Received Radical Chemoradiotherapy Research Articles

The practical significance of using Canephron N medication for radiation cystitis prevention in patients undergoing radiation/chemoradiation therapy

Background. With increasing life expectancy in cervical cancer patients, new medical and social problems associated with radiation therapy become apparent. The combination of radiation therapy and chemotherapy is an important therapeutic component in treatment of malignant neoplasms of the genital area in women, but the frequency and severity of side effects has been increasing. Radiation complications occur in 20–50 % of patients. In 5 % of patients, they can represent a severe and potentially life-threatening condition. Prevention of negative effects on the genitourinary system in cervical cancer patients receiving radiation therapy on the pelvis is a matter of importance.Aim. To evaluate the clinical efficacy of a phytotherapeutic preparation Canephron N containing centaury, lovage root, rosemary leaves in the prevention of radiation cystitis during chemoradiotherapy in patients with advanced cervical cancer.Materials and methods. The study included 60 patients with locally advanced cervical cancer receiving radical chemoradiotherapy. The patients were divided into 2 groups: treatment group consisting of patients receiving phytotherapeutic preparation Canephron N for prevention of radiation complications, and control group consisting of patients not receiving symptomatic treatment. The treatment results were evaluated using questionnaires, clinical, laboratory and instrumental studies. The obtained data were compared with the results of treatment of the control group which were not prescribed a medication for prevention of urological complications.Results and conclusion. The use of Canephron N in accompanying therapy had significantly decreased the risk and incidence of radiation cystitis.

Abdominal Radical Hysterectomy as an Alternative Treatment Option for Patients with Cervical Cancer without Access to Radiotherapy Facilities

Background: To compare the oncological outcomes of Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer (CC) receiving radical chemoradiotherapy (R-CT), abdominal radical hysterectomy (ARH), or neoadjuvant chemotherapy and radical surgery (NACT). Methods: Overall, 4086 patients in 47 hospitals from 2004 to 2018 were divided into groups according to stage (4029 with stage IIIC1 and 57 with stage IIIC2). Kaplan-Meier and Cox regression analyses were applied to compare the 5-year overall survival (OS) and disease-free survival (DFS) of the three initial treatments before and after propensity score matching (PSM). Results: The 5-year DFS was worse in patients with stage IIIC2 than in those with stage IIIC1 (post-PSM: 68.3% vs. 39.9%, p < 0.001). For stage IIIC1, the ARH group had better 5-year OS (post-PSM: 71.0% vs. 80.0%, p < 0.001) and DFS (post-PSM: 67.2% vs. 71.0%, p < 0.001) than the R-CT group, while the NACT group had worse 5-year DFS (post-PSM: 67.7% vs. 55.3%, p = 0.002). The 5-year OS (post-PSM: 80.9% vs. 70.5%, p < 0.001) and DFS (post-PSM: 70.7% vs. 54.1%, p < 0.001) were better in the ARH than in the NACT group. For stage IIIC2, the 5-year DFS was better in the ARH than in the NACT group (45.4% vs. 30.1%, p = 0.025). Conclusions: The oncological prognosis of patients with stage IIIC1 CC was generally better than that of patients with stage IIIC2, thereby supporting the rationale behind the classification of stage IIIC. In less developed areas, the ARH is a promising alternative treatment option for patients with stage IIIC; nonetheless, the use of NACT is not advisable. Clinical Trial Registration: The study was registered at http://apps.who.int/trialsearch/, registration number CHiCTR1800017778.

Laryngo-Esophageal Dysfunction Free Survival of Chemoradiation for Cervical Esophageal Cancer

Chemoradiotherapy is often the treatment of choice for cervical esophageal cancer due to the invasiveness of surgery. However, toxicity after chemoradiotherapy often affects the quality of life related to swallowing and speech. This study evaluated laryngoesophageal dysfunction-free survival (LEDFS) in patients with cervical esophageal cancer, which has recently been used in head and neck cancer. We analyzed 59 patients with cervical esophageal cancer without distant metastases other than supraclavicular lymph node metastases who received radical chemoradiotherapy with 5-fluorouracilplus platinum between 2002 and 2018. Loco-regional control (LRC), overall survival (OS), LEDFS, metachronous esophageal cancer incidence rates, and late toxicities were evaluated. LEDFS events were defined as death, local recurrence, total or partial laryngectomy, tracheostomy for more than 2 years, and feeding tube use for more than 2 years, as recommended by the Larynx Preservation Consensus Panel. The Kaplan-Meier method was used to calculate survival rates. The generalized Wilcoxon test was used to compare the two groups. The Common Terminology Criteria for Adverse Events v5.0 was used to assess toxicities. The median age was 66 years (range, 38-83). There were 13 women and 46 men. Stage I, II, III, IVA, and IVB disease according to UICC 8th staging were 15, 9, 9, 10, and 16 patients, respectively. 22 received conventional radiotherapy and 37 received volumetric modulated arc therapy. The median total irradiation dose was 66 Gy. Platinum plus 5-fluorouracil chemotherapy was administered to all patients. The median follow-up for survivors was 87.5 months. The 5-year LRC, OS, and LEDFS rates were 54.2%, 48.9%, and 41.9%, respectively. The prognostic factors for OS were performance status (PS), hypopharyngeal extension, and clinical stage in univariate analysis and only clinical stage (hazard ratio [HR] 3.87, 95% Confidence interval [CI]: 1.52-9.87, p<0.01) in multivariate analysis; the prognostic factors for LEDFS were PS, hypopharyngeal extension and clinical stage in univariate analysis and hypopharyngeal extension (HR 2.38, 95% CI: 1.12-5.03, p = 0.02) and clinical stage (HR 4.07, 95% CI: 1.48-11.06, p<0.02) in multivariate analysis. Metachronous esophageal cancer was observed in 28.6% of patients at 5 years. As severe late toxicities, grade 3 pneumonitis, esophageal stricture, esophageal fistula, laryngeal stricture, and laryngeal edema were observed in 1 (2%), 1 (2%) and 4 (7%), 1 (2%) and 1 (2%), respectively. Grade 2 hypothyroidism was observed in 31 (53%) patients. Chemoradiation for cervical esophageal cancer showed good results. The prognostic factors for LEDFS were pharyngeal extension and clinical stage. Late esophageal and laryngeal toxicity, hypothyroidism, and metachronous esophageal cancer should be noted.

Significance of neoadjuvant immunotherapy combined with chemotherapy in the treatment of larynx preservation in locally advanced hypopharyngeal squamous cell carcinoma

Objective:To evaluate the clinical significance of neoadjuvant immunotherapy combined with chemotherapy in the treatment of larynx preservation in locally advanced hypopharyngeal squamous cell carcinoma. Methods:Patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were eligible. All received 2 cycles of pembrolizumab combined with docetaxel and platinum neoadjuvant induction therapy. After two cycles, the efficacy was evaluated, followed by radical chemoradiotherapy or surgery and adjuvant chemoradiotherapy according to the efficacy. The primary endpoints were objective response rate（ORR） ，larynx-preservation（LP） rate at 3 months post-treatment and the adverse reactions during neoadjuvant therapy. Results:From December 2021 to December 2022, 10 patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were enrolled. After 2 cycles of the neoadjuvant therapy, 2 patients achieved complete response（CR）, 7 patients achieved partial response（PR）, 1 patient was stable disease（SD）, objective response rate（ORR） was 90%, and disease control rate（DCR） was 100%. 5 patients received radical chemoradiotherapy, 5 patients received surgery and adjuvant chemoradiotherapy, four of them received partial laryngectomy and partial hypopharyngeal resection surgery, and one of them received total laryngectomy and partial hypopharyngeal resection surgery. All patients were able to withstand adverse reactions of neoadjuvant therapy and successfully completed the whole treatment of HPSCC without grade 3-4 treatment-related adverse reactions. There was no recurrence or metastasis during 3-18 months of follow-up. 1 patient died of severe pneumonia 3 months after the completion of radical chemoradiotherapy. At 3 months after treatment, the larynx-preservation rate was 80%. Conclusion:Neoadjuvant immunotherapy combined with chemotherapy has good short-term efficacy and the adverse reactions were tolerable. It can improve the larynx-preservation rate of patients with locally advanced HPSCC, thus improving the prognosis and quality of life of patients.

P1.10-02 ImmunoPET: A Phase 0/1 Study Characterising PD-L1 with 89Zr-Durvalumab (MEDI4736) PET/CT in Stage III NSCLC Patients Receiving Chemoradiation

ImmunoPET is a multicentre, single arm, phase 0-1 study investigating the use of 89Zr-durvalumab PET/CT to interrogate the expression of PD-L1 in patients with NSCLC, in preparation for large clinical trials. We describe novel processes for automated production of zirconium-labelled Immune-PET tracers, validation processes and imaging credentialing for a multicentre trial of 89Zr-durvalumab (89Zr-durva) to characterize PD-L1 upregulation during the treatment of locally advanced non-small cell lung cancer (NSCLC) patients receiving radical chemoradiotherapy.

High-grade carcinoma with neuroendocrine differentiation of the urinary bladder

Neuroendocrine bladder carcinoma is considered a rare variant (&lt;1%) with highly aggressive potential. Because of the rarity of its presentation, available data are mainly from published case reports. A 40-year-old male presented with painless hematuria for the past 3 months. After evaluation, he underwent radical cystectomy with pelvic lymph node dissection with urinary diversion. Histopathology from the postoperative specimen was suggestive of high-grade carcinoma with neuroendocrine differentiation (CK-focal positive, synaptophysin-focal positive, GATA-3, CD-56 positive and Ki-67 85%–90% chromogranin A-negative) stage pT4bN2M0. The case was discussed in the multidisciplinary tumor board and was planned for adjuvant chemotherapy with cisplatin (75 mg/m2) and etoposide (100 mg/m2) Repeated every 21 days. He completed six cycles of adjuvant chemotherapy and was on follow-up. Within 3 months of completing adjuvant therapy, he presented again with a complaint of hematuria and on evaluation found to have a localized recurrence, following which he received radical chemoradiotherapy and is now on follow-up. Our case provides evidence to think us in new dimension, with chemotherapy in adjuvant and radiation in salvage settings instead of adjuvant settings.

Efficacy and Safety of Simultaneous Integrated Boost Intensity-Modulation Radiation Therapy Combined with Systematic and Standardized Management for Esophageal Cancer.

ObjectiveTo analyze and compare the efficacy and safety of simultaneous integrated boost intensity-modulation radiation therapy (SIB-IMRT) combined with systematic and standardized management for esophageal cancer.MethodsFrom January 2012 to January 2019, 200 patients with esophageal cancer who received radical chemoradiotherapy in our hospital were treated with lymphatic drainage area radiation prevention combined with systematic and standardized management. According to difference in radiotherapy methods, the patients were divided into local lesion 92 patients treated with simultaneous integrated boost intensity-modulation radiation therapy (SIB-IMRT) combined with systematic standardized management (SIB-IMRT group), and late course boost intensity-modulation radiation therapy (LCB-IMRT) combined with systematic standardized management 108 patients (LCB-IMRT group). The short-term eficacy of the two groups were compared. The dose volume parameters of the organ in danger are evaluated based on the dose volume histogram. The related adverse reactions during chemoradiotherapy were compared between two groups. The local control rate and survival rate were compared between the two groups.ResultsThe recent total effective rates of rats in the SIB-IMRT group and LCB-IMRT group were 95.65% and 90.74%, respectively, and there was no significant difference between the two groups (p > 0.05). The mean doses to left and right lung, heart and spinal cord in the SIB-IMRT group were significantly lower than that in the LCB-IMRT group (p < 0.05). There was no significant difference in the incidence of adverse reactions such as radiation esophagitis, radiation pneumonitis, radiation tracheitis, gastrointestinal reaction and bone marrow suppression between the SIB-IMRT group and LCB-IMRT groups (p > 0.05). The one-year and three-year overall survival rates in the SIB-IMRT group and LCB-IMRT groups were 82.61%, 42.39% and 77.78%, 34.26%, respectively, and the median survival times were 38 and 29 months, respectively. The local control rates in the SIB-IMRT group and LCB-IMRT group in one and three years were 84.78%, 56.52% and 75.93%, 41.67%, respectively. The 3-year local control rate in the SIB-IMRT group was higher than that in the LCB-IMRT group (p < 0.05), but there was no significant difference in the 1-and 3-year overall survival rates between the two groups (p > 0.05).ConclusionSIB-IMRT combined with systematic and standardized management in the treatment of esophageal cancer can reduce the amount of some organs at risk and improve the local control rate of the lesion.

Combined Modality of Bevacizumab With Radical Radiotherapy and Chemotherapy in the Treatment of Refractory Cervical Cancer

Cervical cancer with bulky primary tumor, regional lymph node metastasis, oliog-distant metastasis, non-squamous carcinoma and huge pelvic relapse after radical surgery are defined as refractory cervical cancer (RCC). Patients with RCC were traditionally treated by concurrent chemoradiotherapy, with limited effectiveness. RTOG 0417 was the first and the only trial used bevacizumab in LACC patients' initial treatment but did not meet the "refractory" criteria. This study aimed to evaluate the safety and effectiveness of bevacizumab combining radical chemoradiotherapy in RCC.129 patients with cervical cancer between Jan 2016 and Dec 2019 were enrolled for retrospective analysis in our institutions. All patients were administered with radical concurrent chemoradiotherapy. Sixty-four of 129 patients were treated with bevacizumab combining chemoradiotherapy. Treatment response was evaluated by RECIST 1.1 criteria. The Cox proportional hazard was analyzed for all patients and tumor response during treatment was analyzed for patients treated with bevacizumab.1. Univariate and multivariate analyses about overall survival of 129 patients showed that bevacizumab was a prognostic factor for refractory cervical cancer receiving radical chemoradiotherapy (P = 0.017). 2. With a median follow-up of 24.1 months, the 3-year overall survival (OS), locoregional relapse-free survival (LRFS) and distance metastasis free survival (DMFS) for the 64 patients treated with bevacizumab were 87.2%, 98.1% and 81%. The 3-y OS for patients had achieved cCR before brachytherapy (BT) was higher than others. 3. In all 64 patients treated with bevacizumab, tumor median volume before treatment, after NAT (Neoadjuvant treatment) and before BT were 61.26 cm3 (25.19-264.8 cm3), 3.19 cm3 (0-71.84 cm3) and 0 cm3 (0-13.43 cm3), respectively. Tumor regression rates of 90.16% (35.21-100%) after NAT and 100% (74.06-100%) before BT were calculated. Accordingly, tumor cCR rates were 37.8% (17/45) after NAT and 62.5% (40/64) before BT. 4. Sixty-four patients treated with bevacizumab were well tolerated. Grade 3 or 4 hematological toxicity occurred in 43.8% (28/64) patients. Grade 3 GI toxicity occurred in 3 (4.7%) patients.Bevacizumab combining concurrent chemoradiotherapy was a safe and tolerable treatment option for refractory cervical cancer, with quicker tumor regression, high OS, LRFS and DMFS.H. Yang: None. Y. Zhang: None. C. Liu: None. L. Zhao: None. L. Wei: None.

Prediction of Locoregional Recurrence-Free Survival of Oesophageal Squamous Cell Carcinoma After Chemoradiotherapy Based on an Enhanced CT-Based Radiomics Model.

Background and PurposeChemoradiotherapy is the standard treatment for moderate and advanced oesophageal cancer. The aim of this study was to establish a predictive model based on enhanced computed tomography examination, and to evaluate its clinical value for detecting locoregional recurrence-free survival (LRFS) in cases of oesophageal squamous cell carcinoma after radiotherapy.Materials and MethodsIn total, 218 patients with pathologically diagnosed oesophageal squamous cell carcinoma who received radical chemoradiotherapy from July 2016 to December 2017 were collected in this study. Patients were randomly divided into either a training group (n=153) or a validation group (n=65) in a 7:3 ratio. Clinical patient information was then recorded. The enhanced computed tomography scan images of the patients were imported into 3D-slicer software (version 4.8.1), and the radiomic features were extracted by the Python programme package. In the training group, the dimensionality reduction of the radiomic features was implemented by Lasso regression, and then a radiological label, the model of predicting LRFS, was established and evaluated. To achieve a better prediction performance, the radiological label was combined with clinical risk factor information to construct a radiomics nomogram. A receiver operating characteristic curve was used to evaluate the efficacy of different models. Calibration curves were used to assess the consistency between the predicted and observed recurrence risk, and the Hosmer-Lemeshow method was used to test model fitness. The C-index evaluated the discriminating ability of the prediction model. Decision curve analysis was used to determine the clinical value of the constructed prediction model.ResultsOf the 218 patients followed up in this study, 44 patients (28.8%) in the training group and 21 patients (32.3%) in the validation group experienced recurrence. There was no difference in LRFS between the two groups (χ2 = 0.525, P=0.405). Lasso regression was used in the training group to select six significant radiomic features. The radiological label established using these six features had a satisfactory prediction performance. The C-index was 0.716 (95% CI: 0.645–0.787) in the training group and 0.718 (95% CI: 0.612–0.825) in the validation group. The radiomics nomogram, which included the radiological label and clinical risk factors, achieved a better prediction than the radiological label alone. The C-index was 0.742 (95% CI: 0.674–0.810) in the training group and 0.715 (95% CI: 0.609–0.820) in the validation group. The results of the calibration curve and decision curve analyses indicated that the radiomics nomogram was superior in predicting LRFS of oesophageal carcinoma after radiotherapy.ConclusionsA radiological label was successfully established to predict the LRFS of oesophageal squamous cell carcinoma after radiotherapy. The radiomics nomogram was complementary to the clinical prognostic features and could improve the prediction of the LRFS after radiotherapy for oesophageal cancer.

SLC7A11 regulated by NRF2 modulates esophageal squamous cell carcinoma radiosensitivity by inhibiting ferroptosis

BackgroundSolute carrier family 7 member 11(SLC7A11) is a component of cysteine/glutamate transporter, which plays a key role in tumor growth; however, its underlying effect on radiosensitivity in esophageal squamous cell carcinoma (ESCC) remains unclear. This study aimed to clarify SLC7A11’s expression and correlation with nuclear expression of nuclear factor erythroid-2 (NRF2)-associated radioresistance in ESCC.MethodsWe included 127 ESCC patients who received radical chemoradiotherapy. Immunohistochemical staining was used to detect SLC7A11 and NRF2 nuclear expression, and the relationship between clinicopathological characteristics and survival rates or therapy response were evaluated. Western blot, dual-reporter assays and Chromatin immunoprecipitation (ChIP)-sequencing were used to analyze their relationship in vitro. Their roles in radioresistance were then investigated through multiple validation steps.ResultsNRF2 nuclear expression and SLC7A11 expression were overexpressed in ESCC tissues and were positively correlated with one another. NRF2 nuclear expression was significantly associated with tumor length, lymph node metastasis, and TNM stage, while SLC7A11 expression was associated with lymph node metastasis. Patients with high NRF2 nuclear expression and SLC7A11 expression had significantly shorter overall and progression-free survival, and poor treatment response. The multivariate model showed that NRF2 nuclear expression and SLC7A11 expression, sex and tumor location are independent prognostic factors. In vitro analysis confirmed that hyperactivation of NRF2 induced SLC7A11 expression by directly binding to its promoter region, promoting radioresistance, reducing radiotherapy-induced lipid peroxidation levels, PTGS2 expression, and radiotherapy-related ferroptosis morphologic features.ConclusionOur study reveals a connection between high SLC7A11 expression and NRF2 nuclear expression in patients with ESCC that was related to worse survival and poorer therapy outcomes. SLC7A11-mediated ferroptosis inhibition induced NRF2-associated radioresistance, highlighting potential of NRF2/SLC7A11/ferroptosis axis as future therapeutic targets against therapy resistance biomarker.

Lower lobe origin is related to unfavorable outcomes in patients with stage I-III lung cancer treated with radical chemoradiotherapy.

The influence of tumor location on survival was investigated in patients with lung cancer who received radical chemoradiotherapy. We examined the relationships between radiation site and survival outcome in patients with lung cancer. A total of 14,640 patients with lung cancer who received radical chemoradiotherapy for stage I-III disease were reviewed from Surveillance, Epidemiology, and End Results Program (SEER) datasets. We further retrospectively collected cases from a cohort of 148 eligible patients diagnosed between December 2013 and December 2019. Female sex, adenocarcinoma, and stage III disease were significantly correlated with right lung lobe tumor. Advanced age at diagnosis was associated with lower lung tumor origin. For the patients who received radical chemoradiotherapy, 1- and 3-year survival rates were 56.5% and 22.9%. Lower lobe origin was closely related to a shorter overall survival compared to non-right lower lobe tumors (p < 0.001). We also validated the difference in our cohort (p = 0.004). Our results suggest that lower lobe tumor increases mortality risk in patients with lung cancer treated with radical chemoradiotherapy.

Predictive Model and Precaution for Oral Mucositis During Chemo-Radiotherapy in Nasopharyngeal Carcinoma Patients.

PurposeTo explore risk factors for severe acute oral mucositis of nasopharyngeal carcinoma (NPC) patients receiving chemo-radiotherapy, build predictive models and determine preventive measures.Methods and MaterialsTwo hundred and seventy NPC patients receiving radical chemo-radiotherapy were included. Oral mucosa structure was contoured by oral cavity contour (OCC) and mucosa surface contour (MSC) methods. Oral mucositis during treatment was prospectively evaluated and divided into severe mucositis group (grade ≥ 3) and non-severe mucositis group (grade < 3) according to RTOG Acute Reaction Scoring System. Nineteen clinical features and nineteen dosimetric parameters were included in analysis, least absolute shrinkage and selection operator (LASSO) logistic regression model was used to construct a risk score (RS) system.ResultsTwo predictive models were built based on the two delineation methods. MSC based model is more simplified one, it includes body mass index (BMI) classification before radiation, retropharyngeal lymph node (RLN) area irradiation status and MSC V55%, RS = −1.480 + (0.021 × BMI classification before RT) + (0.126 × RLN irradiation) + (0.052 × MSC V55%). The cut-off of MSC based RS is −1.011, with an area under curve (AUC) of 0.737 (95%CI: 0.672-0.801), a specificity of 0.595 and a sensitivity of 0.786. OCC based model involved more variables, RS= −4.805+ (0.152 × BMI classification before RT) + (0.080 × RT Technique) + (0.097 × Concurrent Nimotuzumab) + (0.163 × RLN irradiation) + (0.028 × OCC V15%) + (0.120 × OCC V60%). The cut-off of OCC based RS is −0.950, with an AUC of 0.767 (95%CI: 0.702–0.831), a specificity of 0.602 and a sensitivity of 0.819. Analysis in testing set shown higher AUC of MSC based model than that of OCC based model (AUC: 0.782 vs 0.553). Analysis in entire set shown AUC in these two method-based models were close (AUC: 0.744 vs 0.717).ConclusionWe constructed two risk score predictive models for severe oral mucositis based on clinical features and dosimetric parameters of nasopharyngeal carcinoma patients receiving chemo-radiotherapy. These models might help to discriminate high risk population in clinical practice that susceptible to severe oral mucositis and individualize treatment plan to prevent it.

1125P - Prophylactic versus reactive nutritional supplement in local advanced nasopharyngeal carcinoma patients receiving radical chemo-radiotherapy

1125P - Prophylactic versus reactive nutritional supplement in local advanced nasopharyngeal carcinoma patients receiving radical chemo-radiotherapy

Deformable Image Registration and Dose Accumulation for Locally Advanced Non-Small Cell Lung Cancer, Comparing Delivered and Planned Radiotherapy Doses

Uncertainty in the radiotherapy doses actually received over the course of treatment for locally-advanced non-small cell lung cancer (LA-NSCLC) may explain, in part, low long term survival rates for these patients. This is because target and nodal dose coverage, up to this point, have been assumed constant; however disease volume and location are known to change during the course of radiation treatment. In this study, deformable registration (DIR) and dose accumulation (DA) were used to calculate the accumulated dose received over the course of treatment. These accumulated doses are then compared with the clinical treatment plan against acceptable tolerances. This single institution retrospective study randomly selected 26 patients diagnosed with LA-NSCLS receiving radical chemo-radiotherapy. 9 Patients received a dose of 60Gy/30fx and the other 17 patients received a dose of 66/33fx. The clinical delivered plan was exported into RayStation 4.5.2. Using this system's deformable image registration (DIR) tools, doses calculated on daily cone-beam CT images acquired for daily verification are deformed and mapped onto the planning CT images, thus accounting for daily treatment incorporating set-up shifts and changes in the patients anatomy. The accumulated dose delivered was then compared to the clinical treatment plan in terms of target coverage and avoidance of organs at risk. This study demonstrates successfully that, on average, the accumulated doses calculated were not statistically different from the clinical plan. Furthermore, the accumulated doses to the clinical target volumes (CTV's) for both targets and nodes are within acceptable range, illustrating that our current PTV margins are robust against anatomical changes observed during the course of radiation therapy treatment. Differences between CTV doses calculated for the clinical treatment plan compared to the accumulated plan was within 2%. The accumulated OAR doses are also maintained as compared to the clinical plan. We successfully demonstrated that DIR and DA is a useful and valued tool confirming doses received for patients receiving radiation for LA-NSCLC. We have confirmed that our PTV margins are adequate and robust from a dosimetric perspective. Given our relatively small sample size, our results may not be representative of the entire population. Further accrual would confirm our initial findings.

Comparing Delivered and Planned Radiation Therapy Doses Using Deformable Image Registration and Dose Accumulation for Locally Advanced Non–small Cell Lung Cancer

There are uncertainties in radiotherapy doses received over the course of treatment for locally-advanced non-small cell lung cancer (LA-NSCLC). This may explain poor long term survival rates for these patients as target and nodal dose coverage, have been assumed constant throughout treatment. However, disease volume and location are known to change. In this study, deformable registration (DIR) and dose accumulation (DA) were used to calculate the dose delivered over the course of treatment. These delivered doses were then compared with the clinical treatment plan. This single institution, retrospective study selected 26 sequential patients diagnosed with LA-NSCLC receiving radical chemo-radiotherapy. Using RayStation 4.5.2, doses were calculated on daily cone-beam CT images acquired for daily verification were then deformed and mapped back onto the planning CT images. DA results were compared to the clinical treatment plan for both target coverage and organs at risk. Findings are summarized in Table 1. On average, DA calculations were not statistically different from the clinical plan (p<0.05). The DA to the clinical target volumes for both targets (CTV-T) and nodes (CTV-N) demonstrated that coverage remained close to that planned. The DA for OARs was also maintained as compared to the clinical plan. While, on average, delivered doses remained within our routine clinical tolerances, outliers were observed. DA for each patient indicated a small decrease of the delivered dose with respect to their clinical plan, although large variations were observed for organs at risk. We successfully demonstrated that DIR and DA can assess delivered doses to patients receiving radiotherapy for LA-NSCLC. We have confirmed that, on average, our PTV margins are adequate and robust from a dosimetric perspective. Given our LA-NSCLC sample, our results may not be representative Non-Small Cell (NSCLC) population. Although no average differences seen, outliers persist and will be the focus of future research.Abstract 3659; Table 1Planned vs Accumulated DosesROIDelivered Dose(±SD)[Min – Max]Planned Dose(±SD)[Min – Max]% change from plan/patient (±SD)[Min – Max]ProtocolD99% CTV-T95.5 ± 3.9%[88 – 102%]97 ± 3.1%[91 – 102%]-1.3 ± 1.9[-6 – 2 %]92%D99% CTV-N94.7 ± 4.8%[79 – 100%]95.8 ± 3.2%[87 – 100%]-1.3 ± 2.2[-9 – 2 %]92%Spinal canal4450 ± 691 cGy[1317 – 5378 cGy]4438 ± 276 cGy[4008 – 5110 cGy]-2.0 ± 2.1[-5 – 5 %]4500 cGyMean lung dose1465 ± 412 cGy[657 – 1911 cGy]1401 ± 390 cGy[611 – 1876 cGy]-1.4 ± 3.5[-11 – 6 %]1800 cGyV20 lung25.9 ± 7.6%[9 – 34%]26.3 ± 8.9%[9 – 45%]-0.3 ± 4.4[-6 – 12%]30%V40 heart13.4 ±13.2%[0 – 50%]14.7 ± 13.1%[0 – 49%]-10.6 ± 24[-89 – 53%]60%V40 esophagus37 ± 17%[6 – 73%]36 ± 19%[0 – 74%]-0.8 ± 8%[-10 – 28%]60% Open table in a new tab

Feasibility of Hippocampal Avoidance Radiotherapy for Glioblastoma

With improvements in survival for good performance status patients and in specific molecular subtypes of glioblastoma, some patients will survive to develop significant neurocognitive dysfunction. This retrospective planning study quantified hippocampal radiation doses in patients with glioblastoma receiving radical chemo-radiotherapy and compared this with the radiation doses that showed clinical correlation with neurocognitive dysfunction, and evaluated the potential for clinically meaningful hippocampal dose reduction using helical TomoTherapy®.

Accelerated Radiation Therapy Using Weekend Boost with Concurrent Cisplatin in Head and Neck Squamous Cell Cancers: An Indian Institutional Experience

PurposeThe purpose of the study was to evaluate the feasibility and efficacy of an accelerated radiotherapy schedule using weekend boost in terms of tumor response, compliance, and acute toxicities for head and neck squamous cell carcinoma, and to report long-term clinical outcomes. Materials and MethodsTwenty-six patients with stages III-IV head and neck squamous cell carcinoma receiving radical chemoradiotherapy were accrued prospectively into the study. External beam radiation therapy to a total dose of 66–70 Gy in 33–35 fractions, 1.8–2.0 Gy per fraction along with concurrent weekly cisplatin was planned. Radiation regimen included delivery of six fractions per week, with boost field delivered as the sixth fraction on the weekend. The compliance, tumor response, and toxicities were recorded. Survival curves were estimated using the Kaplan–Meier method. ResultsTwenty-one of 26 patients (81%) completed treatment as planned and five patients died during the course of treatment. Sixteen patients (62%) completed treatment in less than 44 days and, at the end of 3 months’ follow-up, 18 patients (69%) showed complete response and two patients (8%) showed partial response. The 2- and 5-year actuarial disease-free survival were 90% and 65%, respectively, and 2- and 5-year actuarial overall survival were 60% and 38%, respectively. ConclusionAccelerated fractionation using weekend boost, along with concurrent weekly concurrent cisplatin, is an effective and promising approach with favorable impact on initial tumor response, comparable results, and acceptable toxicities.

An analysis of the influencing factors for long-term survival in patients with esophageal carcinoma undergoing radical chemoradiotherapy

Objective To analyze the efficacy of chemoradiotherapy in the treatment of esophageal carcinoma and its influencing factors, and to provide an optimal combination mode of chemoradiotherapy for treating esophageal carcinoma. Methods A retrospective analysis was performed on clinical data from 232 patients with esophageal carcinoma who were admitted to our hospital from January 2006 to December 2012 and received radical chemoradiotherapy. All patients received three-dimensional conformal radiotherapy or intensity-modulated radiotherapy as well as platinum-based chemotherapy. The overall survival (OS) and local control (LC) rates were calculated using the Kaplan-Meier method and analyzed using the Logrank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox proportional hazard model, respectively. Results In all patients, the 1-, 3-, and 5-year LC rates were 66.1%, 42.2%, and 38.5%, respectively; the median LC time was 24.4 months; the 1-, 3-, and 5-year OS rates were 73.3%, 37.2%, and 19.5%, respectively; the median OS time was 21 months. The univariate analysis revealed that T stage, N stage, clinical stage, irradiation range, and no less than 3 cycles of chemotherapy were influencing factors for OS (P=0.000, 0.000, 0.000, 0.030, 0.001) and LC (P=0.112, 0.031, 0.009, 0.074, 0.218). The multivariate analysis revealed that N stage, clinical stage, and no less than 3 cycles of chemotherapy were independent prognostic factors for OS (P=0.006, 0.000, 0.001). Conclusions The LC and long-term OS rates in patients with early-stage esophageal carcinoma can be substantially improved by radical chemoradiotherapy. The irradiation range and no less than 3 cycles of chemotherapy improve the long-term survival in patients. Key words: Esophageal neoplasms/three-dimensional radiotherapy; Esophageal neoplasms/chemotherapy; Prognosis

Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study.

BackgroundThe accuracy of 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery.MethodsMedical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3 months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6 months after CRT.ResultsMaximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0 %, 83.8 %, 98.3 %, and 45.0 %, respectively. Of 78 patients studied, postSUVmax ≥4.4 prevailed in 20 (25.6 %), with postSUVmax <4.4 in 58 (74.4 %). At postSUVmax ≥4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7 %; P = 0.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1 %; P < 0.001). At postSUVmax ≥4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6 %; Log-rank P = 0.913).ConclusionPost CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2147-y) contains supplementary material, which is available to authorized users.

P0041 The role of the radiotherapy technologist in quality of life scores in patients with head and neck cancer on radical chemoradiotherapy: A pilot study

Background Cancer and its subsequent treatment may cause physical, emotional, and psychological difficulties for individuals. Quality of life (QoL) indices are as important as the traditional end points of overall survival, disease-free survival, and tumour response in cancer management. QoL is particularly relevant for patients with head and neck cancer because social interaction and emotional expression depend to a great extent on the structural and functional integrity of the head and neck region. Methods During the period June, 2012, to June, 2013, 33 patients with head and neck squamous cell carcinoma who received radical chemoradiotherapy were prospectively assessed for QoL score using the European Organization for Research and Treatment of Cancer (EORTC) core Questionnaires version 3 (QLQ-C30) and the EORTC QLQ-H & N35, in any one of three languages (English, Hindi, Bengali). The score was assessed before the start of radical treatment, just after completion of radical treatment, and at the time of first follow up (latter not included in this report). Questionnaires were served by both nursing staff and radiotherapy technologists. QoL scores before and at completion of treatment were compared using paired t -tests. Findings There was significant improvement at treatment completion in emotional function ( p = 0.04), social function ( p = 0.05), and insomnia ( p = 0.03), and significant deterioration in appetite ( p = 0.001), nausea/vomiting ( p = 0.002), pain ( p = 0.012), swallowing ( p = 0.002), dry mouth ( p = 0.033), sticky saliva (p = 0.003), taste sensation ( p = 0.001), cough ( p = 0.004), speech ( p = 0.002), feeling ill ( p = 0.00), social contact ( p = 0.005), social eating ( p = 0.001), and using painkillers ( p = 0.03). There was no significant difference in Global QoL scores. Interpretation Radiotherapy technologists can be involved not only with treatment delivery but also with the process of assessment of QoL data in patients with head and neck cancer, and can serve as an interface between the patient and the clinician, for the holistic care of the patients on radiotherapy.