radiotherapy

The main goal of hyperthermia is to elevate the tumor temperature to kill tumor cells and improve local control. The usage of hyperthermia is combination with radiotherapy or chemotherapy. Hyperthermia is delivered in different types of cancers like breast cancer, melanoma and sarcoma. Breast cancer treatment enroll surgery, chemotherapy, radiotherapy and hormone therapy. Hyperthermia is given once or twice a week concomitantly with radiotherapy or chemotherapy. This short review will enlight the types, physics, and the results of hyperthermia especially in the management of breast cancer therapy.

We evaluated a total of 115 patients diagnosed with anal cancer, who were treated at our clinic from 1995 to 2012. Their average age was 61 years, most often were diagnosed in stages II and III, in most cases it was a squamous cell carcinoma located in the anal canal. The mean follow-up was 83 months (minimum 1 month and maximum 240 months). We combined external radiotherapy with boost of brachytherapy or boost of external radiotherapy and possibly a combination of both boosts. Half of the patients received concomitant chemotherapy. We specifically evaluated local tumor regression, overall survival and the impact to therapeutic effect of the chosen irradiation technique. Complete regression was achieved in 92 patients, partial regression in 21 patients. Overall survival, regardless of stage, was 80% 3-year, 74% 5-year and 67% 10-year. The age of patients, the size of their own primary tumor and the therapeutic method used had a statistically significant effect on survival - especially the importance of brachytherapy was irreplaceable.

Bone metastases in cancer patients are highly painful and decrease the quality of life for these group of population. Covid-19 pandemia is a global challenging issue that mostly affect the patients with immune suppression or having comorbid diseases older than 65 years old. The palliation and management of bone metastases varies from single dose to several fractionation. The main goal of this article is to decide that short or long term fit for the cancer patients with bone metastasis in the Covid-19 era. We reviewed the topic about the short course and long term radiotherapy in the patients with painful bone metastases via novel literature.

Introduction: Desmoplastic Malignant Mesothelioma (DMM) is a rare histological subtype of sarcomatoid malignant mesothelioma arising most frequently in the pleura or peritoneum and less frequently in the lung parenchyma. Patient concerns: A 52-year-old female with no apparent asbestos exposure was referred for consultation in our center after 1 month of cough and no concomitant symptoms of chest. Diagnosis: Chest computed Tomography (CT) revealed a localized mass measuring 4.5 x 3.9 cm in the right lung middle lobe with inhomogeneous enhancement following injection of contrast, and without pleural lesions, considered a primary intrapulmonary desmoplastic mesothelioma. Interventions: Surgical intervention was performed. Outcomes: Following complete tumor resection, the patient declined to receive chemotherapy or radiotherapy. The final diagnosis of intrapulmonary desmoplastic mesothelioma was confirmed by pathological and immunohistochemical examination. In addition, no local tumor recurrence was observed within 10 months of follow-up. Conclusion: Even elderly female patients with localized pulmonary masses without significant pleural lesions should not excluded the possibility of malignant mesothelioma in the lungs.

Purpose: Adaptive planning is often needed in lung cancer proton therapy to account for geometrical variations, such as tumor shrinkage and other anatomical changes. The purpose of this study is to present our findings in adaptive radiotherapy for lung cancer using uniform scanning proton beams, including clinical workflow, adaptation strategies and considerations, and toxicities. Methods: We analyzed 165 lung patients treated using uniform scanning proton beams at our center. Quality assurance (QA) plans were generated after repeated computerized tomography (CT) scan to evaluate anatomic and dosimetric change during the course of treatment. Plan adaptation was determined mutually by physicists and physicians after QA plan evaluation, based on several clinical and practical considerations including potential clinical benefit and associated cost in plan adaption. Detailed analysis was performed for all patients with a plan adaptation, including the type of anatomy change, at which fraction the adaption was made, and the strategy for adaptation. Toxicities were compared between patients with and without plan adaptation. Results: In total, 32 adaptive plans were made for 31 patients out of 165 patients, with one patient undergoing adaptive planning twice. Anatomy changes leading to plan adaptation included tumor shrinkage (17), pleural effusion (3), patient weight loss (2), and tumor growth or other anatomy change (9). The plan adaptation occurred at the 15th fraction on average and ranged from the 1st to 31st fraction. Strategies of plan adaptation included range change only (18), re-planning with new patient-specific hardware (9), and others (5). Most toxicities were Grade 1 or 2, with dermatitis the highest toxicity rate. Conclusion: Adaptive planning is necessary in proton therapy to account for anatomy change and its effect on proton penetration depth during the course of treatment. It is important to take practical considerations into account and fully understand the limitations of plan adaptation process and tools to make wise decision on adaptive planning. USPT is a safe treatment for lung cancer patients with no Grade 4 toxicity.

Rectourethral fistula (RUF) is a divesting complication after prostate cancer treatment. The RUF incidence after radical prostatectomy is about 0.5% to 2%, [1,2]. Radiotherapy, criotherapy and high intensity focused ultrasound are other more severe causes [3,4]. Repair of RUF is a challenging surgical procedure. There are some possible approaches but transperineal is the most utilized. In cases of complex fistulas interposition of muscle flaps between the rectum and urethra is highly recommended. Gracilis muscle transposition (GMT) is the preferred, due to excellent mobility and vascularization for perineal reconstruction [5,6]. Dissection of the gracilis muscle is done using one, 2 or 3 large incisions in the medial border of the thigh. The aim of this report is present a new minimally invasive access to obtain a pediculate flap of gracilis muscle to interposition between bladder and rectum to treat RUF.

We report an interesting case of a 21 year old male who presented with recurrent mucoepidermoid carcinoma of parotid with facial nerve involvement as facial tics. Intraoperatively, the tumour was noted to be firm, irregular and adherent to the underlying structures. The patient underwent extended total parotidectomy, division of buccal branch of facial nerve, selective neck dissection with cervical local rotational flap repair and post-operative radiotherapy. This presentation of Mucoepidermoid carcinoma with involvement of facial nerve as facial tics is one of the rare unique reported cases.

Leiomyosarcoma is a malignant smooth-muscle tumor that has a predilection for the gastrointestinal and female genital tract and is a rare entity in the paranasal sinuses. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent total maxillectomy followed by radiotherapy. At present after 5 years of follow up, he is symptom free with no recurrence.

Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex. Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1-4]. Adrenal glands are one of the metastatic fields. In wide autopsy series, adrenal metastasis has been determined between the rates of 13-17% [5]. While unilateral metastasis is common, bilateral metastasis’ rate of incidence is between 4-20%. It has been stated that lung (35%), gastric (14%), esophageal (12%) and hepatobiliary (10%) primary carcinomas adrenal metastasis are prevalent most frequently [2]. Curative treatments are tested on patients having cancer with oligo metastasis limited with adrenal gland and primary source is under control because of the expectation of long-term survival, and the surgery is the first choice. These bulks can be treated with open and laparoscopic surrenalectomy in a curative way. It was reported in studies that overall survival was longer in resection of clinically isolated adrenal metastases when compared with nonsurgical therapy (including RFA, external beam radiotherapy, arterial embolization, radioembolization, chemical ablation, and cryoablation) [1,2,5,7]. Lo et al., found one-year survival as 73% and two-year survival as 40% in their study conducted on 52 patients having curative resection for solitary adrenal metastasis [3]. Tanvetyanon et al., demonstrated 5-year survival rates of 25% following resection of isolated synchronous adrenal metastases and reported 26% after resection of metachronous adrenal metastases in their study conducted on NSCLC patients developing solitary adrenal metastasis [4]. Conducted studies revealed that the rate of complication was 9-20% in patients having adrenalectomy for solitary adrenal metastasis [2-4,7]. In recent years, the use of radiotherapy, which is a treatment modality as effective as surgical resection, has become prevalent for the management of oligometastases. Today, three different modalities have been tested in the radiotherapy treatment of adrenal gland metastases. In the first one, total 50 Gy treatment dose with 3D-CRT as daily 2 Gy fraction dose is given [8]. The second one is IMRT implementations for adrenal gland metastases but it isn’t thought as suitable according to Practice Guidelines for Neuroendocrine Tumors published by NCCN in 2010. The third radiotherapy modality is stereotactic body radiotherapy (SBRT). SBRT implementations have started to be preferred today since they are completed in a few fractions in addition to that they show close results to surgery for primary tumors and metastases. Holy et al., implemented SBRT to patients having 13 solitary adrenal metastases with NSCLC at 5 fractions and between 20 and 40 Gy total doses. They found disease-free survival as median 12 months, overall survival as median 23 months and local control rate as 77% [9]. In SBRT implementations for different cancer types determined 30 adrenal metastases, Chawla et al., reported the rates of one-year survival, local control and distant metastasis as 44%, 55% and 13% respectively [10]. In Casamassima et al.,’s study on this issue, the rate of two-year local control was found as 90% [11]. Second degree toxicity was seen in none of the above mentioned studies according to the RTOG toxicity classification. Wardak et al., reported that the patient having lung cancer that they implemented SBRT for bilateral adrenal metastases developed adrenal insufficiency depending on SBRT [6]. Ippolito et al., Reported that adrenal insuffiency may be due to both the tumor and the local treatment [12]. Incidence of symptomatic adrenal insufficiency were reported 4% [2,13]. Casamassima et al and Onishi et al studies, two grade 2 adrenal insuffiencies were reported [11,14]. Consequently, when all these data were evaluated, it is seen that SBRT use has gradually become prevalent for patients not suitable for surgery because of comorbid disease, for patients having oligometastatic cancer that are not suitable for surgery since it has vital risk to resect or that refuse surgery. However, it hasn’t been clear yet that local control will be provided with how many total doses and which fraction schema. There is no agreement on the examination of the adrenal hormone axes because of the short length of life. Besides, it should be kept in mind that adrenal insufficiency can develop in patients implemented SBRT because of bilateral adrenal metastasis developing as synchronous or metachronous. The hormone levels of these patients need to be followed. More researches should be done to lighten this matter.  

Spleen is one of the most important organ of the reticuloendothelial system and coordinates the immune response. Splenectomy is performed for hypersplenism, and staging of hematological malignancy. In conservatively followed patients, radiation therapy can be used to reduce hypersplenism symptoms. Splenectomy or palliative radiotherapy to spleen may probably cause an immune suppressive condition. This may probably local and systemic complications.

Radiation of different wavelengths can kill living organisms, although, the mechanism of interactions differs depending on their energies. Understanding the interaction of radiation with living cells is important to assess their harmful effects and also to identify their therapeutic potential. Temporally, this interaction can be broadly divided in three stages – physical, chemical and biological. While radiation can affect all the important macromolecules of the cells, particularly important is the damage to its genetic material, the DNA. The consequences of irradiation include- DNA damage, mutation, cross-linkages with other molecules, chromosomal aberrations and DNA repair leading to altered gene expression and/or cell death. Mutations in DNA can lead to heritable changes and is important for the induction of cancer. While some of these effects are through direct interaction of radiation with the target, radiation can interact with the surrounding environment to result in its indirect actions. The effects of radiation depend not only on the total dose but also on the dose rate, LET etc. and also on the cell types. However, action of radiation on organisms is not restricted to interactions with irradiated cells, i.e. target cells alone; it also exerts non-targeted effects on neighboring unexposed cells to produce productive responses; this is known as bystander effect. The bystander effects of ionizing radiations are well documented and contribute largely to the relapse of cancer and secondary tumors after radiotherapy. Irradiation of cells with non-ionizing Ultra-Violet light also exhibits bystander responses, but such responses are very distinct from that produced by ionizing radiations.

German surgeon, Vincenz Czerny, transplanted a patient’s own lipoma located in the hip to it’s breast after gland excision due to mastitis in 1895. Dr. Vincenza reported that for at least a year he didnt observe any problem on the operated breast [1]. Injection of adipose tissue to the breast has been used in breast cancer patients during breast reconstruction and lumpectomy. And in cases of revision autologous tissues are used for reconstruction. In clinical practice, many breast cancer patients apply to the clinics mostly after radiotherapy for reconstruction. Rigotti et al used purified autologous lipoaspirates in breast cancer patients with late term complications of radiation therapy and observed increase in neovascularization and wound healing [2]. Panettiere and colleagues compared aesthetic and functional features of fat grafts in radiotherapy received breast cancer patients and control group. In the fat graft group, all clinical symptoms and aesthetic scores were significantly higher than the control group [3]. In plastic surgery especially after the surgical treatment of breast cancer, prosthetic techniques, various autologous flaps or combinations of both are performed for breast reconstruction. Particularly breast reconstructions following adjuvant radiotherapy have less success rates due to adverse effects of radiotherapy [4-10]. There are reports showing reduced complications rates with use of fat grafts before and after breast reconstruction with prosthesis in patients received radiotherapy after lumpectomy or mastectomy. With that, in patients receiving radiotherapy after fat grafting, local complications such as fat necrosis, infection can be seen more [3,11]. It was reported that adipocytes may had paracrine and endocrine interactions with tumor cells and stromal elements [12]. The fat grafts used in breast cancer were thought to cause local recurrence, distant metastasis or development of new cancers; there was no relationship in the clinical series. There is aromatase activity in the adipose tissue. Thus, fat tissue is the main source of post-menopausal estrogen hormone. Tumor cells and surrounding tissue were found to be higher in aromatase activity. Therefore, when fat tissue is injected subcutaneous or under the gland rather than into the parenchyma local recurrence risk is low [2]. When fat tissue is injected to breast, a good physical examination and mammography should be performed. After fat injection, sometimes calcifications are formed as a result of undergoing necrosis and they interfere with malignancy. Therefore before and after the procedure, mammography must be taken for comparison and existing and or newly developed calcifications should be determined.

Ependymomas, which account for 10% of pediatric central nervous system (CNS) tumors, arise from the ependymal cells that line the cerebral ventricles and the central canal of the spinal cord. Extraneural metastasis to lung is rare for ependymomas primary tumors. Repeated surgeries that disrupt the blood-brain barrier may contribute to haematogenous spread, but the mechanism remains unclear. We present a case of ependymoma with extraneural metastasis to lung in a child and discuss reported cases of extracranial metastatic ependymoma with this presentation.

The increasing use of highly conformal radiation deliberates a higher accurate targeting. Contouring and clinical judgment are presumably the crucial point, thus positron emission tomography/magnetic resonance imaging PET/MRI with somatostatin analogs appears to be useful in radiotherapy target definition. A case report of a 43-year-old woman presented with a recurrence of a meningioma (World Health Organization group I classification) in skull base, 2 years after resection. Magnetic resonance imaging (MRI) revealed a left sided skull base mass on sphenoid wing, anterior clinoid and with a soft tissue component in the lateral portion of the orbit. Contrast-enhanced MRI and a computed tomography (CT) dedicated were used to the radiotherapy planning. Aiming an improvement on target volume delineation, 68Ga-DOTATOC-PET/MRI was also performed due the difficult localization of the tumor in skull base. Was treated using intensity-modulated radiotherapy (IMRT) to a total dose of 54 Gy in 28 fractions. It was prescribed to the planning target volume (PTV), defined based of both imaging modalities. In our case PET/MRI helped to define the target, which volume becomes bigger than that based exclusively on MRI and CT.

Purpose: In an aspect of qualitative treatment, this research gathered lung cancer patients’ actual experiences to understand deeply, such as their expectation for treatment results, their difficulties during treatment, and their various requests to their family and medical teams. Methods: From May to June 2013, semi-structured interviews were conducted with 9 lung cancer patients. Data were collected through a tape-recorded in-depth interview. The analysis of the data was made through the qualitative method. Results: 124 themes regarding the experience were found. From these 35 concepts, 24 subcategories were emerged. The core category was enduring hardship of the treatment with the hope for full recovery. Six categories included ‘Wishing to be cured but concern about recurrence’, ‘Receiving radiation treatment with pleasure and difficult at the same time’. ‘Being sorry for their family’s full support and trying to stand alone‘, ‘Having confidence in their medical team’, ‘regretting for their old days’, and ‘Wanting to live a long life without illness and pain’. Conclusion: The results of this study would help oncology nurses to understand the lung cancer patients receiving concurrent chemo-radiotherapy (CCRT) and to develop a quality of life improvement program for physical, psychosocial, and spiritual aspects of nursing.

Background: Gliomas represent the most frequent primary tumors of central nervous system (CNS), contributing to more than half of the incidence of brain tumors. Cancer stem cell markers (CSC) identify a group of patients at high risk for progression. Nestin is an intermediate filament (IF) protein was first described as a neural stem cell/progenitor cell marker. Nestin-positive neuroepithelial stem cells are detected in the subventricular zone of the human adult brain and they remain mitotically active throughout adulthood. The expression of Nestin in gliomas has been suggested to be related to dedifferentiation, improved cell motility, invasive potential and increased malignancy. This study aims to investigate Nestin immunohistochemical expression in different types of glioma and its correlation with different clinicopathological parameters. Materials and Methods: Nestin immunostaining was studied in 60 specimens of glioma using avidin-biotin peroxidase method. Results: Nestin was strongly expressed in 11/60 (18.33%), moderately expressed in 29/60 (48.33%) and weekly expressed in 15/60 (25%) of studied gliomas. A significant positive correlation was found between Nestin expression and histologic type (p < 0.001) and increasing grade of gliomas (p < 0.001). Conclusion: Increased Nestin expression is correlated with tumor progression, increasing grade and poor prognostic parameter of glioma. Nestin is a useful marker for detection of CSC in high-grade glioma which is responsible for resistance to chemo-radiotherapy and may serve as a predictor for patient outcomes.

We report a case of 30-year-old immunocompetent man, with a previous history of cranial-facial trauma, who presented with progressive left exophthalmos due to an intracranial left frontal-ethmoidal-orbital mass. Histology of the resected tumor revealed a classical Hodgkin’s Lymphoma (HL). Epstein-Barr virus encoded RNA/EBER was detected in typical Hodgkin and Reed-Sternberg cells. After postoperative radiotherapy and chemotherapy administration, the patient remains free of systemic disease or recurrence on 4 years of follow-up. Intracranial involvement by HL has rarely been described, mostly as a late localization or as a recurrence of a disseminated disease, in a setting of immunosuppression. Primary HL of the central nervous system occurring as an isolated disease is even more uncommon, with only 16 reported cases documented to date. The prognosis of these rare cases appears comforting with appropriate treatment. Tumor resection and, in appropriate cases, treatment with radiation and/or chemotherapy seem to warrant a durable response. For this reason a systemic disease should be excluded in all cases intracranial HL by a comprehensive work-up. To the best of our knowledge, this case represents the first report that documents the association of intracranial HL and local trauma with subsequent intracranial infection.

Background and objectives: Brainstem gliomas are tumors of the central nervous system which have varying presentations and clinical courses. This study aims to analyze the frequency, clinical and therapeutic aspects of brainstem glioma.Methods: We retrospectively analyzed the data from the record of the patients treated for brainstem glioma under the age of 20 between January 2007 and July 2020 in the Radiation Oncology department of the Ibn Rochd UHC.Results: There were fifteen patients (10 males and 5 females). The mean age of onset was 12 years (range 8 - 14 years). The duration of symptoms varied from 1 month to 2 years. Nine of the patients had intracranial hypertension due to hydrocephalus, six had cranial nerve deficits at presentation, and five patients had cerebellar signs. The lesion was pontine in 12 cases. None of the patients had a tumoral resection, nine had a ventriculo-peritoneal shunt insertion for the hydrocephalus and three had a Stereotactic biopsy that revealed one astrocytoma grade 1, one low grade glioma and one glioblastoma. The radiotherapy was indicated in all the cases but only nine patients had a 3D radiotherapy with a total dose of 54 Gy. Three patients received chemotherapy. Six patients are still alive, two are lost to follow up and seven patients are dead with a mean survival period of 8 months.Conclusion: Brainstem glioma is a devastating disease with a bad prognosis. The clinical presentation is variable and the management is multidisciplinary. Our study illustrates the importance of treatment by radiation.

Saliva is produced by and secreted from salivary glands. It is an extra-cellular fluid, 98% water, plus electrolytes, mucus, white blood cells, epithelial cells, enzymes, and anti-microbial agents. Saliva serves a critical role in the maintenance of oral, dental, and general health and well-being. Hence, alteration(s) in the amount/quantity and/or quality of secreted saliva may induce the development of several oro-dental variations, thereby the negatively-impacting overall quality of life. Diverse factors may affect the process of saliva production and quantity/quality of secretion, including medications, systemic or local pathologies and/or reversible/irreversible damage. Herein, chemo- and/or radio-therapy, particularly, in cases of head and neck cancer, for example, are well-documented to induce serious damage and dysfunction to the radio-sensitive salivary gland tissue, resulting in hypo-salivation, xerostomia (dry mouth) as well as numerous other adverse Intra-/extra-oral, medical and quality-of-life issues. Indeed, radio-therapy inevitably causes damage to the normal head and neck tissues including nerve structures (brain stem, spinal cord, and brachial plexus), mucous membranes, and swallowing muscles. Current commercially-available remedies as well as therapeutic interventions provide only temporary symptom relief, hence, do not address irreversible glandular damage. Further, despite salivary gland-sparing techniques and modified dosing strategies, long-term hypo-function remains a significant problem. Although a single governing mechanism of radiation-induced salivary gland tissue damage and dysfunction has not been yet elucidated, the potential for synergy in radio-protection (mainly, and possibly -reparation) via a combinatorial approach of mechanistically distinct strategies, has been suggested and explored over the years. This is, undoubtfully, in parallel to the ongoing efforts in improving the precision, safety, delivery, and efficacy of clinical radiotherapy protocols/outcomes, and in designing, developing, evaluating and optimizing (for translation) new artificial intelligence, technological and bio-pharmaceutical alternatives, topics covered in this review.

A critical component of the radiation regimen for treating cancer patients is the precise dose delivery to the treatment organ while minimizing the dose to the healthy tissue. This study aims to evaluate in-field organ dose and dose distribution outside the target organs to estimate the excess lifetime risk of second cancer. The study was carried out with a male Alderson Rando Phantom. 20 sets of thermoluminescence dosimeters (MTS-100) were used in this study. The in-field organs absorbed dose was measured by inserting TLDs at different geometrical depths of the left lung, right lung, and stomach, and for peripheral organs skin dose TLDs were placed at the surface of the corresponding organs. Target organs were irradiated at 100 cGy and 200 cGy by a 60Co teletherapy unit, and irradiated TLDs were read out by a RE-2000 TLD reader. For precise dose delivery to the cancerous organs by 60Co teletherapy, the depth dose correction factor for lung cancer treatment is 0.8667 ± 0.01, and for the stomach is 0.7856 ± 0.017. In the case of the treatment for the lung and stomach, the closest organs received significant doses compared to the other distant organs. Thus, the risk of second cancer due to the peripheral dose is obtained. The stomach is at the highest risk when the lung is the target and the liver is at the highest risk when the stomach is the targeted organ.