Noncirrhotic portal hypertension: An under-reported late adverse event of SIRT in metastatic colorectal cancer patients

Introduction: Selective internal radiation therapy (SIRT) is increasingly used in different scenarios. Although portal hypertension (PHT) has been described as a nonclinically relevant finding after SIRT, its real incidence could have been neglected due to the nature of the diseases for which SIRT is indicated. Case Reports: Here we report three cases with clinically relevant late PHT after treatments including SIRT and oxaliplatin among others. Discussion: The sequential use of oxaliplatin and SIRT in patients with colorectal cancer metastases could have additive effects on the liver

Relation of radiotherapy dose and sternocleidomastoid muscle (SM) mass or late response in patients with nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To investigate the relationship of radiation dose with the volume and late toxicity of the sternocleidomastoid muscle ( SM) in patients with nasopharyngeal carcinoma. Methods SM was divided into upper part and lower part based on the lower edge of cricoid cartilage. Patients were divided into three groups according to the prescribed dose for clinical target volume at the lower neck ( CTV2 ) ( 0, 54,60 Gy) . The dosimetric parameters included Dmean , V66 , and V60 for the upper, lower, and whole SM. SM was delineated and the volume was calculated on computed tomography images in the treatment planning system before and at 6, 12, and 18 months after treatment. The anteroposterior and transversal diameters of SM at C3?C4 , C4?C5 , C5?C6 , and C6?C7 levels were measured and recorded. Late toxicity of neck skin and SM was evaluated according to the Common Terminology Criteria for Adverse Events V4 .0 criteria. Between?group comparison was made by t?test or Kruskal?Wallis non?parametric test. Between?group comparison of the sample rate was made by one?way analysis of variance. The correlation analysis was made by Spearman correlation. Results There were significant difference in SM volume between the three time points after treatment ( P=0. 000) . At 12 or 18 months after treatment, the volume of SM wasignificantly reduced ( P=0. 000,0. 000);the reduction in SM volume was significantly correlated with V66 of the SM and the upper SM ( P=0. 015,0. 020) . At 18 months after treatment, SM fibrosis was significantly correlated with V60 of the upper SM ( P=0. 030);the fibrosis of neck skin was significantly correlated with the Dmean and V60 of the upper SM ( P=0. 029,0. 005) . Conclusions In order to prevent the incidence of the fibrosis of neck skin and SM, the dose homogeneity should be as high as possible, while the number of hot spots should be as small as possible.

Long-term efficacy and adverse effects of intensity-modulated radiotherapy for nasopharyngeal carcinoma / 中华放射肿瘤学杂志

[Abstra ct] Objective To investigate the long-term efficacy and adverse effects of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods A total of 869 patients with biopsy-proven NPC without distant metastasis who underwent the whole course of IMRT from 2009 to 2010 were enrolled.Of all the patients, 84.8%received cisplatin-based chemotherapy.The prescribed dose to the primary lesion in the nasopharynx was 66-70Gy in 30-32 fractions, and the dose to the positive lymph nodes in the neck was 66 Gy in 30-32 fractions.The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for difference analysis and univariate prognostic analysis , and the Cox proportional hazards model was used for multivariate prognostic analysis .Rseu lts The 5-year overall survival( OS ) , local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival, and disease-free survival ( DFS ) were 84.0%, 89.7%, 94.5%, 85.6%, and 76.3%, respectively.In the patients with locally advanced NPC,concurrent chemotherapy tended to reduce distant metastasis (83.6%vs.75.7%, P=0.050) and improve OS (82.6%vs.77.0 %, P=0.082).Induction chemotherapy tended to improve OS ( 80.7% vs.71.4%, P=0.057 ) , and the induction chemotherapy containing docetaxel or gemcitabine tended to improve OS (83.3%vs.72.2%, P=0.058).The patients who received a boost after the initial radiotherapy had a significantly lower DFS rate than those who did not (52.2%vs.71.1%, P=0.004).The concurrent chemotherapy increased the incidence rates of long-term xerostomia and trismus, while a high dose of cisplatin increased the incidence rates of xerostomia and hearing impairment.Conclusions IMRT for NPC provides satisfactory long-term efficacy.Concurrent chemotherapy combined with IMRT tends to reduce the incidence of distant metastasis, and other values need further investigation.The boost therapy after radiotherapy may be associated with poor prognosis.Chemotherapy increases the incidence of long-term toxicities.

Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, Recommendations

Progress in head and neck cancer (HNC) therapies has improved tumor response, loco-regional control, and survival. However, treatment intensification also increases early and late toxicities. Dysphagia is an underestimated symptom in HNC patients. Impairment of swallowing process could cause malnutrition, dehydration, aspiration, and pneumonia. A comprehensive literature review finalized in May 2012 included searches of electronic databases (Medline, Embase, and CAB abstracts) and scientific societies meetings materials (American Society of Clinical Oncology, Associazione Italiana Radioterapia Oncologica, Associazione Italiana di Oncologia Cervico-Cefalica, American Head and Neck Society, and European Society for Medical Oncology). Hand-searches of HNC journals and reference lists were carried out. Approximately one-third of dysphagia patients developed pneumonia requiring treatment. Aspiration pneumonia associated mortality ranged from 20% to 65%. Unidentified dysphagia caused significant morbidity, increased mortality, and decreased the quality of life. In this review we underline definition, causes, predictive factors of dysphagia and report on pretreatment and on-treatment evaluation, suggesting some key points to avoid underestimation. A multi-parameter assessment of swallowing problems may allow an earlier diagnosis. An appropriate evaluation might lead to a better treatment of both symptoms and cancer.

Evalúan la quimioterapia con vinblastina, bleomicina y metotrexato en el linfoma de Hodgkin / Assessment of chemotherapy with vinblastine, bleomicine and methotrexate in Hodgkin's lymphoma

Background: VBM chemotherapy (vinblastine, bleomycin and methotrexate) plus irradiation is an effective therapeutic combination in early-stage Hodgkin's lymphoma, but conflicting results have been collected on the toxicity of and correct indication for this combination. Patients and methods: The GISL treated 169 evaluable patients with early-stage, favorable presentation Hodgkin's disease in two successive trials. In the first (MH-1), conducted between 1988-1995, 87 patients were administered the original VBM schedule coupled with extended-field radiotherapy (EF-RT). In the subsequent study (MH1b), performed between 1996-2004, the doses of vinblastine and methotrexate were intensified, the dose of bleomycin was reduced, and small amounts of prednisone were given contemporaneously with any infusion of antitumoral drug (VbMp); irradiation was delivered to involved sites only and had to begin at least 25 days after the end of chemotherapy. Of the 82 patients treated with the MH-1b protocol, 67 were < 65 years old (MH-1b ≤ 65) and 15 were > 65 years old (MH-1b > 65). Results: Complete remission was achieved by 96, 91 and 80% of the patients in the MH-1, MH-1b ≤ 65 and MH-1b > 65 trials, respectively; relapse rates were 12, 9 and 0%, with median follow-ups of 111, 55 and 49 months. Hematological and pulmonary toxicity were acceptable on the whole in the MH-1 group, but more severe when chemotherapy followed radiotherapy than vice versa. In the MH-1b ≤ 65 both these toxicities were abated, while in the MH-1b > 65 severe infections affected 3/15 patients. Conclusions: VbMp followed by involvedfield radiotherapy shows negligible hematological and pulmonary toxicity. The modified protocol appeared as effective as the original VBM + EF-RT protocol, with minimal and not statistically significant differences. The addition of cyclophosphamide to VbMp is under investigation to improve the cell-killing potential of the regimen. The purpose is to cure even early unfavorable presentations of the disease maintaining radiotherapy to involved sites only and avoiding the risk of late cardiotoxicity given by combinations including anthracyclines

Antecedentes: La quimioterapia con vinblastina, bleomicina y metotrexato (VBM) asociada a la irradiación constituye una combinación terapéutica efectiva en el estadio temprano del linfoma de Hodgkin, aunque se publicaron resultados contradictorios respecto de la toxicidad y la indicación adecuada de esta asociación. Pacientes y métodos: El GISL trató y evaluó ­en dos ensayos clínicos­ 169 pacientes en fases tempranas de la enfermedad de Hodgkin con presentación favorable. En el primer estudio (MH-1), realizado entre 1998 y 1995, 87 pacientes fueron medicados con el esquema VBM original asociado a radioterapia de campo extendido (RCE). En el ensayo siguiente (MH-1b), llevado a cabo entre 1996 y 2004, se incrementaron las do-sis de vinblastina y metotrexato, se redujeron las de bleomicina y se administró una pequeña cantidad de prednisona junto con la infusión de cualquier droga antitumoral (VbMp); la irradiación se limitó solamente a los sitios afectados y debía comenzar al menos 25 días después de la finalización de la quimioterapia. De los 82 pacientes tratados con el protocolo MH-1b, 67 tenían 65 años o menos (MH-1b ≤ 65) y 15 eran mayores (MH-1b > 65). Resultados: La remisión completa fue obtenida por 96%, 91% y 80% de los pacientes de los estudios MH-1, MH-1b ≤ 65 y MH1b > 65, respectivamente; las tasas de recaída fueron del 12%, 9% y 0 y las medianas de los períodos de seguimiento de 111, 55 y 49 meses. Para la totalidad del grupo MH-1, la toxicidad pulmonar fue aceptable y más grave cuando la quimioterapia siguió a la radioterapia y no a la inversa. En el grupo M-1b ≤ 65, estas toxicidades fueron mitigadas y en el MH-1b > 65, 3 de 15 pacientes fueron afectados por infecciones graves. Conclusiones: La VbMp seguida de radioterapia del sitio afectado (RSA) presenta una toxicidad hematológica y pulmonar casi nula. El protocolo modificado pareció tan efectivo como el original VBM + RCE y las diferencias fueron mínimas y estadísticamente no significativas. En fases de investigación se estudia el agregado de ciclofosfamida al régimen VbMp con el fin de mejorar su poder citodestructor. El objetivo está constituido por la curación, incluso de las formas tempranas y no favorables de la enfermedad, a través de la aplicación de radioterapia exclusivamente a los sitios afectados y evitar el riesgo de cardiotoxicidad tardía que se observa en las asociaciones con antraciclinas