Impact of Adaptive Radiotherapy on Locally Advanced Head and Neck Cancer - A Dosimetric and Volumetric Study
Abhinav DewanSuresh K. SharmaAK. DewanHimanshu SrivastavaSheh RawatAnjali KakriaManinder MishraT M SureshKrati Mehrotra
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Objective of the study is to evaluate volumetric and dosimetric alterations taking place during radiotherapy for locally advanced head and neck cancer (LAHNC) and to assess benefit of replanning in them. Materials and Methods: Thirty patients with LAHNC fulfilling the inclusion and exclusion criteria were enrolled in a prospective study. Planning scans were acquired both pre-treatment and after 20 fractions (mid-course) of radiotherapy. Single plan (OPLAN) based on initial CT scan was generated and executed for entire treatment course. Beam configuration of OPLAN was applied to anatomy of interim scan and a hybrid plan (HPLAN30) was generated. Adaptive replanning (RPLAN30) for remaining fractions was done and dose distribution with and without replanning compared for remaining fractions. Results: Substantial shrinkage of target volume (TV) and parotids after 4 weeks of radiotherapy was reported (p<0.05). No significant difference between planned and delivered doses was seen for remaining fractions. Hybrid plans showed increase in delivered dose to spinal cord and parotids for remaining fractions. Interim replanning improved homogeneity of treatment plan and significantly reduced doses to cord (Dmax, D2% and D1%) and ipsilateral parotid (D33%, D50% and D66%) (p<0.05). Conclusions: Use of one or two mid-treatment CT scans and replanning provides greater normal tissue sparing along with improved TV coverage.Cite
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Objective:To study on whether radiotherapy affects on T cell subgroups,and to research on the effects of immunoenhancing agents on the immune side effects of radiotherapy.Methods:Sixty-six malignant tumour patients were divided into two groups,radiotherapy alone and radiotherpay plus immunoinhancing agents therapy groups.All patients were subjected to high energy X-rays and electronic rays outer local reginal therapy.T cell subgroups levels were measured before and after the radiotherapy.Results:CD 3,CD 4 and CD 8 decreased significantly after radiotherapy (P0.05) in radiotherapy alone group.There were no differences in CD 3,CD 4 and CD 8 before and after radiotherapy in the group of radiotherapy plus immunoinhancing agents therapy.Conclusions:Radiotherapy may cause the decrease in T cells of all subgroups and immunoinhancing agents may antagonize the side effects of radiotherapy. [
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This chapter contains sections titled: Introduction The great debate: surgery versus radiotherapy Surgery plus adjuvant radiotherapy How does radiotherapy work? Methods of radiotherapy administration Radiotherapy simulation and planning Radiotherapy treatment factors Optimising radiotherapy treatment Treatment-related toxicities Acute radiotherapy toxicities Late radiotherapy toxicities Second malignancies Radiotherapy and quality of life Conclusion Frequently asked questions Resources References
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Radiotherapy is useful in the palliative treatment of many large incurable tumours. This study evaluates the effectiveness of computed tomography (CT) as an adjunct in the radiotherapy planning of these patients. Forty-five patients had their treatment fields simulated using findings from physical examination, x-rays etc. The patients were then scanned under conditions simulating the radiotherapy and the dosimetry was recalculated. CT scanning was found to be valuable in the radiotherapy planning in 56% of the treatment series (field geometry: 27% dosimetry: 46%).
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Objective To analyze the effects between three different therapy materials for non-small cell lung cancer(NSCLC).Methods 327 patients who suffered from NSCLC were treated by radiotherapy alone,radiotherapy after operation,and chemotherapy combined with radiotherapy.Results The 3-and 5-year survival rates of radiotherapy after operation were higher than radiotherapy alone and chemotherapy combined radiotherapy groups; radiotherapy alone higher than chemotherapy combined radiotherapy groups.Conclusions There was on relationship between the survival rate and the pathological classification,but there was a close relationship between the clinical stage and the selecting therapy in survival rate.
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To analyze the effects of radiotherapy and its timing on the survival and safety of patients with newly diagnosed distant metastatic NPC in non-high-incidence areas.We retrospectively analyzed 94 newly diagnosed NPC patients with distant metastatic admitted to our hospital from January 2011 to June 2018. They were divided into three groups: no radiotherapy group received chemotherapy alone, early radiotherapy group was combined with radiotherapy during 1 to 3 cycles of chemotherapy, and late radiotherapy group was combined with radiotherapy after 4-6 cycles of chemotherapy were effective. The efficacy and side effects of the three groups were compared, and the prognostic factors were analyzed.The 6-month, 1-year and 2-year PFS were 53.6%, 14.3% and 3.6% in no radiotherapy group, 71.0%, 38.7% and 19.4% in early radiotherapy group, 88.6%, 48.6% and 22.9% in late radiotherapy group; the radiotherapy groups were better than the no radiotherapy group, and the difference was statistically significant (P < 0.017). The 1-year, 2-year and 3-year OS were 75.0%, 32.1% and 0 in no radiotherapy group, 77.4%, 54.8% and 12.9% in early radiotherapy group, 85.7%, 71.4% and 31.4% in late radiotherapy group; the radiotherapy groups were better than the no radiotherapy group, and the differences were statistically significant (P < 0.017). There was no significant difference in OS and PFS between the two radiotherapy groups. Univariate and multivariate analysis showed that HBV (P = 0.031), number of metastases (P = 0.002), liver metastases (P = 0.038), radiotherapy (P < 0.001) and treatment response (P = 0.011) were related to OS. There was no significant difference in the incidence of adverse events (P > 0.017).Early and late combined radiotherapy had similar clinical efficacy and both prolonged PFS and OS for patients with newly diagnosed distant metastatic NPC in non-high-risk areas. If chemotherapy response is expected to be poor, radiotherapy can be received early.
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Objective: To compare efficacy of chemo radiotherapy and single radiotherapy treatment on advanced cervical cancer and its side effects.Methods: A total of 46 cervical cancer cases at II b-IV stage confirmed by pathological analysis were selected and randomly divided into chemo radiotherapy group and radiotherapy group by half.The method and dosage of radiotherapy were the same in two groups.And patients in chemo radiotherapy group also had cisplatin combination chemotherapy for 3 times.every four weeks.Short-term,long-term treatment effects and side effects were observed and compared.Results:The short-term efficacy of chemo radiotherapy group was 95.23%(22/23),significantly higher than 69.20%(16/23) of the radiotherapy alone group(P0.05);3 and 5-year survival rates of chemo radiotherapy group were 86.96% and 65.22%,significant higher than that of the radiotherapy alone group(60.87% and 43.48%)(P0.05);toxicity and radiation adverse reactions of of the radiotherapy alone group was significantly higher than the radiotherapy alone group(P0.05),but after treatment they were tolerable.Conclusions: Synchronous radiochemical therapy have better clinical efficacy than that with radiotherapy alone in treatment of advanced cervical cancer,although with higher toxicity and side effect.But after treatment it can be tolerated,and does not affect the efficacy.
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