فهرست مطالب

  • Volume:6 Issue:1, 2020
  • تاریخ انتشار: 1398/10/25
  • تعداد عناوین: 5
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  • Thimmaiah Naveen *, K. Sruthi, Rahul Loni, Pasha Tanvir, Sridhar Poojar, V. Lokesh Page 1
    Background

    Accelerated repopulation in HNSCC (head and neck squamous cell cancer) is responsible for poor outcomes; which can be tackled either by hyperfractionation or hypofractionation. Multiple daily fractionations in a setting with more patient load is cumbersome; hence we have tried to escalate the dose to the tumor with SIB by increasing the dose per fraction in the last two weeks of treatment to the tumor; thus, trying to achieve better locoregional control within a shorter period of treatment time.

    Methods

    A total of 20 histologically proven LAHNSCC patients, enrolled alternatively into the control arm (GTV 66Gy, CTVhigh risk 60Gy, and CTVlow risk 54Gy) and the study arm (32Gy to the GTV, CTVhigh risk, CTVlow risk in 16 fractions followed by 30Gy to the GTV, 25Gy to the CTVhigh risk and 20 Gy to CTVlow risk in 10 fractions,), in both arm patients received one fraction per day, five days per week. The radiological response assessment was done using a CT scan at the end of one month after treatment. Toxicity assessment was done weekly during treatment, at the end of treatment, in the first month, and at the end of two months.

    Results

    In this study the patients completed treatment with 26 fractions in about five to six weeks with Grade 3 mucositis in 90% and grade 3 dysphagia in 40% of the patients, which necessitated Ryle’s tube feeding in 30% of the with complete resolution of the mucositis and to grade 1 dysphagia by the end of three months. Grade 1 xerostomia was noted in all the patients with gradual resolution of symptoms. The overall complete response (CR) was achieved in 50% of the patients and the CR with reference to the tumor was seen in 80% and with reference to the node was seen in 50% of the patients, respectively.

    Conclusions

    IMRT with Hypofractionated concomitant simultaneous integrated boost (SIB) was better than standard IMRT with SIB in LAHNSCC, with respect to radiological response, however, at the cost of higher toxicity.

    Keywords: Simultaneous Integrated Boost, IMRT, Hypofractionation, Head Neck Cancers
  • Sridhar Poojar, Rahul Loni *, Krishna Raj H K, Thimmaiah Naveen, V Lokesh Page 2
    Background

    Most common intracranial tumor in adults is brain metastasis. Different fractionation schedules used for whole brain radiation therapy are 20 gray/5 Fr, 30 gray/10 Fr, and 40 gray/20 Fr, which in four weeks have shown equivalent response rate, period of improvement, palliative effect, time to disease progression, and survival. However, there is lacking literature on the effect of different fractionation schedules of radiation therapy on memory function.

    Objectives

    Hence, we evaluated memory function in two different fractionation schedules of whole brain radiation therapy (WBRT) in patients with brain metastases.

    Methods

    A total of 20 patients, who were histologically proven primary and recently diagnosed brain metastases, with a RPA class of I/II, and satisfying eligibility criteria were taken into this study. Patients were randomly assigned to whole brain radiation therapy of 40 gray in 20 fractions (group A) and 30 gray in 10 fractions (group B) with concurrent Temozolomide. Memory function assessment was done using P.G.I. Memory scale before, during, and after the treatment, as well as at three months and six months of follow-up. Two groups were compared for with appropriate statistical tests.

    Results

    Patients in group A showed improvement in five domains of memory function (attention and concentration, remote and recent memory, mental balance and verbal retention for similar pair) during radiation therapy, compared to group B patients. However, deterioration of memory function was noted in both groups at 3- and 6-months post chemoradiation therapy.

    Conclusions

    Fourty Gy in 20 fractions given over four weeks with concurrent TMZ 75 mg/m2 is a better and preferable treatment option for patients with brain metastasis with respect to memory function.

    Keywords: Whole Brain Radiotherapy (WBR), Brain Metastases, Memory Function
  • Thimmaiah Naveen, Uday Krishna AS *, Vezokhoto Phesao, Pasha Tanvir, V. Lokesh Page 3
    Objectives

    To study the correlation of magnetic resonance spectroscopy (MRS) changes in hippocampal and perihippocampal regions and neuro-psychologic evaluation with various clinical factors following whole brain radiotherapy in brain metastasis.

    Methods

    A total of 33 patients with newly diagnosed brain metastasis, referred to our Department of Radiation Oncology were recruited after a prior informed written consent. All patients underwent baseline clinical/neurological evaluation, detailed MMSE examination, gadolinium enhanced MRI along with MRS (for ratio of Choline: NAA = CNI) from the bilateral hippocampal and perihippocampal areas. All patients then underwent WBRT by two opposing lateral portals on a linear accelerator to a dose of 30 gray in 10 fractions delivered over 2 weeks. Serial evaluations along with MRS and MMSE score were done at 1st, 3rd and 6 months after WBRT. The trends of CNI and MMSE scores at last follow-up were correlated with various clinical factors.

    Results

    Our cohort had 33 patients, predominantly women (M:F, 12:21) with a median age of 47 years, median KPS (Karnofsky performance status) of 80, mean RPA (recursive partitioning analysis) class 2, primary histology (lung, breast, GI, Gy, GU, MUO (metastasis of unknown origin): 10, 11, 2, 4, 4, 2). Median survival of the cohort was 4 months. At the end of 14 months of follow-up 30% of the patients were alive with a mean KPS of 70. Trend in the CNI values with time showed that, KPS (P = 0.079), RPA class (P = 0.079), primary diagnosis site (P = 0.049), number of brain metastasis (P = 0.045) showed statistical significance in terms of change in mean value of CNI value at last follow-up. Site of primary (lung/breast vs. others, P = 0.02) and number of metastasis (solitary/oligo vs. multiple, P = 0.02) showed significant correlation with decline in CNI. The KPS at presentation (< 70 or > 70, P = 0.04); RPA class (class II or higher, P = 0.04); Site of primary (lung/breast vs. others, P = 0.01), presence of extracranial disease (yes or no, P = 0.045), number of metastasis (solitary/oligo vs. multiple, P = 0.06), Size of the largest metastatic lesion (< or > 4 cm, P = 0.02) showed significant correlation with decline in MMSE at last follow-up.

    Conclusions

    Cognitive functioning after WBRT is influenced by a number of factors; patient related, systemic disease burden and local tumor load. Local disease control has significant impact on preservation of neurocognition. The trend in the CNI index and MMSE scores at last follow-up correlated with various factors and can be used as a guide to aid in patient selection for hippocampus- avoidance WBRT.

    Keywords: Brain Metastasis, Magnetic Resonance Spectroscopy, MMSE, Neurocognition
  • Tanvir Pasha, Siddanna Rudrappa Palled *, Rahul Loni, Shwetha Bondel, Purushottam Chavan, Ashok Shenoy, Thimmaiah Naveen, V Lokesh Page 4
    Background

    Thirty to fifty percent of HNSCC patients treated with chemoradiation therapy present with recurrence and can be treated with maximum debulking surgery combined with re-irradiation. Re-irradiation can be done using external beam radiation therapy (EBRT) or brachytherapy. The advantage of brachytherapy over EBRT is that owing to rapid dose falls off, a higher dose can be delivered to the target area sparing normal tissue. Hence, we evaluated toxicity and outcomes [overall survival (OS) and disease-free survival (DFS)] in high-risk (HR) recurrent HNSCC patients undergoing re-irradiation using interstitial brachytherapy following surgery.

    Objectives

    To evaluate toxicity and outcomes of re-irradiation using Interstitial High Dose-Rate Brachytherapy (HDR-BRT) in high-risk Head and Neck Squamous Cell Carcinoma (HNSCC) patients.

    Methods

    Ten biopsy-proven recurrent HNSCC patients treated with primary chemoradiation therapy who had the HR of the second recurrence at nodal disease were evaluated. All patients underwent surgery followed by the intraoperative placement of catheters in a single plane, at 10 - 12 mm apart and fixed with stay sutures. The CT simulation was done on the 5th - 7th postoperative day. Volumetric optimization was done with a 5-mm dwell position. The dose of 30 Gy/10 Fractions, 3 Gy/Fraction, two fractions per day, 6 hours apart after 5 days was planned.

    Results

    The DFS and OS for the entire cohort in 1 and 2 years were 60% and 40%, respectively. One patient had carotid blowout where the disease was stuck to the carotid vessel. No other significant acute or late toxicity was noted.

    Conclusions

    The HDR-interstitial brachytherapy in the recurrent HR, HNSCC with the intraoperative placement of catheters at tumor bed provides reasonably good local control without significant acute or late toxicity.

    Keywords: Re-Irradiation, Interstitial Brachytherapy, Recurrent Head Neck Squamous Cell Cancer, High Dose-Rate Brachytherapy
  • Ahmad Ameri, Zohreh Azma *, Nazanin Rahnama, Ahmad Mousavizadeh Page 5
    Introduction

    In this paper, we present the first experience of linac-based stereotactic body radiation therapy (SBRT) in Iran to treat a single liver metastasis.

    Case Presentation

    A 23-year-old girl with a history of visceral melanoma of the uterine was treated for liver metastasis. Stereotactic body radiotherapy was selected as the treatment of choice after tumor recurrence following surgical removal and radiofrequency ablation. The treatment was delivered in five fractions to a total dose of 50 Gy. The patient tolerated the treatment without any considerable side effect and the lesion remained progression-free twelve months after treatment.

    Conclusions

    It can be presumed that SBRT can be safely applied using IGRT-equipped conventional linear accelerators with a few but no adverse events if it is delivered with due consideration.

    Keywords: SBRT, Liver Melanoma, Linac-based SBRT