AIM:To assess the feasibility of volumetric intensity-modulated arc radiotherapy (VMAT) in patients with limited polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. METHODS:...AIM:To assess the feasibility of volumetric intensity-modulated arc radiotherapy (VMAT) in patients with limited polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. METHODS:A 70-year-old male with histologically confirmed osteosclerotic myeloma was treated in our department in July 2010 with VMAT. Fourty-six Gray in 23 fractions were given on three bone lesions. Doses delivered to target volume and critical organs were compared with a tridimensional conformal radiotherapy (3D-RT) plan. Treatment was well tolerated without any side effects.RESULTS:VMAT improved dose homogeneity within the target volume, as compared to 3D-RT (standard deviations:2.9 Gy and 1.6 Gy for 3D and VMAT, respectively). VMAT resulted in a better sparing of critical organs. Dose delivered to 20% of organ volume (D20) was reduced from 22 Gy (3D-RT) to 15 Gy (VMAT) for small bowel, from 24 Gy (3D-RT) to 17 Gy (VMAT) for bladder and from 47 Gy (3D-RT) to 3 Gy (VMAT) for spinal cord. Volumes of critical organs that received at least 20 Gy (V20) were decreased by the use of VMAT, as compared to 3D-RT (V20 bladder:10% vs 99%; V20 small bowel:6% vs 21%). One year after treatment completion, no tumor progression has been reported. CONCLUSION:VMAT improved dose distribution as compared to 3D-RT for limited osteosclerotic myeloma, with better saving of critical organs.展开更多
Immunoradiotherapy holds promise for improving outcomes in patients with advanced solid tumors,including in soft-tissue sarcoma(STS).However,the ideal combination of treatment modalities remains to be determined,and r...Immunoradiotherapy holds promise for improving outcomes in patients with advanced solid tumors,including in soft-tissue sarcoma(STS).However,the ideal combination of treatment modalities remains to be determined,and reliable biomarkers to predict which patients will benefit are lacking.Here,we report the results of the STS cohort of the SABR-PDL1 phase Il trial that evaluated the anti-PDL1 atezolizumab combined with stereotactic body radiation therapy(SBRT)delivered concurrently with the 2nd cycle to at least one tumor site,Eligible patients received atezolizumab until progression or unmanageable toxicity,with SBRT at 45 Gy in 3 fractions).The primary endpoint was one-year progression-free survival(PFS)rate with success defined as 13 patients achieving 1-year PFS.Sixty-one heavily pretreated patients with STS(median 5 prior lines;52%men;median age 54 years;28%leiomyosarcoma)were enrolled across two centers(France,Spain).SBRT was delivered to 55 patients(90%),with the lung being the most commonly irradiated site(50%).After a median follow-up of 45 months,the one-year PFS rate was 8.3%[95%Cl:3.6-18.1].Median PFS and overall survival were 2.5 and 8.6 months,respectively.Best responses included partial responses(5%)and stable disease(60%).Immune profiling revealed increased immunosuppressive tumor-associated macrophages(e.g,IL4l1,HES1)and monocyte-recruiting chemokines in non-responders.Higher monocyte/lymphocyte ratios(MonoLR)in tumor and blood correlated with progression.PD-L1 status,lymphoid infiltration,and tertiary-lymphoid structures were not predictive.Although the primary endpoint was not met,this study highlights MonoLR imbalance as a potential biomarker to identify STS patients likely to benefit from immunoradiotherapy.EudraCT No.2015-005464-42;Clinicaltrial.gov number:NCT02992912.展开更多
文摘AIM:To assess the feasibility of volumetric intensity-modulated arc radiotherapy (VMAT) in patients with limited polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. METHODS:A 70-year-old male with histologically confirmed osteosclerotic myeloma was treated in our department in July 2010 with VMAT. Fourty-six Gray in 23 fractions were given on three bone lesions. Doses delivered to target volume and critical organs were compared with a tridimensional conformal radiotherapy (3D-RT) plan. Treatment was well tolerated without any side effects.RESULTS:VMAT improved dose homogeneity within the target volume, as compared to 3D-RT (standard deviations:2.9 Gy and 1.6 Gy for 3D and VMAT, respectively). VMAT resulted in a better sparing of critical organs. Dose delivered to 20% of organ volume (D20) was reduced from 22 Gy (3D-RT) to 15 Gy (VMAT) for small bowel, from 24 Gy (3D-RT) to 17 Gy (VMAT) for bladder and from 47 Gy (3D-RT) to 3 Gy (VMAT) for spinal cord. Volumes of critical organs that received at least 20 Gy (V20) were decreased by the use of VMAT, as compared to 3D-RT (V20 bladder:10% vs 99%; V20 small bowel:6% vs 21%). One year after treatment completion, no tumor progression has been reported. CONCLUSION:VMAT improved dose distribution as compared to 3D-RT for limited osteosclerotic myeloma, with better saving of critical organs.
基金supported by the French National Research Agency under the FRANCE2030 investment plan(grant application No.ANR-21-RHUS-0005)by the imCORE research network(No.SG40863)+1 种基金The authors would like to thank the collaborators from the histopathology department of Gustave Roussythe Experimental and Translational Pathology(PETRA,AMMICA,INSERM US23/CNRS)。
文摘Immunoradiotherapy holds promise for improving outcomes in patients with advanced solid tumors,including in soft-tissue sarcoma(STS).However,the ideal combination of treatment modalities remains to be determined,and reliable biomarkers to predict which patients will benefit are lacking.Here,we report the results of the STS cohort of the SABR-PDL1 phase Il trial that evaluated the anti-PDL1 atezolizumab combined with stereotactic body radiation therapy(SBRT)delivered concurrently with the 2nd cycle to at least one tumor site,Eligible patients received atezolizumab until progression or unmanageable toxicity,with SBRT at 45 Gy in 3 fractions).The primary endpoint was one-year progression-free survival(PFS)rate with success defined as 13 patients achieving 1-year PFS.Sixty-one heavily pretreated patients with STS(median 5 prior lines;52%men;median age 54 years;28%leiomyosarcoma)were enrolled across two centers(France,Spain).SBRT was delivered to 55 patients(90%),with the lung being the most commonly irradiated site(50%).After a median follow-up of 45 months,the one-year PFS rate was 8.3%[95%Cl:3.6-18.1].Median PFS and overall survival were 2.5 and 8.6 months,respectively.Best responses included partial responses(5%)and stable disease(60%).Immune profiling revealed increased immunosuppressive tumor-associated macrophages(e.g,IL4l1,HES1)and monocyte-recruiting chemokines in non-responders.Higher monocyte/lymphocyte ratios(MonoLR)in tumor and blood correlated with progression.PD-L1 status,lymphoid infiltration,and tertiary-lymphoid structures were not predictive.Although the primary endpoint was not met,this study highlights MonoLR imbalance as a potential biomarker to identify STS patients likely to benefit from immunoradiotherapy.EudraCT No.2015-005464-42;Clinicaltrial.gov number:NCT02992912.
