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  • 1
    Publication Date: 2018-07-10
    Description: Publication date: Available online 9 July 2018 Source: Radiotherapy and Oncology Author(s): Fausto Petrelli, Tiziana Comito, Sandro Barni, Gianfranco Pancera, Marta Scorsetti, Antonio Ghidini Introduction While surgery is the preferred option for isolated, operable liver metastases from colorectal cancer (CRC), ablative techniques are endorsed for medically or technically inoperable lesions. Stereotactic body radiotherapy (SBRT) is an alternative ablative local therapy that delivers high RT doses in a few fractions to the cancer, sparing surrounding critical tissue. We have performed a systematic review of published trials to evaluate the efficacy of SBRT as a primary modality therapy for CRC liver oligometastases. Materials and methods We searched the Cochrane Central Register of Controlled Trials, Pubmed, and EMBASE for publications regarding SBRT for CRC liver metastases. Overall survival (OS: median, 1- and 2-year OS %) was the primary endpoint, and median PFS and one- and two-year local control (LC) were the secondary endpoints. A random-effect model pooled-analysis was performed to calculate the aggregated OS rates at 1 and 2 years as well as the one- and two-year LC. Results A total of 18 studies, encompassing 656 patients, were included in the analysis. The pooled one- and two-year OS were 67.18% (95% CI, 42.1–92.2) and 56.5% (95% CI, 36.7–76.2), respectively. Median PFS and OS were 11.5 and 31.5 months. The pooled one-year LC was 67% (95% CI, 43.8–90.2), while the pooled two-year LC was 59.3% (95% CI, 37.2–81.5). Correlation analysis revealed a moderate/poor linear relationship between the SBRT (BED10) dose and LC ( p  = 0.001, R  = 0.47)/OS ( p  = 0.001, R  = 0.29) at 2 years. Mild-moderate and severe liver toxicity were 30.7% and 8.7%. Conclusion SBRT for liver oligometastases is an effective option for patients with advanced CRC, with encouraging local control and survival. However, a definitive validation in large randomised studies is required, due to the retrospective or non-randomised nature of the included studies and the limitations of series with different doses/schedules of treatment.
    Print ISSN: 0167-8140
    Electronic ISSN: 1879-0887
    Topics: Medicine
    Published by Elsevier
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  • 2
    Publication Date: 2018-07-09
    Description: Publication date: Available online 7 July 2018 Source: Radiotherapy and Oncology Author(s): Johannes A. Langendijk, Roberto Orecchia, Karin Haustermans, Daniel Zips, Jacques Balosso, Denis Lacombe, Yolande Lievens, Damien C. Weber, Cai Grau, Esther G.C. Troost The overarching aim of work package 1 of the European Proton Therapy Network (EPTN) is to create a firm basis for evidence-based particle therapy at the European level. To achieve this, this work package will set up a worldwide unique prospective data registration programme for nine different tumour sites. Such programme will provide more insights into the current practice across all European particle therapy centres and into the results of particle therapy with regard to radiation-induced toxicity and efficacy in terms of local control and survival. More importantly, prospective data registration provides major opportunities to continuously improve the quality of particle therapy, by defining bench marks, to identify best practices that may learn others to improve quality of particle therapy, to synchronize selection criteria and to create more homogeneous patient cohorts to evaluate results, which is particularly important in rare tumours. This will be supported by EORTC through existing and new IT-infrastructure for data collection in different formats next to QA-platforms. In addition, work package 1 will define the requirements for high quality clinical trials in order to enhance high quality clinical trial proposals and determine alternative methods for RCT, such as the model-based approach.
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    Electronic ISSN: 1879-0887
    Topics: Medicine
    Published by Elsevier
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  • 3
    Publication Date: 2018-07-08
    Description: Publication date: Available online 6 July 2018 Source: Radiotherapy and Oncology Author(s): Everett J. Moding, Ranjana Advani, Saul A. Rosenberg, Richard T. Hoppe Background and purpose The role of irradiation to non-bulky and bulky sites of disease in advanced stage Hodgkin lymphoma is controversial. We aimed to review the long-term outcomes of patients treated with combined modality therapy to clarify the role of consolidative radiotherapy. Materials and methods Patients with stage III or IV Hodgkin lymphoma treated with Stanford V chemotherapy and consolidative radiotherapy to initial sites of disease ≥5 cm were analyzed retrospectively to determine patient outcomes, patterns of failure, and factors associated with treatment failure. Results A total of 170 patients were analyzed. Overall survival was 91.2%, freedom from progression was 80.6%, and progression-free survival was 78.9% at 10 years. 5 patients (2.9%) had refractory disease and 27 patients (15.9%) relapsed after treatment. Only an International Prognostic Score (IPS) greater than 2 predicted disease progression. 19 out of 27 relapses occurred exclusively outside of the radiation treatment field, and 17 out of 27 relapses occurred exclusively at original sites of disease. However, only 11 of 170 patients (6.5%) relapsed exclusively at original, non-bulky sites of disease not treated with radiation therapy. The cumulative incidence of local failure at 10 years was 4.6% for unirradiated sites and 2.6% for irradiated sites. Conclusion Patients with advanced stage Hodgkin lymphoma treated with combined modality therapy including consolidative radiotherapy to bulky disease sites had excellent long-term outcomes. Given the low frequency of isolated failures at initial sites, our results suggest that selective radiation therapy to sites at high risk of relapse may be feasible.
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    Electronic ISSN: 1879-0887
    Topics: Medicine
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  • 4
    Publication Date: 2018-07-08
    Description: Publication date: Available online 6 July 2018 Source: Radiotherapy and Oncology Author(s): Ritu Raj Upreti, Ashwini Budrukkar, Udita Upreti, Tabassum Wadasadawala, Shagun Misra, Lavanya Gurram, Rima Pathak, Deepak D. Deshpande Purpose To investigate dosimetric impact of inter-observer variation in clinical target volume(CTV) delineation for patients undergoing interstitial partial breast brachytherapy. Methods Five radiation oncologists delineated CTV in twenty patients who underwent multi-catheter partial breast brachytherapy. Five treatment plans for each patient were graphically optimized for CTV of all observers and evaluated using coverage index(CI), external volume index(EI), overdose volume index(OI) and conformal index(COIN). In addition, volume enclosed by prescription isodose(V 100 ), its spatial concordance(CI common ), mean coverage of all CTVs with common volume of prescription dose(V 100_common ) and mean CTV coverage for all pairs of observer with common prescription volume of respective pairs(V 100_pair ) were also computed. Results The mean ± standard deviation(SD) of CI and COIN ranged from 0.756 ± 0.076 to 0.840 ± 0.070 and 0.591 ± 0.090 to 0.673 ± 0.06 respectively. When a plan made for CTV of individual observer was evaluated on CTV of all observers, the maximum variations( ρ  〈 0.05) in the mean CI,COIN,OI and EI were 10.6%,11.4%,10.6% and 72.7% respectively. The observed mean ± SD of V 100 , CI common of V 100 , CTV coverage with V 100_common and V 100_pair was 160.7 ± 52.1, 0.70 ± 0.09, 73.1 ± 8.1% and 77.9 ± 7.3% respectively. Conclusion Inter-observer variation in delineation of CTV showed significant dosimetric impact with mean CTV coverage of 73.1% and 77.9% by common and paired prescription dose volume respectively among all observers.
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    Electronic ISSN: 1879-0887
    Topics: Medicine
    Published by Elsevier
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  • 5
    Publication Date: 2018-07-07
    Description: Publication date: Available online 5 July 2018 Source: Radiotherapy and Oncology Author(s): Susan Mercieca, José Belderbos, Judith van Loon, Kenneth Gilhuijs, Peter Julyan, Marcel van Herk Purpose The aim of the study was to compare simple SUVmax and SUVpeak based segmentation methods for calculating the lung tumour volume, compared to a pathology ground truth. Methods Thirty patients diagnosed with early stage Non-Small Cell lung cancer (NSCLC) underwent surgical resection in the Netherlands between 2006 and 2008. FDG PET-CT scans for these patients were acquired within a median of 20 days before surgery. The tumour volume for each percentage SUVmax and SUVpeak threshold, with and without background correction, was calculated for each patient. The percentage threshold that provided the tumour volume that corresponded best with the pathology volume was considered to be the optimal threshold. The optimal thresholds were plotted as a function of tumour volume using a power law function and cross validated using the leave-one-out technique. Results The mean optimal percentage threshold was 50% ± 10% and 62% ± 15% for the SUVmax and SUVpeak without background correction respectively and 47% ± 10% and 60 ± 15% for the SUVmax and SUVpeak with background correction respectively. The optimal threshold curves could be fitted well with power law function. After cross validation the correlation between the effective tumour diameter in pathology and autosegmentation was 0.900 and 0.905 for the SUVmax and SUVpeak without background correction respectively and 0.913 and 0.908 for the SUVmax and SUVpeak with background correction respectively. Conclusion No benefit was shown on clinical data for the SUVpeak based segmentation method over a SUVmax based one. Both methods can be used to determine the tumour volumes in resected NSCLC tumours.
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    Electronic ISSN: 1879-0887
    Topics: Medicine
    Published by Elsevier
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  • 6
    Publication Date: 2018-07-07
    Description: Publication date: Available online 5 July 2018 Source: Radiotherapy and Oncology Author(s): Vikneswary Batumalai, Jesmin Shafiq, Gabriel Gabriel, Timothy P. Hanna, Geoff P. Delaney, Michael Barton Background and purpose Despite evidence of the benefits of radiotherapy (RT) in the treatment of cancer patients, its underutilisation has been reported for various tumour sites. The aim of this study was to estimate survival shortfall, ‘years of potential life lost’ (YPLL) and ‘disability-adjusted life years lost’ (DALY) to demonstrate the impact of radiotherapy underutilisation in Australia. Materials and methods Optimal and actual RT utilisation (RTU) was compared to assess RT underutilisation to estimate 5-year overall survival shortfall using 2006 data from New South Wales (NSW) for 26 common tumour sites. 5-year overall survival shortfall is defined as number of people not surviving for 5-years due to RT underutilisation [=benefit proportion × shortfall [(optimal-actual RTU)/optimal RTU] proportion × No. of new cases]. YPLL = survival shortfall × estimated years of life lost per person (overall life expectancy − median age at death for specific cancer). DALY = (Years lived with disability + Years of life lost) × survival shortfall. Results The total number of new cases with cancer in 2006 in NSW was 20,741. Optimal RTU was 48% while actual RTU was 26%, resulting in estimated of 411 deaths due to underutilisation. Each death resulted in an average of 10.4 YPLL and 17.5 DALY. It was estimated RT underutilisation resulted in a total of 4,289 YPLL and 7,192 DALY overall. Conclusion This study illustrates the value of considering different mortality statistics, which include measures of the burden of cancer deaths on both the population and patients.
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    Topics: Medicine
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  • 7
    Publication Date: 2018-07-06
    Description: Publication date: Available online 4 July 2018 Source: Radiotherapy and Oncology Author(s): Hongming Li, Maya Galperin-Aizenberg, Daniel Pryma, Charles B. Simone, Yong Fan Background and purpose To predict treatment response and survival of NSCLC patients receiving stereotactic body radiation therapy (SBRT), we develop an unsupervised machine learning method for stratifying patients and extracting meta-features simultaneously based on imaging data. Material and methods This study was performed based on an 18 F-FDG-PET dataset of 100 consecutive patients who were treated with SBRT for early stage NSCLC. Each patient’s tumor was characterized by 722 radiomic features. An unsupervised two-way clustering method was used to identify groups of patients and radiomic features simultaneously. The groups of patients were compared in terms of survival and freedom from nodal failure. Meta-features were computed for building survival models to predict survival and free of nodal failure. Results Differences were found between 2 groups of patients when the patients were clustered into 3 groups in terms of both survival ( p =  0.003) and freedom from nodal failure ( p  = 0.038). Average concordance measures for predicting survival and nodal failure were 0.640 ± 0.029 and 0.664 ± 0.063 respectively, better than those obtained by prediction models built upon clinical variables ( p  〈 0.04). Conclusions The evaluation results demonstrate that our method allows us to stratify patients and predict survival and freedom from nodal failure with better performance than current alternative methods.
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    Topics: Medicine
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  • 8
    Publication Date: 2018-07-05
    Description: Publication date: Available online 3 July 2018 Source: Radiotherapy and Oncology Author(s): Patricia J.A.M. Brouwers, Erik van Werkhoven, Harry Bartelink, Alain Fourquet, Claire Lemanski, Judith van Loon, John H. Maduro, Nicola S. Russell, Luc J.E.E. Scheijmans, Dominic A.X. Schinagl, Antonia H. Westenberg, Philip Poortmans, Liesbeth J. Boersma Purpose In the Young Boost trial (YBT), breast cancer patients ≤50 years of age, treated with breast conserving therapy (BCT) were randomized between a 26 Gy boost dose and a 16 Gy boost dose, with local recurrence as primary and cosmetic outcome (CO) as secondary endpoint. Data of the YBT was used to investigate which factors are related with worse cosmetic outcome after BCT. Methods From 2004 to 2011, 2421 cT1-2N0-2a breast cancer patients were randomized. CO was scored subjectively by the patient and physician, and objectively using BCCT.core: at baseline, one and four years after treatment. Associations between potential risk factors for worse cosmetic outcome, based on the objective BCCT.core, were investigated using a proportional odds model. Results At four years, CO was significantly better in the standard boost group for all three scoring methods (satisfied CO ±65% vs 55%). A photon boost, high boost dose, poor cosmesis before radiation therapy, large boost volume and adjuvant chemotherapy significantly deteriorated CO. Conclusion Important risk factors for worse CO were the use of a photon boost instead of an electron boost, a high boost dose, cosmesis at baseline, adjuvant chemotherapy and boost volume. These results can be used to define strategies aimed at improving CO.
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    Topics: Medicine
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  • 9
    Publication Date: 2018-07-04
    Description: Publication date: Available online 2 July 2018 Source: Radiotherapy and Oncology Author(s): Huixun Jia, Xiaotao Shen, Yun Guan, Meimei Xu, Jia Tu, Miao Mo, Li Xie, Jing Yuan, Zhen Zhang, Sanjun Cai, Ji Zhu, ZhengJiang Zhu Purpose The present study aimed to identify a panel of potential metabolite biomarkers to predict tumor response to neoadjuvant chemo-radiation therapy (NCRT) in locally advanced rectal cancer (LARC). Experimental design Liquid chromatography–mass spectrometry (LC–MS)-based untargeted metabolomics was used to profile human serum samples ( n  = 106) from LARC patients treated with NCRT. The samples were collected from Fudan University Shanghai Cancer Center (FUSCC) from July 2014 to January 2016. Statistical methods, such as partial least squares (PLS) and Wilcoxon rank-sum test, were used to identify discriminative metabolites between NCRT-sensitive and NCRT-resistant patients according to their tumor regression grade (TRG). This trial is registered with Clinical Trials.gov, number NCT03149978. Results A panel of metabolites was selected as potential predictive biomarkers of pathological response to NCRT. A total of 4810 metabolic peaks were detected, and 57 significantly dysregulated peaks were identified. These 57 metabolic peaks were used to differentiate patients using PLS in a dataset containing NCRT-sensitive ( n  = 56) and NCRT-resistant ( n  = 49) patients. The combination of 57 metabolic peaks had AUC values of 0.88, 0.81 and 0.84 in the prediction models using PLS, random forest, and support vector machine, respectively, suggesting that metabolomics has the potential ability to predict responses to NCRT. Furthermore, 15 metabolite biomarkers were identified and used to construct a logistic regression model and explore dysregulated metabolic pathways using untargeted metabolic profiling and data mining approaches. Conclusions A panel of metabolites has been identified to facilitate the prediction of tumor response to NCRT in LARC, which is promising for the generation of personalized treatment strategies for LARC patients.
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    Topics: Medicine
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  • 10
    Publication Date: 2018-07-04
    Description: Publication date: Available online 2 July 2018 Source: Radiotherapy and Oncology Author(s): Julian Jacob, Thomas Durand, Loïc Feuvret, Jean-Jacques Mazeron, Jean-Yves Delattre, Khê Hoang-Xuan, Dimitri Psimaras, Hassen Douzane, Monica Ribeiro, Laurent Capelle, Alexandre Carpentier, Damien Ricard, Philippe Maingon Life expectancy of patients treated for brain tumors has lengthened due to the therapeutic improvements. Cognitive impairment has been described following brain radiotherapy, but the mechanisms leading to this adverse event remain mostly unknown. Technical evolutions aim at enhancing the therapeutic ratio. Sparing of the healthy tissues has been improved using various approaches; however, few dose constraints have been established regarding brain structures associated with cognitive functions. The aims of this literature review are to report the main brain areas involved in cognitive adverse effects induced by radiotherapy as described in literature, to better understand brain radiosensitivity and to describe potential future improvements.
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    Electronic ISSN: 1879-0887
    Topics: Medicine
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