INTRODUCTION: Oral cancer is a major public health concern in India. Both conventional and altered fractionation radiotherapy schedules have been used in curative treatment of oral cancer. This study aimed to retrospectively evaluate the clinical profile and treatment outcomes of patients with carcinoma buccal mucosa who underwent treatment with definitive hypofractionated accelerated radiotherapy. METHODS: A total of 517 patients treated from January 2011 to December 2016 were eligible for the analysis. All patients were treated with definitive hypofractionated accelerated radiotherapy schedule of 5,250 cGy in 15 fractions over 3 weeks. Survival estimates were generated using the Kaplan-Meier method. RESULTS: At a median follow-up of 77.4 months, 473 (91.5%) patients attained complete remission with radiation therapy. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 69% and 80.5%, respectively. The 5-year OS for stage I, II, III and IVa tumours was 80.3%, 84.4%, 81.4% and 73.7%, respectively, and the DFS was 75.7%, 73.2%, 69.6% and 60.2%, respectively. Age >50 years was found to be a significant factor affecting DFS ( P = 0.026) and OS ( P = 0.048) in multivariate analysis. Fifty-three (10.3%) patients developed osteoradionecrosis of the mandible. CONCLUSION Excellent outcome could be achieved in less-aggressive, low-volume carcinoma of the buccal mucosa with radical accelerated hypofractionated radiotherapy. A radiotherapy schedule over a 3-week period is useful in high-volume centres.
Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Mouth Neoplasms/mortality* ; Mouth Mucosa/radiation effects* ; Treatment Outcome ; Aged ; Adult ; Radiation Dose Hypofractionation ; Disease-Free Survival ; India ; Kaplan-Meier Estimate ; Dose Fractionation, Radiation ; Aged, 80 and over

PURPOSE: To evaluate the adequacy of retreatment, including hypofractionated re-irradiation (HFReRT), after surgery for recurrent glioblastoma (GBM) and related prognosticators of outcomes. MATERIALS AND METHODS: From 2011 to 2014, 25 consecutive patients with recurrent (n=17) or secondary (n=7) disease underwent maximal surgery and subsequent HFReRT after meeting the following conditions: 1) confirmation of recurrent or secondary GBM after salvage surgery; 2) Karnofsky performance score (KPS) ≥60; and 3) interval of ≥12 months between initial radiotherapy and HFReRT. HFReRT was delivered using a simultaneous integrated boost technique, with total dose of 45 Gy in 15 fractions to the gross tumor volume (GTV) and 37.5 Gy in 15 fractions to the clinical target volume. RESULTS: During a median follow-up of 13 months, the median progression-free and overall survival (OS) were 13 and 16 months, respectively. A better KPS (p=0.026), no involvement of the eloquent area at recurrence (p=0.030), and a smaller GTV (p=0.005) were associated with better OS. Additionally, OS differed significantly between risk groups stratified by the National Institutes of Health Recurrent GBM Scale (low-risk vs. high-risk, p=0.025). Radiologically suspected radiation necrosis (RN) was observed in 16 patients (64%) at a median of 9 months after HFReRT, and 8 patients developed grade 3 RN requiring hospitalization. CONCLUSION: HFReRT after maximal surgery prolonged survival in selected patients with recurrent GBM, especially those with small-sized recurrences in non-eloquent areas and good performance.
Adult ; Brain Neoplasms/mortality/pathology/*therapy ; Dose Hypofractionation ; Female ; Glioblastoma/mortality/pathology/*therapy ; Humans ; Karnofsky Performance Status ; Male ; Middle Aged ; Neoplasm Recurrence, Local/mortality/pathology/*therapy ; Prognosis ; *Radiosurgery ; Re-Irradiation/*methods ; Salvage Therapy/methods ; Survival Rate ; Treatment Outcome

PURPOSE: This study retrospectively evaluated the clinical outcomes and complications of proton beam therapy (PBT) in a single institution in Korea and quantitatively analyzed the change in tumor volume after PBT using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Twenty-four treatment-naïve patients who underwent PBT for choroidal melanoma between 2009 and 2015 were reviewed. Dose fractionation was 60-70 cobalt gray equivalents over 5 fractions. Orbital MRIs were taken at baseline and 3, 6, and 12 months after PBT and annually thereafter. The tumor volume was reconstructed and evaluated by stacking the tumor boundary in each thin-sliced axial T1-weighted image using MIM software. RESULTS: The median follow-up duration was 36.5 months (range, 9 to 82 months). One patient had suspicious local progression and two patients had distant metastasis. The 3-year local progression-free survival, distant metastasis-free survival, and overall survival rates were 95.8%, 95.8%, and 100%,respectively. Five Common Terminology Criteria for Adverse Event ver. 4.03 grade 3-4 toxicities were observed in four patients (16.7%), including one with neovascular glaucoma. The mean tumor volume at the baseline MRI was 0.565±0.084 mL (range, 0.074 to 1.610 mL), and the ratios of the mean volume at 3, 6, and 12 months to that at baseline were 81.8%, 67.3%, and 60.4%, respectively. CONCLUSION: The local controlrate and complication profile after PBT in patientswith choroidal melanoma in Korea were comparable with those reported in a previous PBT series. The change in tumor volume after PBT exhibited a gradual regression pattern on MRI.
Choroid* ; Cobalt ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Korea* ; Magnetic Resonance Imaging ; Melanoma* ; Neoplasm Metastasis ; Orbit ; Proton Therapy* ; Protons* ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Tumor Burden

We present our experience on the hypofractionated Gamma Knife radiosurgery (FGKS) for large skull base meningioma as an initial treatment. We retrospectively reviewed 23 patients with large skull base meningioma ≥10 cm³ who underwent FGKS as the initial treatment option. The mean volume of tumors prior to radiosurgery was 21.2±15.63 cm³ (range, 10.09~71.42). The median total margin dose and marginal dose per fraction were 18 Gy (range, 15~20) and 6 Gy (range, 5~6), respectively. Patients underwent three or four fractionations in consecutive days with the same Leksell® frame. The mean follow-up duration was 38 months (range, 17~78). There was no mortality. At the last follow-up, the tumor volume was stationary in 15 patients (65.2%) and had decreased in 8 patients (34.8%). Six patients who had cranial neuropathy at the time of FGKS showed improvement at the last clinical follow-up. Following FGKS, 4 patients (17%) had new cranial neuropathy. The trigeminal neuropathy was the most common and all were transient. The mean Karnofsky Performance Status score at pre-FGKS and the last clinical follow-up was 97.0±10.4 points (median, 100) and 98.6±6.9 (median, 100) points, respectively. FGKS has showed satisfactory tumor control with functional preservation for large skull base meningiomas. Further prospective studies of large cohorts with long term follow-up are required to clarify the efficacy in the tumor control and functional outcome as well as radiation toxicity.
Cohort Studies ; Cranial Nerve Diseases ; Dose Hypofractionation ; Follow-Up Studies ; Humans ; Karnofsky Performance Status ; Meningioma* ; Mortality ; Prospective Studies ; Radiosurgery* ; Retrospective Studies ; Skull Base* ; Skull* ; Trigeminal Nerve Diseases ; Tumor Burden

PURPOSE: This study was conducted to compare clinical outcomes and treatment-related toxicities after stereotactic body radiation therapy (SBRT) with two different dose regimens for small hepatocellular carcinomas (HCC) ≤3 cm in size. MATERIALS AND METHODS: We retrospectively reviewed 44 patients with liver-confined HCC treated between 2009 and 2014 with SBRT. Total doses of 45 Gy (n = 10) or 60 Gy (n = 34) in 3 fractions were prescribed to the 95% isodose line covering 95% of the planning target volume. Rates of local control (LC), intrahepatic failure-free survival (IHFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using the Kaplan-Meier method. RESULTS: Median follow-up was 29 months (range, 8 to 64 months). Rates at 1 and 3 years were 97.7% and 95.0% for LC, 97.7% and 80.7% for OS, 76% and 40.5% for IHFFS, and 87.3% and 79.5% for DMFS. Five patients (11.4%) experienced degradation of albumin-bilirubin grade, 2 (4.5%) degradation of Child-Pugh score, and 4 (9.1%) grade 3 or greater laboratory abnormalities within 3 months after SBRT. No significant difference was seen in any oncological outcomes or treatment-related toxicities between the two dose regimens. CONCLUSIONS: SBRT was highly effective for local control without severe toxicities in patients with HCC smaller than 3 cm. The regimen of a total dose of 45 Gy in 3 fractions was comparable to 60 Gy in efficacy and safety of SBRT for small HCC.
Carcinoma, Hepatocellular ; Dose Fractionation ; Follow-Up Studies ; Humans ; Methods ; Radiosurgery ; Retrospective Studies

PURPOSE: Several accelerated partial breast radiation (APBR) techniques have been investigated in patients with early-stage breast cancer (BC); however, the optimal treatment delivery techniques remain unclear. We evaluated the feasibility and toxicity of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I BC, using a novel fractionation schedule. MATERIALS AND METHODS: Forty-two patients aged ≥65 years, with stage I BC who underwent breast conserving surgery were enrolled in a phase I/II study evaluating APBR using IMRT. Forty eligible patients received 40 Gy in 4 Gy daily fractions. Patients were assessed for treatment related toxicities, and cosmesis, before APBR, during, and after completion of the treatment. RESULTS: The median age was 73 years, median tumor size 0.8 cm and the median follow-up was 54 months. The 5-year locoregional control was 97.5% and overall survival 90%. Erythema and skin pigmentation was the most common acute adverse event, reported by 27 patients (69%). Twenty-six patients (65%) reported mild pain, rated 1-4/10. This improved at last follow-up to only 2 (15%). Overall the patient and physician reported worst late toxicities were lower than the baseline and at last follow-up, patients and physicians rated cosmesis as excellent/good in 93% and 86 %, respectively. CONCLUSION: In this prospective trial, we observed an excellent rate of tumor control with daily APBR. The acceptable toxicity profile and cosmetic results of this study support the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.
Aged* ; Appointments and Schedules* ; Breast Neoplasms ; Breast* ; Dose Hypofractionation ; Erythema ; Follow-Up Studies ; Humans ; Mastectomy, Segmental ; Prospective Studies* ; Radiotherapy, Intensity-Modulated ; Skin Pigmentation

PURPOSE: The purpose of this study was to describe treatment patterns of radiotherapy (RT) for prostate cancer in Korea. MATERIALS AND METHODS: A questionnaire about radiation treatment technique and principles in 2013 was sent to 83 radiation oncologists and data from 57 hospitals were collected analyzed to find patterns of RT for prostate cancer patients in Korea. RESULTS: The number of patients with prostate cancer treated with definitive RT ranged from 1 to 72 per hospital in 2013. RT doses and target volumes increased according to risk groups but the range of radiation doses was wide (60 to 81.4 Gy) and the fraction size was diverse (1.8 to 5 Gy). Intensity-modulated radiation therapy was used for definitive treatment in 93.8% of hospitals. Hormonal therapy was integrated with radiation for intermediate (63.2%) and high risk patients (77.2%). Adjuvant RT after radical prostatectomy was performed in 46 hospitals (80.7%). Indications of adjuvant RT included positive resection margin, seminal vesicle invasion, and capsular invasion. The total dose for adjuvant RT ranged from 50 to 72 Gy in 24–39 fractions. Salvage RT was delivered with findings of consecutive elevations in prostate-specific antigen (PSA), PSA level over 0.2 ng/mL, or clinical recurrence. The total radiation doses ranged from 50 to 80 Gy with a range of 1.8 to 2.5 Gy per fraction for salvage RT. CONCLUSION: This nationwide patterns of care study suggests that variable radiation techniques and a diverse range of dose fractionation schemes are applied for prostate cancer treatment in Korea. Standard guidelines for RT in prostate cancer need to be developed.
Dose Fractionation ; Humans ; Korea* ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Radiotherapy* ; Recurrence ; Seminal Vesicles

PURPOSE: There is controversy regarding the cosmetic outcome after accelerated partial breast radiation (APBR). We report the cosmetic outcome from a single-arm prospective clinical trial of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I breast cancer (BC), using a novel fractionation schedule. MATERIALS AND METHODS: Forty-two patients aged ≥65, with Stage I BC who underwent breast-conserving surgery were enrolled in a phase I/II study evaluating a 2-week course of APBR. Thirty eligible patients received 40 Gy in 4 Gy daily fractions. Cosmetic outcome was assessed subjectively by physician/patient and objectively by using a computer program (BCCT.core) before APBR, during, and after completion of the treatment. RESULTS: The median age was 72 years, the median tumor size was 0.8 cm, and the median follow-up was 50.5 months. The 5-year locoregional control in this cohort was 97% and overall survival 87%. At the last follow-up, patients and physicians rated cosmesis as ‘excellent’ or ‘good’ in 100% and 91 %, respectively. The BCCT.core program scored the cosmesis as ‘excellent’ or ‘good’ in 87% of the patients at baseline and 81% at the last follow-up. The median V50 (20 Gy) of the whole breast volume (WBV) was 37.2%, with the median WBV V100 (40 Gy) of 10.9%. CONCLUSION: An excellent rate of tumor control was observed in this prospective trial. By using multiple assessment techniques, we are showing acceptable cosmesis, supporting the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.
Aged ; Appointments and Schedules* ; Breast Neoplasms* ; Breast* ; Cohort Studies ; Dose Hypofractionation ; Follow-Up Studies ; Humans ; Mastectomy, Segmental ; Prospective Studies*

PURPOSE: The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT. MATERIALS AND METHODS: We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT. RESULTS: Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively. CONCLUSION: Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.
Bilirubin ; Carcinoma, Hepatocellular* ; Cystic Duct ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Gallbladder ; Hepatic Duct, Common ; Humans ; Radiotherapy ; Retrospective Studies

PURPOSE: High dose definitive radiation therapy (RT) alone is recommended to patients with cT1-3N0 non-small cell lung cancer, who are unfit for surgery or stereotactic RT. This study was conducted to evaluate the clinical outcomes and cost-effectiveness following RT alone using two different modest hypofractionation dose schemes. MATERIALS AND METHODS: Between 2001 and 2014, 124 patients underwent RT alone. From 2001 till 2010, 60 Gy in 20 fractions was delivered to 79 patients (group 1). Since 2011, 60 Gy in 20 fractions (group 2, 20 patients), and 60 Gy in 15 fractions (group 3, 25 patients) were selectively chosen depending on estimated risk of esophagitis. RESULTS: At follow-up of 16.7 months, 2-year rates of local control, progression-free survival, and overall survival were 62.6%, 39.1%, and 59.1%, respectively. Overall survival was significantly better in group 3 (p=0.002). In multivariate analyses, cT3 was the most powerful adverse factor affecting clinical outcomes. Incidence and severity of radiation pneumonitis were not different among groups, while no patients developed grade 2 esophagitis in group 3 (p=0.003). Under current Korean Health Insurance Policy, RT cost per person was 22.5% less in group 3 compared with others. CONCLUSION: The current study demonstrated that 60 Gy in 15 fractions instead of 60 Gy in 20 fractions resulted in comparable clinical outcomes with excellent safety, direct cost saving, and improved convenience to the patients with tumors located at ≥ 1.5 cm from the esophagus.
Appointments and Schedules* ; Carcinoma, Non-Small-Cell Lung* ; Cost Savings ; Disease-Free Survival ; Dose Fractionation ; Esophagitis ; Esophagus ; Follow-Up Studies ; Humans ; Incidence ; Insurance, Health ; Multivariate Analysis ; Radiation Pneumonitis ; Radiotherapy