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EANO guidelines for the diagnosis and treatment of meningiomas
Goldbrunner R., Minniti G., Matthias Preusser, Michael D Jenkinson, Kita Sallabanda, Emmanuel Houdart, Andreas von Deimling, Pantelis Stavrinou, Florence Lefranc, Morten Lund-Johansen, Elizabeth Cohen-Jonathan Moyal, Dieta Brandsma, Roger Henriksson, Riccardo Soffi etti, Michael Weller The Lancet Oncology, Volume 17, No. 9, e383–e391, September 2016

 

 

Abstract

Although meningiomas are the most common intracranial tumours, the level of evidence to provide recommendations for the diagnosis and treatment of meningiomas is low compared with other tumours such as high-grade gliomas. The meningioma task force of the European Association of Neuro-Oncology (EANO) assessed the scientifi c literature and composed a framework of the best possible evidence-based recommendations for health professionals. The provisional diagnosis of meningioma is mainly made by MRI. Defi nitive diagnosis, including histological classifi cation, grading, and molecular profi ling, requires a surgical procedure to obtain tumour tissue. Therefore, in many elderly patients, observation is the best therapeutic option. If therapy is deemed necessary, the standard treatment is gross total surgical resection including the involved dura. As an alternative, radiosurgery can be done for small tumours, or fractionated radiotherapy in large or previously treated tumours. Treatment concepts combining surgery and radiosurgery or fractionated radiotherapy, which enable treatment of the complete tumour volume with low morbidity, are being developed. Pharmacotherapy for meningiomas has remained largely experimental. However, antiangiogenic drugs, peptide receptor radionuclide therapy, and targeted agents are promising candidates for future pharmacological approaches to treat refractory meningiomas across all WHO grades. www.thelancet.com/oncology Vol 17 September 2016

Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review.

 

Garcia R, Sallabanda K, Santa-Olalla I, Lopez Guerra JL, Avilés L, Sallabanda M, Rivin E, Samblás J.

Cureus. 2016 May; 8(5): e609.

Abstract

Modern technologies allow the delivery of high radiation doses to intramedullary spinal cord metastases while lowering the dose to the neighboring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known. This study evaluates the acute and late toxicity outcomes in a patient treated with robotic radiosurgery for an intramedullary spinal cord metastasis. A 50-year-old woman diagnosed in May 2006 with invasive ductal carcinoma of the right breast T2N3M1 (two liver metastases) received chemotherapy with a complete response. Subsequently, she underwent adjuvant whole-breast radiotherapy, along with tamoxifen. After several distant relapses, treated mainly with systemic therapy, the patient developed an intramedullary lesion at the C3-C4 level and was referred to our CyberKnife unit for assessment. A total dose of 14 Gy prescribed to the 74% isodose line was administered to the intramedullary lesion in one fraction. One hundred and two treatment beams were used covering 95.63% of the target volume. The mean dose was 15.93 Gy and the maximum dose, 18.92 Gy. Maximum dose to the spinal cord was 13.96 Gy, V12 ~ 0.13 cc and V8 ~ 0.43 cc. Three months after treatment, magnetic resonance imaging showed a reduction in size and enhancement of the intramedullary lesion with no associated toxicity. During this period, the patient showed a good performance status without neurological deficits. Currently, with a follow-up of 37 months, the patient has the ability to perform activities of daily life. Intramedullary spinal cord metastases is a rare and aggressive disease, often treatment-refractory. Our case demonstrates that radiation therapy delivery with robotic radiosurgery allows the achievement of a high local control without adding toxicity.

http://www.ncbi.nlm.nih.gov/pubmed/27330877

A general method for the definition of margin recipes depending on the treatment technique applied in helical tomotherapy prostate plans.

 

Sevillano D, Mínguez C, Sánchez A, Sánchez-Reyes A.

Phys Med. 2016 Jan;32(1):116-22.

Abstract

PURPOSE:

To obtain specific margin recipes that take into account the dosimetric characteristics of the treatment plans used in a single institution.

METHODS:

We obtained dose-population histograms (DPHs) of 20 helical tomotherapy treatment plans for prostate cancer by simulating the effects of different systematic errors (Σ) and random errors (σ) on these plans. We obtained dosimetric margins and margin reductions due to random errors (random margins) by fitting the theoretical results of coverages for Gaussian distributions with coverages of the planned D99% obtained from the DPHs.

RESULTS:

The dosimetric margins obtained for helical tomotherapy prostate treatments were 3.3 mm, 3 mm, and 1 mm in the lateral (Lat), anterior-posterior (AP), and superior-inferior (SI) directions. Random margins showed parabolic dependencies, yielding expressions of 0.16σ(2), 0.13σ(2), and 0.15σ(2) for the Lat, AP, and SI directions, respectively. When focusing on values up to σ = 5 mm, random margins could be fitted considering Gaussian penumbras with standard deviations (σp) equal to 4.5 mm Lat, 6 mm AP, and 5.5 mm SI.

CONCLUSIONS:

Despite complex dose distributions in helical tomotherapy treatment plans, we were able to simplify the behaviour of our plans against treatment errors to single values of dosimetric and random margins for each direction. These margins allowed us to develop specific margin recipes for the respective treatment technique. The method is general and could be used for any treatment technique provided that DPHs can be obtained.

http://www.ncbi.nlm.nih.gov/pubmed/26585538

Effect of radiotherapy delay in overall treatment time on local control and survival in head and neck cancer: Review of the literature.

González Ferreira JA, Jaén Olasolo J, Azinovic I, Jeremic B.

Rep Pract Oncol Radiother. 2015 Sep-Oct;20(5):328-39.

Abstract

Treatment delays in completing radiotherapy (RT) for many neoplasms are a major problem affecting treatment outcome, as increasingly shown in the literature. Overall treatment time (OTT) could be a critical predictor of local tumor control and/or survival. In an attempt to establish a protocol for managing delays during RT, especially for heavily overloaded units, we have extensively reviewed the available literature on head and neck cancer. We confirmed a large deleterious effect of prolonged OTT on both local control and survival of these patients.

http://www.ncbi.nlm.nih.gov/pubmed/26549990

Effectiveness and toxicity of helical tomotherapy for patients with locally recurrent nasopharyngeal carcinoma.

Puebla F, López Guerra JL, García Ramirez JM, Matute R, Marrone I, Minguez C, Sevillano D, Sánchez-Reyes A, Rivin Del Campo E, Praena-Fernández JM, Azinovic I.

Clin Transl Oncol. 2015 Nov;17(11):925-31.

Abstract

PURPOSE:

We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients.

METHODS AND MATERIALS:

Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60-81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50-70.2 Gy), resulting in a median cumulative dose of 134 Gy (122-148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11-126).

RESULTS:

The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18%) developed both local and distant recurrences and only one patient (6%) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82%, respectively. Two-year OS rate was 79%. Acute and late grade 2 toxicities were observed in 8 patients (47%). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015).

CONCLUSION:

Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity.

http://www.ncbi.nlm.nih.gov/pubmed/26108408

Ethnic difference in risk of toxicity in prostate cancer patients treated with dynamic arc radiation therapy.

López Guerra JL, Matute R, Puebla F, Sánchez-Reyes A, Pontes B, Rubio C, Nepomuceno I, Acevedo C, Isa N, Lengua R, Praena-Fernández JM, del Campo ER, Ortiz MJ, Azinovic I.

Tumori. 2015 Jul-Aug;101(4):461-8.

Abstract

AIMS AND BACKGROUND:

The objective of this study was to assess the influence of ethnicity on toxicity in patients treated with dynamic arc radiation therapy (ART) for prostate cancer (PC).

METHODS:

From June 2006 to May 2012, 162 cT1-T3 cN0 cM0 PC patients were treated with ART (primary diagnosis, n = 125; post-prostatectomy/brachytherapy biochemical recurrence, n = 26; adjuvant post-prostatectomy, n = 11) at 2 institutions. Forty-five patients were Latin Americans and 117 were Europeans. The dose prescribed to the prostate ranged between 68 Gy and 81 Gy.

RESULTS:

The median age was 69 years (range 43-87 years). The median follow-up was 18 months (range 2-74 months). Overall, only 3 patients died, none due to a cancer-related cause. Biochemical recurrence was seen in 7 patients. The rates of acute grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities were 19.7% and 17%, respectively. Only 1 patient experienced acute grade 3 GI toxicity, whereas 11 patients (6.7%) experienced acute grade 3 GU toxicity. Multivariate analysis showed that undergoing whole pelvic lymph node irradiation was associated with a higher grade of acute GI toxicity (OR: 3.46; p = 0.003). In addition, older age was marginally associated with a higher grade of acute GI toxicity (OR: 2.10; p = 0.074). Finally, ethnicity was associated with acute GU toxicity: Europeans had lower-grade toxicity (OR: 0.27; p = 0.001).

CONCLUSIONS:

Our findings suggest an ethnic difference in GU toxicity for PC patients treated with ART. In addition, we found that ART is associated with a very low risk of severe toxicity and a low recurrence rate.

http://www.ncbi.nlm.nih.gov/pubmed/26045115

Photodynamic therapy in the treatment of brain tumours. A feasibility study.

Vanaclocha V, Sureda M, Azinovic I, Rebollo J, Cañón R, Sapena NS, Cases FG, Brugarolas A.

Photodiagnosis Photodyn Ther. 2015 Sep;12(3):422-7.

Abstract

BACKGROUND:

Photodynamic therapy (PDT) constitutes a treatment modality that combines a photosensitizing agent with exposure to laser light in order to elicit phototoxic reactions that selectively destroy tumor cells and spare normal cells. PDT is a local treatment modality without long-term systemic effects. Its application can be repeated more than once to the same area without accumulative effects.

METHODS:

Patients diagnosed with primary brain tumors were treated with PDT. Treatment consisted in administration of the photosensitizer followed by craniotomy, surgical resection and laser illumination of the surgical bed. Primary brain tumors received also temozolomide-based chemotherapy and radiotherapy (RT).

RESULTS:

From May 2000 to December 2010, 41 patients (27 male, 14 female) with a median age of 49 years (range 13-70) diagnosed of primary brain tumors were included in the study. In 7 patients PDT was repeated at the time of the relapse. In 22 episodes PDT was part of the initial treatment of primary brain tumors and in 26 episodes was part of the treatment at relapse. Median PFS observed was 10 months for GBM (95% confidence interval 5.7-14.3), 26 months for AA (95% CI 4.5-47.5), and 43 months for OD (95% CI 4.5-47.5). Median OS was 9 months for GBM (95% CI 2.3-15.7), 20 months for AA (95% CI 0.0-59) and 50 months for OD (95% CI 32.5-67.5). The apparent discrepancy between PFS and OS data is due to patients not censored for PFS because they die from causes other than tumor progression. Median OS since first diagnosis was 17 months for GBM (95% CI 15.2-17.8), 66 months for AA (95% CI 2.9-129.1) and 122 months for OD (95% CI 116.1-127.8). Side effects were mild and manageable.

CONCLUSIONS:

This study confirms that PDT can be considered as an adjunctive to surgery and/or RT and chemotherapy in the treatment of brain tumors, excluding those patients with thalamic or brain stem locations. It adds therapeutic effect without adding significant toxicity. In order to improve its contribution, it is essential to find new drugs with more penetration in order to destroy tumor cells more deeply at resection margins.

http://www.ncbi.nlm.nih.gov/pubmed/26073912

Salvage wide resection with intraoperative electron beam therapy or HDR brachytherapy in the management of isolated local recurrences of soft tissue sarcomas of the extremities and the superficial trunk.

Cambeiro M, Aristu JJ, Moreno Jimenez M, Arbea L, Ramos L, San Julian M, Azinovic I, Calvo FA, Martínez-Monge R.

Brachytherapy. 2015 Jan-Feb;14(1):62-70.

Abstract

PURPOSE:

To assess the toxicity and efficacy of salvage wide resection (SWR) with intraoperative electron beam radiation therapy (IOERT) or perioperative high-dose-rate brachytherapy (PHDRB) in previously unirradiated patients (PUP) vs. previously irradiated patients (PIP) with isolated local recurrence of soft tissue sarcomas (STS) of the extremities and the superficial trunk.

METHODS AND MATERIALS:

PUP received SWR and IOERT/PHDRB with external beam radiation therapy. PIP received SWR and IOERT/PHDRB only.

RESULTS:

Fifty patients were analyzed retrospectively. PUP (n = 24; 48%) received IOERT (n = 13) or PHDRB (n = 11). PIP (n = 26; 52%) received IOERT (n = 10) or PHDRB (n = 16). Reintervention because of complications was not required in PUP. Nine of 26 (34%) PIP required reintervention (p = 0.01). After a median followup of 3.7 years (range, 0.2-18.3), the 5-year rates of locoregional control, distant control, and overall survival were 54%, 66%, and 56%, respectively. Five-year locoregional control was higher in PUP than in PIP (81% vs. 26%, p = 0.01) and in the extremity locations compared with trunk locations (68% vs. 28%, p = 0.001). Five-year overall survival was superior in unifocal vs. multifocal presentations (70% vs. 36%, p = 0.03) and for tumor sizes <4 vs. ≥4 cm (74% vs. 50%, p = 0.05).

CONCLUSIONS:

Prior irradiation is the main determinant of locoregional control in patients with isolated local recurrence of STS. The locoregional control rates in PUP were similar to those described in primary STS. In PIP, SWR + IOERT/PHDRB reirradiation yielded modest locoregional control rates and was associated with significant morbidity, especially in PHDRB cases.

http://www.ncbi.nlm.nih.gov/pubmed/25443530

A Phase II Study of Stereotactic Body Radiation Therapy for Low-Intermediate-High-Risk Prostate Cancer Using Helical Tomotherapy: Dose-Volumetric Parameters Predicting Early Toxicity.

Macias VA, Blanco ML, Barrera I, Garcia R.

Front Oncol. 2014 Nov 26;4:336.

Abstract

Endpoint: To assess early urinary (GU) and rectal (GI) toxicities after helical tomotherapy Stereotactic body radiation therapy (SBRT), and to determine their predictive factors.

METHODS:

Since May 2012, 45 prostate cancer patients were treated with eight fractions of 5.48 (low risk, 29%) or 5.65 Gy (intermediate-high risk, 71%) on alternative days over 2.5 weeks. The exclusion criteria were Gleason score 9-10, PSA >40 ng/mL, cT3b-4, IPSS ≥20, and history of acute urinary retention. During the follow-up, a set of potential prognostic factors was correlated with urinary or rectal toxicity.

RESULTS:

The median follow-up was 13.8 months (2-25 months). There were no grade ≥3 toxicities. Acute grade 2 GU complications were found in a 22.7% of men, but in 2.3% of patients at 1 month, 0% at 6 months, and 0% at 12 months. The correspondent figures for grade 2 GI toxicities were 20.4% (acute), 2.3% (1 month), 3.6% (6 months), and 5% (12 months). Acute GI toxicity was significantly correlated with the rectal volume (>15 cm(3)) receiving 28 Gy, only when expressed as absolute volume. The age (>72 years old) was a predictor of GI toxicity after 1 month of treatment. No correlation was found, however, between urinary toxicity and the other analyzed variables. IPSS increased significantly at the time of the last fraction and within the first month, returning to the baseline at sixth month. Urinary-related quality of life (IPSS question 8 score), it was not significantly worsen during radiotherapy returning to the baseline levels 1 month after the treatment. At 12 months follow-up patient’s perception of their urinary function improved significantly in comparison with the baseline.

CONCLUSION:

Our scheme of eight fractions on alternative days delivered using helical tomotherapy is well tolerated. We recommend using actual volume instead of percentual volume in the treatment planning, and not to exceed 15 cm(3) of rectal volume receiving ≥25 Gy in order to diminish acute GI toxicity.

http://www.ncbi.nlm.nih.gov/pubmed/25505734

 

 

Retrospective evaluation of CTV to PTV margins using CyberKnife in patients with thoracic tumors.

Floriano A, García R, Moreno R, Sánchez-Reyes A.

J Appl Clin Med Phys. 2014 Nov 8;15(6):4825

Abstract

The objectives of this study were to estimate global uncertainty for patients with thoracic tumors treated in our center using the CyberKnife VSI after placement of fiducial markers and to compare our findings with the standard CTV to PTV margins used to date. Datasets for 16 patients (54 fractions) treated with the CyberKnife and the Synchrony Respiratory Tracking System were analyzed retrospectively based on CT planning, tracking information, and movement data generated and saved in the logs files by the system. For each patient, we analyzed all the main uncertainty sources and assigned a value. We also calculated an expanded global uncertainty to ensure a robust estimation of global uncertainty and to enable us to determine the position of 95% of the CTV points with a 95% confidence level during treatment. Based on our estimation of global uncertainty and compared with our general mar- gin criterion (5 mm in all three directions: superior/inferior [SI], anterior/posterior [AP], and lateral [LAT]), 100% were adequately covered in the LAT direction, as were 94% and 94% in the SI and AP directions. We retrospectively analyzed the main sources of uncertainty in the CyberKnife process patient by patient. This individualized approach enabled us to estimate margins for patients with thoracic tumors treated in our unit and compare the results with our standard 5 mm margin.

http://www.ncbi.nlm.nih.gov/pubmed/25493508

Image-guided radiation therapy based on helical tomotherapy in prostate cancer: minimizing toxicity.

Acevedo-Henao CM, Lopez Guerra JL, Matute R, Puebla F, Russo M, Rivin E, Sanchez-Reyes A, Ortiz MJ, Azinovic I.

Oncol Res Treat. 2014; 37(6):324-30.

Abstract

BACKGROUND:

We report the clinical results and prognostic factors of image-guided radiation therapy (RT) with helical tomotherapy (HT) for localized and recurrent prostate cancer (PC).

PATIENTS AND METHODS:

We evaluated 70 patients with PC (primary diagnosis, n = 48; adjuvant, n = 5; salvage, n = 17) treated with HT from May 2006 through January 2011. The dose prescribed to the prostate/surgical bed ranged between 60 and 78 Gy. Potential risk factors for genitourinary (GU) and gastrointestinal (GI) toxicity were assessed.

RESULTS:

The median age was 68 years (range 51-87 years). The median follow-up was 37 months (range 3-74 months). The rates of acute grade 2 GI and GU toxicities were 10 and 13%, respectively. Only 1 patient experienced acute grade 3 GU toxicity. The rates of late grade ≥ 2 GI and GU toxicities were 1% each. Multivariate analysis showed an association between rectum mean dose > median (39 Gy) and bladder median dose > median (46 Gy) with a higher grade of acute GI (p = 0.017) and GU (p = 0.019) toxicity, respectively. Additionally, older age was associated with late GU toxicity (p = 0.026).

CONCLUSION:

Toxicity with HT is low and is associated with higher median/mean doses in organs at risk as well as with older age. A prospective validation would be necessary to confirm these results.

http://www.ncbi.nlm.nih.gov/pubmed/24903763

Experience with the CyberKnife for intracranial stereotactic radiosurgery: analysis of dosimetry indices.

Floriano A, Santa-Olalla I, Sanchez-Reyes A.

Med Dosim.2014 Spring; 39(1):1-6.

Abstract

We evaluated coverage, dose homogeneity, dose conformity, and dose gradient in CyberKnife VSI treatment plans. Several dosimetric indices were calculated, and the results were compared with those of previous publications. The effect of target volume on the radiosurgical treatment indices selected was also investigated. The study population comprised the first 40 patients treated at our department from March 2011 to September 2012. Dosimetric indices were calculated and compared with published results for other frame-based and frameless intracranial stereotactic radiotherapy techniques. A comparison of the indices confirmed the ability of the CyberKnife VSI system to provide very high-quality dosing plans. The results were independent of target volume for coverage, homogeneity, and dose conformity. However, a dependence on target volume was observed for the dose-gradient indices analyzed. Based on the indices proposed, CyberKnife provides very good treatment plans and compares favorably with other techniques in most cases. However, greater consensus on the radiosurgery indices calculated would be desirable to facilitate comparison of the various techniques or the same techniques when applied by different users.

http://www.ncbi.nlm.nih.gov/pubmed/24333021

Outcome and toxicity using helical tomotherapy for craniospinal irradiation in pediatric medulloblastoma.

Lopez Guerra JL, Marrone I, Jaen J, Bruna M, Sole C, Sanchez-Reyes A, Rivin E, Ortiz MJ, Calvo F, Matute R.

Clin Transl Oncol. 2014 Jan;16(1):96-101.

Abstract

PURPOSE:

The objective of this study is to evaluate the tolerability and outcome of craniospinal irradiation (CSI) with helical tomotherapy (HT) in the treatment of medulloblastoma.

METHODS:

We evaluated 19 consecutive patients with primary medulloblastoma who were treated with HT from 2007 through 2010. HT regimens to the neuroaxis included: 23.4 Gy at 1.8 Gy/fraction (N = 10), 36 Gy at 1.8 Gy/fraction (N = 7), and 39 Gy bid at 1.3 Gy/fraction (N = 2). The tumor bed received 54-60 Gy. Potential associations between patient, treatment, and toxicity factors and overall survival (OS) were assessed in univariate analyses using the Cox proportional hazards model. Spearman’s rank correlation coefficient was used to correlate potential risk factors with the grade of acute toxicity.

RESULTS:

The median age at diagnosis was 5 years (range 2-14) and the median follow-up for alive patients (N = 14) 40 months (range 10-62). Two- and three-year overall survival was 75 and 68 %, respectively. The most common acute toxicity was hematological (79 %), being grade 2 and grade 3 in 4 (21 %) and 11 (58 %) cases, respectively. No grade ≥2 late toxicities were observed. Higher grades of acute body toxicity were found in older children (P = 0.004). Longer time between diagnosis and radiation therapy was correlated with shorter OS (P = 0.03). In addition, higher grades of acute thrombocytopenia were associated with shorter OS (P = 0.03).

CONCLUSIONS:

CSI delivered with HT for medulloblastoma is well tolerated with low rates of severe acute toxicity. Further research is necessary to assess late toxicity with a longer follow-up.

http://www.ncbi.nlm.nih.gov/pubmed/23632814

Role of genetic polymorphisms in NFKB-mediated inflammatory pathways in response to primary chemoradiation therapy for rectal cancer.

Dzhugashvili M , Luengo-Gil G, García T, González-Conejero R , Conesa-Zamora P, Escolar PP, Calvo F, Vicente V, Ayala de la Peña F.

Int J Radiat Oncol Biol Phys. 2014 Nov 1;90(3):595-602.

Abstract

PURPOSE:

To investigate whether polymorphisms of genes related to inflammation are associated with pathologic response (primary endpoint) in patients with rectal cancer treated with primary chemoradiation therapy (PCRT).

METHODS AND MATERIALS:

Genomic DNA of 159 patients with locally advanced rectal cancer treated with PCRT was genotyped for polymorphisms rs28362491 (NFKB1), rs1213266/rs5789 (PTGS1), rs5275 (PTGS2), and rs16944/rs1143627 (IL1B) using TaqMan single nucleotide polymorphism genotyping assays. The association between each genotype and pathologic response (poor response vs complete or partial response) was analyzed using logistic regression models.

RESULTS:

The NFKB1 DEL/DEL genotype was associated with pathologic response (odds ratio [OR], 6.39; 95% confidence interval [CI], 0.78-52.65; P=.03) after PCRT. No statistically significant associations between other polymorphisms and response to PCRT were observed. Patients with the NFKB1 DEL/DEL genotype showed a trend for longer disease-free survival (log-rank test, P=.096) and overall survival (P=.049), which was not significant in a multivariate analysis that included pathologic response. Analysis for 6 polymorphisms showed that patients carrying the haplotype rs28362491-DEL/rs1143627-A/rs1213266-G/rs5789-C/rs5275-A/rs16944-G (13.7% of cases) had a higher response rate to PCRT (OR, 8.86; 95% CI, 1.21-64.98; P=.034) than the reference group (rs28362491-INS/rs1143627-A/rs1213266-G/rs5789-C/rs5275-A/rs16944-G). Clinically significant (grade ≥2) acute organ toxicity was also more frequent in patients with that same haplotype (OR, 4.12; 95% CI, 1.11-15.36; P=.037).

CONCLUSIONS:

Our results suggest that genetic variation in NFKB-related inflammatory pathways might influence sensitivity to primary chemoradiation for rectal cancer. If confirmed, an inflammation-related radiogenetic profile might be used to select patients with rectal cancer for preoperative combined-modality treatment.

http://www.ncbi.nlm.nih.gov/pubmed/25304949

Infrastructures, treatment modalities, and workload of radiation oncology departments in Spain with special attention to prostate cancer.

López Torrecilla J, Zapatero A, Herruzo I, Calvo FA, Cabeza MA, Palacios A, Guerrero A, Hervás A, Lara P, Ludeña Martínez B, Del Cerro Peñalver E, Nagore G, Sancho G, Mengual JL, Mira M, Mairiño A, Samper P, Pérez S, Castillo I, Martínez Cedrés C, Ferrer E, Rodriguez S, Maldonado X, Gómez Caamaño A, Ferrer C; Grupo de Investigación GICOR-URONCOR-SEOR.

Clin Transl Oncol. 2014 May;16(5):447-54.

Abstract

AIM:

The purpose of the study was to describe infrastructures, treatment modalities, and workload in radiation oncology (RO) in Spain, referred particularly to prostate cancer (PC).

METHODS:

An epidemiologic, cross-sectional study was performed during 2008-2009. A study-specific questionnaire was sent to the 108 RO-registered departments.

RESULTS:

One hundred and two departments answered the survey, and six were contacted by telephone. Centers operated 236 treatment units: 23 (9.7 %) cobalt machines, 37 (15.7 %) mono-energetic linear accelerators, and 176 (74.6 %) multi-energy linear accelerators. Sixty-one (56.4 %) and 33 (30.5 %) departments, respectively, reported intensity-modulated radiation therapy (IMRT) and image-guided RT (IGRT) capabilities; three-dimensional-conformal RT was used in 75.8 % of patients. Virtual simulators were present in 95 departments (88.0 %), 35 use conventional simulators. Fifty-one departments (47.2 %) have brachytherapy units, 38 (35.2 %) perform prostatic implants. Departments saw a mean of 24.9 new patients/week; the number of patients treated annually was 102,054, corresponding to 88.4 % of patients with a RT indication. In 56.5 % of the hospitals, multidisciplinary teams were available to treat PC.

CONCLUSIONS:

Results provide an accurate picture of current situation of RO in Spain, showing a trend toward the progressive introduction of new technologies (IMRT, IGRT, brachytherapy).

http://www.ncbi.nlm.nih.gov/pubmed/24682792

Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast cancer after conservative surgery.

Mansouri S, Naim A, Glaria L, Marsiglia H.

Asian Pac J Cancer Prev. 2014;15(11):4727-32.

Abstract

BACKGROUND:

Breast cancers are becoming more frequently diagnosed at early stages with improved long term outcomes. Late normal tissue complications induced by radiotherapy must be avoided with new breast radiotherapy techniques being developed. The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk between conformal (CRT) and intensity-modulated radiation therapy (IMRT) after breast-conserving surgery.

MATERIALS AND METHODS:

A total of 20 patients with early stage left breast cancer received adjuvant radiotherapy after conservative surgery, 10 by 3D-CRT and 10 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram analyses in terms of PTV homogeneity and conformity indices as well as organs at risk dose and volume parameters.

RESULTS:

The HI and CI of PTV showed no difference between 3D-CRT and IMRT, V95 gave 9.8% coverage for 3D-CRT versus 99% for IMRT, V107 volumes were recorded 11% and 1.3%, respectively. Tangential beam IMRT increased volume of ipsilateral lung V5 average of 90%, ipsilateral V20 lung volume was 13%, 19% with IMRT and 3D-CRT respectively. Patients treated with IMRT, heart volume encompassed by 60% isodose (30 Gy) reduced by average 42% (4% versus 7% with 3D-CRT), mean heart dose by average 35% (495 cGy versus 1400 cGy with 3D-CRT). In IMRT minimal heart dose average is 356 cGy versus 90 cGy in 3D-CRT.

CONCLUSIONS:

IMRT reduces irradiated volumes of heart and ipsilateral lung in high-dose areas but increases irradiated volumes in low-dose areas in breast cancer patients treated on the left side

http://www.ncbi.nlm.nih.gov/pubmed/24969911

Stereotactic radiosurgery in patients with multiple intracranial meningiomas.

Samblas J, Luis Lopez Guerra J, Bustos J, Angel Gutierrez-Diaz J, Wolski M, Peraza C, Marsiglia H, Sallabanda K.

J BUON. 2014 Jan-Mar;19(1):250-5.

Abstract

PURPOSE:

Stereotactic radiosurgery (SRS) delivers a potent, highly focused dose of radiation to the tumor while sparing the surrounding normal tissues. The purpose of this study was to assess the outcome of patients with intracranial meningiomas treated with SRS.

METHODS:

A total of 73 patients with 221 benign meningiomas treated between 1991 and 2005 with SRS and followed up for more than a year were reviewed. Fifty patients (68%) were treated with SRS to the primary meningioma while 23 (32%) received SRS to relapsing tumors adjacent or distant from the site of the initial meningioma that was previously treated with surgery alone. Mean tumor margin dose was 14 Gy (range 10-16). SRS was delivered after surgery in 117 meningiomas (55 patients).

RESULTS:

The median age at diagnosis was 47 years (range 16-74) and the median follow-up 5.8 years (range 1-13.6). The 3- and 5-year overall survival (OS) rates for all patients were 95% and 90%, respectively. The mean gross tumor volume decreased from 4.17 cm3 to 3.23 cm(3) after SRS (p=0.057). Twenty-two (10%) meningiomas increased after SRS. In addition, clinical symptoms improved in 36% and remained stable in 45% of the patients. With regard to morbidity of SRS, only 7 patients (9.6%) had late complications, including edema (N=4), brain necrosis (N=4), gliosis (N=1), and paresis of the III pair nerve (N=1). There was no treatment-related mortality.

CONCLUSION:

SRS for patients with multiple intracranial meningiomas is effective yielding a high rate of local tumor control, whereas treatment-related morbidity remains low.

http://www.ncbi.nlm.nih.gov/pubmed/24659672