C. Rinaldi

The Role of Radiotherapy in Long Bone Metastases and Pelvis

Bone metastases are a common complication of advanced cancer that can cause severe and debilitating effects. External beam radiation therapy (EBRT) provides significant palliation of painful bone metastases in around 70% of patients, induces remineralization, prevents impending fractures, and promotes healing of pathological fractures, reducing the skeletal-related events (SRE). Hypofractionated schedules are used for the treatment of bone metastases; the most commonly used are a single 8 Gy, 20 Gy in five daily treatments (4 Gy per treatment), and 30 Gy in ten daily treatments (3 Gy per treatment). Postoperative external beam irradiation can significantly reduce disease progression and subsequent loss of fixation. In the postoperative setting, the treatment field should include the entire interlocking device, nails, or prosthesis in order to remove any microscopic dissemination of disease. Two-dimensional or 3D conformal radiotherapy could be used for treatment planning. Simple field assessment (anteroposterior-posteroanterior AP-PA field) is often used for treatment planning of long bones, leading to a shorter treatment time. For pelvic bone metastases, a more complex field assessment could be considered to lessen the dose to the organs at risk, leading to a better tolerability of the treatment itself. Recent technological advances, such as intensity-modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT), can be used in a particular setting of oligometastatic patients to deliver a substantial dose of radiation to the tumor and spare healthy normal tissues.

Implementation of a voluntary deep inspiration breath hold technique (vDIBH) using BrainLab ExacTrac infrared optical tracking system

Background Voluntary deep inspiration breath hold technique (vDIBH) is considered as the key to achieving the widest cardiac sparing in whole breast irradiation. Several techniques have been implemented to achieve a reproducible, fast and friendly treatment. The aim of the present study is to implement vDIBH using the ExacTrac (BrainLAB AG, Germany) monitoring system. Methods Women with left-sided breast cancer, younger than 50 years or with cardiac disease, underwent whole breast RT with vDIBH using the ExacTrac (BrainLAB AG, Germany) monitoring system. Simulations were performed with patients positioned supine on a breast board with both arms raised above the head. Five optical markers were placed on the skin around the border of the left breast gland and their position was referenced with ink marking. Each patient received a training session to find the individual deep inspiration level. Finally, a vDIBH CT was taken. All patients were also studied in free breathing (FB) in order to compare the dose distribution for PTV, heart and left anterior descending coronary artery (LAD). Pre-treatment verification was carried out through the ExacTrac (BrainLAB AG, Germany) system and verified with electronic portal imaging (EPI). Moreover, daily real time EPIs in during modality (captured during the beam delivery) were taken in order to check the reproducibility. Results 34 patients have been evaluated and 30 were eligible for vDIBH. Most patients showed small setup errors during the treatment course of below 5 mm in 94.9% of the recorded fields. Mean Displacement was less in cranio-caudal direction. Mean intra-fraction displacement was below 3 mm in all directions. vDIBH plans provided better cardiac dosimetry. Conclusions vDIBH technique using ExacTrac (BrainLAB AG, Germany) monitoring system was applied with good reproducibility.

Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer

Aim: To evaluate the efficacy of a propolis-based syrup, FARINGEL®, in preventing radiation-induced esophagitis in locally advanced lung cancer patients. Methods. Patients were treated with concurrent chemoradiotherapy (CRT) using involved-field radiotherapy (RT). Every patient received FARINGEL at the beginning of CRT until the first follow-up. The data of the study group were compared with the data of a control group treated without the administration of the syrup. Results: Forty-five patients were enrolled. Forty-one (91.1%) completed the protocol and were evaluable for esophagitis. Grade ≥2 toxicity occurred in 9/41 patients (22%). No differences in overall toxicity were detected between the study group and the control group (n = 55, 60.9 vs. 54.5%; p = ns). Grade 2–3 esophagitis was lower in the study group in comparison with the control group (22 and 38%, respectively), but statistical significance was not reached (p = 0.09). However, the onset of grade ≥2 esophagitis was delayed in the study group compared to the control group, occurring at higher doses of RT (41.8 vs. 25.4 Gy; p < 0.001). Furthermore, the mean number of interruption days for esophagitis was lower in the study group than in the control group (0.6 ± 2.0 vs. 2.1 ± 3.6; p = 0.025). Conclusion: FARINGEL was well-tolerated and delayed esophagitis that was induced by CRT for locally advanced lung cancer.