{"title":"Outcomes of neoadjuvant chemoradiotherapy in T4 rectal cancer patients: a real-world single institution experience.","authors":"Reza Ghalehtaki, Kasra Kolahdouzan, Guglielmo Niccolò Piozzi, Saeid Rezaei, Zoha Shaka, Nima Mousavi Darzikolaee, Reyhaneh Bayani, Behnam Behboudi, Mahdi Aghili, Felipe Couñago, Azadeh Sharifian, Farzaneh Bagheri, Reza Nazari, Naeim Nabian, Mohammad Babaei, Mohsen Ahmadi Tafti, Mohammadsadegh Fazeli, Farshid Farhan","doi":"10.3857/roj.2024.00136","DOIUrl":"https://doi.org/10.3857/roj.2024.00136","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients.</p><p><strong>Materials and methods: </strong>A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated.</p><p><strong>Results: </strong>Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05-6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09-4.92, p = 0.025 for RFS).</p><p><strong>Conclusion: </strong>This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 4","pages":"273-280"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Min Cheol Han, Seo Hee Choi, Chae-Seon Hong, Yong Bae Kim, Woong Sub Koom, Jin Sung Kim, Jaeho Cho, Chan Woo Wee, Changhwan Kim, Jong Won Park, Soorim Han, Heejeong Lee, Hong In Yoon, Ik Jae Lee, Ki Chang Keum
{"title":"The first Korean carbon-ion radiation therapy facility: current status of the Heavy-ion Therapy Center at the Yonsei Cancer Center.","authors":"Min Cheol Han, Seo Hee Choi, Chae-Seon Hong, Yong Bae Kim, Woong Sub Koom, Jin Sung Kim, Jaeho Cho, Chan Woo Wee, Changhwan Kim, Jong Won Park, Soorim Han, Heejeong Lee, Hong In Yoon, Ik Jae Lee, Ki Chang Keum","doi":"10.3857/roj.2024.00206","DOIUrl":"https://doi.org/10.3857/roj.2024.00206","url":null,"abstract":"<p><strong>Purpose: </strong>This report offers a detailed examination of the inception and current state of the Heavy-ion Therapy Center (HITC) at the Yonsei Cancer Center (YCC), setting it apart as the world's first center equipped with a fixed beam and two superconducting gantries for carbon-ion radiation therapy (CIRT).</p><p><strong>Materials and methods: </strong>Preparations for CIRT at YCC began in 2013; accordingly, this center has completed a decade of meticulous planning and culminating since the operational commencement of the HITC in April 2023.</p><p><strong>Results: </strong>This report elaborates on the clinical preparation for adopting CIRT in Korea. It includes an extensive description of HITC's facility layout at YCC, which comprises the accelerator and treatment rooms. Furthermore, this report delineates the clinical workflow, criteria for CIRT application, and the rigorous quality assurance processes implemented at YCC. It highlights YCC's sophisticated radiation therapy infrastructure, collaborative initiatives, and the efficacious treatment of >200 prostate cancer cases utilizing CIRT.</p><p><strong>Conclusion: </strong>This manuscript concludes by discussing the prospective influence of CIRT on the medical domain within Korea, spotlighting YCC's pioneering contribution and forecasting the widespread integration of this groundbreaking technology.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 4","pages":"295-307"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abhishek Krishna, Bharat Sai Makkapatti, M S Athiyamaan, Dilson Lobo, Challapalli Srinivas, Johan Sunny, Vaishak Jawahar, Harleen Kaur, Sourjya Banerjee
{"title":"Decoding the influence of external beam radiotherapy to brachytherapy duration and overall treatment on response and early recurrences in cervical cancer patients treated with chemoradiation.","authors":"Abhishek Krishna, Bharat Sai Makkapatti, M S Athiyamaan, Dilson Lobo, Challapalli Srinivas, Johan Sunny, Vaishak Jawahar, Harleen Kaur, Sourjya Banerjee","doi":"10.3857/roj.2023.01025","DOIUrl":"https://doi.org/10.3857/roj.2023.01025","url":null,"abstract":"<p><strong>Purpose: </strong>Cervical cancer is a significant global health issue affecting approximately 600,000 women each year. This study aimed to address the knowledge gaps surrounding the influence of treatment time parameters, including the duration of external beam radiotherapy (EBRT) to brachytherapy and overall treatment duration, on early recurrences.</p><p><strong>Materials and methods: </strong>Details on demographics, tumor characteristics, treatment details, and outcomes in patients undergoing chemoradiation and brachytherapy for cervical cancer were collected from the medical records. Early recurrence was defined as tumor reappearance within 6 months after treatment in patients with an initial complete response. Statistical analyses included descriptive statistics chi-square tests, independent t-tests, and logistic regression.</p><p><strong>Results: </strong>A total of 288 cervical cancer patients were included. Stage IIB was the most common stage and 93% of patients had a complete response, 4.5% partial response, and 3.1% had progressive disease at 3rd month. At 6 months, 8% experienced early. The average interval between EBRT and brachytherapy was 10.4 ± 4.2 days among the no recurrence group and 12.3 ± 4.5 days among early recurrence group. A total of 203 patients had a gap of 10 or fewer days and 123 patients had a gap of more than 10 days between EBRT and brachytherapy. Difference was observed in the overall treatment time between the two groups had significant differences (no recurrence group, 61.6 ± 11.5 days; early recurrence group, 73.8 ± 8.8 days; p < 0.001).</p><p><strong>Conclusion: </strong>The study revealed that longer overall treatment durations were associated with a higher risk of early recurrences, highlighting the need for further investigation and optimized treatment strategies.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 4","pages":"257-262"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of memantine to mitigate radiation-induced cognitive dysfunction in brain metastasis patient receiving whole brain radiotherapy: a systematic review.","authors":"Yoga Dwi Oktavianda, Tiara Bunga Mayang Permata","doi":"10.3857/roj.2024.00269","DOIUrl":"https://doi.org/10.3857/roj.2024.00269","url":null,"abstract":"<p><strong>Purpose: </strong>Identifying comprehensively the evidence of neuroprotective effects of memantine for preserving cognitive function in brain metastasis patients receiving whole brain radiotherapy (WBRT).</p><p><strong>Methods: </strong>We searched randomized clinical trials (RCTs) analyzing the effects of memantine to preserve cognitive function in patients with brain metastasis treated with WBRT, performed in some databases, including PubMed, Embase, and Cochrane Library. The protocol was registered at PROSPERO (CRD42023476632). We reported the selection process according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. The studies were appraised by using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0).</p><p><strong>Results: </strong>We included three RCTs that met the eligibility criteria. No high risk of bias was found. Two articles compared WBRT + memantine to WBRT + placebo, and the other one compared hippocampal avoidance (HA)-WBRT + memantine to WBRT + memantine. There was no significant difference in characteristics among groups of treatment arms. The differences in cognitive function deterioration between treatment arms began to appear four months after initiated the treatment. The risk of cognitive failure was lower in patients receiving memantine compared to placebo. Moreover, combining HA-WBRT + memantine lowered the cognitive failure compared to standard WBRT + memantine. No article stated significant difference in quality of life (QoL) and survival outcomes in patients receiving memantine.</p><p><strong>Conclusion: </strong>Although the evidence was still limited, memantine was reported to have the potential to mitigate radiation-induced cognitive dysfunction in patients with brain metastasis receiving WBRT. However, there was no evidence revealing the benefit of memantine for enhancing QoL and prolonging survival.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 4","pages":"281-294"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unilateral radiotherapy for tonsillar cancer with multiple ipsilateral neck lymph nodes.","authors":"Tae Hyun Kim, Hong-Gyun Wu, Soon-Hyun Ahn, Woo-Jin Jeong, Wonjae Cha, Keun-Yong Eom","doi":"10.3857/roj.2024.00164","DOIUrl":"10.3857/roj.2024.00164","url":null,"abstract":"<p><strong>Purpose: </strong>For tonsillar cancer with multiple ipsilateral neck lymph nodes, the safety and efficacy of unilateral radiotherapy (RT) have long been a topic of debate. We performed retrospective analyses of patients having ipsilateral neck lymph nodes treated with unilateral RT in two tertiary referral hospitals.</p><p><strong>Materials and methods: </strong>This study accrued 29 patients who were diagnosed as well-lateralized tonsillar cancer with multiple ipsilateral neck lymph nodes and underwent unilateral RT from March 2000 to March 2020. Patients underwent treatment with one of the following options or a combination of them: induction chemotherapy, surgery, RT, and concurrent chemoradiotherapy. We analyzed the recurrence pattern and survival with special attention to contralateral neck failure. Also, treatment-related toxicities were compared with a 1:1 matched cohort of those who received bilateral RT, using propensity score matching analysis.</p><p><strong>Results: </strong>At a median follow-up of 68 months, no contralateral neck failure was observed. Five-year actuarial locoregional recurrence-free survival, distant metastasis-free survival, and overall survival were 85.6%, 91.8%, and 92.7%, respectively. Both the acute and chronic grade 2 xerostomia occurred in 10.3% of the patients. When the toxicity for unilateral RT was compared to that of bilateral RT using a propensity score-matched cohort, a significantly lower rate of acute xerostomia was observed in unilateral RT group (55.1% vs. 82.7%, p=0.002), primarily at grade 2 level (10.3% vs. 51.7%, respectively).</p><p><strong>Conclusion: </strong>The results of our study suggest that unilateral RT can be safely performed in well-lateralized tonsillar cancer patients with multiple ipsilateral neck lymph nodes.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 3","pages":"192-199"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supervised deep learning-based synthetic computed tomography from kilovoltage cone-beam computed tomography images for adaptive radiation therapy in head and neck cancer.","authors":"Chirasak Khamfongkhruea, Tipaporn Prakarnpilas, Sangutid Thongsawad, Aphisara Deeharing, Thananya Chanpanya, Thunpisit Mundee, Pattarakan Suwanbut, Kampheang Nimjaroen","doi":"10.3857/roj.2023.00584","DOIUrl":"10.3857/roj.2023.00584","url":null,"abstract":"<p><strong>Purpose: </strong>To generate and investigate a supervised deep learning algorithm for creating synthetic computed tomography (sCT) images from kilovoltage cone-beam computed tomography (kV-CBCT) images for adaptive radiation therapy (ART) in head and neck cancer (HNC).</p><p><strong>Materials and methods: </strong>This study generated the supervised U-Net deep learning model using 3,491 image pairs from planning computed tomography (pCT) and kV-CBCT datasets obtained from 40 HNC patients. The dataset was split into 80% for training and 20% for testing. The evaluation of the sCT images compared to pCT images focused on three aspects: Hounsfield units accuracy, assessed using mean absolute error (MAE) and root mean square error (RMSE); image quality, evaluated using the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) between sCT and pCT images; and dosimetric accuracy, encompassing 3D gamma passing rates for dose distribution and percentage dose difference.</p><p><strong>Results: </strong>MAE, RMSE, PSNR, and SSIM showed improvements from their initial values of 53.15 ± 40.09, 153.99 ± 79.78, 47.91 ± 4.98 dB, and 0.97 ± 0.02 to 41.47 ± 30.59, 130.39 ± 78.06, 49.93 ± 6.00 dB, and 0.98 ± 0.02, respectively. Regarding dose evaluation, 3D gamma passing rates for dose distribution within sCT images under 2%/2 mm, 3%/2 mm, and 3%/3 mm criteria, yielded passing rates of 92.1% ± 3.8%, 93.8% ± 3.0%, and 96.9% ± 2.0%, respectively. The sCT images exhibited minor variations in the percentage dose distribution of the investigated target and structure volumes. However, it is worth noting that the sCT images exhibited anatomical variations when compared to the pCT images.</p><p><strong>Conclusion: </strong>These findings highlight the potential of the supervised U-Net deep learningmodel in generating kV-CBCT-based sCT images for ART in patients with HNC.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 3","pages":"181-191"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
So Hwa Mun, Hong Seok Jang, Byung Ok Choi, Shin Woo Kim, Jin-Ho Song
{"title":"Recurrence pattern of glioblastoma treated with intensity-modulated radiation therapy versus three-dimensional conformal radiation therapy.","authors":"So Hwa Mun, Hong Seok Jang, Byung Ok Choi, Shin Woo Kim, Jin-Ho Song","doi":"10.3857/roj.2024.00381","DOIUrl":"10.3857/roj.2024.00381","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate recurrence patterns of and survival outcomes in glioblastoma treated with intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3D-CRT).</p><p><strong>Materials and methods: </strong>We retrospectively examined 91 patients with glioblastoma treated with either IMRT (n = 60) or 3D-CRT (n = 31) between January 2013 and December 2019. Magnetic resonance imaging showing tumor recurrence and planning computed tomography scans were fused for analyzing recurrence patterns categorized as in-field, marginal, and out-of-field based on their relation to the initial radiation field.</p><p><strong>Results: </strong>The median overall survival (OS) was 18.9 months, with no significant difference between the groups. The median progression-free survival (PFS) was 9.4 months, with no significant difference between the groups. Patients who underwent gross total resection (GTR) had higher OS and PFS than those who underwent less extensive surgery. Among 78 relapse cases, 67 were of in-field; 5, marginal; and 19, out-of-field recurrence. Among 3D-CRT-treated cases, 24 were of in-field; 1, marginal; and 9, out-of-field recurrence. Among IMRT-treated cases, 43 were of in-field; 4, marginal; and 10, out-of-field recurrence. In partial tumor removal or biopsy cases, out-of-field recurrence was less frequent in the IMRT (16.2%) than in the 3D-CRT (36.3%) group, with marginal significance (p = 0.079).</p><p><strong>Conclusion: </strong>IMRT and 3D-CRT effectively managed glioblastoma with no significant differences in OS and PFS. The survival benefit with GTR underscored the importance of maximal surgical resection. The reduced rate of out-of-field recurrence in IMRT-treated patients with partial resection highlights its potential utility in cases with unfeasible complete tumor removal.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 3","pages":"218-227"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allison Y Zhong, Sangwoo S Kim, Austin Hopper, Greg White, Sayuri Miyauchi, Riley N Jones, Dan Scanderbeg, Loren K Mell, Elizabeth Weihe, Nathalie Boutros, Stephen W Doggett, Andrew B Sharabi
{"title":"Long-term treatment of metastatic adenoid cystic carcinoma with sequential brachytherapy and stereotactic body radiotherapy.","authors":"Allison Y Zhong, Sangwoo S Kim, Austin Hopper, Greg White, Sayuri Miyauchi, Riley N Jones, Dan Scanderbeg, Loren K Mell, Elizabeth Weihe, Nathalie Boutros, Stephen W Doggett, Andrew B Sharabi","doi":"10.3857/roj.2024.00325","DOIUrl":"10.3857/roj.2024.00325","url":null,"abstract":"<p><p>Adenoid cystic carcinoma is a malignancy that is difficult to treat and often metastasizes to the lung. Systemic chemotherapies are not effective for this tumor type, thus local therapies are frequently used. Here, we report a case demonstrating the use of extensive ablative interventions in controlling the progression of metastatic adenoid cystic carcinoma. A patient with adenoid cystic carcinoma developed numerous metastases to his lungs and liver. Local ablative therapies including interstitial brachytherapy and SBRT were used to treat approximately 80 different metastases over the course of a decade. Over 850 brachytherapy seeds were implanted in this patient, and the tumor control and patient outcome were good. As of the most recent follow-up in March 2024, the patient has survived for approximately 12 years since his diagnosis of adenoid cystic carcinoma. To our knowledge, this case represents the most brachytherapy treatments reported in a single patient. It highlights the utility of interstitial brachytherapy and SBRT in treating extensive lung and liver metastases.</p>","PeriodicalId":94184,"journal":{"name":"Radiation oncology journal","volume":"42 3","pages":"237-243"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}