Topical natural-origin polynucleotides in radiation-induced skin and mucosal toxicity.

Seventy to 90 percent of patients who have received radiation treatment struggle with radiation skin and mucosal toxicity. The inflicted damage to progenitor cells and local microcirculation makes it more likely that wounds, infections, and fibrosis may occur; lesions of variable severity often co-exist. Acute erythema, hyperpigmentation, and mild desquamation usually wane in weeks and require only minor treatment. Conversely, the management of persistent radiation dermatitis and telangiectasia remains unsatisfactory; chronic lesions may progress to tissue atrophy and disfiguring fibrosis.

Policies for reirradiation of recurrent high-grade gliomas: a survey among Italian radiation oncologists.

PURPOSE: To assess the contribution of Italian radiation oncologists in the current management of recurrent high-grade gliomas (HGG), focusing on a reirradiation (reRT) approach. METHODS: In 2015, the Reirradiation and the Central Nervous System Study Groups on behalf of the Italian Association of Radiation Oncology (AIRO) proposed a survey. All Italian radiation oncologists were individually invited to complete an online questionnaire regarding their clinical management of recurrent HGG, focusing on a reRT approach. RESULTS: A total of 37 of 210 questionnaires were returned (18% of all centers): 16 (43%) from nonacademic hospitals, 14 (38%) from academic hospitals, 5 (13%) from private institutions, and 2 (6%) from hadron therapy centers. The majority of responding centers (59%) treated ≤5 cases per year. Performance status at the time of recurrence, along with a target diameter <5 cm and an interval from primary radiation ≥6 months, were the prevalent predictive factors considered for reRT. Sixty percent of reirradiated patients had already received a salvage therapy, either chemotherapy (40%) or reoperation (20%). The most common approach for reRT was fractionated stereotactic radiotherapy to a mean (photon) dose of 41.6 Gy. CONCLUSIONS: Although there were wide variations in the clinical practice of reRT across the 37 centers, the core activities were reasonably consistent. These findings provide a basis for encouraging a national collaborative study to develop, implement, and monitor the use of reRT in this challenging clinical setting.

Weekly concomitant boost in adjuvant radiotherapy for patients with early breast cancer: preliminary results on feasibility.

AIMS AND BACKGROUND: Recent advances in the management of patients with breast cancer are focused toward the reduction of overall treatment time of radiotherapy by delivering a dose biologically equivalent to a standard schedule. The aim of the present study was to evaluate the feasibility and preliminary toxicity of a moderately hypofractionated whole breast irradiation schedule with the addition of a concomitant boost delivered to the tumor bed once-a-week in patients with early breast cancer submitted to conservative surgery. MATERIALS: We selected patients with pT1c and pT2 N0/N+ M0 carcinoma of the breast with negative surgical margins. The basic course consisted of 4600 cGy prescribed to the ICRU 50 reference point dose and delivered in 20 fractions, 4 times a week for 5 weeks. Once a week, immediately after whole breast irradiation, a concomitant photon boost of 120 cGy was delivered to the lumpectomy area. Overall, according to the linear-quadratic model, the schedule provides a biologically equivalent dose of 87 Gy for breast tumor (assuming alpha/beta = 4 Gy), of 66 Gy for acute responding normal tissues (assuming alpha/beta = 10 Gy), and 99 Gy for late responding normal tissues (assuming alpha/beta = 3 Gy). Biologically, the schedule compares favorably with the 6-week conventional regimen consisting of 50 Gy, 2 Gy/fraction, followed by a 10 Gy boost (BED(tumor), 90 Gy; BED(acute effects), 72 Gy, and BED(late effects), 100 Gy). RESULTS: From November 2004 to April 2007, we tested this radiotherapy schedule in 176 patients. All enrolled patients had achieved a minimum follow-up of 6 months and were considered in detail for the evaluation of feasibility. Three clinical examinations were performed by a group of independent physicians at treatment end, after 1 month and after 6 months. According to the RTOG/EORTC Toxicity Criteria, of the 176 assessable patients at the end of radiotherapy, 58% showed grade 0-1 skin toxicity, 30% grade 2 and 12% grade 3. At one month of follow-up, grade 0 toxicity was observed in 47% of cases, grade 1 in 46% and grade 2 in 7%. At 6 months, late (skin and subcutaneous tissue) toxicity was assessed with the following scores: grade 0 in 68%, grade 1 in 26% and grade 2 in 6% of the patients. At 6 months, cosmesis was excellent, good and fair in 71%, 24% and 5% of patients, respectively. CONCLUSIONS: The explored adjuvant schedule planned to intensify the radiotherapy course for patients with early breast cancer by adding a weekly concomitant boost appears to be feasible and provides low local toxicity and excellent to good short-term cosmetic results.