Postoperative Conformal Radiotherapy Research Articles

Reste-t-il une place pour la radiothérapie adjuvante dans les carcinomes bronchiques non à petites cellules ? Non…

Postoperative radiotherapy has been widely used with the objective of improving local progression-free survival and possibly overall survival. In 1998, it was proven that post-operative radiotherapy had a deleterious effect for p N0 and p N1 and the question remains unresolved for N2. The absence of a complete preoperative assessment, a variable quality of excision, the absence of adjuvant chemotherapy and “old” radiotherapy could also explain these results. Even if the international LUNG ART trial, carried out with all current quality standards, showed a reduction of nearly 50% in locoregional relapses, the risk of systemic relapse is such, to which is added an increase in cardiopulmonary toxicities, that it did not show an improvement in Progression-Free Survival with conformal post-operative radiotherapy in patients operated on in stage IIIA pN2 patients with post-operative radiotherapy. Thus, postoperative radiotherapy should not be performed in all patients with N2 invasion. It can be discussed on a case-by-case basis in patients at high risk of relapse.In this “controversial” article, two visions are presented, with the discussion on subgroups of patients who may or may not benefit from postoperative radiotherapy and on the possible toxicities of the combined treatment.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

The Lung ART adjuvant radiotherapy phase 3 randomized trial: Impact of quality of resection in stage IIIAN2 patients.

8522 Background: Lung ART is an international phase 3 trial whose main objective was to evaluate the impact of post-operative conformal radiotherapy (PORT) on disease-free survival (DFS) in patients with completely resected pathologically proven N2 non-small cell lung cancer (NSCLC), with or without neo- or adjuvant chemotherapy. Previously communicated results showed no impact of PORT on DFS. However, as quality of surgical resection and extent of lymph node dissection were expected to be critically important in the interpretation of results, surgical and pathological reports were centrally reviewed by a surgical committee. Methods: A surgical advisory committee composed of 4 expert thoracic surgeons reviewed anonymized surgical and pathological reports of all included patients. Pre-defined classification rules were defined using published guidelines from the International Association for the Study of Lung Cancer and the European Society of Thoracic Surgeons. Tumor resection was defined as complete (no residual tumor and adequate lymph node assessment), uncertain (highest mediastinal nodal station involved, incomplete nodal exploration, involved N2 removed in fragments) or incomplete (presence of residual tumor). Nodal exploration was classified as sampling, selective dissection or extensive dissection. Results: 501 patients were included in the Lung ART trial. Before surgical committee review intervention, all patients except 2 had complete resection. 496 patients’ reports were analyzed by the surgical advisory committee. The basic characteristics are specified in the following table: Conclusions: Monitoring of the quality of nodal exploration and of resection should be implemented in randomized studies evaluating peri-operative strategies in NSCLC in order to provide reliable and generalizable results. Clinical trial information: NCT00410683. [Table: see text]

1170O An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement: Characterisation of PORT efficacy in lung ART (IFCT-0503, UK NCRI, SAKK)

Primary analysis of Lung ART trial has shown (ESMO 2020) a non-statistically significant effect of PORT on disease-free survival (DFS) in N2 NSCLC patients (HR = 0·86 (95% CI 0·68-1·08]; p=0·18). However PORT was associated with a reduction of 51% in the risk of mediastinal relapse (MR). Patterns of relapse as well as prognostic factors of PORT efficacy warranted further investigations to determine which patients could benefit more from PORT.

LBA3_PR An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement: Primary end-point analysis of LungART (IFCT-0503, UK NCRI, SAKK) NCT00410683

LBA3_PR An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement: Primary end-point analysis of LungART (IFCT-0503, UK NCRI, SAKK) NCT00410683

Patterns of recurrence in patients receiving conformal radiation for intracranial meningioma: a single-institution experience

AbstractAim:To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma.Materials and methods:Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence.Results:The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm.Conclusion:Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

Stereotactic Radiosurgery for the Treatment of Recurrent High-grade Gliomas: Long-term Follow-up.

High-grade gliomas (HGG) are the most frequent primary central nervous system tumors; treatment of HCGs includes surgery and post-operative conformal radiotherapy associated with temozolomide (TMZ or procarbazine/lomustine/vincristine [PCV], specifically in patients with anaplastic oligodendrogliomas or anaplastic oligoastrocytomas). However, recurrence is common. Re-irradiation has been utilized in this setting for years and remains a feasible option, although there is always a concern regarding toxicity. Modern high-precision conformal techniques, including stereotactic radiosurgery (SRS), could improve the therapeutic ratio by delivering high biologically equivalent doses while reducing high-dose radiotherapy (RT) to normal brain tissue. In this paper, we present the results obtained after prolonged follow-up in patients who underwent SRS as a treatment for recurrent high-grade gliomas at San Francisco Hospital in Madrid, Spain

Postoperative conformal radiotherapy of locally advanced squamous-cell oropharyngeal cancer

The study objective is to demonstrate the necessity of individual selection of radiation plan in patients with locally advanced squamous-cell oropharyngeal cancer after multicomponent operation to decrease radioreactions and radiation injuries. Materials and methods . The study included data on 64 patients with primary locally advanced oropharyngeal cancer after combination treatment at the Nizhny Novgorod Regional Clinical Oncological Dispensary in 2013–2018. Radiation treatment was performed after surgeries. The 1st group included 30 patients who underwent conformal radiation using linear accelerators. The 2nd group included 34 patients who underwent conventional radiation. Results . For conformal radiotherapy, grade I mucositis was observed in 2 (6.6 %) patients, grade II – in 25 (83.4 %) patients, grade III– IV – in 3 (10 %) patients. In the 1st group, radioreactions developed at dose 30 Gy, in the 2nd group at 20 Gy. In the 2nd group, radioreactions were more severe. Grade II mucositis after conventional radiation were observed in 21 (61.7 %) patients, grade III–IV – in 13 (38.3 %) patients, among them 8 (23.5%) received split-course radiotherapy. Partial necrosis of the flap was detected in 1 (3.3 %) patient in the 1st group and in 4 (2.9 %) patients in the 2nd group. Conclusion . Conformal radiotherapy, including modulated intensity, is characterized by better isodose distribution with minimal effect on the surrounding healthy tissue and vascular pedicle of the transplant after multicomponent operations. This type of radiation allows to decrease the risk of radioreactions and complications requiring expensive accompanying therapy or even split-course treatment.

102 - Lung ART: phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

102 - Lung ART: phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

Postoperative radiotherapy for prostate cancer

PurposeThe aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer.Materials and methodsBased on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups.ResultsFor local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7 Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3 Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5‑year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5‑year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%.ConclusionsDespite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4‑field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects.

Malignant intracranial hemangiopericytoma in a 22-year-old male with head injury and implications

We report a case of intracranial hemangiopericytoma of a young male of 22 years who presented with neurological signs of impaired memory, left hemiparesis, headache, and two episodes of focal seizures. A significant history of head trauma 9 years back was given. A space-occupying lesion was identified in the bilateral frontoparietal region. The surgical intervention involved bilateral frontoparietal craniotomy and Simpson Grade II excision of tumor. Postoperative conformal radiotherapy was administered. A marked neurological improvement was subsequently observed. Peak incidence of this disease is in the fourth or fifth decade. However, our case is an exception presenting at an age of 22 years. Associated history of head trauma has only been infrequently reported in the past.

169: Lung ART: Phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

169: Lung ART: Phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

Long-term survival in glioblastoma: methyl guanine methyl transferase (MGMT) promoter methylation as independent favourable prognostic factor.

BackgroundIn spite of significant improvement after multi-modality treatment, prognosis of most patients with glioblastoma remains poor. Standard clinical prognostic factors (age, gender, extent of surgery and performance status) do not clearly predict long-term survival. The aim of this case-control study was to evaluate immuno-histochemical and genetic characteristics of the tumour as additional prognostic factors in glioblastoma.Patients and methodsLong-term survivor group were 40 patients with glioblastoma with survival longer than 30 months. Control group were 40 patients with shorter survival and matched to the long-term survivor group according to the clinical prognostic factors. All patients underwent multimodality treatment with surgery, postoperative conformal radiotherapy and temozolomide during and after radiotherapy. Biopsy samples were tested for the methylation of MGMT promoter (with methylation specific polymerase chain reaction), IDH1 (with immunohistochemistry), IDH2, CDKN2A and CDKN2B (with multiplex ligation-dependent probe amplification), and 1p and 19q mutations (with fluorescent in situ hybridization).ResultsMethylation of MGMT promoter was found in 95% and in 36% in the long-term survivor and control groups, respectively (p < 0.001). IDH1 R132H mutated patients had a non-significant lower risk of dying from glioblastoma (p = 0.437), in comparison to patients without this mutation. Other mutations were rare, with no significant difference between the two groups.ConclusionsMolecular and genetic testing offers additional prognostic and predictive information for patients with glioblastoma. The most important finding of our analysis is that in the absence of MGMT promoter methylation, longterm survival is very rare. For patients without this mutation, alternative treatments should be explored.

Resistance mechanisms in glioblastoma stem cells: finding opportunities in challenges

Glioblastoma remains the most aggressive and devastating form of primary brain tumor with universally dismal survival outcomes despite multi-modality management, essentially rendering it incurable in contemporary neuro-oncologic practice. It displays all the classical hallmarks of cancer including immune suppression, sustained proliferative signalling, inhibition of apoptosis, angiogenesis and invasion (1,2). Glioblastoma is biologically very heterogeneous; this intra-tumoral heterogeneity is explained by the stochastic model (2,3), wherein the tumor arises from a single clone of cells with further progression resulting from random accumulation of somatic mutations in genetically unstable cell population and sequential selection of malignant sub-clones through micro-environment cues. The current standard of care for newly-diagnosed glioblastoma comprising maximal safe resection followed by post-operative focal conformal radiotherapy to the tumor bed with concurrent and adjuvant temozolomide chemotherapy, results in a median survival of around 15 months and a 5-year overall survival rarely exceeding 8–10% (4).

Three-dimensional conformal postoperative radiotherapy in patients with parotid tumors: 10 years' experience at the European Institute of Oncology.

Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-related toxicity and clinical outcome in patients treated at our division with postoperative radiotherapy (pRT) for parotid tumors. Forty-three consecutive patients (32 with primary parotid tumors, 9 with parotid metastases and 2 with recurrent benign diseases) were retrospectively analyzed. The median follow-up was 28 months. Twenty and 5 patients had a follow-up longer than 2 and 5 years, respectively. Thirty-seven patients were alive and most of them (78%) were free from disease. The local and distant control rates were higher in patients with primary parotid tumors (94% and 87.5%) than in patients with parotid metastases (87.5% and 75%). Grade 3 radiotherapy-related acute toxicity of skin and mucosa was recorded in 20.9% and 28% of patients, respectively. Two patients (4.7%) had grade 4 skin toxicity. Late toxicity data were available for 33 (77%) patients. None of the patients developed severe (grade 3 and 4) late toxicity of soft tissues, skin or temporomandibular joints. Postoperative radiotherapy is a feasible treatment that was found to be effective mainly in patients with primary parotid tumors. Toxicity was acceptable but could probably be further reduced using more advanced radiotherapy techniques. Longer follow-up is required to achieve definitive results.

Post-Operative Prostate and Seminal Vesicle Fossae Contouring Module: Evaluation of Medical Student Target Delineation Before and After a Teaching Intervention

Abstract Introduction Currently, there is a lack of formalized educational curricula for medical students rotating through radiation oncology electives. A curriculum including both didactics and ha...

189: Lung ART: phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

189: Lung ART: phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

217 Lung ART: Phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

217 Lung ART: Phase III study comparing post-operative conformal radiotherapy to no post-operative radiotherapy in patients with completely resected non-small cell lung cancer and mediastinal N2 involvement

Target volume for postoperative radiotherapy in non-small cell lung cancer: Results from a prospective trial

Background and purposeA previous prospective trial reported that three-dimensional conformal postoperative radiotherapy (PORT) for pN2 NSCLC patients using a limited clinical target volume (CTV) had a late morbidity rate and pulmonary function that did not differ from those observed in pN1 patients treated with surgery without PORT. The aim of this study was to assess locoregional control and localization of failure in patients treated with PORT. Materials and methodsThe pattern of locoregional failure was evaluated retrospectively in 151 of 171 patients included in the PORT arm. The CTV included the involved lymph node stations and those with a risk of invasion >10%. Competing risk analysis was used to assess the incidence of locoregional failure and its location outside the CTV. ResultsOverall survival at 5years was 27.1% with a median follow-up of 67months for 40 living patients. The 5-year cumulative incidence of locoregional failure was 19.4% (95% CI: 18.2–20.5%) including a failure rate of 2% (95% CI: 0–17%) in locations outside or at the border of the CTV. ConclusionsThe use of limited CTV was associated with acceptable risk of geographic miss. Overall locoregional control was similar to that reported by other studies using PORT for pN2 patients.

Three dimensional conformal postoperative radiotherapy for unilateral parotid gland cancer: A comparison of three different parotid gland irradiation techniques

IntroductionPostoperative radiotherapy of the parotid gland could be achieved with various radiotherapy techniques. However they irradiate differently the surrounding organs at risk (OARs) in particular the cochlea, oral cavity & contralateral parotid causing significant increase in the risk of oral mucositis, xerostomia, and hearing deficits on the irradiated side. ObjectivesThe aim of this study was to compare radiation doses received by target volume and different surrounding OARs using three different parotid irradiation techniques aiming to achieve the optimum technique which shows adequate target coverage and sparing of surrounding OARs during postoperative 3DCRT treatment of parotid gland cancer patients. MethodologyTen patients diagnosed as having parotid cancer were included in this study. They were subjected to CT simulation and scans were transferred to the treatment planning system. Target volumes and contralateral parotid, oral cavity, cochlea, spinal cord, brain stem, eyes, lenses and optic nerves were contoured. Three plans were done using (a) ipsilateral oblique wedged photon pair, (b) oblique wedged photon pair and direct lateral field, and (c) ipsilateral mixed photon electron beams.For three plans, the dose volume parameters (DVPs) for target volume and surrounding OARs were compared and analyzed statistically. ResultsTarget dose coverage was adequate and comparable for techniques 1 and 2. Technique 2 showed the best dose homogeneity and conformity and lowest max dose to PTV and to the whole body and although the dose to OARs was higher compared to technique 1 it was far lower than OARs tolerance. On the other hand, technique 3 showed unaccepted underdose & dose inhomogeneity within the PTV, the highest doses to OARs and the highest PTV max and body max dose. ConclusionThe ipsilateral oblique wedged photon pair and direct lateral photon field technique is an optimal treatment technique for parotid cancer patients in comparison to other plans.

Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma?

As most patients with retroperitoneal sarcomas (RPS) die of local recurrence, front-line aggressive surgery (FAS) has been developed, and it seems to achieve better local control. The aim of this study was to evaluate conformal postoperative radiotherapy (PORT) in patients who had enlarged surgery. Between 1994 and 2008, 110 patients with primary RPS mainly operated by FAS were analysed. Sixty-two patients underwent surgery and no PORT (group S), and 48 received surgery and PORT (group S + R). The median age was 52. Most patients had 3D conformal PORT (81%) with a median dose of 50 Gy. Comparing results at 5 years in the S and the S + R group, the cumulative rate of local failure was, respectively, 36% and 22% (NS); relapse-free survival was 47% and 60% (P = 0.02), and overall survival was, respectively, 77% and 71% (NS). Even if patients with adjuvant PORT were at higher risk of recurrence, there was a trend for radiotherapy (RT) to decrease the local relapse rate and improve recurrence-free survival. This study confirms that adjuvant conformal RT should be evaluated in a randomized trial, the control arm being FAS. Adjuvant RT in the preoperative setting is being evaluated in an EORTC trial.