Calculating interfractional prostate motion during radiation therapy course using fiducial markers.

PURPOSE: In this study we evaluated the day to day prostate displacement during radiation therapy by using implanted radiopaque fiducials and daily image guided position verification. METHODS: The data of 10 patients that received radiation therapy to the prostate were analyzed. Three fiducial markers were implanted in the prostate before treatment initiation for everyday verification of the target's position. Daily X ray images (kilovolt/KV films) of the pelvis were acquired for verification and were matched with baseline images produced during treatment preparation using bony structures and fiducials as landmarks. We calculated the mean difference between the two methods and the prostate displacement derived from these measurements. RESULTS: A total of 208 KV films were obtained. Our results showed a non-uniform prostate motion, with most of the displacements observed in the caudal direction followed by anterior, posterior, cranial, right and left. The mean target motion in each of the above directions was 3.5 mm, 3.5 mm, 3.3 mm, 3.9 mm, 2 mm and 2.4 mm. Based on the cumulative frequency of the target's displacement, a margin of 8 mm, 7mm, 5 mm, 4 mm, 9 mm and 7 mm in the anterior, posterior, left, right, cranial and caudal direction respectively would account for 95% of prostate's motion, provided that every day KV image guidance is performed. CONCLUSION: A non-isotopic margin of 8 mm, 7mm, 5 mm, 4 mm, 9 mm and 7 mm around the prostate can be considered safe for treatment delivery.

Late results of a randomized trial on the role of mild hypofractionated radiotherapy for the treatment of localized prostate cancer.

Background: Prostate cancer is considered to be highly sensitive to changes in radiation therapy dose per fraction, specifically to hypofractionation. An increase in the fractionation dose could cause a higher increase to the prostate than to the normal tissues leading to better disease control with less toxicity. Here we present the results of a randomized trial comparing mild hypofractionation to conventional fractionation after a median of 3,6 years follow up. Patients and Methods: 139 patients were randomized to receive either hypofractionated radiotherapy with 2,25 Gy/fr to a total of 72 Gy (arm 1) or conventionally fractionated treatment with 2Gy/fr to a total of 74 Gy (arm 2). 72 patients were assigned to arm 1 and 67 to arm 2. Results: After a median follow up of 3,6 years, 23 patients (31,9%) from arm 1 developed grade≥ 2 acute genitourinary toxicity and 21 (31,3%) from arm 2 (p=0,79). The corresponding values from gastrointestinal were 15 (20,8%) and 12 (17,9%) (p=0,6). For late toxicity from GU, 8 patients (11,1%) developed grade≥ 2 symptoms in arm 1 and 7 (10,4%) in arm 2 (p=0,92). late GI toxicity grade≥ 2 was observed in 8 (11,1%) patients in arm 1 and 8 (11,9%) in arm 2 (p=0,88). In multivariate analysis, hormone therapy was significantly associated with late GI events, while acute toxicity from both GU and GI was a prognostic factor of late adverse reaction. Conclusion: No difference in the toxicity profile could be identified between hypofractionation and conventional fractionation. Our schedule of 2,25Gy/fr seems safe and tolerable by the patients with acceptable rates of acute and late toxicity.

The role of hypofractionated radiotherapy for the definitive treatment of localized prostate cancer: early results of a randomized trial.

Background: Prostate cancer is considered to have a special biology which could affect the radiation therapy result based on the selected fractionation scheme. We present the preliminary results of a randomized trial comparing conventionally and hypofractionated radiation therapy for prostate cancer. Methods: Patients included in the study had localized prostate cancer (cT1c-T3bN0M0) and were randomly assigned to mild hypofractionated (72 Gy in 32 fractions, arm1) or conventionally fractionated (74 Gy in 37 fractions, arm2) radiation therapy treatment with Volumetric Arc Therapy technique. The treatment was delivered only to the prostate with or without the seminal vesicles according to physician's discretion and hormone therapy was optional according to the disease stage and comorbidities. Here we present the preliminary results of acute toxicity from the gastrointestinal (GI) and genitourinary (GU) system. Results: Between 2015 and 2016, 139 patients were enrolled. 67 patients were treated with conventional fractionation and 72 were treated with hypofractionation. Grade≥ 2 toxicity from GU and GI was observed in 23 and 21 patients (31,9% vs 31,3%, p=0,79) and 15 and 12 (20,8% vs 17,9%, p=0,6) for arm1 and arm2 respectively. No statistically significant differences were observed between arms in the incidence of early toxicity. There was no correlation observed between patient characteristics and toxicity from either GU or GI. Conclusions: Hypofractionated radiotherapy appears to be equally tolerated compared to conventional fractionation in the early setting. Longer follow up is needed to assess the late toxicity profile of the patients and any potential differences between the control and experimental arm.

Assessment of xerostomia and its impact on quality of life in head and neck cancer patients undergoing radiation therapy.

Xerostomia in head and neck (H&N) cancer patients significantly affects their quality of life (QoL). The aim of the present study was to investigate the associations among QoL, xerostomia and quantity of saliva in a sample of H&N cancer patients who had received conventional radiotherapy (RT). A total of 60 H&N adult patients were enrolled in this prospective study. The patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30), the Quality of Life Questionnaire Head and Neck Module (QLQ-H&N35) and the Greek version of the XQ questionnaire at 4 timepoints: At the beginning of RT, at the end of RT, 6 months after RT completion and 1 year after RT completion. Patients with distant metastases or serious comorbidities were excluded from the study. Salivary pH, and stimulated and unstimulated salivary flow rate were assessed. All functional scales and symptom scales, apart from cognitive functioning in QLQ-C30 and feeding tube in H&N35 exhibited an abrupt deterioration at timepoint 3 and were then gradually restored over time. The difference was statistically significant (P<0.001). XQ scores at different timepoints exhibited a statistically significant negative correlation with salivary flow rates. Salivary flow rate and XQ scores almost parallelled one another. Flow rates recovered at a mean level of 20% below baseline values at the end of the follow-up period. The subjective symptom of xerostomia parallelled salivary flow and QoL. Despite receiving conventional RT, the participants exhibited a considerable preservation of salivary gland function after 12 months, allowing some optimism regarding the course of xerostomia in selected patients.

Validity and reliability of the Greek version of the xerostomia questionnaire in head and neck cancer patients.

PURPOSE: Xerostomia after radiation therapy for head and neck (H&N) cancer has serious effects on patients' quality of life. The purpose of this study was to validate the Greek version of the self-reported eight-item xerostomia questionnaire (XQ) in patients treated with radiotherapy for H&N cancer. METHODS: The XQ was translated into Greek and administered to 100 XQ patients. An exploratory factor analysis was performed. Reliability measures were calculated. Several types of validity were evaluated. The observer-rated scoring system was also used. RESULTS: The mean XQ value was 41.92 (SD 22.71). Factor analysis revealed the unidimensional nature of the questionnaire. High reliability measures (ICC, Cronbach's α, Pearson coefficients) were obtained. Patients differed statistically significantly in terms of XQ score, depending on the RTOG/EORTC classification. CONCLUSION: The Greek version of XQ is valid and reliable. Its score is well related to observer's findings and it can be used to evaluate the impact of radiation therapy on the subjective feeling of xerostomia.

Comparison of the impact of radiotherapy and radiochemotherapy on the quality of life of 1-year survivors with cervical cancer.

Improvement of screening programs and new treatment strategies against cervical cancer (CC) have increased survival rates of patients in the last decades. As more women survive this type of cancer, their quality of life (QOL) has become a field of great scientific and social importance. Different types of therapy have varying results on the QOL of patients. In this study, we compared the impact of radiotherapy (RAD) and radiochemotherapy (RAD/CHEM) on CC patients' QOL. Our sample included 105 women who suffered from CC stages IA-IIIA. They were treated either with RAD or RAD/CHEM, and filled in the questionnaires 1 year after treatment completion. We used 4 questionnaires, EORTC QLQ C-30, EORTC QLQ-C24, Questionnaire of Post-traumatic Psychological Disorder, and Greek Symptom Control Questionnaire by M.D. Anderson, in order to assess their QOL. Except for differences in descriptive characteristics of the patients' (age, number of children, contraceptives) and early toxicity in some organs, no statistically significant difference was observed in the main (physical, sexual, emotional) aspects of life between the 2 groups of treated patients. Treatment type had no effect on total QOL. In conclusion, the addition of CHEM to RAD in the treatment plan of CC patients had no significant impact on their QOL.

Evaluation of cardiotoxicity five years after 2D planned, non-simulated, radiation therapy for left breast cancer.

INTRODUCTION: Radiation treatment has been associated with radiation induced cardiotoxicity, especially with older, long-outdated, techniques. Such complications include pericarditis, myocardial fibrosis, valvular injury, ischemic heart disease, and myocardial infarction. AIM: To assess the effect of outdated breast radiation therapy (RT) - using a diagnostic CT scanner in the absence of a CT simulator - on cardiac function in women with stage II left breast cancer. PATIENTS AND METHODS: Sixty-two women under 65 with stage II left breast cancer who received post-operative RT using a diagnostic computed tomography scanner were studied between 1997 and 2001. Participants underwent a clinical interview, ECG, and echocardiography before and 6 months and 5 years after RT. RESULTS: There was no serious cardiotoxicity at 6 months and 5 years after radiotherapy. A 23% increase in hypertensive patients, and a slight decrease (2.3%) in ejection fraction was observed after 5 years, with 3 patients (5%) developing abnormalities. Two patients presented abnormal electrocardiographic findings within 6 months of RT. CONCLUSION: Our study showed that RT for left breast cancer was not associated with significant alteration in heart morbidity or mortality within 5 years of treatment, despite the lack of a simulator.