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1.
Int J Radiat Oncol Biol Phys ; 117(2): 422-433, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37120027

ABSTRACT

PURPOSE: Involved internal iliac and obturator lateral lymph nodes (LLNs) are a known risk factor for the occurrence of ipsilateral local recurrences (LLR) in rectal cancer. This study examined coverage of LLNs with routine radiation therapy practice in the Netherlands and associated LLR rates. METHODS AND MATERIALS: Patients with a primary tumor ≤8 cm of the anorectal junction, cT3-4 stage, and at least 1 internal iliac or obturator LLN with short axis ≥5 mm who received neoadjuvant (chemo)radiation therapy, were selected from a national, cross-sectional study of patients with rectal cancer treated in the Netherlands in 2016. Magnetic resonance images and radiation therapy treatment plans were reviewed regarding segmented LLNs as gross tumor volume (GTV), location of LLNs within clinical target volume (CTV), and received proportion of the planned radiation therapy dose. RESULTS: A total of 223 out of 3057 patients with at least 1 LLN ≥5 mm were selected. Of those, 180 (80.7%) LLNs were inside the CTV, of which 60 (33.3%) were segmented as GTV. Overall, 202 LLNs (90.6%) received ≥95% of the planned dose. Four-year LLR rates were not significantly higher for LLNs situated outside the CTV compared with those inside (4.0% vs 12.5%, P = .092) or when receiving <95% versus ≥95% of the planned radiation therapy dose (7.1% vs 11.3%, P = .843), respectively. Two of 7 patients who received a dose escalation of 60 Gy developed an LLR (4-year LLR rate of 28.6%). CONCLUSIONS: This evaluation of routine radiation therapy practice showed that adequate coverage of LLNs was still associated with considerable 4-year LLR rates. Techniques resulting in better local control for patients with involved LLNs need to be explored further.


Subject(s)
Neoplasm Recurrence, Local , Rectal Neoplasms , Humans , Cross-Sectional Studies , Neoplasm Recurrence, Local/pathology , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Rectal Neoplasms/pathology , Recurrence , Retrospective Studies , Neoplasm Staging
2.
Radiat Oncol ; 15(1): 89, 2020 Apr 22.
Article in English | MEDLINE | ID: mdl-32321553

ABSTRACT

BACKGROUND: Prognostication tools for early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) are currently lacking. The purpose of this study was to develop and externally validate a nomogram to predict overall survival in individual patients with peripheral early-stage disease. METHODS: A total of 587 NSCLC patients treated with biologically effective dose > 100 Gy10 were eligible. A Cox proportional hazards model was used to build a nomogram to predict 6-month, 1-year, 3-year and 5-year overall survival. Internal validation was performed using bootstrap sampling. External validation was performed in a separate cohort of 124 NSCLC patients with central tumors treated with SBRT. Discriminatory ability was measured by the concordance index (C-index) while predictive accuracy was assessed with calibration slope and plots. RESULTS: The resulting nomogram was based on six prognostic factors: age, sex, Karnofsky Performance Status, operability, Charlson Comorbidity Index, and tumor diameter. The slope of the calibration curve for nomogram-predicted versus Kaplan-Meier-estimated overall survival was 0.77. The C-index of the nomogram (corrected for optimism) was moderate at 0.64. In the external validation cohort, the model yielded a C-index of 0.62. CONCLUSIONS: We established and validated a nomogram which can provide individual survival predictions for patients with early stage lung cancer treated with SBRT. The nomogram may assist patients and clinicians with treatment decision-making.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Nomograms , Radiosurgery/mortality , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Prognosis , Proportional Hazards Models , Reproducibility of Results
3.
J Vasc Interv Radiol ; 30(12): 1901-1907, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31530487

ABSTRACT

PURPOSE: To evaluate safety of endovascular coil fiducial placement and compare complication rates with transthoracic fiducial placement in patients with peripheral early-stage lung cancer receiving fiducial markers for stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS: This retrospective study included consecutive patients who received endovascular coils (n = 416 patients, n = 1,335 coils) or transthoracic fiducials (n = 30 patients, n = 80 fiducials) for SBRT between August 2005 and January 2017. During the first 3 years of the study period, patients preferentially received cylindrical platinum fiducial markers by percutaneous transthoracic placement; only patients with contraindications received endovascular coils. Thereafter, patients received endovascular fiducials as the first-line procedure. Endovascular embolization coils were placed via the femoral vein into subsegmental pulmonary artery branches near the tumor. Complications were scored by SIR criteria. RESULTS: The success rate of endovascular coil placement was 99.8%. One patient developed grade 2 hemoptysis requiring procedure discontinuation. Following placement, 1 patient (0.2%) developed grade 3 cardiac arrhythmia. A total of 36 patients (9%) developed grade 1 complications: mild hemoptysis (n = 4; 1%), small asymptomatic pulmonary infarction or hemorrhage (n = 30; 7%), hypoglycemia (n = 1; 0.2%), and vasovagal episode (n = 1; 0.2%). Following transthoracic marker placement, 4 patients (13%) developed a pneumothorax requiring hospital admission and chest tube (grade 2), 6 patients (20%) developed pneumothorax requiring no intervention (grade 1), 2 patients (7%) experienced asymptomatic pulmonary bleeding, and 1 patient (3%) developed persistent pain. CONCLUSIONS: Endovascular coil fiducial placement for lung SBRT is associated with high procedural success rates and lower rates of clinically relevant complications than transthoracic marker placement.


Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Embolization, Therapeutic/instrumentation , Endovascular Procedures/instrumentation , Fiducial Markers , Lung Neoplasms/surgery , Pulmonary Artery/diagnostic imaging , Radiosurgery/instrumentation , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/pathology , Embolization, Therapeutic/adverse effects , Endovascular Procedures/adverse effects , Female , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Radiosurgery/adverse effects , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
4.
Radiat Oncol ; 2: 2, 2007 Jan 03.
Article in English | MEDLINE | ID: mdl-17201913

ABSTRACT

Common complications of thoracic radiotherapy include esophagitis and radiation pneumonitis. However, it is important to be aware of uncommon post-radiotherapy complications such as bronchiolitis obliterans organizing pneumonia (BOOP). We report on two patients with carcinoma of the breast who developed an interstitial lung disease consistent with BOOP. BOOP responds to treatment with corticosteroids and the prognosis is generally good despite of the need for long-term administration of corticosteroids as relapses can occur during tapering of steroids. This report provides guidelines for the evaluation and treatment of patients with pulmonary infiltrates after radiotherapy.


Subject(s)
Breast Neoplasms/complications , Breast Neoplasms/radiotherapy , Carcinoma/complications , Carcinoma/diagnostic imaging , Cryptogenic Organizing Pneumonia/diagnosis , Cryptogenic Organizing Pneumonia/etiology , Radiation Pneumonitis/etiology , Radiotherapy/adverse effects , Aged, 80 and over , Cryptogenic Organizing Pneumonia/diagnostic imaging , Female , Humans , Lung/diagnostic imaging , Middle Aged , Radiation Injuries , Radiation Pneumonitis/diagnostic imaging , Tomography, X-Ray Computed/methods
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