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Hoffmann C, Ringbaek T, Eckstein A, Deya W, Santiago A, Heintz M, Lübcke W, Indenkämpen F, Sauerwein W, Flühs A, Le Guin C, Huettmann A, von Tresckow J, Göricke S, Deuschl C, Moliavi S, Poettgen C, Gauler T, Guberina N, Johansson P, Bechrakis N, Stuschke M, Guberina M. Long-Term Follow-Up of Patients with Conjunctival Lymphoma after Individualized Lens-Sparing Electron Radiotherapy: Results from a Longitudinal Study. Cancers (Basel) 2023; 15:5433. [PMID: 38001692 PMCID: PMC10670077 DOI: 10.3390/cancers15225433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Irradiation with electrons is the primary treatment regime for localized conjunctival low-grade lymphomas. However, radiation-induced cataracts are a major cause of treatment-related morbidity. This study investigates whether lens-sparing electron irradiation produces sufficient disease control rates while preventing cataract formation. All consecutive patients with strictly conjunctival, low-grade Ann Arbor stage IE lymphoma treated with superficial electron irradiation between 1999 and 2021 at our department were reviewed. A total of 56 patients with 65 treated eyes were enrolled with a median follow-up of 65 months. The median dose was 30.96 Gy. A lens-spearing technique featuring a hanging rod blocking the central beam axis was used in 89.2% of all cases. Cumulative incidences of 5- and 10-year infield recurrences were 4.3% and 14.6%, incidences of 5- and 10-year outfield progression were 10.4% and 13.4%. We used patients with involvement of retroorbital structures treated with whole-orbit photon irradiation without lens protection-of which we reported in a previous study-as a control group. The cumulative cataract incidence for patients treated with electrons and lens protection was significantly lower (p = 0.005) when compared to patients irradiated without lens protection. Thus, electrons are an effective treatment option for conjunctival low-grade lymphomas. The presented lens-sparing technique effectively prevents cataract formation.
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Affiliation(s)
- Christian Hoffmann
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Toke Ringbaek
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Anja Eckstein
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Ophthalmology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Deya
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Alina Santiago
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Martin Heintz
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Lübcke
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Frank Indenkämpen
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Sauerwein
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
| | - Andrea Flühs
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- Department of Radiotherapy, Medical Physics Section, University Hospital Essen, 45147 Essen, Germany
| | - Claudia Le Guin
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Ophthalmology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Andreas Huettmann
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Hematology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Julia von Tresckow
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Hematology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Sophia Göricke
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Cornelius Deuschl
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Sourour Moliavi
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Christoph Poettgen
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Thomas Gauler
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Patricia Johansson
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Nikolaos Bechrakis
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- Department of Ophthalmology, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, West German Cancer Centre, University Hospital Essen, 45147 Essen, Germany (M.G.)
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
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Young L, Wootton LS, Kalet AM, Gopan O, Yang F, Day S, Banitt M, Liao JJ. Dosimetric effects of bolus and lens shielding in treating ocular lymphomas with low-energy electrons. Med Dosim 2018; 44:35-42. [PMID: 29699800 DOI: 10.1016/j.meddos.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/12/2018] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
Radiation therapy is an effective treatment for primary orbital lymphomas. Lens shielding with electrons can reduce the risk of high-grade cataracts in patients undergoing treatment for superficial tumors. This work evaluates the dosimetric effects of a suspended eye shield, placement of bolus, and varying electron energies. Film (GafChromic EBT3) dosimetry and relative output factors were measured for 6, 8, and 10 MeV electron energies. A customized 5-cm diameter circle electron orbital cutout was constructed for a 6 × 6-cm applicator with a suspended lens shield (8-mm diameter Cerrobend cylinder, 2.2-cm length). Point doses were measured using a scanning electron diode in a solid water phantom at depths representative of the anterior and posterior lens. Depth dose profiles were compared for 0-mm, 3-mm, and 5-mm bolus thicknesses. At 5 mm (the approximate distance of the anterior lens from the surface of the cornea), the percent depth dose under the suspended lens shield was reduced to 15%, 15%, and 14% for electron energies 6, 8, and 10 MeV, respectively. Applying bolus reduced the benefit of lens shielding by increasing the estimated doses under the block to 27% for 3-mm and 44% for 5-mm bolus for a 6 MeV incident electron beam. This effect is minimized with 8 MeV electron beams where the corresponding values were 15.5% and 18% for 3-mm and 5-mm bolus. Introduction of a 7-mm hole in 5-mm bolus to stabilize eye motion during treatment altered lens doses by about 1%. Careful selection of electron energy and consideration of bolus effects are needed to account for electron scatter under a lens shield.
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Affiliation(s)
- Lori Young
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195.
| | - Landon S Wootton
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195
| | - Alan M Kalet
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195
| | - Olga Gopan
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195; Northwest Medical Physics Group, Lynnwood, WA 33136
| | - Fei Yang
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195; Department of Radiation Oncology, University of Miami, Miami, FL 33136
| | - Samuel Day
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195
| | - Michael Banitt
- Department of Ophthalmology, University of Washington, Seattle, WA 98195
| | - Jay J Liao
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195
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Gerbi BJ, Antolak JA, Deibel FC, Followill DS, Herman MG, Higgins PD, Huq MS, Mihailidis DN, Yorke ED, Hogstrom KR, Khan FM. Recommendations for clinical electron beam dosimetry: supplement to the recommendations of Task Group 25. Med Phys 2009; 36:3239-79. [PMID: 19673223 DOI: 10.1118/1.3125820] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The goal of Task Group 25 (TG-25) of the Radiation Therapy Committee of the American Association of.Physicists in Medicine (AAPM) was to provide a methodology and set of procedures for a medical physicist performing clinical electron beam dosimetry in the nominal energy range of 5-25 MeV. Specifically, the task group recommended procedures for acquiring basic information required for acceptance testing and treatment planning of new accelerators with therapeutic electron beams. Since the publication of the TG-25 report, significant advances have taken place in the field of electron beam dosimetry, the most significant being that primary standards laboratories around the world have shifted from calibration standards based on exposure or air kerma to standards based on absorbed dose to water. The AAPM has published a new calibration protocol, TG-51, for the calibration of high-energy photon and electron beams. The formalism and dosimetry procedures recommended in this protocol are based on the absorbed dose to water calibration coefficient of an ionization chamber at 60Co energy, N60Co(D,w), together with the theoretical beam quality conversion coefficient k(Q) for the determination of absorbed dose to water in high-energy photon and electron beams. Task Group 70 was charged to reassess and update the recommendations in TG-25 to bring them into alignment with report TG-51 and to recommend new methodologies and procedures that would allow the practicing medical physicist to initiate and continue a high quality program in clinical electron beam dosimetry. This TG-70 report is a supplement to the TG-25 report and enhances the TG-25 report by including new topics and topics that were not covered in depth in the TG-25 report. These topics include procedures for obtaining data to commission a treatment planning computer, determining dose in irregularly shaped electron fields, and commissioning of sophisticated special procedures using high-energy electron beams. The use of radiochromic film for electrons is addressed, and radiographic film that is no longer available has been replaced by film that is available. Realistic stopping-power data are incorporated when appropriate along with enhanced tables of electron fluence data. A larger list of clinical applications of electron beams is included in the full TG-70 report available at http://www.aapm.org/pubs/reports. Descriptions of the techniques in the clinical sections are not exhaustive but do describe key elements of the procedures and how to initiate these programs in the clinic. There have been no major changes since the TG-25 report relating to flatness and symmetry, surface dose, use of thermoluminescent dosimeters or diodes, virtual source position designation, air gap corrections, oblique incidence, or corrections for inhomogeneities. Thus these topics are not addressed in the TG-70 report.
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Affiliation(s)
- Bruce J Gerbi
- University of Minnesota, Minneapolis, Minnesota 55455, USA.
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