43 research outputs found
Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix
Background: Patients with locally advanced cervical cancer are often
severely distressed with incessant vaginal bleeding, offensive
discharge and pelvic pain and are in some instances are beyond curative
potential. At our institution we routinely use monthly palliative
pelvic radiotherapy for these patients. Methods and Material: One
hundred patients treated between 2000 & 2004 were included in this
analysis. Patients were treated with parallel-opposed pelvic portals
with megavoltage radiation monthly up to a maximum of three fractions
(10Gy/ fraction). Patients with good response after second fraction
were considered for intracavitary brachytherapy delivering 30Gy to
point A. Response was documented with regard to relief of bleeding,
vaginal discharge and pelvic pain. The other aspects evaluated were
patient compliance, disease response, toxicity and survival. Results:
Sixty-eight percent had FIGO stage IIIB, 12% had stage IVA and 14% had
IVB disease. Twenty patients had metastatic disease. The median symptom
duration was 5 months. Majority (67%) presented with vaginal bleeding,
followed by discharge (69%) and pelvic pain (48%). All patients
received at least one fraction of palliative pelvic radiotherapy.
Sixty-one patients received the second fraction and 33 the third. Five
patients received an intracavitary application. The overall response
rates in terms of control of bleeding, discharge and pain were 100%,
49% and 33% respectively. The treatment was generally well tolerated
with a median survival of 7 months. Conclusions: Monthly palliative
pelvic radiotherapy results in satisfactory control of symptoms in
patients with locally advanced carcinoma of cervix with acceptable
complications
Empiric Radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation
The standard of care for managing early stage non-small cell lung cancer (NSCLC) is definitive surgical resection. Stereotactic body radiation therapy (SBRT) has become the standard treatment for patient who are medically inoperable, and it is increasingly being considered as an option in operable patients. With the growing use of screening thoracic CT scans for patients with a history of heavy smoking, as well as improved imaging capabilities, the discovery of small lung nodes has become a common dilemma. As a result, clinicians are increasingly faced with managing lung nodules in patients in whom diagnostic biopsy is not safe or feasible. Herein, we describe the scope of the problem, tools available for predicting the probability that a lung nodule is a malignancy, staging procedures, benefits of pathology-proven and empiric SBRT, considerations of safety based on location of the lesion of concern, and overall efficacy of SBRT
American Radium Society (ARS) and American College of Radiology (ACR) Appropriate Use Criteria Systematic Review and Guidelines on Reirradiation for Non-small Cell Lung Cancer (NSCLC)
Background: Reirradiation (reRT) for locoregional recurrences can provide durable control and improved symptoms and progression-free survival for select NSCLC patients. Thoracic reRT, however, is particularly challenging due to its considerable risk and the current lack of standardized approaches, guidelines and dose constraints. To date, no systematic review on the safety and efficacy of reRT for NSCLC exists, and no dedicated guidelines are available.
Objectives: This ARS-ACR Appropriate Use Criteria Systematic Review and Guidelines on Reirradiation for NSCLC provides direct guidance on the safety and efficacy of reRT and recommends consensus dose constraints for thoracic reRT to minimize risks of high grade toxicities.
Methods: A PRISMA systematic review assessed all studies published through 3/2019 evaluating toxicities, local control and/or overall survival for NSCLC thoracic reRT. Of 236 articles, 49 remained after exclusions (3 prospective) and formed the basis for these recommendations on: 1) the role of concurrent chemotherapy with reRT, 2) factors associated with toxicity from reRT and 3) what reRT modalities, dose-fractionation schemas and dose rates should be used. Composite dose constraints were also recommended.
The available data suggest potential benefit in clinical outcomes with concurrent chemoradiation for reRT, but the decision should be based on patient performance status, tolerance to prior systemic therapy and other individual patient/tumor characteristics. There are no data to guide the use of concurrent targeted therapy or immunotherapy with reRT, and this is not recommended outside of a clinical trial. Acute esophagitis and pneumonitis and late pulmonary, cardiac/great vessel, esophageal, brachial plexus and spinal toxicities are dose limiting for reRT. Limited data exist regarding the use of hyperfractionation and low- or high-dose rate reRT for NSCLC. For conventionally fractionated reRT, intensity-modulated radiation therapy (IMRT) is recommended over 3D conformal radiation therapy (3DCRT) to increase dose conformality. Particle therapy may further reduce toxicities and/or enable safer reRT dose escalation compared with 3DCRT and IMRT. Stereotactic body radiation therapy (SBRT) can provide increased conformality and dose escalation and is optimal for primary-alone failures, but caution is needed for central reRT with SBRT. Recommended reRT composite dose constraints in 2 Gy equivalent dose are: esophagus V60 \u3c40% and DMax \u3c100-110 Gy, lung V20 \u3c40%, heart V40 \u3c50%, aorta/great vessels DMax \u3c120 Gy, trachea and proximal bronchial tree DMax \u3c110 Gy, spinal cord DMax \u3c57 Gy, and brachial plexus DMax \u3c85 Gy.
Conclusions: For the first time, consensus dose constraints for thoracic reRT are recommended to minimize the risks of high-grade and potentially fatal toxicities from repeat radiotherapy. Additional prospective data are needed, and toxicities should be correlated with reRT course and composite dose constraints
Epidemiology, diagnosis, and optimal management of glioma in adolescents and young adults
Neoplasms of the central nervous system (CNS) are the most frequently encountered solid tumors of childhood, but are less common in adolescents and young adults (AYA), aged 15–39 years. Gliomas account for 29%–35% of the CNS tumors in AYA, with approximately two-thirds being low-grade glioma (LGG) and the remaining being high-grade glioma (HGG). We review the epidemiology, work-up, and management of LGG and HGG, focusing on the particular issues faced by the AYA population relative to pediatric and adult populations. Visual pathway glioma and brainstem glioma, which represent unique clinical entities, are only briefly discussed. As a general management approach for both LGG and HGG, maximal safe resection should be attempted. AYA with LGG who undergo gross total resection (GTR) may be safely observed. As age increases and the risk factors for recurrence accumulate, adjuvant therapy should be more strongly considered with a strong consideration of advanced radiation techniques such as proton beam therapy to reduce long-term radiation-related toxicity. Recent results also suggest survival advantage for adult patients with the use of adjuvant chemotherapy when radiation is indicated. Whenever possible, AYA patients with HGG should be enrolled in a clinical trial for the benefit of centralized genetic and molecular prognostic review and best clinical care. Chemoradiation should be offered to all World Health Organization grade IV patients with concurrent and adjuvant chemotherapy after maximal safe resection. Younger adolescents with GTR of grade III lesions may consider radiotherapy alone or sequential radiotherapy and chemotherapy if unable to tolerate concurrent treatment. A more comprehensive classification of gliomas integrating pathology and molecular data is emerging, and this integrative strategy offers the potential to be more accurate and reproducible in guiding diagnostic, prognostic, and management decisions
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Radiation therapy considerations during the COVID-19 Pandemic: Literature review and expert opinions.
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Proton stereotactic body radiation therapy for non-small cell lung cancer.
Isolated non-Hodgkin's lymphoma of the pancreas: Case report and review of literature
Background: Isolated primary pancreatic lymphoma (PPL) is a rare
extra-lymphatic non-Hodgkin\u2032s lymphoma comprising less than 1% of
all extra-lymphatic lymphomas. It is seen in people of advanced age and
there is a slight male preponderance. It is difficult to diagnose; the
vague presenting symptoms and nonspecific laboratory/radiological
findings make it difficult to differentiate the condition from
pancreatic adenocarcinoma. Histopathological examination is of
paramount importance to conclusively establish the diagnosis since the
treatment involves lymphoma protocols, and prognosis and survival in
PPL are considerably superior to that in adenocarcinoma pancreas. Case
Report: We report a case of isolated PPL diagnosed after Tru-Cut biopsy
and immunohistochemistry after a thorough staging workup. Result: The
patient was treated with multi-agent combination chemotherapy followed
by radiotherapy. Discussion: A review of literature was done using a
Medline search to determine the incidence and prevalence of isolated
PPL and to note the diagnosis and management of previously reported
cases. Conclusion: An exceedingly rare entity, isolated PPLs need to be
differentiated from pancreatic adenocarcinomas by histopathological
evaluation since management is on the lines of other extralymphatic
lymphomas and prognosis is significantly better
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How Histopathologic Tumor Extent and Patterns of Recurrence Data Inform the Development of Radiation Therapy Treatment Volumes in Solid Malignancies
The ability to deliver highly conformal radiation therapy using intensity-modulated radiation therapy and particle therapy provides for new opportunities to improve patient outcomes by reducing treatment-related morbidities following radiation therapy. By reducing the volume of normal tissue exposed to radiation therapy (RD, while also allowing for the opportunity to escalate the dose of RT delivered to the tumor, use of conformal RT delivery should also provide the possibility of expanding the therapeutic index of radiotherapy. However, the ability to safely and confidently deliver conformal RT is largely dependent on our ability to clearly define the clinical target volume for radiation therapy, which requires an in-depth knowledge of histopathologic extent of different tumor types, as well as patterns of recurrence data. In this article, we provide a comprehensive review of the histopathologic and radiographic data that provide the basis for evidence-based guidelines for clinical tumor volume delineation. (C) 2018 Elsevier Inc. All rights reserved