scholarly journals Short Course High Dose Radiotherapy in the Treatment of Anaplastic Thyroid Carcinoma

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Mark J. Stavas ◽  
Eric T. Shinohara ◽  
Albert Attia ◽  
Matthew S. Ning ◽  
Jeffrey M. Friedman ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Local Control ◽  
Radiation Treatment ◽  
Anaplastic Thyroid Carcinoma ◽  
High Dose ◽  
Treatment Schedule ◽  
Local Progression ◽  
Short Course ◽  
Metastatic Setting ◽  
Hypofractionated Radiation

Purpose. Anaplastic thyroid carcinoma (ATC) is a rare but aggressive tumor with limited survival. To date, the ideal radiation treatment schedule, one that balances limited survival with treatment efficacy, remains undefined. In this retrospective series we investigate the effectiveness and tolerability of hypofractionated radiation therapy in the treatment of ATC.Methods. 17 patients with biopsy proven ATC treated between 2004 and 2012 were reviewed for outcomes and toxicity. All patients received short course radiation.Results. The most commonly prescribed dose was 54 Gy in 18 fractions. Median survival was 9.3 months. 47% of patients were metastatic at diagnosis and the majority of patients (88%) went on to develop metastasis. Death from local progression was seen in 3 patients (18%), 41% experienced grade 3 toxicity, and there were no grade 4 toxicities.Conclusions. Here we demonstrated the safety and feasibility of hypofractionated radiotherapy in the treatment of ATC. This approach offers shorter treatment courses (3-4 weeks) compared to traditional fractionation schedules (6-7 weeks), comparable toxicity, local control, and the ability to transition to palliative care sooner. Local control was dependent on the degree of surgical debulking, even in the metastatic setting.

Long-Term Remission in a Case of Anaplastic Thyroid Carcinoma following Local Irradiation and High-Dose Chemotherapy with Autologous Peripheral Blood Stem Cell Transplantation

2007 ◽  
Vol 1 ◽  
pp. CMO.S435
Author(s):  
Koji Kato ◽  
Yuju Ohno ◽  
Shoshu Mitsuyama ◽  
Satoshi Toyoshima ◽  
Junichi Ito ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Thyroid Carcinoma ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
High Dose Chemotherapy ◽  
Anaplastic Thyroid Carcinoma ◽  
High Dose ◽  
Blood Stem Cell Transplantation

Anaplastic thyroid carcinoma (ATC) is a tumor with bad prognosis and long-term survival is very low. However, appropriate combinations of chemotherapy, surgery, and radition have been reported to potentially improve the treatment results for ATC. We describe a case of refractory ATC successfully treated with high-dose chemotherapy (HDC) followed by autologous peripheral blood stem cell transplantation (auto-PBSCT). There has not been any evidence of recurrence for 10 years after auto-PBSCT. To the best of our knowledge, this is the first case of ATC that has been followed up for a long-term period after HDC with auto-PBSCT. This case suggests that intensive therapeutic approach such as HDC with auto-PBSCT may be useful.

Stereotactic hypofractionated high-dose irradiation (STI) for stage I non-small cell lung cancer (NSCLC): Mature results in 300 cases of a Japanese multi-institutional study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7045-7045 ◽  
Author(s):  
H. Onishi ◽  
Y. Nagata ◽  
H. Shirato ◽  
K. Karasawa ◽  
K. Gomi ◽  
...  
Keyword(s):  
Total Dose ◽  
Local Control ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Pulmonary Complications ◽  
Stage I ◽  
High Dose ◽  
Stage Ib ◽  
Local Progression ◽  
Stage Ia

7045 Background: With the increasing accuracy of localization for tumor-bearing areas using various new techniques, hypofractionated or single high-dose stereotactic irradiation (STI) has been actively investigated for stage I NSCLC in Japan. The current study retrospectively evaluated Japanese multi-institutional results for high-dose STI for stage I NSCLC. Methods: From 1993 to 2003, stereotactic three-dimensional treatment was performed using 3–10 non-coplanar dynamic arcs or 6–20 static ports for a total of 300 stage I (median age, 75 years; T1N0M0, n = 193; T2N0M0, n = 107) patients with primary NSCLC (adenocarcinoma, n = 138; squamous cell carcinoma, n = 129; and others, n = 33) in 14 institutions. Totally 190 patients were medically inoperable, and other 110 were medically operable but selected STI. A total dose of 18–75 Gy at the isocenter was administered in 1–22 fractions. Median calculated biological effective dose (BED) was 108 Gy (range, 57–180 Gy). Results: Median follow-up period of survivors was 38 months (range; 2–128 months). Pulmonary complications of NCI-CTC criteria (version 2.0) grade ≥ 3 were noted in 9 patients (3.0%). Local progression occurred in 44 patients (14.7%), and 5-year local control rate was high (86%) for BED ≥100 Gy (n = 227) compared to 67% for <100 Gy (n = 73) (P < 0.001). Overall 5-year survival rates of operable and inoperable patients were 65% and 37%, respectively. Overall 5-year survival rates in operable cases was high (74%) for BED ≥100 Gy (n = 85) compared to 37% for <100 Gy (n = 24) (P < 0.01). In a subset of operable patients irradiated with BED ≥100, 3-year locally progression-free survival rates was high (81%) for stage IA (n = 60) compared to 67% for stage IB (n = 23) (P < 0.05) Conclusions: Local control and survival rates of STI for stage I NSCLC are better with BED ≥100 Gy compared to <100 Gy. Survival rates in selected patients (medically operable, BED ≥100 Gy) were excellent, and potentially comparable to those of surgery. Stage IB patients displayed higher rate of local progression than stage IA. We have started multi-institutional prospective study for stage IA NSCLC with a schedule of total dose of 48 Gy in 4 fractions during 4–8 days. No significant financial relationships to disclose.

scholarly journals Complete Remission of Anaplastic Thyroid Carcinoma after Concomitant Treatment with Docetaxel and Radiotherapy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Ichiro Abe ◽  
Satoko Karasaki ◽  
Yayoi Matsuda ◽  
Shohei Sakamoto ◽  
Torahiko Nakashima ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Survival Rate ◽  
Mortality Rate ◽  
Complete Remission ◽  
Thyroid Carcinoma ◽  
Therapeutic Potential ◽  
Anaplastic Thyroid Carcinoma ◽  
High Dose ◽  
Concomitant Treatment ◽  
Very High

Anaplastic thyroid carcinoma (ATC) although rare is the most lethal form of thyroid cancer. The mortality rate for ATC is very high, with a median survival time of only 5 months; the survival rate at 1 year after diagnosis is <20%. Management of ATC is extremely difficult and rife with uncertainties. Herein, we describe a 75-year-old woman who presented with ATC and was successfully treated using concomitant treatment with docetaxel and high-dose radiotherapy. This case appears to be the first to have been reported in the literature involving complete remission of ATC confirmed by autopsy, suggesting the therapeutic potential of this combination.

Retrospective Evaluation of the Bifractionated Scheme in Utero-Vaginal Brachytherapy in the Treatment of Cervical Cancer : Experience of the Radiotherapy Oncology Service at Marrakech University Hospital

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 2-2
Author(s):  
A Zayane ◽  
M Elanigri ◽  
H Abourrazek ◽  
Y Bouchabaka ◽  
I Lalya ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Treatment Time ◽  
Locally Advanced ◽  
Good Alternative ◽  
High Dose Rate ◽  
University Hospital ◽  
High Dose ◽  
Local Progression ◽  
Metastatic Relapse

Objective: To retrospectively report the results in terms of local control and toxicities, of the 2 x 9 Gy fractionation used in our service, in high dose rate brachytherapy, during the treatment of locally advanced cervical cancer, preceded by a concomitant chemotherapy radiotherapy association. Material and method: Report and analyze data from 106 patients treated in our center between 2015 and 2018, for cervical cancer stage IIB and IIIB according to the FIGO classification. Results: The median follow-up was 29 months. Among the 106 patients analyzed, 75.5% had good local control at 3 years against 7.5% who had local progression, while 9.5% had local relapse and 7.5% had metastatic relapse. The average time for the occurrence of an event (progression, local or remote relapse) was 8 months. Most patients (90.6%) did not have acute toxicity. As for chronic toxicities, 66% had good long-term tolerance, while 27.4% had synechiae or even vaginal stenosis. The other toxicities were in the minority. Conclusion: Despite the considerable advantage of 2 x 9 Gy fractionation in uterovaginal brachytherapy in terms of reduction in treatment time, it is not the ideal choice in terms of local control and toxicity and the 3 x 8 Gy scheme seems a good alternative.

A common sense approach to radiation treatment planning of temporal lobe GBM

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2044-2044
Author(s):  
F. Bokstein ◽  
F. Kovner ◽  
Z. Ram ◽  
H. Templehoff ◽  
A. A. Kanner ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Temporal Lobe ◽  
Stable Disease ◽  
Radiation Treatment ◽  
Combined Modality Therapy ◽  
Infratemporal Fossa ◽  
Tumor Control ◽  
High Dose ◽  
Tumor Spread ◽  
Local Progression

2044 Background: Irradiation remains the cornerstone of management for glioblastoma multiforme (GBM). Guidelines adopted by the RTOG and EORTC advocate encompassing the primary tumor (sometimes with edema), and a 2 cm margin in the high dose volume. These recommendations have emerged from imaging studies and post-mortem analyses. A shortcoming of this approach is the exposure of critical structures (e.g. optic apparatus) to doses of radiation that may exceed organ tolerance. We sought to determine whether the temporal bone (rather than the aforementioned 2 cm radius) serves as a barrier to tumor spread when regarded as the anterior margin for temporal lobe lesions. We hypothesized that toxicity could be reduced without compromising tumor control. Methods: During the period 2003–2006, 250 patients with GBM were treated with surgery and primary irradiation at our institution. Chemotherapy (e.g., Stupp regimen) was given to approximately one-third of patients. 31 patients had lesions confined to the temporal lobe. All patients had MRI at baseline and at monthly intervals following a course of 60 Gy delivered by conformal techniques. The Clinical Target Volume included the primary lesion, the edema when present and a 2 cm margin except in the direction of the temporal bone. At follow-up (median = 10 months), patients were judged to have stable disease, local progression (i.e. failure within the temporal lobe), distant progression (i.e., brain failure beyond the temporal lobe) or combinations of the latter 2. Results: 11 patients have remained with stable disease. 17 have failed locally. 3 have manifested distant failure. Of the latter, only one patient failed in the infratemporal fossa. Conclusions: An acceptable level of recurrence (e.g., <5% beyond the temporal bone) is seen when the temporal bone, rather than a 2 cm margin is employed as the anterior border of the CTV. As GBM patients live longer in the era of combined modality therapy, a greater opportunity will exist to express radiation damage. The strategy proposed herein provides tumor control while respecting optic tolerance without resorting to complex, expensive approaches such as IMRT. No significant financial relationships to disclose.

scholarly journals Dose-volume effects on brainstem dose tolerance in radiosurgery

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 189-196 ◽  
Author(s):  
Jinyu Xue ◽  
H. Warren Goldman ◽  
Jimm Grimm ◽  
Tamara LaCouture ◽  
Yan Chen ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Radiation Treatment ◽  
High Dose ◽  
Severe Toxicity ◽  
Volume Data ◽  
Single Fraction ◽  
Dose Volume ◽  
Hypofractionated Radiation ◽  
Dose Tolerance ◽  
Volume Effects

Object Dose-volume data concerning the brainstem in stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) were analyzed in relation to associated complications. The authors present their set of data and compare it with currently cited information on brainstem dose tolerance associated with conventional fractionated radiation therapy and hypofractionated radiation treatment of other diseases. Methods Stereotactic radiosurgery for TN delivers a much higher radiation dose to the brainstem in a single fraction than doses delivered by any other procedures. A literature survey of articles on radiosurgery for TN revealed no incidences of severe toxicity, unlike other high-dose procedures involving the brainstem. Published data on brainstem dose tolerance were investigated and compared with dose-volume data in TN radiosurgery. The authors also performed a biological modeling study of dose-volume data involving the brainstem in cases of TN treated with the Gamma Knife, CyberKnife, and linear accelerator–based systems. Results The brainstem may receive a maximum dose as high as 45 Gy during radiosurgery for TN. The major complication after TN radiosurgery is mild to moderate facial numbness, and few other severe toxic responses to radiation are observed. The biologically effective dose of 45 Gy in a single fraction is much higher than any brainstem dose tolerance currently cited in conventional fractionation or in single or hypofractionated radiation treatments. However, in TN radiosurgery, the dose falloff is so steep and the delivery so accurate that brainstem volumes of 0.1–0.5 cm3 or larger receive lower planned and delivered doses than those in other radiation-related procedures. Current models are suggestive, but an extensive analysis of detailed dose-volume clinical data is needed. Conclusions Patients whose TN is treated with radiosurgery are a valuable population in which to demonstrate the dose-volume effects of an extreme hypofractionated radiation treatment on the brainstem. The result of TN radiosurgery suggests that a very small volume of the brainstem can tolerate a drastically high dose without suffering a severe clinical injury. The authors believe that the steep dose gradient in TN radiosurgery plays a key role in the low toxicity experienced by the brainstem.

Intraoperative phosphorus-32 brachytherapy plaque for multiply recurrent high-risk epidural neuroblastoma

2014 ◽  
Vol 13 (4) ◽  
pp. 388-392 ◽  
Author(s):  
William Y. Tong ◽  
Michael R. Folkert ◽  
Jeffrey P. Greenfield ◽  
Yoshiya Yamada ◽  
Suzanne L. Wolden
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
High Risk ◽  
Local Control ◽  
Therapeutic Target ◽  
Radiation Treatment ◽  
High Dose Rate ◽  
High Dose ◽  
Crucial Component ◽  
Dose Radiation

Achieving local control is a crucial component in the management of neuroblastoma, but this may be complicated in the setting of prior radiation treatment, especially when the therapeutic target is in proximity to critical structures such as the spinal cord. The authors describe a pediatric patient with multiply recurrent neuroblastoma and prior high-dose radiation therapy to the spine who presented with progressive epidural disease. The patient was managed with resection and intraoperative high-dose-rate brachytherapy using a phosphorus-32 (32P) plaque previously developed for the treatment of brain and spine lesions.

Clinical significance of prophylactic intrathecal chemotherapy in the treatment of glioblastoma multiforme

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e13022-e13022
Author(s):  
T. Iuchi ◽  
K. Hatano ◽  
T. Sakaida ◽  
S. Hirono
Keyword(s):  
Clinical Significance ◽  
Local Control ◽  
Progression Free Survival ◽  
Intrathecal Administration ◽  
High Dose ◽  
Free Survival ◽  
Local Progression ◽  
Group A ◽  
Group B ◽  
Group D

e13022 Backgrounds: We previously have reported that hypo-fractionated high-dose irradiation (HdI; 68Gy/8F) showed excellent local control but no effect on prevention of cerebrospinal fluid dissemination (CSFd), resulted in limited efficacy on patients’ survival in glioblastoma (GBM). The aim of present analysis is to evaluate the clinical significance of prophylactic intrathecal administration of thiotepa (iT) in the treatment of GBM patients. Methods: Histologically confirmed GBMs without CSFd at diagnosis were enrolled. Patients were classified into four groups owing to the post-surgical treatment strategy as follows: Group A patients (n = 65) were treated by conventional radiotherapy (cRT; 60Gy/30F) alone; Group B patients (n = 17) were by cRT concurrent witn iT; Group C patients (n = 28) were by HdI alone; Group D patients (n = 30) were by HdI concurrent with iT. In Group B and D, Ommaya reservoir was placed into the lateral ventricle and 10mg of thiotepa was administrated weekly after surgery for five times. The local progression-free survival (PFS), CSFd-free survival (CFS), and overall survival (OS) were compared in these four groups. Results: Group C and D patients showed significantly longer PFS than Group A and B (p < 0.0001), suggesting the clinical significance of HdI for local control of this tumor. On the other hand, CFS in Group B and D was significantly longer than that in Group A and C (p = 0.049), demonstrating the effect of iT for prevention of CSFd. However, significant improvement of OS on the conventional treatment (Group A, median OS: 12.3 months) was observed only in Group D (median OS: 30.2 months, p = 0.002) and not in Group B or C (24 months, p = 0.135, and 14.9 months, p = 0.481 respectively). Conclusions: These data indicated that both of local control and prevention of CSFd were required for better survival of patients with GBM, and iT concurrent with HdI may be one of the treatments that fill these requirements. No significant financial relationships to disclose.

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