Complications of thoracic radiotherapy

Chargari, Cyrus; Riet, F.-G.; Mazevet, Marianne; Morel, Éric; Lepéchoux, C.; Deutsch, Éric

doi:10.1016/j.lpm.2013.06.012

Cited by 54 publications

(47 citation statements)

References 85 publications

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“…Additionally, the CR rate was higher among DA‐R‐EPOCH treated patients (84% vs. 70%) and the use of radiation therapy was considerably lower with only 10/76 (13%) DA‐R‐EPOCH treated patients receiving consolidative radiation. Limiting radiation use can spare patients from both short‐term and long‐term toxicities which include secondary cancers, lung fibrosis, premature coronary artery disease and pulmonary/cardiac dysfunction (Hodgson, ; Chargari et al , ). Our DA‐R‐EPOCH survival outcomes are corroborated by a recent abstract that retrospectively reviewed outcomes with DA‐R‐EPOCH chemotherapy alone for PMBCL.…”

Section: Discussionmentioning

confidence: 99%

R‐CHOP versus dose‐adjusted R‐EPOCH in frontline management of primary mediastinal B‐cell lymphoma: a multi‐centre analysis

et al. 2017

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Primary mediastinal (thymic) large B-cell lymphoma (PMBCL) is an uncommon subtype of non-Hodgkin lymphoma (NHL) that presents with a mediastinal mass and has unique clinicopathological features. Historically, patients with PMBCL were treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy ± involved field radiation. Since a phase II trial, published in April 2013, demonstrated excellent results using dose-adjusted (DA) R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), this treatment has gained popularity. We performed a retrospective, multicentre analysis of patients aged ≥18 years with PMBCL since January 2011. Patients were stratified by frontline regimen, R-CHOP versus DA-R-EPOCH. 132 patients were identified from 11 contributing centres (56 R-CHOP and 76 DA-R-EPOCH). The primary outcome was overall survival. Secondary outcomes included progression-free survival, complete response (CR) rate, and rates of treatment-related complications. Demographic characteristics were similar in both groups. DA-R-EPOCH use increased after April 2013 (79% vs. 45%, P < 0·001), and there was less radiation use after DA-R-EPOCH (13% vs. 59%, P < 0·001). While CR rates were higher with DA-R-EPOCH (84% vs. 70%, P = 0·046), these patients were more likely to experience treatment-related toxicities. At 2 years, 89% of R-CHOP patients and 91% of DA-R-EPOCH patients were alive. To our knowledge, this represents the largest series comparing outcomes of R-CHOP to DA-R-EPOCH for PMBCL.

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Section: Discussionmentioning

confidence: 99%

R‐CHOP versus dose‐adjusted R‐EPOCH in frontline management of primary mediastinal B‐cell lymphoma: a multi‐centre analysis

et al. 2017

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“…17 Systemic toxicity and complications are also significant concerns in radiation therapy as well as in surgery, which is an invasive procedure on its own. 18, 19 Although PDT seems to have the potential to overcome these challenges, the current PS and light sources still have a number of limitations and have room for improvement. Skin phototoxicity (patients treated with PDT must avoid direct sunlight or strong indoor lighting for weeks), 20 low tumor/normal tissue accumulation ratio (especially in organs such as liver and spleen which possess leaky vasculature), 21 strong oxygen dependence which cannot be well satisfied in hypoxic tumor tissue, 22 sub-optimal EPR effect, aggregation of hydrophobic PS resulting in reduced ROS formation due to self-quenching of the excited state, 23, 24 and limited penetration of light to deep tissues are among the main challenges.…”

Section: Nanoparticles As Drug Delivery Vehicles For High Efficacy Pdtmentioning

confidence: 99%

Photodynamic Therapy: One Step Ahead with Self-Assembled Nanoparticles

Avci¹,

Erdem²,

Hamblin³

2014

j biomed nanotechnol

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Photodynamic therapy (PDT) is a promising treatment modality for cancer with possible advantages over current treatment alternatives. It involves combination of light and a photosensitizer (PS), which is activated by absorption of specific wavelength light and creates local tissue damage through generation of reactive oxygen species (ROS) that induce a cascade of cellular and molecular events. However, as of today, PDT is still in need of improvement and nanotechnology may play a role. PDT frequently employs PS with molecular structures that are highly hydrophobic, water insoluble and prone to aggregation. Aggregation of PS leads to reduced ROS generation and thus lowers the PDT activity. Some PS such as 5-aminolevulinic acid (ALA) cannot penetrate through the stratum corneum of the skin and systemic administration is not an option due to frequently encountered side effects. Therefore PS are often encapsulated or conjugated in/on nano-drug delivery vehicles to allow them to be better taken up by cells and to more selectively deliver them to tumors or other target tissues. Several nano-drug delivery vehicles including liposomes, fullerosomes and nanocells have been tested and reviewed. Here we cover non-liposomal self-assembled nanoparticles consisting of polymeric micelles including block co-polymers, polymeric micelles, dendrimers and porphysomes.

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“…Patients treated with adjuvant external beam radiation therapy (RT) after breast surgery are exposed to high doses of radiation to the chest. Radiation toxicity on healthy lung tissues appears to be of concern for chest irradiation, and in some case, it may reduce the survival benefits of radiation treatment …”

mentioning

confidence: 99%

“…Radiation toxicity on healthy lung tissues appears to be of concern for chest irradiation, and in some case, it may reduce the survival benefits of radiation treatment. 1 Clinically significant symptomatic radiation pneumonitis occurs in patients irradiated for cancers of the lung (approximately 5-50%), mediastinal lymphatics (5-10%), and breast (1-5%) 2,3 and is one of the most common clinical toxicities in these patients. For a large fraction of patients, subclinical RT-induced injury such as reductions in pulmonary function tests and/or radiologic changes may be chronic and reduce the patient's reserve to deal with future cardiopulmonary stresses.…”

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confidence: 99%