34 research outputs found
ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer
Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer.
Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for
cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT).
Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation
strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative
treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging
survival rates have been documented in patients treated with preoperative chemoradiation followed by
radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative
treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears
to prolong long-term survival within the subset of patients who remain relapse-free for>2 years
(>30 months median survival; >40% survival at 3 years). Improvement of local control through higher
RT doses has an impact on the survival of patients with a lower tendency towards disease spread.
IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and
extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique
can be adapted to systemic therapy and surgical progress. International guidelines (National
Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close
surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer
Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study
BACKGROUND: Solitary plasmacytoma (SP) of the bone is a rare plasma-cell neoplasm. There are no conclusive data in the literature on the optimal radiation therapy (RT) dose in SP. Therefore, in this large retrospective study, we wanted to assess the outcome, prognostic factors, and the optimal RT dose in patients with SP. METHODS: Data from 206 patients with bone SP without evidence of multiple myeloma (MM) were collected. Histopathological diagnosis was obtained for all patients. The majority (n = 169) of the patients received RT alone; 32 chemotherapy and RT, and 5 surgery. Median follow-up was 54 months (7–245). RESULTS: Five-year overall survival, disease-free survival (DFS), and local control was 70%, 46%, and 88%; respectively. Median time to MM development was 21 months (2–135) with a 5-year probability of 51%. In multivariate analyses, favorable factors were younger age and tumor size < 5 cm for survival; younger age for DFS; anatomic localization (vertebra vs. other) for local control. Older age was the only predictor for MM. There was no dose-response relationship for doses 30 Gy or higher, even for larger tumors. CONCLUSION: Younger patients, especially those with vertebral localization have the best outcome when treated with moderate-dose RT. Progression to MM remains the main problem. Further investigation should focus on adjuvant chemotherapy and/or novel therapeutic agents
Uncertainties and controversies in axillary management of patients with breast cancer
The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register
Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials
Are breast conservation and mastectomy equally effective in the treatment of young women with early breast cancer? Long-term results of a population-based cohort of 1,451 patients aged ≤40 years
Detection of local recurrence following breast-conserving treatment in young women with early breast cancer: Optimization of long-term follow-up strategies
Quality assurance in the EORTC phase III randomised 'boost vs. no boost' trial for breast conserving therapy: comparison of the results of two individual case reviews performed early and late during the accrual period
To evaluate the impact of quality assurance on treatment compliance, we compared the outcome of the two individual case reviews (ICR) conducted early and late during the accrual period of a large prospective multi-centre trial. At the onset of the trial, medical files of five patients from each participating centre were evaluated for the compliance to the protocol for eligibility, surgery, pathology and radiotherapy and for the quality of reporting of the data on the case report forms. In nine major centres, this procedure was repeated near the end of the trial. Both in the early and the late ICR, we found a very limited number of deviations from the guidelines for eligibility, staging, surgery, and pathology. Compliance to radiotherapy requirements was good with the exception of a too low minimal dose in 30% and the lack of target volume delineation in the majority of the evaluated patients. The comparison of the late with the early ICR demonstrated an improvement of the quality of data reporting by 6% and of target volume delineation from 33 to 53%. The initial ICR has lead to the identification of a number of parameters, which needed a clarification in the protocol. These items have been corrected and the individual institutions have been made aware of the necessary adaptations. The evaluation at the end of the trial period showed that there was an improvement but also showed that continuous monitoring is necessary, especially for institutions which have the most deviations in the first IC
Prostatic Duct Adenocarcinoma: Clinical Characteristics, Treatment Options, and Outcomes - a Rare Cancer Network Study
WOS: 000276245900004PubMed ID: 20389142Background: To evaluate the clinical characteristics, contemporary treatment options, and outcome of prostatic duct adenocarcinoma (PDA), we initiated a Rare Cancer Network (RCN) study. Materials and Methods: Six member institutions of the RCN collected clinical data on 31 patients. Treatment consisted of definitive radiotherapy in 14 patients and radical prostatectomy in 16 patients. One patient was treated with androgen deprivation alone. The mean follow-up period was 56 months. Results: Of the 14 patients managed with radiotherapy, 1 patient developed bone metastases and died of prostate cancer, and 1 patient had a biochemical relapse 8 years after definitive radiotherapy. Of the 16 patients who underwent radical prostatectomy, 2 patients developed bone metastases, one of who died of disease. Three patients that relapsed after prostatectomy were successfully salvaged with radiotherapy. The patient that was treated with androgen deprivation alone developed bone metastases at 10 months, was treated with chemotherapy, and was alive after 22 months. Conclusions: Our results suggest that PDA is a cancer with a behavior similar to that of high Gleason grade acinar carcinoma. Good local control can be achieved by either radiation or surgery. Postoperative radiotherapy seems to work as an adjuvant or salvage treatment, and most tumors appear to respond to androgen deprivation
ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy in borderline-resected pancreatic cancer
Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer.
Intraoperative radiation therapy (IORT) is a very precise RT modality to intensify the irradiation effect for
cancer involving upper abdominal structures and organs, generally delivered with electrons (IOERT).
Unresectable, borderline and resectable disease categories benefit from dose-escalated chemoradiation
strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative
treatment may act as a filter for selecting patients with occult resistant metastatic disease. Encouraging
survival rates have been documented in patients treated with preoperative chemoradiation followed by
radical surgery and IOERT (>20 months median survival, >35% survival at 3 years). Intensive preoperative
treatment, including induction chemotherapy followed by chemoradiation and an IOERT boost, appears
to prolong long-term survival within the subset of patients who remain relapse-free for>2 years
(>30 months median survival; >40% survival at 3 years). Improvement of local control through higher
RT doses has an impact on the survival of patients with a lower tendency towards disease spread.
IOERT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and
extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique
can be adapted to systemic therapy and surgical progress. International guidelines (National
Comprehensive Cancer Network or NCCN guidelines) currently recommend use of IOERT in cases of close
surgical margins and residual disease. We hereby report the ESTRO/ACROP recommendations for performing IOERT in borderline-resectable pancreatic cancer
Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage i to III breast cancer (EORTC trial 22922/10925)
Introduction. The EORTC 22922/10925 trial investigated the potential survival benefit and toxicity of elective irradiation of the internal mammary and medial supraclavicular (IM-MS) nodes Accrual completed in January 2004 and first results are expected in 2012. We present the toxicity reported until year 3 after treatment. Patients and methods. At each visit, toxicity was reported but severity was not graded routinely. Toxicity rates and performance status (PS) changes at three years were compared by χ2 tests and logistic regression models in all the 3 866 of 4 004 patients eligible to the trial who received the allocated treatment. Results. Only lung (fibrosis; dyspnoea; pneumonitis; any lung toxicities) (4.3% vs. 1.3%; p < 0.0001) but not cardiac toxicity (0.3% vs. 0.4%; p = 0.55) significantly increased with IM-MS treatment. No significant worsening of the PS was observed (p = 0.79), suggesting that treatment-related toxicity does not impair patient's daily activities. Conclusions. IM-MS irradiation seems well tolerated and does not significantly impair WHO PS at three years. A follow-up period of at least 10 years is needed to determine whether cardiac toxicity is increased after radiotherapy