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Background: Conformal Radiotherapy techniques adapting to the ballistics of delineated volumes allowed significant reduction in excess radiation induced mortality however the increasing number of long-term survivors and expanding use of cardiotoxic drug highlight the persistent need for maximal cardiac possible sparing. The low dose volume of left ventricle are better predictor of acute coronary events than mean heart dose. Materials and Methods: 38 post-MRM patients were randomized to treatment by 3Dimensional Conformal Radiotherapy (3D CRT) and Intensity Modulated Radiotherapy (IMRT) technique. Two tangential beams were used in 3D CRT technique while five to seven (mostly tangential beams) were used in inversely planned IMRT technique. The dose volume parameters of planning target volume, heart and left ventricle were compared. Results: The dosimetry of Planning target volume showed significantly better coverage in IMRT technique (D90, D95) however the D50 was comparable in both the techniques. In dosimetry of heart, the high dose volumes (V30, V40) were nearly comparable in both the techniques. The other dose volume parameters (V5, V10, V20, V25, D33, D67, D100) and the mean dose were significantly lesser in 3D CRT technique along with significantly better sparing of left ventricle (Dmean and V5). Conclusion: The dosimetry of target volume was better with IMRT technique, but this was accompanied by a huge increase in dose to whole heart and specifically the left ventricle which has strong potential to translate into an increased cardiotoxicity. A better distribution of the target region may be obtained by multiple segmentation of the two tangential fields in 3D CRT plans with further reduction in dose to heart and left ventricle.
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Objective: To explore related influence factors of the long-term curative effect of 3D conformal radiotherapy for patients with esophagus cancer. Methods: 472 patients with esophageal cancer were carried out simulative location by using CT, and they were implemented radical operative 3D conformal radiotherapy. And their basic documents and image documents were analyzed by using single factor analysis, and then these screened factors were token into Cox model to carry out multiple-factor analysis so as to seek the influence factor of long-term curative effect. Results: The 1 year, 3-year and 5-year survival rate of all of patients were 71.0%, 33.1% and 26.2%, respectively. The results of single factor analysis showed that series of factors, included parts of stratification, length of lesion, the longest diameter of the lesion, largest anteroposterior diameter of lesion, the largest transverse diameter of lesion, wall thickness of lesions, GTV-E, GTV-LN, GTV-T, whether out invasion, whether lymph node metastasis, lymph node metastasis model and the number of lymph nodes under X-ray, were significantly relative with long-term prognosis of patients. And then, the multiple-factor analysis of Cox model showed that the longest diameter of the lesion and GTV-T were the independent factor that can influence the long-term prognosis (OR=1.647, OR=1.379, P<0.05). Conclusion:GTV-T and the longest diameter of lesion on the CT image of patients with esophagus cancer can influence the long-term curative effect of 3D conformal radiotherapy for esophagus cancer. Therefore, they should be applied as the important evaluation index in formulating therapeutic schedule.
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Las técnicas definitivas de quimio-radioterapia para el cáncer anal, radioterapia tridimensional conformada (3DCRT) o radioterapia de intensidad modulada (IMRT) dan excelentes resultados a largo plazo. Evaluamos resultados en centros de radiación basados en la comunidad. Se evaluaron retrospectivamente 281 pacientes tratados con quimio-radioterapia definitiva para carcinoma anal loco-regional, entre 2006 y 2014. El 95% realizó quimioterapia. Se evaluaron datos de toxicidades, progresión de la enfermedad y necesidad de colostomía durante el período de seguimiento. La supervivencia global, supervivencia libre de progresión y colostomía libre se calcularon con métodos de Kaplan-Meier. La edad media fue 63.7 años con seguimiento medio de 60 meses. Ciento sesenta y nueve pacientes recibieron IMRT y 112 recibieron 3DCRT. La dosis total media tumoral fue 54 Gy. El 80% experimentó complicaciones agudas, y el 56% requirió interrupción de tratamiento. No hubo diferencias significativas en supervivencia global, supervivencia libre de progresión, supervivencia libre de colostomía ni control local a dos años entre ambos grupos. La IMRT tuvo menos suspensión del tratamiento (48% vs. 65%) (p=0.0261). El grupo IMRT tuvo una reducción significativa de todas las toxicidades agudas ≥3 y gastrointestinales (GI) tardías, en comparación con los tratados con 3DCRT. Esta serie representa una de las mayores comparaciones 3DCRT vs. IMRT para el tratamiento definitivo de cáncer anal. Los resultados a largo plazo no difieren significativamente en función de la técnica de radioterapia (RT). La IMRT reduce todas las toxicidades ≥ grado 3 y la necesidad de interrupción en comparación con 3DCRT (AU)
The definitive techniques of chemo-radiotherapy for anal cancer, 3DCRT or IMRT, give excellent long-term results. We evaluated results in community-based radiation centers. We retrospectively evaluated 281 patients treated with definitive chemo-radiotherapy for locoregional anal carcinoma, between 2006 and 2014. The 95% performed chemotherapy. Toxicity data, progression of the disease, need of colostomy during the follow-up period were evaluated. Global survival (GS), progression free survival (PFS), and free colostomy survival (CFS) were calculated with Kaplan-Meier methods. Mean age was 63.7 years with a mean follow-up of 60 months. One hundred and sixty nine patients received IMRT and 112 received 3DCRT. The total mean tumor dose was 54 Gy. The 80% experienced acute complications, and 56% required treatment interruption. There was no significant difference in GS, PFS, CFS or local control at two years between both groups. The IMRT had less treatment discontinuation (48% vs. 65%) (p = 0.0261). The IMRT group had a significant reduction in all acute toxicities ≥3 and late gastrointestinal, compared with those treated with 3DCRT. This series represents one of the largest 3DCRT vs. IMRT comparisons for the definitive treatment of anal cancer. The long-term results do not differ significantly depending on the RT technique. The IMRT reduces all toxicities ≥ grade 3 and the need for interruption compared to 3DCRT (AU)
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Humans , Anus Neoplasms/radiotherapy , Radiotherapy, Conformal , Radiotherapy, Intensity-Modulated , Retrospective Studies , ToxicityABSTRACT
Objective To compare the field-matching techniques and dosimetric characteristics in the target area of testicular seminoma including the abdominal and pelvic cavities between direct aperture optimization intensity modulated radiation therapy (DAO-IMRT) and 3D conformal radiation therapy (3D-CRT),and to analyse the advantages and disadvantages of DAO-IMRT.Methods DAO-IMRT and 3D-CRT plans were designed with Pinnacle treatment planning system for 7 testicular seminoma patients,and the characteristics of both the irradiation methods were analyzed and evaluated by means of the parameters like dose homogeneity indexes,dose volume histograms and etc.Results DAO-IMRT had the hot and cold volumes in the target areas both significantly smaller than those by 3D-CRT,while the conformity index and homogeneity index superior to those by 3D-CRT.The mean doses (Dmean) by DAO-IMRT of the organs at risk (OAR) except the left femur head were all lower than those by 3D-CRT,aud the V15 values of liver,double kidney,small intestine and rectum by DAO-IMRT were statistically lower than those by 3D-CRT (P＜0.01).3D-CRT had the V5 values of OAR all lower than those by DAO-IMRT,in which the differences of double kidney,small intestine,bladder,left femur head and normal tissues were significant statistically (P＜0.05).The monitor units by DAO-IMRT roughly doubled when compared with those by 3D-CRT,and the difference was also significant (P＜0.01).Conclusion DAO-IMRT with easy operation and high reliability can avoid the connection of fields in the target area of testicular seminoma,and is superior to 3D-CRT in dosimetry.
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Objective To investigate the long-term effect and radiation side reaction of different boost methods in patients with local remnants of locally advanced nasopharyngeal carcinoma after curative radiotherapy Methods Based on the retrospective analysis , 102 patients with local remnants of locally advanced nasopharyngeal carcinoma, after curative radiotherapy, were enrolled from February 2009 to May 2011. Forty-nine patients received gamma knife boost and 53 patients received 3-dimensional conformal radiotherapy (3D-CRT). The long-term effect and radiation side reaction were compared between the two groups. Results The 1-year, 3-year, and 5-year relapse-free survival rate (RFS) in the gamma knife boost group and the 3D-CRT group was 97.8%, 90.0%, 80.8%, and 94.3%,76.1%,72.9%, respectively (P < 0.05). No significant differences of the overall survival and metastasis-free survival rate wer found in two groups , as well as the long-term radioactive reaction. Conclusion The gamma knife boost is better than 3D-CRT with respect to local control rate , but the long-term radiation side reactions were similar between the methods.
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OBJECTIVE:To observe clinical efficacy and safety of tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treatment of elderly patients with local advance esophageal cancer. METHODS:48 cases of local advance esophageal cancer were divided into group A,B and C according to random number table method,with 16 cases in each group according to random number table method. Group A was given 3D-CRT with total dose of 60-66 Gy totnlly for 6-7 weeks;group B was additionally given tegafur gimeracil oteracil potassium 60 mg/(m2·d),bid,on the basis of group A 3 weeks for a course of treatment,until the end of radvotherapy;group C was additionally given thermotherapy on the basis of group B 3 weeks for a course of treatment,until the end of radvotherapy. Clinical efficacy,1-year survival rate,dysphagia,weight and KPS score were compared among 3 groups,and the occurrence of toxic reactions(radioactive esophagitis,radioactive pneumonia, bone marrow suppression and gastrointestinal reaction) were observed in 3 groups. RESULTS:Total effective rate,1-year survival rate and the remission rate of dysphagia of group C were 93.75%,87.50% and 93.75%,which were significantly higher than those of group A(50.00%,50.00% and 56.25%)and B(68.75%,68.75% and 68.75%),with statistical significance(P0.05). The incidence of radioactive esophagitis and radioactive pneumonia in group C were significantly lower than in group A and B,with statistical significance(P0.05). CONCLUSIONS:Tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treat-ment of elderly patients with local advance esophageal cancer further improves clinical efficacy and survival rate,but shows low inci-dence of toxic reaction.
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Objective To evaluate the clinical curative effect,survival rate and adverse reactions of three-dimensional conformal radiotherapy(3D-CRT )in combination with chemotherapy on lymph nodes metastasis of esophageal carcinoma.Methods Using supraclavicular 3D-CRT combined with chemotherapy on and simple 3D-CRT supraclavicular lymph node metastasis of esophageal cancer patients,3D-CRT com-bined synchronous chemotherapy (treatment group),51 cases,only 3D-CRT 49 cases (control group).3D-CRT combined synchronous chemotherapy 51 cases (treatment group),simple 3D-CRT 49 cases (control group).These patients 3D-CRT were given the total dose of 50 ~60Gy/25 ~30F.TN chemotherapy regi-mens were applied:paclitaxel 135 mg/m2 ,d1;Nedaplatin 25 mg/m2 ,d1,1 ~3,21 days cycle in fist week and fourth week.Results Local control and treatment group survival rates in 1,2 year were significantly higher than that of control group (P <0.05).Treatment group adverse reaction rate is higher than the con-trol group,but there was no statistically significant difference.Conclusions The recent curative effect and survival rate could be significantly improved by 3D-CRT joint TN synchronous chemotherapy regimen for pa-tients with supraclavicular lymph node metastasis of esophageal cancer,but the relatively high incidence of adverse reactions,clinical application should be considered comprehensively according to actual situation.
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Objective To explore the dosimetry of simplified intensity modulated radiotherapy (sIMRT)in the spinal component of craniospinal irradiation(CSI)compared with conventional plan(3D-CRT).Methods Five previously treated patients were adopted to generate 3D-CRT,3-and 5-field slMRT plans.The prescribed dose was 36 Gy to the planning target volume(PTV)in 20 fractions.The dose distributions of target volume and normal tissues,and homogeneity index(HI)were ananlyzed using the dose volume histogram.The total monitor units(MUs)were also analyzed to compare the delivery time indirectly.Results For 3D-CRT plans,the region of the neighbouring fields only received 70％ of the prescribed dose,and the maximum dose delivered in the normal tissues was increased to approximately 140％ of the prescribed dose.The homogeneity index(HI)of 3-and 5-field sIMRT were 0.09 ± 0.01 and 0.08 ±0.01,respectively,superior to that of 3D-CRT(0.18 ± 0.02,t=7.80,7.65,P＜0.05).The values of V10 for the heart of 3-and 5-field sIMRT were(8.4 ± 1.9)％ and(8.4 ± 2.0)％,respectively,lower than that of 3D-CRT((36.0 ± 6.0)％(t=13.3,13.0,P＜0.05).V20 for the thyroid gland were (12.4±1.5)％ and(12.4±1.6)％,respectively,lower than(69.4±5.7)％ of 3D-CRT(t=26.3,26.4,P＜0.05).V20 for the larynx were(17.2 ± 1.2)％ and(17.9 ± 1.5)％,respectively,lower than that of 3D-CRT[(89.4±7.0)％(t=25.5,26.5,P＜0.05)].V30for the NTwas(4.4±1.4)％,(4.9± 1.9)％,lower than that of 3 D-CRT[(31.9 ± 6.1)％(t=8.5,10.1,P＜0.05)].The averaged values of total MUs for 3-and 5-field sIMRT were 1100 ± 177 and 1160 ±204,respectively,higher than that of 3D-CRT(640 ± 151).Conclusions Compared with the 3D-CRT CSI technique,3-and 5-field sIMRT have better dose distribution and can improve target dose uniformity and protect the organs at risk.
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Objective To compare the dose distribution between three-dimensional conformal radiotherapy(3D-CRT) and intensity-modulated radiotherapy (IMRT) in treating locally advanced pancreatic cancer,and report the efficacy of IMRT combined with regional chemotherapy using gemcitabine (GEM).Methods Ten patients with locally advanced pancreatic cancer were enrolled in this study.3D-CRT and IMRT plans were designed for each patient.The dose distributions of target volume and normal tissues were analyzed using the dose volume histogram (DVH).Twenty-five locally advanced pancreatic cancers patients who were treated by IMRT combined with regional chemotherapy using gemcitabine (combined group) were retrospective analyzed,as well as 25 hospitalized patients of the same period who were treated by regional chemotherapy using gemcitabine alone (chemotherapy alone group).The therapeutic efficacy and adverse events were compared between two groups.Results IMRT plans decrease the mean dose and volume of duodenum,liver,stomach,both kidney and small bowel that received highdose irradiation.The 1-,2-year survival rate of the combined group and chemotherapy alone group was 60％,28％ and 36％,12％.The median survival time of two groups was 15 and 10 months,respectively (x2 =4.16,P ＜0.05).The total response rate of the combined group and the chemotherapy alone group was 64％ and 32％,respectively (x2 =5.13,P ＜ 0.05).The upper gastrointestinal side-effect rate of the combined group was higher than that of the chemotherapy alone group(Z =-2.354,P ＜ 0.05).There was no statistic significance in hematologic toxicity,liver and renal functional damage between the two groups.Conclusions Compared with 3D-CRT plan,IMRT plan could reduce the dose of organ at risks.IMRT combined with regional chemotherapy using gemcitabine could significantly improve the survival rate of patients with locally advanced pancreatic cancer with mild adverse events.
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Objective To assess the evaluation of SRT (Stereotactic radiotherapy ) and 3D-CRT (Three-dimensional conformal ra-diotherapy)on treatment of brain metastasis from lung cancer .Methods From June 2009 to June 2011 ,74 patients with multiple brain metastasis(brain metastasis ≤3 ,tumor mass ≤3 cm) from lung cancer were analyzed retrospectively ,37 patients received 3D-CRT alone were retrospectively compared with 37 patients who received SRT alone .the results was evaluated by median survival time(MS) ,local control(LC) and toxicity effect .Results The median survival time(MS) was 9 .3 ,which 8 .6 months after 3D-CRT ,and 10 .6 months after SRT .the local control rate was 73 .5% for 3D-CRT ,and 79 .6% for SRT after 3 months .there was no difference between two groups on toxicity effect from stastic .Conclusion The SRT was a efficacious methods for the treatment of brain metastasis from lung cancer ,which could improve the local control rate ,but there was no more toxiticy .
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Objective To compare the dosimetry between inversely optimised intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy using the field-in-field technique (FIF) for whole-breast radiotherapy with a boost to the tumor bed after breast-conserving surgery.Methods IMRT and FIF treatment plans were respectively performed and optimised for 9 patients with early stage leftbreast cancer after breast-concerving surgery.The prescribed dose of breast was 50.4 Gy in 28 fractions,1.8 Gy per fraction and that of tumor bed was 61.6 Gy in 28 fractions,2.2 Gy per fraction.The conformity index,the dose and volume for OAR( organs at risks),time of planning and treatment for the two plans were compared.Results The conformity index(CI) for IMRT was improved compared with the FIF in breast [(1.82±0.16) vs.(2.21±0.15)] and tumor bed [(1.19±0.04) vs.(1.59±0.11),t=2.08,3.97,P ＜ 0.05 ].There was no difference for V20 of ipsilateral lung and V30 of heart between two plans.The Dmax and Dmean of the contralateral lung of FIF were (5.41 ±2.76) and (0.51 ±0.10) Gy,lower than those of IMRT [ (25.72 ± 2.61 ) and (7.46 ± 0.39) Gy,t =-22.44,- 21.14,P ＜ 0.05 ].The Dmax and Dmean of the contralateral breast of FIF were (8.50 ± 5.61 ) and (0.47 ± 0.11 ) Gy,lower than those of IMRT [(27.73±4.30) and (6.38±0.48) Gy,t=-5.66,-14.83,P＜0.05].ForFIF,theV5of the contralateral lung and breast were (0.09 ± 0.09) ％ and (0.45 ± 0.45 ) ％,respectively,lower than those of IMRT,which were (84.66 ±3.06) ％ and (60.79 ±4.94)％ (t =-28.19,- 12.80,P＜0.05).The time of optimised plan was (61.57 ± 0.89) min for FIF and(241.28 ± 1.06) min for IMRT (t=-32.35,P＜0.05),and that of treatment were (16.14±1.42) min for FIF and (29.85 ±0.59) min for IMRT (t =- 8.82,P ＜ 0.05).Conclusions For patients with early stage breast cancer after breast-concerving surgery,IMRT could improve the conformity index of target but increase the dose of eontralateral lung and breast.However,FIF has advantage on the time of optimising plan and treatment.
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The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.
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Adolescent , Female , Humans , Follow-Up Studies , Mechlorethamine , Methotrexate , Mycosis Fungoides , Phototherapy , Radiotherapy, Conformal , Recurrence , SteroidsABSTRACT
Background and purpose: Cerebral gliomas is one of the common brain tumors, and has a poor prognosis. Therefore, multidisciplinary treatment strategy has been much investigated recently. This study investigated the efficacy of 3 dimensional conformal radiotherapy (3D-CRT) concurrent with Temozolomide chemotherapy in the treatment of postoperative cerebral gliomas. Methods: Sixty-two patients with cerebral glioma who had residual tumor surgery after surgery were randomized into 3D-CRT group (radiotherapy group, n=31) and 3D-CRT concurrent chemotherapy group (chemoradiotherapy group, n=31) prospectively. All patients received a dose of 50-60Gy/25-30F/5-6 weeks by 6MV-X ray, 1fx/day, 5 times a week. Chemotherapy regimen was Temozolomide: 75 mg/(m~2·d),concomitantly with radiotherapy,followed by 150-200mg/(m~2·d)for 5 days,28 days per cycle for total 3-6 cycles. Results: The total response rate was 35.3% (11/31) in the radiotherapy group, and 61.3% (19/31) in the chemoradiotherapy group. The difference was significant (P=0.042). But no significant difference was observed in terms of survival in the two groups (P=0.263). Stratified analysis showed that patients with grade Ⅲ gliomas in chemoradiotherapy group had better prognosis than those in the radiotherapy group (P=0.043). Conclusion. 3D-CRT concurrent with chemotherapy can improve the survival of pathological grade Ⅲ gliomas.
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Three-dimensional conformal radiation therapy(3D-CRT) and intensity-modulated radiation therapy(IMRT) are becoming important parts for research of treatment in esophageal carcinoma patients.The advances of dosimetric study in 3D-CRT,IMRT of esophageal carcinoma and the evaluation indices are reviewed.
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Objective To discuss errors of conformal plumbic blocks made with manual cutter and automatic cutter.Methods According to beam files of Treatment Planning System,the conformal plumbic blocks were made with manual cutter and automatic cutter respectively.Then their errors were measured.Results With manual cutter,the errors of conformal plumbic blocks were 2.355 mm.With automatic cutter,the errors of conformal plumbic blocks were 1.425 mm.Conclusion The errors of conformal plumbic blocks made with automatic cutter are less than the errors of conformal plumbic blocks made with manual cutter,so automatic cutter should be a necessary tool in making conformal plumbic blocks.
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Objective To discuss the three-dimensional conformal radiotherapy(3D-CRT) plan for pancreatic tumors.Methods The 3D-CRT plan of 30 cases of primary pancreatic cancer were designed according to the request of the doctors for PTV and the restricted receiving dose of the peripheral normal sensitive organs.The best plan was chosen referring the dose-volume histogram.Results By using ICRU dose reference point(the central point of target)as theunitary dose,95% dose line could be surrounded above 95% of the PTV.Conclusion The focus in different localization can be treated with different design in treating the pancreatic tumors.The reaction to radiotherapy is directly influenced by the volume and dosage of radiation to the normal hepatic tissues.
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PURPOSE: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received 63~70 Gy (Median 66 Gy, fraction size 1.8~2 Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. RESULTS: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were 15+/-1.65 and 11+/-0.95 months, respectively. There was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were 21+/-5.03 and 12+/-1.59 months, respectively, while for Arm 2 patients they were 14+/-0.94 and 10+/-1.63 months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; 44.7% versus 19.2%. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. CONCLUSION: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.
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Humans , Arm , Diagnosis , Disease-Free Survival , Edema , Follow-Up Studies , Glioblastoma , Magnetic Resonance Imaging , Multivariate Analysis , Neurologic Examination , Prospective Studies , Radiotherapy , Retrospective Studies , Survival Rate , Tomography, X-Ray Computed , Treatment Outcome , Tumor BurdenABSTRACT
Selecting the optimal treatment of each stage of prostate cancer is very challenging, partly because the options for treatment today are far better than they were ten years ago, but also because not enough reliable data are available on which to base the decisions. Accordingly, scientifically controlled, long-term studies are still needed to compare the benefits and risks of the various treatments. In the process of counseling and discussing therapeutic options with patients with prostate cancer, it is important to present all available data regarding the variable natural history of this disease, prognostic significance of the diagnosis, potential therapeutic benefit of the various modalities, and immediate as well as late treatment-related sequelae. Radiation therapy can be given either as external beam radiation over perhaps 6 or 7 weeks or as an implant of radioactive seeds (brachytherapy) directly into the prostate. In external beam radiation, high energy x-rays are aimed at the tumor and the area immediately surrounding it. In brachytherapy, radioactive seeds are inserted through needles into the prostate gland under the guidance of transrectally taken ultrasound pictures. This article will describe recent advances in external beam radiotherapy (3D conformal radiotherapy (3D-CRT) and Intensity Modulated Radiotherapy (IMRT)), indications of radiotherapy, response evaluation and assessment of relapse after the radiation treatment for prostate cancer, and radiation-related complications.
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Humans , Brachytherapy , Counseling , Diagnosis , Natural History , Needles , Prostate , Prostatic Neoplasms , Radiotherapy , Radiotherapy, Conformal , Recurrence , Risk Assessment , UltrasonographyABSTRACT
PURPOSE: To evaluate the feasibility, treatment outcome, and toxicity of hyperfractionated 3-D conformal radiotherapy and concurrent MVP chemotherapy in locally advanced, unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From August 1993 to December 1996, 161 patients with unresectable stage III NSCLC were entered into this trial, and 146 (91%) completed the treatment. Hyperfractionated radiotherapy was given to a total dose of 64.8~70 Gy (1.2 Gy/fx, bid) with 2 cycles of concurrent MVP (Mitomycin-C 6 mg/m2 d2 and d29, Vinblastine 6 mg/m2 d2 and d 29, and Cisplatin 60 mg/m2 d1 and d28) chemotherapy. Of the 146 patients who completed the treatment, 78 received noncoplanar 3D conformal radiotherapy using 4~6 fields and 17 received coplanar-segmented conformal radiotherapy. Clinical tumor response was assessed one month after the completion of radiotherapy by a computerized tomography (CT) scan. Toxicity was graded using the SWOG criteria. Normal tissue complication probability (NTCP) for the lung was calculated to determine any the correlation with radiation pneumonitis. Nineteen (13%) had stage IIIa and 127 (87%) had IIIb disease, which included 16 patients with pleural effusion and 20 with supraclavicular lymph node metastasis. RESULTS: The response rate was 75%, composed of 22% complete responders and 53% partial responders. With a minimum follow up of 45 months, overall survival was 51.2% at 1 year, 25.1% at 2 years and 14.8% at 5 years; median survival was 12 months. Patients achieving complete response (n=32) had a 2-year overall survival of 49.8% and a 5 year survival of 39.2%, compared to 22.5% and 11.4% survival for the partial responders (n=78) (p=0.0001). Actuarial local progression free survivals for all patients were 65% at 1 year, 42% at 2 years and 36% at 4 years, and actuarial distant free survival was 58% at 1 year, 49% at 2 years and 41% at 5 years. Severe weight loss (more than 10%) occurred in 20 of the 146 patients (13.7%) during treatment, 42 patients (29%) developed radiation pneumonitis, 29 had grade 1 and 13 showed grade 2. The average NTCP value of the patients who showed radiation pneumonitis was significantly higher than that of patients without pneumonitis (66.0% vs. 26.4%). Four patients died of treatment related toxicity. CONCLUSION: Hyperfractionated 3D conformal radiotherapy and concurrent chemotherapy, as described here, is a well tolerate regimen with acceptable toxicity. More effective treatment scheme will be required to improve on local disease control and overall survival.