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Modern Radiotherapy in Current Oncology

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 14951

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Special Issue Editors

Dr. Chai Hong Rim

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Guest Editor

Department of Radiation Oncology, Korea University Medical College, Seoul, Republic of Korea
Interests: radiation oncology; stereotactic body radiotherapy; lung cancer; hepatocellular carcinoma; cancer prevention
Special Issues, Collections and Topics in MDPI journals

Prof. Jeongshim Lee

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Guest Editor

Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea
Interests: radiation oncology; brain tumor; breast cancer; head and neck cancer; gynecologic cancer; hematologic malignancy; re-irradiation

Prof. Won Sup Yoon

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Guest Editor

Department of Radiation Oncology, Ansan Hospital, Korea University Medicine, Gyeonggi-do, Korea
Interests: image-guided radiotherapy; geriatric oncology; breast cancer; hepatocellular carcinoma

Special Issue Information

Dear Colleagues,

External beam radiation therapy has been commonly used as a curative modality in recent decades, whereas it had been used mostly for palliative or adjuvant purposes in the past. In current clinical practice, radiation therapy plays a curative role in the treatment of various cancers, such as those of the brain, head and neck, lung, liver, prostate, anus, and uterus. The application of sterotactic radiation therapy for localized malignancies has begun to serve as a novel curative and non-invasive option of treatment. Modern radiotherapies, including intensity-modulated radiotherapy or particle therapy, have enabled treating diseases that were previously contraindicated for radiotherapy by significantly reducing treatment toxicities.

This Special Issue covers all subjects related to the application of external beam radiation therapy in modern clinical practice. Research on treatment efficacy and side effects of stereotactic body radiotherapy, intensity-modulated radiotherapy or particle therapy are welcomed. Meta-analyses related to the above topics will also be considered for publication. Studies on surgical treatment or chemotherapy applied with radiation therapy are also welcomed.

Prof. Chai Hong Rim
Prof. Jeongshim Lee
Prof. Won Sup Yoon
Guest Editors

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Keywords

External beam radiation therapy
Radiotherapy
Stereotactic body radiation therapy
Stereotactic ablative body radiotherapy
Radiosurgery
Intensity-modulated radiotherapy
Particle beam therapy
Quality of life

Published Papers (7 papers)

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Research

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12 pages, 737 KiB

Open AccessArticle

Preoperative Chemoradiotherapy for Gastroesophageal Junction Adenocarcinoma Modified by PET/CT: Results of Virtual Planning Study

by Marek Slavik, Petr Burkon, Iveta Selingerova, Pavel Krupa, Tomas Kazda, Jaroslava Stankova, Tomas Nikl, Renata Hejnova, Zdenek Rehak, Pavel Osmera, Tomas Prochazka, Eva Dvorakova, Petr Pospisil, Peter Grell, Pavel Slampa and Radka Obermannova

Medicina 2021, 57(12), 1334; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57121334 - 06 Dec 2021

Viewed by 2051

Abstract

Background and Objectives: The treatment of gastroesophageal junction (GEJ) adenocarcinoma consists of either perioperative chemotherapy or preoperative chemoradiotherapy. Radiotherapy (RT) in the neoadjuvant setting is associated with a higher probability of resections with negative margins (R0) and better tumor regression rate, which might be enhanced by incrementing RT dose with potential impact on treatment results. This virtual planning study demonstrates the feasibility of increasing the dose to GEJ tumor and involved nodes using PET/CT imaging. Materials and Methods: 16 patients from the chemoradiotherapy arm of the phase II GastroPET study were treated by a prescribed dose of 45.0 Gray (Gy) in 25 fractions. PET/CT was performed before treatment. The prescribed dose was virtually boosted on PET/CT-positive areas to 54.0 Gy by 9 Gy in 5 fractions. Dose-volume histograms (DVH) were compared, and normal tissue complication (NTCP) modeling was performed for both dose schedules. Results: DVHs were exceeded in mean heart dose in one case for 45.0 Gy and two cases for 54.0 Gy, peritoneal space volume criterion V_45Gy < 195 ccm in three cases for 54.0 Gy and V_15Gy < 825 ccm in one case for both dose schedules. The left lung volume of 25 Gy isodose exceeded 10% in most cases for both schedules. The NTCP values for the heart, spine, liver, kidneys and intestines were zero for both schemes. An increase in NTCP value was for lungs (median 3.15% vs. 4.05% for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy, respectively, p = 0.013) and peritoneal space (median values for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy were 3.3% and 14.25%, respectively, p < 0.001). Conclusion: Boosting PET/CT-positive areas in RT of GEJ tumors is feasible, but prospective trials are needed. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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13 pages, 1977 KiB

Open AccessArticle

Effectiveness of Postoperative or Preoperative Radiotherapy on Prognosis in Patients with Stage II Resectable Non-Small Cell Lung Cancer: A Retrospective Study Based on the SEER Database

by Deng Chen and Jinming Yu

Medicina 2021, 57(11), 1202; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111202 - 04 Nov 2021

Cited by 2 | Viewed by 1634

Abstract

Background and Objectives: The research on the therapeutic effect of preoperative radiotherapy (PRRT) for patients with early non-small cell lung cancer (NSCLC) is still insufficient, and the impact of postoperative radiotherapy (PORT) on the prognosis of patients with early NSCLC remains controversial. We conducted this study to investigate the effect of PORT and PRRT on prognosis for these patients. Materials and Methods: In total, 3640 patients with stage II NSCLC who underwent a lobectomy or pneumonectomy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate regression was adopted to identify the independent influence of PORT or PRRT on patients’ prognosis. Subgroup analysis of survival was performed in patients with different combinations of key clinical features. We also used Kaplan-Meier analysis and competitive risk analysis to explore to which extent PORT or PRRT impacted the overall survival and cumulative mortality. Results: PORT was an independent risk factor of NSCLC-specific death among patients with N0 stage (HR, 1.648; 95% CI, 1.309–2.075, p < 0.001) and in N1 stage with <3 positive lymph nodes (HR, 2.698; 95% CI, 1.910–3.812, p < 0.001) in multivariate analysis. Findings from subgroup analysis for the risk of NSCLC-specific death, competitive risk analysis of NSCLC-specific cumulative mortality, and overall survival analysis also demonstrated PORT was detrimental to patients in these two subgroups above (p < 0.05). However, in patients with N1 stage with ≥3 positive lymph nodes, PORT may help prolong median survival. PRRT was an independent risk factor for NSCLC-specific death in multivariate analysis of patients with N0 stage (HR, 1.790; 95% CI, 1.201–2.668, p = 0.004), and significantly decreased overall survival in these patients (p < 0.001). Conclusion: PORT is associated with worse survival outcome and better cumulative mortality of stage II patients of NSCLC with N0 disease or N1 disease (<3 nodes), while PRRT is associated with reduced prognosis in patients with N0 stage. On the other hand, PORT may help to improve the prognosis of patients with N1 stage who have three or more lymph node metastases. Hence, PORT and PRRT should not be recommended for patients with N0 stage. However, in patients with “high volume” N1 stage, PORT might improve oncological outcomes. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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9 pages, 499 KiB

Open AccessArticle

Clinical Impact of Supraclavicular Lymph Node Involvement of Stage IIIC Non-Small Cell Lung Cancer Patients

by Sunmin Park, Won Sup Yoon, Mi Hee Jang and Chai Hong Rim

Medicina 2021, 57(3), 301; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030301 - 23 Mar 2021

Cited by 5 | Viewed by 1986

Abstract

Background and Objective: Investigations on the clinical impact of supraclavicular lymph node (SCN) involvement in stage IIIC non-small cell lung cancer (NSCLC) remain scarce. We evaluated the oncological outcomes of definitive radiochemotherapy and the clinical significance of SCN involvement. Materials and Methods: Between November 2009 and June 2019, a total of 40 patients with N3-positivity and NSCLC were evaluated. Most patients received concomitant chemotherapy, but six patients who received radiotherapy (RT) alone were also included. Twenty-one patients (52.5%) received 3D-conformal RT (3DCRT), and the remainder received intensity-modulated RT (IMRT). Results: The median follow-up duration was 10.7 months (range: 1.7–120.6 months). Median overall survival (OS) and cause-specific survival (CSS) times were 10.8 months and 16.3 months, respectively. Among the 40 patients, 17 (42.5%) had SCN involvement. SCN involvement negatively affected progression-free survival (hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.04–4.17, p = 0.039) and local control (HR: 3.05, 95% CI: 1.09–8.50, p = 0.034). However, IMRT use was correlated with higher local control (HR: 0.28, 95% CI: 0.09–0.86, p = 0.027). Grade ≥3 esophagitis and pneumonitis accounted for 7.5% and 15.0% of all cases, respectively. A higher RT dose (mean dose: 66.6 vs. 61.7 Gy) was significantly correlated with grade ≥3 pneumonitis (p = 0.001). RT modality was a significant factor (p = 0.042, five of six cases occurred in the IMRT group). Conclusions: SCN involvement could negatively affect oncologic outcomes of stage IIIC NSCLC patients. High-dose irradiation with IMRT could increase local control but may cause lung toxicities. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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11 pages, 665 KiB

Open AccessFeature PaperArticle

Germline BRCA Mutation and Clinical Outcomes in Breast Cancer Patients Focusing on Survival and Failure Patterns: A Long-Term Follow-Up Study of Koreans

by Hakyoung Kim, Doo Ho Choi and Won Park

Medicina 2020, 56(10), 514; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56100514 - 01 Oct 2020

Cited by 2 | Viewed by 2062

Abstract

Background and Objectives: This study aimed to evaluate the effect of a BRCA mutation on survival and failure patterns, focusing on the risk of ipsilateral recurrence and contralateral breast cancer in patients. Materials and Methods: We retrospectively reviewed medical records of 300 patients with breast cancer who underwent genetic screening for BRCA1/2 genes and were treated at Samsung Medical Center between 1 January 2000 and 31 December 2010. Ultimately, clinical outcomes of 273 patients were analyzed. Results: The median follow-up duration was 102 months (range, 1 to 220 months). Patients with BRCA1/2-mutated tumors had a shorter 10-year disease-free survival (DFS) rate compared to those with non-mutated tumors (62.8% vs. 80.0%, p = 0.02). Regarding failure patterns, patients with BRCA1/2-mutated tumors showed a higher incidence of contralateral breast cancer than those with non-mutated tumors (BRCA1/2 non-mutated vs. mutated tumors: 4.9% vs. 26.0%, p < 0.001). BRCA mutation status remained a significant prognostic factor for contralateral breast recurrence-free survival (HR: 4.155; 95% CI: 1.789–9.652; p = 0.001). Korean patients with a BRCA mutation showed inferior DFS compared to those without a BRCA mutation. Conclusions: BRCA mutation status is a strong predictor of recurrence in contralateral breast cancer. Strategies such as prophylactic treatment and active surveillance should be discussed with breast cancer patients who have a BRCA mutation. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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Review

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11 pages, 1291 KiB

Open AccessReview

Updating Perspectives on Meta-Analyses in the Field of Radiation Oncology

by In-Soo Shin and Chai Hong Rim

Medicina 2021, 57(2), 117; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020117 - 28 Jan 2021

Cited by 13 | Viewed by 1708

Abstract

Meta-analyses have been conventionally performed to extract the firmest conclusions from randomized controlled trials while minimizing the risk of bias. However, the field of oncology does not always allow for collecting the best evidence. Radiation oncology is a discipline where intractable or rare diseases are commonly encountered; hence, more practical data suitable for detailed clinical evaluations are needed. This review discusses new viewpoints regarding meta-analyses by pointing out heterogeneities among clinical studies and issues related to analyzing observational studies, thus clarifying the practical utility of meta-analyses in radiation oncology. Limitations of previous systematic reviews or meta-analyses are also assessed to suggest future directions. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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Other

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11 pages, 4037 KiB

Open AccessCase Report

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

by Gianluca Ferini, Vito Valenti, Ivana Puliafito, Salvatore Ivan Illari, Valentina Anna Marchese and Giuseppina Rita Borzì

Medicina 2021, 57(12), 1379; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57121379 - 18 Dec 2021

Cited by 11 | Viewed by 2609

Abstract

The peculiar and rare clinical condition below clearly requires a customized care approach in the context of personalized medicine. An 80-year-old female patient who was subjected in 2018 to surgical removal of a cutaneous Merkel cell carcinoma (MCC) nodule located on the posterior surface of the left thigh and to three subsequent palliative radiotherapy treatments developed a fourth relapse in October 2020, with fifteen nodular metastases located in the left thigh and leg. Since the overall macroscopic disease was still exclusively regionally located and microscopic spread was likely extended also to clinically negative skin of the thigh and leg, we performed an irradiation of the whole left lower extremity. For this purpose the total target (65.5 cm) was divided into three sub-volumes. Dose prescription was 30 Gy in 15 daily fractions. A sequential boost of 10 Gy in 5 daily fractions was planned for macroscopic nodules. Plans were calculated by means of volumetric modulated arc therapy (VMAT) with the field overlap technique. Thanks to this, we obtained a homogeneous dose distribution in the field junction region; avoidance structures were delineated in the central part of the thigh and leg with the aim of achieving an optimal superficial dose painting and to reduce bone exposure to radiation. This case study demonstrates that VMAT allows for a good dose coverage for circumferential cutaneous targets while sparing deeper organs at risk. A reproducible image-guided set-up is fundamental for an accurate and safe dose delivery. However, local treatments such as radiotherapy for very advanced MCC of the lower extremities might have limited impact due to the high probability of systemic progression, as illustrated in this case. Radiation is confirmed as being effective in preventing MCC nodule progression toward skin wounding. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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17 pages, 1374 KiB

Open AccessSystematic Review

Salvage External Beam Radiotherapy after Incomplete Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

by Dae Sik Yang, Sunmin Park, Chai Hong Rim, Won Sup Yoon, In-Soo Shin and Han Ah Lee

Medicina 2021, 57(10), 1000; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101000 - 22 Sep 2021

Cited by 5 | Viewed by 1897

Abstract

Background and objective: Although transarterial chemoembolization (TACE) has been the commonest local modality for hepatocellular carcinoma (HCC), incomplete repsonse occurs especially for tumors with a large size or difficult tumor accessment. The present meta-analysis assessed the efficacy and feasibility of external beam radiotherapy (EBRT) as a salvage modality after incomplete TACE. Materials and Methods: We systematically searched the PubMed, Embase, Medline, and Cochrane databases. The primary endpoint was overall survival (OS), and the secondary endpoints included the response ratem toxicity of grade 3, and local control. Results: Twelve studies involving 757 patients were included; the median of portal vein thrombosis rate was 25%, and the pooled median of tumor size was 5.8 cm. The median prescribed dose ranged from 37.3 to 150 Gy (pooled median: 54 Gy in *EQD2). The pooled one- and two-year OS rates were 72.3% (95% confidence interval (CI): 60.2–81.9%) and 50.5% (95% CI: 35.6–65.4%), respectively; the pooled response and local control rates were 72.2% (95% CI: 65.4–78.1%) and 86.6 (95% CI: 80.1–91.2%) respectively. The pooled rates of grade ≥3 gastrointestinal toxicity, radiation-induced liver disease, hepatotoxicity, and hematotoxicity were 4.1%, 3.5%, 5.7%, and 4.9%, respectively. Local control was not correlated with intrahepatic (p = 0.6341) or extrahepatic recurrences (p = 0.8529) on meta-regression analyses. Conclusion: EBRT was feasible and efficient in regard to tumor response and control; after incomplete TACE. Out-field recurrence, despite favorable local control, necessitates the combination of EBRT with systemic treatments. *Equivalent dose in 2 Gy per fraction scheme. Full article

(This article belongs to the Special Issue Modern Radiotherapy in Current Oncology)

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