Safety Of External Beam Radiation Therapy Research Articles

Functional outcomes following external beam radiation therapy for patients with prior holmium laser enucleation of the prostate.

Holmium laser enucleation of the prostate (HoLEP) is an increasingly popular size-independent technique of treating male voiding dysfunction due to benign prostatic hypertrophy. Some patients after HoLEP may develop clinically significant prostate cancer and opt for definitive treatment with external beam radiation therapy (EBRT). Little is known about the safety of EBRT after HoLEP and how it may functionally impact voiding after HoLEP has altered the anatomy of the prostate. Our study aimed to assess patient-reported voiding outcomes following EBRT after HoLEP with a focus on incontinence related patient outcomes. This study was conducted with approval from our hospital's institutional review board. Patients that underwent HoLEP followed by EBRT were identified and data were collected in a retrospective nature from a single surgeon HoLEP cohort over the past 4years (2019-2023). Patient demographics, disease and radiation therapy characteristics, radiation therapy, and baseline voiding symptoms were recorded. Current functional voiding outcomes were also collected via phone-call or portal communication in a cross-sectional manner with questions pertaining to type of incontinence, IPSS quality of life score, and administration of the Michigan incontinence symptom index (M-ISI). Adverse events encountered during follow-up were recorded. 24 patients were identified who received RT for prostate cancer after HoLEP with an average age of 73.6 (± 5.3). One third of patients reported no incontinence whatsoever after radiation and of those who experienced incontinence, the majority felt that it was not worsened after radiation. Median IPSS QoL score following radiation was 1 (range 0-6), median M-ISI Severity Score was 4 out of a maximum of 32, and median M-ISI bother score was 0 out of a maximum of 8. One patient developed a bladder neck contracture (BNC) approximately 1year following his radiation therapy (approximately 18months after HoLEP) causing bothersome incontinence and LUTS. In our cohort most patients who received RT after HoLEP reported a high urinary-symptom related quality of life and a low rate of urinary incontinence. One patient who received SBRT suffered a BNC which is a known adverse event with RT but given our small sample size it remains unclear if the risk is higher in patients receiving RT after HoLEP. Larger studies should focus on examining the rate of bladder neck contracture in patients receiving RT after HoLEP, particularly focusing on whether the degree of dose fractionation may impact their development.

Efficacy and Safety of External-beam Radiation Therapy for Unresectable Primary or Local Recurrent Cholangiocarcinoma.

Treatment options for unresectable cholangiocarcinoma are limited. The aim of the study was to evaluate the clinical outcomes of definitive external-beam radiation therapy (EBRT) for patients with unresectable cholangiocarcinoma. Patients with unresectable primary cholangiocarcinoma, or local recurrent cholangiocarcinoma after primary surgery, without distant metastasis who received definitive EBRT (≥45 Gy) between January 2006 and December 2020 at our Institution were analyzed retrospectively. EBRT was basically performed using conventional fractionation (1.8-2 Gy per fraction). Prophylactic nodal irradiation was not performed. A total of 21 consecutive patients were analyzed: 7 primary and 14 recurrent cases. The median age was 70 (range=38-85) years at initiation of EBRT. A median dose of 54 (range=45-60) Gy comprising 1.8 (range=1.8-3) Gy per fraction was administered to the primary/recurrent local tumor site. The median follow-up period was 21.6 months. The 2-year overall survival, cause-specific survival, progression-free survival, and local recurrence-free rates were 35.7, 35.7, 16.1, and 32.7%, respectively. Long-term local control (>2 years after EBRT) was achieved in 19.0%. Grade 3 toxicities related to EBRT were observed in 4.8% (duodenum hemorrhage). No grade 4 or higher toxicities were observed. Definitive EBRT for unresectable cholangiocarcinoma was feasible and achieved long-term local control in a subset of patients. As the avoidance of local recurrence may lead to the benefits of prolonging biliary patency and subsequently alleviating the need for an invasive procedure for biliary drainage, EBRT could be one sustainable therapeutic option for patients with unresectable cholangiocarcinoma.

Safety of External-Beam Radiation Therapy (EBRT) across All Stages of Hepatocellular Carcinoma (HCC) in Cirrhotic Patients: a Monocentric Western Experience

Safety of External-Beam Radiation Therapy (EBRT) across All Stages of Hepatocellular Carcinoma (HCC) in Cirrhotic Patients: a Monocentric Western Experience

Efficacy and safety of external-beam radiation therapy for hepatocellular carcinoma: An overview of current evidence according to the different target population.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. During the recent years, external-beam radiation therapy (EBRT) has been safely and effectively employed for the management of HCC. We overviewed the current evidence regarding the efficacy and safety of EBRT for HCC according to the different target population. PubMed database was searched for identifying English-language full-text articles regarding EBRT for the treatment of HCC. Search items were "hepatocellular carcinoma AND radiation therapy". Until now, preliminary evidence has suggested the following role of EBRT for HCC. 1) EBRT, especially stereotactic body radiation therapy, is an emerging choice of therapy for small HCC. 2) EBRT combined with non-surgical treatment can achieve an excellent intrahepatic tumor control and a potential survival benefit for huge HCC. 3)Adjunctive EBRT may improve the efficacy of transarterial chemoembolization for HCC with portal vein tumor thrombosis. 4) EBRT can relieve the pain and improve the quality of life for patients with extrahepatic metastases. 5) EBRT may be a bridge to liver transplantation by minimizing the tumor progression. 6) Adjunctive EBRT may reduce the tumor recurrence and improve the survival after resection. In summary, EBRT is a promising choice of treatment of HCC. However, more high-quality evidence is needed to further establish the status of EBRT for the management of HCC.

TU‐D‐BRA‐03: Real‐Time‐Image Guidance in Radiation Therapy: Is There a Role for Ultrasound Imaging?

The curative potential of External Beam Radiation Therapy (EBRT) is critically dependent on having the ability to accurately aim radiation beams at intended targets while avoiding surrounding healthy tissues. Cone‐beam computed tomography, planar x‐ray imaging, radiographic or electromagnetic tracking of implanted fiducials, as well as operator‐performed ultrasound are currently used for EBRT image guidance. However, these technologies are incapable of addressing the challenge of real‐time volumetric (4D) visualization, localization, and tracking of soft‐tissue motion and deformation concurrent with treatment beam delivery. Thus a significant opportunity exists for improving the therapeutic ratio and the safety of EBRT. We will present and discuss two solutions that can realize this opportunity through the integration of spatially localized, remotely controlled operator‐free ultrasound imaging with radiation delivery systems.The first approach relies on a custom designed compact ultrasound probe based on two‐dimensional matrix array of capacitive micro‐machined ultrasonic transducers integrated with radiofrequency electronics. For operator‐free imaging, the probe is to be fixed to a subject by a belt with appropriate acoustical coupling. Dedicated beam forming methodology and image reconstruction is necessary to enable large volume data collection at a volume rate of 3 Hz or higher.The second approach employs a novel, minimally interfering, tele‐robotic ultrasound imaging based on commercial transducers. It uses a customized human‐safe robotic manipulator to control the pressure and pitch of an abdominal probe while avoiding gantry collisions. A haptic device is integrated to remotely control the robotic manipulator motion and image acquisition outside the therapy room.Learning objectives:1. Understand basic relationships between ultrasound imaging system design and performance parameters such as spatial resolution, frame rate, and field of view. Recognize the dependencies between these parameters.2. Identify limitations of current EBRT ultrasound guidance systems and identify physics, design and workflow causes behind them.3. Understand how remote‐operator free imaging and appropriately designed workflow can enable real‐time soft‐tissue image guidance concurrent with radiation delivery and reduce ultrasound localization uncertainties.4. Recognize potential interferences between the radiation delivery system and the operator‐free imaging system and appreciate their magnitude and mutual impact.