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Combined treatment of adenoid cystic carcinoma with cetuximab and IMRT plus C12 heavy ion boost: ACCEPT [ACC, Erbitux? and particle therapy]
Alexandra D Jensen, Anna Nikoghosyan, Axel Hinke, Jürgen Debus, Marc W Münter
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-70
Abstract: The ACCEPT trial is a prospective, mono-centric, phase I/II trial evaluating toxicity (primary endpoint: acute and late effects) and efficacy (secondary endpoint: local control, distant control, disease-free survival, overall survival) of the combined treatment with IMRT/carbon ion boost and weekly cetuximab in 49 patients with histologically proven (≥R1-resected, inoperable or Pn+) ACC. Patients receive 18 GyE carbon ions (6 fractions) and 54 Gy IMRT (2.0 Gy/fraction) in combination with weekly cetuximab throughout radiotherapy.The primary objective of ACCEPT is to evaluate toxicity and feasibility of cetuximab and particle therapy in adenoid cystic carcinoma.Clinical Trial Identifier: NCT 01192087EudraCT number: 2010 - 022425 - 15Adenoid cystic carcinomas are rare tumors mostly of the head and neck accounting for approximately 10-15% of malignant salivary gland tumors [1]. They are characterised by a rather slow growth pattern but also perineural spread. Standard treatment so far consists of preferably complete surgical resection followed by adjuvant irradiation in case of close margins, perineural invasion, extensive primary tumor (T3, T4) or high-grade histology [2-5].Local control in this disease could already be improved high-precision radiotherapy techniques such as stereotactic radiotherapy and/or intensity-modulated radiation therapy (IMRT), dose escalation, and high-LET RT. Treatment of large inoperable or residual tumors with IMRT resulted in increased local control as compared to conventional RT achieving progression-free survival rates of 38% at 3 years [6]. Neutron RT with a local control of 75% at 5 years, so far yielded the highest control rates in adenoid cystic carcinoma though unfortunately also accompanied by significant late toxicity [7,8].Combined IMRT and C12 heavy ion boost are able to achieve similar or superior control rates as compared to neutron RT but without increase of late toxicity and subsequent morbidity. Recent results of our own g
Combined treatment of malignant salivary gland tumours with intensity-modulated radiation therapy (IMRT) and carbon ions: COSMIC
Alexandra D Jensen, Anna Nikoghosyan, Christine Windemuth-Kieselbach, Jürgen Debus, Marc W Münter
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-546
Abstract: The COSMIC trial is a prospective, mono-centric, phase II trial evaluating toxicity (primary endpoint: mucositis ≥ CTCAE°3) and efficacy (secondary endpoint: local control, disease-free survival) in the combined treatment with IMRT and carbon ion boost in 54 patients with histologically proved (≥R1-resected, inoperable or Pn+) salivary gland malignancies. Patients receive 24 GyE carbon ions (8 fractions) and IMRT (50 Gy at 2.0 Gy/fraction).The primary objective of COSMIC is to evaluate toxicity and feasibility of the proposed treatment in all salivary gland malignancies.Clinical trial identifier NCT 01154270Malignant salivary gland tumours are rare and a heterogenous group of tumours accounting for about 3-5% of head and neck cancers. High-grade tumours such as mucoepidermiod carcinoma (35%) and adenoid cystic carcinoma (25%) are the most common histological subtypes [1], characterised by a rather slow pattern of growth, perineural spread and high propensity for haematogenous metastases. So far, standard therapy of high-grade salivary gland carcinoma consists of complete surgical resection and adjuvant radiation in high-risk situations (R+ or close margin, perineural spread, neural infiltration, large tumours (T3/4), or nodal metastases [2-4]. To achieve local control, radiation doses of > 60 Gy or even 66 Gy (5) are recommended [5,6], with apparently all tumour stages profiting from postoperative radiotherapy [5,7-9].Regarding radiation therapy, local control was also significantly improved by the application of high-precision techniques, dose-escalation and high-LET radiation [9-13].Intensity-modulated radiation therapy (IMRT) as well as fractionated stereotactic RT could already improve local control as compared to conventional RT techniques achieving 3-year PFS rates of 38% [14].So far, the highest local control rates at 75 - 100% [11,13] were achieved by neutron radiation albeit at the cost of significant late toxicity.Dose escalation [12] though only in a smal
The Role of Postoperative Irradiation in the Treatment of Locally Recurrent Incompletely Resected Extra-Abdominal Desmoid Tumors  [PDF]
James Fontanesi,Michael P. Mott,Michael J. Kraut,David P. Lucas,Peter R. Miller
Sarcoma , 2004, DOI: 10.1155/2004/378521
Abstract: Background: To define the efficacy of postoperative irradiation in patients with recurrent extra-abdominal desmoid tumors in whom surgical intervention has resulted in microscopically or grossly positive surgical margins.
Diagnosis and Treatment of Tracheal or Bronchuotracheal Adenoid Cystic Carcinoma  [PDF]
Ming QIN,Yu FU,Daping YU,Shaofa XU
Chinese Journal of Lung Cancer , 2010,
Abstract: Background and objective Adenoid cystic carcinoma is primary bronchopulmonary carcinoma with low malignancy, and 43 patients treated in the past 50 years in our hospital were retrospectively studied. The aim of this study is to discuss the clinical symptoms, pathologic characteristic and therapeutic method of primary tracheal or bronchuotracheal adenoid cystic carcinoma. Methods This study summarized total 43 patients of primary tracheal or bronchus adenoid cystic carcinoma treated in our hospital from Jan. 1958 to Dec. 2007. Among them, 40 patients were treated by surgical resection, and 3 patients were treated by fiberoptic bronchoscope’s interventional treatment. Results The 1-yr, 3-yr, 5-yr survival rates of the 43 patients above were 100% (41/41), 89.5% (34/38), 87.1% (27/31), respectively. Conclusion Primary tracheal or bronchus adenoid cystic carcinoma are rare and low malignancy carcinoma. The clinical symptoms of them are not typical. The best treatment is early detection and taking measures of operation plus radiotherapy. The other palliative treatment is fiberoptic bronchoscope’s interventional treatment.
Dosimetric and physical comparison of IMRT and CyberKnife plans in the treatment of localized prostate cancer
Cemile CEYLAN,Nadir Kü?üK,Hande BA? AYATA,Ayhan KILI?
Turkish Journal of Oncology , 2010,
Abstract: OBJECTIVES: We aimed to conduct a retrospective dosimetric and physical comparison of CK (CyberKnife) and IMRT (intensity-modulated radiotherapy) plans in 16 prostate cancer cases. METHODS: For the comparison of IMRT and CK in 16 patients, CI (conformity index), HI (homogeneity index), and the 100% (V100), 66% (V66), 50% (V50), 33% (V33) and 10% (V10) doses received by rectum and bladder volumes were investigated. RESULTS: The doses of V10, V33 and V50 rectum volumes were found to be lower in CK (p<0.001, 0.001, and 0.019, respectively). Percentage doses of V66 and V100 volumes were higher in CK. Mean percentage doses received by V10 and V33 bladder volumes were found to be lower in CK. The percentage doses received by the V50 and V60 bladder volumes were 5.4% and 3.45% in IMRT and 13.4% and 8.05% in CK. Mean CI was 0.94 in IMRT and 1.23 in CK; HI was 1.08 in IMRT and 1.33 in CK (p<0.001). CONCLUSION: In the high-dose region, CK treatment was found to be superior to IMRT. Dose heterogeneity in target volume was lower in CK plans due to the properties of the system. While CI was better in IMRT, critical organ protection was better in CK.
Nasopharyngeal Adenoid Cystic Carcinoma: Report of Five Cases and Treatment Outcome  [cached]
Bijan Khademi,Hajar Bahranifard,Sayed Hamed Kabiri,Samiraz Razzaghi
Middle East Journal of Cancer , 2011,
Abstract: Background: The present study aimed to report the characteristics and treatment outcomes of five patients with nasopharyngeal adenoid cystic carcinoma and a literature review. Methods: Between 2000 and 2009, five consecutive patients (4 men, 1 woman) were diagnosed with nasopharyngeal adenoid cystic carcinoma and treated at our institution. Three patients had stage IVa (T4N0M0) and two patients had stage III (T3N0M0) cancer. Primary treatment consisted of concurrent chemoradiation in three patients andradiotherapy alone in two patients. Surgery was limited to endoscopic biopsy for histological diagnosis. Results: Four patients achieved complete response during or after completion of treatment and remained free of disease for a median of 27 months. Four patients developed local recurrence 8-30 months after initial treatment. The fifth patient is alive and free of disease.Conclusion: The findings of the present study and literature review suggest that local failure is a major problem in adenoid cystic carcinoma of the nasopharynx.
Dosimetric analysis and comparison of IMRT and HDR brachytherapy in treatment of localized prostate cancer  [cached]
Murali V,Kurup P. G. G.,Mahadev P,Mahalakshmi S
Journal of Medical Physics , 2010,
Abstract: Radical radiotherapy is one of the options for the management of prostate cancer. In external beam therapy, 3D conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) are the options for delivery of increased radiation dose, as vital organs are very close to the prostate and a higher dose to these structures leads to an increased toxicity. In brachytherapy, low dose rate brachytherapy with permanent implant of radioactive seeds and high dose rate brachytherapy (HDR) with remote after loaders are available. A dosimetric analysis has been made on IMRT and HDR brachytherapy plans. Ten cases from each IMRT and HDR brachytherapy have been taken for the study. The analysis includes comparison of conformity and homogeneity indices, D100, D95, D90, D80, D50, D10 and D5 of the target. For the organs at risk (OAR), namely rectum and bladder, V100, V90 and V50 are compared. In HDR brachytherapy, the doses to 1 cc and 0.1 cc of urethra have also been studied. Since a very high dose surrounds the source, the 300% dose volumes in the target and within the catheters are also studied in two plans, to estimate the actual volume of target receiving dose over 300%. This study shows that the prescribed dose covers 93 and 92% of the target volume in IMRT and HDR brachytherapy respectively. HDR brachytherapy delivers a much lesser dose to OAR, compared to the IMRT. For rectum, the V50 in IMRT is 34.0cc whilst it is 7.5cc in HDR brachytherapy. With the graphic optimization tool in HDR brachytherapy planning, the dose to urethra could be kept within 120% of the target dose. Hence it is concluded that HDR brachytherapy may be the choice of treatment for cancer of prostate in the early stage.
Treatment of malignant sinonasal tumours with intensity-modulated radiotherapy (IMRT) and carbon ion boost (C12)
Alexandra D Jensen, Anna V Nikoghosyan, Christine Windemuth-Kieselbach, Jürgen Debus, Marc W Münter
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-190
Abstract: The IMRT-HIT-SNT trial is a prospective, mono-centric, phase II trial evaluating toxicity (primary endpoint: mucositis ≥ CTCAE°III) and efficacy (secondary endpoint: local control, disease-free and overall survival) in the combined treatment with IMRT and carbon ion boost in 30 patients with histologically proven (≥R1-resected or inoperable) adeno-/or squamous cell carcinoma of the nasal cavity or paransal sinuses. Patients receive 24 GyE carbon ions (8 fractions) and IMRT (50 Gy at 2.0 Gy/fraction).The primary objective of IMRT-HIT-SNT is to evaluate toxicity and feasibility of the proposed treatment in sinonasal malignancies.Clinical trial identifier NCT 01220752Sinonasal malignancies are a heterogeneous group of tumours of the nasal cavity and paranasal sinuses accounting for about 5% of head and neck tumours and 1% of all cancers [1,2]. Most commonly, these are adenocarcinomas and squamous cell carcinomas, however also rare tumours such as adenoidcystic carcinomas, aesthesioneuroblastoma, sarcomas, melanomas, and other rare histologies are occasionally found in the nasal cavity and paranasal sinus [3]. Malignant sinonasal tumours are often asymptomatic until late in the course of the disease, therefore patients frequently present with extensive tumours displacing adjacent organs or infiltrating surrounding tissues. Due to the proximity of critical organs such as eyes, optic nerves, chiasm, lacrimal gland, temporal lobe, and pituary gland complete resection of these tumours is rarely possible. In addition, surgical en-bloc resections are impossible in this area of the body, which is another reason why surgical resection margins in locally advanced tumours are rarely free. Extensive surgical procedures are also severely mutilating if a radical maxillectomy or orbital exenteration are necessary to remove the tumour. Chemotherapy for the treatment of sinunasal malignancies is still under discussion, however, recent results showed a significant advantage for postoper
On the performances of different IMRT treatment planning systems for selected paediatric cases
Antonella Fogliata, Giorgia Nicolini, Markus Alber, Mats ?sell, Alessandro Clivio, Barbara Dobler, Malin Larsson, Frank Lohr, Friedlieb Lorenz, Jan Muzik, Martin Polednik, Eugenio Vanetti, Dirk Wolff, Rolf Wyttenbach, Luca Cozzi
Radiation Oncology , 2007, DOI: 10.1186/1748-717x-2-7
Abstract: Datasets (CT images and volumes of interest) of four patients were used to design IMRT plans. The tumour types were: one extraosseous, intrathoracic Ewing Sarcoma; one mediastinal Rhabdomyosarcoma; one metastatic Rhabdomyosarcoma of the anus; one Wilm's tumour of the left kidney with multiple liver metastases. Prescribed doses ranged from 18 to 54.4 Gy. To minimise variability, the same beam geometry and clinical goals were imposed on all systems for every patient. Results were analysed in terms of dose distributions and dose volume histograms.For all patients, IMRT plans lead to acceptable treatments in terms of conformal avoidance since most of the dose objectives for Organs At Risk (OARs) were met, and the Conformity Index (averaged over all TPS and patients) ranged from 1.14 to 1.58 on primary target volumes and from 1.07 to 1.37 on boost volumes. The healthy tissue involvement was measured in terms of several parameters, and the average mean dose ranged from 4.6 to 13.7 Gy. A global scoring method was developed to evaluate plans according to their degree of success in meeting dose objectives (lower scores are better than higher ones). For OARs the range of scores was between 0.75 ± 0.15 (Eclipse) to 0.92 ± 0.18 (Pinnacle3 with physical optimisation). For target volumes, the score ranged from 0.05 ± 0.05 (Pinnacle3 with physical optimisation) to 0.16 ± 0.07 (Corvus).A set of complex paediatric cases presented a variety of individual treatment planning challenges. Despite the large spread of results, inverse planning systems offer promising results for IMRT delivery, hence widening the treatment strategies for this very sensitive class of patients.Radiation Therapy is administered to approximately one-half of the children affected by oncological pathologies to manage their disease [1]. The choice of available radiation treatments includes intensity-modulated radiotherapy (IMRT) that should therefore be investigated in the challenging field of paediatric radio-onc
Intensity Modulated Radiotherapy (IMRT) in the Planning of Hypofractionated Treatment in Head and Neck Tumors  [PDF]
Misleidy Nápoles Morales, Rogelio Díaz Moreno
International Journal of Clinical Medicine (IJCM) , 2018, DOI: 10.4236/ijcm.2018.99056
Abstract: Head and neck cancer (HNCC) is the sixth most common cancer with an incidence of approximately 600,000 cases per year and 300,000 annual deaths worldwide1y2. In Cuba, cancer of the larynx is the fourth cause in incidence, being the fourth cause of cancer death in men. Radiotherapy constitutes an important modality in the control of these tumors and the Intensity Modulated Radiotherapy (IMRT) is a new advance in this field. With it, it is possible to improve dose distribution, decreasing the dose in adjacent healthy tissues and escalating dose in tumor. In this work we present 33 patients of National Institute of Oncology and Radiobiology in Cuba (INOR), in whom the IMRT was used as a treatment technique with a hypofractionation of the dose. Their response was observed at the end of the treatment and one month later. 56% (19) of the patients had a complete response to treatment at the primary site of the tumor and neck. 10% (3) had no response, progressed. 11 of the patients had no response at the lymph node site at the end of treatment, 8 of these 11 had complete remission one month after radiotherapy ended.
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