Radiation Therapy In Adults Research Articles

The Benefit of Supplemental Vitamin E to Reduce Radiation-Induced Oral Side Effects in Head and Neck Cancer

Antioxidant use during oncology treatment is controversial. Inconsistent research indicates that antioxidant supplementation can be both beneficial and harmful. The purpose of this review is to evaluate the recently published literature to determine whether oral supplementation with the antioxidant vitamin E is beneficial for reducing common side effects of radiation therapy in adults diagnosed with head and neck cancer. Three studies demonstrated supplementation can be effective in reducing side effects without compromising locoregional control, disease-free survival, or overall survival. Larger studies are needed to determine the optimal dose and duration of supplementation and the effectiveness of vitamin E as monotherapy.

Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Adult patients (older than 18 yr of age) with newly diagnosed brain metastases. If whole brain radiation therapy (WBRT) is used, is there an optimal dose/fractionation schedule? Level 1: A standard WBRT dose/fractionation schedule (ie, 30 Gy in 10 fractions or a biological equivalent dose [BED] of 39 Gy10) is recommended as altered dose/fractionation schedules do not result in significant differences in median survival or local control. Level 3: Due to concerns regarding neurocognitive effects, higher dose per fraction schedules (such as 20 Gy in 5 fractions) are recommended only for patients with poor performance status or short predicted survival. Level 3: WBRT can be recommended to improve progression-free survival for patients with more than 4 brain metastases. What impact does tumor histopathology or molecular status have on the decision to use WBRT, the dose fractionation scheme to be utilized, and its outcomes? There is insufficient evidence to support the choice of any particular dose/fractionation regimen based on histopathology. Molecular status may have an impact on the decision to delay WBRT in subgroups of patients, but there is not sufficient data to make a more definitive recommendation. Separate from survival outcomes, what are the neurocognitive consequences of WBRT, and what steps can be taken to minimize them? Level 2: Due to neurocognitive toxicity, local therapy (surgery or SRS) without WBRT is recommended for patients with≤4 brain metastases amenable to local therapy in terms of size and location. Level 2: Given the association of neurocognitive toxicity with increasing total dose and dose per fraction of WBRT, WBRT doses exceeding 30 Gy given in 10 fractions, or similar biologically equivalent doses, are not recommended, except in patients with poor performance status or short predicted survival. Level 2: If prophylactic cranial irradiation (PCI) is given to prevent brain metastases for small cell lung cancer, the recommended WBRT dose/fractionation regimen is 25 Gy in 10 fractions, and because this can be associated with neurocognitive decline, patients should be told of this risk at the same time they are counseled about the possible survival benefits. Level 3: Patients having WBRT (given for either existing brain metastases or as PCI) should be offered 6 mo of memantine to potentially delay, lessen, or prevent the associated neurocognitive toxicity. Does the addition of WBRT after surgical resection or radiosurgery improve progression-free or overall survival outcomes when compared to surgical resection or radiosurgery alone? Level 2: WBRT is not recommended in WHO performance status 0 to 2 patients with up to 4 brain metastases because, compared to surgical resection or radiosurgery alone, the addition of WBRT improves intracranial progression-free survival but not overall survival. Level 2: In WHO performance status 0 to 2 patients with up to 4 brain metastases where the goal is minimizing neurocognitive toxicity, as opposed to maximizing progression-free survival and overall survival, local therapy (surgery or radiosurgery) without WBRT is recommended. Level 3: Compared to surgical resection or radiosurgery alone, the addition of WBRT is not recommended for patients with more than 4 brain metastases unless the metastases' volume exceeds 7 cc, or there are more than 15 metastases, or the size or location of the metastases are not amenable to surgical resection or radiosurgery.The full guideline can be found at: https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_3.

Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors.

Adaptive Radiation Therapy in Adults With Nasopharyngeal Carcinoma: A Retrospective Study at 1 Institution

Adaptive Radiation Therapy in Adults With Nasopharyngeal Carcinoma: A Retrospective Study at 1 Institution

Neurocognitive effects of proton radiation therapy in adults with low-grade glioma.

To understand neurocognitive effects of proton radiation therapy (PRT) in patients with low-grade glioma, we evaluated 20 patients who received this therapy prospectively and over 5 years with a comprehensive neuropsychological battery. 20 patients were evaluated at baseline and at yearly intervals for up to 5 years with a battery of neuropsychological measures that assessed intellectual, attention, executive, visuospatial and memory functions as well as mood and functional status. We evaluated change in cognitive functioning over time. We analyzed the relationship between cognitive performance and tumor location and also examined whether patients' performance differed from that reported in a study of normative practice effects. Overall, patients exhibited stability in cognitive functioning. Tumor location played a role in performance; those with tumors in the left hemisphere versus in the right hemisphere were more impaired at baseline on verbal measures (p < .05). However, we found greater improvement in verbal memory over time in patients with left than with right hemisphere tumors (p < .05). Results of our study, the first to investigate, in depth, neurocognitive effects of PRT in adults with low-grade gliomas, are promising. We hypothesize that the conformal advantage of PRT may contribute to preservation of cognitive functioning, although larger sample sizes and a longer period of study are required. Our study also highlights the need to consider normative practice effects when studying neurocognitive functioning in response to treatment over time, and the need to utilize comprehensive neuropsychological batteries given our findings that differentiate patients with left and right hemisphere tumors.

A single team experience of adjuvant radiation therapy in adults with intermediate or high-grade limb soft tissue sarcoma

19509 Background: Limb Soft tissue sarcomas (STS) are currently treated with limb sparing surgery (LSS) followed by radiation therapy (RT). This paper summarizes a one-team experience with homogenous population of adult patients, with intermediate or high grade STS confined to a limb, who were approached by LSS and postoperative RT. Methods: From October 1994 through October 2002, 133 adult patients (75 males, 58 females, age range 18–88 years, median 54) with biopsy-proven intermediate or high-grade limb STS were approached by LSS followed by RT. Their files were retrospectively reviewed for treatment outcome: local control, RT side effects, and time to progression. Tumor site was classified according to its proximal border. STS that involved the arm and the upper axilla was classified as axillary STS. Results: RT related toxicity was manageable, with a low rate of severe effects. At 4-year median follow up, there were 48 recurrences of any type, 23 of isolated local failure, and 35 of systemic spread w/o local failure. DFS and OS were influenced by disease stage II versus I, primary site in the upper limb versus lower limb, MPNST versus other types, induction therapy versus no induction, adequate resection Vs marginal resection or involved margins, and good response to induction therapy versus bad response. DFS and OS were Patient’s age and sex, tumor depth, acute or late toxicity of RT, or the interval of time between the date of definitive surgery and the start of RT did not affect DFS and or OS. Conclusions: The RT protocol is applicable in the era of complicated, expensive and time-consuming 3-D therapy. Our results of LSS + RT in adults with limb HG STS are satisfactory. No significant financial relationships to disclose.

Limb sparing approach: Adjuvant radiation therapy in adults with intermediate or high-grade limb soft tissue sarcoma

Background Limb soft tissue sarcomas (STS) are currently treated with limb sparing surgery (LSS) followed by radiation therapy (RT). Patients and methods Between October 1994 and October 2002, 133 adult patients with intermediate or high-grade limb STS were approached by LSS+RT. Results RT related toxicity was manageable, with a low rate of severe effects. At 4-year median follow-up, there were 48 recurrences of any type, 23 of isolated local failure, and 35 of systemic spread w/o local failure. DFS and OS were influenced by disease stage II vs I, primary site in the upper limb vs lower limb, MPNST vs other types, induction therapy vs no induction, adequate resection vs marginal resection or involved margins, and good response to induction therapy vs bad response. DFS and OS were Patient's age and sex, tumor depth, acute or late toxicity of RT, or the interval of time between the date of definitive surgery and the start of RT did not affect DFS and or OS. Conclusions The RT protocol is applicable in the era of complicated, expensive and time-consuming 3D therapy. Our results of LSS+RT in adults with limb HG STS are satisfactory.

83 Proton radiation therapy in adults with low-grade chondrosarcomas of the cranial base

83 Proton radiation therapy in adults with low-grade chondrosarcomas of the cranial base

Cisplatin does not enhance the effect of radiation therapy in malignant gliomas

The aim of this randomised trial was to test the effect of cisplatin given during radiation therapy in adults with supratentorial malignant gliomas. Of 285 patients included, 246 were evaluable. The main reasons for exclusion were: inadequate pathology or no pathology review (24 patients), exclusion of the institution (11 patients), and inadequate follow-up (4 patients). For 121 patients randomised to receive cisplatin 50 mg/m2 on days 1, 8, 15 and 22 of radiation therapy, 81 were given the full dose. Radiation therapy alone was given to 125 control patients. All patients were followed until the recurrence of clinical signs (free interval) and until death (survival). Neither of these two parameters was modified by cisplatin. No signs of major toxicity were reported. It is concluded that at the doses used, cisplatin does not enhance the effects of radiation therapy in malignant gliomas.

Reversal of cranial nerve dysfunction with radiation therapy in adults with lymphoma and leukemia

Twenty patients with leukemic (8) or lymphomatous (12) meningitis and cranial nerve palsies were treated with cranial irradiation at Memorial Sloan-Kettering Cancer Center from June 1987 through December 1988. The diagnosis of malignant meningitis was confirmed by malignant or `suspicious' cerebrospinal fluid cytology in 13 20 patients. The 6th and 7th cranial nerves were most commonly involved. Multiple nerve involvement was present in 11 20 patients, for a total of 42 nerves affected. Treatment consisted of whole brain irradiation to a median dose of 2400 cGy (range: 1000–3000) at 200–300 cGy per fraction. Median survival was 7 months. Forty of 42 nerves improved, for an actuarial response rate of 95% at 3 months. The complete response rate was 44% and was better for patients with lymphoma than for those with leukemia (72% vs 19%, p = 0.04). Delaying initiation of irradiation more than 3 days after the onset of symptoms did not affect the ultimate response rate, but slightly increased the median time to response (9 days vs 14 days, p = 0.1). Radiation therapy is an effective means of reversing cranial nerve dysfunction in leukemia and lymphoma. Higher doses may be needed to increase the rate of complete response.