Search

Objective: To report preliminary findings of a phase II study exploring the clinical outcomes of moderate hypofractionated radiotherapy performed with helical tomotherapy (HT) using computed tomography–magnetic resonance imaging–based planning for localized prostate cancer. Methods: The phase II prospective study received ethics approval from our institutional ethics committee. A dose of 60 Gy/20 fractions for low–intermediate risk prostate cancer by means of HT was explored. Primary endpoints of the study were acute and late gastrointestinal (GI) and genitourinary (GU) toxicities. Secondary endpoints were quality of life and biochemical-free survival. Results: A total of 35 patients were included in this interim report. At the time of the analysis, median follow-up was 36 months (range, 13–62). Acute GI toxicity was recorded as follows: grade 1 in 34% and grade 2 in 14%; acute GU toxicity was grade 1 in 71% and grade 2 in 11%. For the entire population of the study, no acute toxicities ⩾ grade 3 occurred. A single case of late grade 3 GU toxicity was registered, whereas no late GI toxicity ⩾grade 3 was recorded. At the time of the final assessment, no biochemical failure was detected. Conclusions: The preliminary results of the present phase II trial, using HT for moderate hypofractionation in localized prostate cancer, are optimal. In fact, HT guaranteed an acceptable tolerability profile with low rates of GU and GI side effects and, more specifically, no acute severe adverse events were recorded. Long-term findings are warranted.

Aim: Metastases from colorectal cancer are poorly responsive to stereotactic ablative radiation therapy (SABR) due to intratumoral hypoxia. Intratumoral oxygenation is improved by administration of angiogenesis inhibitors. Thus, there could be a clinical synergistic effect of SABR with bevacizumab on metastases from colorectal cancer. The aim of this study was to evaluate the feasibility and efficacy of SABR after bevacizumab in lung oligometastases from colon cancer. Methods: The data of patients with lung metastases from colon cancer who underwent SABR were retrospectively evaluated according to the following inclusion criteria: number of metastases ≤3; lung oligometastases from colon cancer in patients who underwent SABR; patients receiving previous chemotherapy alone or in combination with bevacizumab; Karnofsky performance status >80; life expectancy >6 months; at least 6 months’ follow-up after SABR; presence of KRAS mutation. The results were compared with those of a similar cohort of patients with irradiated lung lesions from colorectal cancer in whom bevacizumab was not previously administered. Results: A total of 40 lung metastases were analyzed. The complete response rate after SABR was higher in patients who had received bevacizumab than in those who had not (p = 0.04). Additionally, in the bevacizumab group, a higher rate of post-SABR complete response was observed in case of oligopersistent versus oligorecurrent metastases (p = 0.001). Conclusions: In the setting of lung oligometastases from colon cancer the present study attested the higher efficacy of SABR after bevacizumab administration. Further studies in this field of research are strongly advocated.

Exhaustive criteria and definitive data to identify the ideal lung oligometastatic patient as a candidate for stereotactic body radiotherapy (SBRT) are lacking. Three distinct cohorts of oligometastatic patients could be distinguished: (1) patients with upfront diagnosis of oligometastases (synchronous or metachronous); (2) patients with oligorecurrent disease in terms of relapsed oligometastatic phase; (3) oligoprogressive patients after cytoreductive treatment. The aim of the present review is to analyze available data concerning the efficacy/safety of SBRT for oligometastatic/oligoprogressive/oligorecurrent lung metastases.

Aim For simultaneous bilateral breast cancer (SBBC) treatment, conventional radiotherapy (RT) has a number of critical shortcomings. Thus, the usefulness of volumetric arc therapy (VMAT) for SBBC is undeniable. Case Report A 34-year-old woman with SBBC received neoadjuvant chemotherapy followed by breast-conserving surgery and bilateral lymph node dissection. Given the conservative surgery and the nodal involvement after neoadjuvant chemotherapy, bilateral adjuvant RT to the breasts and regional nodes with doses of 50 Gy in 25 fractions and a simultaneous integrated boost (SIB) of 60 Gy to the surgical bed was proposed. Monoisocentric VMAT using 2 pairs of arcs was performed with adequate target dose coverage and low doses to the organs at risk. The results of this case were compared with those of previous studies in terms of RT technique and irradiated volumes. Conclusions VMAT is feasible and safe in the treatment of SBBC with SIB and nodal irradiation.

Purpose To evaluate the influence of radiation dose on tumor regression grade (TRG) and sphincter preservation rate in a series of cT3N0-1 rectal cancer patients treated with neoadjuvant chemoradiotherapy (CT-RT) with or without a sequential radiation boost. Materials and methods Between May 2002 and September 2013, 116 cases were eligible for retrospective evaluation. Radiotherapy was delivered for a total dose of 45 Gy (no boost arm) or 50.4 Gy (boost arm). TRG was evaluated with the Dworak scale. Results Median follow-up was 62 months (range, 12-138 months). The 5-year overall survival and local control rates were 72% and 93%, respectively. Fifty-five patients (47%) were treated with a sequential radiation boost and 61 (53%) without a boost. Eighty patients (72%) presented T3N0 disease and 32 (28%) T3N1 disease. Concomitant capecitabine was administered in 92 cases (79%) and intravenous 5-fluorouracil in 24 cases (21%). Sphincter preservation was performed in 82% of patients in the boost arm and 66% in the no-boost arm. A higher TRG was related to a longer interval between neoadjuvant treatment and surgery (pConclusions The long-term results from our single-center experience confirm literature data on the role of a sequential boost in tumor response after neoadjuvant CT-RT in a series of cT3N0-1 rectal cancer patients.

Background The aim of this case report is to report on a dosimetric comparison between volumetric modulated arc therapy (RapidArc technique and active scanning proton therapy (single-field (SFO) and multifield (MFO) techniques) in a case of nasal cavity cancer recurrence. Case Report A 72-year-old man, who received adjuvant radiotherapy for a carcinoma of the nasal cavity, experienced an unresectable local recurrence in the previous surgical bed. Hence, the patient was evaluated for reirradiation by comparing different modalities, with a total prescribed dose of 50 Gy in standard fractionation. RA plan was revealed to be equivalent to the MFO plan in terms of target dose coverage and conformity index. SFO plan was not able to respect a maximum dose of 9 Gy to nervous structures, in contrast to RA and MFO plans. Conclusions In this challenging scenario, although a clear preference would be given to the MFO proton plan, the RA plan was revealed to be adequate for the clinical goal of target coverage and sparing of organs at risk.

There is limited evidence regarding the impact of 11C-methionine positron emission tomography/computed tomography (MET-PET/CT) on radiation therapy planning of primary brain tumors. Our aim was to assess the effect of this imaging modality on treatment volumes and clinical outcome of patients eligible for radiation therapy in this oncologic setting.Between November 2009 and May 2012, 31 consecutive patients (male:female, 20:11; mean age, 53.0 years) with pathologically proven primary/relapsed glioma were treated with radiation therapy at the Humanitas Research Hospital. All patients were submitted to the same multi-imaging protocol including MET-PET/CT for biological target volume (PET) and contrast-enhanced magnetic resonance imaging/CT for gross tumor volume, in order to define the clinical target volume. Different volumes were compared and analyzed with respect to treatment planning modification after MET-PET/CT and impact on disease outcome. In 19/31 cases, patients were re-evaluated after completing radiotherapy, and in these cases, progression-free survival and overall survival were determined. The study was submitted to and data collection was approved by the local ethics committee.All patients completed the treatment. In 29 of 31 patients, a biological target volume was defined (mean volume, 18.3 cc), which in 20 cases (65%) resulted in a modification of the clinical target volume (mean, 65.9 cc; range, 8.5-165.6). In the other two cases, PET was negative and did not influence treatment planning. The mean percentage of added volume was 9.2%, ranging between -29% and 38%. With a mean follow-up of 5.4 months, treatment modification according to MET-PET/CT was the only predictor demonstrating a significant correlation with both progression-free survival ( P = 0.018) and overall survival (P = 0.003). None of the other factors evaluated in the analyses, including age, tumor histology, previous treatment, and tumor uptake, was correlated with the outcome.Despite the limited study population, our data indicate that MET-PET/CT can have a significant impact on radiation therapy planning in patients with primary brain tumors. Moreover, treatment modification according to PET appears to be a predictor of clinical outcome in this group of patients.