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Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions.

ABSTRACT: We aimed to analyze the outcomes of hypofractionated high-energy electron beam radiotherapy for the treatment of keloids. From February 1998 to January 2012, 568 patients with a total of 834 keloids underwent radiotherapy: 826 lesions with postoperative radiotherapy, and 36 with skin-grafting. Lesion size was >5 cm in 335 keloids. An electron-beam of 6 or 7 MeV was used, with a total dose of 18 Gy (two fractions with a 1-week interval) covering the lesion with a 1-cm margin. The time between surgery and radiotherapy was 24-48 h. Skin-grafted patients underwent radiotherapy 10-15 days after the operation. The median follow-up was 40 months (range: 12-160 months). The local control rate was 88.25% (736/834). The relapse rate was 9.59% (80/834), and the time to relapse was 6-28 months (median: 12 months). Univariate analyses showed that gender, age, keloid size, keloid site, skin grafting, and operation-to-irradiation interval influenced the local control rate. Multivariate analysis showed that the relapse rate was correlated with gender (P = 0.048), age (P < 0.01), operation-to-irradiation interval (P < 0.01), keloid site (P < 0.01), surgical method (P = 0.04) and keloid size (P < 0.02). Adverse effects were observed in 9.83% (82/834). No radiation-induced cancers were observed. Hypofractionated high-energy electron beam radiotherapy for keloids yielded excellent outcomes, especially in cases without skin grafting. Early postoperative radiotherapy with limited hypofractionation could be a good choice for keloid treatment.

SUBMITTER: Shen J

PROVIDER: S-EPMC4577000 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions.

Shen Jie J Lian Xin X Sun Yuliang Y Wang Xiaojun X Hu Ke K Hou Xiaorong X Sun Shuai S Yan Junfang J Yu Lang L Sun Xiansong X Li Wenbo W Wang Xinhai X Guan Qiu Q Pang Tingtian T Zhang Fuquan F

Journal of radiation research 20150728 5

We aimed to analyze the outcomes of hypofractionated high-energy electron beam radiotherapy for the treatment of keloids. From February 1998 to January 2012, 568 patients with a total of 834 keloids underwent radiotherapy: 826 lesions with postoperative radiotherapy, and 36 with skin-grafting. Lesion size was >5 cm in 335 keloids. An electron-beam of 6 or 7 MeV was used, with a total dose of 18 Gy (two fractions with a 1-week interval) covering the lesion with a 1-cm margin. The time between sur ...[more]

PMID: 26224888

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Project description:Background Little is known about the effectiveness of hypofractionated radiation therapy (HFRT) or stereotactic body radiation therapy (SBRT) for the treatment of patients with oligometastatic (OM) or oligoprogressive (OP) thymic malignancies. Methods We retrospectively reviewed Stage IV patients with OM or OP thymic malignancies treated with HFRT or SBRT between 2009–2021. We defined OM as 5 or fewer sites of metastatic disease and OP as 5 or fewer sites of metastatic disease increasing in radiological size at the time of radiation. Analysis of local failure (LF, defined as failure within a treated lesion) and distant failure (DF, defined as failure outside the treated lesion) was done at the treatment course level using univariate analysis Fine-Gray regression adjusted for clustering. Analysis of overall survival (OS) and progression-free survival (PFS) was done at the patient level utilizing only the first course of treatment for each patient. Results Our analysis included 50 patients with 92 treatment courses. Patients had thymoma (50%), thymic carcinoma (TC, 40%), or atypical thymic carcinoid (ATC, 10%). The median biologic effective dose (BED) was 51 Gy (range, 38–106 Gy). With a median follow-up of 36 months, the median OS and PFS were 50 and 6.5 months, respectively. Patients with TC or ATC had significantly worse PFS than those with thymoma [hazard ratio (HR) 2.37; 95% confidence interval (CI): 1.18–4.76, P=0.013], but similar OS (P=0.55) and LF (P=0.729). Treated thymoma lesions had a lower hazard of DF than TC/ATC lesions, but this was not statistically significant (HR 0.59; 95% CI: 0.34–1.03, P=0.065). Lesions treated to a BED higher than 60 Gy had lower hazards of LF and DF, although this was not statistically significant (HR 0.29; 95% CI: 0.05–1.68, P=0.166 and HR 0.58; 95% CI: 0.3–1.1, P=0.096, respectively). Conclusions In our analysis, patients with TC or ATC had worse PFS than those with thymoma. Treated thymoma and TC/ATC lesions had similar hazards of LF, indicating similar radiation sensitivity in thymic lesions regardless of histology. There was a trend towards increased local control with higher BED regimens, but this did not reach statistical significance. Overall, our analysis points to the need for clinical trials on HFRT/SBRT for the treatment of these rare malignancies.

Project description:IntroductionThe recent results from the Nordic-HILUS study indicate stereotactic body radiation therapy (SBRT) is associated with high-grade toxicity for ultracentral (UC) tumors. We hypothesized that magnetic resonance-guided SBRT (MRgSBRT) or hypofractionated radiation therapy (MRgHRT) enables the safe delivery of high-dose radiation to central and UC lung lesions.MethodsPatients with UC or central lesions were treated with MRgSBRT/MRgHRT with real-time gating or adaptation. Central lesions were defined as per the Radiation Therapy Oncology Group and UC as per the HILUS study definitions: (1) group A or tumors less than 1 cm from the trachea and/or mainstem bronchi; or (2) group B or tumors less than 1 cm from the lobar bronchi. The Kaplan-Meier estimate and log-rank test were used to estimate survival. Associations between toxicities and other patient factors were tested using the Mann-Whitney U test and Fisher's exact test.ResultsA total of 47 patients were included with a median follow-up of 22.9 months (95% confidence interval: 16.4-29.4). Most (53%) had metastatic disease. All patients had central lesions and 55.3% (n = 26) had UC group A. The median distance from the proximal bronchial tree was 6.0 mm (range: 0.0-19.0 mm). The median biologically equivalent dose (α/β = 10) was 105 Gy (range: 75-151.2). The most common radiation schedule was 60 Gy in eight fractions (40.4%). Most (55%) had previous systemic therapy, 32% had immunotherapy and 23.4% had previous thoracic radiation therapy. There were 16 patients who underwent daily adaptation. The 1-year overall survival was 82% (median = not reached), local control 87% (median = not reached), and progression-free survival 54% (median = 15.1 mo, 95% confidence interval: 5.1-25.1). Acute toxicity included grade 1 (26%) and grade 2 (21%) with only two patients experiencing grade 3 (4.3%) in the long term. No grade 4 or 5 toxicities were seen.ConclusionsPrevious studies noted high rates of toxicity after SBRT to central and UC lung lesions, with reports of grade 5 toxicities. In our cohort, the use of MRgSBRT/MRgHRT with high biologically effective doses was well tolerated, with two grade 3 toxicities and no grade 4/5.

Project description:PurposeData comparing moderately hypofractionated intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) are lacking. We aim to compare late toxicity profiles of patients with early-stage prostate cancer treated with moderately hypofractionated PBT and IMRT.Methods and materialsThis multi-institutional analysis included patients with low- or intermediate-risk biopsy-proven prostate adenocarcinoma from 7 tertiary referral centers treated from 1998 to 2018. All patients were treated with moderately hypofractionated radiation, defined as 250 to 300 cGy per daily fraction given for 4 to 6 weeks, and stratified by use of IMRT or PBT. Primary outcomes were late genitourinary (GU) and gastrointestinal (GI) toxicity. Adjusted toxicity rates were calculated using inverse probability of treatment weighting, accounting for race, National Comprehensive Cancer Network risk group, age, pretreatment International Prostate Symptom Score (GU only), and anticoagulant use (GI only).ResultsA total of 1850 patients were included: 1282 IMRT (median follow-up 80.0 months) and 568 PBT (median follow-up 43.9 months). Overall toxicity rates were low, with the majority of patients experiencing no late GU (56.6%, n = 1048) or late GI (74.4%, n = 1377) toxicity. No difference was seen in the rates of late toxicity between the groups, with late grade 3+ GU toxicity of 2.0% versus 3.9% (odds ratio [OR] 0.47; 95% confidence interval 0.17-1.28) and late grade 2+ GI toxicity of 14.6% versus 4.7% (OR 2.69; confidence interval 0.80-9.05) for the PBT and IMRT cohorts, respectively. On multivariable analysis, no factors were significantly predictive of GU toxicity, and only anticoagulant use was significantly predictive of GI toxicity (OR 1.90; P = .008).ConclusionsIn this large, multi-institutional analysis of 1850 patients with early-stage prostate cancer, treatment with moderately hypofractionated IMRT and PBT resulted in low rates of toxicity. No difference was seen in late GI and GU toxicity between the modalities during long-term follow-up. Both treatments are safe and well tolerated.

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Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions.

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Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions.

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