The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Michael Molls - One of the best experts on this subject based on the ideXlab platform.
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stereotactic Hypofractionated Radiotherapy in stage i t1 2 n0 m0 non small cell lung cancer nsclc
Acta Oncologica, 2006Co-Authors: Frank Zimmermann, H Geinitz, S Schill, R Thamm, Carsten Nieder, U Schratzenstaller, Michael MollsAbstract:Stereotactic Radiotherapy has the potential to produce high local control rates with low risk of severe lung toxicity. From December 2000 to January 2006, 68 inoperable patients (median age 76 years) with stage I NSCLC received definitive hSRT. A mean total dose of 37.5 Gy (24–40 Gy; 60%-isodose) in 3–5 fractions was applied. Immobilisation was carried out by means of a vacuum couch and low pressure foil (Medical Intelligence, Schwab Munchen, Germany). Staging procedures were thoracic and abdominal CT-scan, FDG-PET and CT or MRI of the brain in all patients. Clinical target volume was the tumor as seen in lung windowing of CT and in FDG-PET. Organ movements (6–22 mm) and patient positioning in the couch (3–12 mm) were added as safety margin for the definition of the planning target volume (PTV), that was enclosed by the 60%-isodose. We observed four (6%) local tumor recurrences, resulting in an actuarial local tumor control rate of 96%, 88% and 88% after 1, 2 and 3 year follow-up. Nineteen patients died, ...
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stereotactic Hypofractionated Radiotherapy in stage i t1 2 n0 m0 non small cell lung cancer nsclc
Acta Oncologica, 2006Co-Authors: Frank B Zimmermann, H Geinitz, S Schill, R Thamm, Carsten Nieder, U Schratzenstaller, Michael MollsAbstract:Stereotactic Radiotherapy has the potential to produce high local control rates with low risk of severe lung toxicity. From December 2000 to January 2006, 68 inoperable patients (median age 76 years) with stage I NSCLC received definitive hSRT. A mean total dose of 37.5 Gy (24-40 Gy; 60%-isodose) in 3-5 fractions was applied. Immobilisation was carried out by means of a vacuum couch and low pressure foil (Medical Intelligence, Schwab Munchen, Germany). Staging procedures were thoracic and abdominal CT-scan, FDG-PET and CT or MRI of the brain in all patients. Clinical target volume was the tumor as seen in lung windowing of CT and in FDG-PET. Organ movements (6-22 mm) and patient positioning in the couch (3-12 mm) were added as safety margin for the definition of the planning target volume (PTV), that was enclosed by the 60%-isodose. We observed four (6%) local tumor recurrences, resulting in an actuarial local tumor control rate of 96%, 88% and 88% after 1, 2 and 3 year follow-up. Nineteen patients died, with eight patients due to cancer (12%), two to local tumor progression alone. Cancer-specific survival is 96%, 82% and 73% at 1, 2 and 3 years. Eleven patients died from comorbidities, making a 53% overall 3-year survival. Fifty five percent of the patients were affected by mild acute and subacute side effects, with only 3% experiencing pneumonitis III degrees . Late effects were pneumonitis III degrees in 1%, rib fractures in 3%, and benign pleural effusion in 2 patients. Hypofractionated SRT is safe even in elderly patients with stage I NSCLC and significantly reduced lung capacity. It leads to high local control rates and should be offered to patients not amenable for curative resection.
A Tree - One of the best experts on this subject based on the ideXlab platform.
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intensity modulated fractionated Radiotherapy versus stereotactic body Radiotherapy for prostate cancer pace b acute toxicity findings from an international randomised open label phase 3 non inferiority trial
Lancet Oncology, 2019Co-Authors: Douglas Brand, A Tree, P Ostler, Hans Van Der Voet, Andrew Loblaw, William Chu, Daniel Ford, Shaun TolanAbstract:Summary Background Localised prostate cancer is commonly treated with external-beam Radiotherapy. Moderate hypofractionation has been shown to be non-inferior to conventional fractionation. Ultra-Hypofractionated stereotactic body Radiotherapy would allow shorter treatment courses but could increase acute toxicity compared with conventionally fractionated or moderately Hypofractionated Radiotherapy. We report the acute toxicity findings from a randomised trial of standard-of-care conventionally fractionated or moderately Hypofractionated Radiotherapy versus five-fraction stereotactic body Radiotherapy for low-risk to intermediate-risk localised prostate cancer. Methods PACE is an international, phase 3, open-label, randomised, non-inferiority trial. In PACE-B, eligible men aged 18 years and older, with WHO performance status 0–2, low-risk or intermediate-risk prostate adenocarcinoma (Gleason 4 + 3 excluded), and scheduled to receive Radiotherapy were recruited from 37 centres in three countries (UK, Ireland, and Canada). Participants were randomly allocated (1:1) by computerised central randomisation with permuted blocks (size four and six), stratified by centre and risk group, to conventionally fractionated or moderately Hypofractionated Radiotherapy (78 Gy in 39 fractions over 7·8 weeks or 62 Gy in 20 fractions over 4 weeks, respectively) or stereotactic body Radiotherapy (36·25 Gy in five fractions over 1–2 weeks). Neither participants nor investigators were masked to allocation. Androgen deprivation was not permitted. The primary endpoint of PACE-B is freedom from biochemical or clinical failure. The coprimary outcomes for this acute toxicity substudy were worst grade 2 or more severe Radiation Therapy Oncology Group (RTOG) gastrointestinal or genitourinary toxic effects score up to 12 weeks after Radiotherapy. Analysis was per protocol. This study is registered with ClinicalTrials.gov , NCT01584258 . PACE-B recruitment is complete and follow-up is ongoing. Findings Between Aug 7, 2012, and Jan 4, 2018, we randomly assigned 874 men to conventionally fractionated or moderately Hypofractionated Radiotherapy (n=441) or stereotactic body Radiotherapy (n=433). 432 (98%) of 441 patients allocated to conventionally fractionated or moderately Hypofractionated Radiotherapy and 415 (96%) of 433 patients allocated to stereotactic body Radiotherapy received at least one fraction of allocated treatment. Worst acute RTOG gastrointestinal toxic effect proportions were as follows: grade 2 or more severe toxic events in 53 (12%) of 432 patients in the conventionally fractionated or moderately Hypofractionated Radiotherapy group versus 43 (10%) of 415 patients in the stereotactic body Radiotherapy group (difference −1·9 percentage points, 95% CI −6·2 to 2·4; p=0·38). Worst acute RTOG genitourinary toxicity proportions were as follows: grade 2 or worse toxicity in 118 (27%) of 432 patients in the conventionally fractionated or moderately Hypofractionated Radiotherapy group versus 96 (23%) of 415 patients in the stereotactic body Radiotherapy group (difference −4·2 percentage points, 95% CI −10·0 to 1·7; p=0·16). No treatment-related deaths occurred. Interpretation Previous evidence (from the HYPO-RT-PC trial) suggested higher patient-reported toxicity with ultrahypofractionation. By contrast, our results suggest that substantially shortening treatment courses with stereotactic body Radiotherapy does not increase either gastrointestinal or genitourinary acute toxicity. Funding Accuray and National Institute of Health Research.
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the role of Hypofractionated Radiotherapy in prostate cancer
Current Oncology Reports, 2017Co-Authors: Linus C Benjamin, A Tree, D P DearnaleyAbstract:It is now accepted that prostate cancer has a low alpha/beta ratio, establishing a strong basis for hypofractionation of prostate Radiotherapy. This review focuses on the rationale for hypofractionation and presents the evidence base for establishing moderate hypofractionation for localised disease as the new standard of care. The emerging evidence for extreme hypofractionation in managing localized and oligometastatic prostate cancer is reviewed. The 5-year efficacy and toxicity outcomes from four phase III studies have been published within the last 12 months. These studies randomizing over 6000 patients to conventional fractionation (1.8–2.0 Gy per fraction) or moderate hypofractionation (3.0–3.4 Gy per fraction). They demonstrate hypofractionation to be non-inferior to conventional fractionation. Moderate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Extreme hypofractionation may have a role in managing prostate oligometastases, but further studies are needed.
Blandine Boru - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Hypofractionated Radiotherapy rx in melanoma patients who failed anti pd 1 monotherapy assessing the abscopal effect
Journal of Clinical Oncology, 2019Co-Authors: Philippe Saiag, Bouchra Baghad, Magali Fort, Iman Aouidadd, Anissa Roger, Jeanjacques Mazeron, Y Otmezguine, Astrid Blom, Christine Longvert, Blandine BoruAbstract:9537Background: Radiotherapy (Rx) and anti-PD-1 mAb are potentially synergistic. No study has tested this combination only in pts who failed on anti-PD-1 mAb, which allows to assess the abscopal ef...
Douglas Brand - One of the best experts on this subject based on the ideXlab platform.
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intensity modulated fractionated Radiotherapy versus stereotactic body Radiotherapy for prostate cancer pace b acute toxicity findings from an international randomised open label phase 3 non inferiority trial
Lancet Oncology, 2019Co-Authors: Douglas Brand, A Tree, P Ostler, Hans Van Der Voet, Andrew Loblaw, William Chu, Daniel Ford, Shaun TolanAbstract:Summary Background Localised prostate cancer is commonly treated with external-beam Radiotherapy. Moderate hypofractionation has been shown to be non-inferior to conventional fractionation. Ultra-Hypofractionated stereotactic body Radiotherapy would allow shorter treatment courses but could increase acute toxicity compared with conventionally fractionated or moderately Hypofractionated Radiotherapy. We report the acute toxicity findings from a randomised trial of standard-of-care conventionally fractionated or moderately Hypofractionated Radiotherapy versus five-fraction stereotactic body Radiotherapy for low-risk to intermediate-risk localised prostate cancer. Methods PACE is an international, phase 3, open-label, randomised, non-inferiority trial. In PACE-B, eligible men aged 18 years and older, with WHO performance status 0–2, low-risk or intermediate-risk prostate adenocarcinoma (Gleason 4 + 3 excluded), and scheduled to receive Radiotherapy were recruited from 37 centres in three countries (UK, Ireland, and Canada). Participants were randomly allocated (1:1) by computerised central randomisation with permuted blocks (size four and six), stratified by centre and risk group, to conventionally fractionated or moderately Hypofractionated Radiotherapy (78 Gy in 39 fractions over 7·8 weeks or 62 Gy in 20 fractions over 4 weeks, respectively) or stereotactic body Radiotherapy (36·25 Gy in five fractions over 1–2 weeks). Neither participants nor investigators were masked to allocation. Androgen deprivation was not permitted. The primary endpoint of PACE-B is freedom from biochemical or clinical failure. The coprimary outcomes for this acute toxicity substudy were worst grade 2 or more severe Radiation Therapy Oncology Group (RTOG) gastrointestinal or genitourinary toxic effects score up to 12 weeks after Radiotherapy. Analysis was per protocol. This study is registered with ClinicalTrials.gov , NCT01584258 . PACE-B recruitment is complete and follow-up is ongoing. Findings Between Aug 7, 2012, and Jan 4, 2018, we randomly assigned 874 men to conventionally fractionated or moderately Hypofractionated Radiotherapy (n=441) or stereotactic body Radiotherapy (n=433). 432 (98%) of 441 patients allocated to conventionally fractionated or moderately Hypofractionated Radiotherapy and 415 (96%) of 433 patients allocated to stereotactic body Radiotherapy received at least one fraction of allocated treatment. Worst acute RTOG gastrointestinal toxic effect proportions were as follows: grade 2 or more severe toxic events in 53 (12%) of 432 patients in the conventionally fractionated or moderately Hypofractionated Radiotherapy group versus 43 (10%) of 415 patients in the stereotactic body Radiotherapy group (difference −1·9 percentage points, 95% CI −6·2 to 2·4; p=0·38). Worst acute RTOG genitourinary toxicity proportions were as follows: grade 2 or worse toxicity in 118 (27%) of 432 patients in the conventionally fractionated or moderately Hypofractionated Radiotherapy group versus 96 (23%) of 415 patients in the stereotactic body Radiotherapy group (difference −4·2 percentage points, 95% CI −10·0 to 1·7; p=0·16). No treatment-related deaths occurred. Interpretation Previous evidence (from the HYPO-RT-PC trial) suggested higher patient-reported toxicity with ultrahypofractionation. By contrast, our results suggest that substantially shortening treatment courses with stereotactic body Radiotherapy does not increase either gastrointestinal or genitourinary acute toxicity. Funding Accuray and National Institute of Health Research.
Ernesto Maranzano - One of the best experts on this subject based on the ideXlab platform.
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short course versus split course Radiotherapy in metastatic spinal cord compression results of a phase iii randomized multicenter trial
Journal of Clinical Oncology, 2005Co-Authors: Ernesto Maranzano, Rita Bellavita, Marco Lupattelli, Alessandro Frattegiani, Romina Rossi, Verena De Angelis, Rita Bagnoli, Marcello Mignogna, S Beneventi, P PonticelliAbstract:Purpose Hypofractionated Radiotherapy (RT) is often used in the treatment of metastatic spinal cord compression (MSCC). This randomized trial was planned to assess the clinical outcome and toxicity of two different Hypofractionated RT regimens in MSCC. Patients and Methods Three hundred patients with MSCC were randomly assigned to a short-course RT (8 Gy × 2 days) or to a split-course RT (5 Gy × 3; 3 Gy × 5). Only patients with a short life expectancy entered the protocol. Median follow-up was 33 months (range, 4 to 61 months). Results A total of 276 (92%) patients were assessable; 142 (51%) treated with the short-course and 134 (49%) treated with the split-course RT regimen. There was no significant difference in response, duration of response, survival, or toxicity found between the two arms. When short- versus split-course regimens were compared, after RT 56% and 59% patients had back pain relief, 68% and 71% were able to walk, and 90% and 89% had good bladder function, respectively. Median survival wa...
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radiation induced myelopathy in long term surviving metastatic spinal cord compression patients after Hypofractionated Radiotherapy a clinical and magnetic resonance imaging analysis
Radiotherapy and Oncology, 2001Co-Authors: Ernesto Maranzano, Rita Bellavita, Piero Floridi, Grazia Celani, Enrico Righetti, Marco Lupattelli, B M Panizza, Alessandro Frattegiani, Gian Piero Pelliccioli, P LatiniAbstract:Abstract Background and purpose : Hypofractionated Radiotherapy is often administered in metastatic spinal cord compression (MSCC), but no studies have been published on the incidence of radiation-induced myelopathy (RIM) in long-term surviving patients. Our report addresses this topic. Patients and methods : Of 465 consecutive MSCC patients submitted to Radiotherapy between 1988 and 1997, 13 live patients (seven females, six males, median age 69 years, median follow-up 69 months) surviving for 2 years or more were retrospectively reviewed to evaluate RIM. All patients underwent Radiotherapy. Eight patients underwent a short-course regimen of 8 Gy, with 7 days rest, and then another 8 Gy. Five patients underwent a split-course regimen of 5 Gy ×3, 4 days rest, and then 3 Gy ×5. Only one patient also underwent laminectomy. Full neurological examination and magnetic resonance imaging (MRI) were performed. Results : Of 12 patients submitted to Radiotherapy alone, 11 were ambulant (eight without support and three with support) with good bladder function. In nine of these 11 patients, MRI was negative; in one case MRI evidenced an in-field relapse 30 months after the end of Radiotherapy, and in the other, two new MSCC foci outside the irradiated spine. In the remaining patient RIM was suspected at 18 months after Radiotherapy when the patient became paraplegic and cystoplegic, and magnetic resonance images evidenced an ischemic injury in the irradiated area. The only patient treated with surgery plus postoperative Radiotherapy worsened and remained paraparetic. Magnetic resonance images showed cord atrophy at the surgical level, explained as an ischemic necrosis due to surgery injury. Conclusions : On the grounds of our data regarding RIM in long-term surviving MSCC patients, we believe that a Hypofractionated Radiotherapy regimen can be used for the majority of patients. For a minority of patients, more protracted radiation regimens could be considered.