The document compares xerostomia levels and quality of life in nasopharyngeal cancer patients treated with intensity modulated radiation therapy (IMRT) versus conventional two-dimensional radiation therapy (2DCRT). Results showed that IMRT patients had higher saliva flow rates and less severe xerostomia compared to 2DCRT patients. IMRT patients also reported better quality of life scores for categories like global health status, physical functioning, and pain. The study concludes that IMRT is superior to 2DCRT in preserving salivary gland function and improving patient quality of life.
Exposure rate measurements and radiation control in post therapy with I131IJRES Journal
During hyperthyroidism treatment, I131activities from 111MBqup to 296 MBq are used. In the aim to
determine if the I131uptake by the patient is a radiological risk to family members and public around the patient exposure
rate measurements were carried out, using a limit 1.8 mR/h. Measurements were carried out in the Nuclear Medicine
department of Almenara hospital in Lima, Peru. The exposure rate was measured to 0.3, 0.6, and 1.0 m from the patient
from 0 to 11 days after post-administrated dose (PDA). In this study measurements were carried out in 21 hyperthyroid
patients. Measurements to 1 meter, along 2-4(16/16), 5-7(15/15), and8-11(14/14) days after PDA, indicatethe
dose rate around 100% of patients is≤1.8mR/h. Measurements to 0.6 metersalong 2-4(16/16), 5 -7(15/15), and
8-11(14/14) days after PDA, indicatethat the dose rate around 44%(7/16), 93% (14/15),and100%(14/14) of
patientsis≤1.8mR h.On the other hand, dose rate measurements to 0.3 meters, along 2-4 (16/16), 5-7 (15/15),
and 8 -11 (14/14) days after PDA, indicate that de dose rate is 13% (2/16), 6% (1/15), and 43% (6/14) of
patients is ≤ 1.8 mR/h.Measured exposure rates are alike to values reported in the literature, and were used to
define radiation control recommendations.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
The document discusses treatment options for recurrent nasopharyngeal carcinoma, including radiotherapy, surgery, chemotherapy, and targeted therapy. Radiotherapy options mentioned are external beam radiation, brachytherapy, and stereotactic radiosurgery. Surgery discussed is nasopharyngectomy. Chemotherapy mentioned includes single agents, platinum-based combinations, and targeted agents like cetuximab and erlotinib. Overall response rates and survival times are provided for some therapies.
Stereotactic body radiation therapy (SBRT) is a form of high-precision radiotherapy that delivers large, precise radiation doses to tumors in just a few treatment sessions. Studies have shown SBRT provides excellent local tumor control of early stage non-small cell lung cancer comparable to surgery, with less invasive treatment. Ongoing and completed prospective studies continue to evaluate SBRT's long-term outcomes and toxicities compared to other standard treatments like surgery or conventional radiation therapy. SBRT is becoming an important treatment option for medically inoperable early stage lung cancer patients.
The document discusses the increasing use of computed tomography (CT) scans and the resulting rise in medical radiation exposure. While CT scans provide important medical benefits, there is growing concern about the potential long-term health risks of radiation exposure, especially for pediatric patients. The literature review found that average radiation doses have doubled in some cases over the past decade and CT scans are now responsible for a significant portion of population radiation exposure from medical imaging. However, there is no system currently in place to track patients' cumulative lifetime radiation exposure from medical sources. The document examines various proposals to help minimize radiation doses from CT scans and optimize protocols while also exploring the feasibility of developing a standardized method for tracking and recording lifetime medical radiation exposure information.
This document discusses treatment options for early stage lung cancer, including surgery, stereotactic body radiotherapy (SBRT), and other ablative modalities. It provides details on the types of surgical resection, factors affecting operability, and morbidity and quality of life outcomes following surgery. It also describes the historical use of radiotherapy, development of SBRT, studies investigating SBRT dose and fractionation schedules, and outcomes from SBRT clinical trials including local control and toxicity rates.
This study compared the precision of semi-automated and high-precision QT interval measurement techniques using data from two thorough QT studies that assessed the effects of moxifloxacin on the QTc interval. Both techniques detected the QTc prolongation induced by moxifloxacin with similar accuracy. However, the high-precision technique improved the precision of QTc measurement by 31% in Study I and 15% in Study II as evidenced by the reduction in the standard deviation of the DQTcF values. More precise QTc measurement could lower the likelihood of false positive results and reduce the necessary sample size in thorough QT studies. Pairwise comparisons found close agreement between the techniques with small mean differences and narrow limits of agreement. Therefore,
Exposure rate measurements and radiation control in post therapy with I131IJRES Journal
During hyperthyroidism treatment, I131activities from 111MBqup to 296 MBq are used. In the aim to
determine if the I131uptake by the patient is a radiological risk to family members and public around the patient exposure
rate measurements were carried out, using a limit 1.8 mR/h. Measurements were carried out in the Nuclear Medicine
department of Almenara hospital in Lima, Peru. The exposure rate was measured to 0.3, 0.6, and 1.0 m from the patient
from 0 to 11 days after post-administrated dose (PDA). In this study measurements were carried out in 21 hyperthyroid
patients. Measurements to 1 meter, along 2-4(16/16), 5-7(15/15), and8-11(14/14) days after PDA, indicatethe
dose rate around 100% of patients is≤1.8mR/h. Measurements to 0.6 metersalong 2-4(16/16), 5 -7(15/15), and
8-11(14/14) days after PDA, indicatethat the dose rate around 44%(7/16), 93% (14/15),and100%(14/14) of
patientsis≤1.8mR h.On the other hand, dose rate measurements to 0.3 meters, along 2-4 (16/16), 5-7 (15/15),
and 8 -11 (14/14) days after PDA, indicate that de dose rate is 13% (2/16), 6% (1/15), and 43% (6/14) of
patients is ≤ 1.8 mR/h.Measured exposure rates are alike to values reported in the literature, and were used to
define radiation control recommendations.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
The document discusses treatment options for recurrent nasopharyngeal carcinoma, including radiotherapy, surgery, chemotherapy, and targeted therapy. Radiotherapy options mentioned are external beam radiation, brachytherapy, and stereotactic radiosurgery. Surgery discussed is nasopharyngectomy. Chemotherapy mentioned includes single agents, platinum-based combinations, and targeted agents like cetuximab and erlotinib. Overall response rates and survival times are provided for some therapies.
Stereotactic body radiation therapy (SBRT) is a form of high-precision radiotherapy that delivers large, precise radiation doses to tumors in just a few treatment sessions. Studies have shown SBRT provides excellent local tumor control of early stage non-small cell lung cancer comparable to surgery, with less invasive treatment. Ongoing and completed prospective studies continue to evaluate SBRT's long-term outcomes and toxicities compared to other standard treatments like surgery or conventional radiation therapy. SBRT is becoming an important treatment option for medically inoperable early stage lung cancer patients.
The document discusses the increasing use of computed tomography (CT) scans and the resulting rise in medical radiation exposure. While CT scans provide important medical benefits, there is growing concern about the potential long-term health risks of radiation exposure, especially for pediatric patients. The literature review found that average radiation doses have doubled in some cases over the past decade and CT scans are now responsible for a significant portion of population radiation exposure from medical imaging. However, there is no system currently in place to track patients' cumulative lifetime radiation exposure from medical sources. The document examines various proposals to help minimize radiation doses from CT scans and optimize protocols while also exploring the feasibility of developing a standardized method for tracking and recording lifetime medical radiation exposure information.
This document discusses treatment options for early stage lung cancer, including surgery, stereotactic body radiotherapy (SBRT), and other ablative modalities. It provides details on the types of surgical resection, factors affecting operability, and morbidity and quality of life outcomes following surgery. It also describes the historical use of radiotherapy, development of SBRT, studies investigating SBRT dose and fractionation schedules, and outcomes from SBRT clinical trials including local control and toxicity rates.
This study compared the precision of semi-automated and high-precision QT interval measurement techniques using data from two thorough QT studies that assessed the effects of moxifloxacin on the QTc interval. Both techniques detected the QTc prolongation induced by moxifloxacin with similar accuracy. However, the high-precision technique improved the precision of QTc measurement by 31% in Study I and 15% in Study II as evidenced by the reduction in the standard deviation of the DQTcF values. More precise QTc measurement could lower the likelihood of false positive results and reduce the necessary sample size in thorough QT studies. Pairwise comparisons found close agreement between the techniques with small mean differences and narrow limits of agreement. Therefore,
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate...Max Peters
This document discusses a study comparing urethral and bladder dosimetry and rates of late genitourinary (GU) toxicity between focal salvage (FS) and total salvage (TS) Iodine-125 brachytherapy (I-125-BT) for recurrent prostate cancer. FS I-125-BT significantly reduces dose to the urethra and bladder compared to TS. Late severe (grade 3 or higher) GU toxicity occurred in 38% of TS patients versus one case in the FS group. For TS patients, bladder D2cc of less than 70 Gy and urethral V100 of less than 0.40 cc were identified as dose constraints associated with reducing late GU toxicity
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
Several institutions have studied stereotactic body radiation therapy (SBRT) for primary lung cancer. Indiana University studies showed a maximum tolerated dose of 66 Gy for T2 lesions delivered over 3 fractions, with 1-year local control rates of 98%. Other studies from Aarhus University, Kyoto University, Air Force General Hospital in Beijing, and University of Marburg demonstrated 1-2 year local control rates ranging from 85-95% using SBRT dose fractions between 30-60 Gy delivered over 1 to 10 fractions.
STEREOTACTIC BODY RADIATION THERAPY USING CYBERKNIFE® FOR LIVER METASTASES: A...accurayexchange
Zhi-Yong Yuan, MD, PhD
Chun-Lei Liu, MD Ma0-Bin Meng, MD, PhD
CyberKnife Center, Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital
This document summarizes information on radiosurgery for lung cancer. It discusses stereotactic body radiation therapy (SBRT) as a technique that uses precisely targeted radiation to treat small or moderate lung tumors with a large dose per fraction. Studies show SBRT provides better local control and survival rates than conventional radiation for early stage lung cancer and results similar to surgery with less toxicity. For central tumors, lower SBRT doses are safer to reduce risks of excessive toxicity. SBRT is shown to be effective for tumors over 4 cm and in elderly patients.
Robert Sinha, M.D., Radiation Oncologist .Western Radiation Oncology - Dorothy Schneider Cancer Center - 2013 Mills-Peninsula Health Services Cancer Symposium
Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally ad...Enrique Moreno Gonzalez
Current standard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy, and, variably per institution, postoperative adjuvant chemotherapy. Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both randomized and observational studies. The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer, hepatic metastases from colorectal cancer and is currently tested in primary colon cancer.
SBRT versus Surgery in Early lung cancer : DebateRuchir Bhandari
This document discusses stereotactic body radiation therapy (SBRT) versus surgery for early stage non-small cell lung cancer (NSCLC). SBRT delivers a high dose of precision radiation to the tumor target in 1-5 fractions. Several studies have shown comparable survival and recurrence rates between lobectomy and sublobar resection for stage I lung cancer. SBRT has comparable or better local tumor control and survival rates than conventional radiation therapy for early stage NSCLC, with fewer side effects. While surgery may remain the standard of care, SBRT has emerged as a viable alternative to surgery for medically inoperable early stage NSCLC patients, with some studies investigating its use in operable patients as well.
This document is the abstract presentation from volume 149 of the Journal of the European Society for Radiotherapy and Oncology from August 2020. It was presented by Dr. A Premchand, a 2nd year DNB resident in Radiotherapy and Oncology. The journal covers original research and review articles relating to radiation oncology, including clinical radiotherapy, combined modality treatment, radiobiology, chemobiology, hyperthermia, tumor biology, and physical aspects of imaging, dosimetry and radiation therapy planning. It also includes papers on general oncology topics like chemotherapy, surgery and immunology. This issue features 2 reviews, 1 guideline, 1 meta-analysis, 4 clinical trials, 14 site specific articles,
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
- Small cell lung cancer (SCLC) has seen little therapeutic advancement in over 20 years. Platinum-etoposide remains the standard chemotherapy regimen.
- For limited-stage SCLC, concurrent chemoradiation is the standard of care and provides better outcomes than sequential treatment. Early twice-daily radiotherapy with prophylactic cranial irradiation improves survival.
- For extensive-stage SCLC, prophylactic cranial irradiation after chemotherapy reduces the risk of brain metastases and improves survival compared to no cranial irradiation.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
This document provides an overview of image-guided radiation therapy (IGRT) for lung cancer. It discusses the role of IGRT in managing tumor motion through techniques like breath hold methods, free breathing with gating or tracking, and 4D imaging. Segmentation of the tumor and organs at risk on 4D CT scans is covered. Dose fractionation schedules and biological effective dose calculations for hypofractionated stereotactic body radiation therapy are reviewed. Toxicities, outcomes, and challenges of IGRT in lung cancer are also mentioned.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
This document summarizes a study of 62 patients with squamous cell carcinoma of the maxillary sinus treated at a single institution between 1994-1999. The majority of patients presented with locally advanced disease. 40 patients (65%) underwent surgery followed by radiation therapy. The 3 and 5-year overall survival rates were 38% and 35% respectively. The most common site of recurrence was at the primary site, occurring in 28 patients (45%). The study concludes that new treatment approaches are needed given the poor outcomes with conventional therapies and high rates of local recurrence.
16 cco korean perspectives of nasopharynx cancer managementYong Chan Ahn
This document discusses nasopharynx cancer (NPC) in Korea. It begins by providing background on NPC epidemiology and the association between NPC subtypes and Epstein-Barr virus prevalence. It then discusses the establishment of a Korean NPC database and findings from analyses of the database. Key findings include improvements in survival over time associated with advances in imaging, radiation technique, and use of concurrent chemotherapy. Studies from the database found concurrent chemoradiation is optimal for stage II NPC and that neoadjuvant or adjuvant chemotherapy did not provide additional benefits when added to concurrent chemoradiation for advanced stages.
1) This study compared parotid sparing intensity modulated radiation therapy (IMRT) to conventional radiation therapy in patients with head and neck cancer.
2) It found significantly lower rates of grade 2 or worse xerostomia at 1 and 2 years for patients receiving IMRT compared to conventional radiation.
3) IMRT also resulted in improved saliva flow and quality of life scores compared to conventional radiation with comparable overall survival and progression-free survival between the two groups.
This document contains abstracts from several studies related to head and neck cancers. The first abstract compares outcomes of 3D conformal radiotherapy versus cobalt-60 teletherapy for larynx cancer. It found no significant differences in overall survival or local control between the two techniques, but acute reactions differed significantly. The second abstract finds that simultaneous integrated boost IMRT may be superior to sequential IMRT for nasopharyngeal cancer in reducing dose to organs at risk and toxicity. The third explores whether neck irradiation can replace neck dissection for stage 1 tongue cancer patients, finding no significant difference in disease-free survival between the two groups.
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate...Max Peters
This document discusses a study comparing urethral and bladder dosimetry and rates of late genitourinary (GU) toxicity between focal salvage (FS) and total salvage (TS) Iodine-125 brachytherapy (I-125-BT) for recurrent prostate cancer. FS I-125-BT significantly reduces dose to the urethra and bladder compared to TS. Late severe (grade 3 or higher) GU toxicity occurred in 38% of TS patients versus one case in the FS group. For TS patients, bladder D2cc of less than 70 Gy and urethral V100 of less than 0.40 cc were identified as dose constraints associated with reducing late GU toxicity
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
Several institutions have studied stereotactic body radiation therapy (SBRT) for primary lung cancer. Indiana University studies showed a maximum tolerated dose of 66 Gy for T2 lesions delivered over 3 fractions, with 1-year local control rates of 98%. Other studies from Aarhus University, Kyoto University, Air Force General Hospital in Beijing, and University of Marburg demonstrated 1-2 year local control rates ranging from 85-95% using SBRT dose fractions between 30-60 Gy delivered over 1 to 10 fractions.
STEREOTACTIC BODY RADIATION THERAPY USING CYBERKNIFE® FOR LIVER METASTASES: A...accurayexchange
Zhi-Yong Yuan, MD, PhD
Chun-Lei Liu, MD Ma0-Bin Meng, MD, PhD
CyberKnife Center, Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital
This document summarizes information on radiosurgery for lung cancer. It discusses stereotactic body radiation therapy (SBRT) as a technique that uses precisely targeted radiation to treat small or moderate lung tumors with a large dose per fraction. Studies show SBRT provides better local control and survival rates than conventional radiation for early stage lung cancer and results similar to surgery with less toxicity. For central tumors, lower SBRT doses are safer to reduce risks of excessive toxicity. SBRT is shown to be effective for tumors over 4 cm and in elderly patients.
Robert Sinha, M.D., Radiation Oncologist .Western Radiation Oncology - Dorothy Schneider Cancer Center - 2013 Mills-Peninsula Health Services Cancer Symposium
Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally ad...Enrique Moreno Gonzalez
Current standard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy, and, variably per institution, postoperative adjuvant chemotherapy. Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both randomized and observational studies. The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer, hepatic metastases from colorectal cancer and is currently tested in primary colon cancer.
SBRT versus Surgery in Early lung cancer : DebateRuchir Bhandari
This document discusses stereotactic body radiation therapy (SBRT) versus surgery for early stage non-small cell lung cancer (NSCLC). SBRT delivers a high dose of precision radiation to the tumor target in 1-5 fractions. Several studies have shown comparable survival and recurrence rates between lobectomy and sublobar resection for stage I lung cancer. SBRT has comparable or better local tumor control and survival rates than conventional radiation therapy for early stage NSCLC, with fewer side effects. While surgery may remain the standard of care, SBRT has emerged as a viable alternative to surgery for medically inoperable early stage NSCLC patients, with some studies investigating its use in operable patients as well.
This document is the abstract presentation from volume 149 of the Journal of the European Society for Radiotherapy and Oncology from August 2020. It was presented by Dr. A Premchand, a 2nd year DNB resident in Radiotherapy and Oncology. The journal covers original research and review articles relating to radiation oncology, including clinical radiotherapy, combined modality treatment, radiobiology, chemobiology, hyperthermia, tumor biology, and physical aspects of imaging, dosimetry and radiation therapy planning. It also includes papers on general oncology topics like chemotherapy, surgery and immunology. This issue features 2 reviews, 1 guideline, 1 meta-analysis, 4 clinical trials, 14 site specific articles,
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
- Small cell lung cancer (SCLC) has seen little therapeutic advancement in over 20 years. Platinum-etoposide remains the standard chemotherapy regimen.
- For limited-stage SCLC, concurrent chemoradiation is the standard of care and provides better outcomes than sequential treatment. Early twice-daily radiotherapy with prophylactic cranial irradiation improves survival.
- For extensive-stage SCLC, prophylactic cranial irradiation after chemotherapy reduces the risk of brain metastases and improves survival compared to no cranial irradiation.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
This document provides an overview of image-guided radiation therapy (IGRT) for lung cancer. It discusses the role of IGRT in managing tumor motion through techniques like breath hold methods, free breathing with gating or tracking, and 4D imaging. Segmentation of the tumor and organs at risk on 4D CT scans is covered. Dose fractionation schedules and biological effective dose calculations for hypofractionated stereotactic body radiation therapy are reviewed. Toxicities, outcomes, and challenges of IGRT in lung cancer are also mentioned.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
This document summarizes a study of 62 patients with squamous cell carcinoma of the maxillary sinus treated at a single institution between 1994-1999. The majority of patients presented with locally advanced disease. 40 patients (65%) underwent surgery followed by radiation therapy. The 3 and 5-year overall survival rates were 38% and 35% respectively. The most common site of recurrence was at the primary site, occurring in 28 patients (45%). The study concludes that new treatment approaches are needed given the poor outcomes with conventional therapies and high rates of local recurrence.
16 cco korean perspectives of nasopharynx cancer managementYong Chan Ahn
This document discusses nasopharynx cancer (NPC) in Korea. It begins by providing background on NPC epidemiology and the association between NPC subtypes and Epstein-Barr virus prevalence. It then discusses the establishment of a Korean NPC database and findings from analyses of the database. Key findings include improvements in survival over time associated with advances in imaging, radiation technique, and use of concurrent chemotherapy. Studies from the database found concurrent chemoradiation is optimal for stage II NPC and that neoadjuvant or adjuvant chemotherapy did not provide additional benefits when added to concurrent chemoradiation for advanced stages.
1) This study compared parotid sparing intensity modulated radiation therapy (IMRT) to conventional radiation therapy in patients with head and neck cancer.
2) It found significantly lower rates of grade 2 or worse xerostomia at 1 and 2 years for patients receiving IMRT compared to conventional radiation.
3) IMRT also resulted in improved saliva flow and quality of life scores compared to conventional radiation with comparable overall survival and progression-free survival between the two groups.
This document contains abstracts from several studies related to head and neck cancers. The first abstract compares outcomes of 3D conformal radiotherapy versus cobalt-60 teletherapy for larynx cancer. It found no significant differences in overall survival or local control between the two techniques, but acute reactions differed significantly. The second abstract finds that simultaneous integrated boost IMRT may be superior to sequential IMRT for nasopharyngeal cancer in reducing dose to organs at risk and toxicity. The third explores whether neck irradiation can replace neck dissection for stage 1 tongue cancer patients, finding no significant difference in disease-free survival between the two groups.
This document discusses stereotactic body radiation therapy (SBRT) for head and neck cancers. It provides an overview of SBRT indications, efficacy, toxicity profiles, quality of life outcomes, fractionation schedules, target definition, constraints, and the role of cetuximab. Several studies on SBRT for recurrent head and neck cancers, primary cancers metastatic to the head and neck region, and target volume delineation are summarized. Toxicities are generally low but carotid blowout syndrome remains a concern, especially for tumors adjacent to carotid arteries.
Effect of Time of Echo on 1H-magnetic Resonance Spectroscopy Imaging of Metab...submissionclinmedima
The aim of this study is to evaluate the effect of time of echo (TE) on magnetic resonance spectroscopy imaging (MRSI) of metabolites in maxillofacial carcinoma. 1.2. Methods: Twenty maxillofacial carcinoma patients and 10 healthy volunteers were recruited to undergo 1.5-Tesla high-resolution routine MRI and multi-voxel MRSI with a TE of 35 ms and 144 ms.
This survey aimed to assess clinicians' use of stereotactic radiotherapy and targeted therapies for metastatic renal cell carcinoma and determine support for future clinical trials. The primary objective was to evaluate the proportion of clinicians using radiotherapy for metastatic renal cell carcinoma. Secondary objectives included evaluating the proportion using targeted therapies and radiotherapy simultaneously, stopping targeted therapies for radiotherapy, and supporting further research. The online survey was distributed to members of urology and oncology groups in Australia and New Zealand to collect data on current practices. Results and conclusions will be presented at an upcoming conference.
This document summarizes several oral presentations made at the 36th Annual Conference of the Association of Radiation Oncologists of India. It includes summaries of studies on locally advanced breast cancer, locally advanced cervical cancer, laryngeal cancer, head and neck cancer, and cancer of the lip. One study found that adding paclitaxel to standard neoadjuvant chemotherapy improved outcomes for locally advanced breast cancer. Another study found that low-dose radiation prior to chemoradiation reduced tumor size and improved outcomes for cervical cancer. A third study compared outcomes and toxicities of different radiation techniques for laryngeal cancer.
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...JohnJulie1
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...AnonIshanvi
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alteration
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...NainaAnon
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...EditorSara
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
The document discusses intensity-modulated radiation therapy (IMRT) for head and neck cancers. It describes how IMRT improves target coverage and sparing of organs-at-risk like the parotid glands compared to conventional radiation therapy. Studies show IMRT reduces the risk of xerostomia and improves quality of life outcomes for patients.
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...daranisaha
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...semualkaira
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...semualkaira
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to conventional chemoradiation for locally advanced head and neck squamous cell carcinoma. 104 patients were randomized to receive either gefitinib plus cisplatin-based chemoradiation (experimental arm) or cisplatin-based chemoradiation alone (control arm). The study found a statistically significant difference in overall response rates favoring the gefitinib arm, as well as improved disease-free survival. However, the gefitinib arm also resulted in higher rates of manageable toxicities like dermatitis, mucositis, and diarrhea.
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to concurrent chemoradiation for locally advanced head and neck squamous cell carcinoma. Between 2008-2011, 104 patients were randomized to receive either cisplatin-based chemoradiation plus daily gefitinib (experimental arm) or cisplatin-based chemoradiation alone (control arm). The study found that the experimental arm had a statistically significant higher overall response rate compared to the control arm. Disease-free survival also favored the experimental arm. However, the experimental arm resulted in more grade 2-3 dermatitis, mucositis and diarrhea. Adding gefitinib to chemoradiation improved outcomes
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to concurrent chemoradiation for locally advanced head and neck squamous cell carcinoma. Between 2008-2011, 104 patients were randomized to receive either cisplatin-based chemoradiation plus daily gefitinib (experimental arm) or cisplatin-based chemoradiation alone (control arm). The overall response rate was significantly higher in the gefitinib arm compared to the control arm. Disease-free survival also favored the gefitinib arm. However, the gefitinib arm resulted in more grade 2-3 dermatitis, mucositis and diarrhea. Adding gefitinib to chem
The Role of Radiotherapy in the Treatment of Early Stage Ocular Marginal Zone...daranisaha
To evaluate the benefit of radiotherapy, compared with other treatment in ocular marginal zone lymphoma, retrospectively we analyzed our experience, with the end-points: efficacy, measured for complete response, Progression-Free Survival (PFS) and Overall Survival
This document summarizes the use of intensity-modulated radiation therapy (IMRT) for lung cancer. It discusses:
1) Types of IMRT including LINAC-based step-and-shoot, dynamic, and VMAT techniques as well as tomotherapy-based helical IMRT.
2) Retrospective studies show IMRT improves target coverage and reduces toxicity compared to 3DCRT, though results for organ at risks are mixed.
3) Prospective studies demonstrate the safety and efficacy of hypofractionated IMRT schedules.
4) Proton therapy may further improve sparing of organs at risk compared to photon-based IMRT techniques.
Unveiling the Dynamic Personalities, Key Dates, and Horoscope Insights: Gemin...my Pandit
Explore the fascinating world of the Gemini Zodiac Sign. Discover the unique personality traits, key dates, and horoscope insights of Gemini individuals. Learn how their sociable, communicative nature and boundless curiosity make them the dynamic explorers of the zodiac. Dive into the duality of the Gemini sign and understand their intellectual and adventurous spirit.
At Techbox Square, in Singapore, we're not just creative web designers and developers, we're the driving force behind your brand identity. Contact us today.
Recruiting in the Digital Age: A Social Media MasterclassLuanWise
In this masterclass, presented at the Global HR Summit on 5th June 2024, Luan Wise explored the essential features of social media platforms that support talent acquisition, including LinkedIn, Facebook, Instagram, X (formerly Twitter) and TikTok.
Discover timeless style with the 2022 Vintage Roman Numerals Men's Ring. Crafted from premium stainless steel, this 6mm wide ring embodies elegance and durability. Perfect as a gift, it seamlessly blends classic Roman numeral detailing with modern sophistication, making it an ideal accessory for any occasion.
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Industrial Tech SW: Category Renewal and CreationChristian Dahlen
Every industrial revolution has created a new set of categories and a new set of players.
Multiple new technologies have emerged, but Samsara and C3.ai are only two companies which have gone public so far.
Manufacturing startups constitute the largest pipeline share of unicorns and IPO candidates in the SF Bay Area, and software startups dominate in Germany.
The 10 Most Influential Leaders Guiding Corporate Evolution, 2024.pdfthesiliconleaders
In the recent edition, The 10 Most Influential Leaders Guiding Corporate Evolution, 2024, The Silicon Leaders magazine gladly features Dejan Štancer, President of the Global Chamber of Business Leaders (GCBL), along with other leaders.
Building Your Employer Brand with Social MediaLuanWise
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The Evolution and Impact of OTT Platforms: A Deep Dive into the Future of Ent...ABHILASH DUTTA
This presentation provides a thorough examination of Over-the-Top (OTT) platforms, focusing on their development and substantial influence on the entertainment industry, with a particular emphasis on the Indian market.We begin with an introduction to OTT platforms, defining them as streaming services that deliver content directly over the internet, bypassing traditional broadcast channels. These platforms offer a variety of content, including movies, TV shows, and original productions, allowing users to access content on-demand across multiple devices.The historical context covers the early days of streaming, starting with Netflix's inception in 1997 as a DVD rental service and its transition to streaming in 2007. The presentation also highlights India's television journey, from the launch of Doordarshan in 1959 to the introduction of Direct-to-Home (DTH) satellite television in 2000, which expanded viewing choices and set the stage for the rise of OTT platforms like Big Flix, Ditto TV, Sony LIV, Hotstar, and Netflix. The business models of OTT platforms are explored in detail. Subscription Video on Demand (SVOD) models, exemplified by Netflix and Amazon Prime Video, offer unlimited content access for a monthly fee. Transactional Video on Demand (TVOD) models, like iTunes and Sky Box Office, allow users to pay for individual pieces of content. Advertising-Based Video on Demand (AVOD) models, such as YouTube and Facebook Watch, provide free content supported by advertisements. Hybrid models combine elements of SVOD and AVOD, offering flexibility to cater to diverse audience preferences.
Content acquisition strategies are also discussed, highlighting the dual approach of purchasing broadcasting rights for existing films and TV shows and investing in original content production. This section underscores the importance of a robust content library in attracting and retaining subscribers.The presentation addresses the challenges faced by OTT platforms, including the unpredictability of content acquisition and audience preferences. It emphasizes the difficulty of balancing content investment with returns in a competitive market, the high costs associated with marketing, and the need for continuous innovation and adaptation to stay relevant.
The impact of OTT platforms on the Bollywood film industry is significant. The competition for viewers has led to a decrease in cinema ticket sales, affecting the revenue of Bollywood films that traditionally rely on theatrical releases. Additionally, OTT platforms now pay less for film rights due to the uncertain success of films in cinemas.
Looking ahead, the future of OTT in India appears promising. The market is expected to grow by 20% annually, reaching a value of ₹1200 billion by the end of the decade. The increasing availability of affordable smartphones and internet access will drive this growth, making OTT platforms a primary source of entertainment for many viewers.
Zodiac Signs and Food Preferences_ What Your Sign Says About Your Tastemy Pandit
Know what your zodiac sign says about your taste in food! Explore how the 12 zodiac signs influence your culinary preferences with insights from MyPandit. Dive into astrology and flavors!
LA HUG - Video Testimonials with Chynna Morgan - June 2024Lital Barkan
Have you ever heard that user-generated content or video testimonials can take your brand to the next level? We will explore how you can effectively use video testimonials to leverage and boost your sales, content strategy, and increase your CRM data.🤯
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Xerostomia level
1. XEROSTOMIA LEVEL AND QUALITY OF LIFE AFTER NASOPHARYNGEAL
CANCER RADIOTHERAPY, INTENSITY MODULATED RADIATION THERAPY VS
CONVENTIONAL
Abstract
Introduction: Radiation in nasopharyngeal cancer in Indonesia is currently the main choice of
therapeutic modality. the use of radiation techniques in most patients in Indonesia is a
conventional type using two-dimensional techniques. This conventional technique causes severe
side effects of advanced toxicity. the most common toxicity caused by radiation is xerostomia.
the use of imrt techniques can limit the radiation dose received by critical organs including the
parotid gland so that it can alleviate xerostomia and improve quality of life
Method: Twenty NPC patients using IMRT technique and 20 patients using 2DCRT technique
were collected consecutively. Whole saliva flow (stimulated and not stimulated) were measured
in every subject. European Organization for Research and Treatment of Cancer (EORTC) core
questionnaire, and EORTC head and neck module (QLQ-H&N35) were also completed. Both
questionnaire and saliva flow were collected at one time ( cross sectional study ), with criteria
that all subject already pass 6 months after last radiation date.
Result: The IMRT group makes higher saliva flow rate than 2DCRT group (p<0.001), and if
categorized into CTCAE criteria the IMRT group achieve better degree of xerostomia than
2DCRT group (p<0.05). in IMRT group, there was moderate correlation between recovery time
and saliva flow rate (p<0.05). from the QLO-C30 questionnaire score, the IMRT group prove to
be better than 2DCRT group in categories : Global health status, physical functioning, Emotional
functioning, pain and insomnia (p<0.05). From the head and neck module questionnaire (QLQ-
H&N35), IMRT group also prove to be better in categories : head and neck pain. Swallowing,
speech problems, trouble with social eating, trouble with social contact, dry mouth (p<0.05), &
sticky saliva (p<0.001).
Conclusion : IMRT was significantly superior to 2DCRT in preserving and sparing the salivary
gland especially parotid, and improve quality of life.
Introduction
the main management of nasopharyngeal cancer is surgery and radiotherapy. however, the
difficulty of surgical procedures is mainly due to the location of the nasopharynx which is
difficult to achieve and the difficulty in obtaining sufficient incisions so that radiotherapy is the
first choice because it is able to produce good results and is able to reach difficult areas.1
At present, nasopharyngeal cancer therapy provides better survival rates and local control due to
technological developments and numerous studies on nasopharyngeal cancer. the use of
chemotherapy combined with radiation has been shown to increase the survival of patients,
especially at advanced stages. besides that the development of diagnostic technology and
improved radiation techniques play a role in increasing the success of nasopharyngeal cancer
therapy. Radiation techniques such as IMRT (intensity modulated radiation therapy) or 3DCRT
2. (three-dimensional conformal) or a combination with brachytherapy can provide larger doses at
the location of nasopharyngeal tumors but reduce toxic side effects on normal tissue
Radiation in nasopharyngeal cancer in Indonesia is currently the main choice of therapeutic
modality. the use of radiation techniques in most patients in Indonesia is a conventional type
using two-dimensional techniques. This conventional technique causes severe side effects of
advanced toxicity. the most common toxicity caused by radiation is xerostomia.
The use of IMRT techniques that have been running since 2009 provides new hope in improving
the quality of therapy. the IMRT technique can limit the radiation dose received by critical
organs including the parotid gland so that this technique can improve xerostomia specifically and
the quality of life of patients in general. This study aims to compare the further side effects
caused by the IMRT and 3DCRT techniques, especially xerostomia degrees and quality of life
scores
Method
This study was a cross-sectional analysis to compare the degree of xerostomia and quality of life
scores of nasopharyngeal cancer patients treated using conventional 2D techniques with those
using the IMRT technique at Department of Radiotherapy, Cipto Mangunkusumo Hospital,
Indonesia from August 2012 until December 2012.
the target population was all nasopharyngeal carcinoma patients who had been treated for
curative purposes using conventional 2D or IMRT techniques in the RSCM radiotherapy
department. accessible population is the target population in the last three years (2009-2012) and
lives in the Jakarta and surrounding areas, which can be contacted, or come to RSCM for control.
The research subject approval form was included before carrying out this research.
the selection of samples from accessible populations was carried out using non-probability
sampling. the method used is consecutive sampling. from the conventional 2D group, all subjects
who came to control the ENT polyclinic and fulfilled the selection criteria will be included until
the required number of subjects is fulfilled. whereas in the IMRT group, the selection of subjects
was carried out in consecutive sampling based on the sequence of medical record data which was
earlier
Twenty NPC patients using IMRT technique and 20 patients using 2DCRT technique were
collected consecutively. Whole saliva flow (stimulated and not stimulated) were measured in
every subject. European Organization for Research and Treatment of Cancer (EORTC) core
questionnaire, and EORTC head and neck module (QLQ-H&N35) were also completed. Both
questionnaire and saliva flow were collected at one time ( cross sectional study ), with criteria
that all subject already pass 6 months after last radiation date.
Result
From this study, a total of 40 research subjects were divided into two groups. ages ranged from
17 to 60 years with a mean age of 43.7 years in the conventional 2D group, and 18 to 68 years
with an average age of 48.3 years in the IMRT group. measurement of the flow of saliva is
divided into stimulated and not stimulated. at the unstimulated salivary flow rate using an
independent sample T-test where 2D techniques have a mean of 0.196 (SD 0.156) (IK95% 0.12;
0.61) ml / minute with a median value of 0.20 ml / minute while the IMRT technique has a mean
3. 0.5 (SD 0.254) (IK95% 0.38; 0.61) ml / minute with a median value of 0.50 ml / minute. at
stimulated salivary flow rate, 2D technique has a mean of 0.188 (SD 0.219) (IK95% 0.08; 0.29)
ml / minute with a mean value of 0.10 ml / minute while the IMRT technique has an average
value of 1.085 (SD 0.409) ( IK95% 0.89; 1.27) ml / minute with a median value of 1.00 ml /
minute.
The comparison of salivary flow rates not stimulated between radiation techniques if
converted to the degree of the Common Terminology Criteria for Adverse Events (CTCAE
version 3).
the results of the calculation of salivary flow rate statistics based on the CTCAE category, the
degree of xerostomia using 2D radiation techniques there are 7 cases of grade 1, 6 cases of grade
2 and 7 cases of grade 3 while those using the IMRT technique have 16 cases of grade 1, 3 cases
of grade 2 and 1 case of grade 3.
Correlation between recovery time and saliva flow rate
the relationship between recovery time and salivary flow rate is divided into two groups, namely
conventional 2D and IMRT techniques. in conventional 2D techniques, the correlation of
recovery time with salivary flow rate not stimulated using Pearson correlation test with r = 0.108
and p = 0.652. on the correlation of recovery time with stimulated saliva flow rate using the
spearman correlation test with r = 0.272 and p = 0.246. in the IMRT technique, the correlation of
recovery time with the salivary flow rate was not stimulated using the Spearman correlation test
obtained r = 0.555 and p = 0.011. the correlation of recovery time with stimulated saliva flow
rate using the spearman correlation test with r = 0.517 and p = 0.02.
Correlation between salivary flow rate and average dose received by the parotid gland
(IMRT)
the results of the correlation test between the average dose of the parotid gland (Gy) and the
salivary flow rate. the correlation test was divided into two, stimulated saliva flow rates and not
stimulated in subjects who received therapy with the IMRT technique. at parotid average doses
with not stimulated salivary flow rate using Pearson bivariate correlation test obtained r = -0.521
and p = 0.018. At parotid average doses with stimulated saliva flow rate using Pearson bivariate
correlation test, r = -0.458 and p = 0.042
The results of the EORTC questionnaire data
the results of the EORTC questionnaire data were divided into 2 groups, namely the quality of
life questionnaire in general with the QLQ-C30 and a more specific questionnaire asking about
the area of the neck head with the QLQ-H & N35.
In processing QLQ-C30 questionnaire data using the Mann Whitney test there were significant
differences in the Global Health Status (QoL) where the mean 2D was 70.8 with SD (16.1)
(CI95% 63.3; 78.3) median (66.6 ) while IMRT, mean 82.9 SD (21.19) (CI95% 72.9; 92.8)
median (87.5). at physical functioning (PF2) obtained in 2D mean 79.3 SD (18.08) (CI95% 70.8;
87.7) median (80) whereas at IMRT mean 93 SD (9.04) (CI95% 88, 7; 97.2) median 96.6.
emotional functioning (EF) is obtained in 2D mean 71.2 SD (18.82) (CI95% 62.4; 80) median
(75) whereas in IMRT it is obtained mean 88.3 SD (18.21) (CI95% 79 , 8; 96.8) median (95.8).
results on pain (PA) for 2D mean 21.6 SD (27.62) (CI95% 8.7; 34.5) median (16.6) and at IMRT
mean 6.6 SD (11.34) (CI95 1.3%, 11.9) median 0. Insomnia (SL) is obtained in 2D mean 20 with
SD (22.68) (CI95% 9.3; 30.6) median (16.6) and in IMRT mean 6.6 SD (13.67) (CI95% 0.2;
13.0) median (0)
The results of the QLH-H & N35 questionnaire data
4. In processing the QLQ-H & N35 questionnaire data using the Mann Whitney test there were
significant differences in Pain (HNPA) where the mean 2D was 20.4 with SD (29.05) (CI95%
6.8; 34.0) median (8.3) while IMRT, mean 4.5 SD (10.28) (CI95% -0.2; 9.3) median (0). on
swallowing (HNSW) was obtained in 2D mean 29.5 SD (24.84) (CI95% 17.9; 41.2) median (25)
whereas in IMRT mean 14.5 SD (14.01) (CI95% 8 , 0; 21.1) median (12.5). Speech problems
(HNSP) were obtained in 2D mean 22.7 SD (20.85) (CI95% 13.0; 32.5) median (22.2) whereas
in IMRT the mean was 11.1 SD (16.51) (CI95% 3.3; 18.8) median (0). results of trouble with
social eating (HNSO) for 2D mean 37.9 SD (29.55) (CI95% 24.0; 51.7) median (33.3) and at
IMRT mean 16.2 SD (18.43 ) (CI95% 7.6; 24.8) median 8.3. in Dry mouth (HNDR) it was found
in 2D mean 70 with SD (30.39) (CI95% 55.7; 84.2) median (66.6) and at IMRT mean 45 SD
(29.16) (CI95% 31 , 3; 58.6) median (50)
Discussion
Based on previous research by Lee et al., in the management of nasopharyngeal cancer, the
IMRT technique has severe mucositis side effects. this happens because the accumulation of
doses is quite high in the oral mucosa.2 Xerostomia is the main symptom of late side effects in
nasopharyngeal cancer. the salivary flow rate decreased after the salivary gland received a dose
of 10-15 Gy. Saliva production continues to decline to doses of 20-40 Gy, and above 40 Gy
decreases to more than 75% of production.3
The IMRT group made the higher saliva flow rate than 2DCRT group (p <0.001) both at the
stimulated saliva flow rate and not stimulated. this indicates that the salivary gland still has better
function after radiation with the IMRT technique than 2D techniques. in the comparison of
stimulated and unstimulated salivary flow rates in the 2D group, there was no significant
difference (p = 0.23) whereas in the IMRT group there were significant differences (p <0.001)
where when the parotid gland was stimulated by food, more saliva would be produced than the
saliva flow rate is not stimulated
if categorized into CTCAE criteria the IMRT group achieve better degree of xerostomia than
2DCRT group (p<0.05). the use of the IMRT technique is more experienced in lower degrees of
xerostomia (degree 1), while the use of conventional 2D has a higher degree of xerostomia
(second and third degree). this means that the IMRT technique did not damage the salivary gland
too much and the salivary gland can still work better than conventional 2D techniques
in 2D group, there was a weak correlation between recovery time and saliva flow rate. the longer
the recovery time, the higher the saliva flow rate. but this statistic does not have a significant
relationship. based on this study, it was found that the salivary flow rate cannot recover over
time. too large doses received by the salivary gland cause this to happen. in conventional 2D
techniques opposing laterally, the parotid gland can be exposed to a dose of 60-70 Gy. whereas
in the literature it is said that the maximum dose of the parotid gland to irreversible is 60 Gy.
(13) (4). whereas in IMRT group, there was a moderate correlation between recovery time and
saliva flow rate (p <0.05) where the longer the recovery time, the higher the salivary flow rate
both at the stimulated salivary flow rate and not stimulated. this proves that IMRT patients after
salivary gland radiation therapy can recover over time.
5. From the QLO-C30 questionnaire score, the IMRT group prove to be better than 2DCRT group
in categories : Global health status, physical functioning, Emotional functioning, pain and
insomnia (p<0.05). From the head and neck module questionnaire (QLQ-H&N35), IMRT group
also prove to be better in categories : head and neck pain. Swallowing, speech problems, trouble
with social eating, trouble with social contact, dry mouth (p<0.05), & sticky saliva (p<0.001).
Overall the use of the IMRT technique has been shown to reduce the side effects of xerostomia
and provide a better quality of life. xerostomia in the IMRT group can also improve over time.
however, there is a lack in the EORTC questionnaire in the form of no measurement criteria for
hearing function. reduced hearing function is one of the most side effects besides xerostomia and
soft tissue fibrosis. (39). so far, xerostomia is believed to be the main factor causing the decline
in the quality of life of patients, but the direct causal relationship between these two things
cannot be ascertained. The use of the IMRT technique in nasopharyngeal cancer not only reduces
xerostomia complaints but also in other organs in the head and neck region which ultimately
improves overall quality of life (12)
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