Stereotactic radiosurgery for limited brain metastasis using three different techniques: helical tomotherapy, volumetric modulated arc therapy, and cone-based LINAC radiosurgery

Purpose@#Specific radiation delivered to tumors by stereotactic radiosurgery (SRS) has become widely used in the treatment of brain metastasis. This study aimed to compare radiation therapy planning and its parameters from SRS using three different modalities: helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and cone-based linac radiosurgery (Cone-based). @*Materials and Methods@#Each contouring dataset of patents who experienced one to four brain metastasis received SRS in our center was re-planned to create radiation therapy planning in all three treatment systems (HT, VMAT, and Cone-based). The parameters of conformity index (CI), homogeneity index (HI), CI50, and gradient index (CGI) were analyzed to compare the effects of the three techniques. Decision score analysis was used to evaluate the performance on dosimetric and organs-at-risk parameters among the different techniques by applying the Cone-based technique as a benchmark. @*Results@# A total of 21 patients with 39 lesions were included in this study. The results from the decision score analysis demonstrated statistically identical CI, CI50, and CGI values between Cone-based and VMAT for single lesions. For multiple lesions, VMAT also provided better CI when compared to Cone-based technique while HT exhibited the poorest dosimetric parameters. Moreover, VMAT exhibited the lowest BrainV5Gy value and displayed the shortest beam-on time calculation. @*Conclusion@#We have conducted a comprehensive comparison of SRS planning approaches. The Cone-based technique revealed the highest HI value, while VMAT provided the best estimated beam-on time value. HT displayed a feasible SRS modality for single lesions, but not for multiple lesions.

A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial / 부인종양

OBJECTIVE: To compare response rate and survivals of locally advanced stage cervical cancer patients who had standard concurrent chemoradiation therapy (CCRT) alone to those who had adjuvant chemotherapy (ACT) after CCRT. METHODS: Patients aged 18–70 years who had International Federation of Gynecology and Obstetrics stage IIB–IVA without para-aortic lymph node enlargement, Eastern Cooperative Oncology Group scores 0–2, and non-aggressive histopathology were randomized to have CCRT with weekly cisplatin followed by observation (arm A) or by ACT with paclitaxel plus carboplatin every 4 weeks for 3 cycles (arm B). RESULTS: Data analysis of 259 patients showed no significant difference in complete responses at 4 months after treatment between arm A (n=129) and arm B (n=130): 94.1% vs. 87.0% (p=0.154) respectively. With the median follow-up of 27.4 months, 15.5% of patients in arm A and 10.8% in arm B experienced recurrences (p=0.123). There were no significant differences of overall or loco-regional failure. However, systemic recurrences were significantly lower in arm B than arm A: 5.4% vs. 10.1% (p=0.029). The 3-year progression-free survival (PFS) and 3-year overall survival (OS) of the patients in both arms were not significantly different. The hazard ratio of PFS and OS of arm B compared to arm A were 1.26 (95% CI=0.82–1.96; p=0.293) and 1.42 (95% CI=0.81–2.49; p=0.221) respectively. CONCLUSIONS: ACT with paclitaxel plus carboplatin after CCRT did not improve response rate and survival compared to CCRT alone. Only significant decrease of systemic recurrences with ACT was observed, but not overall or loco-regional failure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036164 Thai Clinical Trials Registry Identifier: TCTR 20140106001

The using of megavoltage computed tomography in image-guided brachytherapy for cervical cancer: a case report

We present a case of cervical cancer treated by concurrent chemoradiation. In radiation therapy part, the combination of the whole pelvic helical tomotherapy plus image-guided brachytherapy with megavoltage computed tomography of helical tomotherapy was performed. We propose this therapeutic approach could be considered in a curative setting in some problematic situation as our institution.

The using of megavoltage computed tomography in image-guided brachytherapy for cervical cancer: a case report

We present a case of cervical cancer treated by concurrent chemoradiation. In radiation therapy part, the combination of the whole pelvic helical tomotherapy plus image-guided brachytherapy with megavoltage computed tomography of helical tomotherapy was performed. We propose this therapeutic approach could be considered in a curative setting in some problematic situation as our institution.

THE ROLE OF INTERSTITIAL BRACHYTHERAPY IN GYNECOLOGICAL CANCERS

Objectives Materials and methods fi ve had boost treatment after external irradiation. Aftertreatment was completed, the patients were appointed to attend a follow-up program toevaluate results and toxicities.Results fi stula, due to tumour progression.Conclusions fi t and gain of the patients. Chiang Mai MedicalJournal 2009;48(4):151-157.Interstitial brachytherapy can be used as an option to irradiate patients andboost treatment. However re-irradiation with brachytherapy should be critically evaluatedfor toxicities and local control for the beneAt the median follow up of 5 months, Three patients (23%) yielded good localcontrol. One patient developed vesico-vaginalFrom January 2007 to December 2008, thirteen patients withgynaecological cancers were treated by interstitial brachytherapy. Eight patients wererecurrent after irradiation andTo report the results of interstitial brachytherapy (ISBT) in gynaecologicalcancers.

RADIOTHERAPY IN CERVICAL CARCINOMA

Cervical cancer is one of the most common cancers in females in developing countries.Radiation therapy plays a major role in the treatment of early and advanced stages.Concurrent chemoradiation has improved treatment outcome in locally advanced cervicalcancer. The implementation of intensity-modulated radiotherapy (IMRT) and imageguidedbrachytherapy (IGBT) is waiting to be proved.Chiang Mai Medical Journal2009;48(4):125-133.