Сравнительный анализ эффективности лазерной термотерапии и криодеструкции в лечении ретинобластомы периферической локализации

Maximizing local tumor control and survival after proton beam radiotherapy of uveal melanoma

Survival in oral cavity squamous cell carcinoma (OSCC) depends heavily on locoregional control. In this study, we sought to determine the independent prognosticators for local tumor control, disease-specific survival (DSS), and overall survival (OS) rates in a series of OSCC patients undergoing radical surgery. We retrospectively reviewed 827 consecutive OSCC patients undergoing radical surgery from January 1998 to March 2005. Postoperative radiotherapy was performed in patients with pT4 tumors, positive lymph node(s), or close margins (< or = 4 mm). Local control rates and survivals were plotted using the Kaplan-Meier method. On multivariate analysis (MVA), unfavorable prognostic factors for local control were pathological margins < or = 7 mm (P < 0.001), pathological tumor depth > or = 10 mm (P < 0.001), pathological positive lymph node(s) (P = 0.001), and the presence of betel quid chewing (P = 0.012). The same predictors, with the exception of betel quid chewing and pathological positive lymph node(s), were independently associated with DSS and OS in MVA. A prognostic scoring system was formulated by summing up the four significant local control covariates from MVA. Patients with scores of 3-4 had a significantly poorer local control rate compared to patients with scores of 0-2 (score 3 versus score 0-2: P < 0.001; score 4 versus score 0-2: P < 0.001) Taken together, our data suggest that pathological margins and pathological tumor depth are major independent prognosticators not only for local tumor control, but also for DSS and OS.

Several clinical situations call for the use of radiobiological principles as powerful clinical tools. The aim of this project is to examine the effect of radiotherapy dose intensity on local tumour control for non-small cell lung cancer (NSCLC) using the biological effective dose (BED) concept. A two-year tumour control probability (TCP) model was developed based on the linear-quadratic cell concept combined with Poisson statistics. The two-year local control outcome was analysed for the radiotherapy dose using the BEDs. The BED calculations and the TCP model were fitted to a series of NSCLC patients drawn from the literature. The investigation is based on the two-year local tumour control rate for stage I-II NSCLC for a dose fractionation size that varied from 1.5-20 Gy per fraction delivered via three radiotherapy treatments: 3D-conformal radiation therapy (3D-CRT), continuous hyperfractionated accelerated radiotherapy (CHART) and stereotactic ablative body radiotherapy (SABR). The BED values of 2,280 patients were computed and analysed as a function of local tumour control. To quantitatively assess the correlation between the BED and local tumour control, a residuals analysis and linear regression were performed. Higher radiotherapy doses were associated with improved local tumour control and survival rates for NSCLC, as suggested by the coefficient of the correlation R2 statistical test: 0.83 for the 3D-CRT and 0.91 for the SABR treatment.

Objective: To explore the short-term efficacy and safety of proton radiotherapy as an adjuvant treatment for medulloblastoma in children, focusing on evaluating its impact on local tumor control rate, neurocognitive function, and pituitary-thyroid axis. Methods: Thirty children with medulloblastoma who completed surgery between May 2023 and May 2024 were included in the study. The patients were randomly assigned to two groups: the experimental group received proton radiotherapy, while the control group underwent conventional photon radiotherapy. Both groups followed a standard dose regimen: 36Gy for the whole brain and spinal cord, and 54Gy for the tumor bed. Observation indicators included the local tumor control rate, acute radiotherapy-related toxicities, and changes in pituitary-thyroid function within 6 months. Results: The local tumor control rate was better in the proton radiotherapy group compared to the control group, with no significant increase in acute toxic side effects. In neurocognitive assessments, children in the experimental group showed more stable cognitive function maintenance. Endocrine monitoring revealed that the pituitary-thyroid axis function was relatively stable in the proton group, and the risk of impairment was significantly lower than that in the photon group. Conclusion: Proton radiotherapy has significant clinical advantages as an adjuvant treatment for medulloblastoma in children. Its precise dose delivery reduces exposure to normal brain tissue, significantly reducing the risk of neurocognitive and endocrine function impairment. This therapy not only improves local tumor control but also balances the quality of life for the children, providing a more ideal treatment option. Future studies need to expand the sample size and extend follow-up time to verify long-term safety and durability of efficacy. The results of this study provide a solid clinical basis for the promotion and application of proton radiotherapy in the treatment of pediatric brain tumors.

Management of locally advanced carcinoma of the breast by primary radiation therapy

Long-Term Results of High-Dose 2-Fraction Carbon Ion Radiation Therapy for Hepatocellular Carcinoma

Pretreatment CT volumetric measurement of the primary tumor has been shown to be a predictor of local control in patients with laryngeal carcinoma treated with radiation therapy (RT) alone. A direct association has been demonstrated between tumor volume of supraglottic squamous cell carcinoma (SGSCCA) and local control. However, the association between tumor volume of SGSCCA and local control has not been investigated in patients treated surgically. The purpose of this study was to determine the relationship between SGSCCA tumor volume and local control in patients treated surgically. Primary site tumor volume was calculated from pretreatment CT studies in 37 laryngeal supraglottic carcinomas treated surgically. All patients had clinical follow-up for evidence of recurrent tumor along the surgical margins at the primary site for a minimum of 2 years after completion of treatment. Statistical analysis consisted of Mantel-Haenszel chi-square tests and Fisher's exact test. Overall local control rate was 92% (33 of 37). Tumor volume was significantly associated with local control (p <. 05). Local control rate for tumors with volumes <16 cc was 94% (32 of 34) (p <.05). Pretreatment CT volumetric analysis is useful for predicting local control in patients with SGSCCA carcinoma treated surgically.

To report on safety and clinical effectiveness of cryoablation for the treatment of spinal metastases (SM) in patients needing pain palliation or local tumor control (LTC). All consecutive patients with SM who underwent cryoablation from May 2008 to September 2020 in two academic centers were retrospectively identified and included in the present analysis. Patient characteristics, goal of treatment (curative/palliative), SM characteristics, procedural details, and clinical outcomes (pain relief; local tumor control [LTC]) were analyzed. There were 74 patients (35 women; median age 61years) accounting for 105 SM. Additional cementoplasty was used for 76 SM (76/105; 72.4%). There were 9 complications (out of 105 SM [8.5%]; 2 major and 7 minor) in 8 patients. Among the 64 (64/74; 86.5%) patients with painful SM, the mean Numerical Pain Rating Scale dropped from 6.8 ± 2.2 (range, 0-10) at the baseline to 4.1 ± 2.4 (range, 0-9; p < 0.0001) at 24h, 2.5 ± 2.6 (range, 0-9; p < 0.0001) at 1month, and 2.4 ± 2.5 (range, 0-9; p < 0.0001) at the last available follow-up (mean 14.7 ± 19.6months; median 6). Thirty-four patients (34/64; 53.1%) were completely pain-free at the last follow-up. At mean 25.9 ± 21.2months (median 16.5) of follow-up, LTC was achieved in 23/28 (82.1%) SM in 21 patients undergoing cryoablation with curative intent. Cryoablation of SM, often performed in combination with vertebral augmentation, is safe, achieves fast and sustained pain relief, and provides high rates of LTC at mean 2-year follow-up. •Cryoablation of spinal metastases is safe. •Cryoablation of spinal metastases allows rapid and sustained pain relief. •The mean2-year rate of local tumor control after cryoablation of spinal metastases is 82.1%.

This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. We included 22 consecutive patients (3 women; age 74.2 ± 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 ± 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 ± 13.6 min and 43.7 ± 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 ± 8.8 months, local recurrence-free survival was 14.4 ± 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 ± 16.6 ml/min/1.73 m(2) before RF ablation vs. 47.2 ± 11.9 ml/min/1.73 m(2) after RF ablation; not significant). CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

Radiobiological hypoxia, histological parameters of tumour microenvironment and local tumour control after fractionated irradiation

The ECLIPSE Study: Efficacy of Cryoablation on Metastatic Lung Tumors With a 5-Year Follow-Up

Ewing’s sarcoma is a malignant disease that requires multimodal treatment to obtain high cure rates (Malwer et al. 1989). Radiation therapy is an important component of the treatment of the primary lesion. The reported rates of local control attributed to radiation therapy vary widely (Halperin et al. 1989). Tumor volume and the site of the primary tumor have been related to major differences in local tumor control. Thus isolated local recurrences have been reported in 15% of patients with lesions of the extremities, in 47% with rib primaries, and in 69% with pelvic tumors (Brown et al. 1987). The rate of local persistence/ tumor recurrence, as evaluated by clinical and autopsy findings, was reported by Tepper et al. (1980) to be 35%, 25%, and 7% in patients treated with primary radiation therapy for central, proximal extremity, and distal extremity lesions respectively (Tepper et al. 1980). Overall rates of local tumor control with radiotherapy are in the region of 90% for lesions less than 8 cm in maximum diameter, and 70% for those more than 8 cm in maximum diameter (Marcus and Million 1984).KeywordsLocal Tumor ControlActuarial Survival CurveEwing Sarcoma PatientRadiat Oncol Bioi PhysInitial Local ControlThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

AK-2123, a nitrotriazole hypoxic cell sensitizer has reportedly improved results in head and neck cancers, uterine cervical cancers and other solid tumours when added to radical radiotherapy. A prospectively randomised trial was initiated by the International Atomic Energy Agency (IAEA) evaluating AK-2123 and radiotherapy in treatment of uterine cervical cancer stage IIIA and IIIB. A total of 333 patients were randomised between May 1995 and December 1998. Patients were randomised to either standard radical treatment (radiation therapy alone, RT) or standard radical radiotherapy and additional administration of AK-2123 (RT+AK-2123). The total dose of 45-50.8 Gy was delivered in 20 to 28 fractions over 4 to 5 1/2 weeks. The dose to the central disease was escalated to a radiobiologically equivalent dose of 70 Gy by external beam or brachytherapy, in accordance with each centres individual practice. In the study arm, patients received 0.6 g/sqm AK-2123 by intravenous administration before external beam radiotherapy, treating with AK-2123 on alternate days (e.g. Monday-Wednesday-Friday) during the entire course of external beam therapy. After a median follow up of 57 months (range 30-73 months) the rate of local tumour control was significantly higher in the group who received radiotherapy and additional administration of AK-2123. Local tumour control at the last follow up was 61% after combined radiotherapy and AK-2123 and 46% after radiotherapy alone (p = 0.005). AK-2123 neither increased gastro-intestinal toxicity nor gave any haematological toxicity. A mild peripheral neuropathy (Grade 1:11% and Grade 2:3%) was seen infrequently after AK-2123 administration and was usually completely reversible. Crude survival rates were 41% after radical treatment compared to 57% after combined therapy (p = 0.007). We conclude that the addition of AK-2123 to radical radiotherapy significantly increases response rates and local tumour control in advanced squamous cell cancer of the uterine cervix without any increase in major toxicity. Further analysis and follow up are needed to evaluate if this benefit will translate into prolonged survival. We strongly suggest that our initially very promising study should lead other centres to further studies of AK-2123 in randomised clinical trials.

OBJECTIVE Hemangiopericytomas (HPCs) are rare tumors widely recognized for their aggressive clinical behavior, high recurrence rates, and distant and extracranial metastases even after a gross-total resection. The authors report a large multicenter study, through the International Gamma Knife Research Foundation (IGKRF), reviewing management and outcome following stereotactic radiosurgery (SRS) for recurrent or newly discovered HPCs. METHODS Eight centers participating in the IGKRF participated in this study. A total of 90 patients harboring 133 tumors were identified. Patients were included if they had a histologically diagnosed HPC managed with SRS during the period 1988-2014 and had a minimum of 6 months' clinical and radiological follow-up. A de-identified database was created. The patients' median age was 48.5 years (range 13-80 years). Prior treatments included embolization (n = 8), chemotherapy (n = 2), and fractionated radiotherapy (n = 34). The median tumor volume at the time of SRS was 4.9 cm3 (range 0.2-42.4 cm3). WHO Grade II (typical) HPCs formed 78.9% of the cohort (n = 71). The median margin and maximum doses delivered were 15 Gy (range 2.8-24 Gy) and 32 Gy (range 8-51 Gy), respectively. The median clinical and radiographic follow-up periods were 59 months (range 6-190 months) and 59 months (range 6-183 months), respectively. Prognostic variables associated with local tumor control and post-SRS survival were evaluated using Cox univariate and multivariate analysis. Actuarial survival after SRS was analyzed using the Kaplan-Meier method. RESULTS Imaging studies performed at last follow-up demonstrated local tumor control in 55% of tumors and 62.2% of patients. New remote intracranial tumors were found in 27.8% of patients, and 24.4% of patients developed extracranial metastases. Adverse radiation effects were noted in 6.7% of patients. During the study period, 32.2% of the patients (n = 29) died. The actuarial overall survival was 91.5%, 82.1%, 73.9%, 56.7%, and 53.7% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. Local progression-free survival (PFS) was 81.7%, 66.3%, 54.5%, 37.2%, and 25.5% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. In our cohort, 32 patients underwent 48 repeat SRS procedures for 76 lesions. Review of these 76 treated tumors showed that 17 presented as an in-field recurrence and 59 were defined as an out-of-field recurrence. Margin dose greater than 16 Gy (p = 0.037) and tumor grade (p = 0.006) were shown to influence PFS. The development of extracranial metastases was shown to influence overall survival (p = 0.029) in terms of PFS; repeat (multiple) SRS showed additional benefit. CONCLUSIONS SRS provides a reasonable rate of local tumor control and a low risk of adverse effects. It also leads to neurological stability or improvement in the majority of patients. Long-term close clinical and imaging follow-up is necessary due to the high probability of local recurrence and distant metastases. Repeat SRS is often effective for treating new or recurrent HPCs.

Local Recurrence After Primary Proton Beam Therapy in Uveal Melanoma: Risk Factors, Retreatment Approaches, and Outcome