Bruno Meduri1, Fabiana Gregucci2, Elisa D'Angelo3, Anna Rita Alitto4, Elisa Ciurlia5, Isacco Desideri6, Lorenza Marino7, Paolo Borghetti8, Michele Fiore9, Alba Fiorentino2. 1. Radiation Oncology Unit, University Hospital of Modena, Via del pozzo, 71, 41124, Modena, Italy. 2. Radiotherapy Oncology Department, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy. 3. Radiation Oncology Unit, University Hospital of Modena, Via del pozzo, 71, 41124, Modena, Italy. dangelo.elisa@aou.mo.it. 4. Radiotherapy Oncology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radioterapia, Rome, Italy. 5. Radiotherapy Oncology Department, Vito Fazzi Hospital, Lecce, Italy. 6. Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Firenze, Italy. 7. Radiotherapy Oncology Department, REM, Viagrande, Catania, Italy. 8. Radiation Oncology Department University and Spedali Civili, Brescia, Italy. 9. Radiation Oncology, Campus Bio-Medico University, Rome, Italy.
Abstract
PURPOSE: New RT techniques and data emerging from follow-up for several tumor sites suggest that treatment volume de-escalation may permit to minimize therapy-related side effects and/or obtain better clinical outcomes. Here, we summarize the main evidence about volume de-escalation in RT. METHOD: The relevant literature from PubMed was reviewed in this article. The ClinicalTrials.gov database was searched for clinical trials related to the specific topic. RESULTS: In Lymphoma, large-volume techniques (extended- and involved-field RT) are being successfully replaced by involved-site RT and involved-node RT. In head and neck carcinoma, spare a part of elective neck is controversial. In early breast cancer, partial breast irradiation has been established as a treatment option in low-risk patients. In pancreatic cancer stereotactic body radiotherapy may be used to dose escalation. Stereotactic radiosurgery should be the treatment choice for patients with oligometastatic brain disease and a life expectancy of more than 3 months, and it should be considered an alternative to WBRT for patients with multiple brain metastases. CONCLUSION: Further clinical trials are necessary to improve the identification of suitable patient cohorts and the extent of possible volume de-escalation that does not compromise tumor control.
PURPOSE: New RT techniques and data emerging from follow-up for several tumor sites suggest that treatment volume de-escalation may permit to minimize therapy-related side effects and/or obtain better clinical outcomes. Here, we summarize the main evidence about volume de-escalation in RT. METHOD: The relevant literature from PubMed was reviewed in this article. The ClinicalTrials.gov database was searched for clinical trials related to the specific topic. RESULTS: In Lymphoma, large-volume techniques (extended- and involved-field RT) are being successfully replaced by involved-site RT and involved-node RT. In head and neck carcinoma, spare a part of elective neck is controversial. In early breast cancer, partial breast irradiation has been established as a treatment option in low-risk patients. In pancreatic cancer stereotactic body radiotherapy may be used to dose escalation. Stereotactic radiosurgery should be the treatment choice for patients with oligometastatic brain disease and a life expectancy of more than 3 months, and it should be considered an alternative to WBRT for patients with multiple brain metastases. CONCLUSION: Further clinical trials are necessary to improve the identification of suitable patient cohorts and the extent of possible volume de-escalation that does not compromise tumor control.
Entities:
Keywords:
Breast cancer; Head and neck cancer; Hodgkin’s lymphoma; Pancreatic cancer; Stereotactic body radiotherapy; Target volume de-escalation
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