Search

• Radiation dose-escalation with IOERT feasible with limited toxicity to stomach, colon, kidneys and duodenum. • Abdominal pain improvement is a palliative effect observed after single high-dose electron irradiation. • Median survival time predominantly ranges from 8 to 12 months in electron boosted patients. • Long-term survivors with a low level of morbidity are reported in the context of small primary tumour size, use of systemic therapy and intraoperative radiation therapy. Radiation therapy (RT) is a valuable component of multimodal treatment for localized pancreatic cancer. Intraoperative radiation therapy (IORT) is a very precise sub-component of RT that can intensify the irradiation effect for cancer involving an anatomically well-defined volume, generally delivered with electrons (IOERT). Unresectable disease categories benefit from dose-escalated chemoradiation strategies in the context of active systemic therapy and potential radical surgery. Prolonged preoperative treatment may act as a filter for selecting patients with occult resistant metastatic disease. Long-term survivors were observed among unresected patients treated with external beam RT and an IOERT boost (OS 6% at 3 years; 3% >5 years). Improvement of local control through higher RT doses has an impact on the survival of patients with a lower tendency towards disease spread. IOERT is a well-accepted asset in the clinical scenario (maturity and reproducibility of results, albeit of low official level of evidence) and extremely accurate in terms of dose-deposit characteristics and normal tissue sparing. It is a technique that can be integrated with systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) currently recommend the use of IOERT in cases of close surgical margins and residual disease. We report the ESTRO/ACROP recommendations for performing IOERT in unresected pancreatic cancer. [ABSTRACT FROM AUTHOR]

• Radiotherapy improves LC and DFS in operated extremities/superficial trunk HPC/SFT. • Radiotherapy should be considered after resection of extracranial HPC/SFT. • Margin status could influence LC, DFS and MFS in extracranial HPC/SFT. • Maximum tumor diameter could influence OS, DFS and MFS in extracranial HPC/SFT. • Pathological grading could influence DFS in intra-thoracic/retroperitoneal HPC/SFT. The role of radiotherapy (RT) in the treatment of hemangiopericytoma/solitary fibrous tumor (HPC/SFT) is still under debate. We aimed at investigating whether radiotherapy can improve the results in patients operated for extracranial HPC/SFT. Data from patients with HPC/SFT, treated from 1982 to 2012, were retrospectively reviewed within the Rare Cancer Network framework. Actuarial local control (LC), disease-free survival (DFS), metastasis-free survival (MFS) and overall survival (OS) were calculated with Kaplan-Meyer method. Patient and tumor parameters were analyzed by univariate and multivariate analysis. Of 114 HPC/SFT, 58 (50.9%) occurred in the extremities/superficial trunk and 56 (49.1%) in intra-thoracic/retroperitoneum. Seventy-eight patients (68.4%) underwent surgery only (Sx), and 36 (31.6%) Sx and RT (Sx + RT). Median RT dose was 60 Gy (range 45–68.4 Gy) in 1.6–2.2 Gy fractions. In the extremities/superficial trunk group of patients, actuarial 5-year LC rates were 50.4% after Sx and 91.6% after Sx + RT (p < 0.0001) for LC, and 50.4% after Sx and 83.1% after Sx + RT (p = 0.008) for DFS. In the intra-thoracic/retroperitoneum group of patients, actuarial 5-year rates were 89.3% after Sx and 77.8% after Sx + RT (p = 0.99) for LC, and 73.8% after Sx and 77.8% after Sx + RT (p = 0.93) for DFS. At multivariate analysis, the addition of RT resulted in better LC and DFS in the whole series. The advantage was confirmed for LC in the group of patients affected by extremity/superficial trunk tumors. Addition of RT to Sx could improve the prognosis, in terms of LC and DFS, essentially in patients with extremities/superficial trunk tumor locations. [ABSTRACT FROM AUTHOR]

Summary: More than 20 hadrontherapy centres are active in the world and about 40''000 patients have been treated, almost 4''000 with ions. Physical selectivity and high relative biologic efficiency (RBE) represent the rationale for using ions in the treatment of tumours. The clinical results are very promising and justify the construction of new centres. We present the main characteristics of CNAO (Centro Nazionale Adroterapia Oncologica) and its possible integration in a nationwide network. The Italian project started in 1991 thanks to the activity of the TERA Foundation and was financed by the Italian Government in 2002. The CNAO will be built in Pavia to start clinical activity in 2007. The equipment will include a synchrotron and 3 treatment rooms mainly devoted to carbon ions but able to deliver also protons. The Centre should be able to deliver up to 20''000 fractions / year. The realization of CNAO is part of a more ambitious project to set up an integrated national network. The need of hadrontherapy centres is defined by epidemiological studies based on Italian tumour registries showing that almost 900 patients can be electively treated with protontherapy and about 10''000 could be included in clinical trials. Considering that ions could be used for radioresistant tumours that affect about 25''000 new patients/year, we estimate that 10–15%, i.e. 3''000–4''000 patients would benefit from ion therapy. The realization of a nationwide network possibly linked to a larger European network will be very helpful in making available hadrontherapy for a large part of the population. [Copyright &y& Elsevier]

• Predictive and prognostic factors in anal cancer are limited.Bio-humoral prognostic factors are easy to assess and use. • The Hemo-Eosinophils Inflammation (HEI) Index has been recently proposed for anal cancer. • HEI was confirmed to be a prognosticator in anal cancer patients. • Model discrimination in the external validation cohort was acceptable. A prognostic scoring system based on laboratory inflammation parameters, [Hemo-Eosinophils-Inflammation (HEI) index], including baseline hemoglobin level, the systemic inflammatory index and eosinophil count was recently proposed in patients with squamous cell carcinoma of the anus (ASCC). HEI was shown to discriminate disease-free (DFS) and overall (OS) survival in ASCC patients treated with concurrent chemoradiation (CRT). We tested the accuracy of the model on a multicentric cohort for external validation. Patients treated with CRT were enrolled. The Kaplan–Meier curves for DFS and OS based on HEI risk group were calculated and the log-rank test was used. Cox proportional hazards models were used to assess the prognostic factors for DFS and OS. The exponential of the regression coefficients provided an estimate of the hazard ratio (HR). For model discrimination, we determined Harrell's C-index, Gönen & Heller K Index and the explained variation on the log relative hazard scale. A total of 877 patients was available. Proportional hazards were adjusted for age, gender, tumor-stage, and chemotherapy. Two-year DFS was 77 %(95 %CI:72.0–82.4) and 88.3 %(95 %CI:84.8–92.0 %) in the HEI high- and low- risk groups. Two-year OS was 87.8 %(95 %CI:83.7–92.0) and 94.2 %(95 %CI:91.5–97). Multivariate Cox proportional hazards model showed a HR = 2.02(95 %CI:1.25–3.26; p = 0.004) for the HEI high-risk group with respect to OS and a HR = 1.53(95 %CI:1.04–2.24; p = 0.029) for DFS. Harrel C-indexes were 0.68 and 0.66 in the validation dataset, for OS and DFS. Gonen-Heller K indexes were 0.67 and 0.71, respectively. The HEI index proved to be a prognosticator in ASCC patients treated with CRT. Model discrimination in the external validation cohort was acceptable. [ABSTRACT FROM AUTHOR]

The ACCIRAD project, commissioned by the European Commission (EC) to develop guidelines for risk analysis of accidental and unintended exposures in external beam radiotherapy (EBRT), was completed in the year 2014. In 2015, the “General guidelines on risk management in external beam radiotherapy” were published as EC report Radiation Protection (RP)-181. The present document is the third and final report of the findings from the ACCIRAD project. The main aim of this paper is to describe the key features of the risk management process and to provide general guidelines for radiotherapy departments and national authorities on risk assessment and analysis of adverse error-events and near misses. The recommendations provided here and in EC report RP-181 are aimed at promoting the harmonisation of risk management systems across Europe, improving patient safety, and enabling more reliable inter-country comparisons. [ABSTRACT FROM AUTHOR]

Purpose To describe the current status of implementation of European directives for risk management in radiotherapy and to assess variability in risk management in the following areas: 1) in-country regulatory framework; 2) proactive risk assessment; (3) reactive analysis of events; and (4) reporting and learning systems. Material and Methods The original data were collected as part of the ACCIRAD project through two online surveys. Results Risk assessment criteria are closely associated with quality assurance programs. Only 9/32 responding countries (28%) with national regulations reported clear “requirements” for proactive risk assessment and/or reactive risk analysis, with wide variability in assessment methods. Reporting of adverse error events is mandatory in most (70%) but not all surveyed countries. Conclusions Most European countries have taken steps to implement European directives designed to reduce the probability and magnitude of accidents in radiotherapy. Variability between countries is substantial in terms of legal frameworks, tools used to conduct proactive risk assessment and reactive analysis of events, and in the reporting and learning systems utilized. These findings underscore the need for greater harmonisation in common terminology, classification and reporting practices across Europe to improve patient safety and to enable more reliable inter-country comparisons. [ABSTRACT FROM AUTHOR]

In 2011 the European Commission launched a tender to develop guidelines for risk analysis of accidental and unintended exposures in external beam radiotherapy. This tender was awarded to a consortium of 6 institutions, including the ESTRO, in late 2011. The project, denominated “ACCIRAD”, recently finished the data collection phase. Data were collected by surveys administered in 38 European countries. Results indicate non-uniform implementation of event registration and classification, as well as incomplete or zero implementation of risk assessment and events analysis. Based on the survey results and analysis thereof, project leaders are currently drafting proposed guidelines entitled “Guidelines for patient safety in external beam radiotherapy – Guidelines on risk assessment and analysis of adverse-error events and near misses”. The present article describes the aims and current status of the project, including results of the surveys. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the impact of functional polymorphisms in genes related to DNA repair mechanisms (XRCC1, TP53, MSH2, MSH3, XPD), oxidative stress response (GSTP1, GSTA1, eNOS, SOD2) and fibroblast proliferation (TGFβ1) on the risk of acute skin toxicity in breast cancer patients receiving radiotherapy. Material and methods: Skin toxicity was scored according to the Radiation Therapy Oncology Group criteria in 286 breast cancer patients who received radiotherapy after breast conserving surgery. Genotyping was conducted by PCR-RFLP analysis and real-time PCR allelic discrimination assay on genomic DNA extracted from peripheral blood. Results: In the multivariate analysis, nominally significant associations, before multiple testing corrections, were found between XRCC1 T-77C (T carriers vs. CC, OR: 2.240, 95% CI: 1.015–4.941, P =0.046), eNOS G894T polymorphisms (TT vs. G carriers, OR: 2.473, 95% CI: 1.220–5.012, P =0.012), breast diameter (OR: 1.138, 95% CI: 1.001–1.293, P =0.048), boost dose-fractionation (3Gy vs. no boost, OR: 4.902, 95% CI: 1.458–16.483, P =0.010) and ⩾grade 2 acute radiation skin toxicity in breast cancer patients. Conclusions: As our exploratory study suggests that XRCC1 T-77C and eNOS G874T may confer an increased risk of acute skin reactions to radiotherapy in breast cancer patients, further confirmatory studies are warranted to determine the clinical significance. [Copyright &y& Elsevier]

Abstract: To determine whether radiation therapy could be an acceptable alternative to surgery in young patients with adenocarcinoma of the prostate, we analysed the outcome of 39 patients aged under 55 with organ confined tumours who received external radiation therapy in a curative intent. Our results suggest that similar local control in younger and older patients can be expected from either external beam radiotherapy or radical prostatectomy. [Copyright &y& Elsevier]