Radiotherapy of brain metastases from non-small cell lung cancer

Brain metastases risk at the time of diagnosis or during the course of disease is high in non-small cell lung cancer (NSCLC). Even the incidence of brain metastases has increased in recent years, due to detection of smaller asymptomatic lesions with MRI screening as well as improved survival as a consequence of developments in systemic therapies. In the last decade, there have been many trials in the management of NSCLC patients with brain metastases, questioning the role of adjuvant whole brain radiotherapy (WBRT) after surgery or stereotactic radiosurgery (SRS), WBRT, compared to best supportive care in patients not amenable to surgery, aggressive local therapies in solitary brain metastases, postsurgical cavity SRS, SRS in non-oligometastatic patients, cranial radiotherapy in patients with driver mutations, thyrosine kinase inhibitors, immune check point inhibitors and the impact of therapies on neurocognitive functions and quality of life. The main objective of this review is to provide an update on current trends in radiotherapy in the management of newly diagnosed brain metastases from NSCLC

Superparamagnetic iron oxide nanoparticle (SPION) mediated in vitro radiosensitization at megavoltage radiation energies

WOS: 000426219900016The purpose of this study was to assess SPION's in vitro radiosensitizer effect at 6MV-energies and to calculate nanoparticle enhancement ratio (NER) of SPIONs. Citrate coated-SPION's were synthesized. Trypan-blue, metabolic activity tests were performed. Cell cultures were irradiated at 0,2,4,6,8 Gy at 6MV-energy. Clonogenic survival assays, NER calculations were carried out. SPIONs were biocompatible. NERs were cell-line specific and dose dependent. The highest radiosensitization were seen in radiosensitive MCF-7 and MDAH-2447 cells at 2 Gy (NER:1.49 and 1.39 respectively), in relatively radioresistant MDA-MB-231 cells at 4 Gy (NER:1.20). By increasing doses radiosensitizer effect disappeared. There is possibility that by synergistic effect, SPIONs may cause dose-dependent and cell-line specific radiosensitization at 6MV.Turkish Radiation Oncology Society (TROD)We thank to Turkish Radiation Oncology Society (TROD) for their financial support for this research

Diagnostic delay in rare diseases

OBJECTIVE Post-operative radiotherapy (PORT) in non-small cell lung cancer (NSCLC), especially after complete resection, has long been an unresolved dilemma and debated among therapeutic disciplines. We aimed to evaluate the effects of different radiotherapy volumes and techniques on local-regional recurrence patterns and PORT results in patients with NSCLC. METHODS The results of 389 patients who underwent surgery and received PORT at 11 centers were analyzed retrospectively. The surgical margin was positive or closes in 100 (26%) patients. The PORT dose was a median of 50 Gy (36-60 Gy). Intensity-modulated RT methods were used in 68 (17.5%) patients. RESULTS The first recurrence of the patients who developed relapse, local recurrence was found in 77 (19.8%) patients, distant recurrence was found in 95 (24%) patients, and both recurrences was found in 30 (8%) patients. The median time to locoregional relapse was 14 months (1.84-59.7 months). Local-regional recurrence was not significantly higher in patients with positive surgical margins than in negative pa-tients (39% vs. 29%, p=0.1), but the dose administered to these patients was also higher. Mediastinal recurrence occurred in 28 (19%) patients who did not receive radiotherapy to the mediastinum; 25 of these recurrences (89%) were just near or outside the field. Cardiac events became 7% in all groups and did not change according to chosen mediastinal radiotherapy volume. CONCLUSION A clear description of the PORT volumes according to the localization of the primary tumor and the involved lymph nodes would be beneficial in terms of establishing the recurrence/toxicity balance better

Factors Affecting Treatment and Prognosis in Thymomas: A Multi-Center Experience

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Factors Affecting Treatment and Prognosis in Thymomas: A Multi-Center Experience

OBJECTIVEThymomas, a rare malignancy, are located in 95% anterior mediastinum. They are associated with para-neoplastic syndromes, especially myasthenia graves. Although many classifications are used considering the depth of invasion, presence of metastasis, predominant cell type, or immunohistochemical proper-ties in staging, Masoaka classification is commonly used. Surgery is the most effective method in the treatment of thymoma, and neoadjuvant chemotherapy is recommended in advanced stages (III-IV). Adjuvant radiotherapy has proven efficacy in advanced and inoperable patients. in this study, we aimed to evaluate treatment outcomes and factors affecting prognosis in thymoma patients.METHODSPatients with thymoma who were included in this study voluntarily from seven centers between January 2002 and August 2018 were evaluated retrospectively.RESULTSOf the 158 patients with thymoma, 125 patients with complete data were included in this study. the mean age of the patients was 51.84 (18-84), and 72 were male. Myasthenia graves were present in 64 patients. One hundred thirteen patients were operated and 12 were inoperable. One hundred patients were stage 2, 9 were stage 3, and 16 were stage 4. in our study, 3-year survival was 84.4%, and 5-year survival was 74.9%; inoperable patients, surgical margin positivity, advanced disease and radiotherapy dose less than 50.4’Gy were found to be negative factors affecting survival. in patients with myasthenia graves (MG), survival was higher in patients with stage 2B and less. Survival was lower in epithelial type B3 and type C histologic types. Age, sex, and capsule involvement did not seem to affect survival.CONCLUSIONThymoma is a locally controlled disease with long survival and the results of our study are consistent with the literature. the number of patients should be increased to better define prognostic factors

Adult Rhabdomyosarcoma: Clinical Features and Radiotherapy Outcomes-The Turkish Oncology Group (TOG) Bone and Soft Tissue Sarcoma Study Group

WOS: 000457150800001OBJECTIVE Although rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma diagnosed in childhood, it represents only 2%-5% of adult soft tissue sarcomas. The aim of the present study was to better understand the clinical characteristics, treatment approaches, and outcomes of patients with adult RMS who received radiotherapy (RT) as a component of their multidisciplinary management since there are scarce data on adult RMS due to its rarity. METHODS The medical records of patients with adult RMS who were >= 18 years old and treated with RT between January 1995 and August 2016 in four different radiation centers were evaluated in terms of clinical characteristics, treatment, and follow-up data retrospectively. RESULTS There were 28 patients. The median age at diagnosis was 28 (19-53) years. The most common site of involvement was the head and neck (25%), and parameningeal region involvement was prominent (92%) among them. In general, unfavorable site of involvement was markedly higher than favorable ones (82% vs. 18%). Alveolar and pleomorphic subtypes compromised 75% of the cases. Fifteen patients had surgery, 26 chemotherapy, 10 radical intent of RT, 9 adjuvant, 3 preoperative, and 6 palliative. The follow-up time was from 3 to 235 (median 18) months, disease-free survival was between 2 and 48 (median 12) months, and 5-year overall survival (OS) was 25% (median OS 20 (4-235) months). There were significant differences in terms of survival according to histopathological subtypes (p: 0.017), risk groups (p<0.001), Intergroup Rhabdomyosarcoma Study Group (IRSG) grouping and IRSG staging (p<0.001). CONCLUSION Adult RMS has unfavorable clinical presentation and worse outcome compared with pediatric RMS. Histopathological subtype and risk grouping to define the prognosis used in pediatric cases also might be valid in adult RMS

Role of Consolidative Thoracic Radiotherapy for Extensive-stage Small Cell Lung Cancer: Trod Thoracic Oncology Study Group 08-006 Multi-institutional Study

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Risk factors of radiation pneumonitis in patients with NSCLC treated with concomitant chemoradiotherapy--Are we underestimating diabetes?--Turkish oncology group (TOG)/Lung cancer study group

Introduction To evaluate the clinical and dosimetric parameters that increase the risk of radiation pneumonitis (RP) in locally advanced non-small cell lung cancer (NSCLC) patients treated with concomitant chemoradiotherapy of nationwide multicentric data analysis. Methods All data of 268 patients who underwent definitive chemoradiotherapy were retrospectively collected from eight institutes participating in this study. Patient, tumor and treatment-related factors and dosimetric parameters were analyzed for grade >= 2 RP. The toxicity scoring system of The Radiation Therapy Oncology Group used for grading the severity of pneumonitis. A relationship with the risk of RP with potential predictive factors were evaluated by univariate and multivariate analyses. A recursive partition analysis (RPA) was applied to stratify patients according to the risk of developing RP. Results There were 90 (33.6%) patients who had grade >= 2 RP. The median time to pneumonitis after treatment was 4 months (range:1-6 months). In univariate analysis, diabetes mellitus (DM), use of cisplatin/etoposide, total and daily radiotherapy (RT) fraction dose, the planning target volume (PTV) size, mean lung dose, V5, V10 and RT technique were associated with the development of pneumonitis. In multivariate analysis, only DM (P = 0.008) was found to be independent risk factors for RP. According to RPA, the risk of developing RP was highest in patients with DM. Conclusions In our study, besides the known dosimetric factors, DM was found to be the most important risk factor causing RP development in multivariate analysis and RPA. The risk is tripled compared to patients without DM