Τομογραφία εκπομπής ποζιτρονίων (PET/CT SCAN) στο λέμφωμα hodgkin.Συσχέτιση με τη θεραπευτική στρατηγική και την ακτινοθεραπεία.

Εισαγωγή: Η επίδραση της τομογραφίας εκπομπής ποζιτρονίων βάσεως σε συνδυασμό με αξονική τομογραφία (PET/CT), στην επιλογή της πρώτης γραμμής θεραπείας στο Λέμφωμα Hodgkin (HL) δεν έχει μελετηθεί συστηματικά, εκτός κλινικών μελετών. Σκοπός: Σκοπός της παρούσας μελέτης ήταν η διευρεύνηση της ενδεχόμενης επίπτωσης του ΡΕΤ/CT βάσεως στη σταδιοποίηση, στην τροποποίηση της θεραπευτικής στρατηγικής και των προσβεβλημένων πεδίων ακτινοθεραπείας (IFRT), καθώς και η εκτίμησης της προγνωστικής σημασίας των παραμέτρων του PET/CT βάσεως, στην καθημερινή πρακτική. Ασθενείς και Μέθοδοι: Μεταξύ 12/12/2006 και 25/7/2014, μελετήθηκαν αναδρομικά 162 ασθενείς με HL, που εντάχθηκαν διαδοχικά. Ως μοναδικό κριτήριο συμμετοχής τους στη μελέτη ήταν η ύπαρξη PET/CT κατά τη διάγνωση. Αποτελέσματα: Εικοσι έξι ασθενείς (16%) ανέβηκαν στάδιο και 9 (6%) κατέβηκαν στάδιο. Ο αριθμός των προσβεβλημένων περιοχών (ΝΙS) με βάση τη σταδιοποίηση με ΡΕΤ (ΡΕΤ-S) ήταν σημαντικά μεγαλύτερος σε σχέση με αυτόν της κλινικής σταδιοποίησης (CS) (p<0.0001). Η θεραπευτική στρατηγική ( προσαρμοσμένη στα αρχικά ή προχωρημένα στάδια) θα μπορούσε να αλλάξει σε 23 ασθενείς (14%), σύμφωνα με το ΡET-S. Ωστόσο, μόνο σε 10 (6% του συνόλου), ο θεράπων ιατρός αποφάσισε να τροποποιήσει τη θεραπεία και αυτή η τροποποίηση δεν επηρέασε το αποτέλεσμα. Σε 66 ασθενείς, το ΡΕΤ-S θα μπορούσε να οδηγήσει σε τροποποιήσεις του προσβεβλημένου πεδίου της IFRT, αλλά τέτοιες τροποποιήσεις υιοθετήθηκαν στην πραγματικότητα σε 36 (59%) Η επακόλουθη επέκταση του πεδίου της RT δεν επηρέασε το αποτέλεσμα. Τόσο η PET-S όσο και η CS ήταν εξαιρετικά σημαντικές στην πρόβλεψη της ελεύθερης επιδείνωσης νόσου (FFP) (p<0.001). Επιπλέον, το PET-S αποκάλυψε τρεις ισχυρές προγνωστικές παραμέτρους: το NIS από το ΡΕΤ-S, το SUVmax και το γινόμενο του (SUVmax) x (dmax) (dmax= μέγιστη διάμετρο της βλάβης), ως έμμεσο δείκτη της συνολικής γλυκόλυσης της βλάβης (TLG). Οι ασθενείς με ≤ 2, 3-8 και> 8 εντοπίσεις είχαν 5ετή FFP 100%, 80% και 69% αντίστοιχα (p=0.004). Ασθενείς με SUVmax ≤ 9, 9-18 και > 18 είχαν 5ετή FFP 93%,81% και 58% αντίστοιχα (p=0.01), ενώ το γινόμενο (SUVmax) x (dmax) προσδιόρισε τρεις ομάδες ασθενών (≤ 35, 35.1-100 και> 100) με σημαντικά διαφορετική πρόγνωση ( 5ετή FFP: 94%, 81% και 70% αντίστοιχα ,p=0.04) Συμπερασμα: Η σταδιοποίηση με ΡΕΤ (PET-S) μπορεί να μεταβάλλει το κλινικό στάδιο σε 20% των ασθενών με HL, μολονότι εμφανίζει περιορισμένη επίπτωση στην τροποποίηση και την έκβαση της θεραπείας. Παράλληλα, συμβάλλει στην αναγνώριση πρόσθετων ισχυρών προγνωστικών παραμέτρων.  Introduction:The effect of baseline positron emission tomography combined with computed tomography (PET/CT) on first-line treatment choice in Hodgkin lymphoma (HL) has not been systematically studied outside clinical trials. Aim: The aim of this study was the investigation of the potential impact of baseline PET/CT on staging, modification of therapeutic strategy and involved-field radiotherapy fields (IF-RT) in every day practice and the assessment of the prognostic significance of baseline PET/CT parameters. Patients and Methods: Between 12/12/2006 and 25/7/2014, 162 consecutive patients with HL, were retrospectively studied. They were selected solely based on both baseline CT and PET/CT availability. Results: Twenty-six (16%) patients were upstaged and 9 (6%) downstaged. The number of involved sites (NIS) by PET-staging (PET-S) was significantly higher compared to clinical staging (CS) (p<0.0001). Treatment strategy (adjusted for early or advanced stage) could have been changed in 23 patients (14%) based on PET-S. However, in only 10 (6% of total) the treating physician decided to modify treatment, and this modification did not affect the outcome. In 66 patients PET-S could lead to modifications of IF-RT field, but such modifications were actually adopted in 36 (59%). The resulting extension of RT field did not affect outcome. Both PET-S and CS were highly significant in predicting freedom from progression (FFP) (p<0.001). Moreover, PET-S revealed three potent prognostic parameters: the NIS by PET-S, SUVmax and the product of (SUVmax)x(dmax) (dmax=maximal largest lesion diameter), as a surrogate of total lesion glycolysis (TLG). Patients with ≤ 2, 3-8, and >8 sites had 5y-FFP of 100%, 80% and 69% respectively (p=0.004). Patients with SUVmax≤ 9, 9-18 and >18 had 5-year FFP of 93%, 81% and 58% respectively (p=0.01), while (SUVmax)x(dmax) identified three groups of patients (≤ 35, 35.1-100 and >100) with significantly different prognosis (5-year FFP: 94%, 81% and 70% respectively, p=0.04). Conclusion: PET-S may alter clinical stage in 20% of HL patients, though with limited impact on treatment modification and outcome, and contributes to the identification of additional potent prognostic parameters

Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma in Patients Unfit for Resection, Ablation, or Chemotherapy: A Retrospective Study

Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). Methods. Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50–52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. Results. All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. Conclusion. 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies

Evaluation of quality of life outcomes following palliative radiotherapy in bone metastases : a literature review

Purpose: To assess the quality of life (QoL) following palliative radiotherapy (RT) in patients with painful bone metastases. Methods: A literature search limited to English-written publications was carried out, through the Cochrane Central Register of Controlled Trials (November 2018), OvidSP and PubMedCentral (1940-November 2018) databases. Subject headings and keywords included "quality of life"(QoL), "bone metastases", "palliative therapy", "pain" and "radiotherapy". Original articles, literature reviews, trials and meta-analyses revealing alterations in QoL post-RT using ratified measuring tools were examined. Studies referring to other types of metastases (e.g. brain metastases), or to other types of palliative therapy (e.g. the use of bisphosphonates alone), or focusing only on pain, or even reporting QoL only before or only after the use of RT were excluded. Results: Twenty four articles were selected from a total of 1360 articles. Seven trials proceeded to patients' randomization. The most commonly used tool to evaluate QoL was EORTC, followed by Brief Pain Inventory (BPI) and Edmonton Symptom Assessment System (ESAS) questionnaires. All studies showed improvement in symptoms and functional interference scores after RT. The QoL between responders (Rs) and non-responders (NRs) has been juxtaposed in 10 studies. Rs had a significant benefit in QoL in comparison with the NRs. Discussion: Palliative radiotherapy in painful bone metastases improves Rs' QoL

The significanceof positron emission tomography (PET/CT SCAN) in hodgkin lymphoma: correlation with therapeutic strategy and radiotherapy

Introduction:The effect of baseline positron emission tomography combined with computed tomography (PET/CT) on first-line treatment choice in Hodgkin lymphoma (HL) has not been systematically studied outside clinical trials.Aim: The aim of this study was the investigation of the potential impact of baseline PET/CT on staging, modification of therapeutic strategy and involved-field radiotherapy fields (IF-RT) in every day practice and the assessment of the prognostic significance of baseline PET/CT parameters.Patients and Methods: Between 12/12/2006 and 25/7/2014, 162 consecutive patients with HL, were retrospectively studied. They were selected solely based on both baseline CT and PET/CT availability.Results: Twenty-six (16%) patients were upstaged and 9 (6%) downstaged. The number of involved sites (NIS) by PET-staging (PET-S) was significantly higher compared to clinical staging (CS) (p8 sites had 5y-FFP of 100%, 80% and 69% respectively (p=0.004). Patients with SUVmax≤ 9, 9-18 and >18 had 5-year FFP of 93%, 81% and 58% respectively (p=0.01), while (SUVmax)x(dmax) identified three groups of patients (≤ 35, 35.1-100 and >100) with significantly different prognosis (5-year FFP: 94%, 81% and 70% respectively, p=0.04). Conclusion: PET-S may alter clinical stage in 20% of HL patients, though with limited impact on treatment modification and outcome, and contributes to the identification of additional potent prognostic parameters. Εισαγωγή: Η επίδραση της τομογραφίας εκπομπής ποζιτρονίων βάσεως σε συνδυασμό με αξονική τομογραφία (PET/CT), στην επιλογή της πρώτης γραμμής θεραπείας στο Λέμφωμα Hodgkin (HL) δεν έχει μελετηθεί συστηματικά, εκτός κλινικών μελετών.Σκοπός: Σκοπός της παρούσας μελέτης ήταν η διευρεύνηση της ενδεχόμενης επίπτωσης του ΡΕΤ/CT βάσεως στη σταδιοποίηση, στην τροποποίηση της θεραπευτικής στρατηγικής και των προσβεβλημένων πεδίων ακτινοθεραπείας (IFRT), καθώς και η εκτίμηση της προγνωστικής σημασίας των παραμέτρων του PET/CT βάσεως, στην καθημερινή πρακτική.Ασθενείς και Μέθοδοι: Μεταξύ 12/12/2006 και 25/7/2014, μελετήθηκαν αναδρομικά 162 ασθενείς με HL, που εντάχθηκαν διαδοχικά. Ως μοναδικό κριτήριο συμμετοχής τους στη μελέτη ήταν η ύπαρξη PET/CT κατά τη διάγνωση.Αποτελέσματα: Εικοσι έξι ασθενείς (16%) ανέβηκαν στάδιο και 9 (6%) κατέβηκαν στάδιο. Ο αριθμός των προσβεβλημένων περιοχών (ΝΙS) με βάση τη σταδιοποίηση με ΡΕΤ (ΡΕΤ-S) ήταν σημαντικά μεγαλύτερος σε σχέση με αυτόν της κλινικής σταδιοποίησης (CS) (p 8 εντοπίσεις είχαν 5ετή FFP 100%, 80% και 69% αντίστοιχα (p=0.004). Ασθενείς με SUVmax ≤ 9, 9-18 και > 18 είχαν 5ετή FFP 93%,81% και 58% αντίστοιχα (p=0.01), ενώ το γινόμενο (SUVmax) x (dmax) προσδιόρισε τρεις ομάδες ασθενών (≤ 35, 35.1-100 και> 100) με σημαντικά διαφορετική πρόγνωση ( 5ετή FFP: 94%, 81% και 70% αντίστοιχα ,p=0.04)Συμπερασμα: Η σταδιοποίηση με ΡΕΤ (PET-S) μπορεί να μεταβάλλει το κλινικό στάδιο σε 20% των ασθενών με HL, μολονότι εμφανίζει περιορισμένη επίπτωση στην τροποποίηση και την έκβαση της θεραπείας. Παράλληλα, συμβάλλει στην αναγνώριση πρόσθετων ισχυρών προγνωστικών παραμέτρων

Impact of Radiation Therapy on Pain Relief of Cancer Patients Affected by on Malignant Psoas Syndrome: 26 Years of Experience

Aim: The malignant psoas syndrome (MPS) is a rare and complex cancer-related clinical entity, with a significant impact on cancer patients' quality of life. The literature describing malignant infiltration of the psoas muscle as well as its management is limited. The primary endpoint of the study was the assessment of pain relief in symptomatic terminal-stage MPS patients. Materials and Methods: Patients underwent hypofractionated (two- or three-dimensional conformal) radiotherapy as palliative treatment. A dose of 42.5 Gy in 17 daily fractions (2.5 Gy/fraction) was prescribed. Pain response was measured before 3 and 6 months after radiation delivery. Results: Between May 1992 and April 2019, eight patients were treated. The median age was 75 years (range: 59-87 years). All patients had distant metastatic disease at the time of treatment. We found a significant pain relief (median duration of response of 105 days) and an improvement in health-related quality of life. Conclusions: Radiotherapy had a favorable outcome and can be considered an effective analgesic treatment in case of painful MPS

Utilizing Yoga in oncologic patients treated with radiotherapy: Review

Purpose: Several trials on noncancer population indicate that yoga is associated with meaningful clinical effects. This study evaluated the physical and psychosocial outcomes of yoga in oncologic patients treated with radiotherapy. Methods: We focused on a research through Cochrane Register of Controlled Trials (CENTRAL), BioMed Central, and MEDLINE studies up to May 2017. Results: Yoga was found to have a substantial benefit in cancer patients' distress, anxiety, and depression. It also demonstrated a moderate impact on fatigue and emotional function and a small and insignificant effect on functional well-being and sleep disturbances. As far as the effects on psychological outcomes are concerned, there was insufficient evidence. Conclusions: This systematic review of randomized controlled trials showed that yoga has strong beneficial effects on oncologic patients' quality of life. Results of the current review must be interpreted with caution due to the relative small sample sizes of most of the included studies, while a prospective randomized study stands in need for the confirmation of our results

Prognostic Significance of Serum Inflammatory Response Markers in Newly Diagnosed Non-Small Cell Lung Cancer before Chemoirradiation

Purpose. To identify whether the serum’s baseline C-reactive protein (CRP) and albumin (Alb) levels related to clinicopathological parameters and overall survival (OS) in non-small cell lung cancer (NSCLC). Methods. In total, 100 consecutive patients (mean age = 68.38 +/- 10.85 years) that underwent chemoradiotherapy were studied. Measurements of CRP and Alb were performed before any treatment. Results. Serum CRP levels were significantly associated with histological grade (P < 0.001), TNM stage (P < 0.001), PS (P = 0.009), and Alb (P < 0.001). Additionally CRP and Alb levels were found significantly associated with overall survival in univariate analysis (log-rank test, P < 0.001 and P = 0.002, resp.) and CRP remained significant after controlling for age, alcohol, performance status, and TNM stage, whereas albumin showed a borderline effect on the hazard rate (P = 0.052). Conclusions. CRP and Alb are both promising biomarkers in identification of NSCLC patients with poor prognosis and form a possible target for intensifying their therapies

Evaluation of acute/late toxicity and local recurrence in T1-T2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT)

Background. The aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0. Patients and methods. Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence. Results. The median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and 4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively. Conclusions. Our radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules