Radiotherapy In Treatment Of Cancer Research Articles

Factors associated with adherence to remote patient monitoring for early detection of dehydration risk during radiation treatment for head and neck cancer.

6076 Background: Remote patient monitoring (RPM) may improve the early detection and mitigation of cancer treatment-related complications, health-related outcomes and quality of life. RPM’s success may depend, in part, on patients’ adherence to remote monitoring protocols. However, factors that influence adherence to RPM are largely unknown. Daily blood pressure/pulse (BP/P), weight, and electronic patient-reported outcomes (ePROs) were monitored remotely in head and neck cancer (HNC) patients undergoing radiation treatment (RT) to identify dehydration risk. We evaluated potential factors associated with RPM adherence. Methods: During RT (average 6 to 7 weeks), participants were asked to take daily (Monday-Friday) measures of BP/P and weight using Bluetooth-enabled devices and to complete daily ePROs using a mobile tablet application (app). Data were provided to their physicians for daily review. The MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) was completed at baseline and end of RT, and 6-8 weeks post-RT completion. The Patient Activation Measure (PAM) was completed at baseline and 6-8 weeks post-RT completion. A device usability survey measuring perceived usefulness of RPM was completed at the end of RT. Adherence to daily monitoring was recorded objectively. Longitudinal analyses compared the relationship between demographic, clinical, and PRO data and monitoring adherence. Results: Participants (n = 169) were 80% male, 87% White, and 91% married. Overall adherence to monitoring BP/P, weight, and ePROs was 83%, 82% and 74%, respectively. Greater HN-specific symptom severity and interference was associated with decreased adherence to daily monitoring of BP/P, weight, and ePROs (P< 0.021). Higher PAM scores were associated with higher adherence to daily monitoring of BP/P only (p = 0.006). Participants reported modest levels of perceived usefulness of RPM across four categories: symptom management, early problem detection, illness monitoring by healthcare provider, and feeling of security during RT. Only a single item indicating perceived feeling of security was associated with greater adherence to daily monitoring of blood pressure/pulse (p = 0.032) and weight (p = 0.007). Conclusions: A benefit of frequent RPM may be early detection and mitigation of symptoms during RT for HNC, however, increasing symptom burden experienced during treatment may interfere with adherence to daily monitoring. Better adherence may be attributed to patients perceiving a sense of security from daily monitoring and may suggest a potentially important value that patients gain from RPM. Understanding factors that impact patient adherence to RPM may help improve acceptability and clinical utility of RPM in oncology. Clinical trial information: NCT02253238.

Applying 3D-Printed Templates in High-Dose-Rate Brachytherapy for Cervix Cancer: Simplified Needle Insertion for Optimized Dosimetry

In cervical cancer brachytherapy, adding interstitial needles to intracavitary applicators can enhance dosimetry by improving target coverage while limiting normal tissue dose. However, its use is limited to a subset of practitioners with appropriate technical skill. We designed tandem anchored radially guiding interstitial templates (TARGITs) with a 3-dimensional (3D) printing workflow to optimize needle placement and facilitate greater ease-of-use of intracavitary/interstitial (IC/IS) technique. This study compared dosimetry and procedure characteristics between tandem and ovoid (T&O) implants using TARGIT technique versus non-TARGIT technique. This single-institution retrospective cohort study included patients undergoing T&O brachytherapy as part of definitive radiation treatment for cervical cancer between February 2017 and January 2021. TARGIT technique was implemented from November 2019 onwards; all prior procedures involved non-TARGIT technique using a no needle or freehand needle approach. Target coverage, dose to organs at risk, and procedure times were evaluated and compared between TARGIT technique and non-TARGIT technique. The cohort included 70 patients with cervical cancer who underwent 302 T&O procedures: 68 (23%) with TARGIT technique and 234 (77%) with non-TARGIT technique, which included 133 no needle and 101 freehand needle implants. TARGIT implants involved longer average procedure times (+6.3 minutes, P < .0001). TARGIT implants achieved a higher mean high-risk clinical target volume V100% than non-TARGIT implants (+4.4%, P = .001), including for large tumors 30 cm3 or greater (+8.1%, P = .002). Average D90 was 4.6 Gy higher and average D98 was 3.2 Gy higher for TARGIT technique compared with non-TARGIT technique (P = .006 and P = .02). Total treatment doses to rectum, bowel, and bladder were not significantly different for TARGIT versus non-TARGIT technique. The 3D-printed TARGIT approach to T&O brachytherapy achieved greater tumor coverage while sparing normal tissues, particularly for large tumor volumes, with only a slight increase in average procedure time. TARGIT represents a creative technological solution for increasing accessibility of advanced IC/IS brachytherapy technique for cervical cancer definitive radiation treatment.

Assessing the impact of brachytherapy boost and androgen deprivation therapy on survival outcomes for patients with unfavorable intermediate-risk prostate cancer patients treated with external beam radiotherapy

BACKGROUNDCurrent recommendations regarding radiotherapy treatment for unfavorable intermediate-risk prostate cancer (UIR-PCa) include external beam radiotherapy (EBRT) ± brachytherapy boost (BT) ± androgen deprivation therapy (ADT). The ideal radiotherapy treatment approach for UIR-PCa has not been well-defined. We hypothesized that EBRT+BT±ADT is associated with improved overall survival (OS) relative to EBRT±ADT in men with UIR-PCa. MATERIALS AND METHODSThe National Cancer Database (NCDB) was used to retrospectively identify 32,246 men diagnosed between 2004 and 2015 with UIR-PCa who received EBRT (n = 13,265), EBRT+ADT (n = 13,123), EBRT+BT (n = 3440), or EBRT+BT+ADT (n = 2418). OS was the primary outcome. Inverse probability of treatment weighting was used to adjust for covariable imbalances and weight-adjusted multivariable analysis using Cox regression modeling was used to compare OS hazard ratios. RESULTSMedian follow-up was 60 months (range: 3–168 months). EBRT+ADT correlated with improved OS relative to EBRT alone on multivariable analysis (Hazard Ratio (HR): 0.92, [95% Confidence Interval: 0.87–0.98], p = 0.005). Compared to EBRT+ADT, EBRT+BT (HR: 0.77 [0.69–0.85], p = 3 × 10−7) and EBRT+BT+ADT (HR: 0.75 [0.67–0.83], p = 6 × 10−8) were associated with improved OS. Eight-years OS for the EBRT+ADT versus EBRT+BT+ADT was 70% and 78% (p < 0.0001), which is similar to historical clinical trials (ASCENDE-RT 9-year OS: 74% vs. 78%, p = 0.29). Relative to EBRT+BT, EBRT+BT+ADT was not associated with improved OS (HR: 0.99 [0.87–1.11], p = 0.82). CONCLUSIONSIn a large retrospective cohort, the addition of brachytherapy to EBRT correlated with improved survival in men with UIR-PCa. Men receiving EBRT+ADT+BT had improved OS relative to EBRT+ADT. The addition of ADT to EBRT, but not to EBRT+BT, correlated with improved OS.

Regulation of myoepithelial differentiation.

The salivary gland can be permanently impaired by radiation treatment for head and neck cancers. Efforts at tissue regeneration have focused on saliva-producing acinar cells. However, myoepithelial cells are also critical to gland function, but mechanisms that regulate their differentiation are poorly defined. To study myoepithelial differentiation, we employed mSG-PAC1 murine salivary gland epithelial cells. We demonstrate that mSG-PAC1 spheroids exhibit phenotypic plasticity between pro-acinar and myoepithelial cell fates. Increased expression of pro-acinar/acinar or myoepithelial RNAs was identified from spheroids cultured under different media conditions by microarray followed by gene-set enrichment analysis. Spheroids cultured with different medium components expressed proteins typical of either acinar or myoepithelial cells, as detected by immunocytochemistry. We demonstrate that the pattern of TAZ expression in the epithelial compartment of the differentiating murine salivary gland correlates with the expression of the myoepithelial marker alpha-SMA, as is the case for TAZ expression in mSG-PAC1 spheroids. Our analysis also indicates that YAP/TAZ target genes are upregulated together with myoepithelial markers. Importantly, siRNA targeting of TAZ expression in mSG-PAC1 spheroids diminished the expression of myoepithelial markers. Our results in this in vitro cell model implicate TAZ signaling in myoepithelial differentiation.

Acute effects of radiation treatment to submental muscles on burrowing and swallowing behaviors in a rat model.

Swallowing impairments are a major complication of radiation treatment for oropharyngeal cancers, influencing oral intake and quality of life. The timing and functional consequences of radiation treatment on the swallowing process is not clearly understood. A rodent radiation injury model was used to investigate the onset of oral and pharyngeal dysfunctions in deglutition related to radiation treatment. This study tested the hypothesis that (Wall et al., 2013) alterations in normal biting, licking, and swallowing performance would be measurable following 64Gy of fractionated radiation to the submental muscles; and (Kotz et al., 2004) radiation will affect the animal’s general well-being as measured via burrowing activity. Seven rats received radiation using a clinical linear accelerator given in 8 fractions of 8Gy and another seven animals received sham anesthesia only treatment. Swallowing bolus transit/size was assessed via videofluoroscopy, tongue movement during drinking was measured via an electrical lick sensor, and biting was analyzed from acoustic recordings of a vermicelli pasta test. Burrowing activity was measured by the amount of gravel substrate displaced within a container. Measurements were taken at baseline, during treatment (1–4 weeks), and after completion of treatment (weeks 5 & 6). Decreases in licking frequency and increases in inter-lick interval were observed 5- and 6-weeks post-treatment. Significant decreases in burrowing performance, swallowing frequency, and inter-swallow interval were observed starting the last week of treatment and continuing up to 2-weeks after completion. Results suggest that tongue dysfunction is one of the first treatment related feeding problems to present immediately after the completion of radiation to the submental muscles.

Reversing radiation-induced immunosuppression using a new therapeutic modality

Radiation-induced immune suppression poses significant health challenges for millions of patients undergoing cancer chemotherapy and radiotherapy treatment, and astronauts and space tourists travelling to outer space. While a limited number of recombinant protein therapies, such a Sargramostim, are approved for accelerating hematologic recovery, the pronounced role of granulocyte-macrophage colony-stimulating factor (GM-CSF or CSF2) as a proinflammatory cytokine poses additional challenges in creating immune dysfunction towards pathogenic autoimmune diseases. Here we present an approach to high-throughput drug-discovery, target validation, and lead molecule identification using nucleic acid-based molecules. These Nanoligomer™ molecules are rationally designed using a bioinformatics and an artificial intelligence (AI)-based ranking method and synthesized as a single-modality combining 6-different design elements to up- or downregulate gene expression of target gene, resulting in elevated or diminished protein expression of intended target. This method additionally alters related gene network targets ultimately resulting in pathway modulation. This approach was used to perturb and identify the most effective upstream regulators and canonical pathways for therapeutic intervention to reverse radiation-induced immunosuppression. The lead Nanoligomer™ identified in a screen of human donor derived peripheral blood mononuclear cells (PBMCs) upregulated Erythropoietin (EPO) and showed the greatest reversal of radiation induced cytokine changes. It was further tested in vivo in a mouse radiation-model with low-dose (3 mg/kg) intraperitoneal administration and was shown to regulate gene expression of epo in lung tissue as well as counter immune suppression. These results point to the broader applicability of our approach towards drug-discovery, and potential for further investigation of our lead molecule as reversible gene therapy to treat adverse health outcomes induced by radiation exposure.

Alternatives to whole gland treatment for localized prostate cancer: a review of novel focal therapies.

The mainstays of the management of clinically localized prostate cancer have historically rested upon active surveillance, radiation therapy, or radical prostatectomy. Although both radiation and surgical treatment of localized prostate cancer can achieve excellent oncologic outcomes, the subsequent potential adverse effects of urinary stress incontinence and erectile dysfunction are unappealing to patients. This has led to investigational studies centered upon focal treatment of the cancerous lesion, with the aim to improve quality-of-life outcomes. In this review, we describe numerous novel modalities, including nanoparticle ablation and irreversible electroporation, which are being utilized for the focal treatment of clinically localized prostate cancer. Although many of these novel therapies are in their investigational infancy, several have revealed very promising results both in their post-treatment pathologic outcomes as well as objective quality-of-life measures. Initial data regarding novel focal therapy for prostate cancer treatment show promising short-term outcomes in regards to oncologic and quality-of-life assessments. Further investigational studies are needed to determine inclusion criteria for the selection of optimal candidates.

MP22-08 LESS IS MORE IN THE MANAGEMENT OF PROXIMAL STRICTURE DISEASE AFTER PROSTATE CANCER TREATMENT

You have accessJournal of UrologyCME1 May 2022MP22-08 LESS IS MORE IN THE MANAGEMENT OF PROXIMAL STRICTURE DISEASE AFTER PROSTATE CANCER TREATMENT Peris Castaneda, Kai Dallas, Hanson Zhao, and Jennifer Anger Peris CastanedaPeris Castaneda More articles by this author , Kai DallasKai Dallas More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture following treatment for prostate cancer presents unique treatment challenges due to fibrosis and radiated tissue, which renders reconstruction procedures highly morbid. As a result, minimally invasive endoscopic procedures such as TURBN, DVIU, and endoscopic realignment, are often performed. Although self-calibration after endoscopic management is often considered a “failure”, for men after prostate treatment, self-calibration often keeps the outlet open while maintaining social continence. We sought to determine long-term outcomes in men managed with endoscopic procedures followed by self-calibration and the frequency of self-calibration needed once a steady state was achieved. METHODS: A retrospective review was performed of patients with history of pelvic radiation (including brachytherapy and HIFU) or surgical treatment for prostate cancer who developed proximal urethral strictures between November 2010 and September 2020. Endoscopic realignment was performed in the case of total obliteration. Otherwise, DVIU/bladder neck resection was performed. After catheter removal, men were taught to self-calibrate with decreasing frequency until weekly calibration was achieved. After that, asymptomatic men could stop catheterizing. RESULTS: Twenty-one men met inclusion criteria. Average age at first treatment was 71.8 (std. 6.7). Mean follow-up time was 3.1 years. Eleven men (65%) had history of radiation therapy and 10 men (59%), history of prostatectomy. Average number of minimally invasive procedures per patient was 3.3 (std 1.6). (Table 1) Twelve patients (71%) performed self-catheterization at some point during their treatment. Catheterization frequency ranged between 5 times daily in severe cases to once every two months in the office. The average need to catheterize was once every 5.9 days. There were 3 failures of endoscopic realignment for obliteration. Six patients continue to have periodic office dilation and 5 require no dilation. CONCLUSIONS: Minimally invasive treatments for urethral stricture are a viable option for patients with history of treatment for prostate cancer. Patients are likely to need multiple procedures. Most patients will need to self-catheterize, however self-catheterization regimens are not time-intensive. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e374 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peris Castaneda More articles by this author Kai Dallas More articles by this author Hanson Zhao More articles by this author Jennifer Anger More articles by this author Expand All Advertisement PDF DownloadLoading ...

SP-0023 Technical developments in the radiation treatment of oesophageal cancer

SP-0023 Technical developments in the radiation treatment of oesophageal cancer

Swallowing Kinematics in Rats Treated with Low Dose Chemotherapy Concurrently with Fractionated Radiation

Dysphagia is a common consequence of chemotherapy and radiation treatment for oropharyngeal cancer. Injury is thought to occur due to damage to the muscle and/or nerves. This can severely impair swallowing function, leading to serious negative outcomes such as aspiration related pneumonia or tube feeding placement to maintain nutrition. Currently, there are only strategies to prevent swallowing dysfunction; however, the development of chronic radiation associated dysphagia persists effecting ~25% of head and neck cancer survivors. Therefore, there is a need to study the mechanisms associated with radiation associated dysphagia to help guide new treatments to improve swallowing outcomes. The present study investigated the effects of concurrent chemoradiation on swallowing function. We tested the hypothesis that fractionated radiation with low doses of chemotherapy alters swallowing kinematics and bolus transit compared to radiation alone or normal controls. We monitored the functional extent of chemoradiation or radiation treatment using videofluoroscopy swallow study in self feeding rats (n=16) at four weeks post treatment. Twelve rats underwent 48Gy of fractionated radiation to the submental muscles using a clinical linear accelerator given in 12 fractions of 4Gy. Irradiated rats received either cisplatin 1mg/kg or saline IP once per week for four weeks during radiation treatment. Four rats received no treatment. During videofluoroscopy, thin liquids and puree consistencies mixed with 40% w/v barium sulfate were given ad libitum. The movement trajectories of the tongue, mandible, and hyoid bone were quantitatively tracked from video data. Changes in the speed of the jaw and hyoid during swallowing were observed between treated and control rats. No differences were observed in bolus flow parameters i.e. pharyngeal transit speed, inter‐swallow interval, and swallow frequency between treatment groups. The average size of the bolus in vallecula decreased by ~4% prior to initiating pharyngeal swallow with chemoradiated rats (p &lt; 0.05). Results suggest that low doses of chemotherapy in conjunction with radiation appear to have minimal differences in swallowing kinematics compared to radiation alone. Higher doses of chemotherapy may be needed to induce similar abnormalities in swallowing as seen clinically.

The Cardiovascular Effects of Breast Cancer Radiation Therapy

Breast Cancer (BC) is the most common malignancy affecting women worldwide [1]. Adjuvant radiation therapy (RT) of the breast plays a vital role in BC treatment and has been shown to improve overall survival [2]. Due to increased survivorship, the cardiac sequelae that develop due to BC treatments have become more apparent. Radiation therapy, a common BC treatment, exposes the heart to radiation due to its presence in the irradiation field. Although modern RT techniques aim to reduce cardiac radiation exposure, research suggests the persistence of cardiac damage. This scoping review aims to establish the types of cardiovascular disease (CVD) that manifest post‐RT, and create a timeline for early radiation‐induced cardiotoxicity detection and surveillance.A scoping review was conducted utilizing the methodology of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐Scr). A literature search was conducted on MEDLINE and EMBASE in Ovid on July 29th, 2021 for papers published from 1995 to July 2021. MeSH/EMTREE terms and keywords were used for the following concepts: Breast Cancer, Radiation Therapy, Cardiovascular, Treatment Outcomes. Search strategies were optimized for each database. After removing duplicates, 1341 papers were sent to title and abstract screening, of which 276 were sent to full‐text review. 160 studies were included for final data extraction. Agreement from two reviewers was required for an article to move to the next stage of screening. Eligibility criteria included primary clinical studies reporting a cardiovascular outcome of interest for patients who underwent BC RT.Even with modern radiotherapy techniques, patients who have undergone BC RT face an increased risk of the development of cardiovascular morbidities. In the long term, the risk of cardiac disease increases with an increase in mean heart radiation dose. Early‐detection studies reveal that changes in cardiac dysfunction can be detected early on, often characterized by a decline in left ventricular ejection fraction. With most RT‐induced cardiac sequelae manifesting years after RT exposure, studies with a shorter follow‐up period often report lower CVD risk. Articles produced contrasting results regarding whether breast cancer radiation laterality increases the risk of CVD, with many indicating no difference while others concluded those with left‐sided radiation therapy have an increased risk. Detection and surveillance, with a combination of both cardiac biomarkers and imaging, is critical at an early stage for all women who have undergone BC RT.With the majority of current surveillance techniques only detecting cardiovascular damage once it is too late, early detection is a critical prerequisite in improving cardiac sequelae prediction and prevention to ultimately improve breast cancer patients’ quality of life and care.[1] Sung et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin; 72(3):210‐249[2] Correa et al. Coronary Artery Findings After Left‐Sided Compared with Right‐Sided Radiation Treatment for Early‐Stage Breast Cancer. J Clin Oncol, 2007; 25(21):3031‐3037

PO-1884 Automated elective lymph level segmentation for head and neck cancer radiotherapy treatment planning

PO-1884 Automated elective lymph level segmentation for head and neck cancer radiotherapy treatment planning

MR-Guided Adaptive Radiotherapy for OAR Sparing in Head and Neck Cancers

Simple SummaryNormal tissue toxicities in head and neck cancer persist as a cause of decreased quality of life and are associated with poorer treatment outcomes. The aim of this article is to review organ at risk (OAR) sparing approaches available in MR-guided adaptive radiotherapy and present future developments which hope to improve treatment outcomes. Increasing the spatial conformity of dose distributions in radiotherapy is an important first step in reducing normal tissue toxicities, and MR-guided treatment devices presents a new opportunity to use biological information to drive treatment decisions on a personalized basis.MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) methods on MR-Linac devices directed towards the sparing of organs at risk (OAR) and a view of future adaptive techniques seeking to improve the therapeutic ratio. This ratio expresses the relationship between the probability of tumor control and the probability of normal tissue damage and is thus an important conceptual metric of success in the sparing of OARs. Increasing spatial conformity of dose distributions to target volume and OARs is an initial step in achieving therapeutic improvements, followed by the use of imaging and clinical biomarkers to inform the clinical decision-making process in an ART paradigm. Pre-clinical and clinical findings support the incorporation of biomarkers into ART protocols and investment into further research to explore imaging biomarkers by taking advantage of the daily MR imaging workflow. A coherent understanding of this road map for RT in HNC is critical for directing future research efforts related to sparing OARs using image-guided radiotherapy (IGRT).

Modern neuroimaging techniques in the assessment of changes in the brain connectome in patients with postmastectomy syndrome

Relevance. Currently, neuropsychiatric disorders are considered one of the main ones in the pathogenesis of postmastectomy syndrome. Modern neuroimaging techniques — functional (fMRI) and diffusion tensor (DTI) magnetic resonance imaging — allow us to identify functional and structural changes in the brain connectome in patients with postmastectomy syndrome caused by a complex of neuropsychiatric disorders.The purpose of the study. To evaluate changes in the functional and structural connectome of the brain in patients with postmastectomy syndrome using fMRI and DTI techniques.Materials and methods. The study was carried out on a tomograph with a magnetic field induction of 3.0 T. 46 patients with neurological disorders in the long-term postoperative period (more than 6 months) after radical mastectomy, chemotherapeutic and/or radiation treatment of breast cancer were examined.Results. According to the results of the intergroup statistical analysis, all 46 patients with postmastectomy syndrome had differences in functional connectivity in the default mode network and quantitative fractional anisotropy in the white matter tracts of the brain compared with the control group (p &lt; 0.01).Conclusion. The use of fMRI and DTI in patients with postmastectomy syndrome makes it possible to identify changes in the brain connectome correlating with neurological disorders and a decrease in the quality of life of patients. The results obtained will allow improving treatment and rehabilitation approaches in patients receiving treatment for breast cancer.

Single fraction ablative preoperative radiation treatment for early-stage breast cancer: the CRYSTAL study \u2013 a phase I/II clinical trial protocol

BackgroundBreast-conserving surgery (BCS) and whole breast radiation therapy (WBRT) are the standard of care for early-stage breast cancer (BC). Based on the observation that most local recurrences occurred near the tumor bed, accelerated partial breast irradiation (APBI), consisting of a higher dose per fraction to the tumor bed over a reduced treatment time, has been gaining ground as an attractive alternative in selected patients with low-risk BC. Although more widely delivered in postoperative setting, preoperative APBI has also been investigated in a limited, though increasing, and number of studies. The aim of this study is to test the feasibility, safety and efficacy of preoperative radiotherapy (RT) in a single fraction for selected BC patients.MethodsThis is a phase I/II, single-arm and open-label single-center clinical trial using CyberKnife. The clinical investigation is supported by a preplanning section which addresses technical and dosimetric issues. The primary endpoint for the phase I study, covering the 1st and 2nd year of the research project, is the identification of the maximum tolerated dose (MTD) which meets a specific target toxicity level (no grade 3–4 toxicity). The primary endpoint for the phase II study (3rd to 5th year) is the evaluation of treatment efficacy measured in terms of pathological complete response rate.DiscussionThe study will investigate the response of BC to the preoperative APBI from different perspectives. While preoperative APBI represents a form of anticipated boost, followed by WBRT, different are the implications for the scientific community. The study may help to identify good responders for whom surgery could be omitted. It is especially appealing for patients unfit for surgery due to advanced age or severe co-morbidities, in addition to or instead of systemic therapies, to ensure long-term local control. Moreover, patients with oligometastatic disease synchronous with primary BC may benefit from APBI on the intact tumor in terms of tumor progression free survival. The study of response to RT can provide useful information about BC radiobiology, immunologic reactions, genomic expression, and radiomics features, to be tested on a larger scale.Trial registrationThe study was prospectively registered at clinicaltrials.gov (NCT04679454).

Multi-target combinatory strategy to overcome tumor immune escape

Immune therapy has become the fourth approach after surgery, chemotherapy, and radiotherapy in cancer treatment. Many immune checkpoints were identified in the last decade since ipilimumab, which is the first immune checkpoint inhibitor to cytotoxic T-lymphocyte associated protein 4, had been approved by the US Food and Drug Administration (FDA) for the treatment of unresectable or metastatic melanoma in 2011. The use of several antibody drugs that target PD1/PD-L1 for various cancer treatments has been approved by the FDA. However, fewer people are benefitting from immune checkpoint inhibitor treatment in solid cancers. Approximately 80% of patients do not respond appropriately because of primary or acquired therapeutic resistance. Along with the characterization of more immune checkpoints, the combinatory treatment of multiimmune checkpoint inhibitors becomes a new option when monotherapy could not receive a good response. In this work, the author focuses on the combination therapy of multiple immune checkpoints (does not include targeted therapy of oncogenes or chemotherapy), introduces the current progression of multiple immune checkpoints and their related inhibitors, and discusses the advantages of combination therapy, as well as the risk of immune-related adverse events.

Management of oral mucositis caused by radiotherapy – A comprehensive review

Oral cancer is the malignant neoplasm involving the oral cavity. The treatment of oral cancer is surgery, radiotherapy, and adjuvant chemotherapy. Oral mucositis is the most common side effect when radiotherapy treatment for oral cancer is indicated. High.grade oral mucositis results in the delay of the radiotherapy treatment and increases the cost of maintenance. The preventive measures for radiation.induced mucositis include maintaining oral hygiene, treatment of xerostomia, diet modifications, and low.level laser therapy. This article provides a guide for the practicing oncologists about the current treatment, advances in treatment, and alternative medicine for improving radiation.induced mucositis.

Association between radiation dose to organs at risk and acute patient reported outcome during radiation treatment for head and neck cancers.

Associations between patient-reported outcomes and dose to organs at risk (OARs) may promote management and guide future investigations. We retrospectively evaluated PROs and OAR dose in head and neck (H&N) cancer. In 169 patients, we identified weak associations between: "Difficulty swallowing/chewing" and increased mean RT dose to the oral cavity, larynx, pharyngeal constrictor muscles (PCM) and contralateral parotid; "choking/coughing" and larynx mean dose; "problems with mucus in mouth and throat" and oral cavity, contralateral parotid mean dose and parotid V30, contralateral submandibular gland and PCM mean dose; "difficulty with voice/speech" and oral cavity, contralateral parotid, contralateral submandibular gland and larynx mean dose; and "dry mouth" and ipsilateral submandibular gland, oral cavity and PCM mean dose. We identified weak associations between PRO and dose to OARs-these data can guide on treatment management, patient counseling, and serve as a baseline for future investigations.

Skin Dosimetric Comparison of 3DCRT and IMRT Planning for Post-Mastectomy Breast Radiotherapy

Breast cancer is the most common cancer for incidence and mortality among females globally and in Indonesia. Mastectomy is still the most common surgery for female breast cancer in Indonesia. After the mastectomy, several patients will receive a whole breast radiotherapy session. About 68.75 % of breast cancer patients in the radiotherapy department at Lavalette Hospital during 2019 had undergone the mastectomy. Radiotherapy treatment for breast cancer can be delivered using Intensity Modulated Radiotherapy (IMRT) or 3D-Conformal Radiotherapy (3DCRT) technique. This study is aimed to compare the skin dosimetric between IMRT and 3DCRT for post-mastectomy breast radiotherapy. Left-sided breast cancer patients who underwent radiotherapy at Lavalette Hospital during 2019 were included in this study, and 15 patients were selected. All patients received 50 Gy in 25 fractions over 5 weeks using 6 MV photons. The planning target volume (PTV) and organ at risk (OAR) were delineated. Skin with 3 mm thickness along PTV was also contoured for evaluating the dose delivered to the skin. The treatment planning was conducted using 3DCRT and 5 fields IMRT planning. The plans were optimized for at least 95 % of the prescribed dose to cover 95 % volume of the PTV. The mean dose and maximum dose were used for evaluating and comparing each plan. The skin’s mean dose from 3DCRT planning was 24.65 ± 4.12 Gy and 22.85 ± 3.68 Gy ( p = 0.002) for IMRT planning. Meanwhile, skin maximum doses were 54.15 ± 0.68 Gy and 53.89 ± 1.05 Gy ( p = 0.001) respectively for 3DCRT and IMRT planning. These results showed that IMRT offered a lower dose to the skin and a better skin-sparing effect than 3DCRT. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";}

Radiation responses of cancer and normal cells to split dose fractions with uniform and grid fields: increasing the therapeutic ratio

Purpose Radiation treatment of cancer is usually delivered in a prescribed sequence of dose fractions within which the dependence of dose on time is determined by the treatment plan. New techniques, such as stereotactic body radiation therapy (SBRT) and image guided radiation therapy (IGRT) have been introduced with the motivation of improving therapeutic outcomes, with the consequence that the time dependence of the dose within a fraction is modified. Here, we test whether an increased toxicity to cancer cells arises when a radiation treatment fraction is delivered in two equal parts, allowing time for the expression of factors, for example, RONS and cytokines, in response to the first dose which may sensitize cells to the second dose. A medium time delay between 15 and 60 minutes is proposed to allow factors to be expressed before repair takes place. A grid field is used to enhance diffusion of the factors. Materials and methods The cell lines used in the study were two prostate cancers (LNCaP and DU 145), a normal prostate (PNT1A), a non-small cell lung cancer (NCI-H460), and a glioma (Hs 683). Uniform or spatially modulated grid fields, delivering the same mean dose, were used. The results for the clonogenic survival fractions were grouped into a ‘short’ delay (under 10 minutes) and a ‘medium’ delay (between 15 and 60 minutes). Results The medium delay with a grid field yielded a significant increase in toxicity for the four cancer cell lines. The medium delay with a uniform field gave a significant increase in toxicity for the two prostate cancer cell lines. A highly significant increase was found in the therapeutic ratio, defined as the ratio of the survival of prostate normal to prostate cancer cells. Conclusions The findings show that the intra-fractional dose schedule with medium time delay offers an opportunity to increase the toxicity of radiation to cancer cells, relative to a single radiation delivery. For all cancer cell lines, a grid field gives a greater toxic effect than a uniform field. The split dose treatment offers an increase in cancer toxicity while preserving normal cells, improving the outcomes of a treatment.