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449 results for “Hypofractionation”
Dataset related to article "Hypofractionated radiation therapy (HFRT) versus conventional fractionated radiation therapy (CRT) for newly diagnosed glioblastoma patients. A propensity score matched analysis"
<p>This record contains raw data related to article "Hypofractionated radiation therapy (HFRT) versus conventional fractionated radiation therapy (CRT) for newly diagnosed glioblastoma patients. A propensity score matched analysis"</p> <p>The current treatment for newly diagnosed glioblastoma consists of surgery followed by conventional radiotherapy (CRT) with concomitant and adjuvant chemotherapy. Hypofractionated radiation therapy (HFRT) has been investigated and it resulted feasible and safe. The aim of this study was to evaluate whether HFRT can be comparable to CRT.</p> <p>MATERIALS AND METHODS:</p> <p>The analysis included newly diagnosed glioblastoma patients treated with CRT 60 Gy/30 fractions or HFRT 60 Gy/15 fractions. A propensity score matching analysis (PSM) was performed using a logistic regression that considered age, KPS, extent of surgery, MGMT and IDH status.</p> <p>RESULTS:</p> <p>A total of 267 patients were included; before PSM 169 were in CRT-group and 98 in HRFT-group. After 1:1 matching, 82 patients resulted in each group. The median OS time was 17.9 months for the CRT-group and 16.7 months for the HFRT-group; the 1, 2, 3-year OS rates were 75.6%, 32.7%, and 15.5% for the CRT-group, and 75.6%, 33.3%, and 18.9% for the HFRT-group (p value = 0.8). No statistically significant differences were recorded between the two radiation therapy treatments performed.</p> <p>CONCLUSIONS:</p> <p>A short course of radiation therapy would seem comparable to CRT in terms of outcome and less burdensome for these poor prognosis patients.</p> <p> </p>
Dataset related to article "Phase II study of hypofractionated radiation therapy in elderly patients with newly diagnosed glioblastoma with poor prognosis"
<p>This record contains raw data related to article "Phase II study of hypofractionated radiation therapy in elderly patients with newly diagnosed glioblastoma with poor prognosis"</p> <p>OBJECTIVE::</p> <p>To evaluate hypofractionated radiation therapy (HFRT) given at therapeutic effective doses in a phase II study. Endpoints were progression-free survival (PFS) rate, overall survival (OS), and incidence of toxicity.</p> <p>METHODS::</p> <p>Patients with newly diagnosed glioblastoma, age ⩾70 years, Karnofsky performance scale (KPS) score ⩽60, were enrolled. The total dose of HFRT was 52.5 Gy/15 fractions, corresponded to a biological effective dose to the tumor of 70.88 Gy.</p> <p>RESULTS::</p> <p>Thirty patients were treated, with a median age of 75 years. Concurrent and adjuvant temozolomide chemotherapy (TMZ-CHT) was administered in 7 (23.3%) and 11 (40.7%) patients received only adjuvant TMZ-CHT. The median, 6-month PFS, and 12-month PFS were 5.0 months, 43.3%, and 20%, respectively. The median, 6-month OS, and 12-month OS were 8 months, 90%, and 30%, respectively. At the last observation time, 26 patients (86.7%) were dead and 4 (13.3%) were alive. No increase in steroid drugs was required during radiotherapy treatment and a reduction was possible in 12 (40%). Patients with KPS=60, RPA V, MGMT methylated status, neurological status stable or improved after surgery and who underwent HFRT with concurrent and adjuvant CHT, had the better outcome.</p> <p>CONCLUSION::</p> <p>HFRT has proven to be feasible and effective, with limited morbidity, for selected elderly and frail patients with newly diagnosed glioblastoma. The primary objective of this study was not reached in the whole cohort but only in selected patients, who need more aggressive treatment.</p>
Dataset related to article "Locally Advanced Non-Small Cell Lung Cancer: Clinical Outcome, Toxicity and Predictive Factors in Patients Treated with Hypofractionated Sequential or Exclusive Radiotherapy"
<p>This record contains data related to article "Locally Advanced Non-Small Cell Lung Cancer: Clinical Outcome, Toxicity and Predictive Factors in Patients Treated with Hypofractionated Sequential or Exclusive Radiotherapy"</p> <p>Background: This study evaluated the outcome, toxicity and predictive factors in patients unfit for concurrent chemo-radiotherapy (CT-RT) treated with hypofractionated sequential CT-RT or exclusive radiotherapy (RT) for locally advanced non-small cell lung cancer (LA-NSCLC).</p> <p>Methods: We included patients affected by LA-NSCLC (stage IIA-IVA) treated with a total dose of 50–60 Gy in 20 fractions. The primary outcomes were local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS). Univariate analysis was used to correlate outcomes with prognostic factors.</p> <p>Results: Between 2011 and 2019, 210 patients were treated,113 (53.8%) with sequential CT-RT and 97 (46.2%) with exclusive RT. After a median follow-up of 15.3 months, 74 patients (35.2%) had a local progression and 133 (63.3%) had a distant progression.<br> The one-, two- and five-year LC were 73.6%, 55.3% and 47.9%, respectively. At the time of analysis, 167 patients (79.5%) died. The one-, two- and five-year OS were 64.7%, 36% and 20%, respectively. PTV volume correlated with PFS (p = 0.001) and LC (p = 0.005). Acute and late toxicity occurred in 82% and 26% of patients.</p> <p>Conclusions: Albeit with the known limitations of a retrospective and heterogeneous study, our work shows that hypofractionated sequential CT-RT or exclusive RT offer a good local control and toxicity profile and a promising survival rate in LA-NSCLC patients unfit for the concurrent CT-RT scheme.</p>
Dataset related to article "Surgery Followed by Hypofractionated Radiosurgery on the Tumor Bed in Oligometastatic Patients With Large Brain Metastases. Results of a Phase 2 Study"
<p>PURPOSE:</p> <p>This prospective phase II study assessed safety and feasibility of surgery followed by hypofractionated radiosurgery (HSRS) on the tumor bed in oligometastatic patients with single large brain metastases (BMs).</p> <p>METHODS AND MATERIALS:</p> <p>Between June 2015 and May 2018, 101 patients were enrolled. Oligometastatic disease was defined by a maximum of 5 extracranial metastatic lesions. HSRS was performed within 1 month of surgery and consisted of 30 Gy in 3 fractions. Local control, occurrence of new BMs, overall survival, and treatment-related toxicities were assessed.</p> <p>RESULTS:</p> <p>At a median follow-up time of 26 months, local recurrence occurred in 6 patients (5.9%). Six-month, 1-year, and 2-year local control rates were 100%, 98.9% ± 1.1%, and 85.9% ± 0.6%, respectively. New BMs occurred in 39 patients (38.6%); median brain distant progression time and 6-month, 1-year, and 2-year brain distant progression rates were 39 months (95% CI, 19-39 months), 17% ± 3.7%, 31.4% ± 4.8%, and 42.5% ± 5.9%, respectively. At the last observation time, 50 patients (49.5%) were alive and 51 (50.5%) were dead; 10 patients died owing to neurologic causes and 40 as a result of systemic progression. Median overall survival time and 6-month, 1-year, and 2-year overall survival rates were 22 months (95% CI, 20-30 months), 95% ± 2.1%, 81.9% ± 3.8%, and 46.6% ± 6%, respectively. Infratentorial site, residual tumor volume, longer interval time between primary diagnosis and occurrence of BMs, and oligometastatic disease status significantly influenced outcome. Grade 2 to 3 radionecrosis occurred in 26 patients. Neurocognitive functions remained stable or, in some cases, improved.</p> <p>CONCLUSIONS:</p> <p>Surgery followed by HSRS on the tumor bed is a safe and effective approach, affording good brain control with acceptable toxicities. As for extracranial metastatic sites, patients with BMs can benefit from local ablative treatment in the context of an oligometastatic disease.</p>
Dataset related to article "Linac-based stereotactic body radiation therapy vs moderate hypofractionated radiotherapy in prostate cancer: propensity-score based comparison of outcome and toxicity."
<p>OBJECTIVE:</p> <p>Prostate cancer represents the second most common malignancy in the world and majority of patients have diagnosis of localized disease. The aim of the present study was to compare two cohorts of patients treated with moderate hypofractionation (MHRT) or stereotactic body radiation therapy (SBRT).</p> <p>METHODS:</p> <p>We included patients treated between 2010 and 2015. Inclusion criteria were: adenocarcinoma of the prostate; class risks low or intermediate; WHO performance status 0-2. We evaluated rectal, gastrointestinal toxicity and genitourinary. Measures of outcome were biochemical disease-free survival and overall survival. Propensity score was used to approximate the balance in covariates.</p> <p>RESULTS:</p> <p>209 patients were included, treated with MHRT (<em>n</em> = 109) or SBRT (<em>n</em> = 100). Median follow-up time was 37.4 months. Rates of biochemical disease-free survival at 1- and 3 years were 100 and 95%, respectively. There was no significant difference between the two groups (<em>p</em> = 0.868). Rates of overall survival at 1- and 3 years were 100 and 97.1%, respectively with no differences between the two groups (<em>p</em> = 0.312). After propensity scoring matching, no differences were observed in terms of acute and late rectal and gastrointestinal toxicity. While mild genitourinary side-effects were more common in SBRT group (45.5% <em>vs</em> 19.5 %), Grade 2 and 3 toxicity was increased after MHRT (11.7% <em>vs</em> 2.6 %; <em>p</em> = 0.029).</p> <p>CONCLUSIONS:</p> <p>Moderate hypofractionation and SBRT are two effective and safe options for the treatment of low- and intermediate-risk prostate cancer. The analysis showed no difference in terms of disease's control and survival but increased moderate and severe toxicity after MHRT.</p> <p>ADVANCES IN KNOWLEDGE:</p> <p>Moderate hypofractionation and SBRT are comparable in terms of efficacy while moderate and severe toxicity is more common in the first one.</p>
Dataset related to article "Can thoracic nodes oligometastases be safely treated with image guided hypofractionated radiation therapy?"
<p>OBJECTIVE:</p> <p>To evaluate safety and efficacy of image guided-hypofractionated radiation therapy (IG-HRT) in patients with thoracic nodes oligometastases.</p> <p>METHODS:</p> <p>The present study is a multicenter analysis. Oligometastatic patients, affected by a maximum of five active lesions in three or less different organs, treated with IG-HRT to thoracic nodes metastases between 2012 and 2017 were included in the analysis. Primary end point was local control (LC), secondary end points were overall survival (OS), progression-free survival, acute and late toxicity. Univariate and multivariate analysis were performed to identify possible prognostic factors for the survival end points.</p> <p>RESULTS:</p> <p>76 patients were included in the analysis. Different RT dose and fractionation schedules were prescribed according to site, number, size of the lymph node(s) and to respect dose constraints for relevant organs at risk. Median biologically effective dose delivered was 75 Gy (interquartile range: 59-86 Gy). Treatment was optimal; one G1 acute toxicity and seven G1 late toxicities of any grade were recorded. Median follow-up time was 23.16 months. 16 patients (21.05%) had a local progression, while 52 patients progressed in distant sites (68.42 %).Median local relapse free survival was not reached, LC at 6, 12 and 24 months was 96.05% [confidence interval (CI) 88.26<em>-</em>98.71%], 86.68% (CI 75.86<em>-</em>92.87) and 68.21% (CI 51.89<em>-</em>80.00%), respectively. Median OS was 28.3 months (interquartile range 16.1<em>-</em>47.2). Median progression-freesurvival was 9.2 months (interquartile range 4.1<em>-</em>17.93).At multivariate analysis, RT dose, colorectal histology, systemic therapies were correlated with LC. Performance status and the presence of metastatic sites other than the thoracic nodes were correlated with OS. Local response was a predictor of OS.</p> <p>CONCLUSION:</p> <p>IG-HRT for thoracic nodes was safe and feasible. Higher RT doses were correlated to better LC and should be taken in consideration at least in patients with isolated nodal metastases and colorectal histology.</p> <p>ADVANCES IN KNOWLEDGE:</p> <p>Radiotherapy is safe and effective treatment for thoracic nodes metastases, higher radiotherapy doses are correlated to better LC. Oligometastatic patients can receive IG-HRT also for thoracic nodes metastases.</p>
Dataset related to article "Long term results of a phase II trial of hypofractionated adjuvant radiotherapy for early-stage breast cancer with volumetric modulated arc therapy and simultaneous integrated boost "
<p>This record contains raw data related to article “Long term results of a phase II trial of hypofractionated adjuvant radiotherapy for early-stage breast cancer with volumetric modulated arc therapy and simultaneous integrated boost"</p> <p><strong>Purpose: </strong> to report toxicity and cosmetic outcome with a median follow-up of 6 years of a phase II trial of hypofractionated radiotherapy with volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) for early-stage breast cancer after conservative surgery.</p> <p><strong>Materials and methods: </strong> From August 2010 to September 2014, patients requiring adjuvant radiotherapy for early-stage breast cancer were treated according to a phase I-II protocol with SIB to 40.5 and 48 Gy to the breast and the boost region, respectively, with VMAT technique. The primary endpoint evaluated the treatment feasibility regarding adherence to required dose constraints for target, heart and lungs. Acute and late toxicity, local and distant control were secondary endpoints.</p> <p><strong>Results: </strong> 450 patients were included in the trial and analysed after a median follow-up of 6 years. Acute toxicity was already presented in a previous paper. Regarding late toxicity, 93% of patients had no skin alteration at five years, while 5.3% and 1.3% did record G1 and G2 residual toxicity, respectively. Cosmetic outcome was scored good or excellent in almost all cases (97.2%), fair only in 2.3% of patients. Residual tenderness in the irradiated breast was reported by 10% of patients. Cosmesis and breast pain improved during follow-up. Two cases of G2 pneumonitis and two cases of ischemic cardiopathy were registered during follow-up. Five cases presented local recurrence in the homolateral breast, four patients had a new primary cancer in the contralateral breast, while distant metastasis developed in 7 patients.</p> <p><strong>Conclusion: </strong> After more than six years, hypofractionated VMAT with SIB for adjuvant radiotherapy in early-stage breast cancer patients remains a safe and effective approach. Mature data on skin toxicity and cosmetic outcome are encouraging. However, longer follow-up is required to evaluate local control, cardiac toxicity and secondary carcinogenesis.</p>
Dataset related to article "Critical appraisal of the potential role of intensity modulated proton therapy in the hypofractionated treatment of advanced hepatocellular carcinoma"
<p>This record contains raw data related to article "Critical appraisal of the potential role of intensity modulated proton therapy in the hypofractionated treatment of advanced hepatocellular carcinoma"</p> <p>PURPOSE:</p> <p>To investigate the role of intensity modulated proton therapy (IMPT) for advanced hepatocellular carcinoma in comparison with volumetric modulated arc therapy (VMAT).</p> <p>METHODS:</p> <p>An in-silico planning study was performed on 20 patients. The prescription dose was 60Gy in 6 fractions. Patients were planned with abdominal compression. IMPT plans were optimized with or without the inclusion of CT calibration (3%) and isocenter positioning (2,4,6mm) uncertainties. Plan robustness was appraised comparing rubust optimized plans vs standard plans and also in terms of the worst-case scenario. VMAT plans were optimized for 10FFF photon beams using 2 partial arcs.</p> <p>RESULTS:</p> <p>Target coverage was fully achieved by both VMAT and IMPT plans with a significant improvement in homogeneity (~25%) with IMPT. Integral dose was reduced of ~60% with IMPT while the conformality of the dose distributions was similar among techniques. The sparing of the organs at risk was strongly improved with IMPT although all clinical objectives were met for both techniques. The inclusion of the uncertainties in the optimization lead to some deterioration in the target dose homogeneity (from 40 to 80% worse with 4 or 6mm position uncertainty) while none of the coverage parameters or OAR objective was violated. The worst-case scenario analysis demonstrated the risk of a major target underdosage only in the case of the most extreme errors (6mm) with D98% in average ~12% lower than the threshold.</p> <p>CONCLUSION:</p> <p>IMPT with the support of abdominal compression, can be considered a viable solution also for advanced hepatocellular carcinoma patients. Great care shall be put in the minimization of the residual respiration and positioning uncertainties but the dosimetric advantage for organs at risk and the relative robustness on target coverage are promising factors.</p> <p> </p>
Dataset related to article "Hypofractionated volumetric modulated arc therapy in ductal carcinoma in situ Toxicity and cosmetic outcome from a prospective series"
<p>This record contains raw data related to article "Hypofractionated volumetric modulated arc therapy in ductal carcinoma in situ Toxicity and cosmetic outcome from a prospective series"</p> <p>O</p> <p>BJECTIVE:</p> <p>Hypofractionated radiotherapy in early stage breast cancer is an effective adjuvant treatment, but there is a lack of randomized data for patients with ductal carcinoma in situ (DCIS). The aim of this study is the evaluation of skin toxicity and cosmesis, and early clinical outcome of DCIS patients enrolled in an institutional Phase II trial of hypofractionated breast irradiation.</p> <p>METHODS:</p> <p>137 DCIS patients were enrolled in the trial. All patients underwent volumetric modulated arc therapy (VMAT) to the whole breast with a total dose of 40.5 Gy in 15 fractions over 3 weeks, without tumour bed boost. Acute and late skin toxicities were recorded. Cosmetic outcomes were assessed as excellent/good or fair/poor. Early clinical outcome was reported.</p> <p>RESULTS:</p> <p>Median age was 58 y.o. (range 30-86). The median follow-up time was 22 months (range 6-45). At the end of the radiotherapy, skin toxicity was grade G1 in 56% of the patients, G2 in 15%, no patients presented G3 toxicity. In the range of 3-9 months of follow-up, the skin toxicity was G1 in 28% of patients, no G2-G3 cases; cosmetic outcome was good/excellent in 95% of patients. In the follow-up interval of 9-24 months, the skin toxicity was G1 in 12% of patients, no G2-G3 toxicity; cosmetic outcome was good/excellent in 96% of patients. After an early evaluation of clinical outcomes, 5 patients (3.6%) presented an in-breast recurrence.</p> <p>CONCLUSION:</p> <p>Hypofractionated radiotherapy using VMAT is a viable option for DCIS. A longer follow-up is needed to assess clinical outcomes and late toxicity. Advances in knowledge: The use of hypofractionated VMAT is dosimetrically feasible for treating breast DCIS.</p> <p> </p>
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