Background: There is an underutilization of postoperative radiation therapy (PORT) in renal cell carcinoma (RCC) following radical nephrectomy (RN). The main reason for that is the lack of strong evidence and the cont...Background: There is an underutilization of postoperative radiation therapy (PORT) in renal cell carcinoma (RCC) following radical nephrectomy (RN). The main reason for that is the lack of strong evidence and the contradictory data in the literature regarding its benefit. We aimed to evaluate the efficacy of PORT in locally advanced patients with RCC following complete resection. Materials and Methods: The patients had RN and at least two of the poor prognostic factors like lymph nodes involvement (LN+), renal vein invasion (RVI), inferior vena cava invasion (IVCI) and renal capsule infiltration (RCI) were included in the study. Ninety-four patients were retrospectively evaluated;56 patient received PORT 50Gy/25 fractions/5 weeks and 38 patients who did not receive PORT were compared. The LN+, RVI, IVCI and RCI were documented in 63 (67%), 46 (49%), 30 (32%) and 71 (76%) patients respectively. Results: Eight patients (14%) in PORT arm developed local recurrence (LR) are compared with 10 patients (26%) for non-PORT arm. Five-year overall survival (OS) rates were 78% and 70% for PORT and non-PORT arms respectively (p = 0.3), while 5-year locoregional control (LRC) rates were 88% for PORT arm and 70% for the non-PORT arm (p = 0.05). The IVCI and LN+ affected OS significantly (p values 0.007 and 0.009) respectively. The RCI and LN+ only affected the LRC with p values 0.03, 0.04 respectively. Two out of 56 patients (3.5%) received PORT developed intestinal obstruction which was treated surgically. Conclusion: The PORT decreased the LR rate in high risk locally advanced RCC patients significantly. The high incidence of distant metastasis offsets this improvement at the level of overall survival.展开更多
Background: The risk of carotid vessel stenosis is high after radiotherapy (RT) to neck;however, carotid vessels are unavoidable during supraclavicular (SC-RT) in adjuvant treatment of breast cancer (BC). However, car...Background: The risk of carotid vessel stenosis is high after radiotherapy (RT) to neck;however, carotid vessels are unavoidable during supraclavicular (SC-RT) in adjuvant treatment of breast cancer (BC). However, carotid vessels RT dose is less well-understood. We aimed to determine the carotid vessels doses received by different techniques for SC-RT. Materials and Methods: Thirty consecutive BC patients were planned to receive SC-RT and breast after breast conserving surgery (BCS) after taking 5 mm image slices on computed tomography (CT) simulation. Organs at risk (OAR) including carotid vessels, lungs, spinal cord alongwith clinical target volume (CTV) for primary tumor and lymph nodes were delineated. Comparative analysis was done between two treatment plans;three-field conformal radiation therapy (3F-CRT) and four field conformal RT (4F-CRT) for CTV and carotid vessels doses. Results: The 4F-CRT was found better than 3F-3DCRT regarding coverage and homogeneity of the CTV volume. The 98% of the CTV was covered by 84% dose in 3F-CRT and 95% in 4F-CRT (p 0.001). The carotid vessels maximum dose in the in 3F-CRT was 54.5 ± 1.3 Gy compared to 51.6 ± 1.3 Gy in 4F-CRT (p 0.014), however the mean dose did not differ significantly (p value 0.8). The ipsilateral lung dose did not differ between the two techniques (p Value 0.9). Conclusion: The 4F-CRT plan was found better than 3F-CRT in CTV coverage with minimal dose to the carotid vessel and without significant higher dose to the ipsilateral lung.展开更多
文摘Background: There is an underutilization of postoperative radiation therapy (PORT) in renal cell carcinoma (RCC) following radical nephrectomy (RN). The main reason for that is the lack of strong evidence and the contradictory data in the literature regarding its benefit. We aimed to evaluate the efficacy of PORT in locally advanced patients with RCC following complete resection. Materials and Methods: The patients had RN and at least two of the poor prognostic factors like lymph nodes involvement (LN+), renal vein invasion (RVI), inferior vena cava invasion (IVCI) and renal capsule infiltration (RCI) were included in the study. Ninety-four patients were retrospectively evaluated;56 patient received PORT 50Gy/25 fractions/5 weeks and 38 patients who did not receive PORT were compared. The LN+, RVI, IVCI and RCI were documented in 63 (67%), 46 (49%), 30 (32%) and 71 (76%) patients respectively. Results: Eight patients (14%) in PORT arm developed local recurrence (LR) are compared with 10 patients (26%) for non-PORT arm. Five-year overall survival (OS) rates were 78% and 70% for PORT and non-PORT arms respectively (p = 0.3), while 5-year locoregional control (LRC) rates were 88% for PORT arm and 70% for the non-PORT arm (p = 0.05). The IVCI and LN+ affected OS significantly (p values 0.007 and 0.009) respectively. The RCI and LN+ only affected the LRC with p values 0.03, 0.04 respectively. Two out of 56 patients (3.5%) received PORT developed intestinal obstruction which was treated surgically. Conclusion: The PORT decreased the LR rate in high risk locally advanced RCC patients significantly. The high incidence of distant metastasis offsets this improvement at the level of overall survival.
文摘Background: The risk of carotid vessel stenosis is high after radiotherapy (RT) to neck;however, carotid vessels are unavoidable during supraclavicular (SC-RT) in adjuvant treatment of breast cancer (BC). However, carotid vessels RT dose is less well-understood. We aimed to determine the carotid vessels doses received by different techniques for SC-RT. Materials and Methods: Thirty consecutive BC patients were planned to receive SC-RT and breast after breast conserving surgery (BCS) after taking 5 mm image slices on computed tomography (CT) simulation. Organs at risk (OAR) including carotid vessels, lungs, spinal cord alongwith clinical target volume (CTV) for primary tumor and lymph nodes were delineated. Comparative analysis was done between two treatment plans;three-field conformal radiation therapy (3F-CRT) and four field conformal RT (4F-CRT) for CTV and carotid vessels doses. Results: The 4F-CRT was found better than 3F-3DCRT regarding coverage and homogeneity of the CTV volume. The 98% of the CTV was covered by 84% dose in 3F-CRT and 95% in 4F-CRT (p 0.001). The carotid vessels maximum dose in the in 3F-CRT was 54.5 ± 1.3 Gy compared to 51.6 ± 1.3 Gy in 4F-CRT (p 0.014), however the mean dose did not differ significantly (p value 0.8). The ipsilateral lung dose did not differ between the two techniques (p Value 0.9). Conclusion: The 4F-CRT plan was found better than 3F-CRT in CTV coverage with minimal dose to the carotid vessel and without significant higher dose to the ipsilateral lung.
