Evaluation of efficacy and toxicity in two different hypofractionated 3D-conformal external beam radiotherapy schedules in localised muscle invasive bladder cancer.

PURPOSE: To evaluate the efficacy as well as acute and late toxicity of two different accelerated hypofractionated 3D-conformal radiotherapy (Hypo-3DCRT) schedules in patients with bladder cancer. METHODS: Between February 2006 and June 2011, 50 elderly patients with cT1-2N0 bladder carcinoma were treated with Hypo-3DCRT. Mean age was 75 years. All patients were medically inoperable, with poor performance status, who couldn't tolerate either cystectomy or radical external beam irradiation on a daily basis. A dose of 36 Gy in 6 weekly fractions (arm A, N=39) or 39.96 Gy of 3.33 Gy twice daily, once a week, for 6 weeks (arm B, N=11) were prescribed. The primary study endpoints were the evaluation of acute/late gastrointestinal (GI) toxicity according to the EORTC/RTOG scale together with the visual analogue bladder-related pain score (VAS). RESULTS: The GI acute toxicities were: grade 1: arm A 24/39 (61.5%), arm B 9/11 (81.8%); grade 2: arm A 14/39 (35.9%), arm B 1/11 (9.1%); grade 3: arm A 1/39 (9.1%) (x(2), p=0.29). Only grade 1 late GI toxicity was seen and was significantly higher in arm A: arm A 17/39 (43.6%) and arm B 1/11 (9.1%) (x(2), p=0.037). The reduction of VAS score was similar in both arms (p=0.065). The median relapse free survival (RFS) was 15 and 16 months for arm A and B, respectively (log rank, p=0.71). CONCLUSIONS: Beyond the non-randomized design of the trial, the Hypo-3DCRT schedules used appear to be an acceptable alternative to the traditional longer radiotherapy (RT) schedules for elderly patients unfit for daily irradiation.

A weekly hypofractionated radiotherapeutic schedule for bladder carcinoma in elderly patients: local response, acute and late toxicity, dosimetric parameters and pain relief.

PURPOSE: To investigate the early and late toxicity of a hypofractionated radiotherapy (RT) schedule to treat muscle- invasive bladder cancer in relation to radiation parameters according to the organs at risk. METHODS: Forty-three patients with T2-T3 bladder carcinoma were irradiated with a weekly hypofractionated schedule with a total dose of 36 Gy in 6 fractions. Included in this study were elderly patients with poor performance status or unfit for surgery, while they complained of daily pain on urination. Pain evaluation was assessed with the use of the visual analogue scale (VAS) of pain, acute and late toxicities were assessed using the combined RTOG/EORTC criteria by using a dose of 50 Gy (D50), and the relapse free survival (RFS) was estimated from the date of recurrence. RESULTS: No acute side effects were observed in the majority of the patients. Grade I rectal toxicity was registered in 67.4% of the patients, while grade II and III were noted in 30.25% and 2.37percnt; of the patients, respectively. The worst late rectal toxicity was grade I in 30.2% of the patients. The VAS score of pain showed a significant improvement after the hypofractionated schedule. There was a significant correlation between acute and late toxicity on the one hand and the D50 dosimetric parameter on the other. The Kaplan-Meier plot showed a median RFS of 15 months, while age did not have any impact on RFS in patients above or under 75 years of age. CONCLUSION: The performed hypofractionated schedule permitted delivery of an increased radiation dose without increased toxicity, and with a high probability of local control for elderly patients with low survival perspective.

Structure and function of the oncologic boards in Greece. Description of the institutional and scientific frame; objective problems and difficulties.

PURPOSE: Oncology boards should constitute a routine in all hospitals that are dealing with the care of cancer patients. Unfortunately the procedure which should be followed to deal with this health problem has some deficiencies. METHODS: A literature review has recently been attempted, searching Internet databases by using key words such as oncologic board, medical legislation and medical ethics. RESULTS: Current mentality suggests that hiding the truth from the patient is wrong and unethical. However, in the Greek society, this is not the case as it seems not right to adopt foreign practices, i.e. to disclose directly to the patient all information relevant to his health status, the intended therapy and possible outcome. Instead, ambiguous information pass onto relatives who in turn bear the burden of informing the patient. CONCLUSIONS: The best solution would be the integration of the positive elements of the patient's awareness and the beneficial effects of the involvement of the Greek family in the general care of the cancer patient.

Radiotherapy for Hodgkin's lymphoma: too hard to die?

The treatment of Hodgkin's lymphoma (HL) is associated with significant toxicity. The objective of high quality management is to keep the concept of combined modality, while trying to decrease the radiation dose, to diminish to a great extent the irradiated volume and at the same time to reduce the number of chemotherapy courses, introducing the so-called optimisation. New directives should be followed to obtain more effective treatments of HL. Shorter cycles of chemotherapy and the utilization of modern techniques in radiotherapy (RT) constitute fundamental steps to achieve this objective. Analysis of randomized studies supports the inclusion of reduced-field and dose of RT in the radiotherapeutic treatment options for HL. RT is an integral part of the combined-modality therapy (CMT) of HL.

Gastric cancer and adjuvant chemoradiotherapy: when and where, that's the question.

PURPOSE: Although the incidence of gastric cancer is decreasing, there were still 159,900 new cases and 118,200 deaths in Europe in 2006 representing the 5th highest incidence and 4th highest cause of cancer-related deaths. Postoperative adjuvant chemoradiotherapy has been demonstrated to result in a significant improvement in overall and disease-free survival. We studied the current role of adjuvant chemoradiotherapy in gastric cancer. METHODS: Randomized phase III studies and selected phase II studies for adjuvant chemoradiotherapy in gastric cancer were searched in PUBMED using key words. Also, international treatment guidelines as well as review papers were searched and analysed. RESULTS: Based on the published literature, treatment guidelines and reports from international meetings it is obvious that adjuvant chemoradiotherapy in gastric cancer contributes in improved treatment results. CONCLUSION: Surgical resection remains the cornerstone of curative treatment for gastric cancer. The combination of modern radiotherapy techniques with chemotherapy is feasible, safe and improves overall survival of patients with gastric cancer.

Conventional versus virtual simulation for radiation treatment planning of prostate cancer: final results.

PURPOSE: Radiotherapy is widely used to treat patients with prostate cancer. Using conventional x-ray simulation is often difficult to accurately localize the extent of the tumor, to cover exactly the lymph nodes at risk and shield the organs at risk. We report on the results of a study comparing target localization with conventional and virtual simulation. METHODS: One hundred prostate cancer patients underwent both conventional and virtual simulation. The conventional simulation films were compared with digitally reconstructed radiographs (DDRs) produced from the computed tomography (CT) data. All patients underwent target localization for radical prostate radiotherapy. The treatment fields were initially marked with a conventional portal film on linear accelerator (LINAC), plain x-ray film and available diagnostic imaging. Each patient then had a CT and these simulated treatment fields were reproduced within the virtual simulation planning system. The treatment fields defined by the clinicians using each modality were compared in terms of field area and implications for target coverage. RESULTS: Virtual simulation showed significantly greater clinical tumor volume coverage and less normal tissue volume irradiated compared with conventional simulation (p <0.001). CONCLUSION: CT localization and virtual simulation allow more accurate definition of the clinical target volume. This could enable a reduction in geographical misses, reducing at the same time treatment-related toxicity.

Comparison of conventional and virtual simulation for radiation treatment planning of prostate cancer.

PURPOSE: radiotherapy is widely used to treat patients with prostate cancer. Using conventional x-ray simulation is often difficult to accurately localize the extent of the tumor, to cover exactly the lymph nodes at risk and shield the organs at risk. We report the initial results of a study conducted to compare target localization with conventional and virtual simulation. METHODS: fifty patients with prostate cancer underwent target localization for radical prostate radiotherapy using conventional and virtual simulation. The treatment fields were initially marked with a conventional portal film on LINAC, plain x-ray film and available diagnostic imaging. Each patient then had a computed tomography (CT) and these simulated treatment fields were reproduced within the virtual simulation planning system. The treatment fields defined by the clinicians using each modality were compared in terms of field area and implications for target coverage. RESULTS: there was significantly greater clinical tumor volume coverage using virtual simulation compared with conventional simulation and less normal tissue volume irradiated (p<0.001). CONCLUSION: CT localization and virtual simulation allow for more accurate definition of the clinical target volume. This could enable a reduction in geographical misses, while also reducing treatment-related toxicity.