Short course accelerated radiation therapy (SHARON) in palliative treatment of advanced solid cancer in older patients: A pooled analysis

Farina, E.; Capuccini, Jenny; Macchia, G.; Caravatta, L.; Nguyen, Nam P.; Cammelli, S.; Rambaldi, Giuseppe Zanirato; Cilla, Savino; Tigeneh, Wondemagegnhu; Uddin, Aaliya; Sumon, M.A.; Genovesi, Domenico; Buwenge, M.; Cellini, Francesco; Valentini, Vincenzo; Deodato, Francesco; Morganti, Alessio Giuseppe

doi:10.1016/j.jgo.2018.01.004

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…More generally, this study confirmed the efficacy and tolerability of accelerated palliative RT delivered in only two days (four fractions), as previously observed in previous studies on different clinical settings (21)(22)(23)(24)(25)(26)(27). Furthermore, our analysis is in agreement with several studies showing a high palliative response rate after MHB-RT in PCa BM (28)(29)(30), particularly using fractionated regimens (30).…”

Section: Discussionsupporting

confidence: 91%

Accelerated Middle Half Body Radiotherapy in Bone Metastases from Prostate Cancer: A Phase I Study (SHARON Project)

et al. 2019

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Background/Aim: The primary endpoint of this phase I study was the maximum tolerated dose (MTD) of middle half body (MHB) accelerated radiotherapy (RT) in multiple bone metastatic (BM) prostate cancer (PCa) patients. Patients and Methods: Three step dose escalation [13 Gy (3.25 Gy/fraction), 14 Gy (3.5 Gy/fraction), and 15 Gy (3.75 Gy/fraction)] in three consecutive patient cohorts were planned. RT was delivered in two consecutive days and two daily fractions. Six patients were enrolled in the first two cohorts and 12 in the third cohort. Grade ≥3 toxicity was considered as a dose-limiting toxicity (DLT). Results: Twenty-five patients (median age=71 years, median follow-up=7.4 months) were enrolled. Defined MTD dose was 15 Gy. Overall pain response rate was 76%: 9 patients (36%) showed complete and 10 patients (40%) reported partial response of pain. Conclusion: MHB accelerated RT (total dose: 15 Gy) delivered in two consecutive days and two daily fractions is well tolerated.Worldwide, prostatic adenocarcinoma (PCa) represents the second most common cancer in men and the 6th cause of cancer-related death (1). In about 80% of PCa patients, the initial and main site of metastasis is the skeleton (2). Twoand 5-year overall survival (OS) in PCa patients with bone metastases (BM) at the time of diagnosis are 90% and 36%, respectively, (median OS=42.1 months) (3) representing higher rates when compared to patients with visceral metastases (4).Palliative radiotherapy (RT) is a treatment option in BM (5) to reduce pain, prevent pathological fractures, and to improve quality of life (QoL). However, patients requiring palliative RT may suffer from physical discomfort due to transfers to the RT center and/or toxicity, and from emotional distress particularly in case of prolonged treatment duration. These factors can partially explain why in the USA only 3% of hospice patients are treated with RT (6). Based on this background, an optimization of palliative RT is needed with both the aims of reducing toxicity and treatment duration, ultimately improving QoL.In the past decades, several studies reported effective and rapid palliation after half-body RT on multiple BM in patients with different primary tumors (7, 8). In the 90's, Salazar and colleagues evaluated different half-body irradiation treatment schedules (9) and in 2001 the outcomes from a multicenter randomized study sponsored by the International Atomic Energy Agency were published (10). The delivery of 12 Gy in two consecutive days with two fractions/day resulted in an effective and tolerable dose, similar to 15 Gy in 5 daily fractions regimen in several metastatic malignancies but was 5065

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Section: Discussionsupporting

confidence: 91%

Accelerated Middle Half Body Radiotherapy in Bone Metastases from Prostate Cancer: A Phase I Study (SHARON Project)

et al. 2019

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“…As palliative therapy should achieve symptomatic relief with the shortest possible timing, the efficacy of more rapid fractionation schemes was deeply investigated in the last years in our center. In particular, we assessed the tolerability of short‐course accelerated RT in twice daily fractions for two consecutive days in several dose‐escalation trials for head–neck, brain, and pelvic tumors . Our results reported that treatments of twice daily fractions for two consecutive days (5 Gy/fraction) were well tolerated showing a high rate of symptom remission with a good impact on quality of life.…”

Section: Introductionmentioning

confidence: 99%

Partially ablative radiotherapy (PAR) for large mass tumors using simultaneous integrated boost: A dose‐escalation feasibility study

Cilla

Deodato

Ianiro

et al. 2018

J Applied Clin Med Phys

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PurposeThis study aimed to assess the feasibility to plan and deliver highly heterogeneous doses to symptomatic large tumors using volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) during a short course palliative accelerated radiotherapy.MethodsA patient with a large symptomatic chordoma infiltrating the right gluteal region was selected. A modified SIB treatment was implemented to irradiate the central volume of the tumor (boost target volume, BTV) up to 10 Gy/fraction in a dose escalation trial while maintaining the remaining tumor volume (planning target volume, PTV) and the surrounding healthy tissues within 5 Gy/fraction in twice daily fractions for two consecutive days. Four SIB plans were generated in the dual‐arc modality; a basal dose of 20 Gy was prescribed to the PTV, while the BTV was boosted up to 40 Gy. For comparison purposes, plans obtained with a sequential boost (SEQ plans) were also generated. All plans were optimized to deliver at least 95% of the prescription dose to the targets. Dose contrast index (DCI), conformity index (CI), integral dose (ID), and the irradiated body volumes at 5, 10, and 20 Gy were evaluated.ResultsAt equal targets coverage, SIB plans provided major improvement in DCI, CI, and ID with respect to SEQ plans. When BTV dose escalated up to 200% of PTV prescription, DCI resulted in 66% for SIB plans and 37% for SEQ plans; the ID increase was only 11% for SIB plans (vs 27% for SEQ plans) and the increase in healthy tissues receiving more than 5, 10, and 20 Gy was less than 2%. Pretreatment dose verification reported a γ‐value passing rate greater than 95% with 3%(global)‐2 mm.ConclusionA modified SIB technique is dosimetrically feasible for large tumors, where doses higher than the tolerance dose of healthy tissues are necessary to increase the therapeutic gain.

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“…The use of an accelerated hypofractionated bid regimen has been reported in pelvic, 19 head and neck, 20 and brain cancers, 21,22 along with complicated bone metastases 23 and thoracic tumors, 24 with high rates of palliative response and also low toxicity rates in older patients (80 years). 25 Although this schedule has been tested and validated in phase I to II studies planned with 3-dimensional conformal RT, [19][20][21][22][23][24][25] no data on this schedule being delivered using 2-dimensional RT (2D-RT) are available.…”

Section: Introductionmentioning

confidence: 99%

Short-Course 2-Dimensional Radiation Therapy in the Palliative Treatment of Esophageal Cancer in a Developing Country: A Phase II Study (Sharon Project)

Deressa

Wondemagegnehu

Bogale

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Short course accelerated radiation therapy (SHARON) in palliative treatment of advanced solid cancer in older patients: A pooled analysis

Cited by 8 publications

References 8 publications

Accelerated Middle Half Body Radiotherapy in Bone Metastases from Prostate Cancer: A Phase I Study (SHARON Project)

Accelerated Middle Half Body Radiotherapy in Bone Metastases from Prostate Cancer: A Phase I Study (SHARON Project)

Partially ablative radiotherapy (PAR) for large mass tumors using simultaneous integrated boost: A dose‐escalation feasibility study

Short-Course 2-Dimensional Radiation Therapy in the Palliative Treatment of Esophageal Cancer in a Developing Country: A Phase II Study (Sharon Project)

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