External Beam Radiation In Treatment Research Articles

Abstract 4293: Final result of lenvatinib and capecitabine in combination with external beam radiation in treatment of locally advanced rectal cancer: Phase I clinical trial

Abstract Purpose: Targeting dual/multiple angiogenesis receptor has been shown to augment tumor response. Lenvatinib, a multikinase inhibitor aimed towards FGFR/ PDGFR/ KIT/RET has shown potent antitumor activity in preclinical models. This study aims to understand the effectiveness and safety of lenvatinib and capecitabine combined with radiation in patients with locally advanced rectal cancer (LARC). Methods: Patients with MRI or endoscopic ultrasound confirmed stage II or stage III rectal cancer were enrolled in 3 cohorts. All cohorts received standard dose 850 mg/m2 PO BID of capecitabine and external beam radiation (180 cGY) on day 1-5 weekly for 5 ½ to 6 weeks. Oral lenvatinib was administered in dose escalation manner in 3 cohorts of 3 patients per dose level (DL), with an expansion cohort at the MTD [cohort 1:14 mg daily; cohort 2: 20 mg daily; cohort 3:24 mg daily]. At the MTD dose, 10 additional patients were added to further evaluate safety and efficacy. Results: Twenty patients were enrolled and received at least 1 dose of study drug. One patient was deemed not eligible due to having stage IV disease at the time of diagnosis and is only reviewed for toxicity. 3/19 patients had stage II and 16/19 had stage III cancer at time of enrollment. 73.6% (14/19) patients enrolled were male and 26.4% (5/19) were female. The median age was 55 years (42,73). There was no noted dose limited toxicity at maximum tolerated dose (24 mg) of lenvatinib. There were no grade 4 adverse events. The most common grade 3 toxicities were hypertension observed in 15% (3/20) and lymphopenia in 15% (3/20) patients. Other grade 3 toxicities included rectal pain, hyponatremia, lymphopenia, leukocytosis and transaminitis, each noted in 5% (1/20) patients respectively. 19 patients underwent surgery in 6-10 weeks following completion of dual-targeted therapy and radiation. Median time to surgery was 62 days. There were no peri-operative adverse events. 14/19 patients underwent low anterior resection and 5 have had abdominoperineal resection. 7/19 (36.8%) showed complete pathological response (cPR), and downstaging were seen in 73.7% of the patients (14/19). The mean neoadjuvant rectal cancer score (NAR) was 10.4 and median NAR was 8.43. Conclusion: The combination of lenvatinib and capecitabine plus radiation shows encouraging safety and efficacy results. Larger randomized study is warranted to verify our findings. Citation Format: Ankita Tandon, Jessica M. Frakes, Rutika Mehta, Sarah Hoffe, Iman Imanirad, Maria E. Martinez Jimenez, Julian Sanchez, Mokenge Malafa, Seth Felder, Sophie Dessureault, Richard D. Kim. Final result of lenvatinib and capecitabine in combination with external beam radiation in treatment of locally advanced rectal cancer: Phase I clinical trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4293.

EXTERNAL BEAM RADIATION FOR CHOROIDAL LYMPHOMA: Efficacy and Complications.

To determine the efficacy and safety of external beam radiation for treatment of choroidal lymphoma (CL). Retrospective case series. Twenty-five eyes of 24 patients with CL treated with external beam radiation. Review of medical records. Tumor control, visual acuity, and radiation complications. The mean age of the patients was 62 years (median, 65; range, 32-89 years). Only 2 patients (8%) had a history of systemic lymphoma. The most common symptom was painless blurred vision in 14 eyes (58%) and the mean duration of ocular symptoms was 12 months (median, 7; range, 1-36 months). Initial best-corrected visual acuity was 20/40 or better in 10 eyes (40%), 20/50 to 20/150 in 12 eyes (48%), and 20/200 or less in the other 3 eyes (12%). The fovea was involved by the CL in 16 eyes (64%). Mean tumor thickness was 3.1 mm (median, 3.0; range 1.1-6.3 mm). Anterior and posterior transscleral extension of CL were present in 15 (60%) and 14 eyes (56%), respectively. All patients, except 3 (13%), had some form of ocular biopsy confirming the diagnosis of ocular lymphoma. The mean total radiation dose was 2,867 cGy (median, 3,000; range, 1,200-3,600 cGy). At final examination, after a mean follow-up period of 58 months (median, 35; range, 13-228 months), 18 eyes (72%) showed complete regression of CL and 7 eyes (28%) showed partial regression. All eyes (100%) with initial serous retinal detachment (14 eyes), subfoveal fluid (8 eyes), and macular edema (5 eyes) achieved complete resolution of subretinal or intraretinal fluid after treatment. Recurrence of CL after initial partial response developed in only 1 eye (4%). Compared with the initial evaluation, final best-corrected visual acuity had increased in 11 (44%), was stable in 8 (32%), and had decreased in 6 eyes (24%). Only 2 eyes (8%) showed signs of mild nonproliferative retinopathy. In this study, external beam radiation was an effective and safe modality for treatment of CL, achieving long-term tumor regression in 96% and stable or improved vision in 76% after mean follow-up period of 6 years.

Novel Treatment for Radiation Optic Neuropathy With Intravenous Bevacizumab

Radiation optic neuropathy is a devastating form of vision loss that can occur months to years after radiation therapy for tumors and other lesions located in close proximity to the visual pathways. We present the case of a 24-year-old woman who underwent external beam radiation for treatment of a tectal pilocytic astrocytoma, and 5 years later she developed bilateral radiation optic neuropathy and radiation necrosis of the right temporal lobe. We opted to treat her with intravenous bevacizumab with 3 doses every 3 weeks, as well as dexamethasone and pentoxifylline. After the first infusion of bevacizumab, the patient noted improvement in vision and color vision, and a follow-up magnetic resonance imaging study showed that the previous enhancement of the optic nerves and chiasm was diminishing. Her vision improved dramatically and has remained stable over a 3-year period.

The risk of bladder cancer in patients diagnosed with other primary neoplasms: Analysis of the SEER database

ObjectiveWe evaluated patients with history of previous malignancy to determine risk of an ensuing bladder cancer. Materials and methodsThe National Cancer Institute's Surveillance, Epidemiology, and End Results 9 registry database from 1973 to 1999 (SEER) was reviewed for patients with initial primary cancers in oral cavity and pharynx, colon and rectum, respiratory system, breast, prostate, testis, or penis. This group of patients was then examined to identify subsequent separate primary malignancies in the bladder. Comparison was made to the incidence of bladder cancer in the general population to determine a standardized incidence ratio (SIR). Additional analysis was performed based on age at diagnosis, stage, gender, race, and use of external beam radiation for treatment of initial cancer. ResultsA total of 7,289 (0.5%) of patients had a bladder cancer following their initial malignancy. Patients with prostate cancer had the largest increase in risk of bladder cancer with a SIR of 8.24, and all initial cancer groups had an elevated risk of bladder cancer relative to the general population. External beam radiation and non-White gender were associated with an increased risk of bladder cancer. Older age at diagnosis of the initial cancer correlated with a lower risk of subsequent bladder cancer. ConclusionsThis study suggests an increased risk of bladder cancer following a separate initial cancer. Lower threshold for working up those patients for bladder cancer may be warranted.

Percutaneous transperineal placement of gold 198 seeds for treatment of carcinoma of the prostate.

Thirty-one patients have been treated for carcinoma of the prostate with 198Au seeds placed transperineally using transrectal ultrasonic guidance. Twenty patients have been followed postoperatively for periods ranging from 3 to 31 months, with an average follow-up time of 12 months. Cumulative dose of radiation to the prostate calculated by dosimetry was either 9,000 rads or 15,000 rads. Serial transrectal ultrasound examinations performed on these patients showed a decrease in prostate size in all patients within 6 months of treatment, with a statistically significant decrease observed between the third and sixth months. No significant difference in amount or rate of tumor regression was noted when tumor stage and grade were correlated to volume decrease after treatment. Patients who received the larger doses of radiation (15,000 rads) showed a significantly greater rate of decline in prostatic volume than those who received 9,000 rads. Seven patients underwent prostate biopsy between 12 and 18 months after treatment; six biopsies showed residual tumor. Complications after treatment included urinary retention because of prostatic edema (three), radiation urethritis (three), and rectal ulceration (one). Transperineal placement of 198Au is well tolerated and offers an alternative to external beam radiation for treatment of carcinoma of the prostate.