Aim:
Comparison of the integral dose (ID) delivered to organs at risk (OAR), non-target body and target body by using different techniques of craniospinal irradiation (CSI).
Materials and methods:
Ten CSI patients (medulloblastoma) already planned and treated either with linear accelerator three-dimensional conformal radiation therapy (Linac-3DCRT) technique or with linear accelerator RapidArc (Linac-RapidArc) technique by Novalis-Tx Linac machine have been analysed. Retrospectively, these patients are again planned on Radixact-X9 Linac with Helical, Direct-3DCRT and Direct-intensity-modulated radiation therapy (Direct-IMRT) techniques. The dose prescription to planning target volume brain (PTV-Brain) and PTV-Spine is 36 Gy in 20 fractions and is kept the same for all techniques. The target body, non-target body, OARs and total body dose are compared.
Results:
ID is lowest in the RapidArc plan for every patient in comparison to Helical and Direct-IMRT. The ID for Body-PTV was found slightly higher in the RapidArc plan in comparison to 3DCRT plans. But there is better normal tissue sparing for most of the OARs in RapidArc plans if it compares with 3DCRT plans.
Findings:
RapidArc is a better alternative for the treatment of CSI. It provides better target coverage and better OARs sparing from any other treatment techniques.
Background: Pathologic complete response (pCR) is known to be a predictive marker for favorable outcome after neoadjuvant treatment in HER2 positive (þ) breast cancer. Our aim was to investigate the association between hormone receptor (HR) or tumorinfiltrating lymphocytes (TILs) and pCR in HER2 (þ) breast cancer treated with dual anti-HER2 therapy. Methods: Ninety-four patients with HER2 (þ) breast cancer who received neoadjuvant treatment with docetaxel, carboplatin, trastuzumab and pertuzumab (TCHP) were included in this retrospective analysis. Associations between TILs and pCR were assessed in the overall and hormone receptor (HR) positive (þ) and HR negative (-) populations. We classified subgroups with a cutoff value of stromal TILs (20% TILs vs > 20% TILs) based on ROC curves. Results: Of the 94 cases, 54 (57.4%) tumors achieved pCR (ypT0/is N0) and median TILs was 17.07% [13.81-20.65]. In analysis of hormone receptor, pCR was 51.0% (n ¼ 26/51) in HR (þ) group and 65.1% (n ¼ 28/43) in HR (-) group (p ¼ 0.167). The pCR rate was higher in the high TILs group than in the low TILs group (74.1% vs 51.4%, p ¼ 0.038). In HR (-) group, high TILs and low TILs achieved 90% (n ¼ 9/10) and 57.6% (n ¼ 19/33) of pCR, respectively. In HR (þ), pCR rates of high TILs and low TILs subgroups were 64.7% (n ¼ 11/17) and 41.7% (n ¼ 15/34). Conclusions: In HER2 (þ) breast cancer, HR (-) and high TILs showed higher pCR compared with HR(þ) and low TILs. TILs might be a predictive marker for the treatment response to neoadjuvant dual anti HER2 based chemotherapy. Further investigation in a larger cohort of samples is needed to validate these results. Legal entity responsible for the study: Asan Medical Center. Funding: Has not received any funding.
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