• 제목, 요약, 키워드: Radiotherapy

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Long-Term Complications of Radiotherapy in a Patient with Maxillary Squamous Cell Carcinoma: A Matter of Trismus and Osteoradionecrosis

  • Kim, Keon-Hyung;Park, Jo-Eun;Kim, Mee-Eun;Kim, Hye-Kyoung
    • Journal of Oral Medicine and Pain
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    • v.43 no.4
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    • pp.136-141
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    • 2018
  • Oral cancer is a malignant neoplasm of the lips or oral cavity. Surgery, radiotherapy and chemotherapy depending on the location and stage of the tumor can be considered as important treatment modalities of oral cancer. Unfortunately, all three treatments can have both acute and chronic complications. Among them, trismus and osteoradionecrosis (ORN), unique complications of radiotherapy in the orofacial region, are particularly difficult to treat once manifested. Therefore, these two complications of radiotherapy have devastating effects on the patient's oral health and furthermore, overall quality of life. In this study, we present a case of a patient showing trismus and ORN following radiotherapy for the treatment of maxillary squamous cell carcinoma and briefly discuss this matter of trismus and ORN in the perspective of a dentist.

Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma

  • Park, Jongmoo;Park, Jae Won;Kang, Min Kyu
    • Yeungnam University Journal of Medicine
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    • v.36 no.3
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    • pp.192-200
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    • 2019
  • Stereotactic body radiotherapy (SBRT) is an advanced form of radiotherapy (RT) with a growing interest on its application in the treatment of hepatocellular carcinoma (HCC). It can deliver ablative radiation doses to tumors in a few fractions without excessive doses to normal tissues, with the help of advanced modern RT and imaging technologies. Currently, SBRT is recommended as an alternative to curative treatments, such as surgery and radiofrequency ablation. This review discusses the current status of SBRT to aid in the decision making on how it is incorporated into the HCC management.

Impact of radiotherapy on mandibular bone: A retrospective study of digital panoramic radiographs

  • Palma, Luiz Felipe;Tateno, Ricardo Yudi;Remondes, Cintia Maria;Marcucci, Marcelo;Cortes, Arthur Rodriguez Gonzalez
    • Imaging Science in Dentistry
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    • v.50 no.1
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    • pp.31-36
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    • 2020
  • Purpose: The purpose of this study was to investigate the impact of radiotherapy on mandibular bone tissue in head and neck cancer patients through an analysis of pixel intensity and fractal dimension values on digital panoramic radiographs. Materials and Methods: Thirty patients with radiographic records from before and after 3-dimensional (3D) conformational radiotherapy were selected. A single examiner carried out digital analyses of pixel intensity values and fractal dimensions, with the areas of interest unilaterally located in the right angle medullary region of the mandible below the mandibular canal and posterior to the molar region. Results: Statistically significant decreases were observed in the mean pixel intensity (P=0.0368) and fractal dimension (P=0.0495) values after radiotherapy. Conclusion: The results suggest that 3D conformational radiotherapy for head and neck cancer negatively affected the trabecular microarchitecture and mandibular bone mass.

Radiobiological mechanisms of stereotactic body radiation therapy and stereotactic radiation surgery

  • Kim, Mi-Sook;Kim, Wonwoo;Park, In Hwan;Kim, Hee Jong;Lee, Eunjin;Jung, Jae-Hoon;Cho, Lawrence Chinsoo;Song, Chang W.
    • Radiation Oncology Journal
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    • v.33 no.4
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    • pp.265-275
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    • 2015
  • Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS.

Postoperative radiotherapy in salivary ductal carcinoma: a single institution experience

  • Kim, Tae Hyung;Kim, Mi Sun;Choi, Seo Hee;Suh, Yang Gun;Koh, Yoon Woo;Kim, Se Hun;Choi, Eun Chang;Keum, Ki Chang
    • Radiation Oncology Journal
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    • v.32 no.3
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    • pp.125-131
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    • 2014
  • Purpose: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. Materials and Methods: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Results: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Conclusion: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.

Art therapy using famous painting appreciation maintains fatigue levels during radiotherapy in cancer patients

  • Koom, Woong Sub;Choi, Mi Yeon;Lee, Jeongshim;Park, Eun Jung;Kim, Ju Hye;Kim, Sun-Hyun;Kim, Yong Bae
    • Radiation Oncology Journal
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    • v.34 no.2
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    • pp.135-144
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    • 2016
  • Purpose: The purpose of this study was to evaluate the efficacy of art therapy to control fatigue in cancer patients during course of radiotherapy and its impact on quality of life (QoL). Materials and Methods: Fifty cancer patients receiving radiotherapy received weekly art therapy sessions using famous painting appreciation. Fatigue and QoL were assessed using the Brief Fatigue Inventory (BFI) Scale and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) at baseline before starting radiotherapy, every week for 4 weeks during radiotherapy, and at the end of radiotherapy. Mean changes of scores over time were analyzed using a generalized linear mixed model. Results: Of the 50 patients, 34 (68%) participated in 4 sessions of art therapy. Generalized linear mixed models testing for the effect of time on mean score changes showed no significant changes in scores from baseline for the BFI and FACIT-F. The mean BFI score and FACIT-F total score changed from 3.1 to 2.7 and from 110.7 to 109.2, respectively. Art therapy based on the appreciation of famous paintings led to increases in self-esteem by increasing self-realization and forming social relationships. Conclusion: Fatigue and QoL in cancer patients with art therapy do not deteriorate during a period of radiotherapy. Despite the single-arm small number of participants and pilot design, this study provides a strong initial demonstration that art therapy of appreciation for famous painting is worthy of further study for fatigue and QoL improvement. Further, it can play an important role in routine practice in cancer patients during radiotherapy.

Radiotherapy and Concurrent Chemo-Radiotherapy in Locally Advanced Hypopharyngeal Cancers - A Hospital Registry Based Analysis

  • Sharma, Jagannath Dev;Krishnatreya, Manigreeva;Das, Ashok Kumar;Bhattacharyya, Mouchumee;Hazarika, Munlima;Kataki, Amal Chandra;Baishya, Nizara;Nandy, Pintu
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.11
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    • pp.4723-4726
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    • 2015
  • Background: The survival of patients with hypopharyngeal cancer is low amongst head and neck cancer cases. The incidence rates of hypopharyngeal cancers in our population are amongst the highest in the world and there are limited data available on the literature on varied responses to first course of treatment with radiotherapy (RT) and concurrent chemo-radiotherapy (CRT) in our population. Materials and Methods: Clinical characteristics and initial responses to treatment in patients who had received radiotherapy and chemo-radiotherapy in a regional cancer center from January 2010 to December 2013 were evaluated. The data were obtained from the hospital cancer registry, and analysis was carried using descriptive statistics. Pearson's chi-square was used to test for differences in the variables and p<0.05 was considered statistically significant. Results: A total of 554 patients were included in the analysis, 411 (74.2%) receiving RT and 143 (25.8%) being given CRT. There was significantly lower number of patients above 70 years with a higher proportion of patients below 50 years who had received CRT (p<0.05). Some 79.3% and 84.6% of patients in the RT and CRT groups respectively presented with a favorable performance status, and in the RT group 240 (58.4%) showed complete response (CR), and in the CRT group 103 (72.0%) showed CR at the first follow-up (p<0.05). Conclusions: Concurrent chemo-radiotherapy gives better short term response to treatment in locally advanced hypopharyngeal cancers.

Meta-analysis of Associations between ATM Asp1853Asn and TP53 Arg72Pro Polymorphisms and Adverse Effects of Cancer Radiotherapy

  • Su, Meng;Yin, Zhi-Hua;Wu, Wei;Li, Xue-Lian;Zhou, Bao-Sen
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10675-10681
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    • 2015
  • Background: The ataxia telangiectasia mutated (ATM) protein and p53 play key roles in sensing and repairing radiation-induced DNA double strand breaks (DSBs). Accumulating epidemiological evidence indicates that functional genetic variants in ATM and TP53 genes may have an impact on the risk of radiotherapy-induced side effects. Here we performed a meta-analysis to investigate the potential interaction between ATM Asp1853Asn and TP53 polymorphisms and risk of radiotherapy-induced adverse effects quantitatively. Materials and Methods: Relevant articles were retrieved from PubMed, ISI Web of Science and the China National Knowledge Infrastructure (CNKI) databases. Eligible studies were selected according to specific inclusion and exclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled to estimate the association between ATM Asp1853Asn and TP53 Arg72Pro polymorphisms and risk of radiotherapy adverse effects. All analyses were performed using the Stata software. Results: A total of twenty articles were included in the present analysis. In the overall analysis, no significant associations between ATM Asp1853Asn and TP53 Arg72Pro polymorphisms and the risk of radiotherapy adverse effects were found. We conducted subgroup analysis stratified by type of cancer, region and time of appearance of side effects subsequently. No significant association between ATM Asp1853Asn and risk of radiotherapy adverse effects was found in any subgroup analysis. For TP53 Arg72Pro, variant C allele was associated with decreased radiotherapy adverse effects risk among Asian cancer patients in the stratified analysis by region (OR=0.71, 95%CI: 0.54-0.93, p=0.012). No significant results were found in the subgroup analysis of tumor type and time of appearance of side effects. Conclusions: The TP53 Arg72Pro C allele might be a protective factor of radiotherapy-induced adverse effects among cancer patients from Asia. Further studies that take into consideration treatment-related factors and patient lifestyle including environmental exposures are warranted.

Dosimetric Evaluation of 3-D Conformal and Intensity-modulated Radiotherapy for Breast Cancer after Conservative Surgery

  • Mansouri, Safae;Naim, Asmaa;Glaria, Luis;Marsiglia, Hugo
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.11
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    • pp.4727-4732
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    • 2014
  • Background: Breast cancers are becoming more frequently diagnosed at early stages with improved long term outcomes. Late normal tissue complications induced by radiotherapy must be avoided with new breast radiotherapy techniques being developed. The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk between conformal (CRT) and intensity-modulated radiation therapy (IMRT) after breast-conserving surgery. Materials and Methods: A total of 20 patients with early stage left breast cancer received adjuvant radiotherapy after conservative surgery, 10 by 3D-CRT and 10 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram analyses in terms of PTV homogeneity and conformity indices as well as organs at risk dose and volume parameters. Results: The HI and CI of PTV showed no difference between 3D-CRT and IMRT, V95 gave 9.8% coverage for 3D-CRT versus 99% for IMRT, V107 volumes were recorded 11% and 1.3%, respectively. Tangential beam IMRT increased volume of ipsilateral lung V5 average of 90%, ipsilateral V20 lung volume was 13%, 19% with IMRT and 3D-CRT respectively. Patients treated with IMRT, heart volume encompassed by 60% isodose (30 Gy) reduced by average 42% (4% versus 7% with 3D-CRT), mean heart dose by average 35% (495cGy versus 1400 cGy with 3D-CRT). In IMRT minimal heart dose average is 356 cGy versus 90cGy in 3D-CRT. Conclusions: IMRT reduces irradiated volumes of heart and ipsilateral lung in high-dose areas but increases irradiated volumes in low-dose areas in breast cancer patients treated on the left side.

Evaluation of Quality of Life in Turkish Patients with Head and Neck Cancer

  • Akkas, Ebru Atasever;Yucel, Birsen;Kilickap, Saadettin;Altuntas, Emine Elif
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.8
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    • pp.4805-4809
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    • 2013
  • Background: In this study, our aim was to investigate the effect of factors, such as radiotherapy, the dose of radiotherapy, the region of radiotherapy, the age of the patient, performance, co-morbidity, the stage of the disease and the therapy modalities on the quality of life of patients with head and neck cancer. Materials and Methods: Eighty-two patients who were treated by either chemoradiotherapy or radiotherapy, at the Cumhuriyet University Faculty of Medicine, Department of Radiation Oncology, between February 2007 and September 2010, for head and neck cancer were included. The quality of life European Organisation for Research and Treatment of Cancer, Questionnaire module to be used in Quality of Life assessments in Head and Neck Cancer (EORTC QLQ-H&N35) questionnaire was conducted in all patients before starting the radiotherapy, in the middle, at the end, at 1 month and at 6 months after the treatment. Results: According to the questionnaires at the end and at the $6^{th}$ month after the radiotherapy, it was found that the age of the patient, co-morbidity, ECOG performance state, localization, type of treatment, the stage of the disease, the dose and the region of radiotherapy affect some of the symptom scales for quality of life. Conclusions: Quality of life was affected negatively during and after the radiotherapy. However, in the $6^{th}$ month after the therapy, a significant improvement was observed in most symptoms.