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What We Read - Cancer Research
GENERAL
Nagata Y et al. Stereotactic Radiotherapy of Primary Lung Cancer and Other Targets: Results of Consultant Meeting of the International Atomic Energy Agency. IJROBP 79(3) 660-9, 2011.
- Cancer burden increasing worldwide, to 20M new cases/year by 2020. 50% are in developing countries.
- The benefit of SBRT in these countries is clear given the fact that an entire course of therapy can be given in 4-5 fractions.
- Primary lung cancers are now being treated in as few as 3 fractions with over 90% control rate, similar to surgical data; the critical component to therapy is a BED of at least 100.
- Toxicity from this treatment is minimal.
- We are seeing comparable results in lung oligometastases as well as primary and metastatic liver tumors.
- Data is mixed/limited in retroperitoneal tumors such as pancreas and kidney.
- Economically, SBRT is cheaper than surgical intervention and is becoming a standard treatment option worldwide.
Bone Lymphoma
Christie D et al. LIMITED CHEMOTHEARPY AND SHRINKING FIELD RADIOTHERAPY FOR OSTEOLYMPHOMA (PRIMARY BONE LYMPHOMA): RESULTS FROM THE TRANS-TASMAN RADIATION ONCOLOGY GROUP 99.04 AND AUSTRALASIAN LEUKAEMIA AND LYMPHOMA GROUP LY02 PROSPECTIVE TRIAL. IJROBP (in press as of Nov 2010).
- Goal was to est benchmark for CMT used in future studies for primary bone lymphoma
Large multi-group study looking at 3 cycles of CHOP followed by XRT to a dose of 45 Gy in 25 fx using a shrinking field technique
- Study closed after 33 patients (slow accrual given the more widespread use of rituxan). Median f/u 4.3 years. 5 year OS 90%, LC 72%. Only 3 patients had fractures that persisted after treatment, one with recurrence.
- Study concluded that the radiation dose needs to remain higher than other lymphomas given the persistently high LR rate.
- Disability after treatment—related specifically to pathological fracture—was not seen using this regimen.
Dubey P et al. LOCALIZED PRIMARY MALIGNANT LYMPHOMA OF BONE. IJROBP 37(5) 1087-1093, 1997.
- Single institution (MD Anderson)
- Retrospective analysis of 45 patients stage IE and IIE. All patients received at least 40 Gy. Systemic therapy doxorubin based.
- 41 patients with DLBCL. 36 of the 45 patients tx with CMT. NO difference in outcomes XRT alone versus CMT.
- 5 and 10-year OS were 68% and 60%, respectively. Slight trend in favor of CMT over XRT alone. No difference in stage I vs. II or doses less than or greater than 50 Gy.
Fidia P et al. LONG-TERM RESULTS OF COMBINED MODALITY THERAPY IN PRIMARY BONE LYMPHOMAS. IJROBP 45 (5) 1213-1218, 1999.
- Single-institutional study (Mass General) looking at combined tx for primary bone lymphoma
- Total of 37 patients reviewed; 2 with surgery and 35 XRT to median docs of 54 Gy; all patients got multiple chemotx regimen
- DFS a 5 and 10-years was 73 and 78% respectively with OS of 91 and 87%
- No local failures seen
- Negative prognostic factors included path fx at presentation, pelvic primary, and age greater than 60.
- Combined approach was statistically superior to local treatment only based on comparison to controls
- 27% of patient required orthopedic stabilization after completion of therapy; most of the complications were seen in weight-bearing bones.
- Conclusion: CMT was superior to XRT or surgery alone for PBL.
Barbieri E et al. PRIMARY NON-HODGKIN’S LYMPHOMA OF THE BONE: TREATMENT AND ANALYSIS OF PROGNOSTIC FACTORS FOR STAGE I AND STAGE II. IJROBP 59(3) 760-764.
- Retrospective experience at Bologna University; 77 patients over 30 years
- 44 had stage I, 33 stage II, all treated with XRT to median dose 40 Gy and 67/77 received anthrocycline-based chemotx.
- 94.8% CR rate with 18.2% relapse at 23 months; 4 of 14 failures XRT alone.
- 15-year DFS and OS were 76.6% and 88.3% respectively
- Age over 40 was a negative prognostic factor; gender, bulk, and stage were not.
- Acute and late toxicity was “moderate”
- Conclusion: CMT is superior to XRT alone. XRT alone is reserved for lesions in the mandible, which are typically diagnosed at a very small/early stage.
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