- Email: [email protected]
Comparison of four-week accelerated hypofractionated chemo intensity-modulated radiotherapy (IMRT) versus less accelerated schedules in oropharyngeal carcinoma
Clinical Oncology (2017) e203ee205 Contents lists available at ScienceDirect
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Comparison of four-week accelerated hypofractionated chemo intensity-modulated radiotherapy (IMRT) versus less accelerated schedules in oropharyngeal carcinoma
Ian S. Boon, Cheng S. Boon, Peter Nightingale, Jason Cashmore, Gurnaik Sangha, Mitchell Hickman, Helen Benghiat, Charles Fong, Paul Sanghera, Andrew Hartley Purpose: We compared efficacy outcomes at a minimum follow-up of two years in two historic cohorts of locally advanced oropharyngeal carcinoma patients treated with four-week (20#) or 5e7 week (25e35#) schedule in a single institution. Methods and materials: Between June 2009 and May 2012 (four-week cohort), patients undergoing chemo IMRT were treated with 55 Gray (Gy)/ 20# over 25 days, with synchronous carboplatin. From June 2012 to April 2014 (>four week cohort), patients were treated with either (a) 64 Gy/25# over 32 days, (b) 65 Gy/30# over 39 days, or (c) 70 Gy/35# over 46 days, with synchronous cisplatin or carboplatin. Overall survival, local control, distant control, and freedom from recurrence at two years were calculated. The effect of age, T-stage, N-stage, p16 status, smoking status, synchronous chemotherapy agent, use of neoadjuvant chemotherapy, and radiotherapy schedule (four-week vs. >four week) on outcome was analysed. Results: 131 patients with non-metastatic oropharyngeal carcinoma received radical IMRT with concurrent platinum (four-week, n¼70; >4 week, n¼61). T stage was found to have a statistically significant effect on overall survival (p¼0.02) and local control (p¼0.04). p16 status was statistically significantly associated to overall survival (p¼0.002). At two years, local control (p¼0.256), freedom from recurrence (p¼0.192), and overall survival (p¼0.511) were not statistically different between the four-week and >four week cohorts. Conclusion: Survival and disease control were comparable in oropharyngeal carcinoma patients treated with four- week or >four week hypofractionation schedules. Accelerated hypofractionated schedules for radical chemoIMRT in oropharyngeal carcinoma need prospective evaluation. Non-coplanar VMAT treatment for glioblastoma patients; initial experience from Aberdeen Royal Infirmary
Fay Tough, Rafael Moleron, Kirsten Russell, Lizzie Findlay Purpose: Over recent years radiotherapy for glioblastomas has been shifting from traditional 3D conformal techniques to using volumetric arc therapy (VMAT) using complete arcs to obtain optimum dose distribution to the planning target volume (PTV) while reducing doses to the organs at risk. In 2015 at Aberdeen Royal Infirmary we developed a VMAT technique using noncoplanar partial arcs, the objective being to optimise PTV coverage and dose conformity, while sparing surrounding organs at risk (OARs) and reducing overall dose to normal brain tissue. This study looks at the outcomes of all glioblastoma patients treated in a two-year period using this technique. Methods and materials: All patients with glioblastoma World Health Organization (WHO) grade IV, treated between January 2015 to January 2017 with 60 Gray (Gy) in 30 fractions and concurrent temozolamide followed by adjuvant temozolamide were identified from our local planning database. Treatment was delivered through a VMAT technique with two coplanar half arcs and one or two non-coplanar half arcs delivered with the couch at 90 .
Results: We treated 21 patients in this time period. Eight (38.1%) were female and 13 (61.9%) male. Median age was 50.3 years with a range from 26e73. 11 (52.4%) of these patients were MGMT mutated. Nine patients had >90% surgical resection (reported on postop magnetic resonance imaging [MRI]), three had 50e89%, four had <50% resection, three had biopsies and in two cases resection was not reported. Progression free survival in this population was 11 months with an overall survival of 16 months. Conclusion: On review of this cohort of patients treated with partial arc/non coplanar arc VMAT technique, our outcomes in terms of overall and progression free survival are similar to those seen in the literature.
Trifluridine/tipiracil (LonsurfÒ) use in metastatic colorectal cancer: efficacy outcome and toxicity in a single UK centre
Ian S. Boon, Helen Joyce, Adnan Kabir, Max Goodman, Victoria Brown, Rajarshi Roy, Lorcan O’Toole, Amandeep S. Dhadda Purpose: The National Institute for Health and Care Excellence (NICE) approved LonsurfÒ as a third-line palliative option in metastatic colorectal cancer in August 2016. The RECOURSE trial (Mayer et al) reported a superior median survival of 7.1 months versus 5.3 months in placebo. We performed a retrospective analysis to ascertain real-world efficacy outcomes and toxicity data. Methods and materials: All patients on LonsurfÒ were identified from a local database. Retrospective analysis of patient medical records, pathology results and radiological imaging was performed. Results: Twelve patients were treated with LonsurfÒ with a median age of 58 (29e77) years. Five patients are still undergoing treatment, five stopped due to progression and two had treatment interrupted. The demographics of the patients are shown in Table 1. Median World Health Organization (WHO) Performance status was 0. The overall response rate was 0% (9/9) with all patients progressing on treatment at the time of their first assessment imaging. Kaplan Meier estimate of median progression free survival was 2.0 months (95% confidence interval [CI] 1.6e2.4) and mean overall survival was 4.5 months (95% CI 3.1e5.8). Median survival was not reached due to short follow-up but by four months, 45% of patients had died. Toxicity data using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0 showed 58% (7/12) had no toxicities; lethargy in 8% (1/12); neutropenia in 17% (2/12); nausea 8%(1/12) and deranged liver functions test in 8% (1/12). Conclusion: In our cohort of patients, although confounded by short followup; response and clinical benefit rate was 0% and mean survival was 4.5 months on LonsurfÒ. This requires clarification with further follow-up and extended numbers but the benefit of LonsurfÒ in the real world setting would appear to be very modest.
Initial outcome and toxicity of stereotactic ablative body radiotherapy (SABR) for early stage lung cancer in a single UK centre
Ian S. Boon, Jenny E. Marsden, Nilesh S. Tambe, Andrzej Wieczorek, Nabil El-Mahdawi
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Comparison of four-week accelerated hypofractionated chemo intensity-modulated radiotherapy (IMRT) versus less accelerated schedules in oropharyngeal carcinoma
Ian S. Boon, Cheng S. Boon, Peter Nightingale, Jason Cashmore, Gurnaik Sangha, Mitchell Hickman, Helen Benghiat, Charles Fong, Paul Sanghera, Andrew Hartley Purpose: We compared efficacy outcomes at a minimum follow-up of two years in two historic cohorts of locally advanced oropharyngeal carcinoma patients treated with four-week (20#) or 5e7 week (25e35#) schedule in a single institution. Methods and materials: Between June 2009 and May 2012 (four-week cohort), patients undergoing chemo IMRT were treated with 55 Gray (Gy)/ 20# over 25 days, with synchronous carboplatin. From June 2012 to April 2014 (>four week cohort), patients were treated with either (a) 64 Gy/25# over 32 days, (b) 65 Gy/30# over 39 days, or (c) 70 Gy/35# over 46 days, with synchronous cisplatin or carboplatin. Overall survival, local control, distant control, and freedom from recurrence at two years were calculated. The effect of age, T-stage, N-stage, p16 status, smoking status, synchronous chemotherapy agent, use of neoadjuvant chemotherapy, and radiotherapy schedule (four-week vs. >four week) on outcome was analysed. Results: 131 patients with non-metastatic oropharyngeal carcinoma received radical IMRT with concurrent platinum (four-week, n¼70; >4 week, n¼61). T stage was found to have a statistically significant effect on overall survival (p¼0.02) and local control (p¼0.04). p16 status was statistically significantly associated to overall survival (p¼0.002). At two years, local control (p¼0.256), freedom from recurrence (p¼0.192), and overall survival (p¼0.511) were not statistically different between the four-week and >four week cohorts. Conclusion: Survival and disease control were comparable in oropharyngeal carcinoma patients treated with four- week or >four week hypofractionation schedules. Accelerated hypofractionated schedules for radical chemoIMRT in oropharyngeal carcinoma need prospective evaluation. Non-coplanar VMAT treatment for glioblastoma patients; initial experience from Aberdeen Royal Infirmary
Fay Tough, Rafael Moleron, Kirsten Russell, Lizzie Findlay Purpose: Over recent years radiotherapy for glioblastomas has been shifting from traditional 3D conformal techniques to using volumetric arc therapy (VMAT) using complete arcs to obtain optimum dose distribution to the planning target volume (PTV) while reducing doses to the organs at risk. In 2015 at Aberdeen Royal Infirmary we developed a VMAT technique using noncoplanar partial arcs, the objective being to optimise PTV coverage and dose conformity, while sparing surrounding organs at risk (OARs) and reducing overall dose to normal brain tissue. This study looks at the outcomes of all glioblastoma patients treated in a two-year period using this technique. Methods and materials: All patients with glioblastoma World Health Organization (WHO) grade IV, treated between January 2015 to January 2017 with 60 Gray (Gy) in 30 fractions and concurrent temozolamide followed by adjuvant temozolamide were identified from our local planning database. Treatment was delivered through a VMAT technique with two coplanar half arcs and one or two non-coplanar half arcs delivered with the couch at 90 .
Results: We treated 21 patients in this time period. Eight (38.1%) were female and 13 (61.9%) male. Median age was 50.3 years with a range from 26e73. 11 (52.4%) of these patients were MGMT mutated. Nine patients had >90% surgical resection (reported on postop magnetic resonance imaging [MRI]), three had 50e89%, four had <50% resection, three had biopsies and in two cases resection was not reported. Progression free survival in this population was 11 months with an overall survival of 16 months. Conclusion: On review of this cohort of patients treated with partial arc/non coplanar arc VMAT technique, our outcomes in terms of overall and progression free survival are similar to those seen in the literature.
Trifluridine/tipiracil (LonsurfÒ) use in metastatic colorectal cancer: efficacy outcome and toxicity in a single UK centre
Ian S. Boon, Helen Joyce, Adnan Kabir, Max Goodman, Victoria Brown, Rajarshi Roy, Lorcan O’Toole, Amandeep S. Dhadda Purpose: The National Institute for Health and Care Excellence (NICE) approved LonsurfÒ as a third-line palliative option in metastatic colorectal cancer in August 2016. The RECOURSE trial (Mayer et al) reported a superior median survival of 7.1 months versus 5.3 months in placebo. We performed a retrospective analysis to ascertain real-world efficacy outcomes and toxicity data. Methods and materials: All patients on LonsurfÒ were identified from a local database. Retrospective analysis of patient medical records, pathology results and radiological imaging was performed. Results: Twelve patients were treated with LonsurfÒ with a median age of 58 (29e77) years. Five patients are still undergoing treatment, five stopped due to progression and two had treatment interrupted. The demographics of the patients are shown in Table 1. Median World Health Organization (WHO) Performance status was 0. The overall response rate was 0% (9/9) with all patients progressing on treatment at the time of their first assessment imaging. Kaplan Meier estimate of median progression free survival was 2.0 months (95% confidence interval [CI] 1.6e2.4) and mean overall survival was 4.5 months (95% CI 3.1e5.8). Median survival was not reached due to short follow-up but by four months, 45% of patients had died. Toxicity data using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0 showed 58% (7/12) had no toxicities; lethargy in 8% (1/12); neutropenia in 17% (2/12); nausea 8%(1/12) and deranged liver functions test in 8% (1/12). Conclusion: In our cohort of patients, although confounded by short followup; response and clinical benefit rate was 0% and mean survival was 4.5 months on LonsurfÒ. This requires clarification with further follow-up and extended numbers but the benefit of LonsurfÒ in the real world setting would appear to be very modest.
Initial outcome and toxicity of stereotactic ablative body radiotherapy (SABR) for early stage lung cancer in a single UK centre
Ian S. Boon, Jenny E. Marsden, Nilesh S. Tambe, Andrzej Wieczorek, Nabil El-Mahdawi