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Cancers
Special Issues
Hypofractionated Radiotherapy in Cancer Treatments
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Hypofractionated Radiotherapy in Cancer Treatments

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 10055

Special Issue Editors

Dr. Joelle Helou

E-Mail Website
Guest Editor
Department of Oncology, Division of Radiation Oncology, Western University, London, ON N6A 3K7, Canada
Interests: GU and breast malignancies with an emphasis on prostate brachytherapy; extracranial SBRT; quality of life research and health economics
Dr. Noelia Sanmamed Salgado

E-Mail Website
Guest Editor
Radiation Oncology Department at Hospital Clinico San Carlos, Research Institute Hospital Clinico San Carlos, 28040 Madrid, Spain
Interests: GU and GYN malignancies; SBRT and brachytherapy

Special Issue Information

Dear Colleagues,

Hypofractionated radiotherapy describes the delivery of fewer and larger fractions over a shorter period of time than standard radiation therapy. This has become more feasible as a result of advances in technology and imaging, allowing both the delivery of more conformal treatments and the limitation of the dose to the normal tissue.

Over the past decade, multiple large trials have established the non-inferiority of hypofractionated radiotherapy compared to conventional fractionation and, as a result, hypofractionated radiotherapy has gained popularity across multiple tumor sites and indications.

Radiation schemas, under the influence of the so-called '5Rs' of repair, repopulation, redistribution, reoxygenation, and radiosensitivity, have evolved from those of standard fractionation to moderate hypofractionation. In addition, there is currently an increased use of extreme hypofractionation, with stereotactic radiotherapy and high dose-rate brachytherapy.

This shift towards more hypofractionation carries the promise of more convenience, better cost effectiveness and potentially a better therapeutic ratio, with improved dose intensity and conformity and decreased dose being delivered to the normal tissue.

Hypofractionation is now widely accepted as a standard method of care. The aim of this Special Issue is to highlight the use of hypofractionated radiation across multiple cancer sites and indications.

We invite the submission of articles and reviews highlighting the use of hypofractionation.

Suggested themes for submissions.

  • Prostate
  • Prostate Metastatic
  • Metastatic/palliative
  • Breast
  • Gynecologic malignancies
  • Head and neck
  • Lung
  • Kidney
  • GI/liver
  • Cost effectiveness of hypofractionation?
  • QoL

We look forward to receiving your contributions.

Dr. Joelle Helou
Dr. Noelia Sanmamed Salgado
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hypofractionation
  • SBRT
  • brachytherapy
  • therapeutic ratio
  • hypofractionated radiotherapy

Published Papers (7 papers)

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Research

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11 pages, 270 KiB  
Article
Clinical Outcomes of Patients with Metastatic Breast Cancer Treated with Hypo-Fractionated Liver Radiotherapy
by Melinda Mushonga, Joelle Helou, Jessica Weiss, Laura A. Dawson, Rebecca K. S. Wong, Ali Hosni, John Kim, James Brierley, C. Anne Koch, Khalid Alrabiah, Patricia Lindsay, Teo Stanescu and Aisling Barry
Cancers 2023, 15(10), 2839; https://doi.org/10.3390/cancers15102839 - 19 May 2023
Viewed by 1170
Abstract
Purpose: To retrospectively review the clinical outcomes of patients with metastatic breast cancer (MBCa) following liver directed ablative intent radiotherapy (RT). Methods: Demographics, disease and treatment characteristics of patients with MBCa who received liver metastasis (LM) directed ablative RT between 2004–2020 were analysed. [...] Read more.
Purpose: To retrospectively review the clinical outcomes of patients with metastatic breast cancer (MBCa) following liver directed ablative intent radiotherapy (RT). Methods: Demographics, disease and treatment characteristics of patients with MBCa who received liver metastasis (LM) directed ablative RT between 2004–2020 were analysed. The primary outcome was local control (LC), secondary outcomes included overall survival (OS) and progression-free survival (PFS) analyzed by univariate (UVA) and multi-variable analysis (MVA). Results: Thirty MBCa patients with 50 LM treated with 5–10 fraction RT were identified. Median follow-up was 14.6 (range 0.9–156.2) months. Class of metastatic disease was described as induced (12 patients, 40%), repeat (15 patients, 50%) and de novo (three patients, 10%). Median size of treated LM was 3.1 cm (range 1–8.8 cm) and median biologically effective dose delivered was 122 (Q1–Q3; 98–174) Gy3. One-year LC rate was 100%. One year and two-year survival was 89% and 63%, respectively, with size of treated LM predictive of OS (HR 1.35, p = 0.023) on UVA. Patients with induced OMD had a significantly higher rate of progression (HR 4.77, p = 0.01) on UVA, trending to significance on MVA (HR 3.23, p = 0.051). Conclusions: Hypo-fractionated ablative liver RT in patients with MBCa provides safe, tolerable treatment with excellent LC. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)

Review

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26 pages, 401 KiB  
Review
Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings
by Maria Thereza Mansur Starling, Stephane Thibodeau, Cecília Félix Penido Mendes de Sousa, Felipe Cicci Farinha Restini, Gustavo A. Viani, Andre G. Gouveia, Lucas C. Mendez, Gustavo Nader Marta and Fabio Ynoe Moraes
Cancers 2024, 16(3), 539; https://doi.org/10.3390/cancers16030539 - 26 Jan 2024
Cited by 1 | Viewed by 1011
Abstract
The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially [...] Read more.
The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)
16 pages, 1351 KiB  
Review
Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence
by Razan Amjad, Nataliya Moldovan, Hamid Raziee, Eric Leung, David D’Souza and Lucas C. Mendez
Cancers 2024, 16(2), 362; https://doi.org/10.3390/cancers16020362 - 15 Jan 2024
Viewed by 1303
Abstract
Radiotherapy (RT) has a fundamental role in the treatment of gynecologic malignancies, including cervical and uterine cancers. Hypofractionated RT has gained popularity in many cancer sites, boosted by technological advances in treatment delivery and image verification. Hypofractionated RT uptake was intensified during the [...] Read more.
Radiotherapy (RT) has a fundamental role in the treatment of gynecologic malignancies, including cervical and uterine cancers. Hypofractionated RT has gained popularity in many cancer sites, boosted by technological advances in treatment delivery and image verification. Hypofractionated RT uptake was intensified during the COVID-19 pandemic and has the potential to improve universal access to radiotherapy worldwide, especially in low-resource settings. This review summarizes the rationale, the current challenges and investigation efforts, together with the recent developments associated with hypofractionated RT in gynecologic malignancies. A comprehensive search was undertaken using multiple databases and ongoing trial registries. In the definitive radiotherapy setting for cervical cancers, there are several ongoing clinical trials from Canada, Mexico, Iran, the Philippines and Thailand investigating the role of a moderate hypofractionated external beam RT regimen in the low-risk locally advanced population. Likewise, there are ongoing ultra and moderate hypofractionated RT trials in the uterine cancer setting. One Canadian prospective trial of stereotactic hypofractionated adjuvant RT for uterine cancer patients suggested a good tolerance to this treatment strategy in the acute setting, with a follow-up trial currently randomizing patients between conventional fractionation and the hypofractionated dose regimen delivered in the former trial. Although not yet ready for prime-time use, hypofractionated RT could be a potential solution to several challenges that limit access to and the utilization of radiotherapy for gynecologic cancer patients worldwide. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)
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21 pages, 1386 KiB  
Review
MR-LINAC, a New Partner in Radiation Oncology: Current Landscape
by Abrahams Ocanto, Lisselott Torres, Miguel Montijano, Diego Rincón, Castalia Fernández, Beatriz Sevilla, Daniela Gonsalves, Macarena Teja, Marcos Guijarro, Luis Glaría, Raúl Hernánz, Juan Zafra-Martin, Noelia Sanmamed, Amar Kishan, Filippo Alongi, Drew Moghanaki, Himanshu Nagar and Felipe Couñago
Cancers 2024, 16(2), 270; https://doi.org/10.3390/cancers16020270 - 08 Jan 2024
Viewed by 2851
Abstract
Technological advances in radiation oncology are oriented towards improving treatment precision and tumor control. Among these advances, magnetic-resonance-image-guided radiation therapy (MRgRT) stands out, with technological advances to deliver targeted treatments adapted to a tumor’s anatomy on the day while minimizing incidental exposure to [...] Read more.
Technological advances in radiation oncology are oriented towards improving treatment precision and tumor control. Among these advances, magnetic-resonance-image-guided radiation therapy (MRgRT) stands out, with technological advances to deliver targeted treatments adapted to a tumor’s anatomy on the day while minimizing incidental exposure to organs at risk, offering an unprecedented therapeutic advantage compared to X-ray-based IGRT delivery systems. This new technology changes the traditional workflow in radiation oncology and requires an evolution in team coordination to administer more precise treatments. Once implemented, it paves the way for newer indication for radiation therapy to safely deliver higher doses than ever before, with better preservation of healthy tissues to optimize patient outcomes. In this narrative review, we assess the technical aspects of the novel linear accelerators that can deliver MRgRT and summarize the available published experience to date, focusing on oncological results and future challenges. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)
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13 pages, 4123 KiB  
Review
Hypofractionation in Glioblastoma: An Overview of Palliative, Definitive, and Exploratory Uses
by Cecilia Jiang, Casey Mogilevsky, Zayne Belal, Goldie Kurtz and Michelle Alonso-Basanta
Cancers 2023, 15(23), 5650; https://doi.org/10.3390/cancers15235650 - 29 Nov 2023
Viewed by 1194
Abstract
Glioblastoma (GBM) is the most common primary brain malignancy in adults, and its incidence is increasing worldwide. Its prognosis remains limited despite recent imaging and therapeutic advances. The current standard of care is maximal safe resection followed by conventionally fractionated radiotherapy with concurrent [...] Read more.
Glioblastoma (GBM) is the most common primary brain malignancy in adults, and its incidence is increasing worldwide. Its prognosis remains limited despite recent imaging and therapeutic advances. The current standard of care is maximal safe resection followed by conventionally fractionated radiotherapy with concurrent and adjuvant temozolomide (TMZ), with or without tumor-treating fields (TTF). However, hypofractionated radiotherapy (HFRT) has also been utilized for a variety of reasons. It is an established treatment option in the palliative setting, where shortened treatment duration can positively impact the overall quality of life for older patients or those with additional health or socioeconomic considerations. HFRT, and in particular stereotactic radiosurgery (SRS), has also been explored in both the pre- and post-operative setting for newly diagnosed and recurrent diseases. In this review, we summarize the ways in which HFRT has been utilized in the GBM patient population and its evolving role in the experimental space. We also provide commentary on scenarios in which HFRT may be indicated, as well as guidance on dose and fractionation regimens informed by our institutional experience. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)
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20 pages, 360 KiB  
Review
The Evolving Role of Stereotactic Body Radiation Therapy for Head and Neck Cancer: Where Do We Stand?
by Issa Mohamad, Irene Karam, Ahmed El-Sehemy, Ibrahim Abu-Gheida, Akram Al-Ibraheem, Hossam AL-Assaf, Mohammed Aldehaim, Majed Alghamdi, Ibrahim Alotain, May Ashour, Ahmad Bushehri, Mostafa ElHaddad and Ali Hosni
Cancers 2023, 15(20), 5010; https://doi.org/10.3390/cancers15205010 - 16 Oct 2023
Viewed by 1261
Abstract
Stereotactic body radiation therapy (SBRT) is a precise and conformal radiation therapy (RT) that aims to deliver a high dose of radiation to the tumor whilst sparing surrounding normal tissue, making it an attractive option for head and neck cancer (HNC) patients who [...] Read more.
Stereotactic body radiation therapy (SBRT) is a precise and conformal radiation therapy (RT) that aims to deliver a high dose of radiation to the tumor whilst sparing surrounding normal tissue, making it an attractive option for head and neck cancer (HNC) patients who are not suitable for the traditional long course of RT with comprehensive RT target volume. Definitive SBRT for HNC has been investigated in different settings, including early stage glottis cancer, and as an alternative to brachytherapy boost after external beam RT. It is also used as a primary treatment option for elderly or medically unfit patients. More recently, an SBRT combination with immunotherapy in the neoadjuvant setting for HNC showed promising results. Salvage or adjuvant SBRT for HNC can be used in appropriately selected cases. Future studies are warranted to determine the optimum dose and fractionation schedules in any of these indications. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)

Other

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17 pages, 711 KiB  
Systematic Review
Stereotactic Body Radiotherapy for Extracranial Oligometastatic Disease from Head and Neck Primary Cancers: A Systematic Review and Meta-Analysis
by Adam Mutsaers, Aquila Akingbade, Alexander V. Louie, Badr Id Said, Liying Zhang, Ian Poon, Martin Smoragiewicz, Antoine Eskander and Irene Karam
Cancers 2024, 16(5), 851; https://doi.org/10.3390/cancers16050851 - 20 Feb 2024
Cited by 1 | Viewed by 633
Abstract
Introduction: Stereotactic body radiotherapy (SBRT) is increasingly used to treat disease in the oligometastatic (OM) setting due to mounting evidence demonstrating its efficacy and safety. Given the low population representation in prospective studies, we performed a systematic review and meta-analysis of outcomes of [...] Read more.
Introduction: Stereotactic body radiotherapy (SBRT) is increasingly used to treat disease in the oligometastatic (OM) setting due to mounting evidence demonstrating its efficacy and safety. Given the low population representation in prospective studies, we performed a systematic review and meta-analysis of outcomes of HNC patients with extracranial OM disease treated with SBRT. Methods: A systematic review was conducted with Cochrane, Medline, and Embase databases queried from inception to August 2022 for studies with extracranial OM HNC treated with stereotactic radiotherapy. Polymetastatic patients (>five lesions), mixed-primary cohorts failing to report HNC separately, lack of treatment to all lesions, nonquantitative endpoints, and other definitive treatments (surgery, conventional radiotherapy, and radioablation) were excluded. The meta-analysis examined the pooled effects of 12- and 24-month local control (LC) per lesion, progression-free survival (PFS), and overall survival (OS). Weighted random-effects were assessed using the DerSimonian and Laird method, with heterogeneity evaluated using the I2 statistic and Cochran Qtest. Forest plots were generated for each endpoint. Results: Fifteen studies met the inclusion criteria (639 patients, 831 lesions), with twelve eligible for quantitative synthesis with common endpoints and sufficient reporting. Fourteen studies were retrospective, with a single prospective trial. Studies were small, with a median of 32 patients (range: 6–81) and 63 lesions (range: 6–126). The OM definition varied, with a maximum of two to five metastases, mixed synchronous and metachronous lesions, and a few studies including oligoprogressive lesions. The most common site of metastasis was the lung. Radiation was delivered in 1–10 fractions (20–70 Gy). The one-year LC (LC1), reported in 12 studies, was 86.9% (95% confidence interval [CI]: 79.3–91.9%). LC2 was 77.9% (95% CI: 66.4–86.3%), with heterogeneity across studies. PFS was reported in five studies, with a PFS1 of 43.0% (95% CI: 35.0–51.4%) and PFS2 of 23.9% (95% CI: 17.8–31.2%), with homogeneity across studies. OS was analyzed in nine studies, demonstrating an OS1 of 80.1% (95% CI: 74.2–85.0%) and OS2 of 60.7% (95% CI: 51.3–69.4%). Treatment was well tolerated with no reported grade 4 or 5 toxicities. Grade 3 toxicity rates were uniformly below 5% when reported. Conclusions: SBRT offers excellent LC and promising OS, with acceptable toxicities in OM HNC. Durable PFS remains rare, highlighting the need for effective local or systemic therapies in this population. Further investigations on concurrent and adjuvant therapies are warranted. Full article
(This article belongs to the Special Issue Hypofractionated Radiotherapy in Cancer Treatments)
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