Stereotactic Ablative Radiation Therapy as a Potential Curative Treatment in Duodenal Adenocarcinoma: A Case Report

2017 ◽  
Vol 103 (1_suppl) ◽  
pp. S31-S33
Author(s):  
Francesco Maria Aquilanti ◽  
Maria Cristina Barba ◽  
Federico Bianciardi ◽  
Barbara Tolu ◽  
Barbara Nardiello ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Small Bowel ◽  
Large Mass ◽  
Treatment Modalities ◽  
Tumor Control ◽  
High Dose ◽  
Toxicity Profile ◽  
Upper Abdominal ◽  
Cancer Experience ◽  
Stereotactic Ablative Radiation Therapy

Purpose One of the rarest gastrointestinal neoplasm is small bowel cancer. Experience with its treatment modalities is limited. Stereotactic ablative radiation therapy (SABR) has improved, with image-guided radiation therapy becoming a curative option in many tumors. Especially when surgery cannot be performed due to comorbidities, SABR provides a good toxicity profile and an excellent tumor control rate owing to its specific schedule: high dose on a limited and well-defined area. Methods An 83-year-old man had arterial hypertension and congestive cardiomyopathy, with recent history of upper abdominal pain, weight loss over 10 kg, and progressive severe fatigue. The patient underwent endoscopy that showed a large mass partially obstructing the second part of the duodenum; a biopsy revealed a moderately differentiated adenocarcinoma. A staging CT scan confirmed localized disease. Due to the patient's age and comorbidities, a SABR was proposed as the preferred treatment. In order to localize the tumor during radiotherapy sessions, surgical clips were placed endoscopically next to the lesion as fiducial markers. The patient received 25 Gy in 5 fractions on alternate days. Results Resolution of duodenal obstruction and bleeding lasted for 14 months. The patient died of myocardial infarction. Conclusions This case suggests that SABR could have a role in the palliative treatment of small bowel cancers, with good toxicity profile, particularly in patients for whom surgical treatment is not a viable option.

Stereotactic Body Radiation Therapy in Multiple Organ Sites

2007 ◽  
Vol 25 (8) ◽  
pp. 947-952 ◽  
Author(s):  
Robert D. Timmerman ◽  
Brian D. Kavanagh ◽  
L. Chinsoo Cho ◽  
Lech Papiez ◽  
Lei Xing
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Advanced Technology ◽  
Dose Fractionation ◽  
Tumor Control ◽  
High Dose ◽  
Stereotactic Body Radiation ◽  
Phase Ii Studies ◽  
Prospective Phase ◽  
Prospective Trials

Introduction Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver a potent ablative dose to deep-seated tumors in the lung, liver, spine, pancreas, kidney, and prostate. Methods SBRT involves constructing very compact high-dose volumes in and about the tumor. Tumor position must be accurately assessed throughout treatment, especially for tumors that move with respiration. Sophisticated image guidance and related treatment delivery technologies have developed to account for such motion and efficiently deliver high daily dose. All this serves to allow the delivery of ablative dose fractionation to the target capable of both disrupting tumor mitosis and cellular function. Results Prospective phase I dose-escalation trials have been carried out to reach potent tumoricidal dose levels capable of eradicating tumors with high likelihood. These studies indicate a clear dose-response relationship for tumor control with escalating dose of SBRT. Prospective phase II studies have been reported from several continents consistently showing very high levels of local tumor control. Although late toxicity requires further careful assessment, acute and subacute toxicities are generally acceptable. Patterns of toxicity, both clinical and radiographic, are distinct from those observed with conventionally fractionated radiotherapy as a result of the unique biologic response to ablative fractionation. Conclusion Prospective trials using SBRT have confirmed the efficacy of treatment in a variety of patient populations. Although mechanisms of ablative-dose injury remain elusive, ongoing prospective trials offer the hope of finding the ideal application for SBRT in the treatment arsenal.

scholarly journals High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors

2015 ◽  
Vol 23 (6) ◽  
pp. 788-797 ◽  
Author(s):  
Ronny L. Rotondo ◽  
Wendy Folkert ◽  
Norbert J. Liebsch ◽  
Yen-Lin E. Chen ◽  
Frank X. Pedlow ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Control ◽  
High Dose ◽  
Recurrence Rates ◽  
En Bloc ◽  
Primary Tumors ◽  
Entire Cohort

OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.

scholarly journals Dose–volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy

2016 ◽  
Vol 57 (6) ◽  
pp. 668-676 ◽  
Author(s):  
Fumiaki Isohashi ◽  
Seiji Mabuchi ◽  
Yuichi Akino ◽  
Yasuo Yoshioka ◽  
Yuji Seo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Small Bowel ◽  
Concurrent Chemotherapy ◽  
Bowel Loop ◽  
High Dose ◽  
Operating Characteristics ◽  
Gastrointestinal Complications ◽  
Pelvic Radiation ◽  
Dose Volume

Abstract The purpose of this study is to evaluate dose–volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in patients with cervical cancer who have undergone postoperative concurrent chemotherapy and whole-pelvic radiation therapy (WPRT). The subjects were 135 patients who had undergone postoperative WPRT with concurrent nedaplatin-based chemotherapy between 2000 and 2014. Associations between selected DVH parameters and the incidence of chronic GI complications of G3 or higher were evaluated. Chronic GI complications of severity G3 occurred in 18 (13%) patients. Patients with GI complications had significantly greater V5–V45, mean dose and the generalized equivalent uniform dose (gEUD) of the small bowel loops, compared with those without GI complications. V30–V45, mean dose and gEUD of the bowel bag also showed significant differences between patients with and without GI complications. In contrast, no parameter for the large bowel loop was correlated with GI complications. Receiver operating characteristics curve analysis indicated that V30–V45 of the small bowel loops were better predictors than these respective parameters for the bowel bag. Next, patients were divided into four groups based on the median V15 and V40 of the small bowel loops. The group with both a high V15 and a high V40 showed a significantly higher probability of chronic GI complications. In conclusion, the small bowel loops are better predictors of chronic GI complications compared with the bowel bag, and a relatively high-dose volume (e.g. V40) of the small bowel loops is a useful predictor of chronic GI complications.

scholarly journals Combined High-Dose LATTICE Radiation Therapy and Immune Checkpoint Blockade for Advanced Bulky Tumors: The Concept and a Case Report

2021 ◽  
Vol 10 ◽  
Author(s):  
Liuqing Jiang ◽  
Xiaobo Li ◽  
Jianping Zhang ◽  
Wenyao Li ◽  
Fangfen Dong ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Immune Checkpoint ◽  
Radiation Treatment ◽  
Immune Checkpoint Blockade ◽  
Checkpoint Blockade ◽  
High Rate ◽  
Tumor Control ◽  
High Dose ◽  
Large Tumor ◽  
Fractionated Radiotherapy

Although the combination of immune checkpoint blockades with high dose of radiation has indicated the potential of co-stimulatory effects, consistent clinical outcome has been yet to be demonstrated. Bulky tumors present challenges for radiation treatment to achieve high rate of tumor control due to large tumor sizes and normal tissue toxicities. As an alternative, spatially fractionated radiotherapy (SFRT) technique has been applied, in the forms of GRID or LATTICE radiation therapy (LRT), to safely treat bulky tumors. When used alone in a single or a few fractions, GRID or LRT can be best classified as palliative or tumor de-bulking treatments. Since only a small fraction of the tumor volume receive high dose in a SFRT treatment, even with the anticipated bystander effects, total tumor eradications are rare. Backed by the evidence of immune activation of high dose radiation, it is logical to postulate that the combination of High-Dose LATTICE radiation therapy (HDLRT) with immune checkpoint blockade would be effective and could subsequently lead to improved local tumor control without added toxicities, through augmenting the effects of radiation in-situ vaccine and T-cell priming. We herein present a case of non-small cell lung cancer (NSCLC) with multiple metastases. The patient received various types of palliative radiation treatments with combined chemotherapies and immunotherapies to multiple lesions. One of the metastatic lesions measuring 63.2 cc was treated with HDLRT combined with anti-PD1 immunotherapy. The metastatic mass regressed 77.84% over one month after the treatment, and had a complete local response (CR) five months after the treatment. No treatment-related side effects were observed during the follow-up exams. None of the other lesions receiving palliative treatments achieved CR. The dramatic differential outcome of this case lends support to the aforementioned postulate and prompts for further systemic clinical studies.

Therapy-related myeloid leukemia following Pleuropulmonary blastoma: A case report

2022 ◽  
Author(s):  
Nahid Reisi ◽  
Pardis Nematolahy
Keyword(s):  
Radiation Therapy ◽  
Myeloid Leukemia ◽  
Lung Neoplasm ◽  
Treatment Modalities ◽  
Pleuropulmonary Blastoma ◽  
Secondary Malignancy ◽  
High Dose ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Response To Chemotherapy

The development of secondary malignancy (SM) is the most worrisome long-term complication of childhood cancer. Acute myeloid leukemia is the most prevalent neoplasm that occurs after treatment with alkylating agents and topoisomerase II inhibitors. Pleuropulmonary blastoma (PPB) is a rare lung neoplasm in children. Type II and type III of this cancer are markedly aggressive and have a recurrent nature. Chemotherapy, radiation therapy, and hematopoietic stem cell transplant (HSCT) are treatment modalities that make these patients prone to secondary malignancy. Here was presented and discussed a case of myeloid leukemia 3.5 years after treatment of Pleuropulmonary blastoma in a 5.5-year-old boy who was a candidate for high dose chemotherapy and autologous stem cells transplant (auto-SCT) because of frequent recurrence and lack of response to chemotherapy and radiation therapy. It seems this is the first reported case of therapy-related myeloid leukemia (t-AML) after PPB in children. Awareness of the creation of this complication following administration of cytotoxic therapies in the treatment of solid tumors will increase physician attention in the selection of treatment modality as well as the counseling of patients at the time of diagnosis.

The potential role of modern radiotherapy techniques in the treatment of malignant spinal cord compression: a dose planning study

2015 ◽  
Vol 14 (4) ◽  
pp. 418-424 ◽  
Author(s):  
Lotte S. Fog ◽  
Deborah Schut ◽  
Per Sjøgren ◽  
Marianne C. Aznar
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Dose Reduction ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Treatment Modalities ◽  
High Dose ◽  
Lumbar Region ◽  
Field Technique ◽  
Time Required

AbstractAimTo investigate the doses given to the kidneys and the small intestines for three radiation therapy techniques [anterior–posterior (APPA) fields, three fields and volumetric-modulated arc therapy (VMAT)] for spinal cord compression (SCC) patients with metastatic disease in the lower thoracic or lumbar spine and to monitor the time spent by clinicians and dose planners.IntroductionRadiation therapy is one of the main treatment modalities for SCC. Typical palliative radiation therapy techniques have used APPA fields or a three-field technique.However, as delivery techniques have evolved dramatically over the past decades, VMAT has gained wide acceptance. VMAT allows for a dose reduction in the organs at risk. Such a dose reduction may result in less toxicity.The use of the VMAT technique may require more time for contouring and planning compared with the APPA and three-field techniques. Any potential dosimetric benefit of VMAT must not be outweighed by large amounts of extra time spent by clinicians and dose planners.Materials and methodsFor 20 patients treated with radiation therapy for SCC at our hospital, we created a VMAT plan, and the more traditionally used APPA and three-field plans. The mean kidney doses and the volume of bowel, which received 20 Gy, were extracted for each plan. The correlations between parameters for three techniques were determined.Furthermore, the time required for contouring targets for five patients; and the time required to plan five patients, was recorded.ResultsVMAT lead to the most conformal distributions: the high-dose areas were restricted to the target volume, whereas the healthy tissue, especially the bowel, received a lower dose. In contrast, the APPA plan lead to a larger volume of bowel being irradiated, whereas the three-field technique spared the bowel at the expense of a higher dose to the kidneys.The average contouring time was 16 minutes, the average planning time was 38 minutes.ConclusionPatients treated for SCC in the lower thoracic or lumbar region may benefit from VMAT treatment, as it reduces the dose to the bowel and kidneys compared with APPA or three-field treatments.

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