Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patient...Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization(TACE) and radiation therapy. Especially TACE,delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy,has given favorable results on local control and survival. Radiotherapy,as a therapeutic modality of internal radiation therapy with radioisotopes,has also achieved efficacious tumor control in advanced disease. On the contrary,the role of external beam radiotherapy for HCC has been limited in the past,due to the low tolerance of surrounding normal liver parenchyma. However,technological innovations in the field of radiotherapy treatment planning and delivery,have provided the means of delivering radical doses to the tumor,while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy,evaluated for efficacy and safety for HCC,report encouraging results. In this review,we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.展开更多
AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy(HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0 Mx. T...AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy(HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0 Mx. The patients received3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity.RESULTS: The acute radiation induced skin toxicity was as following: grade Ⅰ 27.6%, grade Ⅱ 7.8% and grade Ⅲ 2.6%. No significant correlation was noted between toxicity grading and chemotherapy(P = 0.154, χ2 test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively(P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions(P = 0.47, χ2test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse.CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions.展开更多
AIM:To measure the dose distribution,related to the treatment planning calculations,in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiot...AIM:To measure the dose distribution,related to the treatment planning calculations,in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiotherapy.METHODS:Thirty-four prospectively selected female patients with right breast cancer (pN0,negative surgical margins) were treated with breast-conserving surgery.A total dose of 42.5 Gy (2.66 Gy/fraction) was prescribed;it was requested that planning target volumes be covered by the 95% isodose line.The contralateral mam-mary gland was defined on CT simulation.The dose received was evaluated by dose volume histograms.RESULTS:The measured contralateral breast doses were:(1) Dose maximum:290-448 cGy [Equivalent (Eq) 337-522 cGy];(2) Mean dose:45-70 cGy (Eq 524815 cGy);and (3) Median dose:29-47 cGy (337-547 cGy) for total primary breast dose of 42.5 Gy in 16 equal fractions.The spearman rho correlation showed statistical significance between the contralateral breast volume and maximum dose (P=0.0292),as well as mean dose (P=0.0025) and median dose (P=0.046) to the breast.CONCLUSION:Minimizing the dose to the contralateral breast has to be one of the priorities of the radiation oncologist when using short schedules because of the radiosensitivity of this organ at risk.Further study is necessary to assess the long-term clinical impact of this schedule.展开更多
Radiotherapy(RT)is a cornerstone in the management of head and neck cancer(HNC),with the choice of RT type profoundly affecting patient outcomes,symptom severity,and quality of life(QoL).This review examines photon an...Radiotherapy(RT)is a cornerstone in the management of head and neck cancer(HNC),with the choice of RT type profoundly affecting patient outcomes,symptom severity,and quality of life(QoL).This review examines photon and proton RT types for HNC,focusing on dosimetric advantages,efficacy,and side effect profiles.Understanding these factors is crucial to minimizing adverse effects,enhancing QoL for patients,and effectively improving oncology’s clinical praxis.While photon-based therapies,such as intensity-modulated radiation therapy and volumetric modulated arc therapy,are widely used and effective,proton therapy,including intensity-modulated proton therapy(IMPT)and pencil beam scanning(PBS),offers distinct physical advantages.Photon therapies allow for precise dose distribution but often result in higher integral doses to surrounding healthy tissues.In contrast,protons enable highly conformal dose distributions with minimal exit dose beyond the target,a property that significantly reduces radiation exposure to organs at risk.Background research and comparative analysis demonstrate that proton therapy techniques,particularly IMPT and PBS,outperform photon-based methods in sparing critical structures and thus reducing acute and late treatment-related morbidities,such as xerostomia and dysphagia.As a consequence,patient-reported outcome measures and the overall QoL results suggest that proton therapies lead to better treatment results with fewer severe side effects and improved symptom management.In conclusion,proton therapy,particularly IMPT,shows promise as a treatment of choice for HNC,minimizing toxicities and enhancing QoL.However,continued research and evidence-based approaches are still essential to properly validate and refine proton therapy applications in HNC treatment paradigms and also effectively translate them into future clinical practice.展开更多
文摘Many patients with hepatocellular carcinoma(HCC) present with advanced disease,not amenable to curative therapies such as surgery,transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization(TACE) and radiation therapy. Especially TACE,delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy,has given favorable results on local control and survival. Radiotherapy,as a therapeutic modality of internal radiation therapy with radioisotopes,has also achieved efficacious tumor control in advanced disease. On the contrary,the role of external beam radiotherapy for HCC has been limited in the past,due to the low tolerance of surrounding normal liver parenchyma. However,technological innovations in the field of radiotherapy treatment planning and delivery,have provided the means of delivering radical doses to the tumor,while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy,evaluated for efficacy and safety for HCC,report encouraging results. In this review,we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.
文摘AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy(HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0 Mx. The patients received3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity.RESULTS: The acute radiation induced skin toxicity was as following: grade Ⅰ 27.6%, grade Ⅱ 7.8% and grade Ⅲ 2.6%. No significant correlation was noted between toxicity grading and chemotherapy(P = 0.154, χ2 test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively(P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions(P = 0.47, χ2test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse.CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions.
文摘AIM:To measure the dose distribution,related to the treatment planning calculations,in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiotherapy.METHODS:Thirty-four prospectively selected female patients with right breast cancer (pN0,negative surgical margins) were treated with breast-conserving surgery.A total dose of 42.5 Gy (2.66 Gy/fraction) was prescribed;it was requested that planning target volumes be covered by the 95% isodose line.The contralateral mam-mary gland was defined on CT simulation.The dose received was evaluated by dose volume histograms.RESULTS:The measured contralateral breast doses were:(1) Dose maximum:290-448 cGy [Equivalent (Eq) 337-522 cGy];(2) Mean dose:45-70 cGy (Eq 524815 cGy);and (3) Median dose:29-47 cGy (337-547 cGy) for total primary breast dose of 42.5 Gy in 16 equal fractions.The spearman rho correlation showed statistical significance between the contralateral breast volume and maximum dose (P=0.0292),as well as mean dose (P=0.0025) and median dose (P=0.046) to the breast.CONCLUSION:Minimizing the dose to the contralateral breast has to be one of the priorities of the radiation oncologist when using short schedules because of the radiosensitivity of this organ at risk.Further study is necessary to assess the long-term clinical impact of this schedule.
文摘Radiotherapy(RT)is a cornerstone in the management of head and neck cancer(HNC),with the choice of RT type profoundly affecting patient outcomes,symptom severity,and quality of life(QoL).This review examines photon and proton RT types for HNC,focusing on dosimetric advantages,efficacy,and side effect profiles.Understanding these factors is crucial to minimizing adverse effects,enhancing QoL for patients,and effectively improving oncology’s clinical praxis.While photon-based therapies,such as intensity-modulated radiation therapy and volumetric modulated arc therapy,are widely used and effective,proton therapy,including intensity-modulated proton therapy(IMPT)and pencil beam scanning(PBS),offers distinct physical advantages.Photon therapies allow for precise dose distribution but often result in higher integral doses to surrounding healthy tissues.In contrast,protons enable highly conformal dose distributions with minimal exit dose beyond the target,a property that significantly reduces radiation exposure to organs at risk.Background research and comparative analysis demonstrate that proton therapy techniques,particularly IMPT and PBS,outperform photon-based methods in sparing critical structures and thus reducing acute and late treatment-related morbidities,such as xerostomia and dysphagia.As a consequence,patient-reported outcome measures and the overall QoL results suggest that proton therapies lead to better treatment results with fewer severe side effects and improved symptom management.In conclusion,proton therapy,particularly IMPT,shows promise as a treatment of choice for HNC,minimizing toxicities and enhancing QoL.However,continued research and evidence-based approaches are still essential to properly validate and refine proton therapy applications in HNC treatment paradigms and also effectively translate them into future clinical practice.
