Effects Of Radiotherapy In Patients Research Articles

A Retrospective Analysis of Safety and Outcome of Radiotherapy Given Following Treatment with Ipilimumab for Metastatic Melanoma

ABSTRACT Aim: Case reports have documented abscopal effects of radiation in patients with melanoma, which may be enhanced by combining radiotherapy with immunomodulatory drugs. Ipilimumab upregulates the T cell immune response by blocking CTLA4, stimulating the immune system to target malignant cells. Here we assess the safety and efficacy of palliative radiotherapy following treatment with ipilimumab. Methods: The records of all patients with metastatic melanoma receiving palliative radiotherapy after ipilimumab between September 2010 and January 2013 at University Hospital Southampton NHS Trust were reviewed. Imaging was reassessed by radiologists experienced in tumour assessment and RECIST criteria 1.1 were used to evaluate tumour response both inside and outside the radiation field. Where the radiotherapy field was not imaged following treatment, symptomatic benefit was used. Results: 21 individuals received radiotherapy after ipilimumab between the specified dates. 10 were male; mean age at ipilimumab treatment was 57.6 years; all were ECOG performance status 0 or 1. Primary lesions were cutaneous 18 cases, ocular 1, unknown 2. Median progression free survival following ipilimumab treatment was 92 days; median time between first ipilimumab dose and start of radiotherapy was 74 days (range 3–175), radiotherapy was concurrent in some cases. Radiotherapy sites were brain (7), spine (2) and other (11). 11 individuals had imaging assessment of tumour response within the radiotherapy field, of which 4 had a partial response, 1 individual had on-going response in the radiotherapy field 21 months after irradiation. 5 of the remaining 10 were documented as having a good symptomatic response, meaning overall 42% derived clinical benefit from radiotherapy. There were no cases of radiotherapy inducing disease response outside the radiotherapy field. No individuals experienced radiation toxicity greater than CTCAE grade 2. Conclusions: In our series palliative radiotherapy was safe to use after ipilimumab. 42% of patients derived clinical benefit, one of whom has an ongoing response 21 months post treatment. There were however no cases of abscopal effect. Disclosure: M. Wheater: Support for conference attendance from BMS; C. Ottensmeier: BMS unrestricted clinical trial grant funding, consultancy for BMS and sponsorship for meeting attendance. All other authors have declared no conflicts of interest.

Acute effects of Radiotherapy in patients with Head and Neck Cancer: IMRT vs RapidArcTM

Radiation therapy is a standard treatment in the multidisciplinary approach to the treatment of head and neck carcinomas (HNC). The description and perception of the effects caused by the treatment in the normal tissues is important for the clinical evaluation of the patient because treatment is interrupted if the patient develops several acute side effects which directly affect their survival. This study involved 46 patients over 6 weeks of treatment and evaluated the observed acute effects of treatment in five different anatomical areas - skin, mucosa, salivary glands, pharynx /esophagus and larynx. This evaluation adopted the classification of the Acute Radiation Morbidity Scoring Criteria of the Radiation Therapy Oncology Group (RTOG). Data analysis revealed that the acute effects related to the RapidArc TM technique appeared earlier when compared to IMRT techniques. On the other hand, the IMRT technique showed more exacerbated high-grade effects.

Role of oxidatively-induced DNA damage and inflammation in radiation long term effects and carcinogenesis

Ionizing radiation is undoubtedly the most frequently used means of cancer treatment especially solid tumors like breast, prostate etc. Significant evidence suggests that long-term effects of radiation in patients who have undergone even successful treatment include high oxidative stress and inflammation in their blood and various tissues and the underestimation of the so called “non-targeted” effects. This chronic stress can lead in some cases to malignant transformation (secondary primary cancers) after radiation treatment of primary tumors several years after the initial irradiation. This mini-review discusses the evidence for the role(s) of oxidative DNA damage and inflammation as one of the primary contributing factors in chronic tissue injury and secondary carcinogenesis. Several important questions arise like for example if based on this idea we can develop in vivo reliable predictive biomarkers for radiation-induced chronic injury and pinpointing carcinogenesis precursor sites after radiotherapy treatment even years after the patient exposure.

Nuclear Survivin and Its Relationship to DNA Damage Repair Genes in Non-Small Cell Lung Cancer Investigated Using Tissue Array

PurposeTo investigate the predictive role and association of nuclear survivin and the DNA double-strand breaks repair genes in non-small cell lung cancer (NSCLC): DNA-dependent protein kinase catalytic subunit (DNA-PKcs), Ku heterodimeric regulatory complex 70-KD subunit (Ku70) and ataxia-telangiectasia mutated (ATM).MethodsThe protein expression of nuclear survivin, DNA-PKcs, Ku70 and ATM were investigated using immunohistochemistry in tumors from 256 patients with surgically resected NSCLC. Furthermore, we analyzed the correlation between the expression of nuclear survivin, DNA-PKcs, Ku70 and ATM. Univariate and multivariate analyses were performed to determine the prognostic factors that inuenced the overall survival and disease-free survival of NSCLC.ResultsThe expression of nuclear survivin, DNA-PKcs, Ku70 and ATM was significantly higher in tumor tissues than in normal tissues. By dichotomizing the specimens as expressing low or high levels of nuclear survivin, nuclear survivin correlated significantly with the pathologic stage (P = 0.009) and lymph node status (P = 0.004). The nuclear survivin levels were an independent prognostic factor for both the overall survival and the disease-free survival in univariate and multivariate analyses. Patients with low Ku70 and DNA-PKcs expression had a greater benefit from radiotherapy than patients with high expression of Ku70 (P = 0.012) and DNA-PKcs (P = 0.02). Nuclear survivin expression positively correlated with DNA-PKcs (P<0.001) and Ku70 expression (P<0.001).ConclusionsNuclear survivin may be a prognostic factor for overall survival in patients with resected stage I-IIIA NSCLC. DNA-PKcs and Ku70 could predict the effect of radiotherapy in patients with NSCLC. Nuclear survivin may also stimulates DNA double-strand breaks repair by its interaction with DNA-PKcs and Ku70.

A new hypofractionated schedule of weekly irradiation for basal cell carcinoma of the head and neck skin area in elderly patients

The effectiveness of radiotherapy in patients with basal cell carcinoma (BCC) has been already reported in the literature. However, there is little information about the irradiation of BCC in elderly patients, especially due to the low conformity of them to daily irradiation. Thirty-eight retrospectively selected elderly patients (78 years as median age) diagnosed with skin BCC of the head and neck area were treated with five weekly fractions of 600 cGy by three-dimensional conformal radiotherapy (3DCRT) as an adjuvant treatment. The primary endpoint was the relapse free survival. Acute toxicity, as secondary endpoint, was assessed according to EORTC/RTOG criteria. Among our patients, there were only three local recurrences at 15, 32 and 38 months post-3DCRT. There was no severe toxicity, while only 10 out of 38 patients presented grade II/III skin toxicity. Our proposed irradiation schedule seems effective in terms of local control and acute toxicity and could be an alternative scheme for elderly patients unfit for daily irradiation.

Xerostomia after radiotherapy

Xerostomia is a debilitating side effect of radiotherapy in patients with head and neck cancer. We undertook a prospective study of the effect on xerostomia and outcomes of sparing one or both parotid glands during radiotherapy for patients with squamous cell carcinoma of the head and neck. Patients with locally advanced squamous cell carcinoma of the head and neck received definitive (70Gy in 2Gy fractions) or adjuvant (60-66Gy in 2Gy fractions) curative-intent radiotherapy using helical tomotherapy with concurrent chemotherapy if appropriate. GroupA received < 26Gy to the left and right parotids and groupB received < 26Gy to either parotid. The study included 126patients; 114 (55 in groupA and 59 in groupB) had follow-up data. There were no statistically significant differences between groups in disease stage. Xerostomia was significantly reduced in groupA vs. groupB (p = 0.0381). Patients in groupA also had significantly less dysphagia. Relapse-free and overall survival were not compromised in groupA: 2-year relapse-free survival was 86% vs. 72% in groupB (p = 0.361); 2-year overall survival was 88% and 76%, respectively (p = 0.251). This analysis suggests that reducing radiotherapy doses to both parotid glands to < 26Gy can reduce xerostomia and dysphagia significantly without compromising survival. Sparing both parotids while maintaining target volume coverage and clinical outcome should be the treatment goal and reporting radiotherapy doses delivered to the individual parotids should be standard practice.

Quality of life and acute radiation effects in patients with breast cancer who have received radiotherapy

Quality of life and acute radiation effects in patients with breast cancer who have received radiotherapy

High-Resolution MR Imaging of the Orbit in Patients with Retinoblastoma

Retinoblastoma is the most common intraocular childhood malignancy, with a prevalence of one in 18,000 children younger than 5 years old in the United States. In 80% of patients, retinoblastoma is diagnosed before the age of three, and in 95% of patients, retinoblastoma is diagnosed before the age of five. Although reports exist of retinoblastoma in adults, onset beyond 6 years of age is rare. Broadly, retinoblastoma may be classified into two groups: sporadic and heritable. In either case, the origin of the tumor is a biallelic mutation in primitive neuroepithelial cells. Although their details vary, several staging schemes are used to describe the extent of retinoblastoma according to the following four general criteria: intraocular location, extraocular (extraorbital) location, central nervous system disease, and systemic metastases. In the past decade, substantial changes have taken place in terms of staging and monitoring treatment in patients with retinoblastoma. Diagnosis and treatment of retinoblastoma involve a multidisciplinary approach, for which imaging is a vital component. Increasing awareness and concerns about the effects of radiation in patients with retinoblastoma have led to a shift away from external-beam radiation therapy and toward chemotherapy and locoregional treatment, as well as the establishment of magnetic resonance imaging as the most important imaging modality for diagnosis, staging, and treatment monitoring.

A double-blind randomised controlled trial of a natural oil-based emulsion (Moogoo Udder Cream®) containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer

BackgroundRadiation-induced skin reaction (RISR) is one of the most common and distressing side effects of radiotherapy in patients with cancer. It is featured with swelling, redness, itching, pain, breaks in skin, discomfort, and a burning sensation. There is a lack of convincing evidence supporting any single practice in the prevention or management of RISR.Methods/DesignsThis double-blinded randomised controlled trial aims to investigate the effects of a natural oil-based emulsion containing allantoin (as known as Moogoo Udder Cream®) versus aqueous cream in reducing RISR, improving pain, itching and quality of life in this patient group. One group will receive Moogoo Udder Cream®. Another group will receive aqueous cream. Outcome measures will be collected using patient self-administered questionnaire, interviewer administered questionnaire and clinician assessment at commencement of radiotherapy, weekly during radiotherapy, and four weeks after the completion of radiotherapy.DiscussionDespite advances of radiologic advances and supportive care, RISR are still not well managed. There is a lack of efficacious interventions in managing RISR. While anecdotal evidence suggests that Moogoo Udder Cream® may be effective in managing RISR, research is needed to substantiate this claim. This paper presents the design of a double blind randomised controlled trial that will evaluate the effects of Moogoo Udder Cream® versus aqueous cream for managing in RISR in patients with cancer.Trial registrationACTRN 12612000568819

Outcome of the radical hypofractioned radiotherapy treatment in patients with stage I and II of non-small cell lung cancer

AbstractIntroduction: Surgery is the treatment of choice in stage I and II non-small-cell lung cancer (NSCLC). In the management of patients who are medically unfit to tolerate surgical intervention or who refuse surgery, radiotherapy is an acceptable alternative. We have performed a retrospective analysis of the effectiveness of radical radiotherapy in patients with early stage NSCLC treated over a period of 4 years.Methods: Thirty nine patients treated with radiotherapy of radical intent were identified. All patients received hypofractionated radiotherapy with a total dose of 55Gy in 20 fractions.Results: The median survival of all cases was 29 months. The one and two-year survival was respectively 61 % and 41%. The median survival of patients ≥75 years was 28 months, and age was the only prognostic factor identified in this analysis that affected survival.Conclusions: The presented survival results are consistent with those from other series published in the literature. At present, radical radiotherapy is often offered to patients with medically inoperable stage I and II NSCLC or those who decline surgery. But there is emerging evidence that some new techniques like stereotactic radiotherapy could be also used in the operable, early stage NSCLC.

Change in fibroblast growth factor 2 expression as an early phase radiotherapy‐responsive marker in sequential biopsy samples from patients with cervical cancer during fractionated radiotherapy

The authors previously demonstrated that fibroblast growth factor 2 (FGF2) expression levels in tumor cells (FGF2-T) may be an indicator of the efficacy of radiotherapy in patients with cervical cancer (CC). In the current study, this finding was extended in newly enrolled patients and was investigated further in stromal FGF2 (FGF2-S) expression. Sixty-nine patients with CC were recruited as a validation set for the immunohistochemical detection of FGF2-T from biopsy samples that were taken before (pretreatment) or 1 week after the initiation of radiotherapy (midtreatment). The authors also investigated the expression of FGF2 in tumor FGF2-S and investigated vascular endothelial growth factor (VEGF), and cluster of differentiation 31 (CD31) (also called platelet endothelial cell adhesion molecule) in these patients and in an additional 35 patients from a previous study. FGF2 expression was detected in tumor cells from all patients and in stromal cells from 87% of patients. FGF2-T was significantly higher in midtreatment samples (P=.0002), and a high ratio of midtreatment/pretreatment FGF2-T was related significantly to a better prognosis (P=.025). Increased VEGF expression after the initiation of radiotherapy was related significantly to positive FGF2-S in pretreatment samples (P=.035); however, it was not related to prognosis or microvessel density detected by CD31 expression. Radiation causes a response in tumor cells and adjacent normal cells and changes the extracellular matrix environment. In this study, the authors confirmed their previous findings and demonstrated that changes in FGF2-T expression may be used as a marker to monitor the effectiveness of radiotherapy in patients with CC. These findings should improve patient selection for molecular targeted therapies, such as cytokine inhibitors, after standard-of-care treatment.

An epidemiologic study of the effect of adjuvant radiotherapy on 2D tumor characteristics and prognosis of contralateral breast cancer (CBC).

538 Background: The scatter dose to the opposite breast during adjuvant radiotherapy is approximately 2-3 Gy. Several studies have investigated the potential risk of CBC by adjuvant radiotherapy to the breast, but with inconclusive results, it has not earlier been studied if the prognosis after the CBC could be affected by radiotherapy, should the CBC after all occur. Methods: We used a cohort of all women with CBC during 1976-2005 in Stockholm, Sweden with > 3 months between their cancers (n = 827), for which both register and medical records information were available. Poisson regression was used to calculate the incidence rate ratio (IRR) for distant metastasis within 5 years, adjusted for tumor characteristics of both cancers, calendar period and age at diagnosis of the first. Logistic regression was used to calculate the odds of a patient having worse tumor characteristics at her second cancer compared to at her first, adjusted for calendar period and age at first diagnosis. Finally, Poisson regression was used to estimate the time to the second cancer, adjusted for age, ER-status and stage. Results: We found a strong interaction between radiotherapy and time between the first and second cancer (latency time). For the patients with latency time < 5 years we saw an increased IRR of metastasis of 2.08 (95% CI:1.32-3.23) for women treated with radiotherapy compared to those not treated. Logistic regression also showed a strong interaction with latency time, for CBCs patients with latency < 5 years there was an odds ratio of 2.27 (95% CI:1.18-4.34) for having a worse stage and odds ratio of 2.27 (95% CI:1.20-4.26) for having worse grade, at the second cancer. For all three analysis, we saw no effect of radiotherapy for patients with latency > 5 years. Finally, for patients treated with radiotherapy, time to the second cancer significantly decreased by 24%. Conclusions: We observe a twofold risk for metastasis within 5 years, and for the second cancer to be of worse stage and grade, compared to the first, for CBC patients treated with radiotherapy for their first cancer and had the second cancer occurring within 5 years. The radiotherapy-treated patients also had shortened time to the second cancer. No significant financial relationships to disclose.

Prospective evaluation of the palliative effect of whole-brain radiotherapy in patients with brain metastases and poor performance status

Background/Purpose. The benefit of whole brain radiotherapy (WBRT) for RTOG RPA (Radiation Therapy Oncology Group Recursive Partitioning Analysis) class 3 patients with brain metastases is not well established. The aim of this study was to determine whether WBRT has any benefit in terms of symptoms palliation in such patients. Evaluation of patients’ preferences for WBRT, changes in performance and neurological status were secondary aims. Methods. Ninety-one RTOG RPA class 3 patients were included. All patients received WBRT (20 Gy in 5 fractions) and were asked to complete a questionnaire about their symptoms before and one month after WBRT. The patient's symptom checklist comprised 17 items scored from 0 to 3; a higher score meant a greater symptom intensity. The mean scores at baseline and after treatment were compared. Karnofsky performance status (KPS) and neurological status before and one month after WBRT were also recorded. Patients were asked to express their preference as to the WBRT undergone. Results. Forty-three (47%) patients completed both symptom checklists. The mean scores on the symptom checklist were 18.21 and 21.09 at baseline and one month after WBRT, respectively (p = 0.02). The KPS was estimated after WBRT in 42 patients: 57% of patients improved, 26% worsened, and 17% did not change from the baseline KPS score (p = 0.06). Neurological status did not change from baseline to one month after WBRT (p = 0.44). Only 7% of respondents would not have consented to the WBRT undergone. Conclusion. Our results challenge the palliative value of the WBRT in RPA class 3 patients.

Repeat Stereotactic Radiosurgery for Acoustic Neuromas

To evaluate the outcome of repeat stereotactic radiosurgery (SRS) for acoustic neuromas, we assessed tumor control, clinical outcomes, and the risk of adverse radiation effects in patients whose tumors progressed after initial management. During a 21-year experience at our center, 1,352 patients underwent SRS as management for their acoustic neuromas. We retrospectively identified 6 patients who underwent SRS twice for the same tumor. The median patient age was 47 years (range, 35-71 years). All patients had imaging evidence of tumor progression despite initial SRS. One patient also had incomplete surgical resection after initial SRS. All patients were deaf at the time of the second SRS. The median radiosurgery target volume at the time of the initial SRS was 0.5 cc and was 2.1 cc at the time of the second SRS. The median margin dose at the time of the initial SRS was 13 Gy and was 11 Gy at the time of the second SRS. The median interval between initial SRS and repeat SRS was 63 months (range, 25-169 months). At a median follow-up of 29 months after the second SRS (range, 13-71 months), tumor control or regression was achieved in all 6 patients. No patient developed symptomatic adverse radiation effects or new neurological symptoms after the second SRS. With this limited experience, we found that repeat SRS for a persistently enlarging acoustic neuroma can be performed safely and effectively.

Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up

Our previous study on cognitive functioning among 195 patients with low-grade glioma (LGG) a mean of 6 years after diagnosis suggested that the tumour itself, rather than the radiotherapy used to treat it, has the most deleterious effect on cognitive functioning; only high fraction dose radiotherapy (>2 Gy) resulted in significant added cognitive deterioration. The present study assesses the radiological and cognitive abnormalities in survivors of LGG at a mean of 12 years after first diagnosis. Patients who have had stable disease since the first assessment were invited for follow-up cognitive assessment (letter-digit substitution test, concept shifting test, Stroop colour-word test, visual verbal learning test, memory comparison test, and categoric word fluency). Compound scores in six cognitive domains (attention, executive functioning, verbal memory, working memory, psychomotor functioning, and information processing speed) were calculated to detect differences between patients who had radiotherapy and patients who did not have radiotherapy. White-matter hyperintensities and global cortical atrophy were rated on MRI scans. 65 patients completed neuropsychological follow-up at a mean of 12 years (range 6-28 years). 32 (49%) patients had received radiotherapy (three had fraction doses >2 Gy). The patients who had radiotherapy had more deficits that affected attentional functioning at the second follow-up, regardless of fraction dose, than those who did not have radiotherapy (-1.6 [SD 2.4] vs -0.1 [1.3], p=0.003; mean difference 1.4, 95% CI 0.5-2.4). The patients who had radiotherapy also did worse in measures of executive functioning (-2.0 [3.7] vs -0.5 [1.2], p=0.03; mean difference 1.5, 0.2-2.9) and information processing speed (-2.0 [3.7] vs -0.6 [1.5], p=0.05; mean difference 0.8, 0.009-1.6]) between the two assessments. Furthermore, attentional functioning deteriorated significantly between the first and second assessments in patients who had radiotherapy (p=0.25). In total, 17 (53%) patients who had radiotherapy developed cognitive disabilities deficits in at least five of 18 neuropsychological test parameters compared with four (27%) patients who were radiotherapy naive. White-matter hyperintensities and global cortical atrophy were associated with worse cognitive functioning in several domains. Long-term survivors of LGG who did not have radiotherapy had stable radiological and cognitive status. By contrast, patients with low-grade glioma who received radiotherapy showed a progressive decline in attentional functioning, even those who received fraction doses that are regarded as safe (</=2 Gy). These cognitive deficits are associated with radiological abnormalities. Our results suggest that the risk of long-term cognitive and radiological compromise that is associated with radiotherapy should be considered when treatment is planned. Kaptein Fonds; Schering Plough.

Comparative Study of LDR (Manchester System) and HDR Image-guided Conformal Brachytherapy of Cervical Cancer: Patterns of Failure, Late Complications, and Survival

To compare patterns of failure, late toxicities, and survival in locally advanced cervical cancer patients treated by either low-dose-rate (LDR) or conformal high-dose-rate (HDRc) brachytherapy as a part of curative radiotherapy. A retrospective comparative study of 217 advanced cervix cancer patients was conducted; 90 of these patients received LDR and 127 received HDRc brachytherapy. All patients were staged using International Federation of Gynecology and Obstetrics (FIGO) rules, had pretreatment magnetic resonance imaging (MRI), and were treated with concurrent cisplatin chemoradiotherapy. Both groups matched for FIGO stage, MRI tumor volume, and uterine invasion status. Local and pelvic failures were similar 12-13% and 14% both in both groups. Abdominal and systemic failures in LDR group were 21% and 24%, whereas corresponding failures in HDRc group were 20% and 24%. Sixty-eight percent (87/127) of patients treated by HDRc remained asymptomatic, whereas 42% (38/90) of patients were asymptomatic from the bowel and bladder symptoms after treatment with LDR. The 5-year OS rate was 60% (SE = 4%). The 5-year failure-free survival rate was 55% (SE = 3%). There was no significant difference between the groups. Image-guided HDRc planning led to a large decrease in late radiation effects in patients treated by HDRc. Patterns of failure and survival were similar in patients treated either by LDR or HDRc.

RNA Interference-Mediated Inhibition of Erythropoietin Receptor Expression Suppresses Tumor Growth and Invasiveness in A2780 Human Ovarian Carcinoma Cells

Although recombinant human erythropoietin (rHuEpo) has revolutionized the treatment of anemia, recent clinical trials suggested that rHuEpo use may be associated with decreased survival in cancer patients. Although the expression of erythropoietin (Epo) receptor (EpoR) has been demonstrated in various human cancers, the effect of exogenous Epo on the growth and therapy resistance of EpoR-bearing tumor cells is unclear at present. In the current study, we examined the hypothesis that EpoR may contribute to tumor growth independent of Epo in A2780 human ovarian carcinoma cells. A2780 human ovarian carcinoma cells showed high levels of EpoR expression, but lacked expression of Epo mRNA and biologically active Epo protein under both normoxic and hypoxic conditions. Exogenous Epo did not stimulate EpoR-mediated signaling, proliferation, invasiveness, or resistance to cytotoxic drugs in A2780 cells. In contrast, specific inhibition of EpoR expression using a short hairpin RNA (shRNA) expression plasmid resulted in markedly reduced proliferation and invasiveness in vitro. In addition, inhibition of EpoR expression led to abrogated in vivo ovarian cancer cell growth in a tumor xenograft system and resulted in decreased EpoR signaling. Our findings suggest that EpoR may be constitutively active in some cancer cells in the absence of Epo and provide the first evidence for a potential role of an Epo-independent, EpoR-mediated pathway in the growth of some human cancers.

P53, epidermal growth factor receptor and proliferating cell nuclear antigen in laryngeal squamous cell carcinoma are not predictive markers for the effect of adjuvant radiotherapy

Conclusion. These data indicate that the expression of p53, epidermal growth factor receptor (EGFR) or proliferating cell nuclear antigen (PCNA) is not a reliable predictor of the prognosis or the effect of adjuvant radiotherapy in patients with laryngeal squamous cell carcinoma (LSCC). Objective. The aim of this study was to investigate the prognostic significance of p53, EGFR, and PCNA in LSCC and to assess the relationships between the expression of these molecular markers and the effect of adjuvant radiotherapy. Patients and methods. We retrospectively reviewed the expression of these molecular markers in 75 patients with LSCC. Results. None of the expressions of these molecular markers was associated with disease-free survival or overall survival and no significant correlations were found between them and the effect of adjuvant radiotherapy. Also, they were not associated with each other.

Evaluation of fluoride-labeled boronophenylalanine-PET imaging for the study of radiation effects in patients with glioblastomas

Here we demonstrate that differentiation between glioblastoma (GB) tumor progression (TP) and radiation necrosis (RN) can be achieved with fluoride-labeled boronoalanine positron emission tomography (F-BPA-PET). F-BPA-PET images were obtained from histologically verified 38 GB, 8 complete RN, and 5 RN cases with partial residual tumors. The lesion/normal (L/N) ratios for these groups were 4.2 +/- 1.4, 1.5 +/- 0.3, and 2.0 +/- 0.3, respectively. Ten GB patients underwent F-BPA-PET twice (once before and once after radiation treatment) due to enlargement of the original lesion or the development of new lesions post radiation. The L/N ratios of ten original site lesions had decreased by the second PET, and these lesions were revealed to be RN. In contrast, the L/N ratios of two lesions distant from the original site increased, and these lesions were revealed as cases of TP. Repeat PET imaging was found to be useful for evaluating changes in GB-associated tumor activity with respect to the treatment received.

Outcomes and Effect of Radiotherapy in Patients With Stage I or II Diffuse Large B-Cell Lymphoma: A Surveillance, Epidemiology, and End Results Analysis

To assess disease-specific survival (DSS), overall survival (OS), and the effect of radiotherapy (RT) in patients with localized diffuse large B-cell lymphoma (DLBCL). The Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed with Stage I, IE, II, or IIE DLBCL between 1988 and 2004. The analyzable data included gender, age, race, stage, presence of extranodal disease, and RT administration. Patients who had died or were lost to follow-up within 6 months of diagnosis were excluded. A total of 13,420 patients met the search criteria. Of these, 5,547 (41%) had received RT and 7,873 (59%) had not. RT was associated with a significant DSS (hazard ratio, 0.82, p <0.0001) and OS benefit that persisted during the 15 years of follow-up. Elderly patients, defined either as those >60 or >70 years old, had significantly improved DSS and OS associated with RT. On multivariate analysis, RT was significantly associated with increased DSS and OS. The 5-year DSS outcomes were highly variable among patient subsets, defined by age, stage, and extranodal disease (range for RT-treated patients, 70% for Stage II, age >60 years to 87% for Stage I, age </=60 years). This analysis presents the largest detailed data set of Stage I-II DLBCL patients. The results of our study have demonstrated that RT is associated with a survival advantage in patients with localized DLBCL, a benefit that extends to elderly patients. Outcomes for discrete patient subsets varied greatly. The development of tailored therapy according to the relapse risk is warranted, rather than uniform treatment of all early-stage DLBCL.