scholarly journals Hyperfractionated Thermoradiotherapy Is More Effective and Less Invasive Than Radiation or Chemoradiation in Heatable Cancers: A Meta-Analysis

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Haim I. Bicher
Keyword(s):  
Radiation Dose ◽  
Head And Neck ◽  
Treatment Time ◽  
Early Stage ◽  
Meta Analysis ◽  
Complete Response ◽  
Equivalent Dose ◽  
Dose Treatment ◽  
Less Invasive ◽  
Biological Equivalent Dose

HTRT consists of daily hyperthermia treatments in conjunction with each radiation fraction. Radiation daily doses are progressively decreased from 180 to 100 cGy resulting in protracted treatment time that decreases the isoeffect biological equivalent dose by 15% to 25%. This decrease is compensated by the increased number of hyperthermia fractions which potentiates each radiation dose. Treatment is continued until an objective complete response is attained, or failure determined. Sixty breast patients, 35 head and neck, and 25 prostate patients were treated with a followup of two to five years. All patients were early stage (less than III). HTRT proved to be less toxic and more effective than radiation or chemoradiation therapies.

Survival outcomes in primary angiosarcoma of the head and neck: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18039-e18039
Author(s):  
Sondos Zayed ◽  
Cindy Lin ◽  
Gabriel Boldt ◽  
Pencilla Lang ◽  
Nancy Read ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Treatment Approach ◽  
Early Stage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Size Analysis ◽  
Survival Outcomes ◽  
Curative Intent ◽  
Significant Difference

e18039 Background: Angiosarcoma of the head and neck (ASHN) is a rare entity and confers substantial morbidity and mortality. Yet, the optimal management of ASHN remains unclear. This study aimed to describe the epidemiology of ASHN and to identify the most favorable treatment approach. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary ASHN treated with curative-intent, were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 studies were identified, with 14 articles reporting on 2265 ASHN patients, meeting inclusion criteria. Mean ± SD age was 70.6 ± 7.7 years with 1621 (66.6%) men and 812 (33.4%) women. ASHN involved the scalp (n = 176, 57.9%) and the face (n = 128, 42.1%). 249 patients had early stage I-II disease (39.6%) whereas 379 had late stage III-IV disease (60.4%). Most (n = 529, 45.6%) received surgery and radiotherapy (RT), 305 (26.3%) received surgery alone, 210 (18.1%) received definitive RT/chemoradiotherapy (CRT), 75 (6.5%) received surgery and CRT, and 33 (2.8%) received surgery and chemotherapy. Negative margins were achieved in 471 (55.9%) whereas 371 (44.1%) had positive margins. Mean ± SD follow-up was 41.7 ± 15.4 months. Weighted mean, 1-, 5-, and 10-year overall survival (OS) were 26.9 months, 67.3%, 30.6%, and 20.8% respectively. Mean and 5-year disease-specific survival (DSS) were 72.9 months and 50.3% respectively. Mean ± SD local recurrence rate (LRR) was 32.1 ± 11.7%. Median RT dose delivered was 60 Gy (interquartile range: 60-70). Patients who received surgery had a significantly higher mean OS (34.9 vs. 18.7 months, P = 0.04) and 5-year OS (30.1 vs. 14.2%, P = 0.01) compared with those who did not receive surgery. There was no significant difference in mean OS for receiving adjuvant chemotherapy (P = 0.99) or RT (P = 0.51). Conclusions: In the largest ASHN study to date, definitive surgical resection was associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Randomized trials are needed to establish the optimal treatment approach for ASHN.

scholarly journals Therapeutic Outcome and Related Predictors of Stereotactic Body Radiotherapy for Small Liver-confined HCC: A Systematic Review and Meta-analysis of Observational Studies

2020 ◽  
Author(s):  
Yanyan Long ◽  
Yan Liang ◽  
Shujie Li ◽  
Jing Guo ◽  
Ying Wang ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Tumor Size ◽  
Stereotactic Body Radiotherapy ◽  
Observational Studies ◽  
Early Stage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Tumor Control ◽  
Radiation Induced ◽  
Grade 3

Abstract Background and purpose: Stereotactic body radiotherapy (SBRT) is a promising ablative modality for hepatocellular carcinoma (HCC) especially for those with small-sized or early-stage tumors. This study aimed to synthesize available data to evaluate efficacy and explore relatedpredictors of SBRT for small liver-confined HCC (≤3 lesions with longest diameter ≤6cm).Materials and methods:A systematic search wereperformed of the PubMed and Cochrane Library databases. Primary endpoints were overall survival (OS) and local control (LC) of small HCC patientstreated with SBRT, meanwhile, to evaluateclinical parameters associated with treatment outcomeby two methods including subgroup comparisons and pooled HR meta-analysis.The secondary endpoints were treatment toxicity including grade≥3 hepatic complication and radiation induced liver disease (RILD).Results:After a comprehensive database review, 14 observational studies with 1238 HCC patients received SBRT were included in qualitative and quantitative analyses. Pooled 1-year and 3-year OS rates were 93.0% (95% confidence interval [CI]: 88.0%-96.0%), and 72.0% (95% CI: 62.0%-79.0%), respectively. Pooled 1-year and 3-year LC rates were 96.0% (95% CI: 91.0%-98.0%), and 91.0% (95% CI: 85.0%-95.0%), respectively. Subgroup comparisons regarding Child-Pugh class (stratified by CP-A percentage 100%,75-100%,50-75%) showed there were statistically significant differencesfor both 1-year OS rate and 3-year OS rate (p < 0.01), while that regarding number of lesions, pretreatment situation, age (median/mean age of 65),macrovascular invasion, tumor size, and radiation dose (median BED10 of 100Gy), there were no differences.In subgroup comparisons for LC rate, it showed number of lesions (1 lesion vs. 1-3 lesions) was significantly associated with 1-year LC rate (p=0.04), though not associated with 3-year LC rate (p=0.72).In subgroup comparisons categorized by other factors including pretreatment situation, age, CP-A percentage, macrovascular invasion, tumor size, and radiation dose, there were no significant differences for 1-year or 3-year LC rate.To further explore the association between CP class (A vs. B) and OS, the second method was applied by combining HR and 95% CIs. Results indicated CP-A was predictive of better OS (p=0.001)with pooled HR was 0.31 (95% CIs: 0.11-0.88), which was consistent with previous subgroup comparison results.Concerning adverse effect of SBRT, pooled rates of grade≥3 hepatic complications and RILD were4.0% (95% CI: 2.0%-8.0%) and 14.7% (95% CI: 7.4%-24.7%), respectively.Conclusion: SBRT was apotentlocal treatment for small liver-confined HCC conferring excellent OS and LC persisting up to 3 years, even though parts of included patients were pretreated or with macrovascular invasion. CP-A class was a significant predictor of optimal OS, while number of lesions might affect short term tumor control (1-year LC). Tumor size and radiation dose were notvital factors impacting treatment outcome for such small-sizedHCC patients.

Effect of Amifostine on Survival Among Patients Treated With Radiotherapy: A Meta-Analysis of Individual Patient Data

2011 ◽  
Vol 29 (18) ◽  
pp. 2590-2597 ◽  
Author(s):  
Jean Bourhis ◽  
Pierre Blanchard ◽  
Emilie Maillard ◽  
David M. Brizel ◽  
Benjamin Movsas ◽  
...  
Keyword(s):  
Head And Neck ◽  
Early Stage ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Lung Cancers ◽  
End Point ◽  
Pelvic Cancer ◽  
Radiotherapy Alone ◽  
The Impact

Purpose Controversy exists regarding whether or not amifostine might reduce the efficacy of cancer treatment. The aim of this meta-analysis was to evaluate the impact of amifostine on overall survival (OS) and progression-free survival (PFS) in patients treated with radiotherapy or chemoradiotherapy. Material and Methods Updated data from individual patients with non–small-cell lung cancer, head and neck squamous cell carcinoma, and pelvic cancer treated with radiotherapy or chemoradiotherapy and randomly assigned to amifostine or not were included. The primary end point was OS. Results Twenty-two randomized trials (2,279 patients) were potentially eligible. Data were available for 16 trials (1,554 patients), but four trials (435 patients) were excluded after data checking. Ultimately 12 trials and 1,119 patients were analyzed. A total of 431 patients were treated with radiotherapy alone (three trials), and 688 patients were treated with chemoradiotherapy (nine trials). Thirty-three percent of patients had lung cancers, 65% had head and neck cancers, and 2% had pelvic carcinomas. Ninety-one percent of patients had locally advanced disease (early stage, 9%). Median follow-up was 5.2 years. The hazard ratio (HR) of death was 0.98 (95% CI, 0.84 to 1.14; P = .78). On the basis of 11 trials (1,091 patients), the HR of progression, relapse, or death was 1.05 (95% CI, 0.90 to 1.22; P = .53). The tests for heterogeneity were not significant (P ≥ .73), and there was no significant variation of treatment effect according to sex, age, tumor site, stage, histology, locoregional treatment, or type of administration for either end point. Conclusion Amifostine did not reduce OS and PFS in patients treated with radiotherapy or chemoradiotherapy.

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