Search

Abstract Background The radiation tolerance dose-volume in brain remains unclear for nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT). We performed this study to investigate dosimetric factors associated with temporal lobe necrosis (TLN) in NPC patients treated with IMRT. Methods From 2001 to 2008, 870 NPC patients were treated with IMRT. For the whole group, 40 patients have developed MRI-diagnosed TLN, and 219 patients were followed-up more than 60 months. Predictive dosimetric factors for TLN were identified by using univariate and multivariate analysis in these 259 patients. Results By univariate analyses, rVX ( percent of temporal lobes receiving ≥ X Gy) and aVX ( absolute volumes of temporal lobes receiving ≥ X Gy, values of X considered were 10, 20, 30, 40, 50, 60, 66 and 70) were all significantly associated with TLN. Multivariate analysis by logistic regression showed that rV40 and aV40 were significant factors for TLN. All dosimetric factors in current serials were highly correlated one another (p Conclusions In this study, all dosimetric factors were highly correlated, rV40 and aV40 were independent predictive factors for TLN, IMRT with rV40

Background: The role of chemotherapy given concurrently with thoracic three-dimensional radiotherapy for stage IV non-small cell lung cancer (NSCLC) is not well defined. We performed this study to investigate overall survival and toxicity in patients with stage IV NSCLC treated with this modality.Methods: From 2003 to 2010, 201 patients were enrolled in this study. All patients received chemotherapy with concurrent thoracic three-dimensional radiotherapy. The study endpoints were the assessment of overall survival (OS) and acute toxicity.Results: For all patients, the median survival time (MST) was 10.0 months, and the 1-, 2- and 3-year OS rates were 40.2%, 16.4%, and 9.6%, respectively. The MST was 14.0 months for patients who received a total radiation dose ≥63 Gy to the primary tumor, whereas it was 8.0 months for patients who received a total dose <63 Gy (P = 0.000). On multivariate analysis, a total dose ≥63 Gy, a single site of metastatic disease, and undergoing ≥4 cycles of chemotherapy were independent prognostic factors for better OS (P = 0.007, P = 0.014, and P = 0.038, respectively); radiotherapy involving metastatic sites was a marginally significant prognostic factor (P = 0.063). When the whole group was subdivided into patients with metastasis at a single site and multiple sites, a higher radiation dose to the primary tumor remained a significant prognostic factor for improved OS. For patients who received ≥4 cycles of chemotherapy, high radiation dose remained of benefit for OS (P = 0.001). Moreover, for the subgroup that received <4 chemotherapy cycles, the radiation dose was of marginal statistical significance regarding OS (P = 0.063). Treatment-related toxicity was found to be acceptable.Conclusions: Radiation dose to primary tumor, the number of metastatic sites, and the number of chemotherapy cycles were independent prognostic factors for OS in stage IV NSCLC patients treated with concurrent chemoradiotherapy. In addition to systemic chemotherapy, aggressive thoracic radiotherapy was shown to play an important role in improving OS.Trial Registration: Registered on (ChiCTR-TNC-10001026). [ABSTRACT FROM AUTHOR]

Systemic chemotherapy is the standard treatment modality for stage IV lung adenocarcinoma patients with EGFR wild-type or unknown mutation status. Recent years, there is increasing evidence showed that selected patients with stage IV disease could benefit from aggressive thoracic radiotherapy. Either pemetrexed or docetaxel, combined with cisplatin, can be used for patients with stage IV lung adenocarcinoma. However, no prospective trials have confirmed that Pem-Cis was superior to Doc-Cis in lung adenocarcinoma. In this randomized phase 2 trial, we evaluated survival outcomes, and toxicity of Pemetrexed-Cisplatin (arm A) or Docetaxel-Cisplatin (arm B) with concurrent IMRT to the primary tumor for stage IV lung adenocarcinoma patients with EGFR wild-type or unknown mutation status. Totally, 101 patients were randomly assigned (50 in arm A and 51 in arm B). Using an intention-to-treat analysis, one-year survival rates were 72.0% and 52.9%, respectively (P=0.020). Progression-free survival was also significantly improved in the arm A (median, 12.6 v 7.5 months, P=0.013). The incidence and severity of acute pneumonitis and esophagitis was similar between two arms. Although more of grade 3 or 4 anemia and thrombocytopenia in arm A, and higher rates grade 3 or 4 neutropenia, and leukopenia were observed in arm B. Pem-Cis first-line chemotherapy with concurrent radiation therapy for stage IV lung adenocarcinoma patients with EGFR wild-type or unknown mutation status represents a potential treatment option with acceptable toxicity and high overall survival rates., Competing Interests: None.

Radiation therapy is one of the most important methods for the treatment of malignant tumors. However, in radiotherapy for thoracic tumors such as breast cancer, lung cancer, esophageal cancer, and mediastinal lymphoma, the heart, located in the mediastinum, is inevitably affected by the irradiation, leading to pericardial disease, myocardial fibrosis, coronary artery disease, valvular lesions, and cardiac conduction system injury, which are considered radiation-induced heart diseases. Delayed cardiac injury especially myocardial fibrosis is more prominent, and its incidence is as high as 20–80%. Myocardial fibrosis is the final stage of radiation-induced heart diseases, and it increases the stiffness of the myocardium and decreases myocardial systolic and diastolic function, resulting in myocardial electrical physiological disorder, arrhythmia, incomplete heart function, or even sudden death. This article reviews the pathogenesis and prevention of radiation-induced myocardial fibrosis for providing references for the prevention and treatment of radiation-induced myocardial fibrosis., (Creative Commons Attribution License)

Objective: At present, the clinical data about the effect of overall treatment time (OTT) on local control for nasopharyngeal carcinomas (NPC) patients mainly derived from conventional radiotherapy (CRT). The effect of OTT on local control for NPC patients treated with IMRT is still unclear. This study was to explore the effect of OTT on local control in IMRT for NPC patients., Methods: Clinical data of 850 NPC (T1-4N0-3M0) patients that had undergone radical radiotherapy with IMRT from May 2001 to January 2008 in Sun Yat-sen University Cancer Center were analyzed retrospectively. All patients were divided into two groups, which were group with OTT ≤ 42 and group with OTT > 42 days respectively. Survival was calculated using the Kaplan-Meier method. The log-rank test was used to compare survival curves. The effect of clinical factors and treatment related factors on LCR were studied with univariate and multivariate analyses using logistic regression., Results: The 5-years local recurrence-free survival (LRFS) rate of group with OTT ≤ 42 were 90.7%, and 90.9% in group with OTT > 42, no significant differences were found between these two groups (χ² = 0.028, P = 0.866). Further stratified analysis found that the LRFS rate for early T-stage patients was no significant difference between group with OTT ≤ 42 and group with > 42 days, they were 97.2% and 97.9% (χ² = 0.672, P = 0.412). For advanced T-stage patients, the LRFS rate of OTT ≤ 42 and > 42 days were 86.5% and 87.2% respectively (χ² = 0.151, P = 0.698). The 5-year LRFS rate were 94.4% vs 93.0% (χ² = 0.090, P = 0.764) at OTT > 42 vs ≤ 42 days for patients treated with IMRT alone, and 89.7% vs 87.6% (χ² = 0.060, P = 0.807) for patients in combination chemotherapy with IMRT. We divided all patients into three groups: OTT ≤ 42 d, 43 - 49 d and ≥ 50 d, the 5-years LRFS rate of the three group was 90.7%, 91.7% and 88.4%, respectively, there was no significant difference of LRFS among those three groups (χ² = 0.136, P = 0.934). Univariate analysis showed that T-stage and GTV volume were correlation with local control. In multivariate analysis, GTV volume was confirmed as independent prognostic factors for local control., Conclusions: Within the range of the OTT observed in our study, prolonged OTT did not have adverse effect on local control. GTV volume was independent prognostic factors in local control for NPC patients treated with IMRT.