Description: Publication date: Available online 12 December 2014 Source: Radiotherapy and Oncology Author(s): Esther G.C. Troost , Bianca A.W. Hoeben , Peter Laverman , Jan Bussink , Wim J.G. Oyen

Description: Publication date: Available online 11 December 2014 Source: Radiotherapy and Oncology Author(s): Martin-Immanuel Bittner , Anca-Ligia Grosu , Thomas B. Brunner IMRT has been suggested to reduce treatment-related toxicity in pancreatic cancer. We attempted to identify all IMRT-studies indexed in PubMed/Medline, comparing them with recent 3D-CRT trials. The predominant treatment-related toxicities, namely nausea/vomiting, diarrhoea and late GI toxicity, are significantly reduced with IMRT while there was no apparent difference for outcome measures.

Description: Publication date: Available online 11 December 2014 Source: Radiotherapy and Oncology Author(s): Marleen Kunneman , Arwen H. Pieterse , Anne M. Stiggelbout , Corrie A.M. Marijnen Background and purpose We previously found considerable variation in information provision on preoperative radiotherapy (PRT) in rectal cancer. Our aims were to reach consensus among patients and oncologists on which benefits/harms of PRT should be addressed during the consultation, and to assess congruence with daily clinical practice. Materials and methods A four-round Delphi-study was conducted with two expert panels: (1) 31 treated rectal cancer patients and (2) 35 radiation oncologists. Thirty-seven possible benefits/harms were shown. Participants indicated whether addressing the benefit/harm was (1) essential, (2) desired, (3) not necessary, or (4) to be avoided. Consensus was assumed when ⩾80% of the panel agreed. Results were compared to 81 audio-taped consultations. Results The panels reached consensus that six topics should be addressed in all patients (local control, survival, long term altered defecation pattern and faecal incontinence, perineal wound healing problems, advice to avoid pregnancy), three in male patients (erectile dysfunction, ejaculation disorder, infertility), and four in female patients (vaginal dryness, pain during intercourse, menopause, infertility). On average, less than half of these topics were addressed in daily clinical practice. Conclusions This study showed substantial overlap between benefits/harms that patients and oncologists consider important to address during the consultation, and at the same time poor congruence with daily clinical practice.

Description: Publication date: Available online 10 December 2014 Source: Radiotherapy and Oncology Author(s): Milou H. Martens , Samina Subhani , Luc A. Heijnen , Doenja M.J. Lambregts , Jeroen Buijsen , Monique Maas , Robert G. Riedl , Cecile R.L.P.N. Jeukens , Geerard L. Beets , Ewelina Kluza , Regina G.H. Beets-Tan Background and purpose Dynamic contrast-enhanced MRI (DCE-MRI) provides information on perfusion and could identify good prognostic tumors. Aim of this study was to evaluate whether DCE-MRI using a novel blood pool contrast-agent can accurately predict the response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Materials and methods Thirty patients underwent DCE-MRI before and 7–10 weeks after chemoradiotherapy. Regions of interest were drawn on DCE-MRI with T2W-images as reference. DCE-MRI-based kinetic parameters (initial slope, initial peak, late slope, and AUC at 60, 90, and 120 s) determined pre- and post-CRT and their Δ were compared between good (TRG1–2) and poor (TRG3–5) responders. Optimal thresholds were determined and sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) were calculated. Results Pre-therapy, the late slope was able to discriminate between good and poor responders (−0.05 × 10 −3 vs. 0.62 × 10 −3 , p 〈 0.001) with an AUC of 0.90, sensitivity 92%, specificity 82%, PPV 80%, and NPV 93%. Other pre-CRT parameters showed no significant differences, nor any post-CRT parameters or their Δ. Conclusions The kinetic parameter ‘late slope’ derived from DCE-MRI could potentially be helpful to predict before the onset of neoadjuvant chemoradiotherapy which tumors are likely going to respond. This could allow for personalized treatment-options in rectal cancer patients.

Description: Publication date: Available online 10 December 2014 Source: Radiotherapy and Oncology Author(s): Katie Edmunds , Corrinne Brooks , Vibeke N. Hansen , Victoria Harris , Diana M. Tait

Description: Publication date: Available online 10 December 2014 Source: Radiotherapy and Oncology Author(s): Renaud Mazeron , Pauline Castelnau-Marchand , Isabelle Dumas , Eleonor Rivin del Campo , Léopold Kamsu Kom , Florent Martinetti , George Farha , Anne Tailleur , Philippe Morice , Cyrus Chargari , Dimitri Lefkopoulos , Christine Haie-Meder Purpose To report the prognostic factors for local control in patients treated for locally advanced cervical cancer with image guided pulsed-dose rate brachytherapy. Materials/methods Patients treated with curative intent by a combination of external beam radiotherapy and pulsed-dose rate brachytherapy were selected. Local failure was defined as any relapse in the cervix, vagina, parametria, or uterus during follow-up. Prognostic factors were selected based on log rank tests and then analyzed with a Cox model. Dose/effect correlations were performed using the probit model. Results Two hundred and twenty-five patients treated from 2006 to 2011 were included. According to the FIGO classification, 29% were stage IB, 58% stage II, 10% stage III, and 3% stage IVA; 95% received concomitant chemotherapy. Thirty patients were considered having incomplete response or local failure. Among the selected parameters, D90 for HR-CTV, D90 for IR-CTV, the overall treatment time, the TRAK, and the HR-CTV volume appeared significantly correlated with local control in univariate analysis. In multivariate analysis, overall treatment time >55 days and HR-CTV volume >30 cm 3 appeared as independent. The probit analysis showed significant correlations between the D90 for both CTVs, and the probability of achieving local control ( p = 0.008 and 0.024). The thresholds to reach to warrant a probability of 90% of local control were 85 Gy to the D90 of the HR-CTV and 75 Gy to 90% of the IR-CTV (in 2 Gy equivalent, α / β = 10). To warrant the same local control rate, the D90 HR-CTV should be significantly increased in stage III–IV tumors, in case of HR-CTV >30 cm 3 , excessive treatment time, or tumor width at diagnosis >5 cm (97, 92, 105, and 92 Gy respectively). Conclusions Overall treatment time and HR-CTV volume were independent prognostic factors for local control. The D90 for HR and IR CTV were significantly correlated with local control, and D90 HR-CTV should be adapted to clinical criteria.

Description: Publication date: Available online 10 December 2014 Source: Radiotherapy and Oncology Author(s): Alexander V. Louie , David A. Palma , Max Dahele , George B. Rodrigues , Suresh Senan The use of stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer is growing rapidly, particularly since it has become the recommended therapy for unfit patients in current European and North American guidelines. As three randomized trials comparing surgery and SABR closed prematurely because of poor accrual, clinicians are faced with a dilemma in individual patient decision-making. Radiation oncologists, in particular, should be aware of the data from comparative effectiveness studies that suggest similar survival outcomes irrespective of local treatment modality. The necessity of obtaining a pathological diagnosis, particularly in frail patients prior to treatment remains a challenge, and this topic was addressed in recent European recommendations. Awareness of the high incidence of a second primary lung cancer in survivors, as well as other competing causes of mortality, is needed. The challenges in distinguishing focal scarring from recurrence after SABR also need to be appreciated by multidisciplinary tumor boards. With a shift in focus toward patient-centered decision-making, clinicians will need to be aware of these new developments and communicate effectively with patients, to ensure that treatment decisions are reflective of patient preferences. Priorities for additional research in the area are proposed.

Description: Publication date: Available online 9 December 2014 Source: Radiotherapy and Oncology Author(s): Thomas Mulliez , Liv Veldeman , Bruno Speleers , Khalil Mahjoubi , Vincent Remouchamps , Annick Van Greveling , Monique Gilsoul , Dieter Berwouts , Yolande Lievens , Rudy Van den Broecke , Wilfried De Neve Background and purpose Cardiac disease has been related to heart dose after left-sided breast radiotherapy. This trial evaluates the heart sparing ability and feasibility of deep inspiration breath hold (DIBH) in the prone position for left-sided whole breast irradiation (WBI). Materials and methods Twelve patients underwent CT-simulation in supine shallow breathing (SB), supine DIBH, prone SB and prone DIBH. A validation cohort of 38 patients received prone SB and prone DIBH CT-scans; the last 30 patients were accepted for prone DIBH treatment. WBI was planned with a prescription dose of 40.05 Gy. Results DIBH was able to reduce ( p 〈 0.001) heart dose in both positions, with results for prone DIBH at least as favorable as for supine DIBH. Mean heart dose was lowered from 2.2 Gy for prone SB to 1.3 Gy for prone DIBH ( p 〈 0.001), while preserving the lung sparing ability of prone positioning. Moreover prone DIBH nearly consistently reduced mean heart dose to less then 2 Gy, regardless of breast volume. All patients were able to perform the simulation procedure, 28/30 patients were treated with prone DIBH. Conclusions This trial demonstrates the ability and feasibility of prone DIBH to acquire optimal heart and lung sparing for left-sided WBI.

Description: Publication date: Available online 9 December 2014 Source: Radiotherapy and Oncology Author(s): Wei-Xiang Qi , Shen Fu , Qing Zhang , Xiao-Mao Guo Purpose To perform a systematic review and meta-analysis to compare the clinical outcomes and toxicity of hepatocellular carcinoma (HCC) patients treated with charged particle therapy (CPT) with those of individuals receiving photon therapy. Methods We identified relevant clinical studies through searching databases. Primary outcomes of interest were overall survival (OS) at 1, 3, 5 years, progression-free survival (PFS), and locoregional control (LC) at longest follow-up. Results 73 cohorts from 70 non-comparative observational studies were included. Pooled OS was significantly higher at 1, 3, 5 years for CPT than for conventional radiotherapy (CRT) [relative risk (RR) 1·68, 95% CI 1·22–2·31; p 〈 0·001; RR 3.46, 95% CI: 1.72–3.51, p 〈 0.001; RR 25.9, 95% CI: 1.64–408.5, p = 0.02; respectively]. PFS and LC at longest follow-up was also significantly higher for CPT than for CRT ( p = 0·013 and p 〈 0.001, respectively), while comparable efficacy was found between CPT and SBRT in terms of OS, PFS and LC at longest follow-up. Additionally, high-grade acute and late toxicity associated with CPT was lower than that of CRT and SBRT. Conclusion Survival rates for CPT are higher than those for CRT, but similar to SBRT in patients with HCC. Toxicity tends to be lower for CPT compared to photon radiotherapy.

Description: Publication date: Available online 9 December 2014 Source: Radiotherapy and Oncology Author(s): Yong Bao , Fang Peng , Qi-Chao Zhou , Zhong-Hua Yu , Jian-Cheng Li , Zhi-Bin Cheng , Long Chen , Xiao Hu , Yuan-Yuan Chen , Jin Wang , Yan Wang , Hong-Lian Ma , Zu-Min Xu , Ru-Biao Lu , Xiao-Wu Deng , Ming Chen Purpose The objective of this study was to evaluate the efficacy and safety of Endostar combined with concurrent chemoradiotherapy (CCRT) in patients with stage III non-small-cell lung cancer (NSCLC). Methods Patients with unresectable stage III NSCLC were treated with Endostar (7.5 mg/m 2 /d) for 7 days at weeks 1, 3, 5, and 7, while two cycles of docetaxel (65 mg/m 2 ) and cisplatin (65 mg/m 2 ) were administered on days 8 and 36, with concurrent thoracic radiation to a dose of 60–66 Gy. Primary end points were short-term efficacy and treatment-related toxicity. Results Fifty patients were enrolled into the study, and 48 were assessable. Of the 48 patients, 83% had stage IIIB and 65% had N3 disease. Median follow-up was 25.0 months. Overall response rate was 77%. The estimated median progression-free survival (PFS) was 9.9 months, and the estimated median overall survival (OS) was 24.0 months. The 1-, 2-, and 3-year local control rates were 75%, 67%, and 51%, PFS rates were 48%, 27%, and 16%, and OS rates were 81%, 50%, and 30%, respectively. All toxicities were tolerable with proper treatment. Conclusions The combination of Endostar with CCRT for locally advanced NSCLC patients was feasible and showed promising survival and local control rates.