Local Tumor Control Rate Research Articles

Long-term outcomes of proton beam therapy in patients with previously untreated hepatocellular carcinoma.

Long‐term efficacy of proton beam therapy (PBT) remains unclear for patients with previously untreated hepatocellular carcinoma (HCC). We aimed to study the long‐term outcomes of PBT according to Barcelona Clinic Liver Cancer (BCLC) staging classifications in patients with previously untreated HCC. The major eligibility criteria of this observational study were an Eastern Cooperative Oncology Group performance status (PS) 0–2, Child–Pugh grade A or B, previously untreated HCC covered within an irradiation field, and no massive ascites. A total of 66.0–77.0 GyE was administered in 10–35 fractions. Local tumor control (LTC), defined as no progression in the irradiated field, progression‐free survival (PFS), and overall survival (OS) were assessed according to BCLC staging. From 2002 to 2009 at our institution, 129 patients were eligible. The 5‐year LTC, PFS, and OS rates were 94%, 28%, and 69% for patients with 0/A stage disease (n = 9/21), 87%, 23%, and 66% for patients with B stage disease (n = 34), and 75%, 9%, and 25% for patients with C stage disease (n = 65), respectively. The 5‐year LTC and OS rates of 15 patients with tumor thrombi in major vessels were 90% and 34%, respectively. Multivariate analyses revealed that PS (0 versus 1–2) was a significant prognostic factor for OS. No grade 3 or higher adverse effects were observed. PBT showed favorable long‐term efficacies with mild adverse effects in BCLC stage 0 to C, and can be an alternative treatment for localized HCC especially when accompanied with tumor thrombi. This study was registered with UMIN Clinical Trials Registry (UMIN000025342).

Apoptosis and injuries of heavy ion beam and x-ray radiation on malignant melanoma cell.

This study aims to investigate the influence of high linear energy transfer (LET) heavy ion (12C6+) and low LET X-ray radiation on apoptosis and related proteins of malignant melanoma on tumor-bearing mice under the same physical dosage. C57BL/6 J mice were burdened by tumors and randomized into three groups. These mice received heavy ion (12C6+) and X-ray radiation under the same physical dosage, respectively; their weight and tumor volumes were measured every three days post-radiation. After 30 days, these mice were sacrificed. Then, median survival time was calculated and tumors on mice were proliferated. In addition, immunohistochemistry was carried out for apoptosis-related proteins to reflect the expression level. After tumor-bearing mice were radiated to heavy ion, median survival time improved and tumor volume significantly decreased in conjunction with the upregulated expression of pro-apoptosis factors, Bax and cytochrome C, and the downregulated expression of apoptosis-profilin (Bcl-2, Survivin) and proliferation-related proteins (proliferating cell nuclear antigen). The results indicated that radiation can promote the apoptosis of malignant melanoma cells and inhibit their proliferation. This case was more suitable for heavy ion (12C6+). High LET heavy ion (12C6+) radiation could significantly improve the killing ability for malignant melanoma cells by inducing apoptosis in tumor cells and inhibiting their proliferation. These results demonstrated that heavy ion (12C6+) presented special advantages in terms of treating malignant melanoma. Impact statement Malignant melanoma is a malignant skin tumor derived from melanin cells, which has a high malignant degree and high fatality rate. In this study, proliferating cell nuclear antigen (PCNA) can induce the apoptosis of malignant melanoma cells and inhibit its proliferation, and its induction effect on apoptosis is significantly higher than low LET X-ray; hence, it is expected to overcome its lower sensitivity to radiation. This study can provide theoretical basis for clinical trials, in which malignant melanoma is treated by heavy ion (12C6+), in order to accurately determine the clinical efficacy of heavy ion therapy. Clinical applications has revealed that local tumor control rate is high when heavy ion is used to treat malignant melanoma, indicating that heavy ion is an important direction in treating melanoma in the future.

DART-bid for loco-regionally advanced NSCLC

BackgroundTo report acute and late toxicity with long-term follow-up, and to describe our experiences with pulmonary dose constraints.MethodsBetween 2002 and 2009, 150 patients with 155 histologically/cytologically proven non-small cell lung cancer (NSCLC; tumor stages II, IIIA, IIIB in 6, 55 and 39%, respectively) received the following median doses: primary tumors 79.2 Gy (range 72.0–90.0 Gy), lymph node metastases 59.4 Gy (54.0–73.8 Gy), nodes electively 45 Gy; with fractional doses of 1.8 Gy twice daily (bid). In all, 86% of patients received 2 cycles of chemotherapy previously.ResultsFive treatment-related deaths occurred: pneumonitis, n = 1; progressive pulmonary fibrosis in patients with pre-existing pulmonary fibrosis, n = 2; haemorrhage, n = 2. In all, 8% of patients experienced grade 3 and 1.3% grade 4 pneumonitis; 11% showed late fibrotic alterations grade 2 in lung parenchyma. Clinically relevant acute esophagitis (grade 2 and 3) was seen in 33.3% of patients, 2 patients developed late esophageal stenosis (G3). Patients with upper lobe, middle lobe and central lower lobe tumours (n = 130) were treated with V20 (total lung) up to 50% and patients with peripheral lower lobe tumours (n = 14, basal lateral tumours excluded) up to 42%, without observing acute or late pulmonary toxicity >grade 3. Only patients with basal lateral lower lobe tumours (n = 5) experienced grade 4/5 pulmonary toxicity; V20 for this latter group ranged between 30 and 53%. The mean lung dose was below the QUANTEC recommendation of 20–23 Gy in all patients. The median follow-up time of all patients is 26.3 months (range 2.9–149.4) and of patients alive 80.2 months (range 63.9–149.4.). The median overall survival time of all patients is 26.3 months; the 2-, 5- and 8‑year survival rates of 54, 21 and 15%, respectively. The local tumour control rate at 2 and 5 years is 70 and 64%, the regional control rate 90 and 88%, respectively.Discussion and conclusionGrade 4 or 5 toxicity occurred in 7/150 patients (4.7%), which can be partially avoided in the future (e.g. by excluding patients with pre-existing pulmonary fibrosis). Tolerance and oncologic outcome compare favourably to concomitant chemoradiation also in long-term follow-up.

Ocular oncology: advances in retinoblastoma, uveal melanoma and conjunctival melanoma.

Retinoblastoma, uveal and conjunctival melanomas are important malignancies within the remit of ocular oncology. Outlined are the diagnostic features and management principles, as well as advancements in the field and current challenges. Original papers, reviews and guidelines. Most eyes with retinoblastoma (International Intraocular Retinoblastoma Classification (IIRC) Group A-D) are salvaged, whereas advanced cases (Group E) remain a challenge. Despite a high rate of local tumour control in uveal melanoma, metastatic spread commonly occurs. Conjunctival melanoma is treated by complete resection, but high rates of local recurrence occur, with the possibility of systemic relapse and death. Use of the IIRC in retinoblastoma, and systemic screening in melanomas. Utilization of novel treatment modalities in retinoblastoma and an increasing understanding of the genetic basis of melanomas. Improvements in chemotherapy delivery in retinoblastoma and prognostic tests in melanomas.

Dosimetric and Radiobiological Evaluation of Multiparametric MRI-Guided Dose Painting in Radiotherapy of Prostate Cancer

Radiotherapy is one of the treatment options for locally advanced prostate cancer; however, with standard radiation doses, it is not always very effective. One of the strategies to improve the efficiency of radiotherapy is increasing the dose. In this study, to increase tumor local control rates, a new radiotherapy method, known as dose painting (DP), was investigated. To compare 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) plans with DP for prostate cancer. Twenty-four consecutive patients with locally advanced prostate cancer who underwent an multiparametric-magnetic resonance imaging (MP-MRI) (T2w, diffusion weighted image, dynamic contrast enhancement, and MRS) scan before a diagnostic biopsy from September 2015 to April 2016 were invited to take part in this study. The tumor local control probability (TCP) values for 3D-CRT, IMRT, and DP techniques were 45, 56, and 77%, respectively. The DP technique had a 37.5 and 71% higher TCP than IMRT and 3D-CRT, and these differences were statistically significant (P = 0.001). The mean normal tissue complication probability (NTCP) values of the organ at risks for 3D-CRT, IMRT, and DP showed that there were statistically significant differences among them in three plans (P = 0.01). DP by contours using MP-MRI is technically feasible. This study evaluated biological modeling based on both MP-MRI defined subvolumes and pathologically defined subvolumes. The MP-MRI-guided DP results in better TCP/NTCP than 3D-CRT and IMRT.

Effect comparison between ultrasound guided percutaneous laser ablation and radiofrequency ablation for the treatment of small hepatocellular carcinoma

Objective To compare the effects between ultrasound guided percutaneous laser ablation (LA) and radiofrequency ablation (RFA) for small hepatocellular carcinoma (HHC). Methods We retrospectively reviewed the data of 54 patients with small HHC. According to the different methods of treatment, 54 patients were divided into LA group (n=27) and RFA group (n=27). Patients in LA group were treated with ultrasound guided percutaneous LA, and patients in RFA group were treated with RFA. The adverse reaction and short-term curative effect were observed. The local tumor control rate and progression-free survival (PFS) of patients were follow-up visited. Results After treatment, the total response rates of patients in LA group and RFA group were 81.48% and 77.78% respectively, with no significant difference (χ2=0.11, P=0.74). The 1-year local tumor control rates of patients in LA group and RFA group were 77.78% and 51.85% respectively, with a significant difference (χ2=14.74, P=0.00). The median PFS of patients in LA group and RFA group were (12.52±6.57) months and (8.67±5.13) months, with a significant difference (χ2=4.70, P=0.03). The adverse reactions of patients in LA group and RFA group after treatment were puncture region pain (40.74% vs. 33.33%; χ2=0.32, P=0.57), retroperitoneal hemorrhage (7.41% vs. 11.11%; P=0.64), hemobilia (0 vs. 3.70%; P=0.31), bile leakage (7.41% vs. 14.81%; P=0.39), and abdominal infection (3.70% vs. 11.11%; P=0.30), with no significant differences. Conclusion Compared with RFA, LA may improve the local tumor control rate and prolong the PFS of patients with small HHC, which has a certain clinical practice value and prospect. Key words: Carcinoma, hepatocellular; Catheter ablation; Progression-free survival

Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases? A retrospective analysis of 106 consecutive patients age 80years and older.

BackgroundAdvanced age has been shown to be a factor predicting poor survival in patients with brain metastases (BM). There have been only a few studies focusing on stereotactic radiosurgery (SRS) for elderly BM patients. The present study aimed to investigate the efficacy and limitations of SRS for very elderly BM patients.MethodsThis was a retrospective observational study analyzing 106 consecutive patients (69 males/37 females) age 80 years and older who received upfront Gamma Knife SRS for BM between January 2009 and October 2015. The median age was 84 years, and the median Karnofsky performance status (KPS) was 70. Fifty-two patients had a solitary BM, and others multiple BM. The median cumulative tumor volume was 3.9 mL and the median dose prescribed was 20 Gy. Overall survival (OS), neurological death rates and distant and local intracranial tumor control rates were analyzed.ResultsNo patients were lost to follow-up. Six-month and 12-month OS rates were 54% and 32%, respectively. The median OS time was 7.1 months. Competing risks analysis showed that 6-month and 12-month neurological death rates were 8% and 11%, respectively. In total, 245 / 311 tumors (79%) in 82 patients (77%) with sufficient radiological follow-up data were evaluated. Six-month and 12-month distant BM recurrence rates (per patient) after SRS were 17% and 25%, respectively. Six-month and 12-month rates of local tumor control (per lesion) were 94% and 89%, respectively. Repeat SRS, salvage WBRT and surgical resection were subsequently required in 25, 4 and 1 patient, respectively. Proportional hazard regression analysis showed that KPS ≥ 70 (HR: 0.444, P < .001), controlled primary disease/no extracranial metastases (HR: 0.361, P < .001) and female sex (HR: 0.569, P = 0.028) were independent factors predicting better OS. Similarly, tumor volume (>2 mL) was the only factor predicting a higher rate of local control failure (HR: 12.8, P = 0.003).ConclusionsThe present study suggested an upfront SRS strategy to offer a feasible and effective treatment option for very elderly patients with limited BM. In the majority of patients, neurological death could be delayed or even prevented.

Palliative treatment of pelvic bone tumors using radioiodine (125I) brachytherapy.

BackgroundComplete resection of pelvic bone tumors, especially recurrent and metastatic ones, is often impossible to achieve using conventional surgery. This study aimed to assess the benefits and adverse effects of computed tomography (CT)-guided radioiodine (125I) brachytherapy for inoperable recurrent and metastatic bone tumors of the pelvis.MethodsThis was a retrospective study of 22 patients with confirmed pelvic bone tumors (10 females and 12 males; 15–84 years; 21 with primary pelvic tumor and one with pelvic metastasis). CT-guided 125I brachytherapy was performed using 9–21 125I seeds (radioactivity of 0.5–0.7 mCi). Seed implantation was validated by postoperative CT scanning. Complications, pain, survival, and CT-estimated tumor size were carried out to evaluate the therapeutic benefits.ResultsPostoperative CT scans revealed satisfactory 125I seed implantation, and the radiation dose delivered to 90% of the target area (D90) was higher than the prescription dose (PD). No obvious complications were observed. Pain was reported by 19 of 22 patients, but 17 reported pain relief after implantation. Follow-up ranged 8–27 (median, 19) months. Tumor size was reduced in 11 patients within 1 month after surgery, nine patients showed no change, and tumor size increased in two patients. Finally, 1- and 2-year survival was 81.8 and 45.5%, respectively; 1- and 2-year local tumor control rates were 59.1 and 36.4%, respectively.Conclusions 125I seed implantation significantly reduced bone tumor size and relieved pain, with a low complication rate. These findings suggest that 125I brachytherapy treatment could be a useful palliative approach for pelvic bone tumor treatment.

Investigation of long-term survival outcomes and failure patterns of patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: a retrospective analysis.

Intensity-modulated radiotherapy (IMRT) has replaced the conventional radiotherapy (2D-RT) and improved clinical efficacy in Nasopharyngeal Carcinoma (NPC) patients. In the present study, we retrospectively analyzed the clinical characteristics of patients with NPC treated with IMRT to assess the long-term survival outcomes and failure patterns. Of the 527 patients, One hundred and twenty-one patients experienced treatment failure, 86 patients developed distant metastases, and 12 patients developed a second primary tumor. The local and regional recurrence rates were 31.4% and 14.0%, respectively. The 5-year overall survival (OS), progression-free survival (PFS), local recurrence-free survival (LRFS), regional relapse-free survival (RRFS), and distant metastatic relapse-free survival (DMFS) rates were 80.9%, 75.6%, 91.7%, 96.2%, and 83.0%, respectively. The 5-year LRFS rates of Stage T1-4 patients were 100.0%, 93.1%, 92.0%, and 85.8%, respectively. The 5-year DMFS rates of Stage N0-3 patients were 95.0%, 86.1%, 79.5%, and 67.2%, respectively. Multivariate analysis showed age and T-stage were independent predictors of OS, T-stage was an independent predictor of LRFS, and age and N-stage were independent predictors of PFS and DMFS.In summary, the improved treatment results with IMRT are primarily due to the achievement of a higher local tumor control rate and OS in NPC patients. However, distant metastasis was the most commonly observed failure pattern after treatment. These results provide deep insights about the value of IMRT in the treatment and prognosis of NPC patients.

Percutaneous Image-Guided Cryoablation of Musculoskeletal Metastases: Pain Palliation and Local Tumor Control

PurposeTo evaluate the safety and effectiveness of cryoablation of musculoskeletal metastases in terms of achieving pain palliation and local tumor control. Materials and MethodsA retrospective review was performed of 92 musculoskeletal metastases in 56 patients treated with percutaneous image-guided cryoablation. Mean age of the cohort was 53.9 y ± 15.1, and cohort included 48% (27/56) men. Median tumor volume was 13.0 cm3 (range, 0.5–577.2 cm3). Indications for treatment included pain palliation (41%; 38/92), local tumor control (15%; 14/92), or both (43%; 40/92). Concurrent cementoplasty was performed after 28% (26/92) of treatments. ResultsIn 78 tumors treated for pain palliation, median pain score before treatment was 8.0. Decreased median pain scores were reported 1 day (6.0; P < .001, n = 62), 1 week (5.0; P < .001, n = 70), 1 month (5.0; P < .001, n = 63), and 3 months (4.5; P = .01, n = 28) after treatment. The median pain score at 6-month follow-up was 7.5 (P = .33, n = 11). Radiographic local tumor control rates were 90% (37/41) at 3 months, 86% (32/37) at 6 months, and 79% (26/33) at 12 months after treatment. The procedural complication rate was 4.3% (4/92). The 3 major complications included 2 cases of hemothorax and 1 transient foot drop. ConclusionsCryoablation is an effective treatment for palliating painful musculoskeletal metastases and achieving local tumor control.

The value of 125iodine implantation combining transcatheter arterial chemoembolization to prevent digestive tract bleeding in patients with portal vein tumor thrombus in primary hepatocellular carcinoma

Objective This study was to investigate the value of CT guided 125iodine implantation combining transcatheter arterial chemoembolization(TACE) to prevent digestive tract bleeding in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods Forty patients with portal vein tumor thrombus which were diagnosed to have primary hepatocellular carcinomas by diagnostic criteria of Chinese Anti-Cancer Association were collected prospectively. They were divided into the treatment group and the control group, with 20 patients in each group. The treatment group was treated by TACE for hepatic tumor and 125iodine seed implantation for portal vein tumor thrombus, while the control group was treated by TACE for hepatic tumor and only given β-blockers medicines after treatment. Intraoperative and postoperative surgery-related complications were observed. Three months after surgery, enhanced abdominal CT scanning was performed to evaluate treatment effects which were divided into complete response (CR), partial response (PR), and progressive disease (PD) and stable of disease (SD), and the local tumor control rates were calculated. The bleeding rates and mortality after 3 months, 6 months, 12 months were recorded. Treatment effects of the two groups were compared with continuously correction Chi-square test, bleeding rates were compared with Fisher test, and survival rates were analyzed with Kaplan-Meier survival curve and compared with Log-rank test. Results Overall the 40 patients were treated successfully without serious surgery-related complications. In the treatment group, there were 8 patients with PR, 6 with SD and 6 with PD, and the local control rates were 40% (8/20). In the control group, there were 1 patient with PR, 6 patients with SD and 13 with PD. The difference of the local control rates was statistically significant (χ2= 5.161, P=0.023).The bleeding rates at 3, 6 and 12 months were 2, 2 and 3 cases in the treatment group, for control group they were 2, 6 and 10 cases respectively. There was no statistical difference between the 3 months and 6 months bleeding rates (P values were 1.000 and 0.235), but for 12 months bleeding rates, the difference was statistically significant (P=0.041).The 1 year cumulative survival rates of the treatment group and control group were 70% (14/20) and 40% (8/20), and the difference was statistically significant (χ2= 4.675, P=0.031). Conclusion The treatment of 125iodine implantation combining transcatheter arterial chemoembolization in patients with portal vein tumor thrombus in primary hepatocellular carcinoma can reduce variceal bleeding rate and improve survival rate. Key words: Liver neoplasms; Portal vein; Gastrointestinal hemorrhage; Radiology, interventional

The Preliminary Efficacy and Safety of Fractionated Stereotactic Radiosurgery for Skull Base Schwannoma

The hypothesis is that fractionated stereotactic radiosurgery (SRS) may reduce risk of treatment-related cranial nerve complications and have the same effect as single-fraction SRS in treatment with relative large volume skull base schwannoma. We performed this prospective study and compared the preliminary efficacy and safety of skull base schwannoma treated with single-fraction and fractionated SRS. Thirty-three patients with skull base schwannoma were treated with either single-fraction or three-fraction SRS at the cancer center between March 2012 and November 2014. The magnetic resonance imaging (MRI) scan was fused to the CT scan in all patients. The margin of gross target volume (GTV) was enlarged 1-2 mm for skull base lesion as planning target volume (PTV). The real-time tracking multi-beam focus radiation therapy was used to implement SRS treatment. Tumor local control was defined as needing no additional treatment (i.e., microsurgical resection, repeat SRS). Treatment-related parameters were evaluated and analyzed using predictive analytics software. There were 6 patients treated with 12-14 Gy in a single-fraction SRS and 27 patients with 18-21 Gy in 3-fraction SRS. The median age was 52 years (range, 21-70 years) and the ratio of male and female was 16/17. The median maximal diameter of skull base schwannoma was 2.29 cm (range, 0.9-4.43 cm). The median tumor volume was 4.73 cm3 (range, 0.47-23.9 cm3). The median biological equivalent dose (BED2) was 94.5 Gy (range, 72-112 Gy) if α/β was equal to 2. With the median follow-up of 26.6 months (range, 14.4-46.1 months), the rate of local tumor control was 100%. Compared with that of pre-SRS, the median maximal diameter of skull base schwannoma significantly decreased (2.29 cm vs 1.45 cm, P = 0.001). The Patients treated with single-fraction and fractionated SRS were 18.2% (6/33) and 81.8% (27/33), respectively. Compared with single SRS, the fractionated SRS significantly decreased BED2 (97.5 Gy vs 94.5 Gy, P = 0.015) and had relative large volume of planning target volumes (PTV) (3.29 cm3 vs 5.46 cm3, P = 0.37). There was no statistical difference in local tumor control between single and fractionated SRS. The cranial nerve symptoms were stable and improved after SRS, including tinnitus (80%, 12/15), hearing loss (91%, 20/22), trigeminal paresthesia (62%, 8/13) and trigeminal neuralgia (100%, 2/2). The side effects After SRS involved hemifacial spasm (18%, 6/33), facial nerve paralysis (6%, 2/33), cerebella dystaxia (6%, 2/33) and encephaledema (15%, 5/33), but most symptoms were transient and mild. There was no significant statistically differences in tinnitus, hearing loss, trigeminal paresthesia and neuralgia between single and fractionated SRS. The fractionated SRS was an effective dose-fraction model for skull base schwannoma, offering a similar effect to single SRS and a promising outcome in reducing risk of cranial nerve complication.

PC3 - 138 Stereotactic Radiosurgery for Intracranial Hemangiopericytomas – A Multicenter Study

Hemangiopericytomas (HPC) are widely recognized for their aggressive clinical behavior. We report a large multicenter study, through the International Gamma Knife Research Foundation reviewing management and outcome following stereotactic radiosurgery (SRS) for recurrent or newly-discovered HPC’s. Methods: Eight centers participated, reviewing a total of 90 patients harboring 133 tumors. Prior treatments included embolization (n = 8), chemotherapy (n=2), and fractionated radiotherapy (n=34). The median tumor volume at the time of SRS was 4.9 ml (range 0.2-42.4 ml). WHO-grade II (typical) HPC’s formed 78.9% (n=71) of the cohort. The median margin and maximal doses delivered were 15 Gy (2.8-24) and 32 Gy (8-51), respectively. The median clinical and radiographic follow-up period was 59 months (6-190) and 59 months (6-183), respectively. Results: At last follow-up, 55% of tumors and 62.2% of patients demonstrated local tumor control. New remote intracranial tumors were found in 27.8%. 24.4% of patients developed extra-cranial metastases. Adverse radiation effects were noted in 6.7%. The overall survival was 91.5%, 82.1%, 73.9%, 56.7%, and 53.7% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. Local progression free survival was 81.7%, 66.3%, 54.5%, 37.2%, and 25.5% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. In our cohort, 32 patients underwent 48 repeat SRS procedures for 76 lesions. Margin dose greater than 16 Gy (p=0.037) and tumor histology (p=0.006) were shown to influence PFS. Conclusions: SRS provides a reasonable rate of local tumor control and a low risk of adverse effects

Gamma Knife Surgery for Recurrent or Residual Supratentorial Primitive Neuroectodermal Tumors

Background: Supratentorial primitive neuroectodermal tumors (PNETs) are highly malignant and rare tumors of the central nervous system. Objectives: The aim of this study was to determine the role of Gamma Knife surgery (GKS) as a salvage treatment option for patients with recurrent or residual supratentorial PNETs. Methods: Between 1998 and 2014, 11 patients with supratentorial PNETs were retrospectively analyzed. This series consisted of 7 male and 4 female patients. The median age was 17 years. All patients received surgical resection followed by adjuvant therapy. The median time from operation to the first GKS treatment was 72.5 months. The median tumor volume was 17.5 cm³, and the median marginal dose was 11.5 Gy. Results: 15 (65%) of the 23 tumors had been controlled. The actuarial local tumor control rate was 91% at 3 months, 73% at 6 months, and 44% at 12 months. At the time of analysis, 9 (82%) of the patients had died. The median survival time after the first GKS session was 17 months. The median survival time from the initial diagnosis was 65 months. No adverse radiation effect after GKS treatment occurred in any patient. Conclusions: GKS treatment might be an effective salvage treatment option for recurrent or residual supratentorial PNETs after multimodal treatment.

High-frequency versus low-frequency microwave ablation in malignant liver tumours: evaluation of local tumour control and survival

Purpose: To compare local tumour control and survival rates in patients with liver metastases treated with microwave ablation (MWA), using either a low-frequency (LF) (915 MHz) or high-frequency (HF) system (2.45 GHz).Materials and methods: The retrospective study included 221 patients (mean age: 61.7 years) with 356 malignant hepatic lesions. Ninety-four patients with 133 lesions underwent LF-MWA between September 2008 and February 2011, while 127 patients with 223 lesions were treated with HF-MWA between March 2011 and July 2013. MRI was performed after 24 h from each procedure and at 3, 6, 9, 12, 18 and 24 months post-ablation. Both groups were compared with the Fisher’s exact test. Survival rates were calculated using the Kaplan–Meier test.Results: The mean initial ablation volume of LF-MWA was nearly half of HF-MWA (19.1 mL vs. 39.9 mL). The difference in volume between both systems was significant (p < .0001). With LF-MWA, 39/133 lesions (29.32%) progressed at follow-up while the number of lesions which progressed with HF-MWA was 10/223 (4.5%). The mean time to progression was 5.03 and 5.31 months for the lesions treated with LF-MWA and HF-MWA, respectively. The difference between both systems was significant (p = .00059). The 1-, 2- and 4-year overall survival rates for curative indication were 98.9%, 95.7% and 82.9% for LF-MWA, respectively, and were 100%, 97.6% and 92.9% for HF-MWA, respectively. The difference in survival rates was not significant (p > .05).Conclusion: Both LF- and HF-MWA systems are effective treatment options for oligonodular liver malignant lesions, but significantly higher ablation volumes, longer time to progression and lower progression rates were observed in HF-MWA.

Initial Experience with CT–Guided High-Dose-Rate Brachytherapy in the Multimodality Treatment of Neuroendocrine Tumor Liver Metastases

PurposeTo evaluate efficacy of computed tomography (CT)–guided high-dose-rate brachytherapy (HDRBT) of neuroendocrine liver metastases (NELM) with the goal of local tumor control (LTC). Materials and MethodsThis retrospective study included all patients with unresectable NELM treated with CT–guided HDRBT between January 2007 and April 2015. Magnetic resonance imaging follow-up was performed 6 weeks after ablation and then every 3 months. The primary endpoint was LTC. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and complications. ResultsIn 27 patients, 52 NELM were treated in 40 sessions. Three patients (11.1%) developed local progression with LTC of 1.9–36.8 months (median 10.4 months, mean 16.4 months). The remaining 24 patients (89.9%) had LTC of 3.1–106.1 months (median 31.3 months, mean 32.6 months). Progression or death was observed in 19 patients (70.4%) with PFS of 1.9–55.3 months (median 7.3 months, mean 16.3 months); the remaining 8 patients (29.6%) had PFS of 3.7–50.1 months (median 13.4 months, mean 19.6 months). Four patients (14.8%) died of causes unrelated to the procedure; their OS was 11.7–52.3 months (median 48.7 months, mean 40.4 months). OS was 4.2–106.1 months (median 30.3 months, mean 34.1 months) in the 23 surviving patients (85.2%). One patient experienced pain with nausea and vomiting, and 1 patient with biliodigestive anastomosis had a hepatic abscess. ConclusionCT–guided HDRBT is a promising therapy with excellent LTC rates and low morbidity for patients with isolated/oligometastatic NELM.

Repeated iodine-125 seed implantations combined with external beam radiotherapy for the treatment of locally recurrent or metastatic stage III/IV non-small cell lung cancer: a retrospective study.

BackgroundRecurrent or metastatic lung cancer is difficult to manage. This retrospective study aimed to assess the efficacy of repeated iodine-125 seed implantations combined with external beam radiotherapy (EBRT) for locally recurrent or metastatic stage-III/IV non-small cell lung cancer (NSCLC).MethodsEighteen previously treated stage-III/IV NSCLC patients with local or metastatic recurrences underwent 1-to-3 iodine-125 implantations. Six of these patients received palliative EBRT and six patients received combined chemotherapy using gemcitabine and cisplatin. Near-term treatment efficacy was evaluated 3 months after seed implantation by comparing changes in tumor size on computed tomography images; the evaluated outcomes were complete response, partial response, stable disease, and local tumor control rate. Long-term efficacy was assessed based on 1- and 2-year survival rates.ResultsPatients were followed up for 6 to 50 months. The overall (i.e., complete + partial) response rate was 87.4 %. The local control rates after the first, second, and third years were 94.1, 58.8 and 41.2 %, respectively.ConclusionsThe results of this study demonstrated that repeated implantation of radioactive particles combined with EBRT is a safe treatment that effectively controlled local recurrence and metastasis of stage III/IV NSCLC.

Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system.

Objective:Dynamic jaws (DJ) are expected to be useful in stereotactic radiotherapy (SRT) for brain metastases (BM). The efficacy and optimal dose fractionation were investigated.Methods:In a planning study, 63 treatment plans were generated for the following 3 conditions: 1.0-cm fixed jaws (FJ), 2.5-cm FJ and 2.5-cm DJ. In a clinical study, 30 Gy/3 fr, 35 Gy/5 fr or 37.5 Gy/5 fr were prescribed depending on tumour size. Clinical results of groups treated with 2.5-cm DJ plans and 1.0-cm FJ were compared.Results:In the planning study, the treatment times in 2.5-cm DJ and FJ plans were less than that in 1.0-cm FJ plans (p < 0.001). The brain doses in 1.0-cm FJ plans and 2.5-cm DJ plans were smaller than those in 2.5-cm FJ plans (p < 0.05). In the clinical study, 34 patients with 68 BM were treated with SRT. Of those, 15 patients with 34 BM were treated with 2.5-cm DJ plans and 19 patients with 34 BM were treated with 1.0-cm FJ plans. The overall survival and local tumour control (LC) rates were 52 and 93% at 12 months, respectively. The DJ system achieved favourable LC and 29% shorter treatment time compared with the FJ system (p < 0.001). Grade 2 or 3 necrosis occurred more frequently in patients with 15 cc or larger tumour volumes (p = 0.05).Conclusion:DJ technology enables treatment time to be reduced without worsening the dose distribution and clinical efficacy. The prescribed doses in this study may be acceptable for patients with small tumour volumes.Advances in knowledge:DJ technology enables treatment time to be reduced without worsening the dose.

Advanced Vision System by Subtraction of Background Image for Patient’s Movement during Treatment

According to the International Cancer Institute (IARC), the incidence of cancer in the world is rapidly increasing, and in the method of treating cancer, radiation therapy is 45% or more. As in the normal tissue in radiation therapy, to minimize radiation, it is important to maximize the exact dose to the tumor sites for local tumor control rates in intensive research (Local Tumor Rate). Therefore, at the beginning, therapist accuracy of detecting fatigue in the movement of the patient and therapist has been a problem that is weighted down directly. Also, by using a web camera, a difference value between the image to be updated to the reference image is calculated, and if the result exceeds the reference value, using the system for determining the motion has occurred. However, it is not possible in this system to quantitatively analyze the movement of the patient, as the background is changed when moving the treatment bed in the co-therapeutic device was not able to shift the patient. In this paper, using an alpha (α) filter index is an attempt to solve these limitation points, as it quantifies the movement of the patient by separating a background image of the patient and treatment environment, and it only senses movement of the patient during treatment, it was possible to reduce the problems due to patient movement.

Comparison of the Effectiveness of Radiofrequency Ablation With Stereotactic Body Radiation Therapy in Inoperable Stage I Non-Small Cell Lung Cancer: A Systemic Review and Pooled Analysis

Toperformed a systematic review and pooled analysis to compare clinical outcomes of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) for the treatment of medically inoperable stage I non-small cell lung cancer. A comprehensive literature search for published trials from 2001 to 2012 was undertaken. Pooled analyses were performed to obtain overall survival (OS) and local tumor control rates (LCRs) and adverse events. Regression analysis was conducted considering each study's proportions of stage IA and age. Thirty-one studies on SBRT (2767 patients) and 13 studies on RFA (328 patients) were eligible. The LCR (95% confidence interval) at 1, 2, 3, and 5years for RFA was 77% (70%-85%), 48% (37%-58%), 55% (47%-62%), and 42% (30%-54%) respectively, which was significantly lower than that for SBRT: 97% (96%-98%), 92% (91%-94%), 88% (86%-90%), and 86% (85%-88%) (P<.001). These differences remained significant after correcting for stage IA and age (P<.001 at 1year, 2years, and 3years; P=.04 at 5years). The effect of RFA was not different from that of SBRT on OS (P>.05). The most frequent complication of RFA was pneumothorax, occurring in 31% of patients, whereas that for SBRT (grade ≥3) was radiation pneumonitis, occurring in 2% of patients. Compared with RFA, SBRT seems to have a higher LCR but similar OS. More studies with larger sample sizes are warranted to validate such findings.