Interruption Of Radiation Therapy Research Articles

Towards an Explainable AI Platform to Study Interruptions in Cancer Radiation Therapy.

Radiation therapy interruptions drive cancer treatment failures; they represent an untapped opportunity for improving outcomes and narrowing treatment disparities. This research reports on the early development of the X-CART platform, which uses explainable AI to model cancer treatment outcome metrics based on high-dimensional associations with our local social determinants of health dataset to identify and explain causal pathways linking social disadvantage with increased radiation therapy interruptions.

Treatment Tolerance and Toxicity in Elderly Oropharyngeal Cancer Patients and Implication on Outcomes

To investigate the tolerance level and toxicity for standard of care treatment for oropharyngeal cancer (OP) in elderly patients and their impact on outcomes. Using our in-house head and neck cancer database, we looked for non-metastatic OP cases that received definitive treatment between 1/2009-6/2020. All patients received either definitive radiation therapy (RT) +/- concomitant systemic therapy (ST), or surgery followed by adjuvant RT or RT-ST. For the elderly (age at diagnosis ≥65 years) and young (<65 years) patients, we compared treatment package time (TPT) (time from surgery to RT conclusion) for adjuvant RT, total RT duration and unplanned RT interruptions. ST details and dose/protocol modifications were also compared. We evaluated worst grade of pain and mucositis, hospitalization for non-hydration causes and febrile neutropenia (FN) during RT. Feeding tube (FT) use and weight loss were compared. The independent effect of these indicators on locoregional (LRFS), distant (DRFS) recurrence free and overall (OS) survival was assessed using multivariate analyses (MVA). A cohort of 326 patients was included: 36% elderly (n = 118) and 64% young (n = 208), with no differences in AJCC stage distribution (8th), treatment received and HPV status (HPV+ve: 73% vs 74.6%; p = 0.86). In 23.6 % who received adjuvant RT, median TPT was 86 (range 72-128) and 81 (65-137) days for elderly vs young (p = 0.27); whereas in the definitive RT cases 76.4%, total RT duration was 49 days for both age groups. Overall, prescribed RT course was not completed in 4% and unplanned RT interruptions occurred in 22.8% and both were non-significant between age groups. Among the 261 patients that received ST, elderly utilized more cetuximab (26 vs 12%; p = 0.007). For those who received cisplatin, 20% of elderly had cumulative dose <200 mg/m2 compared to 6% among the younger age group (p = 0.006); and cisplatin was changed to carboplatin or cetuximab in 18% vs 8% (p = 0.019). Delayed/cancelled cycles and dose reductions were similar. There were more hospitalizations (47% vs 27%; p<0.001) and a trend for more FN (9% vs 3%; p = 0.09) with older age, while worst pain and mucositis was similar. FTs were used more in elderly patients (64% vs 50%; p = 0.02), for a median of 97 vs 64 days (p = 0.31); of which 19.5% vs 11% (p = 0.28) were inserted before RT start. However, % weight loss was non-significant. On MVA, longer RT duration, FT use and hospitalizations predicted worse LRFS and DRFS; and they were prognostic for OS in addition to TPT >90 days (p<0.05 for all). Nevertheless, elderly vs young had non-significant 3-year LRFS (91% vs 90% and 67% vs 69%), DRFS (86% vs 90% and 79% vs 81%) & OS (85% vs 81% and 39% vs 52%) for HPV+ve and HPV-ve respectively (p>0.05). Elderly patients with OP need more multi-disciplinary supportive care when receiving RT and concurrent ST. However, survival outcomes are equivalent to younger patients. Ongoing studies should enroll more elderly candidates and stratify endpoints with age.

Influence of interruptions in radiation therapy on long-term results of treatment of stage I-III head and neck cancers in the absence of surgical and chemoradiotherapy

Despite the fact that head and neck tumors are very sensitive to radiation treatment, patients who have completed a course of radiation therapy have a high rate of recurrence and mortality from the underlying disease.The aim of the study was to analyze the event-free survival of patients who completed a course of radiation therapy for stage I-III head and neck cancer according to a radical program under the influence of a number of independent factors such as age, gender, total focal dose, disease stage, duration of a break in a split course of radiation therapy.The effect of the duration of interruption on survival was assessed by analyzing the treatment regimens for patients who received radiation treatment for stage I-III head and neck cancer according to a radical program from 2016 to 2018 at the Brest Regional Oncological Dispensary. Statistical processing of the obtained data included the analysis by the Cox regression method. Data were analyzed using the Kaplan-Meier method to evaluate the outcome.In the multivariate analysis, it was found that the disease stage has the greatest relationship with event-free survival (p &lt; 0.01). The same trend is observed for the duration of interruption in radiotherapy (p &lt; 0.05). The cumulative survival was significantly higher in the group of patients with treatment interruption of less than 3 weeks compared to the group of patients who completed treatment more than 3 weeks apart (80.00 % vs 49.06 %). If the duration of the break is less than 3 weeks, the clinical stage (T1-T3) is not a factor influencing patient survival.Accounting for the effect of interruptions in the course of radiotherapy and the understanding the influence of controllable factors is essential for optimal treatment strategies.

Prospective study on the effect of topical honey on radiation-induced mucositis induced by concurrent chemotherapy and radiation or radiation alone given as radical or adjuvant treatment in head and neck squamous cell malignancies

Pain imparts additional morbidity and economic burden to patients by requiring parenteral analgesia, interruption of radiation therapy (RT) and/or hospitalization, and parenteral or tube feeding, all of which negatively impact patients' quality of life. There are various drugs tried to relieve pain associated with radiation-induced mucositis.&#x0D; The aim: The aim of the study is to evaluate the effect of the topical application of pure natural honey on radiation-induced mucositis in patients undergoing concurrent chemo-radiation or radiation alone for radical or adjuvant treatment for head and neck squamous cell malignancies.&#x0D; Materials and methods: It is a hospital-based prospective study enrolling patients with histopathologically proven head and neck cancers. All histopathologically proven patients of squamous cell carcinoma of Head &amp; Neck cancer (carcinoma of the oral cavity, oropharynx) receiving chemotherapy and radiotherapy or radiotherapy alone in the definitive or adjuvant setting and who meet our inclusion and exclusion criteria will be taken up as study group.&#x0D; Results: Mean age of patients was 49 years, most males 87 %. The oral cavity was the most common primary site (84 %), followed by the oropharynx (16 %). Most cases were locally advanced cancer stage IV (60 %). The set of mucositis is after 5 fractions in both study and control groups, but 89 % in the control group, compared to 33 % in the study group. On grade 3, mucositis is delayed in the study group compared to the control group, and no patients in the study group had grade 4 mucositis.&#x0D; Conclusions: All patients in the study developed mucositis. On the set of grade 3, mucositis is delayed in the study group compared to the control group, and no patients in the study group had grade 4 mucositis. Honey is effective in preventing grade 3 and 4 mucositis. Honey showed no effect on weight loss and oral infections in this study.

Time required for prophylactic oral care in head and neck cancer patients scheduled for radiotherapy: A single center, prospective cohort study.

Prophylactic oral care (POC) before radiotherapy (RT) is an adjunct but an integral process toward preparing patients for RT, however, time to be invested in POC remains unexplored. Prospective treatment records were maintained in head and neck cancer patients, who received POC following a standardized protocol with definite timelines. Data collected for oral treatment time (OTT), interruption in RT due to oro-dental issues, future extraction(s), and incidence of osteoradionecrosis (ORN) up to 18 months after treatment were analyzed. Three hundred thirty-three patients, 275 males and 58 females, mean age 52.45 ± 11.2 years were included. Mean OTT was 21.0 ± 6.2 days and was influenced significantly with the number of extractions (p < 0.00). There was no interruption in RT schedule due to oro-dental issues. Five patients were diagnosed with ORN. Performing POC as demonstrated aid in timely removal of nidus of infection(s), perform RT as scheduled, and maintain satisfactory oral health through the survivorship of patients.

Clinical Effect of Moisturized Skin Care on Radiation Dermatitis of Head and Neck Cancer.

Radiation therapy (RT) for head and neck cancer may cause severe radiation dermatitis (RD) resulting in RT interruption and affecting disease control. A few studies address skin moisture changes during RT for head and neck cancer. The purpose of this study was to explore the effect of moisturized skin care (MSC) on severity of RD. The study includes newly diagnosed head and neck cancer patients undergoing RT. Participants were divided into MSC group and routine skin care (RSC) group based on patient's preferred decision. Skin moisture in the four quadrants of the neck was measured weekly before and after RT. RD was assessed with the Radiation Induced Skin Reaction Assessment Scale (RISRAS) and the Radiation Therapy Oncology Group (RTOG) acute skin toxicity grading criteria. A total of 54 patients were enrolled, of which 49 patients were suitable for the statistical analysis. There was a statistically significant difference in the RISRAS total score since the 5th week after RT between the groups. The severity of RD was less (B=0.814, p=0.021) and the onset was later (B=-0.384, p=0.006) in the MSC group when compared to the RSC group. Skin moisture decreased with cumulative radiation dose. In the upper neck, the MSC group had a slower rate of skin moisture decrease compared to the RSC group (right upper neck: B=0.935, p=0.007; left upper neck: B=0.93, p=0.018). MSC can effectively reduce the severity and delay the onset of RD, while slows down skin moisture decrease during RT.

Independent Predictors for Hospitalization-Associated Radiation therapy Interruptions

PurposeRadiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and MaterialsThis retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. ResultsBetween January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P < .0001), and head and neck (OR: 5.6; 95% CI, 2.96-10.93; P < .0001) malignancies, and prescriptions >20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. ConclusionsHARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.

Quercetin Prevents Radiation-Induced Oral Mucositis by Upregulating BMI-1.

Radiation-induced oral mucositis is a major adverse event of radiotherapy. Severe oral mucositis may cause unwanted interruption in radiotherapy and reduce long-term survival in cancer patients receiving radiotherapy, but until now, there have been no effective options for preventing radiation-induced oral mucositis. Quercetin is a flavonoid that is widely found in food species and has anti-inflammatory, antioxidant, and anticancer activities. In this study, we investigated a new role of quercetin in preventing radiation-induced oral mucositis. Quercetin exerted preventive effects against radiation-induced oral mucositis induced by single-dose (25 Gy) ionizing radiation or fractionated ionizing radiation (8 Gy × 3) in C57BL/6 mice and maintained the proliferation ability of basal epithelial cells. Quercetin pretreatment alleviated reactive oxygen species generation, NF-κB pathway activation, and downstream proinflammatory cytokine production and reduced DNA double-strand breaks and cellular senescence induced by ionizing radiation. Quercetin also upregulated BMI-1 expression in oral epithelial cells and promoted ulcer repair. In addition, quercetin exerted similar radioprotective effects in irradiated primary cultured normal human keratinocytes, reduced reactive oxygen species generation and proinflammatory cytokine release, and promoted DNA double-strand break repair and wound healing by upregulating the expression of BMI-1, which is a polycomb group protein. Thus, quercetin can block multiple pathological processes of radiation-induced oral mucositis by targeting BMI-1 and may be a potential treatment option for preventing radiation-induced oral mucositis.

Status of radiotherapy staff during the coronavirus disease 2019 (COVID-19) epidemic in China.

ObjectiveIn December 2019, coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) broke out in Wuhan, China. The pandemic has posed a great challenge to radiation oncology departments, as interruptions in radiation therapy (RT) increase the risks of cancer recurrence or failure of the therapy as a whole. This study aimed to elucidate the impact of COVID‐19 on radiation therapy staff in China.MethodsAs many working staff at different radiation oncology departments in China as possible were retrospectively enrolled from 23 January to 9 March 2020. They were then invited to answer a questionnaire, for essential data collection, from which their basic information, anxiety level, and workload were analyzed.ResultsSeven (0.39%) of the 1 755 radiation therapy staff who answered the questionnaire had contracted COVID‐19, all of whom were from Wuhan. The factors influencing susceptibility were not sex (P = 1.000), age (P = 0.480), or comorbidities (P = 0.600), but geographic location (P < 0.001) and whether the respondent worked in a designated COVID‐19 hospital (P = 0.003). In terms of protection procedures, four participants carried out basic, one second‐level and two third‐level protection procedures. The difference was not statistically significant (P = 0.720). The infected respondents’ anxiety level related to the outbreak (average score 6.57) was higher than that of their counterparts in Wuhan (5.18), as well as across the country (4.79), and 71.43% of those infected expressed the need for psychological interventions. During the epidemic, departments of 428 respondents (24.39%) shut down, while 76.71% of the respondents reported workload reduction.ConclusionThe factors related to COVID‐19 infection were the geographic location and whether the respondent worked in a designated COVID‐19 hospital. The infected respondents experienced greater psychological pressure than their uninfected counterparts and, therefore, required more psychological interventions.

Emerging Cybersecurity Threats in Radiation Oncology

PurposeModern image guided radiation therapy is dependent on information technology and data storage applications that, like any other digital technology, are at risk from cyberattacks. Owing to a recent escalation in cyberattacks affecting radiation therapy treatments, the American Society for Radiation Oncology's Advances in Radiation Oncology is inaugurating a new special manuscript category devoted to cybersecurity issues. Methods and MaterialsWe conducted a review of emerging cybersecurity threats and a literature review of cyberattacks that affected radiation oncology practices. ResultsIn the last 10 years, numerous attacks have led to an interruption of radiation therapy for thousands of patients, and some of these catastrophic incidents have been described as being worse than the coronavirus disease of 2019 impact on centers in New Zealand. ConclusionsCybersecurity threats continue to evolve, making combatting these attacks more difficult for health care organizations and requiring a change in strategies, tactics, and culture around cyber security in health and radiation oncology. We recommend an assume breach mentality (threat-informed defense posture) and adopting a cloud-first and zero-trust security strategy. A reliance on computer-driven technology makes radiation oncology practices more vulnerable to cyberattacks. Health care providers should increase their resilience and cyber security maturity. The increase in the diversity of these attacks demands improved preparedness and collaboration between oncologic treatment centers both nationwide and internationally to protect patients.

Formulation of objective indices to quantify machine failure risk analysis for interruptions in radiotherapy.

ObjectivesTo evaluate the effect of interruption in radiotherapy due to machine failure in patients and medical institutions using machine failure risk analysis (MFRA).Material and methodsThe risk of machine failure during treatment is assigned to three scores (biological effect, B; occurrence, O; and cost of labor and repair parts, C) for each type of machine failure. The biological patient risk (BPR) and the economic institution risk (EIR) are calculated as the product of B and O (B×O) and C and O (C×O), respectively. The MFRA is performed in two linear accelerators (linacs).ResultThe multileaf collimator (MLC) fault has the highest BPR and second highest EIR. In particular, TrueBeam has a higher BPR and EIR for MLC failures. The total EIR in TrueBeam was significantly higher than that in Clinac iX. The minor interlock had the second highest BPR, whereas a smaller EIR. Meanwhile, the EIR for the LaserGuard fault was the highest, and that for the monitor chamber fault was the second highest. These machine failures occurred in TrueBeam. The BPR and EIR should be evaluated for each linac. Further, the sensitivity of the BPR, it decreased with higher T1/2 and α/β values. No relative difference is observed in the BPR for each machine failure when T1/2 and α/β were varied.ConclusionThe risk faced by patients and institutions in machine failure may be reduced using MFRA.Advances in knowledgeFor clinical radiotherapy, interruption can occur from unscheduled downtime with machine failures. Interruption causes sublethal damage repair. The current study evaluated the effect of interruption in radiotherapy owing to machine failure on patients and medical institutions using a new method, that is, machine failure risk analysis.

Cost-effectiveness randomized clinical trial on the effect of photobiomodulation therapy for prevention of radiotherapy-induced severe oral mucositis in a Brazilian cancer hospital setting.

This study aimed to assess the cost-effectiveness of photobiomodulation therapy (PBMT) in association with a Preventive Oral Care Program (POCP) compared with POCP alone in the treatment of radiotherapy (RT)-induced oral mucositis (OM). The cost-effectiveness was evaluated from the health provider perspective and conducted alongside a randomized, double-blind clinical trial. Participants were randomly assigned to either PBMT (n = 25) or control (n = 23) group. The PBMT group participants received PBMT associated with POCP. In the control group, patients were submitted to POCP alone. Costs were identified, quantified, and valued through observation and consultation of the hospital's financial sector database and estimated in Brazilian real and converted to international dollars using the purchasing power parity exchange rate. The incremental cost-effectiveness ratio (ICER) was estimated by considering the prevention of severe OM, interruption of RT, and oral health-related quality of life (OHRQoL) scores, measured by the OHIP-14 and patient-reported OM symptoms scale (PROMS). The incremental cost of PBMT was $857.35, and the cost per session was $25.69. The ICER was $ 2867.39 to avoid one case of severe OM and $ 2756.75 to prevent one interruption in RT due to OM. ICER to reduce 1 point in OHIP-14 and PROMS scores were $170.79 and $31.75, respectively. PBMT is more cost-effective than POCP alone in preventing severe OM, worsening of the OHRQoL, and RT interruptions. PBMT is a promising therapy, especially to avoid interruptions in oncological treatment. ReBEC-RBR-5h4y4n.

Location as Destiny: Identifying Geospatial Disparities in Radiation Treatment Interruption by Neighborhood, Race, and Insurance

Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities. All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as ≥5 unplanned RT appointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant. Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had ≥2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus commercial/Medicare insurance (22.5% vs 7.2%; P < .0001), low versus high predicted income (13.0% vs 5.9%; P < .0001), Black versus White race (12.0% vs 6.6%; P < .0001), and urban versus suburban treatment location (12.0% vs 6.3%; P < .0001). On multivariable analysis, increased odds of major RTI were seen for Medicaid patients (odds ratio [OR], 3.35; 95% confidence interval [CI], 2.25-5.00; P < .0001) versus those with commercial/Medicare insurance and for head and neck (OR, 3.74; 95% CI, 2.56-5.46; P < .0001), gynecologic (OR, 3.28; 95% CI, 2.09-5.15; P < .0001), and lung cancers (OR, 3.12; 95% CI, 1.96-4.97; P < .0001) compared with breast cancer. Major RTI was mapped to urban, majority Black, low-income neighborhoods and to rural, majority White, low-income regions. Radiation treatment interruption disproportionately affects financially and socially vulnerable patient populations and maps to high-poverty neighborhoods. Geospatial mapping affords an opportunity to correlate RT access on a neighborhood level to inform potential intervention strategies.

Premature discontinuation of curative radiation therapy: Insights from head and neck irradiation

PurposeFactors related to premature discontinuation of curative radiation therapy (PDCRT) are understudied. This study aimed to examine causes and clinical outcomes of PDCRT at our institution by investigating the most common anatomical site associated with PDCRT. Methods and materialsAmong the 161 patients with PDCRT of various anatomic sites at our institution between 2010 and 2017, 36% received radiation to the head and neck region. Pertinent demographic, clinical, and treatment-related data on these 58 patients were collected. Survival was examined using the life-table method and log-rank test. ResultsThe majority of patients were male (81%), white (67%), ≥60 years old (59%), living ≥10 miles away from the hospital (60%), single (57%), with Eastern Cooperative Oncology Group score ≥1 (86%), experiencing significant pain issues (67%), and had treatment interruptions in radiation therapy (RT; 66%). The most common reasons for PDCRT were discontinuation against medical advice (33%), medical comorbidity (24%), and RT toxicity (17%). Of the comorbidities leading to PDCRT, 50% was acute cardiopulmonary issues and 43% was infection. The mean follow-up time was 15.9 months, and the 2-year overall survival and disease-specific survival rates were 61% and 78%, respectively. Patients with illicit substance abuse, cardiovascular disease, and Eastern Cooperative Oncology Group score ≥2 had worse survival. A trend toward improved survival with total completed dose ≥50 Gy versus <50 Gy existed (74% versus 44%, respectively; P = .07). ConclusionsIn this largest-to-date, modern analysis of PDCRT, the most common cause of discontinuation was discontinuation against medical advice, which underscores the importance of patient education, optimization of RT symptoms, involvement of social work, and integration of other supportive services early in treatment. Survival remains suboptimal after PDCRT for H&N tumors, with a 2-year overall survival rate of 61%. Completing >50 Gy appears to confer a relative therapeutic benefit.

Effect of psychosocial distress on outcome for head and neck cancer patients undergoing radiation

To determine the impact of pretreatment psychosocial distress on compliance to radiation therapy (RT) and clinical outcomes for patients with head and neck cancer STUDY DESIGN: Self-reported responses to the mood and anxiety domains of the University of Washington Quality of Life instrument were reviewed among 133 patients with newly diagnosed head and neck cancer prior to initiating RT. Varying definitions were used (total number of unexpectedly missed RT days, >5 days continuous interruption of RT outside of weekends, >10 days continuous interruption of RT, and failure to complete prescribed course of RT) to analyze the effect of psychosocial disruption on compliance. Survival was determined using the Kaplan-Meier method. The prevalence of pretreatment depression and anxiety was 23% and 47%, respectively. Continuous RT breaks >5 days occurred in 46%, 33%, 10%, 9%, and 0% of patients whose mood was rated as "extremely depressed," "somewhat depressed," "neither in a good mood or depressed," "generally good," and "excellent," respectively (P = .0016). The corresponding proportion of patients who did not complete their planned RT was 23%, 11%, 5%, and 3%, and 0%, respectively (P = .043). The 2-year overall survival of patients who were "extremely depressed" or "somewhat depressed" at baseline was 71% versus 86% for all others (P = .026). Depression was independently associated with decreased overall survival on logistical regression analysis. Pretreatment depression predicted for decreased RT compliance and inferior survival for head and neck cancer. Additional research to overcome potential barriers to treatment in this setting may be warranted. 4. Laryngoscope, 128:641-645, 2018.

Adjuvant Chemotherapy Increases the Risk of Radiation Therapy Interruptions in Breast Cancer Patients

Adjuvant Chemotherapy Increases the Risk of Radiation Therapy Interruptions in Breast Cancer Patients

Anti-inflammation and anti-apoptosis effects of pearl extract gel on UVB irradiation HaCaT cells.

Caused by acute radiation skin reaction and injury, receiving radiotherapy treatment process is often performed side-effects on cancer patients. The clinical manifestations of skin irritation, itching, peeling, pigmentation, ulcer bleeding and other symptoms, in addition to causing patient discomfort and affecting quality of life, may increase the risk of local or systemic infection, and lead to interruption of radiation therapy. At present, for acute radiation dermatitis, there is no uniform treatment, and the various methods are evaluated variously. In this study, the authors focus on broken pearls using room temperature super extraction system, the water extraction process of wet-grinding method, nano-scale pearl, along with a large number of high purity natural amino acid extracts in the water. The room-temperature super-extraction system (RTSES) can be extracted from a relatively high-volume of pearl extract. We use pearl extract as the main component of experimental material, and the blending of pearl extract and poly (γ-glutamic acid) is used to form biodegradable composite hydrogels. This study aims to evaluate the use of RTSES to extract the major active components of pearl and enhance their anti-inflammation and anti-apoptosis effects. The possible effect of pearl extract on inducing apoptosis in human keratinocyte cells (HaCaT) under the exposure of low dose UVB has been investigated. Various concentrations of pearl extracts have been used to study the effect of low dosage UVB on HaCaT cells. The results show that pearl extract has no toxic effect on HaCaT cells. Combining the pearl extract and poly (γ-glutamic acid) hydrogels with UVB irradiation would decrease the inflammation and apoptosis of HaCaT cells. The commercial pearl extract has the potential to inhibit radiation dermatitis occurring within keratinocyte cells.

The emerging outcome of postoperative radiotherapy for stage IIIA(N2) non-small cell lung cancer patients: based on the three-dimensional conformal radiotherapy technique and institutional standard clinical target volume.

BackgroundThe aim of this study was to evaluate the clinical efficacy of postoperative radiotherapy (PORT), administered using three-dimensional conformal radiotherapy (3D-CRT) and our institutional standard clinical target volume (CTV) delineation, for completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC).MethodsFrom 2005 to 2012, consecutive patients with pT1-3N2 NSCLC who were treated with PORT employing our institutional CTV delineation after complete surgery or who underwent complete resection in our hospital but without PORT were identified. We excluded patients who had received neoadjuvant chemotherapy or radiation therapy (RT). Kaplan-Meier estimates for locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were performed. In the OS estimation, patients who received epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) during follow-up were censored at the time of TKI initiation.ResultsData from 70 patients in the PORT group and 287 in the non-PORT group were analysed. All 70 cases received 3D-CRT following our institutional CTV guideline, with a median total dose of 50.4 Gy at 1.8 Gy/fraction. At a median follow-up of 34.3 months for the PORT group and 31.2 months for the non-PORT group, PORT significantly improved local control (5-yr LRFS 91.9% for PORT vs 66.4% for non-PORT, P < 0.001) and OS (5-yr OS 57.5% for PORT vs 35.1% for non-PORT, P = 0.003), whereas no differences in DMFS were noted (P = 0.18). In multivariable analyses, PORT was independently associated with an improved LRFS (HR 0.2, P = 0.001) and OS (HR 0.4, P = 0.001). All patients completed the planned RT dose without interruption of RT due to treatment-related complications.ConclusionsOur data suggested that PORT administered using the 3D-CRT technique following our institutional CTV delineation guideline resulted in a promising outcome with favourable survival for completely resected IIIA(N2) NSCLC, after controlling for subsequent EGFR-TKI confounding in the OS analysis. Prospective trials are needed to further corroborate these results.

Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review.

The present review aimed to define the role of nutritional interventions in the prevention and treatment of malnutrition in HNC patients undergoing CRT as well as their impact on CRT-related toxicity and survival. Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Nutritional counseling (NC) and oral nutritional supplements (ONS) should be used to increase dietary intake and to prevent therapy-associated weight loss and interruption of radiation therapy. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube. However, it seems that there is not sufficient evidence to determine the optimal method of enteral feeding. Prophylactic feeding through nasogastric tube or percutaneous gastrostomy to prevent weight loss, reduce dehydration and hospitalizations, and avoid treatment breaks has become relatively common. Compared to reactive feeding (patients are supported with oral nutritional supplements and when it is impossible to maintain nutritional requirements enteral feeding via a NGT or PEG is started), prophylactic feeding does not offer advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy.

SEM and bond strength evaluation of adaptation between liners-composites

Purpose: This study was conducted to determine whether oral care and low-intensity laser therapy (LILT) can reduce the rates of discontinuation of anticancer treatment. Approximately 870,000 new cases of malignant airway and digestive tract tumors are diagnosed annually worldwide. Patients undergoing radiotherapy (RT) for head and neck cancers develop oral mucositis (OM) and other complications as side effects that can lead to discontinuation of anticancer treatment. Methods and materials: We selected patients with carcinoma of the head and neck who underwent radiotherapy with or without chemotherapy (CT) in the Sao Vicente de Paulo Hospital, Passo Fundo, Brazil. A total of 187 patients were evaluated and divided into two groups: Group I (patients receiving oral care) and Group II (patients not receiving oral care). The patients in Group I were subjected to daily assessments, received guidance, and followed a protocol for dental treatment and adjuvant application of LILT throughout the period they performed RT. The patients in Group II were evaluated and followed but did not receive the proposed treatment. Results: A total of 187 patients were included in this study: 144 males (77%) and 43 females (23%). The mean age was 59.9± 12.9 (13–95 years). One-hundred-and-twentyfive patients were included in Group I, and 62 patients were included in Group II. High scores for pain and OM were observed in the patients belonging to group II. Three (2.4%) of the patients in Group I (125 patients) presented an interruption in RT, whereas 20 (34.6%) of the patients in Group II (62 patients) presented an interruption in RT induced by intercurrences, such as pain, dehydration, severe OM, immunity and death (p<0.001). The group that received LILT (Group I) presented a lower rate of antineoplastic treatment interruption compared with Group II (p<0.001). Conclusion: The prevention and early treatment of complications related to RT, such as oral mucositis, can decrease the likelihood that the patient will abandon radiotherapy and consequently contributes to improved prognosis for healing and patient survival.