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Purpose: The dosimetry of scalp dose was prospectively studied and correlated with alopecia following conventional cranial irradiation in primary brain tumors patients. Materials and methods: Patients with primary brain tumors who required conventional radiotherapy were enrolled. A hairline marker was applied to the patient's scalp to identify the entire scalp region. The maximal dose to 2% volume of interest (D2) for the entire scalp region were obtained. The radiation dosages at the localized hair-loss areas were evaluated during the final week of RT (transient alopecia) and six months after completing RT (permanent alopecia). Kruskal-Wallis tests were used to compare the dosimetric parameter values with statistical significance set as p < 0.05. Results: Forty-eight patients were included in the analysis. The prescribed radiation doses ranged from 50.4 to 60.0 Gy. Thirty-two patients experienced alopecia (27 transient and 5 permanent). The median D2 values adjusted for the entire scalp were higher in the alopecia group (38.40 Gy for transient alopecia and 47.84 Gy for permanent alopecia vs 11.90 Gy for no alopecia, p < 0.001). The D2 value was determined as a predictive parameter for alopecia. The threshold values for transient and permanent alopecia over the entire scalp were 22.15 Gy and 36.81 Gy, respectively. At the localized hair-loss areas, the D2 values for transient and permanent alopecia were higher at 44.82 Gy and 50.00 Gy, respectively. The radiation intensity at the localized hair-loss areas was also related to the severity of alopecia, with D2 values of 35.14 Gy and 46.39 Gy for clinically assigned grade 1 and grade 2 transient alopecia, respectively, with the D2 value being even higher for permanent alopecia. Conclusions: The D2 parameter value could be used to predict the type and severity of alopecia. [ABSTRACT FROM AUTHOR]

Purpose: Hydrogen (H2) gas inhalation might alleviate acute radiotherapy toxicities by scavenging free radicals produced by ionizing radiation and anti-inflammatory properties. This study aimed to investigate the feasibility and safety of H2 gas inhalation during concurrent chemoradiotherapy (CCRT) in patients with locally advanced head and neck cancer (LAHNC). Patients and Methods: We designed a pilot prospective study combining CCRT with aerosol inhalation of H2 gas. Each patient was scheduled to receive daily intensity-modulated radiotherapy (IMRT) in 33 fractions on a weekday and six cycles of weekly chemotherapy. All patients inhaled H2 gas through a cannula or mask 1 hour per day, 1– 2 hours before IMRT. The primary endpoint was the feasibility of H2 inhalation. Eighty percent of the patients who completed at least 20 applications of H2 gas inhalation were considered feasible. The secondary endpoints were safety profiles during H2 gas inhalation (vital signs and symptoms related to H2 gas inhalation) and acute toxicities during CCRT. Results: We enrolled 10 patients with LAHNC between July 2023 and December 2023. All patients received 33 fractions of H2 gas inhalation on the same day as the IMRT. Vital signs during and at the end of H2 gas inhalation were stable in all patients. None of the 10 patients had hypertension or hypotension during any of the 33 inhalations. No adverse events related to H2 gas inhalation, such as cough, nasal bleeding, dizziness, headache, nausea, or vomiting, were reported. Grade 3 leukopenia was found in two patients (20%) during the 5th week of CCRT. Grade 2 radiation dermatitis and pharyngitis were found in three patients (30%). Conclusion: H2 gas inhalation combined with CCRT is feasible and safe for patients with LAHNC. [ABSTRACT FROM AUTHOR]

The aim of the study was to analyse of two-year loco-regional failure free survival (LRFFS), distant metastasis free survival (DMFS), overall survival (OS), and toxicity outcomes of the first 100 nasopharyngeal carcinoma patients in Thailand treated by helical tomotherapy.

Aim: This study aimed to evaluate acute and late toxicities in nasopharyngeal cancer (NPC) patients who were treated between split-field (SF) and extended-field (EF) step-and-shoot intensity-modulated radiotherapy (IMRT) techniques. Materials and methods: Between January 2011 and October 2011, 21 NPC patients with stage I-IVB (7th edition American Joint Committee on Cancer Staging) were randomly assigned to undergo radiotherapy with SF or EF step-and-shoot IMRT technique. Results: At a median follow-up time of 60 months (range 3–77), we reported the comparable acute and late toxicities between the two techniques. One patient (9%) in SF-IMRT arm developed grade 3 acute skin toxicity. Findings: Both SF and EF step-and-shoot IMRT techniques for NPC patients did not produce any statistically significant differences in both acute and late toxicities. Although no difference in toxicity was observed, technical problems due to field matching management were the obstacles in utilisation of SF-IMRT in our routine practice. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy is one of the treatments used to treat prostate cancer, and dose escalation to 74–78 Gy in conventional fractionation is the standard regimen. Currently, according to the hypothesis of low alpha/beta ratio in prostate cancer cells, using hypo-fractionation has been reported in many publications with promising results. This retrospective study was designed to evaluate the implementation of a moderate hypo-fractionation regimen in high-risk prostate cancer in our division. Materials and Methods: Between 2012 and 2017, 40 patients with high-risk, localised prostate cancer were treated by a moderate hypo-fractionation regimen (70 Gy at 2·5 Gy per fraction) with intensity-modulated radiation therapy. The data related to treatment outcomes and toxicities were evaluated. Results: The mean PSA at diagnosis was 86·2 ng/mL (95% CI 49·9–122·4). Thirty-eight patients received long-term hormonal therapy. Fifty-two percent had a Gleason score of 8–10, and 65% had an initial PSA >20 ng/mL. The mean doses (in EQD2) to the D50% of PTV, D2% of organs at risk (bladder, rectum and bowels) were 80, 78·3, 76·4, and 50·2 Gy, respectively. Two patients had biochemical recurrence during the follow-up period. Conclusion: A moderate hypo-fractionation regimen (70 Gy at 2·5 Gy per fraction) is feasible. Our experience found that this regimen yields tolerable, acceptable toxicity profiles in high-risk, localised prostate cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To report the outcomes of chemoradiation treatment in locally advanced non-small cell lung cancer [NSCLC] patients and determine the factors affecting survival. Materials and Methods: The medical records of 1,325 NSCLC patients treated with radiotherapy in our division between 2008 and 2013 were reviewed. The patient characteristics, the management characteristics, and outcome data were recorded and analyzed. Univariate and multivariate analysis were performed to identify the prognostic factor for overall survival [OS]. Results: One hundred three patients were included in the analysis. With a median follow-up time of 13.27 months, these patients had a median OS time of 21.4 months (95% CI 17.6 to 25.2) and median progression-free survival [PFS] time of 11.67 months (95% CI 9.69 to 13.65). The 2-year OS and PFS rate were 34.0% and 21.4%, respectively. For the patients treated by concurrent and sequential chemoradiation, the 2-year OS rates were 31.0% and 37.8% (p = 0.349) and the 2-year PFS rates were 24% and 20.6% (p = 0.690), respectively. The multivariate analysis revealed that age (hazard ratio [HR] 1.68, 95% CI 1.06 to 1.69) and stage (HR 2.13, 95% CI 1.43 to 3.39) were signifiicant prognostic factors for OS. Conclusion: The treatment of locally advanced NSCLC in the authors' hospital is feasible and the outcomes are comparable to others. The concurrent and sequential chemoradiation did not show any statistically signifiicant difference in survival rate. The factors that associated with poor prognosis are age (older than 60 years) and stage (IIIB). [ABSTRACT FROM AUTHOR]

Background: Patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT) are at high risk for dysphagia, malnutrition, and immunosuppression. Accordingly, arginine, glutamine, and Omega-3 fatty acidsare immuneenhanced nutrition can promote cellular immunity. We aimed to examine the impact of immunonutrition diet on nutritional status, in addition to CCRT toxicities, within this group of patients. Methods: Forty patients with HNC who were treated with curative CCRT were randomized into group A (n = 20), patients who received a regular diet and dietary counseling by a protocol dietician, and group B (n = 20), patients who received a regular diet plus immuneenhanced nutrition supplements and dietary counseling by the same protocol dietician. Outcome measures were weight loss, protein and energy intake, serum pre-albumin and albumin, and toxicities of CCRT were evaluated at baseline, weekly and at the end of treatment. Results: Both groups were well balanced at baseline. One patient from group A (1/20) withdrew consent. Seven patients from group B (7/20) withdrew from the study; 1 patient could not tolerate the side effect of chemotherapy and 6 patients could not tolerate the taste of oral immune-enhanced nutrition. A significant loss in total body weight was observed in group A patients (p<0.001), whereas in group B there no significant weight loss (p=0.109). Median percentage change from baseline of energy intake was 19.6%, and 22.9% at the end of treatment for group A and B respectively. The circulating levels of nutritional markers, pre-albumin and albumin, decreased after CCRT in both groups. There was a significantly decreased level of albumin in group A compared to that of group B, at the end of treatment. During CCRT; 4 patients (20%) in group A and 1 patient (5%) in group B developed grade 3 mucositis, respectively. One patient (5%) in group A had grade 3 radiation dermatitis. Grade 3-4 hematologic toxicities, mainly in absolute neutrophil count (ANC), were significantly higher in group A than group B: 20% versus 0% (p=0.035). Over the 7-week period of CCRT, both the intention to treat analysis and per protocol analysis revealed similar results in scaled for all endpoints. Conclusions: Nutritional counseling and immuno-nutrition can reduce the deterioration of nutrition status and also significantly reduced hematologic and non-hematologic toxicity of CCRT in head and neck cancer. [ABSTRACT FROM AUTHOR]

Objective: This review article summarizes in vitro, in vivo, and clinical evidence pertaining to temozolomide (TMZ) and bevacizumab (BEV) efficacy and mechanism of action in gliomas. Methods: Relevant publications published before June 2013 in PubMed database were reviewed. Results: Temozolomide and BEV are current chemotherapeutic agents treating patients with high-grade glioma, including glioblastoma. In vitro and in vivo studies have proposed discordant cell death pathways for TMZ as either apoptosis or autophagy using different experimental setting details or cell lines. In addition, BEV may cause cell death through hypoxia-induced autophagy or unspecific indirect effects on cancer cells. The complexity of cancer cells in glioma has contributed to their resistance of both chemotherapies. In clinical trials, overall survival duration in glioma patients with recurrence (8-9 months) is lower than that in newly diagnosed patients (12-15 months). Conclusion: Our collected data support the addition of radiotherapy, BEV, and other targeted agents to TMZ treatment, indicating prolonged survival duration in newly diagnosed patients. However, the optimal regimen for treating high-grade glioma cannot be concluded without more clinical trials. [ABSTRACT FROM AUTHOR]