Radiation has many potential long-term effects on cancer survivors. Female cancer patients may experience decreased fertility depending on the site irradiated. Oncologists should be aware of these ...consequences and discuss options for fertility preservation before initiating therapy.
A comprehensive review of the existing literature was conducted. Studies reporting the outcomes for female patients treated with cranio-spinal, abdominal, or pelvic radiation reporting fertility, pregnancy, or neonatal-related outcomes were reviewed.
Cranio-spinal irradiation elicited significant hormonal changes in women that affected their ability to become pregnant later in life. Women treated with abdomino-pelvic radiation have an increased rate of uterine dysfunction leading to miscarriage, preterm labor, low birth weight, and placental abnormalities. Early menopause results from low-dose ovarian radiation. Ovarian transposition may decrease the rates of ovarian dysfunction.
There is a dose-dependent relationship between ovarian radiation therapy (RT) and premature menopause. Patients treated with RT must be aware of the impact of treatment on fertility and explore appropriate options.
This study aimed to develop robust normal-tissue complication probability (NTCP) models for patients with hepatocellular carcinoma treated with radiation therapy (RT) using Child-Pugh (CP) score and ...albumin-bilirubin (ALBI) grade increase as endpoints for hepatic toxicity.
Data from 108 patients with hepatocellular carcinoma treated with RT between 2008 and 2017 were evaluated, of which 47 patients (44%) were treated with proton RT. Of these patients, 29 received stereotactic body RT and 79 moderately hypofractionated RT to median physical tumor doses of 43 Gy in 5 fractions and 59 Gy in 15 fractions, respectively. A generalized Lyman-Kutcher-Berman (LKB) model was used to model the NTCP using 2 clinical endpoints, both evaluated at 3 months after RT: CP score increase of ≥2 and ALBI grade increase of ≥1 from the pre-RT baseline. Confidence intervals on LKB fit parameters were determined using bootstrap resampling.
Compared with previous NTCP models, this study found a stronger correlation between normal liver volume receiving low doses of radiation (5-10 Gy) and a CP score or ALBI grade increase. A CP score increase exhibited a stronger correlation to normal liver volumes irradiated than an ALBI grade increase. LKB models for CP increase found values for the volume-effect parameter of a = 0.06 for all patients, and a = 0.02/0.09 when fit to photon/proton patients separately. Subset analyses for patients with superior initial liver functions showed consistent dose-volume effects (a = 0.1) and consistent dose-response relationships.
This study presents an update of liver NTCP models in the era of modern RT techniques using relevant endpoints of hepatic toxicity, CP score and ALBI grade increase. The results show a stronger influence of low-dose bath on hepatic toxicity than those found in previous studies, indicating that RT techniques that minimize the low-dose bath may be beneficial for patients.
To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion.
A systematic ...search of the National Library of Medicine's PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein.
The Task Force proposed three patient groups: (1) a "suitable" group, for whom APBI outside of a clinical trial is acceptable, (2) a "cautionary" group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an "unsuitable" group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety.
Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer.
•Zinc-methionine (Zn-Met) improved average daily gain of dairy calves during the second week after birth.•Zn-Met reduced the incidence of diarrhea of dairy calves in the second week of life.•Zn-Met ...reduced intestinal permeability by reducing serum D-lactate concentrations.•Zn-Met increased the expression levels of mRNAs encoding jejunal mucosal tight junction proteins.•Zn-Met improved the intestinal mucosa barrier integrity of postnatal dairy calves.
This study compared the effects of supplementation of postnatal Holstein dairy calves with low doses of zinc-methionine (Zn-Met) or zinc oxide (ZnO) on growth performance, diarrhea incidence, and the integrity of the small intestinal epithelial barrier. Twenty-four male newborn Holstein dairy calves with similar body weight (42.0 ± 1.2 kg) received raw milk and starter containing zinc at 4.05 mg/kg and 176 mg/kg dry matter, respectively. All animals were randomly allocated to one of three groups (n = 8 per group): a control group (CON, without extra zinc supplementation), a Zn-Met group (receiving 455 mg of Zn-Met per day, equivalent to 80 mg of zinc per day), or a ZnO group (receiving 103 mg of ZnO per day, equivalent to 80 mg of zinc per day). The experiment lasted for 14 days. Zn-Met and ZnO were mixed with milk and fed to the calves. Body weight, height, length, and heart girth were measured on the morning of days 1, 7, and 15. Feed intake and fecal scores were recorded daily during the experimental period. Blood samples were collected on day 15 before morning feeding. Thereafter, the animals were euthanized and their small intestines were collected for examination of intestinal morphology and the expression levels of mRNAs encoding jejunal mucosal tight junction (TJ) proteins. The two different sources of zinc did not influence growth performance or diarrhea incidence in dairy calves during days 1–7 or 1–14 after birth. However, Zn-Met supplementation reduced the diarrhea incidence (35.7 % Zn-Met vs. 58.9 % CON) and improved the average daily gain (ADG) (500 g/d Zn-Met vs. 422 g/d CON) and feed efficiency (feed-to-gain ratio: 2.05 Zn-Met vs. 2.47 CON) significantly during the second week after birth (P < 0.05). Supplementation with Zn-Met improved the integrity of the intestinal mucosa barrier, as indicated by increases in the height of the ileal villi and the expression levels of mRNAs encoding jejunal mucosal TJ proteins (claudin-1, occludin, and zonula occludens protein-1), as well as a reduction in serum D-lactate concentration (P < 0.05). By contrast, no significant differences in the parameters examined were observed between the ZnO and CON groups. Overall, these findings suggest that Zn-Met supplementation lowers the incidence of diarrhea in postnatal Holstein dairy calves by reducing intestinal permeability, which sheds light on the effectiveness of zinc application as a potential treatment for diarrhea during early life calf rearing.
Prior to the 1980s, the primary management of localized anal cancer was surgical resection. Dr. Norman Nigro and colleagues introduced neoadjuvant chemoradiotherapy prior to abdominoperineal ...resection. Chemoradiotherapy 5-fluorouracil and mitomycin C afforded patients complete pathologic response and obviated the need for upfront surgery. More recent studies have attempted to alter or exclude chemotherapy used in the Nigro regimen to mitigate toxicity, often with worse outcomes. Reductions in acute adverse effects have been associated with marked advancements in radiotherapy delivery using intensity-modulated radiation therapy (IMRT) and image-guidance radiation delivery, resulting in increased tolerance to greater radiation doses. Ongoing trials are attempting to improve IMRT-based treatment of locally advanced disease with efforts to increase personalized treatment. Studies are also examining the role of newer treatment modalities such as proton therapy in treating anal cancer. Here we review the evolution of radiotherapy for anal cancer and describe recent advances. We also elaborate on radiotherapy's role in locally persistent or recurrent anal cancer.
Despite the historically limited role of radiotherapy in the management of primary hepatic malignancies, modern advances in treatment design and delivery have renewed enthusiasm for radiation as a ...potentially curative treatment modality. Surgical resection and/or liver transplantation are traditionally regarded as the most effective forms of therapy, although the majority of patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma present with locally advanced or unresectable disease on the basis of local vascular invasion or inadequate baseline hepatobiliary function. In this context, many efforts have focused on nonoperative treatment approaches including novel systemic therapies, transarterial chemoembolization, ethanol ablation, radiofrequency ablation, and stereotactic body radiation therapy (SBRT). This review aims to summarize modern advances in radiotherapy, particularly SBRT, in the treatment of primary hepatic malignancies.
摘要
尽管历史上放射疗法在原发性肝脏恶性肿瘤治疗中的作用有限，但其在现代治疗设计和实施上的进展重新激起了将放疗作为一种潜在根治性治疗方式的热情。手术切除和／或肝脏移植在传统上被视为最有效的治疗形式，然而根据局部血管浸润或基线肝胆功能不佳，大多数肝细胞癌和肝内胆管癌患者患有局部晚期或不可切除性疾病。在这种背景下，许多治疗努力偏重于非手术疗法，包括新型全身疗法、经动脉化疗栓塞、乙醇消融、射频消融和体部立体定向放射疗法 (SBRT)。本综述旨在总结现代放疗（特别是 SBRT）在原发性肝脏恶性肿瘤治疗方面的进展。 (The Oncologist) 2014;19:868–879
Despite the historically limited role of radiotherapy in the management of primary hepatic malignancies, modern advances in treatment design and delivery have renewed enthusiasm for radiation as a potentially curative treatment modality. This review aims to summarize modern advances in radiotherapy, particularly stereotactic body radiation therapy, in the treatment of primary hepatic malignancies.
Background
In pancreatic adenocarcinoma (PDAC), increasing tumor size usually correlates with a worse prognosis. However, patients with a very small primary tumor who experience lymph node ...involvement may have a different disease biology. This study sought to determine the interaction between tumor size and lymph node involvement in terms of overall survival (OS).
Methods
The study identified 17,073 patients with a diagnosis of M0 resected PDAC between 1983 and 2013 using the Surveillance, Epidemiology, and End Results database. The patients were stratified by lymph node involvement (N0 vs N+) and T stage (T1a–T1b vs T1c vs T2 vs T3 vs T4). The Kaplan–Meier method was used to estimate OS, and Cox regression analysis was used to compare survival between subgroups after adjustment for patient-specific factors.
Results
Lymph node involvement and T stage significantly interacted (
p
< 0.001). Among the patients with node-negative disease, 5-year OS decreased monotonically with increasing T stage (59.1%, 30.6%, 22.9%, 16.6%, and 8.0%, respectively;
p
< 0.001). In contrast, among the patients with node-positive disease, those with T1a–T1b tumors (< 10 mm) had worse 5-year OS than those with T1c tumors (7.4% vs 17.6%; adjusted hazard ratio, 0.70; 95% confidence interval, 0.50–0.97;
p
= 0.034) and similar survival compared with those who had T2, T3, or T4 tumors (9.7%, 8.2%, and 4.8%, respectively;
p
> 0.2 in all cases).
Conclusions
Among patients with lymph node-positive PDAC, very small primary tumors are associated with decreased OS. This finding raises the possibility that small tumors capable of lymph node metastasis might represent more biologically aggressive cancers.
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