A comparative study of concomitant boost radiation versus concomitant boost with concurrent chemoradiation versus standard fractionation chemoradiation in locally advanced head-and-neck cancer

Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the study was designed to reduce the treatment time and increase efficacy. Aims: Comparative evaluation of the efficacy, toxicity, local control, and survival of concomitant boost radiotherapy (CBRT), CBRT with concurrent chemoradiation (CBRT + CCT) and conventionally fractionated radiotherapy with concomitant chemotherapy (CFRT + CCT) in locally advanced HNC (LAHNC). Materials and Methods: Patients with LAHNC were randomly assigned to 3-groups of 30-patients each. Group I (CBRT) received, 45 Gy/25#/5-weeks and 18 Gy/10# concomitant boost in the last 2-week of treatment, receiving a total dose of 63 Gy. Group II (CBRT + CCT) received CBRT with concomitant cisplatin 75 mg/m 2 on day 1, 17, and 34. Group III (CFRT + CCT) received 64 Gy/32#/6.2 weeks, concurrent with injection cisplatin 75 mg/m 2 on day 1, 22, and 42. Statistical Analysis Used: Stata 9.0 SPSS and Chi-square test were used for analysis and disease-free survival (DFS) rates were calculated using the Kaplan–Meier method. Results: The median follow-up period was 8.2 months. At last follow-up, locoregional control was 36%, 57%, and 40% and DFS was seen in 33%, 53%, and 40% of patients in Group I, II, and III, respectively. Grade-3 cutaneous reactions were significantly higher in Group-II as compared to that of Group-III (P = 0.033) and Group-I (P = 0.715). Conclusion: All three groups have similar response rates and DFS with manageable toxicity

Effect of fractionated radiotherapy of transplanted hepatocellular carcinoma on the splenic immune cells in mice / 中华放射医学与防护杂志

Objective@#To investigate the effect of fractionated radiotherapy on the immune system of mice with subcutaneously transplanted hepatocellular carcinoma.@*Methods@#Logarithmic growth of mouse hepatocellular carcinoma cells Hepa 1-6 were inoculated subcutaneously on the right side of C57BL/6 J mice (1×107 cells /mice). The tumor-bearing mice were randomly divided into control group (Ctrl) and irradiation group (IR), 20 mice in each group. Additionally, 10 healthy mice were set as normal control group. Local fractionated X-ray irradiation of 8 Gy×3 fraction was given to the subcutaneous tumors, and the dose rate was 0.883 Gy/min. At 7 and 14 d after irradiation, the tumor organ index, spleen organ index, spleen pathological changes, and splenic T lymphocyte subsets, B lymphocyte subsets, and NK cells were detected.@*Results@#Compared with Ctrl, at 7 and 14 d after irradiation, the tumor organ index decreased (t=4.649, 26.34, P<0.05), and the percentage of NK cells increased significantly (t=3.952, 3.633, P<0.05). The percentages of CD3+ , CD4+ , CD3+ CD4+ lymphocytes and the ratio of CD4+ /CD8+ lymphocyte decreased at 7 d after irradiation (t=3.193, 3.656, 3.219, 2.641, P<0.05), and the percentage of CD3+ lymphocyte decreased at 14 d after irradiation (t=3.031, P<0.05). But after irradiation, there were no significant changes in spleen organ index, B lymphocyte, CD3+ CD4+ lymphocyte and CD8+ lymphocyte.@*Conclusions@#Local hepatoma radiotherapy causes imbalance of lymphocytes in distal spleen of mice and hence reduces immunity, which provides a novel mechanism of radiological immunity damage.

Effect of fractionated radiotherapy of transplanted hepatocellular carcinoma on the splenic immune cells in mice / 中华放射医学与防护杂志

Objective To investigate the effect of fractionated radiotherapy on the immune system of mice with subcutaneously transplanted hepatocellular carcinoma.Methods Logarithmic growth of mouse hepatocellular carcinoma cells Hepa 1-6 were inoculated subcutaneously on the right side of C57BL/6 J mice (1×107 cells/mice).The tumor-bearing mice were randomly divided into control group (Ctrl) and irradiation group (IR),20 mice in each group.Additionally,10 healthy mice were set as normal control group.Local fractionated X-ray irradiation of 8 Gy×3 fraction was given to the subcutaneous tumors,and the dose rate was 0.883 Gy/min.At 7 and 14 d after irradiation,the tumor organ index,spleen organ index,spleen pathological changes,and splenic T lymphocyte subsets,B lymphocyte subsets,and NK cells were detected.Results Compared with Ctrl,at 7 and 14 d after irradiation,the tumor organ index decreased (t =4.649,26.34,P＜0.05),and the percentage of NK cells increased significantly (t =3.952,3.633,P＜0.05).The percentages of CD3+,CD4+,CD3+CD4+ lymphocytes and the ratio of CD4+/CD8+ lymphocyte decreased at 7 d after irradiation (t=3.193,3.656,3.219,2.641,P＜0.05),and the percentage of CD3+lymphocyte decreased at 14 d after irradiation (t =3.031,P＜0.05).But after irradiation,there were no significant changes in spleen organ index,B lymphocyte,CD3 + CD4+ lymphocyte and CD8 + lymphocyte.Conclusions Local hepatoma radiotherapy causes imbalance of lymphocytes in distal spleen of mice and hence reduces immunity,which provides a novel mechanism of radiological immunity damage.

A Prospective Comparative Study of Concurrent Chemoradiation with Accelerated Fractionated Radiotherapy versus Concurrent Chemoradiation with Conventional Fractionation in Locally Advanced Squamous Cell Carcinoma of Head and Neck

Introduction: Concurrent chemo-radiation is the standard ofcare for locally advanced head and neck carcinoma. Duringlater part of radiation treatment schedule, there is acceleratedrepopulation of surviving tumour cells. So the treatment shouldbe completed as early as possible. Study aimed to comparethe loco-regional control rates between the acceleratedfractionated and conventional fractionated radiotherapy andto compare the rate of acute and late toxicities between thetwo arms.Material and Methods: Thirty patients with locally advancedhead and neck cancer in the study arm (ARM-A) received sixfractions of radiotherapy per week and thirty-two patients in thecontrol arm (ARM-B) received five fractions of radiotherapyper week. Total radiation dose was same in both arms. Inj.Cisplatin at a dose of 100mg/m2 was given to the patients ofboth the arms every three weeks as a radiosensitizer agent.Results: Complete response rate (19/30 vs 14/32) rate thoughhigher in the study arm, was not statistically significant.Similarly overall response rate (25/30 vs 21/32) was notstatistically significant (P value – 0.15). Among acutetoxicities only dysphagia was significantly higher in the studyarm (P value-0.024). Late toxicities were similar in both thearms.Conclusion: So accelerated fractionation radiotherapy canbe used for treating locally advanced head and neck cancerpatients to improve loco-regional control rate with acceptabletoxicities.

Phase Ⅰ study of moderately hypo-fractionated intensity modulated radiotherapy after prostatectomy / 中华放射医学与防护杂志

Objective To assess the acute toxicity of a hypo-fractionated regimen of intensity-modulated radiotherapy to the prostatic bed after prostatectomy.Methods From February to August 2017,twenty cases with prostate adenocarcinoma after prostatectomy were recruited.The prescribed dose to the whole pelvis and the prostatic bed was 45 Gy delivered in 1.8 Gy per fraction and 62.75 Gy delivered in 2.51 Gy per fraction,respectively.Acute toxicity was recorded and graded according to Radiation Therapy Oncology Group (RTOG) criteria and Common Terminology Criteria for Adverse Events (CTCAE) 4.0.Results The median follow-up was 7.5 months.Grade 2 acute genitourinary and gastrointestinal toxicity was observed respectively in two cases (10％) and one (5％),respectively.Two cases (10％) complained of grade 2 urinary incontinence during radiation therapy,but recovered to grade 0 or grade 1 after the first month of follow-up.Conclusions After prostatectomy,moderately hypo-fractionated radiotherapy (2.51 Gy × 25) compared with conventional fractionated radiotherapy previously reported did not increase the risk of acute toxicity.The incidence of urinary incontinence did not increase during short-term of follow-up.

Comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers

Background: Head and neck cancers are the most common malignancy among males in India. Carcinoma of buccal mucosa is the most common cancer among head and neck cancers due to high rate of tobacco chewing habit. Aim and objectives: To study the comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers. Materials and methods: It was a prospective study of acute toxicity and response in patients diagnosed with head and neck malignancy. Patients with oral cavity site, previously untreated locally advanced III, IV-A and IV -B, age of 20-60 years. Results: Primary tumor site of the patients included in the both CRT arm and HFRT was not significant (P=0.755). Majority of patients included were T3 (44% in CRT arm and 46.7% in HFRT arm) and T2 (24% in CRT arm and 26.7% in HFRT arm) lesions. The tumors with respect to T stage, the difference between two arms was not statistically significant (P = 0.988). Most of the patients presented with N1 (44% of CRT arm and 40% of HFRT arm) and N2 (28% of CRT arm and 26.7% of HFRT arm) stage. With respect to nodal (N) stage at presentation, CRT arm and HFRT arm were comparable (P=0.987). In HFRT arm, 7 (46.7%) patients were presented in stage III Kuppa Prakash, A. Ravi Chandran, M. Vijay Kumar. Comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers. IAIM, 2016; 3(9): 228-237. Page 229 and 8 (53.3%) patients were in stage IV. With respect to TNM stage, CRT arm and HFRT arm were comparable (P=0.87). Radiotherapy treatment compared in both CRT Arm and HFRT arms was not statistically significant (P=0.493). In CRT arm Grade 2 toxicity: 13/22 (59%) patients developed skin toxicity, 12/22 (55%) patients developed mucous membrane toxicity, 15/22 (68%) patients developed nausea, 8/22 (36%) patients developed vomiting, 10/22 (45%) salivary gland toxicity. Grade 3 toxicity: 2/22 (9%) patients developed skin toxicity, 10/22 (45%) patients developed mucous membrane toxicity, 5/22 (23%) patients developed nausea, 6/22 (27%) patients developed vomiting. Conclusion: Standard chemo radiation is better than HFRT in Head and Neck (oral cavity) cancers because of less toxicity, less mean overall treatment time, less number of treatment breaks and better response.

Stereotactic body radiotherapy in early stage non-small cell lung cancer: First experience from an Indian Centre.

BACKGROUND: Surgery is the standard of care for early stage (T1-2, N0, M0) non-small cell lung cancer. A considerable number of these patients are ineligible for surgery due to age and comorbidities. Hypo fractionated high-dose stereotactic body radiotherapy (SBRT) is being performed for these group of patients. There is paucity of literature regarding this novel technique from the Indian subcontinent. AIMS AND OBJECTIVES: We hereby report the dosimetry, response and outcome of our small cohort of early stage non-small cell lung cancer patients treated with SBRT. MATERIALS AND METHODS: Between December 2007 and December 2010, 8 patients of early stage (T1-2N0M0) underwent SBRT at our centre. All the patients had undergone whole body PET-CT scan, MRI brain and pulmonary function test (PFT with DLCO). The SBRT schedules included 48 Gy in 6 fractions for peripherally located and 48 Gy in 8 fractions for centrally located tumors. Response and toxicity were assessed in 3 monthly follow up visits. RESULTS: The median duration of follow up was 18 months (range 8-44 months). The median age of the patients was 70 years (range 63-82 years) and the median tumor diameter was 4 cm (range 2.8-5.0 cm). The mean PTV volume was 165 cc(range 127.3- 193.9 cc). The mean dose to the PTV was 99.5% (range 97.7- 102.1%). After 3 months, 7 patients had complete metabolic response and 1 patient had partial metabolic response. Overall survival at 1.5 years was 87.5%. One patient had grade 2 pneumonitis. No toxicities of grade 3 or higher were identified. CONCLUSION: SBRT for early stage NSCLC resulted in excellent local control with minimal toxicity and can be considered as a treatment option in properly selected patients.

An analysis of the advantage of biologically equivalent dose of unconventionally fractionated radiotherapy / 中华放射医学与防护杂志

Objective To analyze the advantage of altered fractionation radiotherapy by calculating the accumulative effects of daily biologically effective dose (BED) to find out the difference between conventional fractionated radiotherapy and altered fractionation radiotherapy.Methods The data in the report of hyperfractionated or accelerated radiotherapy for head and neck cancer published by Cochrane Collaboration in 2010 was analyzed.Based on the radiotherapy processes mentioned in this report,the accumulative effects of daily BED were calculated and compared in different radiotherapy processes by using linear-quadratic mode.The variation of BED in different radiotherapy processes was find out.Results In total dose of unity as the premise of 70 Gy,altered fractionation especially the hyperfractionated accelerated radiotherapy could give a higher BED to the tumor during a shorter period,hyperfractionated radiotherapy could give a lower BED to normal tissues,and hyperfractionated radiotherapy with split course could give higher BED to the tumor while lower BED to normal tissues.Conclusions The variation of BED in different radiotherapy processes can be shown clearly by linear-quadratic mode.It can be simple and shortcut through mathematical models for the evaluation of different radiotherapy plan,on clinical symptomatic selection play a guiding role in tumor therapy.

Influence of PET/CT positioning on the effect of late-course accelerated hyperfractionated and threc-dimensional conformal radiotherapy for stage Ⅲ lung squamous cell carcinoma / 中国基层医药

Objective To investigate the irfluence of PET/CT positioning on the effect of late-course accelerated hyperfractionated and three-dimensional conformal radiotherapy for stage Ⅲ lung squamous cell carcinoma.Methods 79 stage Ⅲ lung squarnous cell carcinoma patients were enrolled and divided into PET/CT group(n =37 cases,PET/CT positioning) and general CT group (n =42 cases,general CT positioning) according to the way of positioning.The conventional fractionated 3 DCRT( about 40 Gy) was used in previous 2/3 time and hyperfractionated( about 1.5 Gy) was used in later 1/3 time.Both groups used chemotherapy as adjuvant therapy.Full course of the treatment was a month or so.And the clinical efficacy and a variety of adverse reactions of the two groups was observed.Results The total rate of remission in PET/CT group were 73.0％,and 71.4％ in general CT group,and there was no significant difference in the two groups (x2 =1.347,P ＞ 0.05 ).The major radiation injury were radioactive pulmonary injury and tracheal damage,incidence rates were 56.8％and 57.1％ in acute stage,and there was no significant difference in the two groups( x2 =2.178,P ＞ 0.05 ) ; but in late stage 69.0％ in general CT group was significantly higher than 62.2％ in PET/CT group(x2 =4.142,P ＜0.05).Ater followed-up 1 year,the recurrence rate of hillar and mediastinal lymph node in PET/CT group was 43.7％,lower than that of the general CT group( 59.4％ ) ( x2 =4.732,P ＜ 0.05 ).Conclusion PET/CT positioning in late-course accelerated hyperfractionated and three-dimensional conformal radiotherapy for stage Ⅲ lung squamous cell carcinoma could reduce late stage radioactive pulmonary injury and tracheal damage,lower the recurrence rate of hillar and mediastinal lymph node.

Comparison of long-term results in three types of fraction radiotherapy for nasopharyngeal carcinoma / 解放军医学杂志

0.05). However, the 5-year local control rate appeared significantly different in three groups (?~2=7.239, P0.05). The 1-,3-,and 5-year disease-free survival rate among three groups were significantly different in the three groups (79.1%, 41.9% and 35.6% for CFR group, 85.7%, 57.1% and 38.1% for FHR group, and 95.4%, 62.8% and 58.1% for LAHR group) (?~2=6.60,P0.05). The incidence of loss of hearing, the radiation-induced temporomandibular joint lesion, and the radiation-induced brain injury was 31.3%, 41.9% and 9.3% in CFR group, and 25.0%, 35.7% and 7.1% in FRH group, and 22.7%, 35.7% and 7.0% in LAHR group, respectively. Conclusion A better 5-year local control rate and disease-free survival rate were achieved in patients in LAHR and FHR groups than those in CFR group. There are no differences in the incidence of late complications and overall survival rate among three groups.

Chromosomal Aberration in Fractionated Radiotherapy / 대한방사선종양학회지

PURPOSE: This study was tried to evaluate the effect of the partial body fractionated irradiation on the frequency of chromosomal aberration. MATERIALS AND METHODS: In three patients with uterine cervix carcinoma, chromosomal aberrations were analyzed during fractionated external beam radiotherapy. Radiation field included whole pelvis and total dose was 5040 cGy in 28 fractions. RESULTS: The values of the frequency of dicentrics and rings (Ydr) in pre- irradiated peripheral lymphocytes in three patients were 0.0060, 0.0000, and 0.0029, respectively. The frequency of dicentrics and rings, estimated during the course of radiotherapy, increased with radiation dose and best fitted to the linear equation, Ydr=7.31x10(-5) D(cGy)+1.45x10(-2). The frequency of dicentrics and rings among the cells with dicentric and/or ring (Qdr) also showed increasing tendency and best fitted to the linear equation, Qdr= 1.01x10(-4) D(cGy)+1.04. CONCLUSION: Ydr increased linearly with radiation dose in the dose range of our study, and Qdr showed increasing tendency with dose.

Chromosomal Aberration in Fractionated Radiotherapy / 대한방사선종양학회지

PURPOSE: This study was tried to evaluate the effect of the partial body fractionated irradiation on the frequency of chromosomal aberration. MATERIALS AND METHODS: In three patients with uterine cervix carcinoma, chromosomal aberrations were analyzed during fractionated external beam radiotherapy. Radiation field included whole pelvis and total dose was 5040 cGy in 28 fractions. RESULTS: The values of the frequency of dicentrics and rings (Ydr) in pre- irradiated peripheral lymphocytes in three patients were 0.0060, 0.0000, and 0.0029, respectively. The frequency of dicentrics and rings, estimated during the course of radiotherapy, increased with radiation dose and best fitted to the linear equation, Ydr=7.31x10(-5) D(cGy)+1.45x10(-2). The frequency of dicentrics and rings among the cells with dicentric and/or ring (Qdr) also showed increasing tendency and best fitted to the linear equation, Qdr= 1.01x10(-4) D(cGy)+1.04. CONCLUSION: Ydr increased linearly with radiation dose in the dose range of our study, and Qdr showed increasing tendency with dose.

COMPARISON OF THE SENSITIZING EFFECT OF METRONIDA-ZOLE DERIVATIVE (CMCa) ON TUMOR BEARING MICE BETWEEN TWO FRACTIONATED RADIOTHERAPY SCHEDULES / 第二军医大学学报

The sensitizing effects of radiosensitizer CMCa on S180 bearing mice in two f rac- tionated radiotherapy schedules were compared. The restlts showed that CMCa had the sensitizing effects in both fractionated schedules. The SER value of 2F/7D schedule was higher than that of 5F/7D. The TCD50(90) dose of 2F/7D was also decreased obviously. There was a significant difference of regression coefficients of dose-response curves between the experimental group and control one. The total radiation dose which was required for disapperance of tumor in all drug treated animals was reduced. The results indicate.that radiosensitizing effect of CMCa with 2F/7D schedule is better than that with 5F/7D.