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Huma C, Hawon L, Sarisha J, Erdal T, Kevin C, Valentina KA. Advances in the field of developing biomarkers for re-irradiation: a how-to guide to small, powerful data sets and artificial intelligence. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2024; 9:3-16. [PMID: 38550554 PMCID: PMC10972602 DOI: 10.1080/23808993.2024.2325936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
Introduction Patient selection remains challenging as the clinical use of re-irradiation (re-RT) increases. Re-RT data is limited to retrospective studies and small prospective single-institution reports, resulting in small, heterogenous data sets. Validated prognostic and predictive biomarkers are derived from large-volume studies with long-term follow-up. This review aims to examine existing re-RT publications and available data sets and discuss strategies using artificial intelligence (AI) to approach small data sets to optimize the use of re-RT data. Methods Re-RT publications were identified where associated public data was present. The existing literature on small data sets to identify biomarkers was also explored. Results Publications with associated public data were identified, with glioma and nasopharyngeal cancers emerging as the most common tumor sites where the use of re-RT was the primary management approach. Existing and emerging AI strategies have been used to approach small data sets including data generation, augmentation, discovery, and transfer learning. Conclusions Further data is needed to generate adaptive frameworks, improve the collection of specimens for molecular analysis, and improve the interpretability of results in re-RT data.
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Affiliation(s)
- Chaudhry Huma
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Lee Hawon
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Jagasia Sarisha
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Tasci Erdal
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Camphausen Kevin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Krauze Andra Valentina
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
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Couñago F, de la Pinta C, Gonzalo S, Fernández C, Almendros P, Calvo P, Taboada B, Gómez-Caamaño A, Guerra JLL, Chust M, González Ferreira JA, Álvarez González A, Casas F. GOECP/SEOR radiotherapy guidelines for small-cell lung cancer. World J Clin Oncol 2021; 12:115-143. [PMID: 33767969 PMCID: PMC7968106 DOI: 10.5306/wjco.v12.i3.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients. The 5-year OS rate in patients with limited-stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive-stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally, we discuss the main indications for reirradiation in local recurrence.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Madrid, Spain
| | - Carolina de la Pinta
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Susana Gonzalo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Castalia Fernández
- Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
| | - Piedad Almendros
- Department of Radiation Oncology, Hospital General Universitario, Valencia 46014, Spain
| | - Patricia Calvo
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Begoña Taboada
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - José Luis López Guerra
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
| | - Marisa Chust
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | | | | | - Francesc Casas
- Department of Radiation Oncology, Thoracic Unit, Hospital Clinic, Barcelona 08036, Spain
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In-field stereotactic body radiotherapy (SBRT) reirradiation for pulmonary malignancies as a multicentre analysis of the German Society of Radiation Oncology (DEGRO). Sci Rep 2021; 11:4590. [PMID: 33633130 PMCID: PMC7907095 DOI: 10.1038/s41598-021-83210-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/29/2021] [Indexed: 12/25/2022] Open
Abstract
Data of thoracic in-field reirradiation with two courses of stereotactic body radiotherapy (SBRT) is scarce. Aim of this study is to investigate feasibility and safety of this approach. Patients with a second course of thoracic SBRT and planning target volume (PTV) overlap were analyzed in this retrospective, multicenter study. All plans and clinical data were centrally collected. 27 patients from 8 centers have been amenable for evaluation: 12 with non-small-cell lung cancer, 16 with metastases, treated from 2009 (oldest first course) to 2020 (latest second course). A median dose of 38.5 Gy to the 65%-isodose over a median of 5 fractions was prescribed in the first course and 40 Gy in 5 fractions for the second SBRT-course. Median PTV of the second SBRT was 29.5 cm3, median PTV overlap 22 cm3. With a median interval of 20.2 months between the two SBRT-courses, 1-year OS, and -LCR were 78.3% and 70.3% respectively. 3 patients developed grade 1 and one grade 2 pneumonitis. No grade > 2 toxicity was observed. Peripheral location and dose were the only factors correlating with tumor control. A second SBRT-course with PTV overlap appears safe and achieves reasonable local control.
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Schlampp I, Rieber J, Adeberg S, Bozorgmehr F, Heußel CP, Steins M, Kappes J, Hoffmann H, Welzel T, Debus J, Rieken S. Re-irradiation in locally recurrent lung cancer patients. Strahlenther Onkol 2019; 195:725-733. [PMID: 30937509 DOI: 10.1007/s00066-019-01457-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 03/14/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Lung cancer remains one of the tumour diagnoses with high lethality, although innovative treatment approaches have yielded improvements in local control and survival rates. There is still no consensus on how to treat local relapse in patients after first-line treatments. Radiotherapy may be considered in this situation; however, data supporting its effectiveness are rare. The purpose of this retrospective analysis was to evaluate outcomes of patients re-irradiated for thoracic tumours in terms of overall survival (OS), local progression-free survival (LPFS), toxicity and dose-volume parameters. PATIENTS AND METHODS Sixty-two patients with locally recurrent previously irradiated lung cancer were analysed retrospectively (NSCLC n = 52, SCLC n = 10). Target volumes both in lung and mediastinum were re-irradiated with conventional three-dimensional or intensity-modulated radiotherapy techniques. Median overall dose of re-irradiation was 38.5 Gy (range 20-60 Gy) with a median single dose per fraction of 2 Gy (1.8-3.0 Gy). Clinical documents and treatment plans were evaluated. RESULTS Median follow-up was 8.2 months (range 0-27 months). OS following re-irradiation was 9.3 months (range: 0-27 months) and LPFS was 6.5 months (range: 0-24 months). OS and LPFS were not affected by histology, total dose or patient age and gender. OS was improved in patients whose re-irradiation volumes included less than two mediastinal lymph node stations (p = 0.016). Twelve patients suffered from pneumonitis ≥grade II (19%) and two from pneumonitis grade III. One patient presumably died from pneumonitis grade V. A slight decline in forced expiratory volume (FEV1) was detected in post-re-irradiation lung function testing. CONCLUSIONS Re-irradiation is an option for patients with tumour recurrence to control local progression and lower the symptom burden. Oncological outcome appears to be affected by size, location of mediastinal target volumes and lung function. Prospective clinical trials are warranted to substantiate the role of re-irradiation in recurrent lung cancer.
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Affiliation(s)
- Ingmar Schlampp
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,HIRO - Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,National Center for Tumor diseases (NCT), Heidelberg, Germany.
| | - Juliane Rieber
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,HIRO - Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Sebastian Adeberg
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,HIRO - Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxlinik, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Claus Peter Heußel
- Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany.,Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Martin Steins
- Department of Thoracic Oncology, Thoraxlinik, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Jutta Kappes
- Department of Thoracic Oncology, Thoraxlinik, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Hans Hoffmann
- Dept. of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Thomas Welzel
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,HIRO - Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,HIRO - Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Stefan Rieken
- University Hospital of Heidelberg, Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,HIRO - Heidelberger Institut für RadioOnkologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
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Nieder C, Langendijk JA, Guckenberger M, Grosu AL. Preserving the legacy of reirradiation: A narrative review of historical publications. Adv Radiat Oncol 2017; 2:176-182. [PMID: 28740929 PMCID: PMC5514242 DOI: 10.1016/j.adro.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 12/09/2022] Open
Abstract
PURPOSE The purpose of this study is to illustrate the historical development of reirradiation during several decades of the 20th century, in particular between 1920 and 1960. METHODS AND MATERIALS We chose the format of a narrative review because the historical articles are heterogeneous. No systematic extraction of baseline data, treatment details, or follow-up care was possible in many cases. RESULTS Both hematological malignancies and solid tumors were treated with a second course of radiation therapy, and indications included local relapse, regional nodal recurrence, and second primary tumors developing in a previously treated region. The literature consists of retrospective single-institution analyses describing treatment approaches that included external beam radiation therapy, brachytherapy, or combinations thereof. Data on toxicities and survival were often provided. Breast cancer and gynecological, head and neck, brain, and skin tumors are among the entities included in this review. CONCLUSIONS The leading pioneers in the field are fully aware of many of the challenges we continue to debate today. These include the process of late tissue changes and development of personalized treatment approaches and better ways to select patients who are likely to benefit from a second course of radiation therapy.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
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Aktan M, Kanyilmaz G, Koc M, Aras S. Thoracic Re-irradiation for Locally Recurrent Lung Cancer. Asian Pac J Cancer Prev 2016; 17:5041-5045. [PMID: 28032737 PMCID: PMC5454717 DOI: 10.22034/apjcp.2016.17.11.5041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Patients with recurrent or progressive lung cancer experience a significant symptom burden, negatively
affecting quality of life and reducing life expectancy. Thoracic re-irradiation can be used for palliative treatment to
relieve symptoms or as a curative treatment. Methods: Using patient charts, we identified and reviewed 28 cases that
had received palliative thoracic re-irradiation for recurrent lung cancer. Results: Before re-irradiation, 32% of patients
had stage III non-small cell lung cancer and six had small cell lung cancer. The median interval between treatments was
18.7 months. Median follow-up was 31.2 months from the initial radiotherapy and 5 months after re-irradiation. A better
performance status before re-irradiation (<80 vs >80, p=0.09) and a lower overlap 90% isodose (<70 vs >70, p=0.09)
showed trends toward improved survival. Grade 1-2 toxicity from re-irradiation was recorded in 12/28 patients, and no
grade 3 or 4 acute toxicity was encountered. Conclusion: The role of palliative treatment in survival is not clear but it
can provide symptomatic relief in patients, with no high grade toxicity. Further studies with greater patient numbers and
longer follow-up times should facilitate determination of the role of this treatment in toxicity and effects on survival.
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7
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Sumita K, Harada H, Asakura H, Ogawa H, Onoe T, Murayama S, Nakamura S, Tanigawa N, Takahashi T, Nishimura T. Re-irradiation for locoregionally recurrent tumors of the thorax: a single-institution, retrospective study. Radiat Oncol 2016; 11:104. [PMID: 27485533 PMCID: PMC4971641 DOI: 10.1186/s13014-016-0673-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Re-irradiation (re-RT) of the thorax is challenging due to the impact of prior therapies on normal tissues, and there are few reports of definitive re-RT. The treatment toxicities and efficacy of re-RT are not well known. The aim of the present study was to assess the safety and efficacy of definitive re-RT of the thorax. METHODS Patients who were treated with thoracic re-RT between March 2007 and December 2014 were retrospectively analyzed. Primary and re-irradiation plans were required to have an overlap of dose distributions for the 80 % isodose level. All doses were recalculated to an equivalent dose of 2 Gy per fraction (EQD2). When possible, analysis of dose accumulation was carried out using the medical image merge (MIM) (®) software program (version 6.5, MIM Software Inc., Cleveland, OH). Administration dosages for organs at risk were defined. RESULTS Fourteen (67 %) and seven (33 %) patients with non-small cell carcinoma (NSCLC) and small cell carcinoma (SCLC), respectively, were identified. The patients' median age was 72 (range 53-85) years. Fifteen patients (71 %) had "proximal" tumors, defined as tumors at the distal 2 cm of the trachea, carina, and main bronchi. The median interval from initial RT to re-RT was 26.8 (range 11.4-92.3) months. Re-RT was delivered by X-ray beam and proton beam therapy in 20 (95 %) patients and 1 (5 %) patient, respectively. The median radiation dose of re-RT was 60 (range 54-87.5) Gy10 and 50 (range 50.0-87.5) Gy10 for patients with NSCLC and SCLC, respectively. Grade 3 acute radiation pneumonitis occurred in only one patient. There were no other serious complications. The median follow-up time was 22.1 (range 2.3-56.4) months. The median local progression-free survival time (LPFS) and overall survival time (OS) were 12.9 (95 % confidence interval (CI): 8.9-27.9) months and 31.4 (95 % CI: 16.9-45.9) months, respectively. Patients receiving ≥ 60 Gy10 at re-RT had longer LPFS (p = 0.04). CONCLUSIONS Good safety with longer OS than in previous reports was demonstrated. Re-RT seems to be a promising treatment option. Further study to define the risk-benefit ratios is necessary.
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Affiliation(s)
- Kiyomi Sumita
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. .,Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010, Japan.
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirofumi Asakura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirofumi Ogawa
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tsuyoshi Onoe
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shigeyuki Murayama
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakatashi, Osaka, 573-1010, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tetsuo Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Ota T, Suzumura T, Sugiura T, Hasegawa Y, Yonesaka K, Makihara M, Tsukuda H, Tada T, Fukuoka M. Spontaneous pneumothorax due to bronchopleural fistula following reirradiation for locoregionally recurrent squamous cell lung cancer. Clin Case Rep 2016; 4:481-5. [PMID: 27190612 PMCID: PMC4856241 DOI: 10.1002/ccr3.547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/21/2016] [Accepted: 03/08/2016] [Indexed: 12/04/2022] Open
Abstract
Spontaneous pneumothorax following radiotherapy for pulmonary malignancy is an unusual clinical condition. Here, we report a case of a 78‐year‐old male suffering from dyspnea during radiotherapy for squamous cell lung cancer of the right main bronchus. Imaging studies and fiberoptic bronchoscopy revealed that pneumothorax was due to a bronchopleural fistula.
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Affiliation(s)
- Takayo Ota
- Department of Medical Oncology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Tomohiro Suzumura
- Department of Medical Oncology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Takamune Sugiura
- Department of Medical Oncology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Yoshikazu Hasegawa
- Department of Medical Oncology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Kimio Yonesaka
- Department of Medical Oncology Sakai Hospital Kinki University Faculty of Medicine Sakai Osaka 590-0132 Japan
| | - Masaru Makihara
- Department of Radiology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Hiroshi Tsukuda
- Department of Medical Oncology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Takuhito Tada
- Department of Radiology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
| | - Masahiro Fukuoka
- Department of Medical Oncology Izumi Municipal Hospital Izumi Osaka 594-0071 Japan
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Logie N, Drodge CS, Boychak O, Fairchild A. Evolving role of salvage reirradiation: Is global harmonization required before treatment guidelines can be developed? World J Meta-Anal 2015; 3:133-138. [DOI: 10.13105/wjma.v3.i3.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/31/2015] [Accepted: 04/20/2015] [Indexed: 02/05/2023] Open
Abstract
Up to 90% of patients initially treated with curative-intent radiotherapy (RT) will experience locoregional failure. Historically, reirradiation (ReRT) was offered purely with palliative intent, if considered at all, due to concerns surrounding toxicity, tolerance of normal tissues, and choice of appropriate dose schedule. With technological advancements in RT delivery, coupled with longer survival in many malignancies secondary to improvements in systemic therapy, a small subset of patients presenting with localized recurrence is increasingly being offered salvage ReRT. However, this is largely on an ad hoc basis, guided mainly by small retrospective, single-institution reports. The patient population retreated, RT modality, dose received, degree of attrition and follow-up are extremely variable. The opportunity presently exists to apply lessons learned from the harmonization of the research efforts within the bone metastases community to the salvage ReRT situation: the adoption of common endpoints, minimum features to be incorporated into clinical trial design, and methods of data analysis and reporting. The ReRT data available must be harmonized so that valid, clinically applicable conclusions can be drawn. Collaboration in the form of an international registry of prospectively collected outcomes of patients reirradiated for cure for a variety of tumour sites would further support the evolution of Radiation Oncology towards personalized medicine, and away from the current “one-dose-fits-all” approach.
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