1186/s12885-023-11232-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
Bone sarcomas are rare tumors representing 0.2% of all cancers. While osteosarcoma and Ewing sarcoma mainly affect children and young adults, chondrosarcoma and chordoma have a preferential incidence in people over the age of 40. Despite this range in populations affected, all bone sarcoma patients require complex transdisciplinary management and share some similarities. The cornerstone of all bone sarcoma treatment is monobloc resection of the tumor with adequate margins in healthy surrounding tissues. Adjuvant chemo- and/or radiotherapy are often included depending on the location of the tumor, quality of resection or presence of metastases. High dose radiotherapy is largely applied to allow better local control in case of incomplete primary tumor resection or for unresectable tumors. With the development of advanced techniques such as proton, carbon ion therapy, radiotherapy is gaining popularity for the treatment of bone sarcomas, enabling the delivery of higher doses of radiation, while sparing surrounding healthy tissues. Nevertheless, bone sarcomas are radioresistant tumors, and some mechanisms involved in this radioresistance have been reported. Hypoxia for instance, can potentially be targeted to improve tumor response to radiotherapy and decrease radiation-induced cellular toxicity. In this review, the benefits and drawbacks of radiotherapy in bone sarcoma will be addressed. Finally, new strategies combining a radiosensitizing agent and radiotherapy and their applicability in bone sarcoma will be presented.
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Affiliation(s)
- Marie-Anaïs Locquet
- Cell Death and Pediatric Cancer Team, Cancer Initiation and Tumor Cell Identity Department, INSERM1052, CNRS5286, Cancer Research Center of Lyon, F-69008, Lyon, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Leon Berard, Unicancer Lyon, 69008, Lyon, France
| | - Jean-Yves Blay
- Cell Death and Pediatric Cancer Team, Cancer Initiation and Tumor Cell Identity Department, INSERM1052, CNRS5286, Cancer Research Center of Lyon, F-69008, Lyon, France
- Department of Medical Oncology, Centre Leon Berard, Unicancer Lyon, 69008, Lyon, France
- Université Claude Bernard Lyon I, Lyon, France
| | - Aurélie Dutour
- Cell Death and Pediatric Cancer Team, Cancer Initiation and Tumor Cell Identity Department, INSERM1052, CNRS5286, Cancer Research Center of Lyon, F-69008, Lyon, France.
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Ma MW, Wang ZS, Li HZ, Gao XS, Liu C, Ren XY, Zhang WL, Yang KW. Breaking barriers: Stereotactic ablative proton and photon radiation therapy for renal cell carcinoma with extensive metastases: A case report. Med Dosim 2023; 49:41-45. [PMID: 37563017 DOI: 10.1016/j.meddos.2023.06.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
Patients with advanced renal cancer (RCC) often have limited success with systemic therapy due to tumor heterogeneity. However, stereotactic ablative radiotherapy (SABR) has been shown to have a beneficial therapeutic effect for oligometastatic disease when used early. Despite this, current guidelines recommend the use of tyrosine kinase inhibitors (TKIs) as the first-line therapeutic agent for patients with recurrent or metastatic kidney cancer. Additionally, there is limited data on the combination of systemic treatment and SABR for extensive metastatic RCC due to concerns about high toxicity. Proton therapy offers a promising treatment option as it emits energy at a specific depth, generating high target doses while minimizing damage to normal tissue. This allows for precise treatment of various tumor lesions. In this case report, we describe a high-risk 65-year-old male with extensive pleural and thoracic lymph node metastases and 2 bone metastases of clear cell renal cancer. While the targeted therapy and immunotherapy effectively treated the bone metastases, it was not effective in treating the chest metastases, including the pleural and lymph node metastases. Thus, the patient received full-coverage radiotherapy with photon for primary renal tumor and intensity-modulated proton therapy (IMPT) for thoracic metastases. The patient showed no evidence of disease for 1 year after the initial radiotherapy, and no severe SABR-related adverse effects were observed until now. The combination of targeted therapy and immunotherapy with full-coverage radiotherapy may be a promising treatment option for selected patients with extensive metastatic renal cancer, especially as proton therapy allows for more precise control of the beam and minimal damage to normal tissue. This case has motivated us to investigate the potential advantages of administering proton therapy concurrently with systemic therapy in the management of metastatic renal cell carcinoma patients.
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Affiliation(s)
- Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Zi-Shen Wang
- Department of Radiation Oncology, Hebei Yizhou Proton Center, Zhuozhou, Hebei Province, 072750, China.
| | - Hong-Zhen Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China.
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China.
| | - Chao Liu
- Department of Radiation Oncology, Hebei Yizhou Proton Center, Zhuozhou, Hebei Province, 072750, China
| | - Xue-Ying Ren
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Wei-Li Zhang
- Department of Radiation Oncology, Hebei Yizhou Proton Center, Zhuozhou, Hebei Province, 072750, China
| | - Kai-Wei Yang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
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35
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Geerling JI, van der Linden YM, Raijmakers NJH, Vermeulen KM, Mul VEM, de Nijs EJM, Westhoff PG, de Bock GH, de Graeff A, Reyners AKL. Randomized controlled study of pain education in patients receiving radiotherapy for painful bone metastases. Radiother Oncol 2023; 185:109687. [PMID: 37169300 DOI: 10.1016/j.radonc.2023.109687] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Although short-course radiotherapy is an effective treatment for patients with painful bone metastases, pain is not always sufficiently controlled. We therefore investigated the additional effect of a nurse-led pain education program on pain control and quality of life (QoL). PATIENTS AND METHODS In this multicenter study, patients with solid tumor bone metastases and a worst pain intensity of ≥5 on a 0-10 numeric rating scale (NRS) were randomized between care as usual (control-group) and care as usual plus the Pain Education Program (PEP-group). PEP consisted of a structured interview and personalized education with follow-up phone calls. Patients completed the Brief Pain Inventory, EORTC QLQ-C15-PAL and BM22 at week 0, 1, 4, 8 and 12. The primary outcome was pain control, defined as the number of patients whose worst pain intensity was <5 on a 0-10 NRS after 12 weeks. Secondary outcomes were time to reach control of pain (NRS < 5), mean worst pain and average pain, and QoL at weeks 1, 4, 8 and 12. RESULTS Of 308 included patients, 182 (92 PEP-group) completed 12 weeks follow-up. At 12 weeks, more patients in the PEP-group (71%) compared to the control-group (52%) reported pain control (P =.008). In the PEP-group, pain control was reached earlier than in the control-group (median 29 days versus 56 days; P =.003). Mean worst and average pain decreased in both groups but decreased more in the PEP-group. QoL did not differ between the groups. CONCLUSION The addition of PEP to care as usual for patients treated with radiotherapy for painful bone metastases resulted in less pain and faster pain control.
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Affiliation(s)
- Jenske I Geerling
- Centre of Expertise in Palliative Care, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Yvette M van der Linden
- Department of Radiotherapy, Leiden University Medical Center, University of Leiden, the Netherlands; Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | | | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Veronique E M Mul
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Ellen J M de Nijs
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands
| | - Paulien G Westhoff
- Department of Radiotherapy, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Alexander de Graeff
- Centre of Expertise in Palliative Care, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Anna K L Reyners
- Centre of Expertise in Palliative Care, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Medical Oncology, University Medical Center Groningen, University of Groningen, the Netherlands.
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Khan M, Parshad S, Naimi MF, Sidhu AK, Lyons F, Hardisty MR, Whyne CM, Smoragiewicz M, Phillips CM, Briones J, Emmenegger U. Sarcopenia in Men With Bone-Predominant Metastatic Castration-Resistant Prostate Cancer Undergoing Ra-223 Therapy. Clin Genitourin Cancer 2023; 21:e228-e235.e1. [PMID: 36849325 DOI: 10.1016/j.clgc.2023.01.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Osteosarcopenia is the progressive loss of musculoskeletal structure and functionality, contributing to disability and mortality. Despite complex interactions between bone and muscle, osteosarcopenia prevention and treatment in men with metastatic castration-resistant prostate cancer (mCRPC) focuses predominantly on bone health. It is unknown whether Radium-223 (Ra-223) therapy affects sarcopenia. METHODS We identified 52 patients with mCRPC who had received Ra-223 and had a baseline plus ≥1 follow-up abdominopelvic CT scan. The total contour area (TCA) and averaged Hounsfield units (HU) of the left and right psoas muscles were obtained at the inferior L3 endplate, and the psoas muscle index (PMI) was calculated therefrom. Intrapatient musculoskeletal changes were analyzed across various time points. RESULTS TCA and PMI gradually declined over the study period (P = .002, P = .003, respectively), but Ra-223 therapy did not accelerate sarcopenia, nor the decline of HU compared to the pre-Ra-223 period. The median overall survival of patients with baseline sarcopenia was numerically worse (14.93 vs. 23.23 months, HR 0.612, P = .198). CONCLUSIONS Ra-223 does not accelerate sarcopenia. Thus, worsening muscle parameters in men with mCRPC undergoing Ra-223 therapy are attributable to other factors. Further research is needed to determine whether baseline sarcopenia predicts poor overall survival in such patients.
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Affiliation(s)
- Maira Khan
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Shruti Parshad
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Mahdi F Naimi
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Amanjot K Sidhu
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Frank Lyons
- Department of Orthopaedic Surgery, Mater University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael R Hardisty
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Cari M Whyne
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Martin Smoragiewicz
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cameron M Phillips
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Medical Oncology, Niagara Health Systems, St. Catharines, Ontario, Canada
| | - Juan Briones
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Zhang L, Akiyama T, Ohno T. ASO Author Reflections: Long-Term Perspective in Choosing Between Carbon-Ion Radiotherapy and Surgery for Malignant Pelvic Bone Tumors. Ann Surg Oncol 2023; 30:4485-4486. [PMID: 36853564 DOI: 10.1245/s10434-023-13293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Liuzhe Zhang
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya Ward, Saitama, 330-0834, Japan
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya Ward, Saitama, 330-0834, Japan.
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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Abstract
ABSTRACT α-Emitter 225 Ac has been considered a candidate for targeted α-therapy. DOTA-IBA is new a precursor targeting bone metastasis. It can be used for radionuclide labeling with 225 Ac. We present a case with refractory bone pain for bone metastasis, who demonstrated an excellent therapy response after 1 cycle of 225 Ac-DOTA-IBA therapy. Moreover, the patient did not have any observable adverse effects.
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Affiliation(s)
- Tingting Xu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; and Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
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Zhang L, Akiyama T, Saito M, Okamoto M, Gokita T, Kobayashi H, Ae K, Ohno T. Complications and Functional Outcome Differences in Carbon Ion Radiotherapy and Surgery for Malignant Bone Tumors of the Pelvis: A Multicenter, Cohort Study. Ann Surg Oncol 2023; 30:4475-4484. [PMID: 36853566 DOI: 10.1245/s10434-023-13226-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Carbon ion radiotherapy (CIRT) is an evolving treatment option for malignant pelvic tumors in patients with poor surgical indications. However, the difference in complications and functional outcomes between CIRT and surgery is poorly understood. This study compares the complications and functional outcomes of CIRT and surgery to facilitate treatment selection. METHODS A total of 28 patients who underwent CIRT for pelvic bone tumors while theoretically meeting the surgical resection criteria were included. Sixty-nine patients who underwent surgery for pelvic bone tumors were included as controls. Major complication rates and functional outcomes (ambulatory, pain, urination, constipation) were evaluated and compared at several time points (pretreatment, discharge, and final follow-up) between the groups. RESULTS Early (within 90 days) major complications were not observed in the CIRT group but occurred in 30% of the surgery group, which was statistically significant (P < 0.001). In contrast, late (after 90 days) major complications occurred more often in the CIRT group than in the surgery group (18% and 4%, respectively; P = 0.042). From pretreatment until discharge, all functional outcomes in the surgery group deteriorated (P < 0.001 for all) but did not change in the CIRT group (P = 0.77-1.00). At the final follow-up, all functional outcomes showed no significant intergroup difference (P = 0.28-0.92) due to the recovery trend in the surgery group and the deterioration trend in the CIRT group. CONCLUSIONS Compared with surgery, CIRT may have favorable safety and stable functional outcomes in the short-term but more late complications. Mid-term functional outcomes were similar between the groups.
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Affiliation(s)
- Liuzhe Zhang
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Masanori Saito
- Department of Orthopedic Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Tabu Gokita
- Department of Orthopedic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keisuke Ae
- Department of Orthopedic Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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Qiu L, Wang Y, Liu H, Wang Q, Chen L, Liu L, Wang L, Feng Y, Chen Y. Safety and Efficacy of 68 Ga- or 177 Lu-Labeled DOTA-IBA as a Novel Theranostic Radiopharmaceutical for Bone Metastases : A Phase 0/I Study. Clin Nucl Med 2023; 48:489-496. [PMID: 36976706 DOI: 10.1097/rlu.0000000000004634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE We designed and synthesized a novel theranostic bisphosphonate radiopharmaceutical ( 68 Ga- or 177 Lu-labeled DOTA-ibandronic acid [ 68 Ga/ 177 Lu-DOTA-IBA]) for bone metastasis. In this study, the dosimetry, safety, and efficacy of 68 Ga/ 177 Lu-DOTA-IBA as a theranostic radiopharmaceutical for bone metastases were evaluated in patients with malignancy based on 68 Ga- and 177 Lu-DOTA-IBA images, blood samples, and dosimetric analysis. PATIENTS AND METHODS Eighteen patients with bone metastasis and progression under conventional therapies were included in this study. Baseline 99m Tc-MDP SPECT and 68 Ga-DOTA-IBA PET/CT were performed for comparative purposes within 3 days. After receiving 891.5 ± 301.3 MBq 177 Lu-DOTA-IBA, serial 177 Lu-DOTA-IBA SPECT bone scan was performed over 14 days. Dosimetric evaluation was performed for main organs and tumor lesions. Safety was assessed by blood biomarkers. Karnofsky Performance Status, pain score, and follow-up 68 Ga-DOTA-IBA PET/CT were performed for response evaluation. RESULTS Baseline 68 Ga-DOTA-IBA PET demonstrated a higher efficacy for detecting bone metastases compared with 99m Tc-MDP SPECT. The time-activity curves showed fast uptake and high retention of 177 Lu-DOTA-IBA in bone metastases (24 hours: 9.43 ± 2.75 %IA; 14 days: 5.45 ± 2.52 %IA). Liver, kidneys, and red marrow time-activity curves revealed a low uptake and fast clearance. The radiation-absorbed dose in bone metastasis lesions (6.40 ± 2.13 Gy/GBq) was significantly higher than that in red marrow (0.47 ± 0.19 Gy/GBq), kidneys (0.56 ± 0.19 Gy/GBq), or liver (0.28 ± 0.07 Gy/GBq), with all P 's < 0.001. Compared with baseline level, only one patient developed new grade 1 leukopenia (toxicity rate, 6%). The 177 Lu-DOTA-IBA therapy had no statistically significant effect on bone marrow hematopoietic function, liver function, and kidney function at any follow-up visit. Bone pain palliation was achieved in 82% (14/17) of patients. The 8-week follow-up 68 Ga-DOTA-IBA PET/CT demonstrated partial response in 3 patients, disease progression in 1 patient, and stable disease in 14 patients. CONCLUSIONS 68 Ga/ 177 Lu-DOTA-IBA provides a set of potential theranostic radiopharmaceuticals and may have a good prospect for the management of bone metastasis.
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Ram P, Mandal S, K Das M, Nayak P. The impact of genetic aberrations on response to radium-223 treatment for castration-resistant prostate cancer with bone metastases. Prostate 2023; 83:613. [PMID: 36717109 DOI: 10.1002/pros.24489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Prasanna Ram
- Department of Urology, All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Swarnendu Mandal
- Department of Urology, All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Manoj K Das
- Department of Urology, All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Prasant Nayak
- Department of Urology, All India Institute of Medical Sciences, Bhubaneshwar, India
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Bokun J, Popović-Vuković M, Stanić D, Grujičić D, Pekmezović T, Janić D, Paripović L, Ilić V, Pudrlja Slović M, Sarić M, Mišković I, Nidžović B, Gavrilović N, Milinčić M, Nikitović M. Clinical Profile and Outcome of 806 Pediatric Oncology Patients Treated With Radiotherapy at the Serbian National Cancer Center. J Pediatr Hematol Oncol 2023; 45:116-122. [PMID: 36730662 DOI: 10.1097/mph.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
Radiotherapy plays an important role in the multimodal treatment of childhood cancer. Our objective was to provide an analysis of pediatric oncology patients treated with radiotherapy in a national referral institution in Serbia. A retrospective chart review of children treated with radiotherapy between January 2007 and July 2018 was conducted. Of the 806 patients who were identified, 767 formed the basis of this study. CNS tumors (31.2%) were the most common tumors followed by leukemias (17.3%) and bone tumors (14.3%). The most common indication for radiotherapy was in adjuvant setting (69.1%). Anesthesia or sedation was performed on 115 patients. The 5-year and 10-year overall survival rates were 65.7% and 62.1%, respectively. A significant difference in survival in relation to tumor type was seen. The best survival rates were obtained in patients with retinoblastoma, followed by lymphomas and nephroblastoma, while patients with bone sarcomas had the worst survival. The intent of radiotherapy treatment was also a parameter associated with survival. Patients treated with palliative and definitive intent lived shorter than patients treated with prophylactic and adjuvant intent. Our study showed that good treatment outcomes can be achieved in specialized centers with an experienced team of professionals who are dedicated to pediatric oncology.
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Affiliation(s)
- Jelena Bokun
- University of Belgrade
- Pediatric Radiation Oncology Department
| | | | - Dragana Stanić
- University of Belgrade
- Pediatric Radiation Oncology Department
| | - Danica Grujičić
- University of Belgrade
- Pediatric Oncology Department
- Neuro-Oncology Department, Clinic of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Tatjana Pekmezović
- University of Belgrade
- Institute of Epidemiology, University of Belgrade, Faculty of Medicine
| | | | | | | | | | - Milan Sarić
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | - Ivana Mišković
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | - Borko Nidžović
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
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Tseng YD. Radiation Therapy for Painful Bone Metastases: Fractionation, Recalcification, and Symptom Control. Semin Radiat Oncol 2023; 33:139-147. [PMID: 36990631 DOI: 10.1016/j.semradonc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Bone is a common site for metastases, which may cause pain and other skeletal-related events (SRE) in patients with advanced cancer. Since the 1980s, prospective clinical trials have demonstrated the high efficacy of external beam radiotherapy (EBRT) for pain relief from focal, symptomatic lesions. In uncomplicated bone metastases, which include those without pathologic fracture, evidence of cord compression, or prior surgical intervention, improvement or complete pain relief with radiotherapy is as high as 60%, with no difference in efficacy when radiotherapy is delivered in a single or multiple fractions. The ability to treat with a single fraction makes EBRT an attractive therapy even for patients with poor performance status and/or life expectancy. Even in patients with complicated bone metastases (eg cord compression), several randomized trials have demonstrated similar rates of pain relief in addition to improved functional outcomes such as ambulation. In this review, we summarize the role of EBRT for alleviating painful bone metastases and explore its role for other endpoints including functional outcomes, recalcification, and prevention of SREs.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA.
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Levin AS. CORR Insights®: Does PARP Inhibition Sensitize Chondrosarcoma Cell Lines to Chemotherapy or Radiotherapy? Results From a Three-dimensional Spheroid Cell Model. Clin Orthop Relat Res 2023; 481:620-622. [PMID: 36638387 PMCID: PMC9928674 DOI: 10.1097/corr.0000000000002525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Adam S Levin
- Associate Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Arnold MT, Geiger EJ, Hart C, Greig D, Trikha R, Sekimura T, Eckardt JJ, Bernthal NM. Is High-dose Radiation Therapy Associated With Early Revision Due to Aseptic Loosening in Patients With a Sarcoma of the Lower Extremities Reconstructed With a Cemented Endoprosthesis? Clin Orthop Relat Res 2023; 481:475-487. [PMID: 35977001 PMCID: PMC9928754 DOI: 10.1097/corr.0000000000002360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/20/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The durability of endoprostheses after limb salvage surgery is influenced by surgical factors (resection length, implant location, and residual bone quality), implant design (modular versus custom design, rotating versus fixed hinge, coating, collars, and the use of cross pins), and host factors (patient's immune status, activity levels, and age). In general, radiation therapy increases the risk of fractures, infection, delayed wound healing, and impaired osseointegration. Several studies have shown exposure to radiation to be associated with higher endoprosthesis revision rates and higher periprosthetic infection rates, but results are inconsistent. Although radiation therapy is not routinely used in the treatment of many bone sarcomas in current practice, it is still used in high doses after resection and prosthetic reconstruction in patients who have Ewing sarcoma with close or positive margins and in patients with soft tissue sarcoma. It is also used in varying doses after prosthetic reconstruction in patients with myeloma or bone metastasis after resection of periarticular destructive tumors. These patients may be at an increased risk of complications due to their radiation exposure, but this is a difficult question to study given the rarity of these diagnoses and poor overall survival of these patients. We therefore leveraged a large, longitudinally collected, 40-year endoprosthesis database that included patients who received radiation to the extremity for many bone and soft tissue sarcomas to investigate the association between preoperative or postoperative radiation therapy and endoprosthesis survival. QUESTIONS/PURPOSES (1) Is receiving preoperative or postoperative radiation therapy in low or high doses for the treatment of bone or soft tissue malignancy of the lower extremities associated with decreased implant survivorship free from amputation or revision due to any cause? (2) Is receiving preoperative or postoperative radiation therapy in low or high doses for the treatment of bone or soft tissue malignancy of the lower extremities associated with decreased implant survivorship free from revision specifically due to aseptic loosening? (3) Is receiving preoperative or postoperative radiation therapy for the treatment of Ewing sarcoma of the femur specifically associated with decreased implant survivorship free from revision specifically due to aseptic loosening? METHODS This was a retrospective, comparative study using our institution's database of 822 endoprostheses. Between 1980 and 2019, we treated 541 patients with primary cemented endoprostheses of the extremities. Of those patients, 8% (45 of 541) were excluded due to unknown radiation status, 3% (17 of 541) because of prior failed allograft, 15% (83 of 541) due to metastatic disease from a carcinoma, 1% (6 of 541) due to a nononcologic diagnosis, 4% (20 of 541) due to benign tumor diagnosis, 16% (87 of 541) due to upper extremity tumor location, 9% (49 of 541) due to not receiving chemotherapy, and 3% (14 of 541) due to expandable prostheses. Of the remaining 220 patients, 6% (13) were considered missing because they did not have 2 years of follow-up and did not reach a study endpoint. No patients had surgery within the last 2 years of the study end date. In all, 207 patients met inclusion criteria and were eligible for analysis. Patients who had received radiation to the lower extremities at any point in their treatment course were included in the radiation group and were compared with patients who did not receive radiation. For patients where radiation dose was available, the radiation group was subdivided into a low-dose (≤ 3000 cGy) and high-dose (> 3000 cGy) group. Revision surgery was defined as any surgery necessitating removal or replacement of the tibial or femoral stem. The complications necessitating revision or amputation were poor wound healing, aseptic loosening, implant breakage, deep infection, and tumor progression. The primary outcome of interest was implant survival free from revision or amputation due to any cause. The secondary outcome of interest was implant survival free from revision or amputation specifically due to aseptic loosening. The Kaplan-Meier survivorship curves were generated with implant survival free from revision or amputation as the endpoint and patient death as a competing risk. A log-rank test was used to identify differences in survivorship between the patients who received radiation and those who did not. Multivariate regression was used to identify factors associated with decreased implant survival. An odds ratio was used to determine relative effect size among the factors associated with decreased implant survival. RESULTS The mean implant survival time for patients who did not receive radiation was 18.3 years (95% confidence interval [CI] 15.4 to 21.3) whereas the mean implant survival time for patients who received low- and high-dose radiation were 19.1 years (95% CI 14.5 to 23.7; p = 0.59) and 13.8 years (95% CI 8.2 to 19.5; p = 0.65), respectively. The mean implant survival free from revision for aseptic loosening for patients who did not receive radiation was 27.1 years (95% CI 24.1 to 30.1) whereas the mean implant survival for patients who received low- and high-dose radiation were 24.1 years (95% CI 19.1 to 29.1; p = 0.34) and 16.4 years (95% CI 10.6 to 22.2; p = 0.01), respectively. Patients who received high-dose radiation had decreased 5-year implant survivorship free from amputation or revision due to aseptic loosening (73% [95% CI 44% to 89%]) compared with patients who did not receive radiation (95% [95% CI 90% to 99%]; p = 0.01). For patients treated for Ewing sarcoma of the femur, the 5-year implant survival free from amputation or revision due to aseptic loosening for patients who did not receive radiation (100% [95% CI 100% to 100%]) was no different compared with patients who received radiation (71% [95% CI 35% to 90%]; p = 0.56). CONCLUSION The results of this study may apply to scenarios where radiation is used, such as Ewing sarcoma with positive margins or local recurrence and after prosthetic reconstruction in patients with myeloma or bone metastasis after resection of periarticular destructive tumors. Surgeons may consider closer monitoring for early clinical and radiographic signs of aseptic loosening in patients who received high-dose radiation. These patients may also benefit from constructs that have increased resistance to aseptic loosening such as cross-pin or side plate fixation. The association between radiation and aseptic loosening should be further studied with larger studies with homogeneity in tumor diagnosis and prosthesis. The dose-dependent relationship between radiation and bone-related complications may also benefit from controlled, laboratory-based biomechanical studies. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Michael T. Arnold
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Erik J. Geiger
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Christopher Hart
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Danielle Greig
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Rishi Trikha
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Troy Sekimura
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Jeffrey J. Eckardt
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA
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van der Doelen MJ, Oving IM, Wyndaele DNJ, van Basten JP, Terheggen F, van de Luijtgaarden ACM, Oyen WJG, van Schelven WD, van den Berkmortel F, Mehra N, Janssen MJR, Prins JB, Gerritsen WR, Custers JAE, van Oort IM. Health-related quality of life, psychological distress, and fatigue in metastatic castration-resistant prostate cancer patients treated with radium-223 therapy. Prostate Cancer Prostatic Dis 2023; 26:142-150. [PMID: 35804188 PMCID: PMC10023564 DOI: 10.1038/s41391-022-00569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/19/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Radium-223 is a registered treatment option for symptomatic bone metastatic castration-resistant prostate cancer (mCRPC). Aim of this multicenter, prospective observational cohort study was to evaluate health-related quality of life (HR-QoL), psychological distress and fatigue in mCRPC patients treated with radium-223. METHODS Primary endpoint was cancer-specific and bone metastases-related HR-QoL, as measured by the EORTC QLQ-C30 and BM-22 questionnaires. Secondary endpoints were psychological distress and fatigue, evaluated by the HADS and CIS-Fatigue questionnaires. Outcomes were analyzed for the total cohort and between subgroups (1-3 versus 4-5 versus 6 radium-223 injections). A trajectory analysis was performed to explore HR-QoL patterns over time. RESULTS In total, 122 patients were included for analysis. Baseline HR-QoL, pain intensity, psychological distress and fatigue were worse in patients who did not complete radium-223 therapy. In patients who completed therapy, stabilization of HR-QoL was perceived and psychological distress and fatigue remained stable, whereas clinically meaningful and statistically significant deterioration of HR-QoL, psychological distress and fatigue over time was observed in patients who discontinued radium-223 therapy. Trajectory analysis revealed that HR-QoL deterioration over time was more likely in patients with baseline opioid use, low hemoglobin and high alkaline phosphatase levels. CONCLUSIONS Patients who discontinued radium-223 therapy showed worse HR-QoL, psychological distress and fatigue at baseline and more frequent deterioration of HR-QoL, psychological distress and fatigue over time when compared to patients who completed therapy. Specific attention with regard to HR-QoL during follow-up is indicated in patients with opioid use, low hemoglobin and high alkaline phosphatase levels before radium-223 therapy initiation. CLINICAL TRIAL REGISTRATION NUMBER NCT04995614.
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Affiliation(s)
- Maarten J van der Doelen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Irma M Oving
- Department of Medical Oncology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Dirk N J Wyndaele
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Frederiek Terheggen
- Department of Medical Oncology, Bravis Hospital, Roosendaal, The Netherlands
| | - Addy C M van de Luijtgaarden
- Department of Medical Oncology, Reinier de Graaf Gasthuis and Reinier Haga Prostate Cancer Center, Delft, The Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Milan, Italy
| | - W Dick van Schelven
- Department of Nuclear Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel J R Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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47
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Rades D, Kristiansen C, Schild SE, Janssen S. Short Communication: Results of a Consensus Conference on Radiotherapy for Brain and Bone Metastases Within the Interreg-Project TreaT. In Vivo 2023; 37:894-897. [PMID: 36881061 PMCID: PMC10026661 DOI: 10.21873/invivo.13158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Differences between radiotherapy for metastases in Northern Germany and Southern Denmark were previously identified, which led to a consensus conference. PATIENTS AND METHODS A consensus conference was held between three centers to harmonize radiotherapy regimens for bone and brain metastases. RESULTS Centers agreed on 1×8 Gy for painful bone metastases in patients with poor or intermediate survival prognoses and 10×3 Gy for favorable-prognosis patients. For complicated bone metastases, 5-6×4 Gy was preferred for poor-prognosis, 10×3 Gy for intermediate-prognosis, and longer-course radiotherapy for favorable-prognosis patients. For ≥5 brain metastases, centers agreed on whole-brain irradiation (WBI) with 5×4 Gy in poor-prognosis and longer-course regimens in other patients. For single brain lesions and patients with 2-4 lesions and intermediate/favorable prognoses, fractionated stereotactic radiotherapy (FSRT) or radiosurgery were recommended. No consensus was reached for 2-4 lesions in poor-prognosis patients; two centers preferred FSRT, one center WBI. Preferred radiotherapy regimens were similar for different age groups including elderly and very elderly patients, but age-specific survival scores were recommended. CONCLUSION The consensus conference was successful, since harmonization of radiotherapy regimens was achieved for 32 of 33 possible situations.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
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48
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Kapoor L, Singh H, Sahoo B, Banjara R, Kumar VS, Bakhshi S, Sharma DN, Khan SA. Factors affecting the incorporation of extracorporeally irradiated autograft for the treatment of bone tumours-a retrospective analysis from a tertiary referral centre. Int Orthop 2023; 47:1361-1372. [PMID: 36847800 DOI: 10.1007/s00264-023-05730-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Re-implantation of the tumor bearing autograft following extracorporeal radiation therapy (ECRT) has been established as an oncologically safe biological reconstruction technique following resection of bone sarcomas. However, factors affecting the ECRT graft-host bone incorporation have not been fully investigated. An insight into the factors that influence graft incorporation can circumvent the complications and increase graft survival. METHODS A total of 96 osteotomies in 48 patients with intercalary resections of primary extremity bone sarcomas (mean age 15.8 years, mean follow-up 42.1 months) were analyzed retrospectively for factors ECRT autograft-host bone union. RESULTS On univariate analysis, age < 20 years, metaphyseal osteotomy site, V-shaped diaphyseal osteotomy, and use of additional plate at diaphyseal osteotomy had a significantly faster time to union, while gender, tumour type, bone involved, resection length, chemotherapy, type of fixation, and use of intra-medullary fibula did not influence union time. In multivariate analysis, V-shaped diaphyseal osteotomy and use of additional plate at diaphyseal ostetomy were the independent factors with favourable time to union. None of the analyzed factors was found to have a significant effect on the union rate. The major complications were non-union in 11.4% patients, graft failure in 2.1%, infection in 12.5%, and soft tissue local recurrences in 14.5% patients. CONCLUSION Modified diaphyseal osteotomy and augmentation of the stability of the reconstruction using additional small plates enhance the incorporation of ECRT autograft.
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Affiliation(s)
- Love Kapoor
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hargovind Singh
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Bismaya Sahoo
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Roshan Banjara
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
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49
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Makita K, Hamamoto Y, Kanzaki H, Nagasaki K, Takata N, Tsuruoka S, Uwatsu K, Kido T. Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy. Med Sci (Basel) 2023; 11:medsci11010017. [PMID: 36810484 PMCID: PMC9944514 DOI: 10.3390/medsci11010017] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to evaluate the expected prognosis and factors affecting local control (LC) of the bone metastatic sites treated with palliative external beam radiotherapy (RT). Between December 2010 and April 2019, 420 cases (male/female = 240/180; median age [range]: 66 [12-90] years) with predominantly osteolytic bone metastases received RT and were evaluated. LC was evaluated by follow-up computed tomography (CT) image. Median RT doses (BED10) were 39.0 Gy (range, 14.4-71.7 Gy). The 0.5-year overall survival and LC of RT sites were 71% and 84%, respectively. Local recurrence on CT images was observed in 19% (n = 80) of the RT sites, and the median recurrence time was 3.5 months (range, 1-106 months). In univariate analysis, abnormal laboratory data before RT (platelet count, serum albumin, total bilirubin, lactate dehydrogenase, or serum calcium level), high-risk primary tumor sites (colorectal, esophageal, hepatobiliary/pancreatic, renal/ureter, and non-epithelial cancers), no antineoplastic agents (ATs) administration after RT, and no bone modifying agents (BMAs) administration after RT were significantly unfavorable factors for both survival and LC of RT sites. Sex (male), performance status (≥3), and RT dose (BED10) (<39.0 Gy) were significantly unfavorable factors for only survival, and age (≥70 years) and bone cortex destruction were significantly unfavorable factors for only LC of RT sites. In multivariate analysis, only abnormal laboratory data before RT influenced both unfavorable survival and LC of RT sites. Performance status (≥3), no ATs administration after RT, RT dose (BED10) (<39.0 Gy), and sex (male) were significantly unfavorable factors for survival, and primary tumor sites and BMAs administration after RT were significantly unfavorable factors for LC of RT sites. In conclusion, laboratory data before RT was important factor both prognosis and LC of bone metastases treated with palliative RT. At least in patients with abnormal laboratory data before RT, palliative RT seemed to be focused on the only pain relief.
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Affiliation(s)
- Kenji Makita
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon 791-0295, Ehime, Japan
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama 791-0280, Ehime, Japan
- Correspondence: ; Tel.: +81-89-960-5371; Fax: +81-89-960-5375
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama 791-0280, Ehime, Japan
| | - Hiromitsu Kanzaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama 791-0280, Ehime, Japan
| | - Kei Nagasaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama 791-0280, Ehime, Japan
| | - Noriko Takata
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon 791-0295, Ehime, Japan
| | - Shintaro Tsuruoka
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon 791-0295, Ehime, Japan
| | - Kotaro Uwatsu
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon 791-0295, Ehime, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon 791-0295, Ehime, Japan
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50
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Ahmed SK, Witten BG, Harmsen WS, Rose PS, Krailo M, Marcus KJ, Randall RL, DuBois SG, Janeway KA, Womer RB, Grier HE, Gorlick RG, Laack NNI. Analysis of Local Control Outcomes and Clinical Prognostic Factors in Localized Pelvic Ewing Sarcoma Patients Treated With Radiation Therapy: A Report From the Children's Oncology Group. Int J Radiat Oncol Biol Phys 2023; 115:337-346. [PMID: 36302496 PMCID: PMC9839580 DOI: 10.1016/j.ijrobp.2022.07.1840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To identify potential clinical prognostic factors associated with a higher risk of local recurrence in patients with localized pelvic Ewing sarcoma treated with radiation therapy. METHODS AND MATERIALS Data for 101 patients treated with definitive radiation therapy (RT) or both surgery and radiation (S + RT) to primary pelvic tumors on INT-0091, INT-0154, and AEWS0031 were analyzed. Imaging data for patients who did not receive radiation were not available for central review; therefore, patients with surgery alone were not included. Cumulative incidence rates for local failure at 5 years from time of local control were calculated accounting for competing risks. RESULTS The most common pelvic subsite was sacrum (44.6%). RT was used in 68% of patients and S + RT in 32%. The local failure rate was 25.0% for RT and 6.3% for S + RT (P = .046). There was no statistically significant difference in local control modality by tumor characteristics. Tumors originating in the ischiopubic-acetabulum region were associated with the highest local failure incidence, 37.5% (P = .02, vs sacrum and iliac/buttock tumors), particularly those treated with RT (50.0%, P = .06). A higher incidence of local failure was seen with each additional 100 mL of tumor at diagnosis (P = .04). Multivariable analysis demonstrated RT alone (hazard ratio [HR], 5.1; P = .04), tumor subsite (particularly ischiopubic-acetabulum tumors; HR 4.6; P = .02), and increasing volume per 100 mL (HR, 1.2; P = .01) were associated with a higher incidence of local recurrence. CONCLUSIONS Combination surgery and RT is associated with improved local control in patients with pelvic Ewing sarcoma compared with definitive RT. Tumors involving the ischiopubic-acetabulum region and increasing tumor volume at diagnosis are associated with inferior local control. Tumor characteristics did not correlate with choice of local therapy modality suggesting an opportunity to develop best local therapy practices guidelines for future studies based on tumor features.
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Affiliation(s)
- Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
| | - Brent G Witten
- Orthopedic Surgery, Aurora Orthopedics, Milwaukee, Minnesota
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark Krailo
- Department of Preventative Medicine, University of Southern California, Los Angeles, California
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center & Harvard Medical School, Boston, Massachusetts
| | - R Lor Randall
- Department of Orthopedic Surgery, UC Davis, Davis, California
| | - Steven G DuBois
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center & Harvard Medical School, Boston, Massachusetts
| | - Katherine A Janeway
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center & Harvard Medical School, Boston, Massachusetts
| | - Richard B Womer
- Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine & Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holcombe E Grier
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center & Harvard Medical School, Boston, Massachusetts
| | - Richard G Gorlick
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nadia N I Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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