BACKGROUND: Stereotactic ablative radiotherapy (SABR) is the standard treatment for medically inoperable early-stage non-small cell lung cancer (ES-NSCLC), but which patients benefit from stereotactic radiotherapy is unclear. The aim of this study was to analyze prognostic factors for early mortality. METHODS: From August 2010 to 2022, 617 patients with medically inoperable, peripheral or central ES-NSCLC were treated with SABR at our institution. We retrospectively evaluated the data from 172 consecutive patients treated from 2018 to 2020 to analyze the prognostic factors associated with overall survival (OS). The biological effective dose was > 100 Gy10 in all patients, and 60 Gy was applied in 3-5 fractions for a gross tumor volume (GTV) + 3 mm margin when the tumor diameter was < 1 cm; 30-33 Gy was delivered in one fraction. Real-time tumor tracking or an internal target volume approach was applied in 96% and 4% of cases, respectively. In uni- and multivariate analysis, a Cox model was used for the following variables: ventilation parameter FEV1, histology, age, T stage, central vs. peripheral site, gender, pretreatment PET, biologically effective dose (BED), and age-adjusted Charlson comorbidity index (AACCI). RESULTS: The median OS was 35.3 months. In univariate analysis, no correlation was found between OS and ventilation parameters, histology, PET, or centrality. Tumor diameter, biological effective dose, gender, and AACCI met the criteria for inclusion in the multivariate analysis. The multivariate model showed that males (HR 1.51, 95% CI 1.01-2.28; p = 0.05) and AACCI > 5 (HR 1.56, 95% CI 1.06-2.31; p = 0.026) were significant negative prognostic factors of OS. However, the analysis of OS showed that the significant effect of AACCI > 5 was achieved only after 3 years (3-year OS 37% vs. 56%, p = 0.021), whereas the OS in one year was similar (1-year OS 83% vs. 86%, p = 0.58). CONCLUSION: SABR of ES-NSCLC with precise image guidance is feasible for all medically inoperable patients with reasonable performance status. Early deaths were rare in our real-life cohort, and OS is clearly higher than would have been expected after best supportive care.
- MeSH
- analýza přežití MeSH
- kohortové studie MeSH
- lidé MeSH
- malobuněčný karcinom plic * patologie MeSH
- nádory plic * radioterapie chirurgie MeSH
- nemalobuněčný karcinom plic * radioterapie chirurgie MeSH
- radiochirurgie * metody MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Východiska: Stereotaktická radioterapie (stereotactic body radiation therapy – SBRT) či stereotaktická ablativní radioterapie (stereotactic ablative radiotherapy – SABR) se stala standardem léčby u pacientů s časným stadiem nemalobuněčného karcinomu plic (early-stage non-small cell lung cancer – ES-NSCLC), kteří nejsou způsobilí k chirurgickému zákroku nebo operaci odmítají. SBRT je metoda zevní radioterapie, která přesně dodává vysokou dávku záření v jedné nebo několika léčebných frakcích. Režimy s biologicky ekvivalentní dávkou ≥ 100 Gy jsou spojeny s dobrou lokální kontrolou a celkovým přežitím, vyšším než u konvenčně frakcionované radioterapie. V indikaci SBRT stále existují sporné oblasti, kde jsou údaje omezené – indikace u starších a komorbidních pacientů, indikace léčby bez histologické verifikace, léčba centrálních/ultracentrálních lézí, indikace u tumorů větších než 5 cm, indikace u operabilních pacientů. Rovněž optimální postup při sledování pacientů po SBRT pro ES-NSCLC zůstává nejasný, vč. frekvence zobrazování, použití PET-CT a požadavků na biopsii. CT změny po SBRT se liší od změn po konvenční radioterapii a je obtížné je odlišit od recidivy nádoru. Vzhledem k vysoké míře lokální kontroly po SBRT plic jsou data o léčbě lokálního selhání nedostatečná. Cíl: Cílem sdělení je shrnout současné poznatky o významu SBRT v indikaci časného karcinomu plic nemalobuněčného typu.
Background: Stereotactic body radiation therapy (SBRT) is now a standard treatment option for patients with early-stage non-small cell lung cancer (ES-NSCLC) who are unfit for surgery or refuse to undergo an operation. SBRT is a method of external beam radiotherapy that accurately delivers a high dose of irradiation in one or few treatment fractions. Intensive regimens of biologically effective dose ≥ 100 Gy are associated with good local control and overall survival, higher than in conventionally fractionated radiotherapy. There are still controversial areas in the SBRT indication where data are limited – indications for elderly and comorbid patients, indications for treatment without histological verification, treatment of central/ultracentral lesions, indications for tumors larger than 5 cm, indications for operable patients. The optimal follow-up practice of these patients also remains unclear, including the frequency of imaging, the use of PET-CT, and requirements for biopsy. CT changes after SBRT differ from those following conventional radiotherapy and it is difficult to distinguish them from tumor recurrence. Due to the high local control achieved with lung SBRT, data on the treatment of local failure are insufficient. Purpose: The aim of the publication is to demonstrate the current information and the importance of SBRT for patients with ES-NSCLC.
- Klíčová slova
- časné stadium nemalobuněčného karcinomu plic,
- MeSH
- lidé MeSH
- nemalobuněčný karcinom plic * chirurgie radioterapie MeSH
- radiochirurgie * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
INTRODUCTION: The incidence of advanced oral cavity and oropharyngeal cancers is generally high. Treatment outcomes for patients, especially those unfit for comprehensive cancer treatment, are unsatisfactory. Therefore, the search for factors to predict response to treatment and increase overall survival is underway. OBJECTIVE: This study aimed to analyze the presence of 32 HPV genotypes in tumor samples of 34 patients and the effect of HPV status and RAD51 on overall survival. METHOD: Tumor samples of 34 patients with locally advanced oropharyngeal or oral cavity cancer treated with accelerated radiotherapy in monotherapy were analyzed using reverse hybridization and immunohistochemistry for the presence of HPV and RAD51. Its effect on overall survival was examined. RESULTS: Only two types of HPV were identified-HPV 16 (dominant) and HPV 66 (two samples). The HPV positivity was associated with a borderline insignificant improvement in 2-year (p = 0.083), 5-year (p = 0.159), and overall survival (p = 0.083). Similarly, the RAD51 overexpression was associated with borderline insignificant improvement in 2-year (p = 0.083) and 5-year (p = 0.159) survival. CONCLUSION: We found no statistically significant differences but detected trends toward improvement in the survival of HPV-positive and RAD51 overexpressing patients unfit for surgical treatment or chemotherapy treated with hyperfractionated radiotherapy. The trends, however, indicate that in a larger group of patients, the effects of these two parameters would likely be statistically significant.
- MeSH
- infekce papilomavirem * komplikace MeSH
- lidé MeSH
- nádory orofaryngu * MeSH
- prognóza MeSH
- rekombinasa Rad51 MeSH
- spinocelulární karcinom * patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: To report prostate deformation during treatment, based on an analysis of fiducial marker positional differences in a large sample. MATERIAL AND METHODS: This study included 144 patients treated with prostate stereotactic body radiation therapy after implantation in each of 4 gold fiducial markers (FMs), which were located and numbered consistently. The center of mass of the FMs was recorded for every pair of X-ray images taken during treatment. The distance between each pair of fiducials in the live X-ray images is calculated and compared with the respective distances as determined in the CT volume. The RBE is the difference between these distances. Mean RBE and intrafraction and interfraction RBE were evaluated. The intrafraction and intefraction RBE variability were defined as the standard deviation, respectively, of all RBE during 1 treatment fraction and of the mean daily RBE over the whole treatment course. RESULTS: We analyzed 720 treatment fractions comprising 24,453 orthogonal X-ray image acquisitions. We observed a trend to higher RBE related to FM4 (apex) during treatment. The fiducial marker in the prostate apex could not be used in 16% of observations, in which RBE was > 2.5 mm. The mean RBEavg was 0.93 ± 0.39 mm (range 0.32-1.79 mm) over the 5 fractions. The RBEavg was significantly lower for the first and second fraction compared with the others (P < .001). The interfraction variability of RBEavg was 0.26 ± 0.16 mm (range 0.04-0.74 mm). The mean intrafraction variability of all FMs was 0.45 ± 0.25 mm. The highest Pearson correlation coefficient was observed between FM2 and FM3 (middle left and right prostate) (R = 0.78; P < .001). Every combination with FM4 yielded lower coefficients (range 0.66-0.71; P < .001), indicating different deformation of the prostate apex. CONCLUSIONS: Ideally, prostate deformation is generally small, but it is very sensitive to rectal and bladder filling. We observed RBE up to 11.3 mm. The overall correlation between FMs was affected by shifts of individual fiducials, indicating that the prostate is not a "rigid" organ. Systematic change of RBE average between subsequent fractions indicates a systematic change in prostate shape.
- MeSH
- celková dávka radioterapie MeSH
- hypofrakcionace při ozařování MeSH
- lidé MeSH
- nádory prostaty diagnostické zobrazování patologie radioterapie MeSH
- plánování radioterapie pomocí počítače metody MeSH
- počítačová rentgenová tomografie metody MeSH
- počítačové zpracování obrazu metody MeSH
- pohyb MeSH
- protézy a implantáty * MeSH
- radioterapie řízená obrazem metody MeSH
- radioterapie s modulovanou intenzitou metody MeSH
- zaměřovací značky pro radioterapii statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: We evaluated the efficiency and toxicity of stereotactic hypofractionated boost in combination with conventionally fractionated radiotherapy in the treatment of advanced floor of the mouth cancer. METHODS: Thirty-seven patients with advanced stage of the floor of the mouth cancer, histologically confirmed squamous cell carcinoma (p16 negative) ineligible for surgical treatment, were indicated for radiochemotherapy or hyperfractionated accelerated radiotherapy (HART). The radiotherapy protocol combined external beam radiotherapy (EBRT) and a stereotactic hypofractionated boost to the primary tumor. The dose delivered from EBRT was 70-72.5 Gy in 35/50 fractions. The hypofractionated boost followed with 10 Gy in two fractions. For the variables-tumor volume, stage and grade a multivariate analysis was performed to find the relationship between overall survival, local progression and metastasis. Toxicity was evaluated according to CTCAE scale version 4. RESULTS: After a median follow-up of 16 months, 23 patients (62%) achieved complete remission. The median time to local progression and metastasis was 7 months. Local control (LC) at 2 and 5-years was 70% and 62%, respectively. Progression-free survival (PFS) and overall survival (OS) were 57% and 49% at 2 years and 41% and 27% at 5 years, respectively. Statistical analysis revealed that larger tumors had worse overall survival and a greater chance of metastasis. Log-Rank GTV > 44 ccm (HR = 1.96; [95% CI (0.87; 4.38)]; p = 0.11). No boost-related severe acute toxicity was observed. Late osteonecrosis was observed in 3 patients (8%). CONCLUSION: The combination of EBRT and stereotactic hypofractionated boost is safe and seems to be an effective option for dose escalation in patients with advanced floor of the mouth tumors who are ineligible for surgical treatment and require a non-invasive approach.
- MeSH
- chemoradioterapie MeSH
- dospělí MeSH
- frakcionace dávky záření * MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory úst mortalita patologie radioterapie MeSH
- následné studie MeSH
- pilotní projekty MeSH
- progrese nemoci MeSH
- radiochirurgie metody MeSH
- radioterapie s modulovanou intenzitou metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spinocelulární karcinom mortalita patologie radioterapie MeSH
- studie proveditelnosti MeSH
- tumor burden MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- Geografické názvy
- Česká republika MeSH
Východiska: Nazofaryngeální tumory jsou v našich zeměpisných šířkách vzácným onemocněním. Kvůli anatomickým poměrům a špatné operabilitě je jako primární léčebná modalita využívána radikální radioterapie s chemoterapií nebo bez ní. Vzhledem k očekávanému dlouhodobému přežití jsou hledány cesty ke zvýšení lokální kontroly za únosné toxicity léčby. Soubor pacientů a metody: Na Klinice onkologické Fakultní nemocnice Ostrava bylo v letech 2010–2014 léčeno 14 pacientů s pokročilým nemetastatickým spinocelulárním karcinomem nazofaryngu stadia II–IVa. Jedenáct (79 %) pacientů bylo léčeno dávkou 70 Gy na primární tumor a postižené lymfatické uzliny normofrakcionovaně (à 2 Gy) a 56 Gy (à 1,6 Gy) na elektivní lymfatické uzliny technikou radioterapie s modulovanou intenzitou s integrovaným konkomitantním boostem. Tři (21 %) pacienti z důvodů komplikací nebo celkového stavu ukončili radioterapii dříve. Devět (64 %) pacientů bylo ozářeno s konkomitantní chemoterapií a 6 (43 %) pacientů dále podstoupilo adjuvantní chemoterapii. Čtrnáct (100 %) pacientů do měsíce od radikální radioterapie absolvovalo cyberboost na oblast primárního tumoru a metastatických lymfatických uzlin, 5 (36 %) nemocných 5 Gy v 1 frakci a 9 (64 %) nemocných 10 Gy ve 2 frakcích. Výsledky: Z 14 pacientů dosáhlo lokální kompletní remise po léčbě 10 (71 %) pacientů. Dva (14 %) pacienti měli poléčebný lokální nález zhodnocen jako stacionární, u 1 byla konstatována lokální progrese s generalizací za 18 měsíců a u druhého pacienta za 13 měsíců. Jeden pacient s poradiační kompletní remisí zgeneralizoval za 43 měsíců při lokální kompletní remisi onemocnění. Průměr 24,6 měsíce do progrese. Pětiletého přežití dosáhlo 9 (64 %) pacientů za akceptovatelné akutní i pozdní toxicity. Závěr: Stereotaktický boost po absolvování komplexního radiačního programu, s přidáním konkomitantní a adjuvantní chemoterapie nebo bez ní, přináší dobrou lokální kontrolu a 5leté přežití za uspokojivé toxicity léčby.
Background: Nasopharyngeal tumors are a rare disease in our latitudes. Due to anatomical conditions and poor operability, radical radiotherapy with or without chemotherapy is used as a primary treatment modality. Due to the unsatisfactory treatment outcomes, ways to intensify the therapy and increase the curable potential under tolerable toxicity are sought. Patients and methods: Fourteen patients with advanced nasopharyngeal non-metastatic squamous cell carcinoma, stage II–IVa, were treated at the Department of Oncology of the University Hospital Ostrava in 2010–2014. Eleven (79%) patients were treated with 70 Gy per primary tumor normalized (2 Gy) and affected lymph nodes and with 56 Gy (à 1,6 Gy) for elective lymph nodes by intensity modulated radiotherapy with integrated concomitant boost. Three (21%) patients completed radiotherapy earlier due to complications or general condition. Nine (64%) patients were exposed to concomitant chemotherapy and 6 (43%) received adjuvant chemotherapy. Fourteen (100%) patients underwent cyberboost in the primary tumor and affected lymph nodes (if any) area within a month of radical radiotherapy, five (36%) patients received 5 Gy in one fraction and nine (64%) patients received 10 Gy in 2 fractions. Results: Out of the 14 patients, local complete remission was achieved in 10 (71%) of them after the treatment. Two (14%) patients had a post-treatment local finding as stationary, local progression with generalization occurred in one case at 18 months and in another patient at 13 months. In one patient with complete remission after the primary treatment, distant metastasis occurred in 43 months at the time of local complete remission of the disease. The average time to progression was 24.6 months. Five (64%) patients achieved 5-year survival with satisfactory toxicity of treatment. Conclusion: Stereotactic boost after a comprehensive radiation program, with or without addition of concomitant and adjuvant chemotherapy, provides good local control and 5-year survival with satisfying toxicity of the treatment.
- Klíčová slova
- ozáření hlavy a krku,
- MeSH
- lidé MeSH
- nádory nosohltanu * chirurgie radioterapie MeSH
- radiochirurgie * metody MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
