Reduction Of Overall Treatment Time Research Articles

Accelerated Orthodontic Treatment using Biomodulation: A Randomized Clinical Trial

ABSTRACT Background: Orthodontic treatment often spans several months or even years, which can be burdensome for patients. Biomodulation techniques have emerged as potential strategies to expedite orthodontic tooth movement. Materials and Methods: A randomized clinical trial was conducted with a sample of 60 orthodontic patients, aged 12–30 years, requiring fixed appliance therapy. Patients were randomly assigned to either the biomodulation group (n = 30) or the control group (n = 30). The biomodulation group received low-level laser therapy (LLLT) along with traditional orthodontic treatment, while the control group received conventional orthodontic treatment without LLLT. Treatment duration, pain perception, and orthodontic tooth movement were assessed during the study period. Results: The results demonstrated a significant reduction in treatment duration in the biomodulation group compared to the control group. The biomodulation group exhibited a 30% reduction in overall treatment time, with an average treatment duration of 8.4 months, while the control group required an average of 12 months (P < 0.001). Pain perception during orthodontic adjustments was lower in the biomodulation group. Additionally, biomodulation was associated with a statistically significant increase in the rate of tooth movement, as evidenced by a 20% reduction in the time required to achieve desired tooth alignment (P < 0.01). Conclusion: Biomodulation through low-level laser therapy represents a promising adjunct to traditional orthodontic treatment, significantly accelerating tooth movement and reducing treatment duration.

External Beam Radiotherapy Interdigitated with High Dose Rate(HDR) Intracavitary Brachytherapy versus External Beam Radiotherapy followed by Sequential HDR Intracavitary Brachytherapy for Locally Advanced Carcinoma Cervix-Randomized Control Study.

In cervical cancer treatment, overall treatment time (OTT) is an important prognostic factor. This study compares the clinical outcomes when High-Dose-Rate Intracavitary-Brachytherapy(HDR-ICRT) is interdigitated with external beam radiotherapy(EBRT) versus sequential HDR-ICRT after EBRT in the treatment of locally advanced carcinoma cervix. Histologically confirmed carcinoma cervix patients [FIGO Stage IIB-IVA (except IIIC-2)] were included and randomized into two groups. The study group received EBRT 50Gy in 25 fractions with interdigitated HDR-ICRT 7Gy per fraction weekly for three fractions starting after completion of 3 weeks of EBRT or as soon as cervical os became negotiable thereafter. Patients in the control group received EBRT 50Gy in 25 fractions with sequential HDR-ICRT 7Gy per fraction weekly for three fractions starting one week after completion of EBRT. All patients were regularly followed up during and after radiotherapy for local toxicity and disease control. This study enrolled 102 patients; 51 in each arm. Median OTT in study and control arm were 46 and 60 days, respectively. Median follow-up duration was 24 months (two years). Loco-regional control after two years of follow-up was 84.31 % and 72.54% of patients in study arm control arm respectively (p-value 0.148). Two (3.92%) patients from study arm and eight (15.68%) from control arm had residual disease. Two patients in study arm and one from control arm had local recurrence. Two patients from study arm three patients from control arm developed distant metastases. RTOG mucosal grade III acute mucosal toxicity in either arm. Cervical-os negotiability was limiting factor for interdigitated HDR-ICRT. Interdigitated HDR-ICRT with EBRT may give local control with manageable toxicities as compared to sequential HDR-ICRT, with the advantage of significant reduction in OTT.<br />.

Immediate Loading of Dental Implants with Fixed Prosthodontic Constructions-Advantages and Methods

“Immediate loading of implants” implies loading of implants after extraction of a tooth. The goal of our study was to observe the loss of keratinized gums and bone tissue in the region surrounding the alveolar ridge after tooth extraction, and to compare it to the immediate loading of dental implants with the same indicator. Recently, immediate implant placement after the extraction of a tooth with early loading has become more common. The advantages of this procedure include fewer surgical interventions, reduction in overall treatment time, reduced soft and hard tissue loss, and psychological satisfaction for the patient. This study shows the advantages and methods for immediate implant placement with immediate provisional restorations.

How does changing the vector of transport disc distraction affect the outcomes of surgery in patients of temporomandibular joint ankylosis with obstructive sleep apnea?

Temporomandibular joint ankylosis (TMJA) in children is associated with retrognathia, reduction in pharyngeal airway volume (PAV), and obstructive sleep apnea (OSA). Distraction-osteogenesis (DO) is the proven method in the management of OSA. There is paucity in literature about the effect of distraction vector on PAV. It can be expected that an oblique vector would improve PAV and relieve OSA. Thus, the study was designed to explore the feasibility, advantages, and disadvantages of this modified technique for managing TMJA and OSA simultaneously. The investigators designed a prospective study on patients of TMJA with retrognathia. Ethical approval was obtained (IECPG-547/14.11.2018). In all patients, simultaneous ankylosis release and mandibular distraction were performed. Primary outcome variables were improvement in 3-dimensional (3D) PAV and maximal interincisal opening (MIO). Secondary outcome variables were changed mandibular length, distraction relapse, and re-ankylosis. Paired t-test and multivariate ANOVA were used to assess all the parameters. The study included 13 joints in 8 patients of TMJA with retrognathia (2 unilateral and 6 bilateral ankylosis) with mean age of 14.25 ± 7.37years. Mean distraction performed was 19 ± 4.0mm. There was a statistically significant improvement of PAV by 225% (p = 0.002), a reduction in Epworth's scale (p = 0.017), an increase in MIO (p = 0.001), and an increase in mandibular length. Three patients had re-ankylosis at the 25-month follow-up. The results of the present study conclude that modification of distraction vector improves 3D PAV and MIO in TMJA patients, with the added advantage of a reduction in overall treatment time and improved patient compliance.

Immediate Loading of Dental Implants with Fixed Prosthodontic Constructions Advantages and Methods

“Immediate loading of implants” implies loading of implants after extraction of a tooth. The goal of our study was to observe the loss of keratinized gums and bone tissue in the region surrounding the alveolar ridge after tooth extraction, and to compare it to the immediate loading of dental implants with the same indicator. Recently, immediate implant placement after the extraction of a tooth with early loading has become more common. The advantages of this procedure include fewer surgical interventions, reduction in overall treatment time, reduced soft and hard tissue loss, and psychological satisfaction for the patient. This study shows the advantages and methods for immediate implant placement with immediate provisional restorations.

"Surgery First" vs "Traditional Sequence" Surgery: A Qualitative Study of Health Experiences in 46 Bimaxillary Orthognathic Patients.

Orthognathic patients are advocating an active role in selecting their appropriate ortho-surgical treatment, between the surgery first (SF) and the traditional sequence (TS) approaches. The aim of this study was to evaluate, through qualitative analysis, the subjective perceptions of the outcomes of each protocol. In-depth interviews were conducted with 46 (10 male and 36 female) orthognathic patients (23 SF and 23 TS) treated with bimaxillary orthognathic surgery by the same surgeon, between 2013 and 2015. Average treatment duration was 6.5months for SF and 12months for TS. Inclusion criteria were: the presence of Class III or Class II asymmetries and open bite. Patients were excluded if they refused interviews or stopped attending post-treatment follow-up. Investigated health experiences included overall satisfaction with appearance, self-confidence after surgery, perceived treatment time, functional recovery, and diet restrictions. All SF and TS patients showed overall satisfaction with their appearance (though TS showed more enthusiastic tones) and approved their degree of functional recovery after surgery. Class III SF patients had earlier improvements in self-confidence after surgery. Orthodontics was considered enduring by both SF and TS patients. SF patients expressed a higher degree of satisfaction with the reduction in overall treatment time and with the early psychological benefit deriving therefrom. Both SF and TS patients completely approved of the aesthetic outcomes and the functional recovery from which they benefitted due to the entire procedure.

Radiotherapy with Intensity-Modulated (IMRT) Techniques in the Treatment of Anal Carcinoma (RAINSTORM): A Multicenter Study on Behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology) Gastrointestinal Study Group.

Simple SummaryConcurrent chemo-radiotherapy is the standard treatment in anal cancer. Intensity-modulated radiotherapy (IMRT) was proved to reduce severe, acute and late toxicities. Moreover, IMRT techniques allow for the planning and delivery of a simultaneous integrated boost (SIB), with a differential dose per fraction given to selected sub-regions during the same treatment session. This boost modality provides the chance to employ a dose-painted approach with a reduction in overall treatment time that could result in a potential clinical advantage. Since a large variability in dose prescription to the primary tumor and elective or involved lymph nodes can be found in available guidelines and clinical practice, a multicenter analysis was conducted to evaluate the pattern of care and the impact of radiotherapy parameters on clinical outcomes for anal cancer patients treated with IMRT techniques within a national cohort.A multi-institutional retrospective study was conducted to evaluate the pattern of care and clinical outcomes of anal cancer patients treated with intensity-modulated radiotherapy (IMRT) techniques. In a cohort of 987 patients, the clinical complete response (CR) rate (beyond 6 months) was 90.6%. The 3-year local control (LC) rate was 85.8% (95% CI: 84.4–87.2), and the 3-year colostomy-free survival (CFS) rate was 77.9% (95% CI: 76.1–79.8). Three-year progression-free survival (PFS) and overall survival (OS) rates were 80.2% and 88.1% (95% CI: 78.8–89.4) (95% CI: 78.5–81.9), respectively. Histological grade 3 and nodal involvement were associated with lower CR (p = 0.030 and p = 0.004, respectively). A statistically significant association was found between advanced stage and nodal involvement, and LC, CFS, PFS, OS and event-free survival (EFS). Overall treatment time (OTT) ≥45 days showed a trend for a lower PFS (p = 0.050) and was significantly associated with lower EFS (p = 0.030) and histological grade 3 with a lower LC (p = 0.025). No statistically significant association was found between total dose, dose/fraction and/or boost modality and clinical outcomes. This analysis reports excellent clinical results and a mild toxicity profile, confirming IMRT techniques as standard of care for the curative treatment of anal cancer patients. Lymph node involvement and histological grade have been confirmed as the most important negative prognostic factors.

Moderately Hypofractionated Intensity-modulated Radiotherapy With a Simultaneous Integrated Boost for Locally Advanced Head and Neck Cancer - Do Modern Techniques Fulfil Their Promise?

Intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) and moderate hypofractionation offers an opportunity for defining individual doses and a reduction in overall treatment time in locally advanced head and neck cancer (HNSCC). We present retrospective data on toxicity and locoregional control of a patient cohort treated with an IMRT-SIB concept in comparison to normo-fractionated 3D-conformal radiotherapy (3D-RT). Between 2012 and 2014, 67 patients with HNSCC (stages III-IVB) were treated with IMRT-SIB either definitively or in the postoperative setting. These patients were matched with those of patients treated with normo-fractionated 3D-RT before mid-2012 and their clinical courses were compared. Chemotherapy or cetuximab was given concomitantly in both groups in the definitive situation (postoperatively, dependent on risk factors). Significantly less toxicity was found in favor of IMRT-SIB concerning dysphagia, dermatitis, xerostomia, fibrosis, and lymphedema. After a median follow-up of 31 months (range=2-104 months), 3-year locoregional control was 73% for those treated with IMRT-SIB versus 78% for those treated with 3D-RT. This moderately hypofractionated IMRT-SIB concept was shown to be feasible, incurring less toxicity than conventional 3D-RT.

Surgical Management of Multiple Dental Anomalies in an Adolescent: A Case Report

Introduction: Unerupted or impacted teeth are commonly seen in young adolescents, whilst transposition of teeth is fairly uncommon. Paediatric patients presenting with an impacted or missing permanent tooth can complicate what may otherwise be a straightforward transition to the permanent dentition. In patients with multiple impacted teeth or transposition of teeth, the complexity of the case is increased further. Case Report: We present a case of impaction and transposition in an adolescent, managed by surgical technique only, using autotransplantation and corticotomy. This technique permitted rapid positional changes of the teeth to give an immediate aesthetic and functional improvement, with less reliance on longterm patient compliance. Conclusion: This report discusses the complexity of different treatment options that could have been undertaken. A multidisciplinary approach gave more treatment options to the patient, and total surgical management had many clinical advantages, along with a huge reduction in overall treatment time.

Hypofractionated radiation therapy with temozolomide versus standard chemoradiation in patients with glioblastoma multiforme (GBM): A prospective, single institution experience.

the study aimed to determine whether hypofractionated radiotherapy (HFRT) with simultaneous and adjuvant temozolomide (TMZ) was feasible and could provide adequate disease control in primary GBM patients with poor prognostic factors including large tumor size, poor performance status, unresectable or multifocal lesions, poor imaging and inflammatory indices. A total of 93 patients with glioblastoma multiforme were collected and distributed randomly as 1:1.7 of cases to controls; cases or arm (I) received HFRT with 45 Gy in 15 fractions over 3 weeks concurrently with TMZ. Controls or arm (II) received standard conventional fractionation radiotherapy of 60 Gy in 30 fractions over 6 weeks concurrently with TMZ. 35 patients were recruited in arm I while 58 patients in arm II with significant difference in site of GBM, pattern of enhancement, type of surgery, and neutrophil to lymphocyte ratio, while no significant differences in tumor size, focality, responses, progression free survival, and overall survival (OS), only the type of surgery was an independent predictor for OS, no significant difference in the type and degree of toxicity between both arms. Our results showed that HFRT with concurrent TMZ is a feasible therapeutic approach in patients with GBM, especially those with poor prognostic factors, assuring high treatment compliance and low toxicity rates. Dose escalation and reduction in overall treatment time are clear advantages of HFRT, while at least the same survival rates as conventional fractionated RT are maintained.

Hypofractionated volumetric modulated arc therapy with SIB adjuvant to breast preservation surgery: retrospective experience from a Regional Cancer Centre in Eastern India

AbstractBackground:The incidence of breast cancer has surpassed cervical cancer in India and it has now become the most common cancer in women. Multiple randomised studies have reported lowα/βvalue in the range of 3–4 for breast cancer, which predict a potential radiobiological advantage for hypofractionated radiotherapy resulting in such schedules becoming standard in many centers with reduction in overall treatment time. Volumetric modulated arc therapy (VMAT) is a novel technique of delivering radiotherapy that reduces treatment delivery time, requires less monitor units (MU) and offers good conformity. The mean dose to normal tissue may be minimised using this technique although there will be inferior sparing if we consider the low-dose volume such asV5, the effect of which is not quantifiable yet.Aim:Reporting acute toxicity, cosmetic effects, and quality of life in patients of early breast cancer treated with adjuvant hypofractionated VMAT with SIB.Material and Methods:The records of 44 patients registered at the hospital between August 2014 and December 2015 were included in this analysis. Acute toxicities were analysed using CTCAE v4.03. Cosmetic outcomes were assessed using Harvard scale, while quality of life outcomes were assessed using EORTC scales and Health Related quality of life (HRQOL) questionnaires (QLQ-C30 and QLQ-BR23).Results:No grade ≥2 skin toxicities were recorded. Breast pain was recorded as Grade 1 in 13·8% patients and Grade 1 fatigue in 18·2%. The maximum haematological abnormality grade recorded was Grade 1. Cosmesis was assessed at the baseline, 6 months, 1 year and 2 years. A total of 88·6% of the patients had an Excellent or good cosmesis at the baseline, which was similar even at 6 months, at 88·7%, improved further at 1 year to 90·9%. At 6 months post radiotherapy, high functional scale QOL scores were noted.Conclusion:The technique is associated with minimum acute toxicity, good to excellent cosmesis and acceptable quality of life.

Interdigitated versus sequential high-dose-rate intracavitary brachytherapy with external beam radiotherapy in locally advanced carcinoma cervix.

To decrease overall treatment time (OTT) and to compare the clinical outcome of interdigitated high-dose-rate intracavitary brachytherapy (HDRICBT) versus sequential HDRICBT with external beam radiotherapy (EBRT) in the treatment of locally advanced carcinoma cervix. Eighty-two patients with histologically confirmed carcinoma of the cervix, untreated International Federation of Gynecology and Obstetrics Stage IIB-IIIB, were included and randomized into two groups. The study group received EBRT 50 Gy/25 fractions with interdigitated HDRICBT 8 Gy/fraction weekly a total of three fractions. Patients in the control group received EBRT 50 Gy/25 fractions with sequential HDRICBT 8 Gy/fraction weekly a total of three fractions. At the end of the study, results of both groups compared in terms of OTT, acute and late toxicities, and response to therapy clinically. A total of 82 patients were enrolled 41 in each arm. Seventy-two patients completed treatment and were analyzed. Mean OTT in study group and control group was 40 and 60 days, respectively. The median follow-up duration was 10 months (3-18). Most of the acute and late toxicities were of Grade 1 and 2 type and comparable in both study and control groups. Treatment interruption due to treatment-related toxicity was slightly higher in the study group than the control group, but it was statistically insignificant. Os negotiability was not found to be a limiting factor for interdigitated HDRICBT. Interdigitated HDRICBT has equivalent response and toxicities as sequential HDRICBT with the advantage of significant reduction in OTT.

EVALUATION OF RESULTS OF THE IMPLANT PLACEMENT IMMEDIATELY AFTER TOOTH EXTRACTION

Background: The concept of immediate implant loading has recently become popular due to less trauma, reduction in overall treatment time, decrease in hard and soft tissue resorption, increase in patient’s acceptance, along with better function, aesthetics and has a psychological satisfaction to the patient. The purpose of this study is to evaluate the results of implant placement immediately after tooth extraction. Materials and method: The study consisted of 32 patients with 43 implants have been placed immediately after tooth extraction in the Odonto-Maxillo-Facial Hospital of Ho Chi Minh City. Evaluation results after dental implants 1 week, 1 month, 3 months, 6 months. Results: Good clinical results after 1 week was 55.8%, after 3 months and 6 months were 100%. After 1 week of implant placement, good healing took 59.4%. After 1 month, 3 months and 6 months, 100% of the patients are well healed. After 3 months, 6 months without any implant has the status of shaky. Most dental implants have good levels of bone graft. The level of good after 3 months of implants was 72.1% and after 6 months all cases are good. The success rate for dental implants was up to 97.7%, failing only 2.3%. After 3 months the implants had a good level of 72.1% and after 6 months, all cases were good. Patients with success in implant placement accounted for a high rate of 97.7%, failure only accounted for 2.3%. Conclusions: Success rate in immediate implant is high. It is necessary to develop this method to restore lost teeth to achieve optimum results. Key words: Dental implant, immediate implant after tooth extraction

Acute toxicity and quality of life in high risk prostate cancer patients: Updated results of randomized hypofractionation trial.

The aim of our study was to perform the final analysis of acute toxicity and quality of life data obtained from 221 consecutive patients who suffered from intermediate-to-high risk prostate cancer. In this trial, 221 patients were randomized to receive either hypofractionated (63 Gy in 20 fractions, 4 fractions/week) or conventionally fractionated (76 Gy in 38 fractions, 5 fractions/week) radiotherapy to the prostate and seminal vesicles. Elective pelvic lymph node irradiation with 46 Gy in 23 fractions sequentially and 44 Gy in 20 fractions simultaneously was also applied. There was no statistically significant difference in acute GU and GI toxicity in men treated with hypofractionated (SIB) (Arm 2) in comparison with patients who had conventional fractionation (Arm 1) radiation therapy. Multivariate analysis using logistic regression showed statistical significant association between acute GU ≥ 1 and PTV(LN) (p = 0.008) only. We found out that clinically relevant decrease (CRD) was significantly higher only in the urinary domain of Arm 1 at month 3 (p = 0.02). Our study demonstrated that hypofractionated radiotherapy was associated with a small but insignificant increase of acute toxicity. The reduction of overall treatment time has no significant influence on patients' QOL in any domain.

Overview of Carbon-ion Radiotherapy

The outcome of radiotherapy depends on potential efficiency of accelerators and their related accessories. In charged particle therapy before the 1990s, accelerators that were primarily installed for physics research had been shared, which however had limited flexibility for clinical use. Therapy-dedicated facility was first constructed at Loma Linda University for PBT in 1990 and at NIRS for CIRT in 1993. Currently, there are more than 56 facilities for PBT, 6 for CIRT, and 6 for PBT/CIRT, and even more facilities are under construction or active planning. CIRT has beneficial property for cancer therapy because, as compared with photon therapy, it offers superior dose distributions by exhibiting a Bragg peak in the body and, as compared with PBT, it has higher radiobiological effectiveness. The number of potential candidates for charged particle therapy is estimated to range from 0.018% to 0.035% of all irradiated cancer patients. In CIRT at NIRS, Japan, more than 9,000 patients have been treated with promising results in non-SCC tumors and photon-resistant types of tumors at various sites. It is of note that in CIRT a significant reduction in overall treatment time and fractions has been successfully achieved.

Accelerated Hypofractionated Radiation in Carcinoma Breast

Aim: Comparison of two different radiation fractionation schedules is done in post mastectomy breast cancer cases in relation to loco regional control, acute and late toxicities, survival and overall treatment time (O.T.T). The patient, tumor and treatment related parameters have also been studied. Materials and Methods: Between December 2011 and December 2013, hundred patients of stage II to III carcinoma breast treated with surgery and chemotherapy received adjuvant radiation therapy with two different fractionation regimes: ● (Regimen-1, 50 patients) - 42.5 Gray/16 fractions/3.1 weeks @ 2.6 Gray/ fraction (#) ● (Regimen-2, 50 patients) - 50 Gray/25 fractions/5 weeks @ 2 Gray/fraction (#) Assessment was done for loco regional and distant control rate, acute and late radiation toxicities, and quality of life related parameters. Results: Maximum numbers of patients were of 40-50 year age, post-menopausal, with invasive ductal carcinoma of grade III and stage II or, III. Regimen 1 in comparison to Regimen 2 resulted in comparable loco regional and distant control rate. It also led to significantly less O.T.T. without any significant difference regarding acute and late radiation toxicities. It resulted in significant improvement in patient’s quality of life parameters related to O.T.T. Conclusion: In breast cancer patients undergoing post mastectomy radiotherapy, accelerated hypofractionated radiation (42.5 Gy/16 #/3.1 weeks) in comparison to the conventional radiotherapy (50 Gy/25#/5 weeks) results in comparable loco regional and distant control rates without any significant difference regarding acute and late radiation toxicities. It also leads to significant reduction in overall treatment time with significant improvement in patient’s quality of life parameters related to O.T.T.

Treatment planning and patient positioning for MR-guided high intensity focused ultrasound treatment: a systematic approach

Treatment duration as well as time spent on patient positioning imposes limitations on therapeutic use of MR-guided High Intensity Focused Ultrasound (MR-HIFU). Reduction of overall treatment time is especially important in potential pediatric applications and in other cases where general anesthesia must be used, due to the risks associated with prolonged anesthesia. Typically, up to 4 hours are allotted for the procedure, with patient positioning and treatment planning requiring an hour or more. If re-positioning is required during treatment, acquisition of needed images and re-planning of treatment may require 30 minutes or longer before ablation can resume. These delays limit the total time allowed for treatment, limiting the size of tumors that can be treated and increasing the risks as well as the cost of the procedure. The aim of this study is to evaluate the information needed to accurately plan MR-HIFU ablation of solid extremity tumors and to rationally design a practical approach to patient positioning for such treatments.

Treatment results of radical radiotherapy of carcinoma uterine cervix using external beam radiotherapy and high dose rate intracavitary radiotherapy

To report the outcome of carcinoma cervix patients treated radically by external beam radiotherapy and high dose rate intracavitary radiotherapy. From January 2005 to December 2006, a total of 709 newly diagnosed cases of carcinoma cervix were reported in our department. All cases were staged according to the International Federation of Gynecologist and Oncologist staging system. Out of 709 cases, 342 completed radical radiotherapy and were retrospectively analyzed for the presence of local residual disease, local recurrence, distant metastases, radiation reaction, and disease free survival. There were 11(3.22%), 82(23.98%), 232(67.83%), and 17(4.97%) patients in stages I, II, III, and IV, respectively. The median follow up time for all patients was 36 months (range 3 -54 months). The overall treatment time (OTT) ranged from 52 to 69 days (median 58 days). The 3 year disease free survival rate was 81.8%, 70.7%, 40.08%, and 11.76% for stages I, II, III, and IV, respectively. There were 91 (26.6%) cases with local residual diseases, 27(7.9%) developed distant metastasis, and 18(5.26%) pts had local recurrence. The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of early staged cancer of uterine cervix. For locally advanced cancer of cervix addition of concurrent chemotherapy, higher radiation doses, reduction of overall treatment time to less than 8 weeks, and use of latest radiotherapy techniques such as IMRT is recommended to improve the results.

Weekly Concomitant Boost in Adjuvant Radiotherapy for Patients with Early Breast Cancer: Preliminary Results on Feasibility

Recent advances in the management of patients with breast cancer are focused toward the reduction of overall treatment time of radiotherapy by delivering a dose biologically equivalent to a standard schedule. The aim of the present study was to evaluate the feasibility and preliminary toxicity of a moderately hypofractionated whole breast irradiation schedule with the addition of a concomitant boost delivered to the tumor bed once-a-week in patients with early breast cancer submitted to conservative surgery. We selected patients with pT1c and pT2 N0/N+ M0 carcinoma of the breast with negative surgical margins. The basic course consisted of 4600 cGy prescribed to the ICRU 50 reference point dose and delivered in 20 fractions, 4 times a week for 5 weeks. Once a week, immediately after whole breast irradiation, a concomitant photon boost of 120 cGy was delivered to the lumpectomy area. Overall, according to the linear-quadratic model, the schedule provides a biologically equivalent dose of 87 Gy for breast tumor (assuming alpha/beta = 4 Gy), of 66 Gy for acute responding normal tissues (assuming alpha/beta = 10 Gy), and 99 Gy for late responding normal tissues (assuming alpha/beta = 3 Gy). Biologically, the schedule compares favorably with the 6-week conventional regimen consisting of 50 Gy, 2 Gy/fraction, followed by a 10 Gy boost (BED(tumor), 90 Gy; BED(acute effects), 72 Gy, and BED(late effects), 100 Gy). From November 2004 to April 2007, we tested this radiotherapy schedule in 176 patients. All enrolled patients had achieved a minimum follow-up of 6 months and were considered in detail for the evaluation of feasibility. Three clinical examinations were performed by a group of independent physicians at treatment end, after 1 month and after 6 months. According to the RTOG/EORTC Toxicity Criteria, of the 176 assessable patients at the end of radiotherapy, 58% showed grade 0-1 skin toxicity, 30% grade 2 and 12% grade 3. At one month of follow-up, grade 0 toxicity was observed in 47% of cases, grade 1 in 46% and grade 2 in 7%. At 6 months, late (skin and subcutaneous tissue) toxicity was assessed with the following scores: grade 0 in 68%, grade 1 in 26% and grade 2 in 6% of the patients. At 6 months, cosmesis was excellent, good and fair in 71%, 24% and 5% of patients, respectively. The explored adjuvant schedule planned to intensify the radiotherapy course for patients with early breast cancer by adding a weekly concomitant boost appears to be feasible and provides low local toxicity and excellent to good short-term cosmetic results.

Clinical advantages of carbon-ion radiotherapy

Carbon-ion radiotherapy (C-ion RT) possesses physical and biological advantages. It was started at NIRS in 1994 using the Heavy Ion Medical Accelerator in Chiba (HIMAC); since then more than 50 protocol studies have been conducted on almost 4000 patients with a variety of tumors. Clinical experiences have demonstrated that C-ion RT is effective in such regions as the head and neck, skull base, lung, liver, prostate, bone and soft tissues, and pelvic recurrence of rectal cancer, as well as for histological types including adenocarcinoma, adenoid cystic carcinoma, malignant melanoma and various types of sarcomas, against which photon therapy could be less effective. Furthermore, when compared with photon and proton RT, a significant reduction of overall treatment time and fractions has been accomplished without enhancing toxicities. Currently, the number of irradiation sessions per patient averages 13 fractions spread over approximately three weeks. This means that in a carbon therapy facility a larger number of patients than is possible with other modalities can be treated over the same period of time.