Deep Inspiration Breath-Hold (DIBH) produces a clinically meaningful reduction in ipsilateral lung dose during loco-regional radiation therapy for some women with right-sided breast cancer

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Jessica L. Conway, Leigh Conroy, Lindsay Harper, Marie Scheifele, Haocheng Li, Wendy L. Smith, Tannis Graham, Tien Phan, Ivo A. Olivotto
Background & PurposeTo determine whether Deep Inspiration Breath Hold (DIBH) produced a clinically meaningful reduction in pulmonary dose compared to free breathing (FB) during loco-regional radiation for right-sided breast cancer.Materials & MethodsFour-field, modified-wide tangent plans with full nodal coverage were developed for 30 consecutive patients on paired DIBH and FB CT scans. Nodes were contoured according to ESTRO guidelines. Plan metrics were compared using Wilcoxon signed-rank testing.ResultsTwenty-one patients (70%) had ≥5% reduction in ipsilateral lung V20 with DIBH compared to FB. The mean ipsilateral lung V20 decrease was 7.8% (0 to 20%; p<0.001). The mean lung dose (MLD) decreased on average by 3.4Gy with DIBH (−0.2 to 9.1; p<0.001). The mean reduction in liver volume receiving 50% of the prescribed dose was 42.3cc (0 to 178.9; p<0.001).ConclusionsDIBH reduced the ipsilateral lung V20 by ≥5% for the majority of patients. For some patients, the volume of liver receiving a potentially toxic dose was reduced with DIBH. DIBH should be available as a treatment strategy to reduce ipsilateral lung V20 prior to compromising IMC nodal coverage for patients with right-sided breast cancer during loco-regional RT if the V20 on FB exceeds 30%.



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Long-term results of adjuvant versus early salvage post-prostatectomy radiation: a large single institutional experience

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Daniela L. Buscariollo, Michael Drumm, Andrzej Niemierko, Rebecca H. Clayman, Sigolene Galland-Girodet, Danielle Rodin, Adam S. Feldman, Douglas Dahl, Francis J. McGovern, Aria Olumi, Alec Eidelman, William U. Shipley, Anthony L. Zietman, Jason A. Efstathiou
PurposeTo evaluate freedom from biochemical failure (FFBF), freedom from androgen deprivation therapy (FFADT), freedom from distant metastases (FFDM), and overall survival (OS) after adjuvant radiation therapy (ART) versus early salvage radiation therapy (ESRT) in men with prostate cancer and adverse pathologic features (pT3 and/or positive surgical margins).Methods and MaterialsOf 718 patients consecutively treated with postoperative radiation therapy (RT) for prostate cancer between 1992 and 2013, we retrospectively identified 171 men receiving ART and 230 receiving ESRT (RT delivered at PSA ≤0.5ng/ml) who had adverse pathologic features. Post-irradiation FFBF (BF was defined as PSA rise to ≥0.2ng/ml), FFADT, FFDM, and OS were compared using Kaplan–Meier and Cox regression methods. Propensity score (PS)-matching was performed to estimate treatment effects while accounting for covariates predicting treatment allocation.ResultsMedian follow-up was 7.4 and 8.0years for patients treated with ART and ESRT, respectively. Ten-year FFBF (69% versus 56%, p=0.003) and 10-year FFADT (88% versus 81%, p=0.046) rates were higher after ART; however, FFDM and OS did not significantly differ. After PS-matching, ART was associated with improved FFBF (p<0.0001), FFADT (p=0.0001), and FFDM (p=0.02). Findings were confirmed in multivariable analyses in unmatched and PS-matched cohorts.ConclusionPostoperative RT confers excellent long-term cancer control. These results suggest ART may be associated with improved FFBF, FFADT, and FFDM, but comparable OS. Given the retrospective study design, these findings should be interpreted with caution. Optimal timing of postoperative RT further awaits results of ongoing trials.



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The Likelihood of Unacceptable Normal Tissue Doses in Breast Cancer Patients Undergoing Regional Nodal Irradiation in Routine Clinical Practice

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Jose Bazan, Dominic DiCostanzo, Karla Kuhn, Lonika Majithia, Allison Quick, Nilendu Gupta, Julia White
PurposeAs indications for regional nodal irradiation (RNI) for breast cancer have expanded, so too has scrutiny over potential late toxicity from radiotherapy. This emphasizes the need for careful radiation treatment planning to maximize the therapeutic ratio. We sought to evaluate how often unacceptable dosing (UD) to organs-at-risk (OAR) occurs and what factors were associated with this for patients receiving RNI in daily practice.Materials and MethodsTreatment records of patients who received RNI from 2/2012–5/2015 were studied. The NSABP B51/RTOG 1304 clinical dose-volume constraints for targets/OAR receiving RNI were used as the benchmark. Dose volume histograms (DVH) were analyzed for the rate of ≥1 UD to the following: Heart mean>5Gy; ipsilateral lung (IL): V20>35%, V10>60%, V5>70%; contralateral lung (CL) V5>15%; contralateral breast (CB) V4.1>5%. Logistic regression was used to test the association between UD to OAR and key variables.Results203 consecutive cases received RNI (105 left, 98 right). RT was to CW in 171 (84%). Internal mammary nodes (IMN) were included in 170 (84%). 77.4% of cases met all OAR constraints. The most common OAR UD were to the CB (n=32, 15.7%) and IL V5 (n=22, 10.8%). On multivariate analysis, use of IMRT (OR=64.7, 95% CI 20.8–201.5, p<0.001) and use of nodal boost (OR=5.5, 95% CI 1.1–27.1, p=0.04) but not IMN irradiation (OR=2.7, p=0.35) or reconstruction (OR=0.62, p=0.33) were independently associated with higher OAR UD rate. For 3DCRT plans, 7.9% had OAR UD.ConclusionThe OAR UD rate with 3DCRT+/−DIBH in routine clinical practice is low and not independently associated with IMN irradiation or reconstruction presence. Women treated with IMRT had a significantly higher overall OAR UD rate, and clinicians should be aware of this as they initiate RNI treatment planning.



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Hydrogel spacer distribution within the perirectal space in patients undergoing radiotherapy for prostate cancer: Impact of spacer symmetry on rectal dose reduction and the clinical consequences of hydrogel infiltration into the rectal wall

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Benjamin W. Fischer-Valuck, Anupama Chundury, Hiram Gay, Walter Bosch, Jeff Michalski
PurposeHydrogel prostate-rectum spacers, biomaterials placed between the prostate and rectum, continue to gain interest as a method to reduce or limit rectal dose during dose escalated prostate cancer radiation therapy. Since the spacer is initially injected into the perirectal space as a liquid, the final distribution can vary. The purpose of this study was to evaluate hydrogel spacer (SpaceOAR® system) implantation and distribution from a recent prospective randomized control trial and correlate spacer symmetry with rectal dose reduction as well as rectal wall infiltration (RWI) to acute and late toxicity.Methods and MaterialsT2-weighted magnetic resonance imaging images for 149 patients enrolled on a prospective clinical trial who received transperineal spacer injection were assessed for hydrogel spacer midline symmetry and RWI using a semi-qualitative scoring system. Symmetry was then correlated to rectal dose reduction using a student t-test (one tailed, paired) while a Fisher's Exact test was used to correlate RWI with acute and late rectal toxicity. All patients had control treatment plans created prior to spacer injection.ResultsHydrogel spacer was symmetrically placed at midline for 71 (47.7%) patients at the prostate mid-gland as well as one centimeter superior and inferior to mid-gland. The remaining 78 (50.9%) patients had some level of asymmetry with only 2 (1.3%) having far lateral-distribution (i.e>2cm) of hydrogel spacer. As the hydrogel spacer became more asymmetric, the level of rectal dose reduction relative to their control plans decreased. However, all but the most asymmetrical 1.3% had significant rectal dose reduction (p<0.05). Rectal wall hydrogel spacer infiltration was seen in 9 (6.0%) patients. There was no correlation between RWI and procedure-related adverse events or acute/late rectal toxicity.ConclusionsSignificant reduction of rectal dose can still be achieved even in the setting of asymmetric hydrogel spacer placement. RWI does not correlate with patient complications.



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Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiotherapy of pancreatic cancer

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): H.D. Heerkens, W.A. Hall, X.A. Li, P. Knechtges, E. Dalah, E.S. Paulson, C.A.T. van den Berg, G.J. Meijer, E.J. Koay, C.H. Crane, K. Aitken, M. van Vulpen, B.A. Erickson
PurposeLocal recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in non-metastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. MRI offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiotherapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of gross tumor volume (GTV) and organs at risk (OARs) using MRI and incorporating multiple MRI sequences.MethodsFive pancreatic cancer patients and one healthy subject were imaged with MRI either on 1.5T or on 3T magnets in two separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting.ResultsAn overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided.ConclusionsWith this report we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and organs at risk. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiotherapy treatment planning with the ultimate goal of improving local control while minimizing morbidity.SummaryThese recommendations describe the contouring of pancreatic tumors and organs at risk (OAR) using MRI. Practical contouring instructions for the gross tumor volume and OAR are provided based on five pancreatic cancer patients and one healthy subject. This report provides recommendations on how to integrate MRI into radiation treatment planning for pancreatic tumors and addresses the potential challenges of MRI.



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Lost in the Woods

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Jyoti Mayadev




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Erratum to: Roos DE, Keys NK, Kirkwood ID. The bone scan as a “biological dosimeter”. Front cover images with case history. Pract Radiat Oncol. July/August 2016;6

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Daniel E Roos, Robert N Keys, Ian D Kirkwood




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Assessment of Hepatic Function Decline After Stereotactic Body Radiation Therapy for Primary Liver Cancer

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Diego A.S. Toesca, Evan C. Osmundson, Rie von Eyben, Jenny L. Shaffer, Albert C. Koong, Daniel T. Chang
Background and PurposeThis study aims to determine how the albumin-bilirubin (ALBI) score compares to Child-Pugh (CP) score for the assessment of liver function following SBRT.Materials and MethodsIn total, 60 patients, 40 with hepatocellular carcinoma (HCC) and 20 with cholangiocarcinoma (CCA), were treated with SBRT. Liver function panels were obtained before and at 1, 3, 6 and 12months after SBRT. Laboratory values were censored after local-regional recurrence, further liver directed therapies or liver transplant.ResultsA significant decline in hepatic function occurred after SBRT for HCC patients only (p=0.001 by ALBI score; p<0.0001 by CP score). The strongest dosimetric predictor of liver function decline for HCC was the VBED1040 using the ALBI score (p=0.07), and the VBED1020 by using the CP score (p=0.0009). For CCA patients, the VBED1040 remained the strongest dosimetric predictor using ALBI score (p=0.002), but no dosimetric predictor was significant using CP score. Hepatic function decline correlated with worse overall survival for HCC (by ALBI p=0.0005; by CP p<0.0001) and for CCA (by ALBI p=NS; by CP p=0.008).ConclusionALBI score was similarly able to predict hepatic function decline compared to CP score, and both systems correlated with survival.



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Evaluation of patients’ engagement in radiation therapy safety

Publication date: Available online 26 October 2016
Source:Cancer/Radiothérapie
Author(s): A. Pernet, V. Mollo, J.-E. Bibault, P. Giraud
PurposeTreatment safety has become a priority in health policies after several incidents occurred around the world in radiation oncology departments. The aim of this study was to analyse the patients' contribution in that field and to understand which actions empower the patient in that regard.MethodsSeveral methods were used in a general hospital and in a comprehensive cancer centre to analyse the activities of the radiation therapists and the patients and the interactions between them: treatment session observations, semidirective interviews with radiation therapists and patients, self and alloconfrontation with radiation therapists and explanatory interviews with patients.ResultsCooperation of the patients in treatment safety acts as an additional step that contributes to safer treatments. Radiation therapy sessions are a creative opportunity for the patient to observe, learn and analyse what is happening. Changes between treatment sessions are a source of anxiety for the patients. This study highlights the factors that favour the patients' participation. A trusting relationship and support from the health professionals can be leveraged in that manner.ConclusionThere is a common will shared between the patients and the health professionals towards better treatment safety. The cooperation is still not well-known and underused. This empowerment of the patient cannot be mandatory but should be promoted and developed.



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Toxicity and early clinical outcomes in cervical cancer following extended field helical tomotherapy to para-aortic lymph nodes

Publication date: Available online 26 October 2016
Source:Cancer/Radiothérapie
Author(s): E. Jouglar, L. Thomas, A. de la Rochefordière, G. Noël, M. Le Blanc-Onfroy, G. Delpon, L. Campion, M.-A. Mahé
PurposeTo evaluate toxicity and early disease outcome among patients treated for cervical cancer with extended-field helical tomotherapy to the para-aortic nodes.Patients and methodsThirty-eight patients (International Federation of Gynecology and Obstetrics [FIGO] stage IB2–IVA) from four institutions received extended-field helical tomotherapy and were retrospectively evaluated. All had nodal disease. Para-aortic lymph nodes were involved in 31 patients. Patients were assessed for toxicity using version 4 of the National Cancer Institute's common terminology criteria for adverse events. Survival curves were plotted using Kaplan-Meier estimates.ResultsAll patients underwent radiation to the tumor region (median dose: 45Gy; range: 44–66Gy), pelvic lymph nodes and para-aortic lymph nodes (median dose: 45Gy; range: 44–60Gy). The median dose to positive lymph nodes was 55Gy (range: 45–65Gy). All received platinum-based chemotherapy (31 concurrently). The median follow-up was 15months. Acute toxicity events observed included one patient with grade 5 febrile neutropenia, 11 patients (29%) with grade 3 hematologic complications. Grades 3–4 gastrointestinal and genitourinary toxicities occurred in six (16%) and four (11%) patients, respectively. Three patients had grade 3 pelvic pain (8%). The 6- and 18-month overall survival rates were 94.7 and 63.9%, respectively. The 18-month locoregional control, disease-free survival, and late grade 3 toxicity rates were 60.2, 43.3 and 7.3%, respectively.ConclusionExtended-field helical tomotherapy was associated with low rates of acute gastrointestinal and genitourinary toxicities with early survival and locoregional control similar to other published series.



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Carcinome mucineux du sein : profil clinique, biologique et évolutif

Publication date: Available online 25 October 2016
Source:Cancer/Radiothérapie
Author(s): N. Naqos, A. Naim, H. Jouhadi, A. Taleb, Z. Bouchbika, N. Benchakroune, N. Tawfiq, S. Sahraoui, A. Benider
Objectif de l'étudeLe carcinome mucineux du sein constitue 1 à 4 % de tous les cancers du sein. Deux formes de pronostic différent sont distinguées : le carcinome mucineux mixte, où la composante carcinomateuse et mucineuse sont intriquées, et le carcinome muqueux pur, de pronostic favorable, où le mucus entoure le tissu tumoral et constitue ainsi une barrière mécanique atténuant l'invasion cellulaire, rendant cette forme moins agressive. L'objectif de l'étude était de préciser rétrospectivement les particularités épidémiologiques, cliniques, biologiques, thérapeutiques ainsi que pronostiques de cette forme rare de cancers mammaires.Matériels et méthodesUne série de 32 cas de carcinome mucineux du sein a été étudiée dans le centre Mohammed-VI pour le traitement des cancers à Casablanca.RésultatsLa taille tumorale moyenne était de 4,5cm (0,5–7cm). Il a été retrouvé dix cas de curage ganglionnaire ayant montré une atteinte, avec dans sept cas une forme mixte avec une taille tumorale entre 4 et 7cm. Le carcinome mucineux était pur dans16 cas, mixte dans 14 et une différentiation neuroendocrine a été retrouvée dans deux. La majorité des cas étaient de grade histologique intermédiaire (n=19), avec une expression des récepteurs hormonaux (68 %). Avec un recul moyen de 30 mois, la rémission complète était maintenue chez 92 % des malades dont les dossiers étaient évaluables.ConclusionLe carcinome mucineux est un type rare de cancer du sein avec un pronostic favorable dans sa forme pure.PurposeMucinous carcinoma of the breast accounts for 1 to 4% of all breast cancer. There are two histological subtypes: mixed mucinous carcinoma, where the ductal carcinoma is associated with the colloid component, and pure mucinous carcinoma, with a favorable prognosis, where the mucus surrounds the tumour tissue and constitutes a mechanical barrier limiting cell invasion and making this form less aggressive. Our study aimed to determine retrospectively the main epidemiological, clinical, biological, and therapeutic features, as well as the prognosis of this rare form of breast carcinoma.Materials and methodsThe authors report 32 cases of mucinous carcinoma of the breast diagnosed in Mohammed-VI centre for cancer treatment in Casablanca.ResultsThe average tumour size was 4.5cm (0.5–7cm). We found ten positive lymph node dissections, seven of them were of mixed mucinous carcinoma with a tumour size ranging between 4 and 7cm. Mucinous carcinoma was pure in 16 cases, mixed in 14 and a neuroendocrine differentiation was found in two cases. Most tumours were of an intermediate histological grade (n=19) with positive hormonal receptors (68%). After a mean follow-up of 30 months, complete remission was maintained in 92% of evaluable patients.ConclusionMucinous carcinoma is a rare type of breast cancer, with a favourable prognosis for the pure form.



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Quelle place pour la chimioradiothérapie postopératoire dans la prise en charge thérapeutique des adénocarcinomes de l’estomac et de la jonction œsogastrique ?

Publication date: Available online 25 October 2016
Source:Cancer/Radiothérapie
Author(s): H. Ben Salah, M. Bahri, F. Dhouib, J. Daoud
Les données disponibles dans la littérature montrent que pour les adénocarcinomes de l'estomac et de la jonction œsogastrique, la chimioradiothérapie postopératoire allonge la survie sans maladie des patients après une chirurgie et un curage D0 ou D1 et probablement D2, ainsi qu'en présence d'envahissement ganglionnaire histologiquement prouvé et en cas de limites d'exérèse envahies (R1). Avec les publications des essais de chimiothérapie périopératoire, la place de la radiothérapie postopératoire dans l'arsenal thérapeutique des adénocarcinomes de l'estomac et de la jonction œsogastrique devient difficile à préciser. Ce traitement postopératoire est indiqué en cas d'exérèse de type R1.The available data in the literature show that for gastric adenocarcinoma or gastroesophageal junction adenocarcinoma, postoperative chemoradiotherapy improves disease-free survival after surgery with D0 or D1 lymph node dissection (and perhaps D2) as well as in case of positive node or R1 resection. With the publications of perioperative chemotherapy trials, the role of postoperative radiotherapy in the therapeutic arsenal of gastric adenocarcinoma or gastroesophageal junction adenocarcinoma becomes difficult to define. Postoperative radiotherapy is indicated in case of R1 resection.



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Fiduciels intraprostatiques dans le cadre de la radiothérapie stéréotaxique du cancer de la prostate

Publication date: Available online 25 October 2016
Source:Cancer/Radiothérapie
Author(s): A. Cordoba, D. Pasquier, P. Nickers, T. Lacornerie, É. Lartigau
Objectif de l'étudeLa radiothérapie guidée par l'image est largement utilisée dans les cancers de la prostate. Le but de cette note est de décrire notre expérience d'implantation de repères fiduciels intraprostatiques.Patients et méthodesSur une période de 6 ans et demi, 226 patients atteints d'un cancer de la prostate ont été traités par le système CyberKnife^® (Accuray) dans notre institution. Dix-huit patients ont été pris en charge pour récidive après prostatectomie et ils ont été exclus de l'étude. Des 208 patients restants, 94 (45,2 %) ont reçu un complément de dose de trois fractions de 6Gy après la radiothérapie externe, 36 (17,3 %) six fractions de 6Gy à titre de ré-irradiation et 78 (37,5 %) comme traitement exclusif cinq fractions de 7,25Gy pour 68 ou de 6,25Gy pour 11. Quatre repères fiduciels ont été implantés chez tous les patients avec l'aide de l'échographie transrectale, sous anesthésie locale, par voie transpérinéale. Les quatre repères fiduciels ont été implantés dans deux brins, les deux étant séparés d'au moins 2cm. Afin de suivre les recommandations du système de guidage par l'image, les deux brins de deux repères fiduciels étaient situés dans le même plan, presque frontal, au milieu de la prostate, au moins 1cm en dehors de la ligne médiane. Après l'insertion, une imagerie par rayons X a été faite afin de vérifier le bon positionnement des marqueurs. Une scanographie de dosimétrie a été réalisée une semaine après la procédure d'implantation ; le suivi de la position de la prostate était possible avant et pendant le traitement par le système d'imagerie intégré. Les données cliniques, la vérification par rayons X et la scanographie de dosimétrie ont été revues rétrospectivement pour tous les patients.RésultatsLa tolérance à la procédure a été excellente ; seuls quatre patients (1,8 %) ont décrit des douleurs liées à l'implant. Aucun effet urinaire secondaire n'a été signalé. Le temps médian écoulé entre l'implantation des repères et la scanographie de dosimétrie était de 16jours (4–113). Les quatre marqueurs ont été observés dans la prostate lors de la scanographie de dosimétrie chez 181 patients et trois chez les 27 restants. Tous les repères intraprostatiques ont été utilisés pour le suivi de la prostate pour la mise en place et pendant le traitement.ConclusionsL'implantation de repères fiduciels est une procédure sûre et reproductible qui nous permet d'avoir un repérage fiable de la prostate pour la mise en place du patient et pendant la radiothérapie en conditions stéréotaxiques.PurposeImage-guided radiotherapy for prostate cancer is widely used in radiotherapy departments. Intraprostatic gold fiducial markers are used to visualize prostate position and motion before and during treatment. The aim of this report is to describe our experience of implanting intraprostatic fiducial markers under local anesthesia before hypofractionated stereotactic radiotherapy for prostate cancer and to assess its tolerance and reproducibility.Patients and methodsOver a 6 and a half year period, 226 patients with prostate cancer received a stereotactic radiotherapy using the CyberKnife^® system (Accuray) in our institution. Eighteen patients were treated for recurrence after prostatectomy; these patients were excluded from the study. Among the 208 remaining patients, 94 patients (45.2%) received stereotactic radiotherapy as a boost after external beam radiotherapy (three fractions of 6Gy); 36 patients (17.3%) were had a re-irradiation (six fractions of 6Gy) and 78 patients (37.5%) had a exclusive stereotactic radiotherapy (68 patients received five fractions of 7.25Gy and 11 patients five fractions of 6.25Gy). Four markers were implanted in all patients using transrectal ultrasound; the procedure was performed under local anesthesia, using transperineal access. The four fiducial markers were implanted in two strands with two fiducial each one, 1cm apart. In order to follow the recommendations of the image-guided radiotherapy system, the two strands of the two markers were located on the same plane in the middle of the prostate, at least 2cm apart from the midline. After insertion, correct positioning of fiducials markers was verified by X-ray. Dosimetry scanning was performed after the implantation procedure; prostate position tracking was possible before and during treatment through the kilovoltage incorporated system of the robotic accelerator. Clinical data, X-ray verification and dosimetry scanner have been retrospectively reviewed for all patients.ResultsThe tolerance to procedure was excellent; only four patients (1.8%) described pain related to implant. No urinary side effects were reported. Median time from fiducial implantation to dosimetry scanner was 16 days (4–113 days). Four fiducials were found within the prostate at dosimetry scanner in 181 patients and three in 27 remaining patients. All intraprostatic fiducials were used to track the prostate gland before and during treatment.ConclusionsIntraprostatic fiducial markers implantation is a safe and reproducible procedure that allows us to have reliable prostate information before and during stereotactic radiotherapy.



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A feasibility study of two millimeter bolus for post-mastectomy radiation therapy

Publication date: Available online 24 October 2016
Source:Practical Radiation Oncology
Author(s): Lauren C. Das, Daniel W. Golden, Eugenia Perevalova DMP, Anthony C. Wong, Kimberly De Nardo, Christopher Stepaniak, Daniel S. Joyce, Bradley P. McCabe, Yasmin Hasan, Steven J. Chmura, Anne McCall
PurposeTo prospectively evaluate the use of daily 2mm bolus in patients undergoing post-mastectomy radiation without reconstruction using optically stimulated luminescence dosimetry (OSLD) and weekly assessment of skin toxicity.Methods and MaterialsWe prospectively collected data from the first 49 women treated with a daily 2mm Superflab™ (Mick Radio-Nuclear Instruments, Mount Vernon, NY) bolus during their post-mastectomy radiation therapy from 2013–2016 at XXXX. Within the first three days of starting radiation therapy, we measured the surface dose in vivo at five anatomical locations under the 2mm bolus on the chest wall. We assessed the acute skin toxicity during radiation weekly using the National Cancer Institute Common Toxicity Criteria (NCI CTC). Patients with reconstruction prior to radiation therapy were excluded.ResultsForty-nine women with a mean age of 54.3years were treated with daily 2mm bolus to the chest wall following mastectomy. Median follow-up was 32.7weeks. The mean percentage of prescribed dose (standard deviation) for the median, central, lateral, superior, and inferior OSLDs were 100.1% (5.6%), 108.1% (6.7%), 98.1% (6.5%), 102.6% (8.9%), and 106.3% (6.6%) respectively. The majority (71.4%) of women experienced a maximum acute NCI CTC skin toxicity score of 2 with only 12.2% experiencing a score of 3. There were no grade 4 toxicities. There were no local recurrences during our follow-up period.ConclusionsDaily 2mm bolus is a feasible regimen for chest wall bolus during post-mastectomy radiation therapy with acceptable dose build-up and skin toxicity.



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Simplified low dose rate infant total body irradiation

Publication date: Available online 24 October 2016
Source:Practical Radiation Oncology
Author(s): Nels Knutson, Y. James Rao, Sridhar Yaddanapudi, Stephanie M. Perkins, H. Harold Li
PurposeLow dose rate total body irradiation (LDR-TBI) in infants possesses unique challenges due to the setup limitations imposed by anesthesia. We present a LDR-TBI method with an AP/PA arrangement and dose rate<10cGy/min for infant patients (thickness<14cm) without the use of a beam attenuator.Materials and methodsThe delivery utilized a 6 MV TrueBeam linear accelerator (Varian Medical Systems, Palo Alto, CA) with adjustable meterset rates below 100 MU/min. A platform was constructed to support the patient 6cm above the floor (~2 meters from the source). A 40x40 cm² field at isocenter along with a 45 degree collimator rotation was used to achieve a maximum field width of approximately 113cm at 2 meters. The patient was positioned supine with head turned towards the patient's right side for the AP beam and prone with the head continuing to turn towards the patient's right side for the PA beam. A scattering plate with custom organ blocks was placed approximately 20cm from the patient's surface. Output, depth-dose, surface-dose, block transmission, and off-axis measurements were taken using solid water slabs, ion chambers, and film.ResultsThe TrueBeam provides several options for this treatment geometry to deliver LDR-TBI at less than 10cGy/min by lowering the linear accelerator meterset rate below 100 MU/min. This allowed for a compromise between dose rate and treatment time to be selected by the radiation oncology team without the use of a beam attenuator, thus improving patient safety. Depth-dose and off-axis measurements confirmed a dose distribution within ±5% of the central-axis dose. A scattering plate distance of ~20cm from the patient's increases surface dose while allowing easy access to the patient during anesthesia.ConclusionsThe method described is useful to pediatric radiation oncologists seeking to deliver LDR-TBI to an infant patient.



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Data Driven Management Using Quantitative Metric and Automatic Auditing Program (QMAP) Improves Consistency of Radiation Oncology Processes

Publication date: Available online 24 October 2016
Source:Practical Radiation Oncology
Author(s): Naichang Yu, Ping Xia, Anthony Mastroianni, Matthew D. Kolar, Samuel T. Chao, John F. Greskovich, John H. Suh
PurposeProcess consistency in planning and delivery of radiotherapy is essential to maintain patient safety, and treatment quality and efficiency. Ensuring the timely completion of each critical clinical task is one aspect of process consistency. The purpose of this work is to report our experience in implementing a quantitative metric and automatic auditing program (QMAP) with a goal of improving the timely completion of critical clinical tasks.Materials and MethodsBased on our clinical electronic medical records (EMR) system, we developed a software program to automatically capture the completion time-stamp of each critical clinical task while providing frequent alerts of potential delinquency. These alerts were directed to designated triage teams within a time window that would offer an opportunity to mitigate the potential for late completion. Since July 2011, 18 metrics were introduced in our clinical workflow. We compared the delinquency rates for 4 selected metrics before the implementation of the metric with the delinquency rate of 2016. Student t-test with one tail was used for statistical analysis.ResultsWith an average of 150 daily patients on treatment at our main campus, the late treatment plan completion rate and late weekly physics check (WPC) were reduced from 18.2% and 8.9% in 2011 to 4.2% and 0.1% in 2016, respectively (p<0.01). The late weekly on-treatment physician visit rate was reduced from 7.2% in 2012 to <1.6% in 2016. The yearly late CBCT review rate was reduced from 1.6% in 2011 to <0.1% in 2016.ConclusionsQMAP is effective in reducing late completions of critical tasks, which can positively impact treatment quality and patient safety by reducing the potential for errors resulting from distractions, interruptions, and rush in completion of critical tasks.



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Development of a model web-based system to support a statewide quality consortium in radiation oncology

Publication date: Available online 20 October 2016
Source:Practical Radiation Oncology
Author(s): Jean M. Moran, Mary Feng, Lisa A. Benedetti, Robin Marsh, Kent A. Griffith, Martha M. Matuszak, Michael Hess, Matthew McMullen, Jennifer H. Fisher, Teamour Nurushev, Margaret Grubb, Stephen Gardner, Daniel Nielsen, Reshma Jagsi, James A. Hayman, Lori J. Pierce
PurposeA database in which patient data is compiled allows analytic opportunities for continuous improvements in treatment quality and comparative effectiveness research. We describe the development of a novel, web-based system that supports the collection of complex radiation treatment planning information from centers that employ diverse techniques, software, and hardware for radiation oncology care in a state-wide quality collaborative, REDACTED.MethodsThe REDACTED database seeks to enable assessment of physician and patient reported outcomes and quality improvement as a function of treatment planning and delivery techniques for breast and lung cancer patients. We created tools to collect anonymized data based on all plans.ResultsThe REDACTED system representing 24 institutions has been successfully deployed in the state of REDACTED. Since 2012, DVH and DICOM-RT plan data, and information on simulation, planning, and delivery techniques have been collected. Audits indicated >90% accurate data submission and spurred refinements to data collection methodology.ConclusionsThis model web-based system captures detailed, high-quality radiotherapy dosimetry data along with patient- and physician-reported outcomes and clinical data for a radiotherapy collaborative quality initiative. The collaborative nature of the project has been integral to its success. Our methodology can be applied to setting up analogous consortiums and databases.SummaryThis work describes the physics database for a radiation oncology-specific registry developed in the state of REDACTED in 2011. Within the consortium, data have been collected for >5000 patients with breast or lung cancer. The information will be used to support analysis of patient- and physician-reported outcomes. Also, practice patterns can be evaluated such as algorithm type for dose calculations and device utilization for motion management. The methodology of the consortium can be used by others designing similar systems.



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Estimation of Radiation-induced Secondary Cancer Risks for Early-stage Non-Small-Cell Lung Cancer Patients after Stereotactic Body Radiotherapy

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Chunhui Han, Timothy E Schultheiss, Jeffrey Y C Wong
Purpose/ObjectivesIn this study, we evaluated radiation-induced secondary lung cancer risks for the lung and the breast from SBRT treatment of early-stage non-small cell lung cancer (NSCLC) with different radiotherapy treatment modalities.Materials/MethodsTen patients (five male and five female) with early-stage NSCLC who received definitive SBRT treatments were retrospectively selected. For each patient, two three-dimensional conformal radiotherapy (3D–CRT) plans using 6 MV and 10 MV photons respectively, a helical tomotherapy (HT) plan, and two volumetric modulated arc therapy (VMAT) plans using one and two arcs, respectively, were generated. The excess absolute risk (EAR) for secondary cancer occurrence was calculated using three organ equivalent dose (OED) models: the linear-exponential model, the plateau model, and the linear model, for prescription dose range of 30 to 70Gy.ResultsThe 3D–CRT plans showed significantly lower monitor units compared to the rotational IMRT plans. Based on each of the three OED models, HT and VMAT plans showed comparable average EAR's to both the lung and the breast compared to the 3D–CRT plans in the prescription dose range of 30 to 70Gy. At a prescription dose of 50Gy and using the linear-exponential model, the average lung EAR estimation ranged from 15.7±5.3 to 16.0±6.5 per 10,000 patients per year with the five delivery techniques, and the average EAR estimation for the breast ranged from 18.0±14.0 to 21.0±15.0 per 10,000 patients per year. The secondary cancer risk increased approximately linearly with mean organ dose. The 3D–CRT plans showed significantly higher secondary cancer risk for the ipsilateral lung, and lower risk for the contralateral lung, compared to the HT and VMAT plans.ConclusionRotational IMRT techniques including helical tomotherapy and VMAT do not increase secondary cancer risks for the lung or the breast compared to 3D–CRT techniques, despite higher monitor units used.



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Radiotherapeutic management of vestibular schwannomas using size and location-adapted fractionation regimens to maximize the therapeutic ratio

Publication date: Available online 28 October 2016
Source:Practical Radiation Oncology
Author(s): Benjamin G Slane, Uma Goyal, Joel L Grow, Christopher Morrison, Craig R Hullet, John Gordon, Abhay Sanan, Baldassarre Stea
BackgroundWe evaluated and compared the radiographic and clinical outcomes of patients with vestibular schwannomas treated with either single fraction stereotactic radiosurgery (SRS), or five fractions of hypofractionated stereotactic radiotherapy (hSRT), or 25–30 fractions of conventionally fractionated stereotactic radiotherapy (cfSRT).Methods and MaterialsFifty-six patients treated with linac-based SRS(median 12.5Gy), hSRT(25Gy) or cfSRT(median 54Gy) were retrospectively reviewed. Fractionation was based on the size of the tumor, proximity to the brainstem, and potential risk of neurological sequelae. Median follow-up time was 55.2 months.ResultsThe pretreatment median tumor diameter was significantly smaller for SRS (1.14 cm) compared with hSRT(1.7 cm) (p=0.03) and cfSRT(2.0 cm) (p<0.001). The overall local tumor control was 96.4%: 100% SRS, 100% hSRT, and 90% cfSRT(p=0.19). Tumor regression was observed in 53.3% SRS, 76.2% hSRT, and 90% cfSRT(p=0.05). There was less transient expansion of tumors treated with cfSRT(5%) than with SRS(53.3%) or hSRT(28.6%) (p=0.005). The median time to regression was 13.8 months SRS, 14.2 months hSRT, and 5.5 months cfSRT (p=0.34). There was 3.6% incidence of grade 3 trigeminal neuropathy, but there was no grade 3 facial neuropathy.ConclusionsAll three regimens demonstrated similar excellent local control with minimal toxicity. However, the ability of hSRT to treat larger tumors with comparable outcomes to SRS and greater patient convenience when compared to cfSRT, suggest that hSRT may offer the optimal treatment approach.



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MRI in Radiotherapy for Lung Cancer: A free breathing protocol at 3T

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Shivani Kumar, Robba Rai, Daniel Moses, Callie Choong, Lois Holloway, Shalini Kavita Vinod, Gary Liney




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Deep Inspiration Breath-Hold (DIBH) produces a clinically meaningful reduction in ipsilateral lung dose during loco-regional radiation therapy for some women with right-sided breast cancer

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Jessica L. Conway, Leigh Conroy, Lindsay Harper, Marie Scheifele, Haocheng Li, Wendy L. Smith, Tannis Graham, Tien Phan, Ivo A. Olivotto
Background & PurposeTo determine whether Deep Inspiration Breath Hold (DIBH) produced a clinically meaningful reduction in pulmonary dose compared to free breathing (FB) during loco-regional radiation for right-sided breast cancer.Materials & MethodsFour-field, modified-wide tangent plans with full nodal coverage were developed for 30 consecutive patients on paired DIBH and FB CT scans. Nodes were contoured according to ESTRO guidelines. Plan metrics were compared using Wilcoxon signed-rank testing.ResultsTwenty-one patients (70%) had ≥5% reduction in ipsilateral lung V20 with DIBH compared to FB. The mean ipsilateral lung V20 decrease was 7.8% (0 to 20%; p<0.001). The mean lung dose (MLD) decreased on average by 3.4Gy with DIBH (−0.2 to 9.1; p<0.001). The mean reduction in liver volume receiving 50% of the prescribed dose was 42.3cc (0 to 178.9; p<0.001).ConclusionsDIBH reduced the ipsilateral lung V20 by ≥5% for the majority of patients. For some patients, the volume of liver receiving a potentially toxic dose was reduced with DIBH. DIBH should be available as a treatment strategy to reduce ipsilateral lung V20 prior to compromising IMC nodal coverage for patients with right-sided breast cancer during loco-regional RT if the V20 on FB exceeds 30%.



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Long-term results of adjuvant versus early salvage post-prostatectomy radiation: a large single institutional experience

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Daniela L. Buscariollo, Michael Drumm, Andrzej Niemierko, Rebecca H. Clayman, Sigolene Galland-Girodet, Danielle Rodin, Adam S. Feldman, Douglas Dahl, Francis J. McGovern, Aria Olumi, Alec Eidelman, William U. Shipley, Anthony L. Zietman, Jason A. Efstathiou
PurposeTo evaluate freedom from biochemical failure (FFBF), freedom from androgen deprivation therapy (FFADT), freedom from distant metastases (FFDM), and overall survival (OS) after adjuvant radiation therapy (ART) versus early salvage radiation therapy (ESRT) in men with prostate cancer and adverse pathologic features (pT3 and/or positive surgical margins).Methods and MaterialsOf 718 patients consecutively treated with postoperative radiation therapy (RT) for prostate cancer between 1992 and 2013, we retrospectively identified 171 men receiving ART and 230 receiving ESRT (RT delivered at PSA ≤0.5ng/ml) who had adverse pathologic features. Post-irradiation FFBF (BF was defined as PSA rise to ≥0.2ng/ml), FFADT, FFDM, and OS were compared using Kaplan–Meier and Cox regression methods. Propensity score (PS)-matching was performed to estimate treatment effects while accounting for covariates predicting treatment allocation.ResultsMedian follow-up was 7.4 and 8.0years for patients treated with ART and ESRT, respectively. Ten-year FFBF (69% versus 56%, p=0.003) and 10-year FFADT (88% versus 81%, p=0.046) rates were higher after ART; however, FFDM and OS did not significantly differ. After PS-matching, ART was associated with improved FFBF (p<0.0001), FFADT (p=0.0001), and FFDM (p=0.02). Findings were confirmed in multivariable analyses in unmatched and PS-matched cohorts.ConclusionPostoperative RT confers excellent long-term cancer control. These results suggest ART may be associated with improved FFBF, FFADT, and FFDM, but comparable OS. Given the retrospective study design, these findings should be interpreted with caution. Optimal timing of postoperative RT further awaits results of ongoing trials.



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The Likelihood of Unacceptable Normal Tissue Doses in Breast Cancer Patients Undergoing Regional Nodal Irradiation in Routine Clinical Practice

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Jose Bazan, Dominic DiCostanzo, Karla Kuhn, Lonika Majithia, Allison Quick, Nilendu Gupta, Julia White
PurposeAs indications for regional nodal irradiation (RNI) for breast cancer have expanded, so too has scrutiny over potential late toxicity from radiotherapy. This emphasizes the need for careful radiation treatment planning to maximize the therapeutic ratio. We sought to evaluate how often unacceptable dosing (UD) to organs-at-risk (OAR) occurs and what factors were associated with this for patients receiving RNI in daily practice.Materials and MethodsTreatment records of patients who received RNI from 2/2012–5/2015 were studied. The NSABP B51/RTOG 1304 clinical dose-volume constraints for targets/OAR receiving RNI were used as the benchmark. Dose volume histograms (DVH) were analyzed for the rate of ≥1 UD to the following: Heart mean>5Gy; ipsilateral lung (IL): V20>35%, V10>60%, V5>70%; contralateral lung (CL) V5>15%; contralateral breast (CB) V4.1>5%. Logistic regression was used to test the association between UD to OAR and key variables.Results203 consecutive cases received RNI (105 left, 98 right). RT was to CW in 171 (84%). Internal mammary nodes (IMN) were included in 170 (84%). 77.4% of cases met all OAR constraints. The most common OAR UD were to the CB (n=32, 15.7%) and IL V5 (n=22, 10.8%). On multivariate analysis, use of IMRT (OR=64.7, 95% CI 20.8–201.5, p<0.001) and use of nodal boost (OR=5.5, 95% CI 1.1–27.1, p=0.04) but not IMN irradiation (OR=2.7, p=0.35) or reconstruction (OR=0.62, p=0.33) were independently associated with higher OAR UD rate. For 3DCRT plans, 7.9% had OAR UD.ConclusionThe OAR UD rate with 3DCRT+/−DIBH in routine clinical practice is low and not independently associated with IMN irradiation or reconstruction presence. Women treated with IMRT had a significantly higher overall OAR UD rate, and clinicians should be aware of this as they initiate RNI treatment planning.



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Hydrogel spacer distribution within the perirectal space in patients undergoing radiotherapy for prostate cancer: Impact of spacer symmetry on rectal dose reduction and the clinical consequences of hydrogel infiltration into the rectal wall

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Benjamin W. Fischer-Valuck, Anupama Chundury, Hiram Gay, Walter Bosch, Jeff Michalski
PurposeHydrogel prostate-rectum spacers, biomaterials placed between the prostate and rectum, continue to gain interest as a method to reduce or limit rectal dose during dose escalated prostate cancer radiation therapy. Since the spacer is initially injected into the perirectal space as a liquid, the final distribution can vary. The purpose of this study was to evaluate hydrogel spacer (SpaceOAR® system) implantation and distribution from a recent prospective randomized control trial and correlate spacer symmetry with rectal dose reduction as well as rectal wall infiltration (RWI) to acute and late toxicity.Methods and MaterialsT2-weighted magnetic resonance imaging images for 149 patients enrolled on a prospective clinical trial who received transperineal spacer injection were assessed for hydrogel spacer midline symmetry and RWI using a semi-qualitative scoring system. Symmetry was then correlated to rectal dose reduction using a student t-test (one tailed, paired) while a Fisher's Exact test was used to correlate RWI with acute and late rectal toxicity. All patients had control treatment plans created prior to spacer injection.ResultsHydrogel spacer was symmetrically placed at midline for 71 (47.7%) patients at the prostate mid-gland as well as one centimeter superior and inferior to mid-gland. The remaining 78 (50.9%) patients had some level of asymmetry with only 2 (1.3%) having far lateral-distribution (i.e>2cm) of hydrogel spacer. As the hydrogel spacer became more asymmetric, the level of rectal dose reduction relative to their control plans decreased. However, all but the most asymmetrical 1.3% had significant rectal dose reduction (p<0.05). Rectal wall hydrogel spacer infiltration was seen in 9 (6.0%) patients. There was no correlation between RWI and procedure-related adverse events or acute/late rectal toxicity.ConclusionsSignificant reduction of rectal dose can still be achieved even in the setting of asymmetric hydrogel spacer placement. RWI does not correlate with patient complications.



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Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiotherapy of pancreatic cancer

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): H.D. Heerkens, W.A. Hall, X.A. Li, P. Knechtges, E. Dalah, E.S. Paulson, C.A.T. van den Berg, G.J. Meijer, E.J. Koay, C.H. Crane, K. Aitken, M. van Vulpen, B.A. Erickson
PurposeLocal recurrence is a common and morbid event in patients with unresectable pancreatic adenocarcinoma. A more conformal and targeted radiation dose to the macroscopic tumor in non-metastatic pancreatic cancer is likely to reduce acute toxicity and improve local control. Optimal soft tissue contrast is required to facilitate delineation of a target and creation of a planning target volume with margin reduction and motion management. MRI offers considerable advantages in optimizing soft tissue delineation and is an ideal modality for imaging and delineating a gross tumor volume within the pancreas, particularly as it relates to conformal radiation planning. Currently, no guidelines have been defined for the delineation of pancreatic tumors for radiotherapy treatment planning. Moreover, abdominal MRI sequences are complex and the anatomy relevant to the radiation oncologist can be challenging. The purpose of this study is to provide recommendations for delineation of gross tumor volume (GTV) and organs at risk (OARs) using MRI and incorporating multiple MRI sequences.MethodsFive pancreatic cancer patients and one healthy subject were imaged with MRI either on 1.5T or on 3T magnets in two separate institutes. The GTV and OARs were contoured for all patients in a consensus meeting.ResultsAn overview of MRI-based anatomy of the GTV and OARs is provided. Practical contouring instructions for the GTV and the OARs with the aid of MRI were developed and included in these recommendations. In addition, practical suggestions for implementation of MRI in pancreatic radiation treatment planning are provided.ConclusionsWith this report we attempt to provide recommendations for MRI-based contouring of pancreatic tumors and organs at risk. This could lead to better uniformity in defining the GTV and OARs for clinical trials and in radiotherapy treatment planning with the ultimate goal of improving local control while minimizing morbidity.SummaryThese recommendations describe the contouring of pancreatic tumors and organs at risk (OAR) using MRI. Practical contouring instructions for the gross tumor volume and OAR are provided based on five pancreatic cancer patients and one healthy subject. This report provides recommendations on how to integrate MRI into radiation treatment planning for pancreatic tumors and addresses the potential challenges of MRI.



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Lost in the Woods

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Jyoti Mayadev




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Erratum to: Roos DE, Keys NK, Kirkwood ID. The bone scan as a “biological dosimeter”. Front cover images with case history. Pract Radiat Oncol. July/August 2016;6

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Daniel E Roos, Robert N Keys, Ian D Kirkwood




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Assessment of Hepatic Function Decline After Stereotactic Body Radiation Therapy for Primary Liver Cancer

Publication date: Available online 17 October 2016
Source:Practical Radiation Oncology
Author(s): Diego A.S. Toesca, Evan C. Osmundson, Rie von Eyben, Jenny L. Shaffer, Albert C. Koong, Daniel T. Chang
Background and PurposeThis study aims to determine how the albumin-bilirubin (ALBI) score compares to Child-Pugh (CP) score for the assessment of liver function following SBRT.Materials and MethodsIn total, 60 patients, 40 with hepatocellular carcinoma (HCC) and 20 with cholangiocarcinoma (CCA), were treated with SBRT. Liver function panels were obtained before and at 1, 3, 6 and 12months after SBRT. Laboratory values were censored after local-regional recurrence, further liver directed therapies or liver transplant.ResultsA significant decline in hepatic function occurred after SBRT for HCC patients only (p=0.001 by ALBI score; p<0.0001 by CP score). The strongest dosimetric predictor of liver function decline for HCC was the VBED1040 using the ALBI score (p=0.07), and the VBED1020 by using the CP score (p=0.0009). For CCA patients, the VBED1040 remained the strongest dosimetric predictor using ALBI score (p=0.002), but no dosimetric predictor was significant using CP score. Hepatic function decline correlated with worse overall survival for HCC (by ALBI p=0.0005; by CP p<0.0001) and for CCA (by ALBI p=NS; by CP p=0.008).ConclusionALBI score was similarly able to predict hepatic function decline compared to CP score, and both systems correlated with survival.



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Evaluation of patients’ engagement in radiation therapy safety

Publication date: Available online 26 October 2016
Source:Cancer/Radiothérapie
Author(s): A. Pernet, V. Mollo, J.-E. Bibault, P. Giraud
PurposeTreatment safety has become a priority in health policies after several incidents occurred around the world in radiation oncology departments. The aim of this study was to analyse the patients' contribution in that field and to understand which actions empower the patient in that regard.MethodsSeveral methods were used in a general hospital and in a comprehensive cancer centre to analyse the activities of the radiation therapists and the patients and the interactions between them: treatment session observations, semidirective interviews with radiation therapists and patients, self and alloconfrontation with radiation therapists and explanatory interviews with patients.ResultsCooperation of the patients in treatment safety acts as an additional step that contributes to safer treatments. Radiation therapy sessions are a creative opportunity for the patient to observe, learn and analyse what is happening. Changes between treatment sessions are a source of anxiety for the patients. This study highlights the factors that favour the patients' participation. A trusting relationship and support from the health professionals can be leveraged in that manner.ConclusionThere is a common will shared between the patients and the health professionals towards better treatment safety. The cooperation is still not well-known and underused. This empowerment of the patient cannot be mandatory but should be promoted and developed.



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Toxicity and early clinical outcomes in cervical cancer following extended field helical tomotherapy to para-aortic lymph nodes

Publication date: Available online 26 October 2016
Source:Cancer/Radiothérapie
Author(s): E. Jouglar, L. Thomas, A. de la Rochefordière, G. Noël, M. Le Blanc-Onfroy, G. Delpon, L. Campion, M.-A. Mahé
PurposeTo evaluate toxicity and early disease outcome among patients treated for cervical cancer with extended-field helical tomotherapy to the para-aortic nodes.Patients and methodsThirty-eight patients (International Federation of Gynecology and Obstetrics [FIGO] stage IB2–IVA) from four institutions received extended-field helical tomotherapy and were retrospectively evaluated. All had nodal disease. Para-aortic lymph nodes were involved in 31 patients. Patients were assessed for toxicity using version 4 of the National Cancer Institute's common terminology criteria for adverse events. Survival curves were plotted using Kaplan-Meier estimates.ResultsAll patients underwent radiation to the tumor region (median dose: 45Gy; range: 44–66Gy), pelvic lymph nodes and para-aortic lymph nodes (median dose: 45Gy; range: 44–60Gy). The median dose to positive lymph nodes was 55Gy (range: 45–65Gy). All received platinum-based chemotherapy (31 concurrently). The median follow-up was 15months. Acute toxicity events observed included one patient with grade 5 febrile neutropenia, 11 patients (29%) with grade 3 hematologic complications. Grades 3–4 gastrointestinal and genitourinary toxicities occurred in six (16%) and four (11%) patients, respectively. Three patients had grade 3 pelvic pain (8%). The 6- and 18-month overall survival rates were 94.7 and 63.9%, respectively. The 18-month locoregional control, disease-free survival, and late grade 3 toxicity rates were 60.2, 43.3 and 7.3%, respectively.ConclusionExtended-field helical tomotherapy was associated with low rates of acute gastrointestinal and genitourinary toxicities with early survival and locoregional control similar to other published series.



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Carcinome mucineux du sein : profil clinique, biologique et évolutif

Publication date: Available online 25 October 2016
Source:Cancer/Radiothérapie
Author(s): N. Naqos, A. Naim, H. Jouhadi, A. Taleb, Z. Bouchbika, N. Benchakroune, N. Tawfiq, S. Sahraoui, A. Benider
Objectif de l'étudeLe carcinome mucineux du sein constitue 1 à 4 % de tous les cancers du sein. Deux formes de pronostic différent sont distinguées : le carcinome mucineux mixte, où la composante carcinomateuse et mucineuse sont intriquées, et le carcinome muqueux pur, de pronostic favorable, où le mucus entoure le tissu tumoral et constitue ainsi une barrière mécanique atténuant l'invasion cellulaire, rendant cette forme moins agressive. L'objectif de l'étude était de préciser rétrospectivement les particularités épidémiologiques, cliniques, biologiques, thérapeutiques ainsi que pronostiques de cette forme rare de cancers mammaires.Matériels et méthodesUne série de 32 cas de carcinome mucineux du sein a été étudiée dans le centre Mohammed-VI pour le traitement des cancers à Casablanca.RésultatsLa taille tumorale moyenne était de 4,5cm (0,5–7cm). Il a été retrouvé dix cas de curage ganglionnaire ayant montré une atteinte, avec dans sept cas une forme mixte avec une taille tumorale entre 4 et 7cm. Le carcinome mucineux était pur dans16 cas, mixte dans 14 et une différentiation neuroendocrine a été retrouvée dans deux. La majorité des cas étaient de grade histologique intermédiaire (n=19), avec une expression des récepteurs hormonaux (68 %). Avec un recul moyen de 30 mois, la rémission complète était maintenue chez 92 % des malades dont les dossiers étaient évaluables.ConclusionLe carcinome mucineux est un type rare de cancer du sein avec un pronostic favorable dans sa forme pure.PurposeMucinous carcinoma of the breast accounts for 1 to 4% of all breast cancer. There are two histological subtypes: mixed mucinous carcinoma, where the ductal carcinoma is associated with the colloid component, and pure mucinous carcinoma, with a favorable prognosis, where the mucus surrounds the tumour tissue and constitutes a mechanical barrier limiting cell invasion and making this form less aggressive. Our study aimed to determine retrospectively the main epidemiological, clinical, biological, and therapeutic features, as well as the prognosis of this rare form of breast carcinoma.Materials and methodsThe authors report 32 cases of mucinous carcinoma of the breast diagnosed in Mohammed-VI centre for cancer treatment in Casablanca.ResultsThe average tumour size was 4.5cm (0.5–7cm). We found ten positive lymph node dissections, seven of them were of mixed mucinous carcinoma with a tumour size ranging between 4 and 7cm. Mucinous carcinoma was pure in 16 cases, mixed in 14 and a neuroendocrine differentiation was found in two cases. Most tumours were of an intermediate histological grade (n=19) with positive hormonal receptors (68%). After a mean follow-up of 30 months, complete remission was maintained in 92% of evaluable patients.ConclusionMucinous carcinoma is a rare type of breast cancer, with a favourable prognosis for the pure form.



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Quelle place pour la chimioradiothérapie postopératoire dans la prise en charge thérapeutique des adénocarcinomes de l’estomac et de la jonction œsogastrique ?

Publication date: Available online 25 October 2016
Source:Cancer/Radiothérapie
Author(s): H. Ben Salah, M. Bahri, F. Dhouib, J. Daoud
Les données disponibles dans la littérature montrent que pour les adénocarcinomes de l'estomac et de la jonction œsogastrique, la chimioradiothérapie postopératoire allonge la survie sans maladie des patients après une chirurgie et un curage D0 ou D1 et probablement D2, ainsi qu'en présence d'envahissement ganglionnaire histologiquement prouvé et en cas de limites d'exérèse envahies (R1). Avec les publications des essais de chimiothérapie périopératoire, la place de la radiothérapie postopératoire dans l'arsenal thérapeutique des adénocarcinomes de l'estomac et de la jonction œsogastrique devient difficile à préciser. Ce traitement postopératoire est indiqué en cas d'exérèse de type R1.The available data in the literature show that for gastric adenocarcinoma or gastroesophageal junction adenocarcinoma, postoperative chemoradiotherapy improves disease-free survival after surgery with D0 or D1 lymph node dissection (and perhaps D2) as well as in case of positive node or R1 resection. With the publications of perioperative chemotherapy trials, the role of postoperative radiotherapy in the therapeutic arsenal of gastric adenocarcinoma or gastroesophageal junction adenocarcinoma becomes difficult to define. Postoperative radiotherapy is indicated in case of R1 resection.



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Fiduciels intraprostatiques dans le cadre de la radiothérapie stéréotaxique du cancer de la prostate

Publication date: Available online 25 October 2016
Source:Cancer/Radiothérapie
Author(s): A. Cordoba, D. Pasquier, P. Nickers, T. Lacornerie, É. Lartigau
Objectif de l'étudeLa radiothérapie guidée par l'image est largement utilisée dans les cancers de la prostate. Le but de cette note est de décrire notre expérience d'implantation de repères fiduciels intraprostatiques.Patients et méthodesSur une période de 6 ans et demi, 226 patients atteints d'un cancer de la prostate ont été traités par le système CyberKnife^® (Accuray) dans notre institution. Dix-huit patients ont été pris en charge pour récidive après prostatectomie et ils ont été exclus de l'étude. Des 208 patients restants, 94 (45,2 %) ont reçu un complément de dose de trois fractions de 6Gy après la radiothérapie externe, 36 (17,3 %) six fractions de 6Gy à titre de ré-irradiation et 78 (37,5 %) comme traitement exclusif cinq fractions de 7,25Gy pour 68 ou de 6,25Gy pour 11. Quatre repères fiduciels ont été implantés chez tous les patients avec l'aide de l'échographie transrectale, sous anesthésie locale, par voie transpérinéale. Les quatre repères fiduciels ont été implantés dans deux brins, les deux étant séparés d'au moins 2cm. Afin de suivre les recommandations du système de guidage par l'image, les deux brins de deux repères fiduciels étaient situés dans le même plan, presque frontal, au milieu de la prostate, au moins 1cm en dehors de la ligne médiane. Après l'insertion, une imagerie par rayons X a été faite afin de vérifier le bon positionnement des marqueurs. Une scanographie de dosimétrie a été réalisée une semaine après la procédure d'implantation ; le suivi de la position de la prostate était possible avant et pendant le traitement par le système d'imagerie intégré. Les données cliniques, la vérification par rayons X et la scanographie de dosimétrie ont été revues rétrospectivement pour tous les patients.RésultatsLa tolérance à la procédure a été excellente ; seuls quatre patients (1,8 %) ont décrit des douleurs liées à l'implant. Aucun effet urinaire secondaire n'a été signalé. Le temps médian écoulé entre l'implantation des repères et la scanographie de dosimétrie était de 16jours (4–113). Les quatre marqueurs ont été observés dans la prostate lors de la scanographie de dosimétrie chez 181 patients et trois chez les 27 restants. Tous les repères intraprostatiques ont été utilisés pour le suivi de la prostate pour la mise en place et pendant le traitement.ConclusionsL'implantation de repères fiduciels est une procédure sûre et reproductible qui nous permet d'avoir un repérage fiable de la prostate pour la mise en place du patient et pendant la radiothérapie en conditions stéréotaxiques.PurposeImage-guided radiotherapy for prostate cancer is widely used in radiotherapy departments. Intraprostatic gold fiducial markers are used to visualize prostate position and motion before and during treatment. The aim of this report is to describe our experience of implanting intraprostatic fiducial markers under local anesthesia before hypofractionated stereotactic radiotherapy for prostate cancer and to assess its tolerance and reproducibility.Patients and methodsOver a 6 and a half year period, 226 patients with prostate cancer received a stereotactic radiotherapy using the CyberKnife^® system (Accuray) in our institution. Eighteen patients were treated for recurrence after prostatectomy; these patients were excluded from the study. Among the 208 remaining patients, 94 patients (45.2%) received stereotactic radiotherapy as a boost after external beam radiotherapy (three fractions of 6Gy); 36 patients (17.3%) were had a re-irradiation (six fractions of 6Gy) and 78 patients (37.5%) had a exclusive stereotactic radiotherapy (68 patients received five fractions of 7.25Gy and 11 patients five fractions of 6.25Gy). Four markers were implanted in all patients using transrectal ultrasound; the procedure was performed under local anesthesia, using transperineal access. The four fiducial markers were implanted in two strands with two fiducial each one, 1cm apart. In order to follow the recommendations of the image-guided radiotherapy system, the two strands of the two markers were located on the same plane in the middle of the prostate, at least 2cm apart from the midline. After insertion, correct positioning of fiducials markers was verified by X-ray. Dosimetry scanning was performed after the implantation procedure; prostate position tracking was possible before and during treatment through the kilovoltage incorporated system of the robotic accelerator. Clinical data, X-ray verification and dosimetry scanner have been retrospectively reviewed for all patients.ResultsThe tolerance to procedure was excellent; only four patients (1.8%) described pain related to implant. No urinary side effects were reported. Median time from fiducial implantation to dosimetry scanner was 16 days (4–113 days). Four fiducials were found within the prostate at dosimetry scanner in 181 patients and three in 27 remaining patients. All intraprostatic fiducials were used to track the prostate gland before and during treatment.ConclusionsIntraprostatic fiducial markers implantation is a safe and reproducible procedure that allows us to have reliable prostate information before and during stereotactic radiotherapy.



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Six generations of epidermolytic palmoplantar keratoderma, associated with a KRT9 R163W mutation

Publication date: Available online 29 October 2016
Source:Cancer Genetics
Author(s): Peng Wang, Xiao-Jing Kang, Xiao-Hui Tang, Jian-Yong Liu, Wen-Zheng Li, Wei-Jia Wang, Sheng-Nan Liang, Yan-Yan Feng, Yuan Ding, Wen-Jing Chen
Epidermolytic palmoplantar keratoderma (EPPK) is a rare autosomal dominant skin disorder characterized by diffuse hyperkeratosis on the palms and soles. Whole-exome sequencing (WES) has become a powerful tool for the detection of rare causal variants of Mendelian disorders. However, no causal gene for EPPK in the Uygur population has been identified until now, and no treatment exists than can address the underlying pathology.WES analysis was undertaken on two individuals from a large Uygur EPPK pedigree whose disease locus mapped to 17q21.2 (chr:38994621–39893408) following previous linkage analysis. KRT9 (NM_000226.3:c.487C>T, p.Arg163Trp), and KRT15 (XM_005257346.1:c.212G>T, XP_005257403.1:p.Gly71Val) located in this region, have been identified as two candidate causative genes for EPPK in the Uygur family. Sanger sequencing was conducted on this region in other affected individuals (n = 38) from this family, non-affected individuals (n = 56) from this family and 100 unrelated controls. The missense mutation KRT9 c.487C>T, identified in this large Uygur population, is a potential causative mutation. To date, EPPK has no effective therapy, siRNA is a potential avenue for EPPK therapy. To investigate this full-length wild-type Keratin9 (KRT9; pKRT9-WT) and p.Arg163Trp (pKRT9-R163W) were then transfected into HaCaT cells. The small interfering RNAs targeting the KRT9 R163W mutant and wildtype KRT9 were transfected into HaCaT cells, and total RNA isolated at 72 h post-transfection. Quantitative polymerase chain reaction and western blotting were used to analyze the effects of knock-down on KRT9 mRNA and protein levels, respectively. siRNA was shown to specifically inhibit mutant KRT9 mRNA and protein expression (p < 0.01, with 95% confidence limits). Our study suggests that KRT9 is a causal gene for EPPK. This information is helpful for understanding the pathogenesis of EPPK in the Uygur population and raises the possibility of designing a novel siRNA treatment strategy for this population of EPPK patients.



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Molecular profiles in foregut oncology

Publication date: Available online 29 October 2016
Source:Cancer Genetics
Author(s): Prashant Sukharamwala, Daniel Hennessey, Thomas Wood, Shelly Singh, Carrie Ryan, Alexander Rosemurgy
Oncology is and will continue to evolve resulting from a better understanding of the biology and intrinsic genetic profile of each cancer. Tumor biomarkers and targeted therapies are the new face of precision medicine, so it is essential for all physicians caring for cancer patients to understand and assist patients in understanding the role and importance of such markers and strategies to target them. This review was initiated in an attempt to identify, characterize, and discuss literature supporting clinically relevant molecular markers and interventions. The efficacy of targeting specific markers will be examined with data from clinical trials focusing on treatments for esophageal, gastric, liver, gallbladder, biliary tract, and pancreatic cancers.



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Chromosomal rearrangements in myoepithelial carcinoma of the breast that presented as metachronic double cancer with invasive ductal carcinoma in the ipsilateral breast

Publication date: Available online 29 October 2016
Source:Cancer Genetics
Author(s): Hiroyuki Kawashima, Takashi Ariizumi, Yasuo Saijo, Masato Moriyama, Hajime Umezu, Yoshiyuki Ikeda, Akira Ogose, Naoto Endo
Myoepithelial carcinoma of the breast is an extremely rare tumor composed entirely of malignant spindle cells with myoepithelial differentiation. The majority of previously reported cases have mainly described the clinicopathological features of the disease, and few have presented cytogenetic data. We herein present the case of a 48-year-old woman who was admitted with a left-sided breast lump in the inner upper quadrant that was initially diagnosed as a myoepithelioma with potentially malignant disorder. At 12 months after resection, she complained about a newly developed solid mass in the subareolar region of the ipsilateral breast that was diagnosed as an invasive ductal carcinoma. In addition, 16 months after the initial admission, a re-growing remnant lesion recurred in the inner upper quadrant and was ultimately diagnosed as a myoepithelial carcinoma. Lymph node metastasis of the myoepithelial carcinoma was also observed in her left axillary region 11 months after local recurrence. A cytogenetic analysis showed recurring specific chromosomal alterations both in the locally recurrent and in the lymph-node metastatic lesion: 48, XX, t(5;18)(q13;q23),del(6)(q?),+14.+mar1. To our knowledge, this is the first published report of clonal chromosomal rearrangements in myoepithelial carcinoma of the breast that presented as metachronic double cancer with invasive ductal carcinoma in the ipsilateral breast.



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Coughing up – Small cell carcinoma lung with gingival metastasis

Publication date: Available online 18 October 2016
Source:Journal of the Egyptian National Cancer Institute
Author(s): Antony George Francis Thottian, Sushmita Pathy, Ajeet Kumar Gandhi, Prabhat Malik, Aruna Nambirajan
Small cell lung cancer (SCLC) is known for its metastatic potential. The most common sites are liver, adrenal, bone and brain. We report a case of a 37year old female patient, diagnosed with SCLC, presenting with gingival metastasis, an unusual metastatic site. Radiation therapy to the metastatic lesion to a dose of 20 Gray in 5 fractions over 5days was delivered which achieved haemostasis and good palliation. However, the patient expired in 2months owing to systemic metastasis.



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Vertigo and deafness: The sole presenting feature of multiple myeloma

Publication date: Available online 19 October 2016
Source:Journal of the Egyptian National Cancer Institute
Author(s): K. Rakul Nambiar, Sreejith G. Nair, Sherin P. Mathew




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Coughing up – Small cell carcinoma lung with gingival metastasis

Publication date: Available online 18 October 2016
Source:Journal of the Egyptian National Cancer Institute
Author(s): Antony George Francis Thottian, Sushmita Pathy, Ajeet Kumar Gandhi, Prabhat Malik, Aruna Nambirajan
Small cell lung cancer (SCLC) is known for its metastatic potential. The most common sites are liver, adrenal, bone and brain. We report a case of a 37year old female patient, diagnosed with SCLC, presenting with gingival metastasis, an unusual metastatic site. Radiation therapy to the metastatic lesion to a dose of 20 Gray in 5 fractions over 5days was delivered which achieved haemostasis and good palliation. However, the patient expired in 2months owing to systemic metastasis.



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Vertigo and deafness: The sole presenting feature of multiple myeloma

Publication date: Available online 19 October 2016
Source:Journal of the Egyptian National Cancer Institute
Author(s): K. Rakul Nambiar, Sreejith G. Nair, Sherin P. Mathew




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Comparing performance of Bonfils fiberscope and GlideScope videolaryngoscope for awake intubation

The recent article by Nassar et al [1] comparing performance of Bonfils fiberscope and GlideScope videolaryngoscope for awake intubation in the morbidly obese patients with expected difficult airways was of great interest to us. They showed that Bonfils fiberscope was more tolerated by patients with statistical difference, whereas GlideScope videolaryngoscope provided shorter intubation time and less intubation attempts but without statistical significance. Given that the airway management of morbidly obese patients often presents a unique challenge to the anesthesiologists, their findings have potential implications.

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Sudden cardiorespiratory collapse associated with Takotsubo cardiomyopathy upon transferring a patient to the operation bed

Here, we report a case of cardiopulmonary collapse associated with Takotsubo cardiomyopathy after moving a patient to the operation bed.

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Rapid-sequence intubation of a patient with difficult airway using a double-lumen endotracheal tube with the Pentax-AWS Airwayscope and a soft-tipped tube exchanger

Rapid-sequence intubation of a double-lumen tube is difficult, especially in patients with difficult airway [1]. Here we report successful rapid-sequence intubation of a patient with difficult airway using a double-lumen endotracheal tube (DLT) with the Pentax-AWS Airwayscope (AWS) (HOYA, Tokyo, Japan) videolaryngoscope equipped with a newly developed Intlock for DLT (ITL-LL) (HOYA), combined with a soft-tipped tube exchange catheter (TE-Soft) (Cook Medical, IN, USA).

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Genetic Predisposition to Leukemia and other Hematologic Malignancies

Publication date: Available online 25 October 2016
Source:Seminars in Oncology
Author(s): Simone Feurstein, Michael W. Drazer, Lucy A. Godley
In this review, we provide an overview of familial myelodysplastic syndromes (MDS)/acute leukemia (AL) and bone marrow failure syndromes, as well as insights into familial myeloproliferative neoplasms (MPNs), familial multiple myeloma (MM), familial Waldenstrom macroglobulinemia (WM), familial lymphoma, and cancer predisposition syndromes with increased risk of MDS/AL. This field will continue to accelerate as next-generation sequencing (NGS) techniques identify novel predisposition alleles in families with a genetic predisposition to hematologic malignancies. Newly identified predisposition genes continue to inform the field of inherited leukemia and other hematologic malignancies. Current developments in clinical translation include techniques detailing the acquisition of appropriate germline material for patient work-ups, methods for genetic testing, and nuances essential for the treatment and clinical management of patients with a genetic predisposition to hematologic malignancies.



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The future of clinical cancer genomics

Publication date: Available online 18 October 2016
Source:Seminars in Oncology
Author(s): Kenneth Offit




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Talimogene laherparepvec (T-Vec) for the treatment of melanoma and other cancers

Publication date: Available online 27 October 2016
Source:Seminars in Oncology
Author(s): Claud Grigg, Zoë Blake, Robyn Gartrell, Adrian Sacher, Bret Taback, Yvonne Saenger
Talimogene laherparepvec (T-Vec) is the first live virus to be approved by the FDA for the treatment of cancer. This engineered version of herpes simplex virus type 1 (HSV-1) is the product of decades of preclinical work aimed at identifying and modifying aspects of the viral genome involved in virulence and immunogenicity. T-Vec preferentially infects and lyses tumor cells and, in some cases, induces a systemic immune response against the tumor. These properties have translated into significant and durable clinical responses, particularly in advanced melanoma. Many unanswered questions remain, including how to augment these clinical responses and which other tumor types may respond to oncolytic therapy. Here, we review the development of T-Vec, our current understanding of its impact on the tumor immune micro-environment, and its safety and efficacy in clinical trials for melanoma and other cancers.



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Transcriptome analysis of distinct long non-coding RNA transcriptional fingerprints in lung adenocarcinoma and squamous cell carcinoma

Abstract

Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related death, including two major pathologic subtypes, adenocarcinoma (AD) and squamous cell carcinoma (SCC). There are significant differences in the aberrant gene profiling and molecular characteristics among LUAD and LUSC, which lead to the different chemotherapeutic regimens administered to the two NSCLC subtypes. Therefore, unique genetic or epigenetic accurately distinguishing these two subtypes is critical for the diagnosis and treatment of patients. In this study, we tried to develop and validate novel long non-coding RNA (lncRNA)-based signatures to facilitate the diagnosis and individualized treatment of LUAD and LUSC. To analyze the distinct lncRNA profiling in LUAD and LUSC, the paired tissue samples of RNA sequencing or microarray data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) was used. We found that lncRNA expression pattern is different in LUAD and LUSC, and three up-regulated and down-regulated lncRNAs expressions in LUAD and LUSC tissues were validated. In addition, knockdown of the up-regulated lncRNA AFAP1-AS1 and LINC00511 impaired LUAD cell proliferation, while knockdown of PVT1 inhibited LUSC cell growth. Furthermore, four 6-lncRNAs signature expression patterns were found to be significantly associated with LUAD and LUSC patient overall and progression-free survival. Taken together, the different lncRNAs signature might accurately distinguish LUAD and LUSC and predict clinical outcome for these two different subtypes of NSCLC.

http://ift.tt/2dXXaq8

Transcriptome analysis of distinct long non-coding RNA transcriptional fingerprints in lung adenocarcinoma and squamous cell carcinoma

Abstract

Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related death, including two major pathologic subtypes, adenocarcinoma (AD) and squamous cell carcinoma (SCC). There are significant differences in the aberrant gene profiling and molecular characteristics among LUAD and LUSC, which lead to the different chemotherapeutic regimens administered to the two NSCLC subtypes. Therefore, unique genetic or epigenetic accurately distinguishing these two subtypes is critical for the diagnosis and treatment of patients. In this study, we tried to develop and validate novel long non-coding RNA (lncRNA)-based signatures to facilitate the diagnosis and individualized treatment of LUAD and LUSC. To analyze the distinct lncRNA profiling in LUAD and LUSC, the paired tissue samples of RNA sequencing or microarray data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) was used. We found that lncRNA expression pattern is different in LUAD and LUSC, and three up-regulated and down-regulated lncRNAs expressions in LUAD and LUSC tissues were validated. In addition, knockdown of the up-regulated lncRNA AFAP1-AS1 and LINC00511 impaired LUAD cell proliferation, while knockdown of PVT1 inhibited LUSC cell growth. Furthermore, four 6-lncRNAs signature expression patterns were found to be significantly associated with LUAD and LUSC patient overall and progression-free survival. Taken together, the different lncRNAs signature might accurately distinguish LUAD and LUSC and predict clinical outcome for these two different subtypes of NSCLC.

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Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers

Abstract

Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5–5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0–19), median LARS score was 4.78 (range 0–33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.

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Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers

Abstract

Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5–5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0–19), median LARS score was 4.78 (range 0–33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.

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