Stereotactic Body Radiotherapy (SBRT) Reirradiation for Recurrent Pancreas Cancer

Objectives: After adjuvant or definitive radiation for pancreas cancer, there are limited conventional treatment options for recurrent pancreas cancer. We explored the role of (Stereotactic Body Radiotherapy) SBRT for reirradiation of recurrent pancreas Cancer. Methods: This is a retrospective study of patients reirradiated with SBRT for recurrent pancreas cancer. All patients were deemed unresectable and treated with systemic therapy. Fiducial gold markers were used. CT simulation was performed with oral and IV contrast and patients were treated with respiratory motion tracking in the CyberknifeTM system. Results: 30 patients (17 men and 13 women) with a median age of 67 years were included in the study. The median target volume was 41.29cc. The median prescription dose was 25Gy (24-36Gy) in a median of 5 fractions prescribed to a mean 78% isodose line. The median overall survival was 14 months. The 1 and 2 year local control was 78%. The worst toxicity included 3/30(10%) Grade III acute toxicity for pain, bleeding and vomiting. There was 2/30 (7%) Grade III long-term bowel obstructions. Conclusions: SBRT can be a useful and tolerable option for patients with recurrent pancreas cancer after prior radiation

Radiation Therapy in the Management of Malignant Melanoma

The initial treatment for primary and locoregional melanoma is surgery. Systemic therapy, and more recently immune therapy, has been the mainstay in the adjuvant and particularly the metastatic setting. Aside from palliation, there is a limited role for definitive radiation therapy for melanoma. However, in the adjuvant setting, postoperative radiation can improve locoregional disease control, albeit with potential toxicity and limited survival benefit. Stereotactic radiosurgery plays a vital role in the treatment of limited brain and extracranial metastasis

Abscopal Effect of Radiotherapy in the Immunotherapy Era: Systematic Review of Reported Cases

Mounting evidence suggests that radiation stimulates the immune system and this contributes to the abscopal effect, which is defined as "response at a distance from the irradiated volume." Though identified more than 50 years ago, the abscopal effect is revisited today. One rationale is that the abscopal effect is often observed with efficient immunotherapy. Here, we give an overview of the clinical data on the abscopal effect, generated by a combination of immunotherapy and radiotherapy (RT). Only papers that included RT in combination with immunotherapy were evaluated according to four main categories including RT parameters, sequencing of therapies, the definition of the abscopal effect, and patient selection. Twenty-four cases in 15 reports were reviewed. The results varied. Patient ages ranged from 24 to 74. RT dose (median total dose 18-58 Gy) varied. Biologically effective dose (BED) 10 was calculated to be a median 49.65 Gy (28-151 Gy). The time to a documented abscopal response ranged from less than a month to 12 months. The large variation concerning fractionation and sequencing of therapies indicates that these conflicting points need to be resolved, to generate for the abscopal effect to be clinically significant

Stereotactic Body Radiotherapy (SBRT) Reirradiation for Pelvic Recurrence From Colorectal Cancer

Background and ObjectivesWhen surgery is not adequate or feasible, stereotactic body radiotherapy (SBRT) reirradiation has been used for recurrent cancers. We report the outcomes of a series of patients with pelvic recurrences from colorectal cancer reirradiated with SBRT

Post operative stereotactic radiosurgery for positive or close margins after preoperative chemoradiation and surgery for rectal cancer

Background: The incidence of positive margins after neoadjuvant chemoradiation and adequate surgery is very low. However, when patients do present with positive or close margins, they are at a risk of local failure and local therapy options are limited. We evaluated the role of stereotactic body radiotherapy (SBRT) in patients with positive or close margins after induction chemoradiation and total mesorectal excision

Therapeutic Potential of Adjuvant Stereotactic Body Radiotherapy for Gallbladder Cancer

Surgical treatment remains the only curative treatment for gallbladder cancer. However, even after liver resection, locoregional failure seems to be a significant problem. While there is no Level I evidence, multiple studies have shown benefit for adjuvant radiation in high-risk patients. After extensive liver resection, tolerance to conventional chemoradiation may be limited by potential liver toxicity. Stereotactic body radiotherapy has been used safely and effectively in hepatobiliary malignancies. We present a case report, highlighting the potential therapeutic role of adjuvant stereotactic body radiotherapy (SBRT) for gallbladder cancer

Therapeutic Potential of Adjuvant Stereotactic Body Radiotherapy for Gallbladder Cancer

Surgical treatment remains the only curative treatment for gallbladder cancer. However, even after liver resection, locoregional failure seems to be a significant problem. While there is no Level I evidence, multiple studies have shown benefit for adjuvant radiation in high-risk patients. After extensive liver resection, tolerance to conventional chemoradiation may be limited by potential liver toxicity. Stereotactic body radiotherapy has been used safely and effectively in hepatobiliary malignancies. We present a case report, highlighting the potential therapeutic role of adjuvant stereotactic body radiotherapy (SBRT) for gallbladder cancer

Serum nectin-2 and nectin-4 are diagnostic in lung cancer: which is superior?

Nectins are immunoglobulin-like molecules that are involved in cell to cell adhesion by forming tight junctions and homophilic/heterophilic interactions. This study aimed to analyze serum nectin-2 and nectin-4 levels in lung cancer patients and to evaluate the prognostic, diagnostic and predictive strengths. Data from 74 lung cancer patients were retrospectively examined and enzyme-linked immunosorbent assays (ELISA) were used to measure serum nectin-2 and nectin-4 concentrations. A total number of 40 age and sex-adjusted healthy controls were also enrolled in the study. The median serum nectin-2 and nectin-4 levels of the patients were significantly higher than those of controls (p & x202f; 0.05), and furthermore they were found not to be correlated with either overall survival or progression-free survival (p & x202f;> 0.05). Even though both markers showed high diagnostic values, serum nectin-2 was found superior to both serum nectin-4 and serum nectin-2 & x202f;+ nectin-4 combinations in the diagnosis of lung cancer according to higher sensitivity, specificity and predictive values. Serum nectin-2 and nectin-4 might be used in lung cancer diagnosis but the diagnostic importance of nectin-2 is higher. The prognostic and predictive strengths in cancer are controversial. Furthermore, the interactions with tumor microenvironments and the potentials as therapeutic targets for malignancies have yet to be elucidated

Neuroendocrine carcinoma of the breast: a case presenting with Octreoscan (TM) positive skin metastases

Primary neuroendocrine carcinoma of the breast is very rare and has been revealed as a result of the widespread use of sensitive techniques for the detection of neuroendocrine markers. Published cases number less than 30, all presenting with a lump in the breast as the first sign. We report a case of neuroendocrine carcinoma of the breast that presented first with skin metastases. A 60-year-old woman with coin skin lesions, 2-3 cm, on the back, belly, and side of the hip was admitted to Istanbul University Oncology Institute. Histopathological results of a punch biopsy revealed lymphangitis carcinomatosa. Mammography and sonography performed as part of the systemic evaluation demonstrated a 6 mm solid lesion. Subsequent evaluation of the biopsy specimen revealed primary neuroendocrine carcinoma. First-line hormonotherapy with letrozole, to inhibit the estrogen receptor, together with monthly injections of long-acting 30 mg octreotide, for the skin lesions, were initiated. The patient was followed-up for 20 months, during which time no progression was observed. Then relaps was seen in the lungs and died six months later. Diagnosis, therapy, and follow-up of the case are presented

Hippocampal Sparing in Stereotactic Radiotherapy for Multiple Brain Metastases: A Comparison of Intensity-modulated Arc Therapy, CyberKnife, and Helical Radiotherapy

OBJECTIVE In this study, we performed a plan study to evaluate brain and hippocampal doses with hippocampal sparing in the treatment of multiple brain metastases with stereotactic radiosurgery (SRS). For this purpose, treatment plans prepared using intensity-modulated arc therapy (IMAT), CyberKnife radio surgery, and helical tomotherapy techniques. The results were compared and evaluated according to their superiority to each other.METHODS Fifteen patients with multiple brain metastases who had a tumor diameter of <3.5 cm were included in this study. IMAT, CK, and HT plans were separately created for each patient. The dose prescription was defined as 18 Gy in the single fraction.RESULTS The D40% of hippocampal (in Gy) averaged 1.63, 1.69, and 0.52 for IMAT, CyberKnife, and Tomotherapy, respectively. The median hippocampal Dmax (in Gy) averaged 2.81, 4.63, and 1.98, respectively. Some plans were statically different in terms of critical organ doses, but the results were clinically acceptable. The mean values of V12 (cc) were found to be 12.6, 38.23, and 37.46 for IMAT, CyberKnife, and Tomotherapy, respectively, when evaluating the doses taken by healthy brain tissue.CONCLUSION Brain radiotherapy is a treatment modality for primary and metastatic lesions. However, after radiotherapy (even with SRS) damage especially in the hippocampus may cause cognitive impairment and a decrease in patients' quality of life. Therefore, when the hippocampus is outlined as organs of risk, it can be protected without compromising PTV coverage. We saw this result in all of three treatment platforms used in this study