Discontinuation Of Radiotherapy Research Articles

Discontinuation of Palliative Brain Radiotherapy in Patients with Brain Metastases: A Case-Control Study.

Background: Discontinuation of radiotherapy is rarely discussed in the scientific literature. The goal of this study was, therefore, to estimate the frequency of and reasons for treatment discontinuations in patients receiving radiotherapy for brain metastases from solid tumors and to identify factors predicting said discontinuations. Methods: All patients treated for brain metastases from solid tumors between 2010 and 2020 at our institution were retrospectively reviewed. In addition to collecting relevant patient characteristics, the Recursive Partitioning Analysis (RPA) and disease-specific Graded Prognostic Assessment (GPA) groups for each patient were calculated to assess the performance of these scores in predicting treatment discontinuations. Results: Out of 468 patients who underwent cranial radiotherapy, 35 treatments (7.5%) were discontinued. The most frequent reason was clinical deterioration, which was documented in 26 (74.3%) of discontinued treatments. Patients whose radiotherapy was discontinued had, on average, more leptomeningeal disease (20.0% vs. 12.6%), worse ECOG performance status (mean ECOG performance status 1.86 vs. 1.39), and more uncontrolled extracranial metastases (85.3% vs. 70.8%). The frequencies of treatment discontinuation increased with worse prognosis and differed significantly across RPA groups (p = 0.037) but not across GPA groups (p = 0.612). Conclusions: Treatment discontinuation occurred in 7.5% of cases, mostly due to clinical deterioration. Poor performance status, as well as more advanced disease and, in turn, poor prognosis, were associated with higher discontinuation rates.

Comparison of Two Cisplatin Regimens for Chemoradiation in Patients With Squamous-cell Carcinoma of the Head and Neck.

Many patients with squamous-cell carcinoma of the head and neck receive cisplatin-based chemoradiation. This retrospective study compared two chemoradiation programs to help identify the optimal cisplatin-regimen. Forty-one patients assigned to chemoradiation with two cycles of 20 mg/m2/days(d)1-5 were compared to 78 patients assigned to chemoradiation with two cycles of 25 mg/m2/d1-4. Groups were compared for toxicity, loco-regional control (LRC), and survival. Both treatments were associated with similar rates of oral mucositis, radiation dermatitis, xerostomia, nausea, decreased renal function, and hematotoxicity. The cisplatin-regimen had no significant impact on LRC (p=0.41) or survival (p=0.85). Survival was significantly worse with radiotherapy interruptions (>1 week) or discontinuation (p<0.001) and administration of <80% of the planned cisplatin dose (p<0.001). Both cisplatin-regimens did not differ significantly regarding toxicities, LRC, and survival. It is important to avoid interruption or discontinuation of radiotherapy and to administer ≥80% of planned cisplatin.

Suvremeni pristup liječenju oralnog mukozitisa

Oral mucositis (OM) is a serious inflammation of the mucosa and occurs in patients with head and neck cancer (HNC) who are being treated with radiotherapy (RT) and/or chemotherapy (CT), and in patients undergoing hematopoietic stem cell transplantation (HSCT). The inflammation accompanied with painful ulcerations inside the oral cavity impairs its function making the basic functions like eating and speech hard or even impossible. It usually occurs at the end of the first week of RT and lasts for several weeks after cessation. The intensity of OM can sometimes lead to discontinuation of RT. The degree of mucositis regarding chemotherapy depends on the type of antineoplastic drug, therapeutic procedure, duration of the therapy and dose, as well as previous exposure of the oral cavity to toxic agents.Prolonged or repeated administration of lower doses of chemotherapy is associated with a higher chance of developing oral mucositis comparing to a bolus, while chronomodulation of chemotherapy reduces the possibility of mucositis without affecting antineoplastic activity. The treatment of OM is symptomatic, as there is still no effective treatment. In this review paper, several contemporary options for alleviating the symptoms of oral mucositis are listed.

Estimating the Probability of Not Completing the Intended Course of Thoracic Radiotherapy for Lung Cancer.

In some patients with lung cancer scheduled for thoracic radiotherapy (RT), treatment is discontinued before reaching the planned dose. For optimal treatment personalization, a tool estimating whether a patient can complete radiotherapy would be helpful. Eleven pre-RT characteristics were analyzed in 170 patients receiving local RT for lung cancer. Characteristics included age, sex, tumor site, histology, tumor and nodal stage, distant metastasis, surgery, systemic treatment, pulmonary function, and smoking history. Age >75 years (p=0.038), distant metastasis (p=0.009), and forced expiratory volume in 1 second <1.2 l (p=0.038) were significantly associated with discontinuation of RT. A prognostic instrument was developed in 126 patients with complete data regarding these characteristics. It included three groups (0, 1, and 2-3 points) with non-completion rates of 33.3%, 55.0% and 75.0% (p=0.004). This new instrument can help estimating the probability that lung cancer patients assigned to local RT cannot complete the planned course of RT.

Adjuvant chemoradiotherapy in elderly patients with head and neck cancer: a\xa0monoinstitutional, two-to-one pair-matching analysis

PurposeAbout one fifth of patients with head and neck cancer are aged 70 years and older at the time of diagnosis. In these patients, risk factors (R1 status or extracapsular extension of lymph node metastases, ECE) often lead to a need for combined chemoradiotherapy (CRT) in the postoperative setting. However, there is considerable concern about the toxicity of such therapy in this age group.MethodsRetrospective evaluation of the data of 53 patients ≥ 70 years of age who underwent surgery in our hospital between 1999 and 2015 for tumors of the oral cavity, the oropharynx, the hypopharynx, or the larynx, who subsequently received adjuvant radiation therapy. Two younger patients (< 70 years) were assigned to each of the elderly patients in a matching procedure based on anatomic sublocalization and tumor stage. The total cohort was comprised of 154 patients.ResultsUnivariate analyses revealed a statistically significant influence of many factors on overall survival (OS) and progression-free survival (PFS), including Karnofsky performance score (KPS), alcohol consumption, smoking, R status, ECE, chemotherapy, and discontinuation of RT. Younger patients had better OS and PFS compared to the elderly (p = 0.013 and 0.012, respectively). In a multivariate Cox regression, no independent influence of age on OS and PFS was found. Survival was primarily dependent on the addition of chemotherapy to radiotherapy (RT), application of the full course of RT, continued alcohol abuse, KPS, and the presence of ECE. Toxicity analysis showed a higher incidence of chronic renal failure but, generally, side effects for elderly patients were not substantially greater.ConclusionPerformance status and behavioral risk factors but not chronological age are crucial for the prognosis of patients who require adjuvant chemoradiation.

Radiodermatitis: severity, predictive factors and discontinuation of radiotherapy in patients with anal and rectal cancer.

to determine the prevalence of radiodermatitis, severity grades and predictive factors of its occurrence in patients with anal and rectal cancer followed up by the nursing consultation, and to analyze the association of severity grades of radiodermatitis with temporary radiotherapy interruption. a quantitative, cross-sectional and retrospective study, carried out with 112 medical records of patients with anal and rectal cancer undergoing curative radiotherapy followed up in the nursing consultation. Data were collected using a form and analyzed using analytical and inferential statistics. 99.1% of patients had radiodermatitis, 34.8% of which were severe. The predictive factors were female sex, age greater than 65 years, anal canal tumor, treatment with cobalt device and IMRT technique. Treatment interruption occurred in 13% of patients, associated with severe radiodermatitis. there was a high prevalence of radiodermatitis, mainly severe, which resulted in treatment interruption.

Risk factors associated with the development of aspiration pneumonia in patients receiving radiotherapy for head and neck cancer: retrospective study.

Patients with head and neck cancer who are receiving radiotherapy can develop aspiration pneumonia. Determination of the incidence of aspiration pneumonia and the associated risk factors could facilitate the identification of high-risk patients. In this retrospective study, we determined the incidence of aspiration pneumonia in 357 patients receiving radiotherapy along with oral care for head and neck cancer. We also performed univariate and multivariable logistic regression analyses to investigate the risk factors for this complication. The incidence of aspiration pneumonia was 17.6%. Hypopharyngeal cancer, grade 3 oral mucositis, and nasogastric tube feeding were independent risk factors. Moreover, the development of aspiration pneumonia was one of the major effects on the discontinuation of radiotherapy. Approximately, one-sixth of the patients developed aspiration pneumonia despite appropriate oral care during radiotherapy for head and neck cancer. Aspiration pneumonia during radiotherapy could adversely affect head and neck cancer management.

Blisters—an unusual effect during radiotherapy

The skin reaction to radiation is regularly monitored in order to detect enhanced radiosensitivity of the patient, unexpected interactions (e.g. with drugs) or any inadvertent overdosage. It is important to distinguish secondary disease from radiation reaction to provide adequate treatment and to avoid unnecessary discontinuation of radiotherapy. A case of bullous eruption or blisters during radiotherapy of the breast is presented. Differential diagnoses bullous pemphigoid, pemphigus vulgaris, and bullous impetigo are discussed and treatment described.

Photodynamic Therapy Curbing the Uncontrolled Proliferations: An Orodental Perspective

Cancer is a terminology known worldwide for a variety of diseases that have in common the proliferation of specific cell populations, with potential to invade nearby and/or distant tissues. Oral cancer is the 11th most common cancer in the world which remains one of the most debilitating and disfiguring of all malignancies. Oral cancer most often refers to squamous cell carcinoma of the oral cavity. Traditional treatments for oral cancer may lead to a broad spectrum of adverse effects to the maxillomandibular complex and associated structures. An exacerbation of infections, such as periapical and periodontal diseases, and severe mucositis may, occasionally, demand an adjustment of treatment or the discontinuation of radiotherapy or chemotherapy, demonstrating that oral complications should be prevented or minimized. This review highlights the principle mechanism of action of photodynamic therapy (PDT), advantages, limitations and its amazing applications in the management of oral malignancies.

Does age matter in achieving optimum chemotherapy delivery in managing head and neck cancer with primary chemo-radiotherapy?

Purpose of the study: Older patientswith head and neck cancermay be denied the potentially beneficial addition of chemotherapy to primary radiotherapy in the management of head and neck cancer, because of fears that older patients will develop relatively more treatment related morbidity and not tolerate treatment, when compared to younger patients. This could lead to breaks in, or discontinuation of radiotherapy giving poorer outcomes for survival and local control in older patients. Methods: We have reviewed a cohort of 141 head and neck cancer patients who had definitive primary chemo-radiotherapy over the period 2007–2009 in our department, and examined whether patients 65 years of age and over received as much chemotherapy as those patients below 65 years and why patients in both groups, did not receive the total chemotherapy dose prescribed. Results: Despite the younger patient group having a better performance status and lower ACE 27 (Adult Co-morbidity Evaluation 27) score, both younger and older groups received comparable total doses of chemotherapy. There were similar admission rates during chemo-radiotherapy for treatment-related morbidity, number of inpatient days, number of multiple admissions and incidence of febrile neutropenia, in both older and younger patient groups. Conclusions: Our study suggests that older patients, with head and neck cancer, where the use of chemotherapy is appropriate, can tolerate primary chemo-radiotherapy as well as younger head and neck cancer patients, and that older patients should not be denied chemotherapy on the basis of presumed increased morbidity.

Listeria brain abscess, Pneumocystis pneumonia and Kaposi's sarcoma after temozolomide

A 55-year-old man with glioblastoma multiforme was treated with continuous, dose-dense temozolomide. This therapy was curtailed after three cycles because of nausea, asthenia, and neuropsychological deterioration. During a subsequent course of radiotherapy, the patient developed fever, headaches, and cutaneous lesions. Physical examination, cerebral MRI, brain biopsy, skin biopsy, immunohistochemistry, bronchoscopy with bronchoalveolar lavage, and laboratory tests. Severe temozolomide-induced immunosuppression, exacerbated by corticosteroids, with profound T-cell lymphocytopenia and simultaneous opportunistic infections with Pneumocystis jiroveci pneumonia, brain abscess with Listeria monocytogenes, and cutaneous Kaposi's sarcoma. Discontinuation of temozolomide, discontinuation of radiotherapy, antibiotic treatment with amoxicillin and gentamicin, and administration of atovaquone and pentamidine.

Pre- and post-treatment daily life function in patients with hormone resistant prostate carcinoma treated with radiotherapy for spinal cord compression

Background and purpose To identify prognostic factors and prospectively evaluate daily life function and pain experience in hormone resistant prostate cancer patients with spinal cord compression treated with radiotherapy. Patients and methods Consecutive patients treated at the Norwegian Radium Hospital from May 1996 to October 1999 participated in the study. Daily life activities were assessed at start and discontinuation of radiotherapy and 2 and 6 months thereafter using a questionnaire based on a slightly modified Barthel activity of daily living Index. The patients were followed to death. Clinical parameters (histology, extent of disease at diagnosis, time from cancer diagnosis to start of radiotherapy, time from neurological symptoms to start of radiotherapy, age, number of spinal lesions, pre-treatment function) were assessed to try to prognosticate post-treatment function. Results Forty-nine patients were evaluable. Time from debut of neurological deficits to start of radiotherapy was median 4 days (range 1–66). Median target dose was 30 Gy (range 9–40). Overall survival from start of radiotherapy was median 3.5 months (range 0.3–36.0). In general, improvement with regard to mobility, daily life activities and sphincter control was reported after irradiation. Post-treatment the majority of patients reported pain, usually intermittent, although they used analgesics. No clinically relevant pre-treatment parameters that predicted function after radiotherapy were identified. Conclusions Radiotherapy may improve mobility, daily life activity and sphincter control in patients with metastatic spinal cord compression due to hormone resistant prostate cancer. Radiotherapy should therefore be considered in all patients irrespective of the neurological deficits.

Comparison of two strategies for the treatment of radiogenic leukopenia using granulocyte colony stimulating factor

Purpose : Radiation-induced leukopenia can cause a delay or discontinuation of radiotherapy. This complication can be overcome with the use of granulocyte colony-stimulating factor (G-CSF). However, an uncertainty exists regarding the mode of application of G-CSF in patients treated with radiotherapy. For this reason, the efficacy of two strategies for the administration of G-CSF in irradiated patients was compared in a prospective randomized clinical study. Methods and Materials : Forty-one patients who developed leukopenia (< 2.5 × 10 9 per liter) while undergoing radiotherapy were treated with G-CSF at a daily dose of 5 μg/kg. The first group received single injections of G-CSF as required ( n = 21). The second group received G-CSF on at least 3 consecutive days ( n = 20). An analysis was made of the changes in leucocyte counts, the number of days on which radiotherapy had to be interrupted, and the side effects of growth-factor treatment. Results : An increase in leucocyte values in the peripheral blood was observed in all patients treated with G-CSF. In the group which received G-CSF when required, two injections (range: 1–8) were administered in most cases. In the second group, most of the patients received three injections (range: 3–9). The average duration of therapy interruptions due to leukopenia was 4.8 days (0–28) in the first therapy arm and 2.5 (0–20) in the second arm. The variance in the duration of therapy interruptions between the two groups was not significant ( p = 0.2). Radiotherapy had to be terminated in two patients due to thrombocytopenia but the application of G-CSF did not seem to be a reason of decreasing platelet counts. Conclusions : Our results reveal that G-CSF is safe and effective in the treatment of radiation-induced leukopenia regardless of the mode of application. Because the calculated difference related to radiation treatment interruptions has no clinical relevance, both approaches examined in our study appear reasonable.