BACKGROUND: We retrospectively analyzed the 5-year biochemical disease-free survival (bDFS) and occurrence of late toxicity in prostate cancer patients treated with pencil beam scanning (PBS) proton radiotherapy. METHODOLOGY: In the period from January 2013 to June 2018, 853 patients with prostate cancer were treated with an ultra-hypofractionated schedule (36.25 GyE/five fractions). The mean PSA value was 6.7 (0.7-19.7) μg/L. There were 318 (37.3%), 314 (36.8%), and 221 (25.9%) patients at low (LR), favorable intermediate (F-IR), and unfavorable intermediate risk (U-IR), respectively. Neoadjuvant hormonal therapy was administered to 197 (23.1%) patients, and 7 (0.8%) patients had adjuvant hormonal therapy. The whole group of patients reached median follow-up time at 62.7 months, and their mean age was 64.8 (40.0-85.7) years. The bDFS rates and late toxicity profile were evaluated. RESULTS: Median treatment time was 10 (7-38) days. Estimated 5-year bDFS rates were 96.5%, 93.7%, and 91.2% for low-, favorable intermediate-, and unfavorable intermediate-risk groups, respectively. Cumulative late toxicity (CTCAE v4.0) of G2+ was as follows: gastrointestinal (GI)-G2: 9.1%; G3: 0.5%; genitourinary (GU)-G2: 4.3%, and no G3 toxicity was observed. PSA relapse was observed in 58 (6.8%) patients: 16 local, 22 lymph node, 4 bone recurrences, and 10 combined sites of relapse were detected. Throughout the follow-up period, 40 patients (4.7%) died, though none due to prostate cancer. CONCLUSION: Ultra-hypofractionated proton beam radiotherapy is an effective treatment for low- and favorable intermediate-risk prostate cancer, with long-term bDFS rates comparable to other techniques. It is promising for unfavorable intermediate-risk prostate cancer and has acceptable long-term GI and favorable GU toxicity.
- Publikační typ
- časopisecké články MeSH
Radioterapie je základní léčebnou modalitou v terapii jak časného stadia, tak lokálně pokročilého nemalobuněčného karcinomu plic (NSCLC), může však být velice technicky náročným procesem díky blízkosti kritických orgánů. Použití protonové terapie otevírá možnosti využití fyzikální výhody charakteristického Braggova peaku, který umožňuje navýšit dávku do cílového objemu při významnějším šetření normální okolní tkáně a tím v konečném důsledku i zvýšení lokální kontroly a celkového přežití při zachování kvality života redukcí toxicity související s léčbou.
Radiation therapy is an essential component of treatment for early stages and also for locally advanced non-small cell lung cancer (NSCLC), but can be technically challenging because of the proximity of lung tumors to nearby critical organs. Using proton therapy offers the potential for further advantages because of the unique depth-dose characteristics of the particles (Bragg peak), which can allow higher dose escalation to tumors with greater sparing of normal tissues, with the ultimate goal of improving local tumor control and survival while preserving quality of life by reducing treatment-related toxicity.
Primární synchronně zjištěný bilaterální karcinom prsu (PSBBC) je relativně vzácná klinická entita. Adjuvantní radioterapie je standardní součástí léčby nepokročilého nádoru prsu. Přestože je tato léčba nenahraditelná, je zatížena nežádoucími účinky, které u části pacientek mohou vést k neakceptovatelnému zvýšení kardiovaskulárního rizika a rizika rozvoje sekundární malignity. Kardiovaskulární komplikace prokazatelně snižují přežití pacientek s karcinomem prsu, a proto je nutná snaha o co největší redukci dávek na srdce a srdeční struktury. Protonová radioterapie, díky svým dozimetrickým výhodám, přináší možnost snížení dávky na rizikové orgány a současně umožňuje zachovat optimální pokrytí cílového objemu. Tato výhoda stoupá se zvětšujícím se rozsahem a rostoucí náročností cílového objemu, mezi které synchronně zjištěný bilaterální karcinom prsu jednoznačně patří.
Primary synchronously detected bilateral breast cancer (PSBBC) is a relatively rare clinical entity. The adjuvant radiotherapy is a standard part of non-metastatic breast cancer treatment. Despite the fact that this treatment is irreplaceable, it bears the burden of side effects, which may lead to an unacceptable increase of cardiovascular risk and risk of developing secondary malignancy in some patients. Cardiovascular complications have been shown to reduce the survival in breast cancer patients, and therefore efforts should be made to reduce the dose to the heart and cardiac structure as much as possible. Due to its dosimetric advantages, proton radiotherapy offers the possibility to reduce dose to organs at risk while maintaining optimal target volume coverage. This advantage grows with increasing extent and severity of the target volume, among which the synchronously detected bilateral breast cancer clearly belongs. We retrospectively attempted to evaluate the feasibility and safety of using proton radiotherapy in the treatment strategy of synchronously detected bilateral breast cancer.
INTRODUCTION: Glomus jugulare tumours (GJT) are benign tumours that arise locally and destructively in the base of the skull and can be successfully treated with radiotherapy. Patients have a long-life expectancy and the late effects of radiotherapy can be serious. Proton radiotherapy reduces doses to critical organs and can reduce late side effects of radiotherapy. The aim of this study was to report feasibility and early clinical results of 12 patients treated using proton therapy. METHODS: Between December 2013 and June 2019, 12 patients (pts) with GJT (median volume 20.4 cm3 ; range 8.5-41 cm3 ) were treated with intensity modulated proton therapy (IMPT). Median dose was 54 GyE (Gray Equivalents) (50-60 GyE) with daily fractions of 2 GyE. Twelve patients were analysed with a median follow-up time of 42.2 months (11.3-86.7). Feasibility, dosimetric parameters, acute and late toxicity and local effect on tumour were evaluated in this retrospective study. RESULTS: All patients finished treatment without interruption, with excellent dosimetric parameters and mild acute toxicity. Stabilisation of tumour size was detected on MRI in all patients. No changes in symptoms were observed in comparison with pre-treatment conditions. No late effects of radiotherapy were observed. CONCLUSION: Pencil-beam scanning proton radiotherapy is highly feasible in the treatment of large GJT with mild acute toxicity and promising short-term results. Longer follow-up and larger patient cohorts are required to further identify the role of pencil-beam scanning (PBS) for this indication.
- MeSH
- celková dávka radioterapie MeSH
- lidé MeSH
- plánování radioterapie pomocí počítače metody MeSH
- protonová terapie * škodlivé účinky metody MeSH
- protony MeSH
- radioterapie s modulovanou intenzitou * škodlivé účinky metody MeSH
- retrospektivní studie MeSH
- tumor glomus jugulare * etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Background: A favourable dose distribution has been described for proton beam therapy (PBT) of anal cancer in dosimetric studies. The relationship between dosimetric parameters in bone marrow and haematologic toxicity, treatment interruptions, and treatment efficacy has also been documented. There are only few references on clinical results of PBT for anal cancer. The primary objective of the retrospective study was to assess the efficacy of pencil beam scanning intensity-modulated proton therapy (PBS IMPT) in the definitive chemoradiotherapy of anal cancer. Secondary objectives were established to identify the risks of acute chronic toxicity risks and to assess colostomy rates. Materials and methods: Patients were treated for biopsy-proven squamous cell cancer (SCC) of the anus at initial or advanced stages. Eligible patients received PBS IMPT at a single institution. Treatment was administered in two volumes: 1-tumour with margins plus involved lymph nodes; 2-regional lymph node groups: perirectal (mesorectal), obturatory, inguinal, internal, external, and common iliac. The total doses of 57.5 GyE and 45 GyE, respectively, were administered in volumes 1 and 2 in 25 fractions, 5 fractions per week, respectively (a simultaneous integrated boost). Concomitant chemotherapy cisplatinum (CDDP) plus 5-FU or CDDP plus capecitabine was administered as per protocol. The treatment effect was assessed using DRE (digital rectal examination) and MRI (magnetic resonance imaging) within the follow-up period. Toxicity was scaled using CTCAE version 4.0 criteria. Results: 39 of 41 patients treated during the period of February 2014-August 2021 were eligible for analysis. All patients completed treatment, 76.9% without interruption. The median treatment time was 35 days (32-35). The median follow-up period was 30 months, 34 patients are alive to-date, 5 patients died prior to the date of analysis, and 2 deaths were unrelated to the primary disease. The 2-year overall survival, relapse-free survival, and colostomy-free survival were 94.2%, 93.8%, and 91.0%, respectively. Complete regression was achieved in 36 patients (92.3%), partial regression was achieved in 2 (5.1%), and immediate progression at end of treatment occurred in 1 patient (2.6%). Salvage resection was indicated for two patients in partial regression and due to severe chronic dermatologic toxicity. The grade 3 and 4 haematological toxicity rates were 7.7% and 5.1%, respectively. The most frequent non-haematological acute toxicities of grade 3-4 observed were dermatitis (23.1%), diarrhoea (7.7%), and dehydration (7.7%). Chronic toxicity emerged predominantly as skin atrophy/ulceration grade 2 (26.5%) and grade 3-4 (5.8%), and radiation proctitis grade 2 (38.2%) and grade 3 (2.9%). Discussion, conclusions: This single-institution study showed the high efficacy of PBS IMPT, achieving a high rate of complete regression. The haematological acute toxicity of grade 3-4 remained low; however, the impact of altered chemotherapy (CDDP instead of mitomycin C) remains unclear. The incidence of other acute toxicities shares similarity with photon therapy investigated in large studies. The acute toxicity completely resolved in all patients, had no lethal outcomes, and never resulted in the necessity for colostomy. By contrast, it was chronic toxicity, skin ulceration, perirectal fistulation, and fibrosis that resulted in salvage surgery and/or the need for a colostomy. A challenging question remains: to what extent can PBT prevent chronic toxicity? Longer follow-up remains necessary.
- Publikační typ
- časopisecké články MeSH
- MeSH
- lidé MeSH
- nádory plic * radioterapie MeSH
- protonová terapie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: To analyze the 5-year biochemical disease-free survival (bDFS) and late toxicity profile in patients with prostate cancer treated with pencil beam scanning (PBS) proton radiation therapy. METHODS AND MATERIALS: Between January 2013 and March 2016, 284 patients with prostate cancer were treated using intensity modulated proton therapy (IMPT), with an ultrahypofractionated schedule (36.25 GyE in 5 fractions). Five patients were immediately lost from follow-up and thus were excluded from analysis. Data for 279 patients were prospectively collected and analyzed with a median follow-up time of 56.5 (range, 3.4-87.5) months. The mean age at time of treatment was 64.5 (40.1-85.7) years, and the median prostate-specific antigen (PSA) value was 6.35 μg/L (0.67-17.3 μg/L). A total of 121 (43.4%) patients had low-risk, 125 patients (44.8%) had favorable, and 33 (11.8%) unfavorable intermediate-risk cancer. In addition, 49 (17.6%) patients underwent neoadjuvant hormonal therapy, and no patients had adjuvant hormonal therapy. bDFS and late toxicity profiles were evaluated. RESULTS: The median treatment time was 9 days (range, 7-18 days). The 5-year bDFS was 96.9%, 91.7%, and 83.5% for the low-, favorable, and unfavorable intermediate-risk group, respectively. Late toxicity (Common Terminology Criteria for Adverse Events v.4) was as follows: gastrointestinal: grade 1, 62 patients (22%), grade 2, 20 patients (7.2%), and grade 3, 1 patient (0.36%); genitourinary: grade 1, 80 patients (28.7%), grade 2, 14 patients (5%), and grade 3, 0 patients. PSA relapse was observed in 17 patients (6.1%), and lymph node or bone recurrence was detected in 11 patients. Four (1.4%) local recurrences were detected. Nine patients (3.2%) died of causes unrelated to prostate cancer. No deaths related to prostate cancer were reported. CONCLUSION: Ultrahypofractionated proton beam radiation therapy for prostate cancer is effective with long-term bDFS comparable with other fractionation schedules and with minimal serious long-term GI and GU toxicity.
- MeSH
- hypofrakcionace při ozařování * MeSH
- lidé středního věku MeSH
- lidé MeSH
- membránové proteiny MeSH
- nádorové supresorové proteiny MeSH
- nádory prostaty radioterapie MeSH
- přežití po terapii bez příznaků nemoci MeSH
- protonová terapie * MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Představujeme kazuistické sdělení zkušeností s léčbou mladé 35leté pacientky s vzácným tumorem CNS - pineoblastomem. Po parciálním neurochirurgickém zákroku byla pacientka indikována multidisciplinárním týmem k protonové terapii tužkovým svazkem s profylaktickým ozářením kraniospinální osy dávkou 36 Gy (Gray equivalent), do celkové dávky na lůžko tumoru 59,4 Gy a konkomitantní aplikací chemoterapie temozolomidem. Po ukončení chemoradioterapie pacientka absolvovala 4 cykly vysokodávkované chemoterapie s podporou periferních kmenových buněk. 11 měsíců po ukončení protonové chemoradioterapie s dobrou tolerancí pacientka zůstává bez příznaků reziduálního onemocnění. Kazuistika poukazuje na příznivou krátkodobou léčebnou odpověď a příznivý neurologický výsledek terapie tohoto vzácného tumoru pineální krajiny. Jsou prodiskutovány různé literárně popisované léčebné strategie.
We present our experience with a treatment of a 35-year old adult female patient with a rare central nervous system tumor pineoblastoma. Postoperative patient was referred to adjuvant pencil beam scanning therapy (PBS) starting with 36 Gy dose of prophylactic craniospinal irradiation followed by a local 23.4 Gy boost to the tumor bed. A total dose of 59.4 Gy was given to the patient along with concurrent temozolomide. After well tolerated proton beam chemoradiotherapy the patient finished 4 cycles of high-dose chemotherapy with peripheral blood hematopoietic stem cell support. At 11 months after proton beam chemoradiotherapy the patient has remained free of recurrence. This case report shows favorable short-term response and neurological outcome in management of this rare pineal region tumor. The various treatment options reported in the literature are discussed.
- MeSH
- dávka záření MeSH
- dospělí MeSH
- histologické techniky MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- neurochirurgické výkony MeSH
- pinealom * chirurgie diagnostické zobrazování farmakoterapie radioterapie terapie MeSH
- protonová terapie * metody MeSH
- radioterapie metody MeSH
- reziduální nádor MeSH
- temozolomid aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
