Dose escalated simultaneous integrated boost of gross nodal disease in gynecologic cancers: a multi-institutional retrospective analysis and review of the literature

Purpose@#Typical doses of 45–50.4 Gy used to treat regional nodes have demonstrated inadequate control of gross nodal disease (GND) in gynecologic cancer, and accelerated repopulation may limit the efficacy of a sequential boost. We reviewed outcomes of patients treated with a simultaneous integrated boost (SIB) at 2.25 Gy per fraction to positron emission tomography (PET) avid GND to evaluate toxicity and tumor control using this dose-escalated regimen. @*Materials and Methods@#A total of 83 patients with gynecologic cancer and PET avid inguinal, pelvic, or para-aortic lymphadenopathy were treated using intensity-modulated radiation therapy (IMRT) with SIB. Primary cancers were mostly cervical (51%) and endometrial (34%), and included patients who received concurrent chemotherapy (59%) and/or brachytherapy boost (78%). @*Results@#Median follow-up from radiation completion was 12.6 months (range, 2.7 to 92.9 months). Median dose to elective lymphatics was 50.4 Gy (range, 45 to 50.4 Gy) at 1.8 Gy/fraction. Median SIB dose and volume were 63 Gy (range, 56.3 to 63 Gy) and 72.8 mL (range, 6.8 to 1,134 mL) at 2–2.25 Gy/fraction. Nodal control was 97.6% in the SIB area while 90.4% in the low dose area (p = 0.013). SIB radiotherapy (RT) field failure-free, non-SIB RT field failure-free, and out of RT field failure-free survival at 4 years were 98%, 86%, and 51%, respectively. Acute and late grade ≥3 genitourinary toxicity rates were 0%. Acute and late grade ≥3 gastrointestinal toxicity rates were 7.2% and 12.0%, respectively. @*Conclusion@#Dose escalated SIB to PET avid adenopathy results in excellent local control with acceptable toxicity.

Dose escalated simultaneous integrated boost of gross nodal disease in gynecologic cancers: a multi-institutional retrospective analysis and review of the literature

Purpose@#Typical doses of 45–50.4 Gy used to treat regional nodes have demonstrated inadequate control of gross nodal disease (GND) in gynecologic cancer, and accelerated repopulation may limit the efficacy of a sequential boost. We reviewed outcomes of patients treated with a simultaneous integrated boost (SIB) at 2.25 Gy per fraction to positron emission tomography (PET) avid GND to evaluate toxicity and tumor control using this dose-escalated regimen. @*Materials and Methods@#A total of 83 patients with gynecologic cancer and PET avid inguinal, pelvic, or para-aortic lymphadenopathy were treated using intensity-modulated radiation therapy (IMRT) with SIB. Primary cancers were mostly cervical (51%) and endometrial (34%), and included patients who received concurrent chemotherapy (59%) and/or brachytherapy boost (78%). @*Results@#Median follow-up from radiation completion was 12.6 months (range, 2.7 to 92.9 months). Median dose to elective lymphatics was 50.4 Gy (range, 45 to 50.4 Gy) at 1.8 Gy/fraction. Median SIB dose and volume were 63 Gy (range, 56.3 to 63 Gy) and 72.8 mL (range, 6.8 to 1,134 mL) at 2–2.25 Gy/fraction. Nodal control was 97.6% in the SIB area while 90.4% in the low dose area (p = 0.013). SIB radiotherapy (RT) field failure-free, non-SIB RT field failure-free, and out of RT field failure-free survival at 4 years were 98%, 86%, and 51%, respectively. Acute and late grade ≥3 genitourinary toxicity rates were 0%. Acute and late grade ≥3 gastrointestinal toxicity rates were 7.2% and 12.0%, respectively. @*Conclusion@#Dose escalated SIB to PET avid adenopathy results in excellent local control with acceptable toxicity.

Histopathological study and treatment results in management of pleural mesothelioma

Nineteen patients with malignant pleural mesothelioma seen at the Alexandria University Hospitals between 1987 and 1991 were the material of this study. The tumours were classified as epithelial, sarcomatous or of mixed type, also four samples from pleural effusion were subjected to routine cytological examination as well as electron microscopic studies. Most of the patients presented with locally advanced disease, the overall response to irradiation and chemotherapy was 55.3% with complete response rate of 33.3%. The response to treatment was correlated to some prognostic factors. The duration of response ranged between three and fifteen months and the median survival for responders was twenty months

Advanced nasopharyngeal carcinoma: radiation treatment and chemotherapy approaches, and life table survival results

Induction combination chemotherapy and radio therapy was tried in 50 patients with T[3]-T[4] nasopharyngeal carcinoma. The results were compared to another matching group of 50 patients given radical radiotherapy. The study showed preliminary improvement of local control rates of the tumour in patients treated by combination chemotherapy with radiation. The actuarial method of survival computation was applied, also the variance and standard error of the four years survival rates for both treatment groups was computed. Comparison of the survival rates showed no significant difference between group I [received combined chemo and radiotherapy] and group II [Radiation therapy] throughout the observation period