J. Jaen

Risk factors for local and regional recurrence in patients with resected N0–N1 non-small-cell lung cancer, with implications for patient selection for adjuvant radiation therapy

BACKGROUNDnThe purpose of this study was to evaluate the actuarial risk of local and regional failure in patients with completely resected non-small-cell lung cancer (NSCLC), and to assess surgical and pathological factors affecting this risk.nnnPATIENTS AND METHODSnBetween January 1998 and December 2009, 1402 consecutive stage I-III (N0-N1) NSCLC patients underwent complete resection without adjuvant radiation therapy. The median follow-up was 42 months.nnnRESULTSnLocal-regional recurrence was identified in 9% of patients, with local failure alone in 3% of patients, regional failure alone in 4% of patients, and both local and regional failure simultaneously in 2% of patients. Patients who had local failure were found to be at increased risk of mortality. By multivariate analyses, three variables were shown to be independently significant risk factors for local [surgical procedure (single/multiple wedges+segmentectomy versus lobectomy+bilobectomy+pneumonectomy), tumor size>2.7 cm, and visceral pleural invasion] and regional (pathologic N1 stage, visceral pleural invasion, and lymphovascular space invasion, LVI) recurrence, respectively.nnnCONCLUSIONnPatients with N0-N1 disease have low rates of locoregional recurrence after surgical resection. However, several prognostic factors can be identified that increase this risk and identify patients who may benefit from adjuvant treatment.

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

PurposeThe objective of this study is to evaluate the tolerability and outcome of craniospinal irradiation (CSI) with helical tomotherapy (HT) in the treatment of medulloblastoma.MethodsWe evaluated 19 consecutive patients with primary medulloblastoma who were treated with HT from 2007 through 2010. HT regimens to the neuroaxis included: 23.4xa0Gy at 1.8xa0Gy/fraction (Nxa0=xa010), 36xa0Gy at 1.8xa0Gy/fraction (Nxa0=xa07), and 39xa0Gy bid at 1.3xa0Gy/fraction (Nxa0=xa02). The tumor bed received 54–60xa0Gy. 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.ResultsThe median age at diagnosis was 5xa0years (range 2–14) and the median follow-up for alive patients (Nxa0=xa014) 40xa0months (range 10–62). Two- and three-year overall survival was 75 and 68xa0%, respectively. The most common acute toxicity was hematological (79xa0%), being grade 2 and grade 3 in 4 (21xa0%) and 11 (58xa0%) cases, respectively. No grade ≥2 late toxicities were observed. Higher grades of acute body toxicity were found in older children (Pxa0=xa00.004). Longer time between diagnosis and radiation therapy was correlated with shorter OS (Pxa0=xa00.03). In addition, higher grades of acute thrombocytopenia were associated with shorter OS (Pxa0=xa00.03).ConclusionsCSI 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.

Hypofractionated helical tomotherapy using 2.5–2.6 Gy daily fractions for localized prostate cancer

BackgroundThe purpose of this study is to evaluate the tolerability of hypofractionated helical tomotherapy (HT) in the treatment of localized prostate cancer.Materials and methodsWe evaluated 48 patients with primary adenocarcinoma of the prostate (cT1-T3N0M0) who were treated with hypofractionated HT from August 2008 through July 2011. Hypofractionated regimens included: 68.04xa0Gy at 2.52xa0Gy/fraction, 70xa0Gy at 2.5xa0Gy/fraction, and 70.2xa0Gy at 2.6xa0Gy/fraction. Genitourinary (GU) and gastrointestinal (GI) toxicity was scored using the Radiation Therapy Oncology Group scoring system.ResultsThirty-two patients were treated with 68.04xa0Gy, 5 patients with 70xa0Gy, and 11 with 70.2xa0Gy. The median age at diagnosis was 69xa0years (range 49–87) and the median follow-up 11xa0months (range 7–40). Grade 2 acute GI toxicity occurred in 9 patients (19xa0%). No grade 3 or higher acute GI toxicity was observed. Grade 2 and 3 acute GU toxicities occurred in 19 and 6xa0% of patients, respectively. The incidence of late grade 2 GI and GU toxicity was 4 and 2xa0%, respectively. No grade 3 or higher late toxicities were observed. Multivariate analysis showed that patients treated at 2.6xa0Gy/fraction or those who received a total radiation dose ≥70xa0Gy had higher rates of grade ≥2 acute GU toxicity (Pxa0=xa00.004 and Pxa0=xa00.048, respectively).ConclusionHypofractionated HT in the treatment of localized prostate cancer is well tolerated with no grade 3 or higher early or late GI and GU toxicities. Further research is needed to assess definitive late toxicity and tumor control.

Stereotactic ablative radiotherapy delivered by image-guided helical tomotherapy for extracranial oligometastases

PurposeTo investigate the outcomes and risk factors of patients treated with stereotactic ablative radiotherapy (SABR) delivered by image-guided helical tomotherapy (HT) for extracranial oligometastases.MethodsFrom August 2006 through July 2011, 42 consecutive patients (median age 69xa0years [range 16–87]) with oligometastases (≤3) received HT to all known cancer sites (lung, nxa0=xa028; liver, nxa0=xa012; adrenal, nxa0=xa02). Prognostic factors were assessed by Cox’s proportional hazards regression analysis.ResultsA total of 60 lesions were treated with hypofractionated HT (median dose 39xa0Gy [range 36–72.5]; median dose per fraction 12xa0Gy [range 5–20]). Complete or partial response was observed in 40 (54xa0%) patients. With a median follow-up period of 15xa0months, 1- and 2-year overall survival (OS) was 84 and 63xa0%, respectively; and 1- and 2-year local control (LC) was 92 and 86xa0%, respectively. Four patients had pneumonitis Grade ≥2 and two patients had lower gastrointestinal toxicity Grade ≥2. Only the lack of complete/partial response was associated with higher risk of mortality on univariate (HRxa0=xa03.8, Pxa0=xa00.04) and multivariate (HRxa0=xa06.6, Pxa0=xa00.01) analyses.ConclusionsSABR delivered by image-guided HT is well tolerated and offers adequate LC with low acute morbidity in patients with extracranial oligometastatic disease. We found that the response to HT was the only predictor for OS.

Toxicity outcome in patients treated with modulated arc radiotherapy for localized prostate cancer.

AIMnThis study evaluates the acute toxicity outcome in patients treated with RapidArc for localized prostate cancer.nnnBACKGROUNDnModern technologies allow the delivery of high doses to the prostate while lowering the dose to the neighbouring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known.nnnMATERIALS AND METHODSnBetween December 2009 and May 2012, 45 patients with primary prostate adenocarcinoma were treated using RapidArc. All patients received 1.8xa0Gy per fraction, the median dose to the prostate gland, seminal vesicles, pelvic lymph nodes and surgical bed was 80xa0Gy (range, 77.4-81xa0Gy), 50.4xa0Gy, 50.4xa0Gy and 77.4xa0Gy (range, 75.6-79.2xa0Gy), respectively.nnnRESULTSnThe time between the last session and the last treatment follow up was a median of 10 months (range, 3-24 months). The incidence of grade 3 acute gastrointestinal (GI) and genitourinary (GU) toxicity was 2.2% and 15.5%, respectively. Grade 2 acute GI and GU toxicity occurred in 30% and 27% of patients, respectively. No grade 4 acute GI and GU toxicity were observed. Older patients (>median) or patients with V60 higher than 35% had significantly higher rates of grade ≥2 acute GI toxicity compared with the younger ones.nnnCONCLUSIONSnRapidArc in the treatment of localized prostate cancer is tolerated well with no Grade >3 GI and GU toxicities. Older patients or patients with higher V60 had significantly higher rates of grade ≥2 acute GI toxicity. Further research is necessary to assess definitive late toxicity and tumour control outcome.