Latkauskas, T. et al. BMC Cancer. Published: 1 December 2016
Background: There still is no evidence which neoadjuvant therapy regimen for stage II–III rectal cancer is superior. The aim of this study was to compare results achieved after long-course chemoradiotherapy (CRT) with short-term radiotherapy (RT) followed by delayed surgery.
Conclusion: Three-years disease-free survival was better in CRT group comparing with RT group with no difference in overall survival.
Zietman, A.L. Journal of Clinical Oncology. July 10, 2016 vol. 34 no. 20 2323-2324
Why is radiation therapy not simply given in one large dose? This is a question that patients often ask of their radiation oncologists. The answer is simple: it could be, but such a dose would be equally damaging to the cancer and to the normal tissues within the radiation field. It would, essentially, be ablative, and this is an outcome that can easily be achieved by many other methods of energy delivery, not to mention surgery. In the early twentieth century, the pioneers of radiation therapy discovered empirically that fractionating the radiation—delivering it in multiple smaller doses to a higher total dose—not only preserved the power of the treatment to eradicate the tumor, but did so while better maintaining the integrity of the nearby normal tissues. Our increased understanding of radiation biology has given a scientific rationale to support fractionation, and radiation therapy became the cornerstone of the nonablative, organ-preserving strategies that we so commonly use today in breast, head and neck, and, of course, prostate cancer. Over the decades, small, daily fractions of 1.8 Gy to 2.0 Gy were recognized as safe, and these doses became customary throughout much of the world. Treatment courses are currently protracted out to ≤ 8 weeks, a time frame that is certainly inconvenient for many but a small price for a patient to pay for a treatment whose legacy may last a lifetime.
Objective: To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks’ course of external beam whole breast radiotherapy (EBRT) treatment.
Setting: (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT.
Participants: 485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres.
Outcome measures: The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy.
Methods: Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test.
Results: TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient).
Conclusions: The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK.
European Society for Radiotherapy and Oncology (ESTRO). ScienceDaily. Published online: 2 May 2016.
Image of photomicrograph showing testicular seminoma.
A large study of testicular cancer patients has shown that radiation therapy is a better treatment than chemotherapy for patients with stage IIa disease (where one or more regional lymph nodes contain cancer cells but they are less than 2cms in diameter).
These findings, presented at the ESTRO 35 conference today (Monday) and published simultaneously in Clinical Oncology, are important because, until now, there has been little evidence about which treatment for testicular seminoma is more effective, and there has been a tendency to move away from radiation therapy towards chemotherapy for treating stage IIa-b patients. Guidelines from the US National Cancer Comprehensive Network recommend radiotherapy for stage IIa, while those from the European Association of Urology allow for either radiation therapy or chemotherapy; both sets of guidelines are equivocal for stage IIb.
The study of 2,437 patients presented today is the largest group of patients with stage II testicular seminoma evaluated so far, and researchers found that 99% of patients with IIa disease were alive after five years if they had been treated with radiation therapy, versus 93% of patients treated with chemotherapy. For patients with IIb disease, the five-year overall survival was 95% for those treated with radiation therapy and 92% for those treated with chemotherapy.