Acta oncologica
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Review Meta Analysis
Risk profile of bevacizumab in patients with non-small cell lung cancer: a meta-analysis of randomized controlled trials.
Severe adverse events (AEs) have been reported in cancer patients treated with bevacizumab. Currently, safety of bevacizumab in patients with non-small cell lung cancer (NSCLC) is not clear. We conducted a meta-analysis to evaluate the risk profile of bevacizumab in NSCLC patients. ⋯ The use of the bevacizumab increases the risk of treatment-related deaths and several grade 3 or 4 AEs in patient with NSCLC. The risk may be dose-dependent. Close monitoring and adequate management are recommended to decrease severe AEs.
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The aim of this model study was to estimate and compare the risk of radiation-induced adverse late effects in pediatric patients with medulloblastoma (MB) treated with either three-dimensional conformal radiotherapy (3D CRT), inversely-optimized arc therapy (RapidArc(®) (RA)) or spot-scanned intensity-modulated proton therapy (IMPT). The aim was also to find dose-volume toxicity parameters relevant to children undergoing RT to be used in the inverse planning of RA and IMPT, and to use in the risk estimations. ⋯ When comparing RA and 3D CRT treatment for pediatric MB it is a matter of comparing higher SC risk against higher risks of non-cancer adverse events. Considering time until onset of the different complications is necessary to fully assess patient benefit in such a comparison. The IMPT plans, including SN dose contribution, compared favorably to the photon techniques in terms of all radiobiological risk estimates.
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Comparative Study
Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer.
Traditionally, radiation therapy plans are optimized without consideration of chemotherapy. Here, we model the risk of radiation pneumonitis (RP) in the presence of a possible interaction between chemotherapy and radiation dose distribution. ⋯ The low dose bath from highly conformal photon techniques may become relevant for lung toxicity when radiation is combined with cytotoxic chemotherapy as shown here. Proton therapy allows highly conformal delivery while minimizing the low dose bath potentially interacting with chemotherapy. Thus, intensive drug-radiation combinations could be an interesting indication for selecting patients for proton therapy. It is likely that the IMRT plans would perform better if the CERD was accounted for during optimization, but more clinical data is required to facilitate evidence-based plan optimization in the multi-modality setting.
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Comparative Study
Photon and proton therapy planning comparison for malignant glioma based on CT, FDG-PET, DTI-MRI and fiber tracking.
The purpose of this study was to compare treatment plans generated using fixed beam Intensity Modulated photon Radiation Therapy (IMRT), inversely optimized arc therapy (RapidArc(R), RA) with spot-scanned Intensity Modulated Proton Therapy (IMPT) for high-grade glioma patients. Plans were compared with respect to target coverage and sparing of organs at risk (OARs), with special attention to the possibility of hippocampus sparing. ⋯ The IMPT technique produced the most conform plans. For tumors located in the one of the cerebral hemispheres, the non-coplanar RA and the IMPT techniques were able to reduce doses to the contralateral hippocampus. The IMPT technique offered the largest sparing of the brain and fiber tracts. RA techniques tended to produce more conform target doses than IMRT.
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Stereotactic body radiotherapy (SBRT) is often the preferred treatment for the advanced liver tumours which owing to tumour distribution, size and multi-focality are out of range of surgical resection or radiofrequency ablation. However, only a minority of patients with liver tumours may be candidates for conventional SBRT because of the limited radiation tolerance of normal liver, intestine and other normal tissues. Due to the favourable depth-dose characteristics of protons, intensity-modulated proton therapy (IMPT) may be a superior alternative to photon-based SBRT. The purpose of this treatment planning study was therefore to investigate the potential sparing of normal liver by IMPT compared to photon-based intensity-modulated radiotherapy (IMRT) for solitary liver tumours. ⋯ A considerable sparing of normal liver tissue can be obtained using proton-based SBRT for solitary liver tumours.