Radiation Therapy Techniques and Treatment-Related Toxicity in the PORTEC-3 Trial:Comparison of 3-Dimensional Conformal Radiation Therapy Versus Intensity-Modulated Radiation Therapy

Purpose Radiation therapy techniques have developed from 3-dimensional conformal radiation therapy (3DCRT) to intensity modulated radiation therapy (IMRT), with better sparing of the surrounding normal tissues. The current analysis aimed to investigate whether IMRT, compared to 3DCRT, resulted in fewer adverse events (AEs) and patient-reported symptoms in the randomized PORTEC-3 trial for high-risk endometrial cancer. Methods and Materials Data on AEs and patient-reported quality of life (QoL) of the PORTEC-3 trial were available for analysis. Physician-reported AEs were graded using Common Terminology Criteria for Adverse Events v3.0. QoL was assessed by the European Organisation for Research and Treatment of Cancer QLQC30, CX24, and OV28 questionnaires. Data were compared between 3DCRT and IMRT. A P value of ≤ .01 was considered statistically significant due to the risk of multiple testing. For QoL, combined scores 1 to 2 (“not at all” and “a little”) versus 3 to 4 (“quite a bit” and “very much”) were compared between the techniques. Results Of 658 evaluable patients, 559 received 3DCRT and 99 IMRT. Median follow-up was 74.6 months. During treatment no significant differences were observed, with a trend for more grade ≥3 AEs, mostly hematologic and gastrointestinal, after 3DCRT (37.7% vs 26.3%, P = .03). During follow-up, 15.4% (vs 4%) had grade ≥2 diarrhea, and 26.1% (vs 13.1%) had grade ≥2 hematologic AEs after 3DCRT (vs IMRT) (both P < .01). Among 574 (87%) patients evaluable for QoL, 494 received 3DCRT and 80 IMRT. During treatment, 37.5% (vs 28.6%) reported diarrhea after 3DCRT (vs IMRT) (P = .125); 22.1% (versus 10.0%) bowel urgency (P = 0039), and 18.2% and 8.6% abdominal cramps (P = .058). Other QoL scores showed no differences. Conclusions IMRT resulted in fewer grade ≥3 AEs during treatment and significantly lower rates of grade ≥2 diarrhea and hematologic AEs during follow-up. Trends toward fewer patient-reported bowel urgency and abdominal cramps were observed after IMRT compared to 3DCRT

Radiation therapy techniques and treatment-related toxicity in the PORTEC-3 trial: comparison of 3-dimensional conformal radiation therapy versus intensity-modulated radiation therapy

Purpose: Radiation therapy techniques have developed from 3-dimensional conformal radiation therapy (3DCRT) to intensity modulated radiation therapy (IMRT), with better sparing of the surrounding normal tissues. The current analysis aimed to investigate whether IMRT, compared to 3DCRT, resulted in fewer adverse events (AEs) and patient-reported symptoms in the randomized PORTEC-3 trial for high-risk endometrial cancer.Methods and materials: Data on AEs and patient-reported quality of life (QoL) of the PORTEC-3 trial were available for analysis. Physician-reported AEs were graded using Common Terminology Criteria for Adverse Events v3.0. QoL was assessed by the European Organisation for Research and Treatment of Cancer QLQC30, CX24, and OV28 questionnaires. Data were compared between 3DCRT and IMRT. A P value of = .01 was considered statistically significant due to the risk of multiple testing. For QoL, combined scores 1 to 2 ("not at all" and "a little") versus 3 to 4 ("quite a bit" and "very much") were compared between the techniques.Results: Of 658 evaluable patients, 559 received 3DCRT and 99 IMRT. Median follow-up was 74.6 months. During treatment no significant differences were observed, with a trend for more grade =3 AEs, mostly hematologic and gastrointestinal, after 3DCRT (37.7% vs 26.3%, P = .03). During follow-up, 15.4% (vs 4%) had grade >= 2 diarrhea, and 26.1% (vs 13.1%) had grade >= 2 hematologic AEs after 3DCRT (vs IMRT) (both P = 3 AEs during treatment and significantly lower rates of grade >= 2 diarrhea and hematologic AEs during follow-up. Trends toward fewer patient-reported bowel urgency and abdominal cramps were observed after IMRT compared to 3DCRT. (C) 2021 The Authors. Published by Elsevier Inc.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Favorable long-term results of primary pterygium removal by bare sclera extirpation followed by a single (90)Strontium application

PURPOSE. To describe and compare long-term (>= 36 months) effects of patients with 86 primary pterygia treated with bare sclera extirpation ( BSE) followed by beta-RT or by sham irradiation. METHODS. Prospective, multicenter, randomized, double-blind study. After BSE of their pterygium, patients were randomized to either beta-RT or sham irradiation. In the case of beta-RT, within 24 hours after the operation, a 90Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham irradiation was given using the same type of applicator without the 90Sr layer. After treatment, both a masked ophthalmologist and a radiation oncologist performed follow-up examinations. These were continued until either a relapse occurred or at least 36 months had elapsed. RESULTS. Adequate follow-up was available of 86 pterygia in 81 patients, treated between February 1998 and September 2002. Fifty-two (60%) patients were male. The mean age of the patients was 50 years ( range: 24-77). After a follow-up of at least 36 months ( mean: 40 months, SD: 13.9 months), 5 out of 44 eyes (11%) treated with beta-RT showed a recurrence versus 32 out of 42 eyes (76%) treated with sham-RT ( after a mean follow-up of 22 months) (p <0.001). In the beta-RT group, 80% were satisfied with the cosmetic result, whereas in the sham group this percentage was 41% ( p <0.001). In the beta-RT group, no scar or a white scar could be detected in 86% of the treated eyes, versus in 24% of the sham irradiated eyes (p <0.001). A change of keratometry (Javal) was seen in 5 patients (12%) following beta-RT compared to 16 (38%) after sham irradiation (p= 0.002). Complications were few: a granuloma was seen in three patients after sham irradiation, mild limitation of abduction in two beta-RT patients versus in five after sham irradiation, and mild scleromalacia in one beta-RT patient. CONCLUSIONS. Bare sclera extirpation of a pterygium without adjuvant treatment has an unacceptably high recurrence rate and therefore should be considered obsolete. Bare sclera extirpation of a primary pterygium followed by a single-dose beta-RT is a simple, effective, and safe treatment with lasting results and very few complication

Outcomes & predictors of progression: SBRT for lymph node oligorecurrent prostate cancer on PSMA-PET

Purpose or Objective To describe outcomes and identify predictors of progression for patients with lymph node oligorecurrent prostate cancer diagnosed on PSMA-PET and treated with stereotactic body radiotherapy (SBRT). Materials and Methods Patients from a prospective cohort study were included if they had 1-3 lymph node metastases diagnosed with PSMA-PET after initial treatment for primary prostate cancer and had not received hormonal therapy in the preceding 24 months. Patients were treated with 5 x 7 Gy or 3 x 10 Gy using MRI- or CBCT-guided SBRT. Acute toxicity was assessed until 3 months post-SBRT. PSA was measured pre-SBRT, after 3 months and then at the discretion of the referring physician. QoL questionnaires were sent pre-SBRT and at 1 and 4 weeks, 3 and 6 months after SBRT and then every 6 months. Clinical and treatment-related variables were assessed for their influence on progression free survival (PFS) using Kaplan-Meier analyses and Cox-regression. Multiple imputation was used for missing data. Progression was defined as a local recurrence (>20% increase in short axis diameter of a target lesion), a newly diagnosed metastatic site, biochemical progression (PSA nadir + 2 ng/mL and >25% increase) or start of ADT. Secondary outcomes were ADT-free survival, biochemical PFS (BPFS), toxicity and QoL. A preliminary risk score was created based on quantiles of the linear predictor from multivariable analysis for PFS. Results 92 patients were included, median follow-up was 26 months. 54 (59%) patients developed at least one progression: diagnosis of a new metastasis in 48 (52%) patients, biochemical progression in 40 (43%) patients and start of ADT in 17 (18%) patients. No local recurrences were observed. Median PFS and BPFS were 15.5 and 20.9 months, respectively. Median ADT-FS was not reached, ADT-FS at 24 months was 73% (95%-CI 62-86%). After correcting for age in multivariable analysis, higher PSA prior to SBRT was significantly associated with worse PFS (Table 1). The risk score, based on multivariable analysis, is depicted in Figure 1. It subdivides patients in low, intermediate and high risk groups, for which significant differences in PFS were observed. Two (1.7%) and five (5.4%) patients experienced acute and late grade 2 genitourinary toxicity, respectively. Grade 1 fatigue was the most predominant acute toxicity (n=40, 34%). No ≥ grade 3 toxicities were observed. QoL analysis only showed a mild increase in fatigue at 1 and 4 weeks after SBRT (median EORTC-C30 fatigue increased from 11 to 22 at 4 weeks compared with baseline, on a 100-point scale). This was normalised again at 6 months and other QoL aspects were unaffected. Conclusion Median PFS of >12 months was attained in patients with lymph node oligometastatic prostate cancer who have been diagnosed on PSMA-PET and treated with image-guided SBRT. Higher pre-SBRT PSA and younger age were found to be predictors of shorter PFS. Toxicity was minor and only transient mild fatigue was observed in quality of life analysis

Nomogram for prediction of outcome for patients with endometrium cancer: a pooled analysis of PORTEC-1 and PORTEC-2 trials

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

A Machine-Learning Based Method for Inter-Institutional QA of MR-Based Brachytherapy Treatment Planning in Cervical Cancer

PURPOSE/OBJECTIVE(S): Inter-institutional quality assurance (QA) of brachytherapy (BT) treatment planning is often based on expert judgment of a limited number of treatment plans. Cohort comparisons are of limited value as patient anatomy has a major impact on organs-at-risk (OAR) dose. Therefore, the aim of this study was to develop and test a QA tool that predicts OAR dose based on patient anatomy. MATERIALS/METHODS: 60 Patients (120 plans) from institute A (data A) and 14 patients (32 plans) from institute B (data B) were included, treated in accordance with EMBRACE II guidelines. Additionally, 71 MR-guided BT pre-EMBRACE II plans (71 patients) from institute B were included (data B'). Histograms of the overlap (OVHs) between delineated OARs and the high-risk CTV were used to objectify patient anatomy. Dimensionality of the OVH data was reduced by principal component analysis. A random-forest model was fitted to training OVHs and DVHs. Model performance was evaluated using leave-one-out cross-validation for data A. Then, different models were created and tested based on data splits according to institute (A versus B and A versus B'), applicator type (ovoid versus ring), application type (IC versus IC+IS). The models predict DVHs from OVHs, from which the D2cm3 of the OARs was computed. Model performance based on data A was evaluated by calculating the distribution (σ) of the difference between planned and predicted D2cm3 values (D2cm3, pl-pr), and the Pearson correlation coefficient (r) of these values. For the models based on the data splits it was tested if the D2cm3, pl-pr values fell within the 95%-confidence interval (CI) of the D2cm3, pl-pr values from data A. RESULTS: Leave-one-out validation of the model based on data A demonstrated predictability of the D2cm3 values for all OARs (bladder r = 0.64, rectum r = 0.75, sigmoid r = 0.88, small bowel r = 0.92). The distribution of D2cm3, pl-pr values was relatively constant for all OARs (bladder σ = 0.61 Gy, rectum σ = 0.56 Gy, sigmoid σ = 0.48 Gy, small bowel σ = 0.53 Gy). For the different data splits, models trained on one applicator or application type could predict D2cm3 values for the other applicator or application type within the CI. Training on data A and testing on data B resulted in predicted bladder D2cm3-values within the CI for 30/32 plans. In contrast, only 42/71 plans of data B' fit within the CI (Chi-squared test, P < 0.001). CONCLUSION: Our OVH-based model can predict D2cm3 values for all applicable OARs in a multi-center setting. The models are robust against differences in applicator and application type, and are sufficiently sensitive to distinguish differences in planning protocols. We believe that OVH-based QA can play an important role to assure treatment plan quality in multi-institutional studies