Patients Received Radiation Doses Research Articles

Adherence of Candida Species Isolated from Patients with Head and Neck Cancer Presented for Radiation Therapy and its Correlation with Hemogram

The objective of the current study was to quantify the adherence property of Candida species causing infections in head and neck cancer patients on radiation therapy (RT) or chemoradiotherapy (CRT). Additionally, the study aimed to establish a correlation between adherence properties and patients’ hemograms. A prospective cohort study was done on head and neck cancer (HNC) patients with oropharyngeal candidiasis. All patients received radiation doses ranging from 60 to 70 Gy using Intensity Modulated Radiation Therapy. Inoperable patients received concurrent chemotherapy with cisplatin 40mg/m2 once weekly during the course of RT. Swabs were collected from patients with signs and symptoms of candidiasis and microbiological confirmation and speciation were done according to standard protocol. An in vitro adherence test was done. Hemogram of all the patients at the start of infection was compared with the adherence. Candidiasis was detected in 58(35.3%) out of a total of 164 patients (Age 36-85). Candida albicans was the most prevalent 39(67.2%) species isolated. C.albicans showed the highest adherence which was statistically significant. The hemogram at the start of treatment and with C. albicans infection showed a statistically significant decrease in the absolute lymphocyte count (p-value 0.0001), RBC count (p-value 0.004) and haemoglobin level (p-value 0.003). Less adherence was seen with non-albicans Candida infection when compared to C.albicans (Odds 0.894, 95% CI -0.818-0.977), significant at 5 % (0.013). C. albicans showed significant adherence, which indicates the severity of infection. The occurrence of oral candidiasis is strongly associated with low lymphocyte count and severity of mucositis. Absolute lymphocyte count needs to be monitored in HNC patients who are undergoing RT or CRT.

Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy.

Keloid is a benign tumor with high recurrence rate; accordingly, complete surgical excision with adjuvant radiotherapy is one of the most effective treatments. This study reviewed outcomes of keloid patients receiving surgery and adjuvant radiotherapy in Kaohsiung Medical University Hospital. All patients received radiation dose with 15 Gy, with their first radiotherapy within 24 hours after surgical excision. The end points were recurrence rate and local recurrence-free interval (LRFI), defined clinically as palpable gross tumor over the treatment site and duration from the last day of radiotherapy to disease recurrence. From May 2017 to July 2020, 32 patients with 40 keloid lesions were included. The mean age for these patients was 37.6 years, and the median follow-up time was 15.3 months. The overall recurrence rate was 52.5%, and the median LRFI was 9.7 months. Recurrence rates for males and females were 46.7% and 56% ( P = 0.567), respectively; for head and ear, chest, shoulder and upper extremities, and abdomen and back were 12.5%, 61.5%, 63.6%, and 62.5% ( P = 0.093); for lesions over 20 cm 2 and below 20 cm 2 were 62.5% and 50% ( P = 0.527); and for megavoltage electron beam and kilovoltage photon beam were 56.7% and 40% ( P = 0.361), respectively. Patients were further classified into 2 groups by lesion sites, which showed lower recurrence rate ( P = 0.011) and longer LRFI ( P = 0.028) with lesions over the head and ear than other sites. We found that lesion site might be a prognostic factor for keloid recurrence. Adjuvant radiation dose escalation for high-recurrence risk areas (other than the head and ear) might be required.

CT-505 Fractionated Total Body Irradiation and Fludarabine Based Conditioning Regimen With Post-Transplant Cyclophosphamide (PTCy) for Mismatched Related and Unrelated Donors HCT for Acute Leukemia and MDS

Allogeneic hematopoietic cell transplantation (HCT) remains the only curable treatment option for malignant hematological disorders. Conditioning regimen and GVL are both important in preventing graft rejection, relapses and GVHD. Choice of regimen depends on the diagnosis, patient characteristic, donor type, disease status and graft source. We present the outcome of patients undergoing FTBI/Fludarabine myeloablative conditioning for mismatched (related or unrelated) donor HCT and PTCy as GVHD prophylaxis. We plan to assess toxicity, outcomes and feasibility of this regimen. To evaluate HCT outcomes in patients undergoing mismatched (related and unrelated) donor transplantation with FTBI/ fludarabine based regimen with posttransplant cyclophosphamide (PTCy). Retrospective design. Single academic center. 155 patients underwent conditioning with FTBI/fludarabine with PTCy-based GVHD prophylaxis for hematologic malignancy at City of Hope from January 2015 to December 2021. All patients received radiation dose ≥ 1200 cGy with fludarabine and GVHD prophylaxis with PTCy 50 mg/kg on days +3 and +4, mycophenolate mofetil (MMF) on days +5 to +35, and tacrolimus or sirolimus started on day +5. Using EMRs, detailed information was obtained on baseline demographics, disease and transplantation characteristics like donor type, CMV status, ABO compatibility, acute & chronic GVHD and relapse data. The primary study outcome is overall survival. Secondary outcomes are GRFS, NRM, relapse, aGVHD, cGVHD and DFS. One hundred and fifty-five patients with median age of 38 (range 9-60) received FTBI/fludarabine based conditioning with PTCy. 56.8% of patients were male and 97.5% had a Karnofsky performance status ≥ 80 with a HCT comorbidity index ≥ 3 in 36.1% cases. The main reason for transplantation was ALL (46.5% cases) and AML (36.1%cases). The median donor age was 31 with 67.1% haplo donors & 32.9% mismatched unrelated. With a median follow-up of 24 months (range: 3 to 81), 100-day NRM was 1.9%, 2-year relapse rate was 11.8%, 2-year OS was 80.1%, and DFS 76.9%. FTBI/ fludarabine is well tolerated MAC regimen in mismatched donors with leukemia and MDS with low transplant related mortality and good outcomes. The study shows FTBI/fludarabine based conditioning regimen as a promising regimen which needs to be studied in future prospective randomized trials.

Patterns of Care and Treatment Pathways for Non-Surgically Managed Early and Locally Advanced Non-Small Cell Lung Cancer Patients at Ain Shams University Clinical Oncology Department: a Retrospective and Descriptive Analysis

Abstract Background Lung cancer is the leading cause of cancer death worldwide, but little is known about how patients with this disease are managed. Aim of the Work We aim to study patterns of care and treatment pathways of non- surgically managed early and locally advanced NSCLC patients from January 2015 to December 2018 in Ain Shams University Clinical Oncology Department. Patients and Methods In this retrospective analysis we included patients the met the following criteria; age >18, histologically confirmed NSCLC patients whom didn’t undergo surgical resection with at least 6 months of follow up data. We collected data from Clinical Oncology department archive in Ain Shams university hospital. Our primary objective is to identify the patterns of care and treatment pathway for non surgically managed NSCLC patients in ASUCOD from January 2015 to December 2018. Results 86 patients finally met our inclusion criteria. Median age at diagnosis of 61 years with a range of (38-85), 95.3% were male. Most of the patients were stage III; 40.7% were stage IIIA, 41.9% were stage IIIB, and 9.3% were stage IIIC. 41 were treated radically, 37 received palliative treatment and only 8 patients received supportive care. Overall median progression free survival in our patients was 9.23 (7.4-13.5) and overall survival duration was13.4 (9.5-18.0). In radically treated patients, 68.3% received sequential chemoradiotherapy (sCRT), 29.2% received concurrent chemoradiotherapy (cCRT) or 2.4% received definitive radiotherapy alone (RT). In palliative treated patients, 73% received chemotherapy alone (CTX), 8.1% received palliative RT and 18.9% received both chemotherapy and palliative dose of radiotherapy (CRT). All treatment modalities were similar regarding median progression free survival and overall survival durations, 17.5 (3.6–19.6) and 20.6 (3.6–31.6) in cCRT, 17.5 (3.6–19.6) and 23.3 (17.7–31.2) in sCRT, 12.9 and 13.4 RT group, P value=0.57 and 0.16 receptively. Similarly, progression free survival and overall survival durations were 8.8 (3.0–15.8) and 16.2 (3.6–18.7) in CRT, 5.3 (0.4–7.6) and 8.6 (6.2–10.2) in CTX, 8.5 (0.4–8.5) and 8.5 (0.4–8.5) in palliative RT group, P value=0.64 and 0.15 receptively. In our study, first-line chemotherapy were Gemcitabine plus Cisplatin (41.9%) or Carboplatin (35.1%).The Second -line chemotherapy were Docetaxel (63.1%) or Paclitaxel plus Carboplatin (26.3%). Paclitaxel plus Carboplatin were the most regimen given with RT. Most of the patients received radiation dose of 60Gy/30Fr (73.2%). Regarding the incidence of toxicity, there were significant high rates of esophagitis in cCRT in grade 3 or more compared to sCRT. Conclusion We have found that less than half of this study population were treated radically while the other half received palliative treatment. And only few patients received best supportive care. Radically treated patients had higher progression free survival and overall survival durations compared to palliative and supportive treatment.

Local treatment of metastases plus systemic chemotherapy on overall survival of patients with metastatic nasopharyngeal carcinoma.

BackgroundTo investigate the effect of local treatment of metastases on overall survival (OS) of patients with metastatic nasopharyngeal carcinoma (NPC).MethodsOne hundred and forty‐seven patients were included. The association between local treatment and OS was examined with propensity score matching (PSM) method.ResultsIn entire cohort, the median OS was significantly longer in patients with local treatment of metastases plus chemotherapy compared to those with chemotherapy alone (71.7 vs. 16.2 months; p < 0.001). In PSM cohort, similar OS benefit of patients with local treatment was observed (55.6 vs. 17.6 months; p = 0.011). The survival benefit of local treatment remained regardless of the number of metastatic lesions and metastatic sites. Patients received radiation doses of >60 Gy had longer OS than those who received less.ConclusionsLocal treatment of metastases could improve OS of patients with metastatic NPC and could be considered in their treatment in addition to chemotherapy.

The Contribution of Intensity-Modulated Radiotherapy after Non-curative Intent Surgery for Head and Neck Adenoid Cystic Carcinoma

Incomplete surgery (gross total resection, near total resection, and subtotal resection) of head and neck adenoid cystic carcinoma (HNACC) is controversially considered as an unfavorable prognostic factor as to curative intent surgery (CIS). However, in Intensity-Modulated Radiotherapy (RT) era, after planed incomplete surgery (PIS), intensified RT or RT with concurrent chemotherapy (CCT) may contribute to tumor control and survival. Thus, we investigated the contribution of IMRT after PIS on local control and survival in HNACC. Retrospective review was performed for 170 consecutive patients with HNACC treated with curative postoperative IMRT with or without concurrent chemotherapy, between 2015 and 2018, after PIS (n = 102) or CIS (n = 68). All plan target volumes were designed to including the primary tumor and related cranial nerve pathway. Patients with other malignant tumors or distant metastasis were excluded. Among the 170 patients (98 women and 72 men; median age, 53 years), the median follow-up time was 27.8 (range, 9.6-59.1) months. The estimated 3-year local-regional recurrence-free survival (LRRFS) rate, progression-free survival (PFS) rate, overall survival (OS) rate, and distant metastasis-free survival (DMFS) rate were 92.4% (95%CI: 87.3-95.9), 74.7% (95%CI: 67.5-81.0), 98.5% (95%CI: 94.9-99.6), and 76.0% (95%CI: 68.7-82.1), respectively. Patients with high grade, Ki-67≥10%, Stage III-IV, extra-nodal extension (ENE), perineural invasion (PNI) and positive margin was associated with worse PFS (p<0.0001, p = 0.002, p = 0.003, and p = 0.0004, p = 0.042, and p = 0.021, respectively). The baseline and treatment characteristics were equally distributed between PIS and CIS group, except that there were more patients with positive margin and received RT dose≥66 Gy in PIS group (p = 0.000 and p = 0.000). There was no difference in LRRFS, DFS, OS, and DMFS between two groups, both in stage I-II and Stage III-IV (p = 0.280, p = 0.371, p = 0.752, and p = 0.549, respectively). Among patients with high grade, Ki-67≥10%, ENE or PNI, there was also no difference in PFS between two groups. Among patients received radiation dose<66Gy, PIS group patients had significant worse PFS (p = 0.029), while among patients without any CCT, PIS group patients had marginal significant worse PFS (p = 0.067). In IMRT era, PIS does not compromise oncologic treatment, even in patients with worse prognostic factors; however, Doses of ≥66 Gy or CCT might be essential. This strategy warrants further evaluation in prospective randomized trials with longer follow-up.

Vestibular Schwannoma Tumor Size Is Associated With Acute Vestibular Symptoms After Gamma Knife Therapy

To assess how pretreatment vestibular schwannoma (VS) tumor characteristics are associated with vestibular symptoms after gamma knife (GK) surgery. Retrospective chart review of patients undergoing GK treatment for VS at our institution from 2005 to 2018. Academic tertiary referral center. Patients receiving primary GK surgery for vestibular schwannomas with at least 6 months of follow up. Patients with neurofibromatosis 2 or previous surgery were excluded. The presence of posttreatment vestibular symptoms within 6 months after GK. Clinical records were assessed for pretreatment tumor, patient, and treatment characteristics that impacted posttreatment symptoms. All patients received radiation doses between 12 and 13 Gy. Of 115 patients, the average age was 60. Thirty-seven (32%) patients developed vestibular symptoms within 6 months post-GK, and 18 patients were referred for vestibular rehabilitation. Ten of 13 patients undergoing vestibular rehabilitation reported improvement. Overall, 112 patients had tumor measurements. Pretreatment tumors were significantly smaller for patients with acute vestibular symptoms (mean 1.43 cm versus 1.71 cm, p = 0.007). On multivariate analysis, smaller tumor size (p = 0.009, odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12-0.73]) was significantly associated with vestibular symptoms within 6 months of GK. Patients with tumors less than 1.6 cm were more likely to receive referrals for vestibular rehabilitation within 6 months posttreatment (25% versus 9.4%, p = 0.026, OR = 3.22, 95% CI [1.00, 11.32]). Smaller vestibular schwannomas were significantly associated with higher rates of post-GK vestibular symptoms. Pretreatment tumor size may be used to counsel patients on the likelihood of post-GK vestibular symptoms and vestibular rehabilitation.

Clinical Predictors of Laryngeal Preservation Rate in Stage III-IV Laryngeal Cancer and Hypopharyngeal Cancer Patients Treated with Organ Preservation

Purpose:To determine factors affecting laryngeal preservation rate in laryngeal and hypopharyngeal cancer patients treated with organ preservation.Material and Methods:Retrospective study examining stage III to IV laryngeal and hypopharyngeal cancer patients who have been treated with organ preservation. Conventional radiation must be applied in all patients with minimum dose of 45 Gray. Weekly or triweekly chemotherapy can be adding during radiation. Salvage surgery should be considered in residual disease or local recurrence. Kaplan-Meier was used for survival analysis and, Log rank test and Cox proportional hazard test were used for uni and multivariate analysis.Results:From January 2010 to October 2014, there were 69 patients treated with laryngeal preservation and 53 patients received radiation dose 61-70 Gray. After completing radiation, we found that 44 patients have no residual tumor within 6 months and 33 patients can preserve their functional larynx later with complete response (median follow up 6 mo, range 0-46.3 mo). The 1-year, 2-year and 3-year laryngeal preservation rate was 49%, 36 % and 32 % respectively. On univariate analysis, lower nodal stage (p = 0.008), stage III disease (p = 0.046), tumor volume <10 ml (p = 0.005), no true vocal cord involvement (p = 0.016), dose 61-70 Gray (p < 0.001) and no interruption of treatment (p = 0.017) have better laryngeal preservation rates. ECOG performance status 2, higher nodal stage, stage IV, presence of true vocal cord involvement, upper airway obstruction before/during radiation and radiation dose below 61-70 Gray had an effect on worse overall survival when evaluated with univariate analysis statistical significance. Conclusion:For factors that affected laryngeal preservation in our study were nodal stage, group stage, tumor volume, true vocal cord involvement, radiation dose and treatment break time more than one week with statistical significance.

Safety and Effectiveness of De-escalated Radiation Dose in T1-3 Nasopharyngeal Carcinoma: A Propensity Matched Analysis.

Backgrounds: With the excellent local control in T1 to T3 nasopharyngeal carcinoma (NPC) treated with intensity modulated radiotherapy (IMRT), the importance of toxicities is increasingly being recognised. This retrospective propensity score analysis sought to assess whether moderate dose reduction compromised long-term outcome compared with standard dose in T1-3 NPCs.Materials and Methods: A total of 266 patients (67 female, 199 male) with a median age of 50 years between June 2011 and June 2015 were analysed. All were treated with IMRT, with or without systemic chemotherapy. The prescription radiation dose to gross tumor is 70Gy/2.12Gy/33F in our institution.Results: With a median follow-up time of 50 months, the 5-year loco-regional failure-free survival (LRFS) and overall survival (OS) were 93.5% and 81.8%, respectively. 32 patients received radiation dose less than prescription dose, with a median dose of 63.6Gy (53-67Gy). Another 234 patients received exactly the prescription dose of 70Gy. Propensity scores were computed (32 patients treated with de-escalated dose and 64 patients with standard dose), there was no significant difference in 5-year LRFS and 5-year OS between the two groups (92.5% and 91.7% with standard dose; 82.1% and 85.7% with de-escalation dose; p=0.863 for LRFS and 0.869 for OS). No independent prognostic factor was associated with loco-regional failure in univariate analysis.Conclusions: T1-3 nasopharyngeal carcinoma presenting with superior locoregional control, a moderately reduced dose (about 10%) delivered with IMRT resulted in comparable prognosis to those with prescription dose of 70Gy.

Prognostic biological factors of radiation pneumonitis after stereotactic body radiation therapy combined with pulmonary perfusion imaging

Radiation pneumonitis (RP) is one of the most common dose-limiting toxicity syndromes in patients with thoracic malignant tumors receiving radiotherapy. The present study aimed to identify biological factors for the prediction of RP. Pulmonary perfusion imaging is capable of reflecting the differential functional activity of various regions of the lung, and in the present study, radiotherapy plans that were established on the basis that pulmonary perfusion images have high biological conformality, which may identify regions vulnerable to RP to spare them from radiation. A total of 46 patients with non-small cell lung cancer (NSCLC), exhibiting high and low levels of apurinic/apyrimidinic endonuclease-1 (Ape-1), intercellular adhesion molecule (ICAM)-1 and interleukin (IL)-17A prior to treatment, with SBRT with respective cut-off values of 4.2, 3.0 and 5.1 µg/l were stratified into groups A and B. Patients received radiation doses within the margin of the planning target volume. Stereotactic body radiation therapy (SBRT) was used for the treatment of NSCLC and single-photon emission computed tomography pulmonary perfusion imaging was used to assess all patients for the presence of RP. Furthermore, the serum levels of Ape-1, ICAM-1 and IL-17A were examined by ELISA. Prior to SBRT, perfusion images indicated that no RP was present in any of the patients, and 23 patients had high levels of Ape-1, ICAM-1 and IL-17A. After SBRT, 22 out of 23 patients in group A (95.65%) presented with RP and 1 patient (4.35%) had no RP. In group B, 6 out of 23 patients (26.09%) had RP and 17 patients (73.91%) had no RP after SBRT. The difference between the two groups in the incidence of RP was significant (P=1.66×10-12 <0.05). In conclusion, high levels of Ape-1, ICAM-1 and IL-17A are associated with an increased risk of RP. A further analysis should be performed in the future to verify whether these factors have significant prognostic value.

Patient Radiation Dose in Neurointerventional Radiologic Procedure: A Tertiary Care Experience.

PurposeNeurointerventional radiology procedures often require a long time to perform. Patient radiation dose is an important issue due to the hazards of ionizing radiation. The objective of this study was to measure the peak skin dose (PSD) and effective dose to estimate the deterministic and stochastic effects of a therapeutic interventional neuroradiologic procedure.Materials and MethodsThe cumulative dose (CD) and dose area product (DAP) were automatically recorded by a fluoroscopic machine and collected prospectively between April and November 2015. The study included 54 patients who underwent therapeutic neurointerventional radiology procedures. The CD of each patient was used to estimate the peak skin dose and the DAP was also calculated to estimate the effective dose.ResultsThe average estimated peak skin dose was 1,009.68 mGy. Two patients received radiation doses of more than 2 Gy, which is the threshold that may cause skin complications and radiation-induced cataract. The average effective dose was 35.32 mSv. The majority of patients in this study (85.2%) who underwent therapeutic neurointerventional radiologic procedures received effective doses greater than 20 mSv.ConclusionNot all therapeutic neurointerventional radiology procedures are safe from deterministic complications. A small number of patients received doses above the threshold for skin complications and radiation induced cataract. In terms of stochastic complications, most neurointerventional radiology procedures in this study were quite safe in terms of radiation-induced cancer.

Role of stereotactic body radiation therapy in patients with hepatocellular carcinoma extensively pretreated with transarterial chemoembolization or yttrium-90.

233 Background: Hepatocellular carcinoma (HCC) is an aggressive disease with dismal outcomes. Patients who are not surgical candidates are routinely treated with local therapies such as TACE, Y90, or SRBT among others. The study aimed to assess treatment response and treatment related toxicity to SBRT in patients who received prior TACE or Y90 at our institution, some of whom subsequently underwent orthotopic liver transplantation. Methods: IRB approval was obtained to retrospectively review 26 medical records of patients who received SBRT at the Loyola University Medical Center from 9/9/14-12/28/16. GI toxicities were analyzed using the Common Terminology Criteria for Adverse Events (CTAE) version 4.0 following SBRT. Skin, pharyngeal/esophageal, thorax, lung, GU, and GI toxicities were included in toxicity analysis. Patients received radiation dose from 36 Gy - 50 Gy in 5 fractions using RTOG 1112 dose constraints for dosimetric plan evaluation. Fisher’s exact tests and Wilcoxon Rank Sum tests were used for statistical analysis. Results: Of the 26 patients, 21 patients had prior TACE (median 3 TACE procedures; ranging from 1-5). 6 patients had prior Y90 with or without prior TACE. Median follow up for the cohort was 51 weeks. No patient showed GI toxicities above grade 1 during SBRT, with fatigue and nausea being the most common. One patient who previously received Y90 developed fatal duodenal perforation. Pathology demonstrated this was related to tumor infiltration of the duodenum and was not related to post radiation necrosis. 6 patients went on to undergo OLT with all patients having treatment response on surgical pathology with 4 patients having complete treatment response. Conclusions: SBRT was shown to safely treat patients after prior therapies including Y90 and TACE. Furthermore, SBRT showed favorable outcomes in post-OLT patients. To our knowledge, this is the first study to assess the effects of SBRT following extensive local therapies for HCC including Y90. Prospective data is needed to evaluate these findings further with longer follow up.

Continuous Effect of Radial Resection Margin on Recurrence and Survival in Rectal Cancer Patients Who Receive Preoperative Chemoradiation and Curative Surgery: A Multicenter Retrospective Analysis

To elucidate the proper length and prognostic value of resection margins in rectal cancer patients who received preoperative chemoradiotherapy (CRT) followed by curative total mesorectal excision (TME). A total of 1476 rectal cancer patients staging cT3-4N0-2M0 were analyzed. All patients received radiation dose of 50.4Gy in 28 fractions with concurrent 5-fluorouracil or capecitabine. Total mesorectal excision was performed 4 to 8weeks after radiation therapy. The recurrence-free survival (RFS) at 5years showed a significant difference between 3 groups: patients with circumferential resection margin (CRM) ≤1mm, CRM 1.1 to 5mm, and CRM >5mm (46.2% vs 68.6% vs 77.5%, P<.001). Patients with CRM ≤1mm showed a significantly higher cumulative incidence of locoregional recurrence (P<.001) and distant metastasis (P<.001) at 5years compared with the other 2 groups. Patients with CRM 1.1 to 5mm showed a significantly higher cumulative incidence of distant metastasis (P<.001), but not locoregional recurrence (P=.192), compared with those with CRM >5mm. Distal resection margin (≤5 vs>5mm) did not show any significant difference in cumulative incidence of locoregional recurrence (P=.310) and distant metastasis (P=.926). Rectal cancer patients with CRM ≤1mm are a high-risk group, with the lowest RFS. Patients with CRM 1.1 to 5mm may be at intermediate risk, with moderately increased distant recurrence. Distal resection margin was not significantly associated with RFS in rectal cancer after neoadjuvant CRT and total mesorectal excision.

The survival outcomes and prognosis of stage IV non-small-cell lung cancer treated with thoracic three-dimensional radiotherapy combined with chemotherapy.

BackgroundThe impact of thoracic three-dimensional radiotherapy on the prognosis for stage IV non-small-cell lung cancer is unclear. This study is to investigate survival outcomes and prognosis in patients with stage IV non-small cell lung cancer (NSCLC) treated with thoracic three-dimensional radiotherapy and systemic chemotherapy.MethodsNinety three patients with stage IV NSCLC had received at least four cycles of chemotherapy and thoracic three-dimensional radiotherapy of ≥40 Gy on primary tumors. The data from these patients were retrospectively analyzed.ResultsOf the 93 patients, the median survival time (MST) was 14.0 months, and the 1, 2, and 3-year survival rates were 54.8%, 20.4%, and 12.9%, respectively. The MST of patients received radiation dose to primary tumor ≥63Gy and <63 Gy for primary tumor were 15.0 and 8.0 months, respectively (P = 0.001). Patients had metastasis to a single site and lower tumor volume (<170 cm3) also produced longer overall survival time (P = 0.002, P = 0.020, respectively). For patients with metastasis at a single site, thoracic radiation dose ≥63 Gy remained a prognostic factor for better overall survival (P = 0.030); patients with metastases at multiple sites, radiation dose ≥63 Gy had a trend to improve overall survival (P = 0.062). A multivariate analysis showed that radiation dose ≥63 Gy (P = 0.017) and metastasis to a single site (P = 0.038) are associated with better overall survival, and the volume of primary tumor was marginally correlated with OS (P = 0.054).ConclusionsIn combination with systemic chemotherapy, radiation dose ≥63 Gy on primary tumor and metastasis to a single site are significant factors for better OS, aggressive thoracic radiotherapy may have an important role in improving OS.

Tumor induction in mice after local irradiation with single doses of either carbon-ion beams or gamma rays

Purpose: To determine the dose-dependent relative biological effectiveness (RBE) for tumor prevalence in mice receiving single localized doses to their right leg of either carbon ions (15, 45 or 75 keV/μm) or 137Cs gamma rays.Methods and materials: A total of 1647 female C3H mice were irradiated to their hind legs with a localized dose of either reference gamma rays or 15, 45 or 75 keV/μm carbon-ion beams. Irradiated mice were evaluated for tumors twice a month during their three-year life span, and the dimensions of any tumors found were measured with a caliper. The tumor induction frequency was calculated by Kaplan-Meier analysis.Results: The incidence of tumors from 50 Gy of 45 keV/μm carbon ions was marginally higher than those from 50 Gy of gamma rays. However, 60 Gy of 15 keV/μm carbon ions induced significantly fewer tumors than did gamma rays. RBE values of 0.87 + 0.12, 1.29 + 0.08 or 2.06 + 0.39 for lifetime tumorigenesis were calculated for 15, 45 or 75 keV/μm carbon-ion beams, respectively. Fibrosarcoma predominated, with no Linear Energy Transfer (LET)-dependent differences in the tumor histology. Experiments measuring the late effect of leg skin shrinkage suggested that the carcinogenic damage of 15 keV/μm carbon ions would be less than that of gamma rays.Conclusions: We conclude that patients receiving radiation doses to their normal tissues would face less risk of secondary tumor induction by carbon ions of intermediate LET values compared to equivalent doses of photons.

Do inflammatory bowel disease patients experience more toxicity after radiotherapy for colorectal and anal cancer?

570 Background: Despite potential oncologic gains from using radiotherapy in patients with inflammatory bowel disease (IBD), it has historically been contraindicated due to increased acute gastrointestinal (GI) toxicity. Yet recent published literature is mixed with regards to toxicity outcomes in these patients. In this study, we examine GI, genitourinary (GU), and skin toxicity in IBD patients compared to non-IBD patients both treated with external beam radiation therapy (EBRT) for anal or colorectal cancer (CRC). Methods: Anal and CRC patients who received EBRT were included in this single institutional IRB-approved study. 15 IBD patients and 30 non-IBD patients were matched 1:2 based on age (±5 years), treatment year (±1 year), BMI (±10 kg/m2), and clinical stage. No IBD patients had documented active disease at the time of treatment. All patients had a pathologic diagnosis of anal or CRC and received EBRT either neoadjuvantly or adjuvantly. Acute toxicity occurred within 100 days of EBRT. Data was collected via retrospective review of the treatment charts. Results: All patients received radiation doses between 45-52 Gy in 1.8Gy/fx or 2Gy/fx, delivered using AP/PA, IMRT, 3-field, or 4-field plans. There was no difference in the rate of grade 3 (20% vs 7%, p=0.19) or grade 4 (7% vs 0%, p=0.13) lower GI toxicity. There was also no difference in the incidence of GU (47% vs 30%, p=0.37), upper GI (60% vs 33.3%, p=0.08), or skin toxicity (40% vs 64%, p=0.17). Post-operatively, IBD patients had a significantly higher rate of wound dehiscence (35.7% vs 7.1%, p=0.02); however, there was no difference in the rate of bleeding (29% vs 18%, p=0.43), infection (50% vs 32%, p=0.50), or ileus (36% vs 11%, p=0.06). Conclusions: IBD patients with anal or CRC who received EBRT neoadjuvantly or adjuvantly did not experience more acute GI, GU, or skin toxicity than matched non-IBD patients with similar treatment. Post-operatively, IBD patients were more likely to have wound dehiscence, but were not more likely to have bleeding, infection, or ileus.

The Role of Thoracic 3-Dimensional Radiation Therapy for Non-Small Cell Lung Cancer Patients With Bone Oligometastases

Purpose/Objective(s): To evaluate the role of three-dimensional radiation therapy for Non-Small Cell Lung Cancer (NSCLC) patients with bone metastasis. Materials/Methods: Clinical data of 95 NSCLC patients with bone metastases were collected, all patients received radiation to thoracic primary tumor and 2 cycles chemotherapy. The Kaplan-Meier method was used to calculate the OS. The log-rank test was used to compare the survival curves. Multivariate Cox regression analysis was used to test independent significant prognostic factors for OS. Results: For these 95 patients, 47 patients had only bone metastasis, 48 had bone concur with other organ metastasis. The median survival time (MST) was 11.0 months (95% CI, 8.5-13.5), and the 1-, 2and 3-year overall survival rate was 43.6%, 16.8% and 8.5%, respectively. The MST was 15.0 months for patients received radiation dose to primary tumor 63 Gy, whereas 9.0 months for those with dose <63 Gy (chi-squareZ 11.038, p Z 0.001). Patients with treatment response (CR + PR) to primary tumor had longer median OS time than those without response (SD + PD) (13.0 months vs 7.0 months, chi-square Z 4.364, p Z 0.037). Overall survival was significantly prolonged in patients with received 4 cycles chemotherapy vs <4 cycles, the MSTwas 14.0 months vs 8.0 months (chi-square Z 6.800, p Z 0.009), radiation to metastatic sites was not correlated with OS. Radiation dose to primary tumor 63 Gy remained significance when patients with bone metastasis only and those had bone intercurrent with other organ metastasis were analyzed separately. For patients with bone metastasis only, patients with T1-2 tumors had longer OS than those with T3-4 tumors, the 1-, 2and 3-year overall survival rate was 50.0% vs 39.5%, 27.8% vs 9.3%, 18.5% vs 2.3% (chi-square Z 3.912, p Z 0.048), respectively; radiation to metastatic sites was marginally significant correlated with OS (chi-squareZ 2.757, pZ 0.097); and patients received 4 cycles chemotherapy and <4 cycles had similar survival times, the MST was 14.0 months vs 12.0 months (chi-square Z 0.756, p Z 0.385). On multivariate analysis, radiation dose 63 Gy, and bone metastasis only were independent prognostic factors for better OS. Conclusions: Radiation dose to primary tumor 63 Gy and bone metastasis only are associated with better overall survival in NSCLC patients with bone metastasis. For patients with bone metastasis only, besides radiation dose, T status was also correlated with OS, whereas the number of chemotherapy cycles was not, aggressive thoracic radiation play an important role in improving OS. Author Disclosure: S. Su: None. B. Lu: None. W. Ouyang: None. Q. Li: None. Y. Hu: None. Z. Ma: None. H. Li: None.

Risk of second malignant neoplasms after cyclophosphamide-based chemotherapy with or without radiotherapy for non-Hodgkin lymphoma

Relatively little information is available on quantitative risks of therapy-induced second malignant neoplasm (SMN) in patients with non-Hodgkin lymphoma (NHL). A nested case–control study was conducted in a cohort of 3412 patients treated for NHL between 1990 and 2006, including 118 patients with SMN and 472 controls. Risks of leukemia/lung/breast/colorectal and bladder cancer were higher in NHL compared with the general population. A higher risk of leukemia was restricted to patients given a cumulative dose of cyclophosphamide more than 11 250 mg/m2. However, no significant association was found between SMN risk with rituximab, fludarabine, anthracyclines, epipodophyllotoxins and platinum, respectively. In combined modality treatment, involved-field radiation therapy (IFRT) had a higher risk for second solid cancers as compared to involved-nodal radiation therapy (INRT). For patients receiving radiation doses exceeding 40 Gy, the risk of lung cancer and breast cancer was increased. In conclusion, we found that cyclophosphamide-based therapy increased the risk of SMN in NHL. Leukemia risk was linked with high-dose cyclophosphamide. A received larger radiation field or higher radiation dose also could be an important risk factor for the development of SMN.

Randomized Phase II Study of Palifermin for Reducing Dysphagia in Patients Receiving Concurrent Chemoradiotherapy for Locally Advanced Unresectable Non-small Cell Lung Cancer

Dysphagia is a common, dose-limiting toxicity of combined chemoradiotherapy (CT/RT) in patients with locally advanced non-small cell lung cancer (NSCLC). This study assessed the efficacy and safety of palifermin in reducing dysphagia from CT/RT followed by consolidation chemotherapy (CT). This randomized, double-blind, phase II trial enrolled adults with unresectable stage III NSCLC. Subjects received weekly paclitaxel (50 mg/m2) and carboplatin (AUC 2.0) with concurrent daily radiation (RT) of 6000 to 6600 cGy, followed by consolidation CT. Palifermin (n = 49) or placebo (n = 46) was administered before starting concurrent CT/RT and once weekly for 6 weeks. The primary end points were the incidence of grade ≥ 2 dysphagia and safety. The incidence of grade ≥ 2 and ≥ 3 dysphagia was numerically lower in palifermin subjects versus placebo subjects (61% versus 70%; p = 0.36; 22% versus 28%, p = 0.50, respectively). Mean duration of dysphagia (grade ≥ 2) was 25 days for palifermin subjects and 32 days for placebo subjects (p = 0.32). The incidence of adverse events was similar in the two treatment groups, and median overall survival and progression-free survival were not adversely affected by palifermin treatment (overall survival: 513 versus 319 days; progression-free survival: 262 versus 235 days for palifermin versus placebo arms, respectively). The palifermin arm received more doses of CT per study design and significantly more patients received RT doses ≥ 6000 cGy (84% versus 61%, p = 0.01). The results of this exploratory trial suggest that additional larger studies may be warranted to further evaluate the effect of palifermin on dysphagia, exposure to CT/RT, and long-term survival.

Radiation doses in a newly founded interventional cardiology department

Coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) radiation doses were investigated in a recently founded Interventional Cardiology (IC) department. The study includes 336 procedures (177 CAs and 159 PTCAs) carried out with a Philips digital flat detector monoplane system. Patient dose was measured in terms of kerma-area product (KAP) and cumulative dose. Using appropriate conversion factors, peak skin dose (PSD) and effective dose (E) were estimated. Median values of KAP (Gy cm(2)), PSD (mGy) and E (mSv) were: 34 478 and 6.1, respectively for CA and 80 885 and 14.4 for PTCA, within European and international reference levels. Only 1.5 % of patients received radiation dose over the 2 Gy threshold (PTCA procedures) for deterministic effects and none reported any skin effect. Radiation doses were within international standards and comparable with other radiological examinations. The percentage of the high-risk patients for radiation skin effects is extremely low.