Search

Abstract Background Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. Methods In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. Results The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. Conclusion HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly selected pediatric patient cohort with clinical features of poor prognosis and/or aggressive therapy needed. Despite of a dosimetrical advantage of HT technique, an exhaustive analysis of long-term follow-up data is needed to assess late toxicity, especially in this potentially sensitive to radiation population.

Brain metastases are not currently an incurable situation and can now be controlled with current treatments, surgery, radiation, and systemic therapies. Radiation therapy is the treatment of choice. It can be administered with other therapies, and even with several techniques of radiotherapy. Due to the greater efficiency and control of extracerebral disease with chemotherapy, radiation, or targeted therapies, it is necessary in brain metastases to achieve more tumor responses with fewer secondary side effects. Radiosurgery and hypofractionated stereotactic radiotherapy achieve these objectives. Whole brain radiotherapy still seems to have a role in certain tumor indications and according to the number and origin of brain metastases. Technical improvements of traditional radiotherapy treatment and combinations of focal therapies make the treatment of brain metastasis one of the most exciting in the current oncology settings. [ABSTRACT FROM AUTHOR]

Pembrolizumab (P) is approved in the first-line (1L) setting in patients with squamous cell carcinoma of the head and neck (SCCHN) with a CPS ≥ 1 and has shown promising activity in the locally-advanced (LA) setting. However, there are no alternatives for patients who are platinum-5FU (PF)-unfit and in need of a rapid tumor response. Taxanes are active agents in SCCHN that could effectively substitute 5FU as shown in Keynote-B10, Frail-Immune and DEPEND trials [1-3]. We evaluated the combination of pembrolizumab plus platinum and taxanes (PCT) +/- prophylactic (p) G-CSF in PF-unfit patients at our institution. Retrospective study of patients diagnosed with SCCHN and treated with PCT at Hospital Clínico Universitario San Carlos, Madrid (Spain). A descriptive study, as well as objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety in the 1L and in the LA setting, were analyzed. Within the period August 2019 - October 2023, 18 patients (1L: n=6; LA: n=12) were identified. Among 1L: Male/Female: 2/4; age: 65y (56-86). Subsite: oral cavity (OC): n=5, larynx (n=1). Median CPS: 40 (5-80). No. combo PCT cycles: 6 (2-9). No. maintenance P cycles: 4 (1-8). ORR: 67% (2 CR, 2 PR, 2 SD). After a median follow-up (F-U) of 9 months (m) (1 -25), median PFS and OS were 8 m (4.7 - 11.3) and NR (NR-NR), respectively. pG-CSF in 4/6 pts. G3/4 toxicity: G3 neutropenia: 4/6, G3 thrombopenia: 1/6. There were no toxic deaths. Among LA: Male/Female: 8/4; age: 72y (47-96). P + wkCBDCA-paclitaxel: n=10/12; P + 3wkCBDCA-paclitaxel: n=1/12, P + 3wkCDDP-docetaxel: n=1/12. Subsite: oropharynx: n=3, OC: n=5, CUP: n=1, Sinonasal: n=3. Median CPS: 30 (3-100). No. combo PCT cycles: 3 (2-4). No. maintenance P cycles: 0 (0-4). ORR after PCT (n=10): 90% (4 CR, 5 PR, 1 PD). Post-PCT Tx: Surgery: n=3; CRTx: n=5; Maint P: n=6. After a median follow-up (F-U) of 4 m (0-34), median PFS and OS were 6 m (NR - NR) and NR (NR-NR), respectively. pG-CSF in 6/12 pts. G3/4 toxicity: G3 neutropenia: 6/12, G3 thrombopenia: 4/12, G3 pneumonia: 1/12, G3 IR-colitis: 1/12, G4 IR-transaminitis: 1/12. There were no toxic deaths. Updated results for the LA population (as of March 2024) will be presented at the meeting. PCT and particularly weekly PCT +/- pG-CSF is a highly effective and safe chemoimmunotherapy option for PF-unfit patients in need of a rapid response and a positive CPS, both in the 1L and LA settings. Trials with weekly PCT should be conducted in comorbid and/or elderly patients with LA and R/M SCCHN not candidates for high-dose CT and in need of rapid response. [ABSTRACT FROM AUTHOR]

Stereotactic radiosurgery (SRS) is an effective treatment for incompletely resected or recurrent pituitary adenomas characterized by high rates of local control and endocrinological remission. The SRS-associated morbidity is usually considered minimal, but could not be neglected. It is mainly related to new pituitary hormone deficit, and seemingly caused by un-intentional inclusion of the hypothalamus, pituitary stalk and gland in the high-dose irradiation area. We report long-term clinical outcomes of 30 pituitary adenoma patients who received SRS in our institution. Dose was generally prescribed to the 90% isodose line and ranged from 10 to 16 Gy (mean and median 14 Gy). Selection of prescription dose was based on a tumor location and proximity to adjacent radiation-sensitive structures and previous radiotherapy. The length of follow-up varied from 15 to 230 months (mean 102.6 months, median 90 months). Overall, in 28 patients (93%) control of tumor growth was observed during the followup. In 19 patients (63%) tumor size was considered stable after SRS, in 9 patients (30%) tumor reduced in size and in 2 patients (7%) tumor progression was observed. Among 26 patients with functioning pituitary adenomas 17 patients (65,4%) had normalization and 4 patients (15,3%) had improvement of endocrinological function. Persistent hypersecretion was observed in 5 patients (19,3%) with functioning pituitary adenomas. New hypopituitarism after SRS treatment was observed in 4 patients (13.3%). The median maximum dose to hypothalamus, pituitary stalk and pituitary gland was 2.33 Gy (range 0.78-6.22 Gy), 11.20 Gy (range 3.17-15.49 Gy) and 12.83 Gy (range 5.00-15.24 Gy), respectively. SRS allows to effectively control tumor growth in 90-100% of patients and in the great part of patients a relatively rapid endocrinological remission is observed. Doses to the structures of hypothalamic-pituitary axis might have influence on the development of radiation-induced hypopituitarism. Every effort should be made to spare these structures as much as possible.

Aims: To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT)., Material and Methods: Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24-56 Gy)., Results: The median follow-up was 51 months (range: 9-102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation)., Conclusion: Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects.