Received Radical External Beam Radiotherapy Research Articles

Anaplastic lymphoma kinase-positive pulmonary inflammatory myofibroblastic tumour: a case report

BackgroundPulmonary inflammatory myofibroblastic tumour (IMT) is a rare condition that usually presents in young individuals and is associated with anaplastic lymphoma kinase (ALK)-translocation.Case presentationWe report a case of an 18-year-old Caucasian man with ALK-translocated pulmonary IMT treated with multimodality therapy. The patient presented with breathlessness and was found to have a collapsed left lung. Further investigations revealed an ALK-translocated pulmonary IMT. This is usually treated with an ALK-inhibitor but patient declined after discussing potential side-effects and had repeated rigid bronchoscopic interventions for local disease control. Due to persistent local recurrence, patient received radical external beam radiotherapy (EBRT) with pulse steroids, and one year later started on Ibuprofen, a non-steroidal anti-inflammatory agent (NSAID). Following multimodality treatment, he developed a complete response. He remains treatment-free for the past seven years. Eleven years on from his diagnosis, he remains in remission with a ECOG performance status of zero.ConclusionsAchieving long-term local control in pulmonary IMT can be challenging. Multimodality treatment is sometimes needed but the overall outlook remains good.

Adequacy of sexual care information given to prostate cancer patients receiving radical external beam radiotherapy

Abstract Background: Despite the acknowledged value of providing prostate radiotherapy patients with sexual dysfunction (SD) information, there is little evidence related to patient perceptions of this or the extent to which information is provided to them. This study aimed to critically evaluate the quality and format of SD information given to patients before, during and after radical EBRT to treat prostate cancer. Method: Members of UK prostate cancer support groups were asked to complete an anonymous online survey tool seeking opinions of the SD information they were given before, during and after external beam radiotherapy (EBRT). Results: There were 56 responses to the survey with over 42% of respondents reporting that they had not received any SD information. Of those who did, 78·1% (25/32) received information before the start of EBRT. Physicians were the most involved in the provision of SD information, with nurses and therapeutic radiographers being underutilised. Responses were mostly negative, or neutral regarding the quality of SD information and the information received about impact on relationships, psychological and emotional health. Many participants wanted more information and support. Conclusion: This study demonstrates that prostate cancer patients who have undergone radical EBRT have not received adequate information relating to potential sexual function side effects and the psychological and emotional effects of SD. This information should be included in verbal and written information provided at all stages of the radiotherapy pathway.

Clinical Outcomes of Dose-escalated Radiotherapy for Localised Prostate Cancer: A Single-institution Experience.

To report the outcomes of patients with prostate cancer treated with dose-escalated radiotherapy over a 15-year period at our Institution. Patients with biopsy-proven cT1-4N0M0 disease who received radical external beam radiotherapy (EBRT) were reviewed. The endpoints were 5-year overall survival (OS), freedom from biochemical failure (FFBF) and late treatment toxicities. A total of 236 patients were eligible. Median follow-up was 70 months. Low-, intermediate- and high-risk disease was found in 9%; 29% and 62% of patients, respectively. The median radiation dose was 73.8 Gy. Overall 42% of patients had dose escalation to >74 Gy. Five-year OS and FFBF were 95.2%/81.6%/75.4% and 95.0%/98.0%/82.0% for low-/intermediate-/high-risk patients, respectively. Dose escalation to >74 Gy did not improve FFBF (hazard ratio=0.97, 95% confidence intervaI=0.43-2.19, p=0.93) and was associated with a 4.3-fold increase in the odds of grade 3 or more rectal bleeding (p<0.01). Dose escalation to >74 Gy did not improve OS or FFBF but was associated with a higher rate of grade 3 or more rectal haemorrhage.

Impact of pre-treatment neutrophil-lymphocyte ratio on outcomes in men receiving radical external beam radiotherapy for localised prostate cancer.

Impact of pre-treatment neutrophil-lymphocyte ratio on outcomes in men receiving radical external beam radiotherapy for localised prostate cancer.

Impact of pre-treatment neutrophil-lymphocyte ratio on outcomes in men receiving radical external beam radiotherapy for localised prostate cancer.

151 Background: There is a shortage of novel biomarkers in clinical use for the diagnosis and management of prostate cancer. The neutrophil-lymphocyte ratio (NLR) is a potentially useful biomarker derived from a standard full blood count from peripheral blood sampling, which is readily available and relatively inexpensive. An elevated NLR has been shown to be a poor prognostic biomarker in many advanced solid cancers, including prostate cancer (PC); however, data on NLR in non-metastatic PC have been inconsistent. The objective of this study was to evaluate baseline NLR as an independent predictor of outcome following radical radiotherapy for non-metastatic PC. Methods: Data from 477 consecutive PC patients treated with radical EBRT between 2005 and 2009 in Northern Ireland were reviewed. Outcomes included biochemical progression-free survival (bPFS; Phoenix definiton), prostate cancer-specific survival (PCSS) and overall survival (OS). A two-tailed Mann-Whitney test (significance level 5%) was used to compare NLR in each group. Results: Complete data for 409 patients were available. At a median follow-up of 75 months (range 12 – 138), 74 men (16%) had biochemical failure (BF), 12 men (3%) had died of PC, and 65 men (14%) had died of all causes. Actuarial 5-year bPFS was 91%, PCSS was 97% and OS was 89%. Median NLR was 2.42 in both the BF and non-BF groups (p = 0.78), 2.21 and 2.42 in men who died from PC and those who did not (p = 0.39) and 2.40 and 2.42 in those men who died from all causes and those men who remained alive (p = 0.83). See Table for additional data. Conclusions: In this cohort with medium- to long-term follow-up, NLR was not predictive for bPFS, PCSS or OS. Multivariate analysis of this cohort is planned. Additional prognostic biomarkers are required in PC. [Table: see text]

Dosimetric study of three-dimensional image-quided brachytherapy combined with intracavitary/interstitial brachytherapy in locally advanced cervical cancer

Objective To explore the dosimetric advantages of computed tomography-based and ultrasound-guided three-dimensional image-quided brachytherapy (3D-IGBT) combined with intracavitary/ interstitial (IC/IS) brachytherapy for locally advanced cervical cancer. Methods A total of 45 patients with FIGO (2009) stage IB2-ⅣA locally advanced cervical cancer who received radical external beam radiotherapy and 3D-IGBT combined with IC/IS brachytherapy in our hospital from 2013 to 2014 were analyzed. After the treatment with 192 Ir-based IC/IS brachytherapy, patients had needles removed from the original images and received treatment only from IC radiation sources. Dosimetric differences in the planning D90 for high-risk clinical target volume ( HR-CTV), D90 for intermediate-risk CTV (IR-CTV), and D2 cm3 for the bladder, rectum, sigmoid colon, and small intestines were determined and analyzed by paired t-test. Results A total of 260 after-loading treatment plans, including IC/IS treatment plans for 130 patients and IC treatment plans for 130 patients, were made. The D90 for HR-CTV and D90 for IR-CTV in the IC/IS brachytherapy group were significantly higher than those in the IC brachytherapy group (P= 0. 000 ; P = 0.000). Moreover, the average D2 cm3 values for the bladder and rectum were significantly reduced in the IC/IS brachytherapy group compared with those in the IC brachytherapy group (P = 0. 000; P =0.006). Conclusions The 3D-IGBT combined with IC/IS brachytherapy not only achieves a higher dose for the target volume, but also reduces the radiation dose to the bladder and rectum in the treatment of locally advanced cervical cancer. Key words: Cervicalneoplasms/three-dimensional brachytherapy; Intracavitary; Interstitial; Dosimetry

The effect of aerobic exercise on treatment-related acute toxicity in men receiving radical external beam radiotherapy for localised prostate cancer

We retrospectively analysed acute radiation toxicity data for patients who had participated in a randomised controlled study in our centre in order to assess the impact of aerobic exercise on acute rectal and bladder morbidity during treatment. Data from 65 of 66 patients were analysed: 33 allocated into a control group (standard advice) and 33 into an exercise group (aerobic walking for 30 min at least three times per week) during 4 weeks of external beam radiotherapy; one patient in the exercise group withdrew after randomisation before starting radiotherapy. There was a trend towards less severe acute rectal toxicity in the exercise group with a statistically significant difference in mean toxicity scores over the 4 weeks of radiotherapy (P=0.004), with no significant difference in bladder toxicity scores between the two groups (P=0.123). The lack of an association for severity of bladder toxicity could be attributed to the confounding effect of lower urinary tract symptoms from their prostate cancer. Keeping active and being asked to adhere to a well-defined exercise schedule appears to reduce the severity of rectal toxicity during radiotherapy to the prostate.

Patterns of relapse following radiotherapy for differentiated thyroid cancer: Implication for target volume delineation

Introduction Post-operative residual disease in differentiated thyroid cancer is an indication for external beam radiotherapy (EBRT) especially if there is poor radioiodine uptake by the residual disease. There are no standardized guidelines or consensus in target delineation for radiotherapy in thyroid cancer. Aims To determine the pattern of recurrence in patients with well differentiated thyroid cancer who received adjuvant or definitive radiotherapy as well as radioiodine ablation following surgery or biopsy with a view to better defining future target volume delineation for radiotherapy. Materials and methods Forty-nine patients with differentiated thyroid cancer received radical external beam radiotherapy and radioiodine ablation (3.5 GBq) following thyroidectomy or biopsy between 1990 and 2000. Nineteen patients had macroscopic residual (11) or inoperable disease (8), whilst 30 patients had clear (5) or microscopic positive resection margin (24), and 1 patient the resection margin status was unknown. All the patients were deemed high risk for local recurrence or progressive disease. The thyroid bed and regional nodes were irradiated using two radiotherapy techniques: (1) non co-planar lateral fields (NCLF) in coronal plane using 6 MV photons to a dose of 45–50 Gy in 16 fractions over 22 days and (2) anterior–posterior parallel pair of 6 MV photons to a dose of 40–42.5 Gy in 16 fractions over 22 days. There was no attempt to irradiate the lymph nodes in that part of the anterior and posterior mediastinum extending from the brachiocephalic veins to the carina. Results The median follow-up was 5.4 years (range 0.9–12.4 years). The actuarial 5-year cause-specific survival and local control for the whole group was 75.7% and 81.4%, respectively. Of the 4 patients with mediastinal recurrence, all had neck recurrences and two had distant metastases. All the medisastinal recurrences occurred in superior mediastinum (level VII) and all were treated with NCLF in coronal plane radiotherapy technique. Furthermore, mediastinal recurrences did not occur in isolation. The 5-years loco-regional control rate was 89.1% for those with clear or microscopic positive margins and 69.2% for those with macroscopic residual or inoperable disease. Five-year cause specific survival was 58.3% for patients with macroscopic residual or inoperable disease and 91.4% for those with clear or microscopic positive margins. Conclusion The status of postoperative margin relating to bulk of disease influences local control and cause specific survival. Surgical resection in locally advanced thyroid cancer should be performed by an experienced surgeon to achieve macroscopic clearance where possible. The majority of recurrences were loco-regional. The few superior mediastinal recurrences did not occur in isolation. All the mediastinal recurrences occurred in the superior mediastinum (level VII). We recommend the target volume should encompass the thyroid bed and regional neck nodes and the superior mediastinum level VII excluding the lymph nodes on both sides of the trachea within the anterior and posterior mediastinum extending from the brachiocephalic veins to the carina (compartment 4). Thus, this should facilitate dose escalation to improve loco-regional control and avoiding radiation induced mediastinal toxicity.

Radical External Beam Radiotherapy for Prostate Cancer in Japan: Results of the 1999–2001 Patterns of Care Process Survey

The Patterns of Care Study evaluated standards of practice for patients with clinically localized prostate cancer treated with radiotherapy in Japan. This study examined the influence of institutional stratification on care for patients receiving radical external beam radiotherapy. A national survey of 66 institutions was conducted using two-stage cluster sampling, and detailed information was accumulated on 283 patients who received radiotherapy between 1999 and 2001. In A (academic) and B (non-academic) institutions, more than 80% of patients had intermediate or unfavorable risk disease. Although there were no significant differences in disease characteristics between A and B institutions, institutional stratification significantly affected radiotherapy practice patterns, such as the use of a CT-based treatment planning (A1: 91.5%, B: 77.1%; P = 0.0007) and the use of conformal therapy (A: 56.4%, B: 24.1%; P < 0.0001). CT-based treatment planning and conformal therapy significantly influenced total radiation dose (P < 0.0001 for each). Hormonal therapy was commonly used in both A and B institutions (A: 89.0%, B: 90.7%). Many patients with a favorable prognosis (A: 62.5%, B: 91.7%) received hormonal therapy, and most patients with unfavorable risk disease (A: 93.6%, B: 91.6%) also received hormonal therapy. During the period 1999-2001, the majority of prostate cancer patients treated in Japan with radical external beam radiotherapy had advanced diseases. Institutional stratification significantly affected radiotherapy practice patterns, with the notable exception that radiotherapy was commonly combined with hormonal therapy regardless of the institutional stratification and individual risk.

Assessment of proliferation indicators in residual prostatic adenocarcinoma cells after radical external beam radiotherapy.

Fifty-five patients who had received radical external beam radiotherapy (RRT) for clinically staged, localized prostatic adenocarcinoma were examined with systematic sextant mapping with the help of transrectal ultrasound-guided core biopsies. The average follow-up after RRT was 6.8 years. Residual cancer was found histopathologically in 67% (37/55) of the patients investigated. In the present report, the viability of these tumor cells was studied using immunohistochemical staining methods with the monoclonal antibodies MIB1 and PC10, which are specific for the proliferation-associated antigens Ki-67 and PCNA. Available data concerning proliferating activity in the pretreatment situation in 12 of these patients revealed that proliferating activity was substantially reduced in the majority of cases after RRT. Post-RRT, Ki-67, and PCNA activity was nonetheless found to varying degrees in 64% and 94% of the 36 evaluable tumor-harboring specimens, respectively. In the majority of cases, the proportion of proliferating cells, designated "score", was low. However, Ki-67 scores of up to 8% and PCNA scores of up to 50% were obtained in 35% (8/23) and 97% (33/34) of the specimens, respectively, with proliferative activity. There was no significant correlation between tumor grade and proliferative score in the follow-up biopsies. In the 36 cases investigated, endocrine treatment did not influence the proliferation results. The present study demonstrates a proliferative capacity in residual tumor cells in a long-term follow-up after RRT, suggesting that these cancer cells might have a biological significance.

Radical Radiotherapy in the Management of Carcinoma of the Prostate

Reasons for the increased role of radical radiotherapy in the management of carcinoma of the prostate are presented. The results of a retrospective survey of 116 patients who received radical external beam radiotherapy to the primary tumour are reviewed. Local tumour control was obtained in 75% of patients with an overall morbidity of 14% mild and 9% severe side effects. The problems of accurate tumour staging, extended field radiotherapy and patient selection are discussed. In selected cases, treatment morbidity may be reduced by using interstitial implant techniques.