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Objective To study the irradiation dose of organs at risk (OAR) in involved field radiation and extended field radiation in patients with thoracic esophageal cancer who received intensity modulated radiotherapy (IMRT). Methods A total of 40 patients with thoracic esophageal cancer were treated with IMRT. The involved field, extended field, and OAR were outlined to generate IMRT plans. The conformity index (CI) and homogeneity index (HI) of planning target volume (PTV) and the irradiation parameters of OAR were evaluated for the two plans. Paired t-test was used for comparison of irradiation parameters. Results The PTV of both plans received the prescribed dose. There were no significant differences in CI and HI of PTV between the two groups (P = 0.317, 0.130). There were significant differences in average lung dose, lung V5, lung V20, lung V30, spinal cord Dmean, heart Dmean, heart Dmax, heart V30, heart V40, and heart V60 between the two groups (P < 0.01). Conclusion Compared with the extended field, the involved field can reduce the irradiation dose of ORA in patients with thoracic esophageal cancer, thus reducing the risk of radiation.
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Objective To analyze the relationship between the radiation doses to mediastinal lymph nodes regions and the regional failure patterns when involved field radiation therapy (IFRT) was used for limited-stage small cell lung cancer (SCLC).Methods The mediastinal lymph node regions (group 1 to 10) of the iimited-stage SCLC patients received definitive radiotherapy were contoured in treatment planning system.The intentional or incidental radiation doses to each lymph node regions were recorded.In-field recurrence,marginal recurrence and out-of-field recurrence were respectively defined as the volume of failed lymph nodes located within the 80％ iso-dose lines,in the 80％-20％ iso-dose lines and beyond the 20％ iso-dose lines of prescribed doses.Results A total of 1 216 lymph node regions in 76 patients were contoured.The median follow-up time was 17.4 months.At diagnosis,lymph node regions with metastatic rates ＞50％ were 4R (68.7％),4L (57.9％),10R (57.9％),2R (56.6％) and 7 (51.3％).The positive lymph node regions were all subjected to prescribed doses.The lymph node regions that received incidental radiation doses of more than 3 000 cGy were:3P,4L,7,6,4R,5,2L.The median lymph node failure-free time was 9.8 months.In this study,only 1 patient developed out-of-field mediastinal lymph nodes failure.The rest of out-of-field recurrences and marginal recurrences were developed in the supraclavicular regions or contralateral hila.Conclusions When IFRT is used to treat mediastinal lymph node regions for patients with SCLC,negative mediastinal regions can be subjected to considerable incidental radiation doses.Out-of-field recurrences of the mediastinal lymph node regions are rare.This is contributed by the incidental radiation dose to these regions.
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A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6/6 in both eyes. Retinal pigment epithelial detachment is a possible complication of radiation therapy in non-Hodgkin's lymphoma with intraocular metastasis. It is essential to alert the managing ophthalmologists about this rare complication.
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Introducción. Objetivo: evaluar la supervivencia y toxicidad de pacientes con diagnóstico de linfoma de Hodgkin en etapa favorable tratados con quimioterapia con VAMP (vinblastina, doxorrubicina, metotrexate, prednisona) y bajas dosis de radioterapia a campos comprometidos. Métodos. Se incluyeron pacientes con etapas favorables tratados con 4 ciclos de VAMP (vinblastina 6 mg/m²sc, doxorrubicina 25 mg/m²sc, metotrexate 20 mg/m²sc y prednisona 40 mg/m²sc). Administrándose en los días 1 y 15; más radioterapia a campos comprometidos (21.6 Gy). La supervivencia se determinó por curvas de Kaplan-Meier y se ajustaron con la prueba de Cox. Resultados. Se incluyeron 17 pacientes, con media de edad de 7 años. Dos pacientes recayeron, uno a los 4 y otro a los 16 meses. La supervivencia global fue de 94.12%, con seguimiento de 66 meses (intervalo de confianza de 95% [IC95%]). La supervivencia libre de evento fue de 88.24% con seguimiento de 63 meses (IC 95%). Conclusiones. El uso de este esquema de quimioterapia y radioterapia (21.6 Gy) a campos comprometidos, tuvo una supervivencia global mayor. La toxicidad a mediano plazo por radioterapia fue elevada, por lo que se debe considerar la disminución de la dosis a 15 Gy para pacientes con respuesta completa.
Introduction. Purpose: To evaluate outcome and assess toxicity of patients with early-stage Hodgkin lymphoma treated with VAMP and low-dose involved-field radiation. Methods. Patients with clinical favorable stages Hodgkin lymphoma were treated with 4 cycles of VAMP (vinblastine 6 mg/m²sc, doxorrubicyn 25 mg/m²sc, methotrexate 20 mg/ m²sc, and prednisone 40 mg/m²sc) administrated on day 1 and day 15. And 21.6 Gy involvedfied radiation. The over-all survival was estimated using Kaplan-Meier and Cox methods. Results. 17 patients were included, the median age was 7 years. Two patients present progressive disease at 4 and 16 months respectively. The overall survival were 94.12% with follow-up of 66 months (IC 95%), the event-free survival were 88.24% with follow up of 63 months (IC 95%). Conclusions. The combined modality therapy with chemotherapy and involved-field radiation (21.6 Gy) shows a better overall survival. The radiation toxicity was elevated, for that reason we must try to reduce the dose of radiotherapy at 15 Gy in patients with complete response to treatment.
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Autologous stem cell transplant (ASCT) is a potentially curative therapy for patients with relapsed and refractory or aggressive non Hodgkin ' s lymphoma, relapse is still common and is caused by high levels of tumour cell burden in the host and contamination of the stem cells with tumour cell. To improve effect of ASCT, ① in vivo puring with riluximab in pre transplant, depletion of B cells from the peripheral blood and clear the contamination of the malignant cells; ②the combination chemotherapy replace with rilumixab and non cross resistance drug in post transplant, killing tumour cells in the host; (3)involved field radiation therapy(IFRT) as a adjunct to pre or post transplant, reducing the relapse rate.
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PURPOSE: Although radiation therapy had been the treatment of choice for localized non-Hodgkin's lymphoma(NHL), recent studies have revealed that treatment result after radiation therapy alone is not successful for localized aggressive NHL, if it is not pathologically but clinically staged. A prospective phase II trial was conducted to evaluate the therapeutic results of 4 cycles of CHOP chemotherapy followed by involved field radiation therapy in clinically staged localized aggressive NHL. MATERIALS AND METHODS: Patients with a diagnosis of aggressive NHL(all intermediate grade and immunoblastic histology in NCI working formulation), Ann Arbor stage I or II without poor prognostic factors(presence of B symptoms, bulky diseases, or 2 or more extranodal involvement) were treated with 4 cycles of CHOP(cyclophosphamide, doxorubicin, vincristine, prednisolone) followed by involved field radiation therapy of 3,000~6,000(median: 4,500) cGy. RESULTS: Between April 1990 and March 1995, 62 consecutive patients entered this trial. Forty six patients with measurable diseases were evaluable for response. Complete response was achieved in 41(89.1%) patients after CHOP chemotherapy and 4 more patients after subsequent radiation therapy, making total CR rate of 98%. Progression free survival(PFS) of all 62 patients were 2.2+~73+ months and 5 year PFS rate was 64.6%. Overall survival(OS) were 2.4+~75+ months and 5 year OS rate was 75.2%. Old age (> 60) was the only significant prognostic factor, which-affected overall survival negatively. Treatment was relatively well tolerated, but 3 patients died associated with treatment. CONCLUSIONS: Four cycles of CHOP chemotherapy followed by involved field radiation therapy is highly curative and safe treatment for clinically staged, localized aggressive NHLs.