ABSTRACT
BACKGROUND: Evaluate the safety, toxicity and efficacy of an institutional-simplified SBRT protocol with two short SBRT regimens (three or five fractions) for the treatment of lung cancer and oligometastases, according to the volume and localization of tumours. METHODS: Patients with stage I (T1 or T2) non-small cell lung cancer or lung oligometastases were treated from August 2011 to October 2015. Patients were required to be considered medically inoperable and were discussed in a multidisciplinary team. RESULTS: 100 patients were analysed, 59 had a peripheral location (P), and 41 a central location (C).All patients finished their SBRT course without interruptions related to acute toxicity. The most frequent acute toxicity was grade 1 asthenia, only one patient developed grade 3 toxicity (pneumonitis) and there were no grade 4 or 5 acute toxicities. Three asymptomatic radiation-induced rib fractures were identified, the 1 and 2-year rib fracture-free survival were 97% and 94%, respectively. Two-year progression-free survival and 2-year overall survival of all patients were 52% and 70%, respectively, with a median PFS and OS of 26 and 43 months. Survival free of local progression (SFLP) at 2 years was 89%. A higher PFS in primary lung cancer compared with metastatic tumours was observed, with a median of 35 months with 19 months (p = 0.01). However, no statistical difference was observed in terms of OS between both diseases. CONCLUSIONS: SBRT in lung cancer with three sessions for peripheral tumours and five sessions for central tumours may be safely delivered, with low morbidity.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/classification , Lung Neoplasms/surgery , Radiosurgery/methods , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/secondary , Female , Follow-Up Studies , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Radiotherapy Dosage , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Head and neck cancer recurrence is a therapeutic challenge due to the anatomical and functional constraints of the head and neck area. Stereotactic body radiotherapy (SBRT) is a high-precision technique of radiotherapy that consists of delivering a high ablative biological dose in 1-5 high-dose fractions, requiring a very high precision of the radiotherapy process with potential application in this clinical setting METHODS: Different studies that investigate the role of SBRT in the treatment of recurrent head and neck cancer have been reviewed. Indications to properly select patients for this treatment are presented. RESULTS: Retrospective studies and phase I-II trials with selected patients have shown low to moderate toxicity, with an efficacy at least similar to that of treatment with combinations of radiotherapy and chemotherapy. In selected patients, SBRT is a treatment option for recurrent head and neck cancer with low toxicity. DISCUSSION: New prospective studies should clarify data regarding the efficacy and toxicity of SBRT in head and neck cancer recurrence.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Radiosurgery/methods , Clinical Trials, Phase I as Topic , Clinical Trials, Phase II as Topic , Humans , Prospective Studies , Radiosurgery/adverse effects , Re-Irradiation , Retrospective StudiesSubject(s)
Cranial Irradiation/methods , Lung Neoplasms/radiotherapy , Small Cell Lung Carcinoma/radiotherapy , Antineoplastic Agents/therapeutic use , Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , Clinical Trials as Topic , Disease-Free Survival , Dose Fractionation, Radiation , Humans , Lung Neoplasms/pathology , Medical Oncology/methods , Neoplasm Metastasis , Remission Induction , Small Cell Lung Carcinoma/pathology , Treatment OutcomeSubject(s)
Humans , Male , Female , Clinical Trials as Topic , Cranial Irradiation/instrumentation , Cranial Irradiation/methods , Brain Neoplasms/radiotherapy , Cranial Irradiation , Lung Neoplasms/radiotherapy , Small Cell Lung Carcinoma/radiotherapy , Antineoplastic Agents/therapeutic use , Brain Neoplasms/secondary , Disease-Free Survival , Dose Fractionation, Radiation , Lung Neoplasms/pathology , Medical Oncology/methods , Neoplasm Metastasis , Remission Induction/methods , Small Cell Lung Carcinoma/pathology , Treatment OutcomeABSTRACT
Hot flashes are a common and disturbing adverse effect of hormonal therapy for cancer. Their pathophysiology is poorly understood. At present, the leading mechanistic hypothesis rests on the assumption that abrupt hormone deprivation will result in loss of negative feedback over hypothalamic noradrenaline synthesis. In this article we critically review the different theories used to explain this phenomenon. A better understanding of the pathophysiology of hot flashes may facilitate the development of new therapeutic approaches (AU)
