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Kim WC, Won YK, Lee SM, Heo NH, Yeo SG, Chang AR, Bae SH, Kim JS, Yoo ID, Hong SP, Min CK, Jo IY, Kim ES. Evaluating the Necessity of Adaptive RT and the Role of Deformable Image Registration in Lung Cancer with Different Pathologic Classifications. Diagnostics (Basel) 2023; 13:2956. [PMID: 37761323 PMCID: PMC10527903 DOI: 10.3390/diagnostics13182956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This study aimed to analyze differential radiotherapy (RT) responses according to the pathological type of lung cancer to see the possibility of applying adaptive radiotherapy (ART). METHODS ART planning with resampled-computed tomography was conducted for a total of 30 patients (20 non-small-cell lung cancer patients and 10 small-cell lung cancer patients) using a deformable image registration technique to reveal gross tumor volume (GTV) changes according to the duration of RT. RESULTS The small-cell lung cancer group demonstrated an average GTV reduction of 20.95% after the first week of initial treatment (p = 0.001), whereas the adenocarcinoma and squamous cell carcinoma groups showed an average volume reduction of 20.47% (p = 0.015) and 12.68% in the second week. The application of ART according to the timing of GTV reduction has been shown to affect changes in radiation dose irradiated to normal tissues. This suggests that ART applications may have to be different depending on pathological differences in lung cancer. CONCLUSION Through these results, the present study proposes the possibility of personalized treatment options for individual patients by individualizing ART based on specific radiation responses by pathologic types of lung cancer.
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Affiliation(s)
- Woo Chul Kim
- Department of Radiation Oncology, Division of Medical Physics, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (W.C.K.); (C.K.M.)
- Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea;
| | - Yong Kyun Won
- Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea;
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (S.M.L.); (I.D.Y.); (S.-p.H.)
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea;
| | - Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon 14584, Republic of Korea; (S.-G.Y.); (S.H.B.)
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea; (A.R.C.); (J.S.K.)
| | - Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon 14584, Republic of Korea; (S.-G.Y.); (S.H.B.)
| | - Jae Sik Kim
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea; (A.R.C.); (J.S.K.)
| | - Ik Dong Yoo
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (S.M.L.); (I.D.Y.); (S.-p.H.)
| | - Sun-pyo Hong
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (S.M.L.); (I.D.Y.); (S.-p.H.)
| | - Chul Kee Min
- Department of Radiation Oncology, Division of Medical Physics, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea; (W.C.K.); (C.K.M.)
- Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea;
| | - In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea;
| | - Eun Seog Kim
- Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Republic of Korea;
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Sardaro A, McDonald F, Bardoscia L, Lavrenkov K, Singh S, Ashley S, Traish D, Ferrari C, Meattini I, Asabella AN, Brada M. Dyspnea in Patients Receiving Radical Radiotherapy for Non-Small Cell Lung Cancer: A Prospective Study. Front Oncol 2020; 10:594590. [PMID: 33425746 PMCID: PMC7787051 DOI: 10.3389/fonc.2020.594590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose Dyspnea is an important symptomatic endpoint for assessment of radiation-induced lung injury (RILI) following radical radiotherapy in locally advanced disease, which remains the mainstay of treatment at the time of significant advances in therapy including combination treatments with immunotherapy and chemotherapy and the use of local ablative radiotherapy techniques. We investigated the relationship between dose-volume parameters and subjective changes in dyspnea as a measure of RILI and the relationship to spirometry. Material and Methods Eighty patients receiving radical radiotherapy for non-small cell lung cancer were prospectively assessed for dyspnea using two patient-completed tools: EORTC QLQ-LC13 dyspnea quality of life assessment and dyspnea visual analogue scale (VAS). Global quality of life, spirometry and radiation pneumonitis grade were also assessed. Comparisons were made with lung dose-volume parameters. Results The median survival of the cohort was 26 months. In the evaluable group of 59 patients there were positive correlations between lung dose-volume parameters and a change in dyspnea quality of life scale at 3 months (V30 p=0.017; V40 p=0.026; V50 p=0.049; mean lung dose p=0.05), and a change in dyspnea VAS at 6 months (V30 p=0.05; V40 p=0.026; V50 p=0.028) after radiotherapy. Lung dose-volume parameters predicted a 10% increase in dyspnea quality of life score at 3 months (V40; p=0.041, V50; p=0.037) and dyspnea VAS score at 6 months (V40; p=0.027) post-treatment. Conclusions Worsening of dyspnea is an important symptom of RILI. We demonstrate a relationship between lung dose-volume parameters and a 10% worsening of subjective dyspnea scores. Our findings support the use of subjective dyspnea tools in future studies on radiation-induced lung toxicity, particularly at doses below conventional lung radiation tolerance limits.
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Affiliation(s)
- Angela Sardaro
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Fiona McDonald
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Academic Radiotherapy Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lilia Bardoscia
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Lavrenkov
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shalini Singh
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Department of Radiotherapy, Lucknow, India
| | - Sue Ashley
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Daphne Traish
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Cristina Ferrari
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Icro Meattini
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Artor Niccoli Asabella
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Michael Brada
- Lung Research Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom.,Academic Radiotherapy Unit, The Institute of Cancer Research, Sutton, United Kingdom.,Department of Radiation Oncology, University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Zhou Y, Yan T, Zhou X, Cao P, Luo C, Zhou L, Xu Y, Liu Y, Xue J, Wang J, Wang Y, Lu Y, Liang B, Gong Y. Acute severe radiation pneumonitis among non-small cell lung cancer (NSCLC) patients with moderate pulmonary dysfunction receiving definitive concurrent chemoradiotherapy: Impact of pre-treatment pulmonary function parameters. Strahlenther Onkol 2019; 196:505-514. [PMID: 31828393 DOI: 10.1007/s00066-019-01552-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Severe acute radiation pneumonitis (SARP) is a life-threatening complication of thoracic radiotherapy. Pre-treatment pulmonary function (PF) may influence its incidence. We have previously reported on the incidence of SARP among patients with moderate pulmonary dysfunction who received definitive concurrent chemoradiotherapy (dCCRT) for non-small cell lung cancer (NSCLC). METHODS The clinical outcomes, dose-volume histograms (DVH), and PF parameters of 122 patients (forced expiratory volume in 1 s [FEV1%]: 60-69%) receiving dCCRT between 2013 and 2019 were recorded. SARP was defined as grade ≥3 RP occurring during or within 3 months after CCRT. Logistic regression, receiver operating characteristics curves (ROC), and hazard ratio (HR) analyses were performed to evaluate the predictive value of each factor for SARP. RESULTS Univariate and multivariate analysis indicated that the ratio of carbon monoxide diffusing capacity (DLCO%; odds ratio [OR]: 0.934, 95% confidence interval [CI] 0.896-0.974, p = 0.001) and mean lung dose (MLD; OR: 1.002, 95% CI 1.001-1.003, p = 0.002) were independent predictors of SARP. The ROC AUC of combined DLCO%/MLD was 0.775 (95% confidence interval [CI]: 0.688-0.861, p = 0.001), with a sensitivity and specificity of 0.871 and 0.637, respectively; this was superior to DLCO% (0.656) or MLD (0.667) alone. Compared to the MLD-low/DLCO%-high group, the MLD-high/DLCO%-low group had the highest risk for SARP, with an HR of 9.346 (95% CI: 2.133-40.941, p = 0.003). CONCLUSION The DLCO% and MLD may predict the risk for SARP among patients with pre-treatment moderate pulmonary dysfunction who receive dCCRT for NSCLC. Prospective studies are needed to validate our findings.
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Affiliation(s)
- Ying Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Tiansheng Yan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xiaojuan Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Peng Cao
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chunli Luo
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Lin Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yong Xu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yongmei Liu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jianxin Xue
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jin Wang
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yongsheng Wang
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Binmiao Liang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Youling Gong
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China. .,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.
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Giuranno L, Ient J, De Ruysscher D, Vooijs MA. Radiation-Induced Lung Injury (RILI). Front Oncol 2019; 9:877. [PMID: 31555602 PMCID: PMC6743286 DOI: 10.3389/fonc.2019.00877] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
Radiation pneumonitis (RP) and radiation fibrosis (RF) are two dose-limiting toxicities of radiotherapy (RT), especially for lung, and esophageal cancer. It occurs in 5-20% of patients and limits the maximum dose that can be delivered, reducing tumor control probability (TCP) and may lead to dyspnea, lung fibrosis, and impaired quality of life. Both physical and biological factors determine the normal tissue complication probability (NTCP) by Radiotherapy. A better understanding of the pathophysiological sequence of radiation-induced lung injury (RILI) and the intrinsic, environmental and treatment-related factors may aid in the prevention, and better management of radiation-induced lung damage. In this review, we summarize our current understanding of the pathological and molecular consequences of lung exposure to ionizing radiation, and pharmaceutical interventions that may be beneficial in the prevention or curtailment of RILI, and therefore enable a more durable therapeutic tumor response.
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Affiliation(s)
- Lorena Giuranno
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jonathan Ient
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marc A Vooijs
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
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Hou TC, Dai KY, Wu MC, Hua KL, Tai HC, Huang WC, Chen YJ. Bio-physic constraint model using spatial registration of delta 18F-fluorodeoxyglucose positron emission tomography/computed tomography images for predicting radiation pneumonitis in esophageal squamous cell carcinoma patients receiving neoadjuvant chemoradiation. Onco Targets Ther 2019; 12:6439-6451. [PMID: 31496743 PMCID: PMC6698165 DOI: 10.2147/ott.s205803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/12/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study integrated clinical outcomes and radiomics of advanced thoracic esophageal squamous cell carcinoma patients receiving neoadjuvant concurrent chemoradiotherapy (NACCRT) to establish a novel constraint model for predicting radiation pneumonitis (RP). PATIENTS AND METHODS We conducted a retrospective review for thoracic advanced esophageal cancer patients who received NACCRT. From 2013 to 2018, 89 patients were eligible for review. Staging workup and response evaluation included positron emission tomography/computed tomography (PET/CT) scans and endoscopic ultrasound. Patients received RT with 48 Gy to gross tumor and 43.2 Gy to elective nodal area in simultaneous integrated boost method divided in 24 fractions. Weekly platinum-based chemotherapy was administered concurrently. Side effects were evaluated using CTCAE v4. Images of 2-fluoro-2-deoxyglucose PET/CT before and after NACCRT were registered to planning CT images to create a region of interest for dosimetry parameters that spatially matched RP-related regions, including V10, V20, V50%, V27, and V30. Correlation between bio-physic parameters and toxicity was used to establish a constraint model for avoiding RP. RESULTS Among the investigated cohort, clinical downstaging, complete pathological response, and 5-year overall survival rates were 59.6%, 40%, and 34.4%, respectively. Multivariate logistic regression analysis demonstrated that each individual set standardized uptake value ratios (SUVRs), neither pre- nor post-NACCRT, was not predictive. Interestingly, cutoff increments of 6.2% and 8.9% in SUVRs (delta-SUVR) in registered V20 and V27 regions were powerful predictors for acute and chronic RP, respectively. CONCLUSION Spatial registration of metabolic and planning CT images with delta-radiomics analysis using fore-and-aft image sets can establish a unique bio-physic prediction model for avoiding RP in esophageal cancer patients receiving NACCRT.
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Affiliation(s)
- Tien-Chi Hou
- Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kun-Yao Dai
- Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Che Wu
- Department of Nuclear Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kai-Lung Hua
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Hung-Chi Tai
- Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wen-Chien Huang
- Department of Surgery, Division of Thoracic Surgery, Mackay Memorial Hospital, Taipei City10449, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung40402, Taiwan
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Yoder T, Hsia AT, Xu Z, Stessin A, Ryu S. Usefulness of EZFluence software for radiotherapy planning of breast cancer treatment. Med Dosim 2019; 44:339-343. [PMID: 30611624 DOI: 10.1016/j.meddos.2018.12.001] [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: 08/31/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/24/2022]
Abstract
This study compared the EZFluence planning technique for irradiation of the breast with commonly used Field-in-Field (FiF) technique by analyzing the dose uniformity, the dose to the lung, heart, and other organs at risk, the total Monitor Unit (MU), and the time spent for planning. Two different 3-dimensional conformal dose plans were created for 20 breast cancer patients. Six patients were treated to a dose of 5000 cGy in 25 fractions and 14 were treated to a dose of 4256 cGy in 16 fractions. Average breast volume was 800 cc (range 128 to 1892 cc). For the FiF technique, the planner manually created between 2 to 4 subfields per gantry angle and sequentially blocked the 115% and 110% isodose line until a homogenous dose distribution was achieved. For the EZFluence technique, the planner implemented the EZFluence script that created an optimal fluence pattern, which was then imported into Eclipse where dose was calculated. Both techniques were optimized to make sure 95% of the breast planning target volume (PTV) received at least 95% of the prescribed dose. Compared to FiF technique, the plans produced by using EZFluence technique, showed the MU increased by 36.9% (p = 0.0002), whereas the planning time decreased significantly by 84.6% (p = 0.00001). The mean heart dose and the relative volume of the heart receiving ≥ 30 Gy (V30) were similar for both techniques. The mean lung dose and the relative volume of lung receiving ≥ 20 Gy (V20) were also comparable between 2 techniques. The contralateral breast mean dose and its relative volume receiving ≥ 3 Gy (V3) and ≥10 Gy (V10) were equally spared and avoided. EZFluence planning technique yielded a 4.6% (p = 0.04) reduction in PTV receiving 105% of the prescribed dose (V105) for the large breast with separation > 22 cm and PTV volume > 650 cc. The EZFluence planning technique yielded the overall comparable or improved dosimetry while significantly reducing planning time.
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Affiliation(s)
- Todd Yoder
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY
| | - An Ting Hsia
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY.
| | - Zhigang Xu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY
| | - Alexander Stessin
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY
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Zhu SC, Shen WB, Liu ZK, Li J, Su JW, Wang YX. Dosimetric and clinical predictors of radiation-induced lung toxicity in esophageal carcinoma. TUMORI JOURNAL 2018; 97:596-602. [DOI: 10.1177/030089161109700510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims and background Radiation-induced lung toxicity occurs frequently in patients with esophageal carcinoma. This study aims to evaluate the clinical and three-dimensional dosimetric parameters associated with lung toxicity after radiotherapy for esophageal carcinoma. Methods and study design The records of 56 patients treated for esophageal carcinoma were reviewed. The Radiation Therapy Oncology Group criteria for grading of lung toxicity were followed. Spearman's correlation test, the chi-square test and logistic regression analyses were used for statistical analysis. Results Ten of the 56 patients developed acute toxicity. The toxicity grades were grade 2 in 7 patients and grade 3 in 3 patients; none of the patients developed grade 4 or worse toxicity. One case of toxicity occurred during radiotherapy and 9 occurred 2 weeks to 3 months after radiotherapy. The median time was 2.0 months after radiotherapy. Fourteen patients developed late irradiated lung injury, 3 after 3.5 months, 7 after 9 months, and 4 after 14 months. Radiographic imaging demonstrated patchy consolidation (n = 5), atelectasis with parenchymal distortion (n = 6), and solid consolidation (n = 3). For acute toxicity, the irradiated esophageal volume, number of fields, and most dosimetric parameters were predictive. For late toxicity, chemotherapy combined with radiotherapy and other dosimetric parameters were predictive. No obvious association between the occurrence of acute and late injury was observed. Conclusions The percent of lung tissue receiving at least 25 Gy (V25), the number of fields, and the irradiated length of the esophagus can be used as predictors of the risk of acute toxicity. Lungs V30, as well as chemotherapy combined with radiotherapy, are predictive of late lung injury.
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Affiliation(s)
- Shu-chai Zhu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-bin Shen
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhi-kun Liu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juan Li
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing-wei Su
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yu-xiang Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Richter A, Weick S, Krieger T, Exner F, Kellner S, Polat B, Flentje M. Evaluation of a software module for adaptive treatment planning and re-irradiation. Radiat Oncol 2017; 12:205. [PMID: 29282089 PMCID: PMC5745858 DOI: 10.1186/s13014-017-0943-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this work is to validate the Dynamic Planning Module in terms of usability and acceptance in the treatment planning workflow. Methods The Dynamic Planning Module was used for decision making whether a plan adaptation was necessary within one course of radiation therapy. The Module was also used for patients scheduled for re-irradiation to estimate the dose in the pretreated region and calculate the accumulated dose to critical organs at risk. During one year, 370 patients were scheduled for plan adaptation or re-irradiation. All patient cases were classified according to their treated body region. For a sub-group of 20 patients treated with RT for lung cancer, the dosimetric effect of plan adaptation during the main treatment course was evaluated in detail. Changes in tumor volume, frequency of re-planning and the time interval between treatment start and plan adaptation were assessed. Results The Dynamic Planning Tool was used in 20% of treated patients per year for both approaches nearly equally (42% plan adaptation and 58% re-irradiation). Most cases were assessed for the thoracic body region (51%) followed by pelvis (21%) and head and neck cases (10%). The sub-group evaluation showed that unintended plan adaptation was performed in 38% of the scheduled cases. A median time span between first day of treatment and necessity of adaptation of 17 days (range 4–35 days) was observed. PTV changed by 12 ± 12% on average (maximum change 42%). PTV decreased in 18 of 20 cases due to tumor shrinkage and increased in 2 of 20 cases. Re-planning resulted in a reduction of the mean lung dose of the ipsilateral side in 15 of 20 cases. Conclusion The experience of one year showed high acceptance of the Dynamic Planning Module in our department for both physicians and medical physicists. The re-planning can potentially reduce the accumulated dose to the organs at risk and ensure a better target volume coverage. In the re-irradiation situation, the Dynamic Planning Tool was used to consider the pretreatment dose, to adapt the actual treatment schema more specifically and to review the accumulated dose.
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Affiliation(s)
- Anne Richter
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany.
| | - Stefan Weick
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Thomas Krieger
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Florian Exner
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Sonja Kellner
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
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Okumus D, Sarihan S, Gozcu S, Sigirli D. The relationship between dosimetric factors, side effects, and survival in patients with non-small cell lung cancer treated with definitive radiotherapy. Med Dosim 2017; 42:169-176. [PMID: 28506589 DOI: 10.1016/j.meddos.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Abstract
The patients with non-small cell lung cancer (NSCLC) treated with definitive conformal radiotherapy (RT) were evaluated in terms of side effects and survival. Normal tissue complication probability (NTCP) was calculated for 68 patients treated between 2009 and 2012. Clinical and dosimetric factors were analyzed. The median dose of 63 Gy (range: 54 to 70 Gy) was given with conformal RT with blocks (n = 37), 3-dimensional conformal RT (3DCRT) (n = 11), or intensity-modulated RT (IMRT) (n = 20). Acute grade 1 to 2 radiation pneumonitis (RP) was seen in 13% of the patients. No significant relationship was found between RP and treatment and dosimetric factors (p > 0.05). There was a positive correlation between median "mean lung dose" (MLD) (17 Gy), lung V30 (20.5%), and NTCP (14%) (p < 0.001). Median and 2-year overall survival (OS) and progression-free survival (PFS) were 27 and 18 months and 51% and 42%, respectively. In univariate analysis, significant dose range for survival was found between 59.4 and 63 Gy (p < 0.01). In multivariate analysis, response (p = 0.001), fraction dose of 1.8 Gy (p = 0.002), MLD <18 Gy (p = 0.04) for OS and response (p < 0.001), total dose > 59.4 Gy (p = 0.01), and tumor biologically effective dose (BED)3(Gy) ≤ 100.8 (p = 0.01) for PFS were found to be favorable factors. In our study, we found a linear correlation between NTCP and MLD for RP risk estimation in patients with NSCLC. Therapeutic dose range where MLD can be kept under 20 Gy with significant survival benefit was found between 59.4 and 63 Gy. Increased therapeutic efficacy will be possible using risk-adaptive RT techniques.
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Affiliation(s)
- Dilruba Okumus
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Sureyya Sarihan
- Department of Radiation Oncology, Faculty of Medicine, Uludag University, 16059 Bursa, Turkey.
| | - Sema Gozcu
- Department of Radiation Oncology, Faculty of Medicine, Uludag University, 16059 Bursa, Turkey
| | - Deniz Sigirli
- Department of Biostatistics, Faculty of Medicine, Uludag University, 16059 Bursa, Turkey
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Waxweiler T, Schubert L, Diot Q, Faught A, Stuhr K, Castillo R, Castillo E, Guerrero T, Rusthoven C, Gaspar L, Kavanagh B, Miften M, Vinogradskiy Y. A complete 4DCT-ventilation functional avoidance virtual trial: Developing strategies for prospective clinical trials. J Appl Clin Med Phys 2017; 18:144-152. [PMID: 28436107 PMCID: PMC5689844 DOI: 10.1002/acm2.12086] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction 4DCT‐ventilation is an exciting new imaging modality that uses 4DCT data to calculate lung‐function maps. Because 4DCTs are acquired as standard of care for lung cancer patients undergoing radiotherapy, 4DCT‐ventiltation provides functional information at no extra dosimetric or monetary cost to the patient. The development of clinical trials is underway to use 4DCT‐ventilation imaging to spare functional lung in patients undergoing radiotherapy. The purpose of this work was to perform a virtual trial using retrospective data to develop the practical aspects of a 4DCT‐ventilation functional avoidance clinical trial. Methods The study included 96 stage III lung cancer patients. A 4DCT‐ventilation map was calculated using the patient's 4DCT‐imaging, deformable registration, and a density‐change‐based algorithm. Clinical trial inclusion assessment used quantitative and qualitative metrics based on the patient's spatial ventilation profile. Clinical and functional plans were generated for 25 patients. The functional plan aimed to reduce dose to functional lung while meeting standard target and critical structure constraints. Standard and dose‐function metrics were compared between the clinical and functional plans. Results Our data showed that 69% and 59% of stage III patients have regional variability in function based on qualitative and quantitative metrics, respectively. Functional planning demonstrated an average reduction of 2.8 Gy (maximum 8.2 Gy) in the mean dose to functional lung. Conclusions Our work demonstrated that 60–70% of stage III patients would be eligible for functional planning and that a typical functional lung mean dose reduction of 2.8 Gy can be expected relative to standard clinical plans. These findings provide salient data for the development of functional clinical trials.
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Affiliation(s)
- Timothy Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leah Schubert
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Austin Faught
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelly Stuhr
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurie Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
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11
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Faught AM, Yamamoto T, Castillo R, Castillo E, Zhang J, Miften M, Vinogradskiy Y. Evaluating Which Dose-Function Metrics Are Most Critical for Functional-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 99:202-209. [PMID: 28816147 DOI: 10.1016/j.ijrobp.2017.03.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/30/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Four-dimensional (4D) computed tomography (CT) ventilation imaging is increasingly being used to calculate lung ventilation and implement functional-guided radiation therapy in clinical trials. There has been little exhaustive work evaluating which dose-function metrics should be used for treatment planning and plan evaluation. The purpose of our study was to evaluate which dose-function metrics best predict for radiation pneumonitis (RP). METHODS AND MATERIALS Seventy lung cancer patients who underwent 4D CT imaging and pneumonitis grading were assessed. Pretreatment 4D CT scans of each patient were used to calculate ventilation images. We evaluated 3 types of dose-function metrics that combined the patient's 4D CT ventilation image and treatment planning dose distribution: (1) structure-based approaches; (2) image-based approaches using the dose-function histogram; and (3) nonlinear weighting schemes. Log-likelihood methods were used to generate normal tissue complication probability models predicting grade 3 or higher (ie, grade 3+) pneumonitis for all dose-function schemes. The area under the curve (AUC) was used to assess the predictive power of the models. All techniques were compared with normal tissue complication probability models based on traditional, total lung dose metrics. RESULTS The most predictive models were structure-based approaches that focused on the volume of functional lung receiving ≥20 Gy (AUC, 0.70). Probabilities of grade 3+ RP of 20% and 10% correspond to V20 (percentage of volume receiving ≥20 Gy) to the functional subvolumes of 26.8% and 9.3%, respectively. Imaging-based analysis with the dose-function histogram and nonlinear weighted ventilation values yielded AUCs of 0.66 and 0.67, respectively, when we evaluated the percentage of functionality receiving ≥20 Gy. All dose-function metrics outperformed the traditional dose metrics (mean lung dose, AUC of 0.55). CONCLUSIONS A full range of dose-function metrics and functional thresholds was examined. The calculated AUC values for the most predictive functional models occupied a narrow range (0.66-0.70), and all showed notable improvements over AUC from traditional lung dose metrics (0.55). Identifying the combinations most predictive of grade 3+ RP provides valuable data to inform the functional-guided radiation therapy process.
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Affiliation(s)
- Austin M Faught
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Tokihiro Yamamoto
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Richard Castillo
- Department of Radiation Oncology, University of Texas Medical Branch of Galveston, League City, Texas
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Jingjing Zhang
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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12
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Jan N, Guy C, Reshko LB, Hugo GD, Weiss E. Lung and Heart Dose Variability During Radiation Therapy of Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017; 98:683-690. [PMID: 28581410 DOI: 10.1016/j.ijrobp.2017.02.227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/16/2017] [Accepted: 02/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the hypothesis that positional and anatomic variations during radiation therapy induce changes in lung and heart volumes and associated radiation doses. METHODS AND MATERIALS In this longitudinal investigation, variations in lung and heart volumes and standard dose parameters of mean lung dose, lung V20Gy, mean heart dose, and heart V40Gy were analyzed on weekly 4-dimensional CT scans of 15 lung cancer patients during conventionally fractionated radiochemotherapy. Tumor, individual lung lobes, and heart were delineated on the mid-ventilation phase of weekly 4-dimensional CT scans. Lung lobes and heart were also contoured on individual breathing phases of pre-, mid-, and end-of-treatment scans. Planning dose was transferred to consecutive scans via rigid registration. Volume and dose variations were assessed relative to the initial planning scan. RESULTS Interfraction lung volume variability relative to week 0 was twice as large as tidal volume variability (8.0% ± 5.3% vs 4.0% ± 3.3%, P=.003). Interfraction lung volume variation ranged between 0.8% and 17.1% for individual patient means. Lower lung lobes had larger volume variability compared with upper lobes (13.5% ± 8.1% vs 7.0% ± 5.0%, P<.00001). Average mean lung dose variation was 0.5 Gy (range, 0.2-1.0 Gy for individual patient means) and average lung V20Gy variation 0.9% (range, 0.2%-1.6%). Average heart volume variation was 7.2% (range, 3.4%-12.6%). Average mean heart dose variation was 1.2 Gy (range, 0.1-3.0 Gy) and average heart V40Gy variation 1.4% (range, 0%-4.2%). CONCLUSIONS Anatomic and positional variations during radiation therapy induce changes in radiation doses to lung and heart. Repeated lung and heart dose assessment will provide a better estimate of the actual delivered dose and will improve prediction models for normal tissue toxicity, if assessed in larger cohorts.
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Affiliation(s)
- Nuzhat Jan
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher Guy
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Leonid B Reshko
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
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13
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Valdes G, Solberg TD, Heskel M, Ungar L, Simone CB. Using machine learning to predict radiation pneumonitis in patients with stage I non-small cell lung cancer treated with stereotactic body radiation therapy. Phys Med Biol 2016; 61:6105-20. [PMID: 27461154 DOI: 10.1088/0031-9155/61/16/6105] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To develop a patient-specific 'big data' clinical decision tool to predict pneumonitis in stage I non-small cell lung cancer (NSCLC) patients after stereotactic body radiation therapy (SBRT). 61 features were recorded for 201 consecutive patients with stage I NSCLC treated with SBRT, in whom 8 (4.0%) developed radiation pneumonitis. Pneumonitis thresholds were found for each feature individually using decision stumps. The performance of three different algorithms (Decision Trees, Random Forests, RUSBoost) was evaluated. Learning curves were developed and the training error analyzed and compared to the testing error in order to evaluate the factors needed to obtain a cross-validated error smaller than 0.1. These included the addition of new features, increasing the complexity of the algorithm and enlarging the sample size and number of events. In the univariate analysis, the most important feature selected was the diffusion capacity of the lung for carbon monoxide (DLCO adj%). On multivariate analysis, the three most important features selected were the dose to 15 cc of the heart, dose to 4 cc of the trachea or bronchus, and race. Higher accuracy could be achieved if the RUSBoost algorithm was used with regularization. To predict radiation pneumonitis within an error smaller than 10%, we estimate that a sample size of 800 patients is required. Clinically relevant thresholds that put patients at risk of developing radiation pneumonitis were determined in a cohort of 201 stage I NSCLC patients treated with SBRT. The consistency of these thresholds can provide radiation oncologists with an estimate of their reliability and may inform treatment planning and patient counseling. The accuracy of the classification is limited by the number of patients in the study and not by the features gathered or the complexity of the algorithm.
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Affiliation(s)
- Gilmer Valdes
- Department of Radiation Oncology, Perelman Center for Advance Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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Briere TM, Krafft S, Liao Z, Martel MK. Lung Size and the Risk of Radiation Pneumonitis. Int J Radiat Oncol Biol Phys 2015; 94:377-84. [PMID: 26675062 DOI: 10.1016/j.ijrobp.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/07/2015] [Accepted: 10/01/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to identify patient populations treated for non-small cell lung cancer (NSCLC) who may be more at risk of radiation pneumonitis. METHODS AND MATERIALS A total of 579 patients receiving fractionated 3D conformal or intensity modulated radiation therapy (IMRT) for NSCLC were included in the study. Statistical analysis was performed to search for cohorts of patients with higher incidences of radiation pneumonitis. In addition to conventional risk factors, total and spared lung volumes were analyzed. The Lyman-Kutcher-Burman (LKB) and cure models were then used to fit the incidence of radiation pneumonitis as a function of lung dose and other factors. RESULTS Total lung volumes with a sparing of less than 1854 cc at 40 Gy were associated with a significantly higher incidence of radiation pneumonitis at 6 months (38% vs 12% for patients with larger volumes, P<.001). This patient cohort was overwhelmingly female and represented 22% of the total female population of patients and nearly 30% of the cases of radiation pneumonitis. An LKB fit to normal tissue complication probability (NTCP) including volume as a dose modifying factor resulted in a dose that results in a 50% probability of complication for the smaller spared volume cohort that was 9 Gy lower than the fit to all mean lung dose data and improved the ability to predict radiation pneumonitis (P<.001). Using an effective dose parameter of n=0.42 instead of mean lung dose further improved the LKB fit. Fits to the data using the cure model produced similar results. CONCLUSIONS Spared lung volume should be considered when treating NSCLC patients. Separate dose constraints based on smaller spared lung volume should be considered. Smaller spared lung volume patients should be followed closely for signs of radiation pneumonitis.
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Affiliation(s)
- Tina Marie Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Shane Krafft
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary K Martel
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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De A, Kamath S, Wong K, Olch AJ, Malvar J, Sposto R, Mascarenhas L, Keens TG, Venkatramani R. Correlation of pulmonary function abnormalities with dose volume histograms in children treated with lung irradiation. Pediatr Pulmonol 2015; 50:596-603. [PMID: 24644268 DOI: 10.1002/ppul.23034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is limited data on pulmonary function test (PFT) abnormalities in children treated with modern irradiation techniques. PFT abnormalities have not been correlated with the dose and volume of irradiation. METHODS A retrospective chart review of PFTs and clinical outcomes in children who received radiation therapy (RT) at Children's Hospital Los Angeles between 1999 and 2009 was performed. Radiation dose distribution to normal lung tissue was calculated. RESULTS Forty-nine patients had PFTs available post-RT at a median time of 2.91 years (range, 0.01-8.28) from irradiation. Sixty-seven percent of patients had at least one PFT abnormality on their last available study. The most common abnormality was obstructive lung disease (24%) followed by hyperinflation (20%). Thoracic surgery prior to RT increased the odds of an abnormal FEV1, RV/TLC, and obstructive disease. The sex of the patient, age at the time of irradiation, and time of the PFT after irradiation did not have a significant association with abnormalities. The mean lung dose, maximum lung dose, and prescribed dose of radiation were significantly associated with the development of PFT abnormalities. The odds of developing an abnormal PFT increased with increase in the minimum threshold dose (V(dose)) of radiation, mostly above V(20). CONCLUSION PFT abnormalities are common even when modern radiation techniques are used. A significant correlation between radiation parameters and PFT abnormalities was noted.
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Affiliation(s)
- Aliva De
- Division of Pulmonology, Children's Hospital Los Angeles, Los Angeles, California
| | - Sunil Kamath
- Division of Pulmonology, Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth Wong
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California.,Department of Radiation Oncology, University of California, Los Angeles, California
| | - Arthur J Olch
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California.,Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Jemily Malvar
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Richard Sposto
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Leo Mascarenhas
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Thomas G Keens
- Division of Pulmonology, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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16
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Gomez D, Liao Z, Saintigny P, Komaki RU. Combinations of Radiation Therapy and Chemotherapy for Non-Small Cell and Small-Cell Lung Carcinoma. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Kataria T, Gupta D, Bisht SS, Karthikeyan N, Goyal S, Pushpan L, Abhishek A, Govardhan HB, Kumar V, Sharma K, Jain S, Basu T, Srivastava A. Adaptive radiotherapy in lung cancer: dosimetric benefits and clinical outcome. Br J Radiol 2014; 87:20130643. [PMID: 24628269 DOI: 10.1259/bjr.20130643] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Anatomical changes during radiotherapy (RT) might introduce discrepancies between planned and delivered doses. This study evaluates the need for adaptive treatment in lung cancer RT. METHODS 15 patients with non-small-cell lung cancer, undergoing radical RT with or without concurrent chemotherapy, consecutively underwent planning CT scans at baseline and after 44-46 Gy. Target volumes were delineated on both scans. Phase I delivered 44-46 Gy to the initial planning target volume (PTV). Two Phase II plans for 16-20 Gy were developed on initial and mid-treatment scans, the treatment being delivered with the mid-treatment plan. The second CT structure set was fused with the initial scan data set using dose wash. Volumetric and dosimetric changes in target volumes and critical structures were assessed. RESULTS There was significant reduction in primary gross tumour volume (34.00%; p = 0.02) and PTV (34.70%; p < 0.01) in the second scan. In Plan 2, delivering the same dose to the initial PTV would have resulted in a significantly higher dose to the lung PTV (V20, 52.18%; V5, 21.76%; mean, 23.93%), contralateral lung (mean, 29.43%), heart (V10, 81.47%; V5, 56.62%; mean, 35.21%) and spinal cord (maximum dose, 37.53%). CONCLUSION Treatment replanning can account for anatomical changes during RT and thereby enable better normal tissue sparing, while allowing radical target doses with the possibility of maximizing local control. ADVANCES IN KNOWLEDGE This study supports the sparse dosimetric data regarding the quantitative tumour volume reduction, re-emphasizing the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control, and adds to the existing body of literature.
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Affiliation(s)
- T Kataria
- Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
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18
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Wang W, Xu Y, Schipper M, Matuszak MM, Ritter T, Cao Y, Ten Haken RK, Kong FMS. Effect of normal lung definition on lung dosimetry and lung toxicity prediction in radiation therapy treatment planning. Int J Radiat Oncol Biol Phys 2013; 86:956-63. [PMID: 23845844 DOI: 10.1016/j.ijrobp.2013.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/14/2013] [Accepted: 05/01/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to compare lung dose-volume histogram (DVH) parameters such as mean lung dose (MLD) and the lung volume receiving ≥20 Gy (V20) of commonly used definitions of normal lung in terms of tumor/target subtraction and to determine to what extent they differ in predicting radiation pneumonitis (RP). METHODS AND MATERIALS One hundred lung cancer patients treated with definitive radiation therapy were assessed. The gross tumor volume (GTV) and clinical planning target volume (PTVc) were defined by the treating physician and dosimetrist. For this study, the clinical target volume (CTV) was defined as GTV with 8-mm uniform expansion, and the PTV was defined as CTV with an 8-mm uniform expansion. Lung DVHs were generated with exclusion of targets: (1) GTV (DVHG); (2) CTV (DVHC); (3) PTV (DVHP); and (4) PTVc (DVHPc). The lung DVHs, V20s, and MLDs from each of the 4 methods were compared, as was their significance in predicting radiation pneumonitis of grade 2 or greater (RP2). RESULTS There are significant differences in dosimetric parameters among the various definition methods (all Ps<.05). The mean and maximum differences in V20 are 4.4% and 12.6% (95% confidence interval 3.6%-5.1%), respectively. The mean and maximum differences in MLD are 3.3 Gy and 7.5 Gy (95% confidence interval, 1.7-4.8 Gy), respectively. MLDs of all methods are highly correlated with each other and significantly correlated with clinical RP2, although V20s are not. For RP2 prediction, on the receiver operating characteristic curve, MLD from DVHG (MLDG) has a greater area under curve of than MLD from DVHC (MLDC) or DVHP (MLDP). Limiting RP2 to 30%, the threshold is 22.4, 20.6, and 18.8 Gy, for MLDG, MLDC, and MLDP, respectively. CONCLUSIONS The differences in MLD and V20 from various lung definitions are significant. MLD from the GTV exclusion method may be more accurate in predicting clinical significant radiation pneumonitis.
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Affiliation(s)
- Weili Wang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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19
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Venkatramani R, Kamath S, Wong K, Olch AJ, Malvar J, Sposto R, Goodarzian F, Freyer DR, Keens TG, Mascarenhas L. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation. Int J Radiat Oncol Biol Phys 2013; 86:942-8. [DOI: 10.1016/j.ijrobp.2013.04.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/14/2013] [Accepted: 04/17/2013] [Indexed: 12/25/2022]
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20
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Rosenzweig KE, Chang JY, Chetty IJ, Decker RH, Ginsburg ME, Kestin LL, Kong FMS, Lally BE, Langer CJ, Movsas B, Videtic GMM, Willers H. ACR appropriateness criteria nonsurgical treatment for non-small-cell lung cancer: poor performance status or palliative intent. J Am Coll Radiol 2013; 10:654-64. [PMID: 23890874 DOI: 10.1016/j.jacr.2013.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 12/25/2022]
Abstract
Radiation therapy plays a potential curative role in the treatment of patients with non-small-cell lung cancer with locoregional disease who are not surgical candidates and a palliative role for patients with metastatic disease. Stereotactic body radiation therapy is a relatively new technique in patients with early-stage non-small-cell lung cancer. A trial from RTOG(®) reported >97% local control at 3 years. For patients with locally advanced disease, thoracic radiation to a dose of 60 Gy remains the standard of care. Sequential chemotherapy or radiation alone can be used for patients with poor performance status who cannot tolerate more aggressive approaches. Chemotherapy should be used for patients with metastatic disease. Radiation therapy is useful for palliation of symptomatic tumors, and a dose of approximately 30 Gy is commonly used. Endobronchial brachytherapy is useful for patients with symptomatic endobronchial tumors. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Liu Y, Xia T, Zhang W, Zhong Y, Zhang L, Wang X, Yu H. Variations of circulating endothelial progenitor cells and transforming growth factor-beta-1 (TGF-β1) during thoracic radiotherapy are predictive for radiation pneumonitis. Radiat Oncol 2013; 8:189. [PMID: 23885707 PMCID: PMC3766170 DOI: 10.1186/1748-717x-8-189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 06/14/2013] [Indexed: 01/08/2023] Open
Abstract
Background The vascular endothelial cells are important targets of radiotherapy, which may be involved in the pathogenesis of radiation pneumonitis (RP). This study investigated the variations of circulating endothelial progenitor cells (EPCs) and transforming growth factor-beta-1 (TGF-β1) during three-dimensional conformal radiation therapy (3D-CRT) in patients with non–small-cell lung cancer (NSCLC) and analyzed the correlation between these variations with the occurrence of RP. Patients and methods From November 2008 to November 2009, eighty-four consecutive patients receiving 3D-CRT for stage III disease were evaluated prospectively. Circulating EPCs and TGF-β1 levels were measured at baseline, every 2 weeks during, and at the end of treatment. RP was evaluated prospectively at 6 weeks after 3D-CRT. Results Thirty-eight patients (47.5%) experienced score 1 or more of RP. The baseline levels of EPCs and TGF-β1 were analyzed, no difference was found between patients with and without RP during and after 3D-CRT. By serial measurement of TGF-β1 and EPCs levels, we found that the mean levels of EPCs in the whole population remained stable during radiotherapy, but the mean levels of TGF-β1 increased slowly during radiotherapy. TGF-β1 and EPCs levels were all significantly higher at week 2, week 4 and week 6 in patients with RP than that in patients without RP, respectively. During the period of radiation treatment, TGF-β1 levels began to increase in the first 2 weeks and became significantly higher at week 6 (P < 0.01). EPCs levels also began to increase in the first 2 weeks and reached a peak at week 4. Using an ANOVA model for repeated-measures, we found significant associations between the levels of TGF-β1 and EPCs during the course of 3D-CRT and the risk of developing RP (P < 0.01). Most of the dosimetric factors showed a significant association with RP. Conclusion Early variations of TGF-β1 and EPCs levels during 3D-CRT are significantly associated with the risk of RP. Variations of circulating TGF-β1 and EPCs levels during 3D-CRT may serve as independent predictive factors for RP. Trial registration Trials registration number: 20070618
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Affiliation(s)
- Yunfang Liu
- Department of Radiotherapy, Capital Medical University Affiliated Beijing Chao- yang Hospital, Beijing 100020, China.
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Garibaldi C, Catalano G, Baroni G, Tagaste B, Riboldi M, Spadea MF, Ciocca M, Cambria R, Serafini F, Orecchia R. Deep inspiration breath-hold technique guided by an opto- electronic system for extracranial stereotactic treatments. J Appl Clin Med Phys 2013; 14:4087. [PMID: 23835375 PMCID: PMC5714523 DOI: 10.1120/jacmp.v14i4.4087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 02/19/2013] [Accepted: 02/13/2013] [Indexed: 11/23/2022] Open
Abstract
The purpose of this work was to evaluate the intrapatient tumor position reproducibility in a deep inspiration breath‐hold (DIBH) technique based on two infrared optical tracking systems, ExacTrac and ELITETM, in stereotactic treatment of lung and liver lesions. After a feasibility study, the technique was applied to 15 patients. Each patient, provided with a real‐time visual feedback of external optical marker displacements, underwent a full DIBH, a free‐breathing (FB), and three consecutive DIBH CT‐scans centered on the lesion to evaluate the tumor position reproducibility. The mean reproducibility of tumor position during repeated DIBH was 0.5±0.3mm in laterolateral (LL), 1.0±0.9mm in anteroposterior (AP), and 1.4±0.9mm in craniocaudal (CC) direction for lung lesions, and 1.0±0.6mm in LL, 1.1±0.5mm in AP, and 1.2±0.4mm in CC direction for liver lesions. Intra‐and interbreath‐hold reproducibility during treatment, as determined by optical markers displacements, was below 1 mm and 3 mm, respectively, in all directions for all patients. Optically‐guided DIBH technique provides a simple noninvasive method to minimize breathing motion for collaborative patients. For each patient, it is important to ensure that the tumor position is reproducible with respect to the external markers configuration. PACS numbers: 87.53.Ly, 87.55.km
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Venkatramani R, Olch AJ, Mascarenhas L, Yoon S, Suterwala B, Mehta B, Wong K. Correlation of long-term pulmonary injury with radiation dose distribution in childhood cancer survivors. Pract Radiat Oncol 2012; 2:237-240. [PMID: 24674127 DOI: 10.1016/j.prro.2011.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/02/2011] [Accepted: 07/07/2011] [Indexed: 12/25/2022]
Affiliation(s)
- Rajkumar Venkatramani
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California.
| | - Arthur J Olch
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California; Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Leo Mascarenhas
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susanne Yoon
- Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Batul Suterwala
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Bhakti Mehta
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth Wong
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California; Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California
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Giroux Leprieur É, Fernandez D, Chatellier G, Klotz S, Giraud P, Durdux C. Cancers bronchiques non à petites cellules : facteurs prédictifs de survenue de pneumopathie radique. Cancer Radiother 2012; 16:257-62. [DOI: 10.1016/j.canrad.2012.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/05/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
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Lee S, Stroian G, Kopek N, AlBahhar M, Seuntjens J, Naqa IE. Analytical modelling of regional radiotherapy dose response of lung. Phys Med Biol 2012; 57:3309-21. [DOI: 10.1088/0031-9155/57/11/3309] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Vinogradskiy Y, Tucker SL, Liao Z, Martel MK. Investigation of the Relationship Between Gross Tumor Volume Location and Pneumonitis Rates Using a Large Clinical Database of Non-Small-Cell Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2012; 82:1650-8. [DOI: 10.1016/j.ijrobp.2011.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/14/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
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Vinogradskiy Y, Tucker SL, Liao Z, Martel MK. A Novel Method to Incorporate the Spatial Location of the Lung Dose Distribution into Predictive Radiation Pneumonitis Modeling. Int J Radiat Oncol Biol Phys 2012; 82:1549-55. [DOI: 10.1016/j.ijrobp.2011.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 04/06/2011] [Accepted: 05/10/2011] [Indexed: 11/28/2022]
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Predictive Models for Pulmonary Function Changes After Radiotherapy for Breast Cancer and Lymphoma. Int J Radiat Oncol Biol Phys 2012; 82:e257-64. [DOI: 10.1016/j.ijrobp.2011.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 02/28/2011] [Accepted: 03/04/2011] [Indexed: 11/21/2022]
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Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH. ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context. Ann ICRP 2012; 41:1-322. [PMID: 22925378 DOI: 10.1016/j.icrp.2012.02.001] [Citation(s) in RCA: 771] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This report provides a review of early and late effects of radiation in normal tissues and organs with respect to radiation protection. It was instigated following a recommendation in Publication 103 (ICRP, 2007), and it provides updated estimates of 'practical' threshold doses for tissue injury defined at the level of 1% incidence. Estimates are given for morbidity and mortality endpoints in all organ systems following acute, fractionated, or chronic exposure. The organ systems comprise the haematopoietic, immune, reproductive, circulatory, respiratory, musculoskeletal, endocrine, and nervous systems; the digestive and urinary tracts; the skin; and the eye. Particular attention is paid to circulatory disease and cataracts because of recent evidence of higher incidences of injury than expected after lower doses; hence, threshold doses appear to be lower than previously considered. This is largely because of the increasing incidences with increasing times after exposure. In the context of protection, it is the threshold doses for very long follow-up times that are the most relevant for workers and the public; for example, the atomic bomb survivors with 40-50years of follow-up. Radiotherapy data generally apply for shorter follow-up times because of competing causes of death in cancer patients, and hence the risks of radiation-induced circulatory disease at those earlier times are lower. A variety of biological response modifiers have been used to help reduce late reactions in many tissues. These include antioxidants, radical scavengers, inhibitors of apoptosis, anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, growth factors, and cytokines. In many cases, these give dose modification factors of 1.1-1.2, and in a few cases 1.5-2, indicating the potential for increasing threshold doses in known exposure cases. In contrast, there are agents that enhance radiation responses, notably other cytotoxic agents such as antimetabolites, alkylating agents, anti-angiogenic drugs, and antibiotics, as well as genetic and comorbidity factors. Most tissues show a sparing effect of dose fractionation, so that total doses for a given endpoint are higher if the dose is fractionated rather than when given as a single dose. However, for reactions manifesting very late after low total doses, particularly for cataracts and circulatory disease, it appears that the rate of dose delivery does not modify the low incidence. This implies that the injury in these cases and at these low dose levels is caused by single-hit irreparable-type events. For these two tissues, a threshold dose of 0.5Gy is proposed herein for practical purposes, irrespective of the rate of dose delivery, and future studies may elucidate this judgement further.
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Santanam L, Hurkmans C, Mutic S, van Vliet-Vroegindeweij C, Brame S, Straube W, Galvin J, Tripuraneni P, Michalski J, Bosch W. Standardizing naming conventions in radiation oncology. Int J Radiat Oncol Biol Phys 2012; 83:1344-9. [PMID: 22245204 DOI: 10.1016/j.ijrobp.2011.09.054] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 09/17/2011] [Accepted: 11/21/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to report on the development of a standardized target and organ-at-risk naming convention for use in radiation therapy and to present the nomenclature for structure naming for interinstitutional data sharing, clinical trial repositories, integrated multi-institutional collaborative databases, and quality control centers. This taxonomy should also enable improved plan benchmarking between clinical institutions and vendors and facilitation of automated treatment plan quality control. MATERIALS AND METHODS The Advanced Technology Consortium, Washington University in St. Louis, Radiation Therapy Oncology Group, Dutch Radiation Oncology Society, and the Clinical Trials RT QA Harmonization Group collaborated in creating this new naming convention. The International Commission on Radiation Units and Measurements guidelines have been used to create standardized nomenclature for target volumes (clinical target volume, internal target volume, planning target volume, etc.), organs at risk, and planning organ-at-risk volumes in radiation therapy. The nomenclature also includes rules for specifying laterality and margins for various structures. The naming rules distinguish tumor and nodal planning target volumes, with correspondence to their respective tumor/nodal clinical target volumes. It also provides rules for basic structure naming, as well as an option for more detailed names. Names of nonstandard structures used mainly for plan optimization or evaluation (rings, islands of dose avoidance, islands where additional dose is needed [dose painting]) are identified separately. RESULTS In addition to its use in 16 ongoing Radiation Therapy Oncology Group advanced technology clinical trial protocols and several new European Organization for Research and Treatment of Cancer protocols, a pilot version of this naming convention has been evaluated using patient data sets with varying treatment sites. All structures in these data sets were satisfactorily identified using this nomenclature. CONCLUSIONS Use of standardized naming conventions is important to facilitate comparison of dosimetry across patient datasets. The guidelines presented here will facilitate international acceptance across a wide range of efforts, including groups organizing clinical trials, Radiation Oncology Institute, Dutch Radiation Oncology Society, Integrating the Healthcare Enterprise, Radiation Oncology domain (IHE-RO), and Digital Imaging and Communication in Medicine (DICOM).
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Affiliation(s)
- Lakshmi Santanam
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
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Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT. Jpn J Radiol 2011; 30:18-24. [DOI: 10.1007/s11604-011-0002-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
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Impact of Induction Chemotherapy on Estimated Risk of Radiation Pneumonitis in Small Cell Lung Cancer. J Thorac Oncol 2011; 6:1553-62. [DOI: 10.1097/jto.0b013e318220c9f6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wennberg BM, Baumann P, Gagliardi G, Nyman J, Drugge N, Hoyer M, Traberg A, Nilsson K, Morhed E, Ekberg L, Wittgren L, Lund JÅ, Levin N, Sederholm C, Lewensohn R, Lax I. NTCP modelling of lung toxicity after SBRT comparing the universal survival curve and the linear quadratic model for fractionation correction. Acta Oncol 2011; 50:518-27. [PMID: 21198416 DOI: 10.3109/0284186x.2010.543695] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In SBRT of lung tumours no established relationship between dose-volume parameters and the incidence of lung toxicity is found. The aim of this study is to compare the LQ model and the universal survival curve (USC) to calculate biologically equivalent doses in SBRT to see if this will improve knowledge on this relationship. MATERIAL AND METHODS Toxicity data on radiation pneumonitis grade 2 or more (RP2+) from 57 patients were used, 10.5% were diagnosed with RP2+. The lung DVHs were corrected for fractionation (LQ and USC) and analysed with the Lyman- Kutcher-Burman (LKB) model. In the LQ-correction α/β = 3 Gy was used and the USC parameters used were: α/β = 3 Gy, D(0) = 1.0 Gy, [Formula: see text] = 10, α = 0.206 Gy(-1) and d(T) = 5.8 Gy. In order to understand the relative contribution of different dose levels to the calculated NTCP the concept of fractional NTCP was used. This might give an insight to the questions of whether "high doses to small volumes" or "low doses to large volumes" are most important for lung toxicity. RESULTS AND DISCUSSION NTCP analysis with the LKB-model using parameters m = 0.4, D(50) = 30 Gy resulted for the volume dependence parameter (n) with LQ correction n = 0.87 and with USC correction n = 0.71. Using parameters m = 0.3, D(50) = 20 Gy n = 0.93 with LQ correction and n = 0.83 with USC correction. In SBRT of lung tumours, NTCP modelling of lung toxicity comparing models (LQ,USC) for fractionation correction, shows that low dose contribute less and high dose more to the NTCP when using the USC-model. Comparing NTCP modelling of SBRT data and data from breast cancer, lung cancer and whole lung irradiation implies that the response of the lung is treatment specific. More data are however needed in order to have a more reliable modelling.
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Affiliation(s)
- Berit M Wennberg
- Department of Medical Physics, Karolinska University Hospital and the Karolinska Institute, Stockholm, Sweden.
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On the use of published radiobiological parameters and the evaluation of NTCP models regarding lung pneumonitis in clinical breast radiotherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2011; 34:69-81. [DOI: 10.1007/s13246-010-0051-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 12/20/2010] [Indexed: 11/26/2022]
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Ramella S, Trodella L, Mineo TC, Pompeo E, Gambacorta MA, Cellini F, Ciresa M, Fiore M, Greco C, Gaudino D, Stimato G, Piermattei A, Cesario A, D'Angelillo RM. Beams Arrangement in Non-Small Cell Lung Cancer (NSCLC) According to PTV and Dosimetric Parameters Predictive of Pneumonitis. Med Dosim 2010; 35:169-78. [DOI: 10.1016/j.meddos.2009.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 02/09/2009] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
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Wong VYW, Tung SY, Ng AWY, Li FAS, Leung JOY. Real-time monitoring and control on deep inspiration breath-hold for lung cancer radiotherapy-Combination of ABC and external marker tracking. Med Phys 2010; 37:4673-83. [DOI: 10.1118/1.3476463] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Efficacy and toxicity of chemoradiotherapy with carboplatin and irinotecan followed by consolidation docetaxel for unresectable stage III non-small cell lung cancer. J Thorac Oncol 2010; 5:533-9. [PMID: 20357618 DOI: 10.1097/jto.0b013e3181ce3e00] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2003, consolidation docetaxel was a promising concept for unresectable stage IIIA/B nonsmall cell lung cancer (NSCLC). To test the hypothesis that chemoradiotherapy with carboplatin and irinotecan followed by consolidation docetaxel would be feasible and clinically active, we conducted a phase II study. METHODS Thirty-two patients with unresectable stage IIIA/B NSCLC received irinotecan (30 mg/m) and carboplatin dosed to a target area under the concentration curve of 2, each administered weekly for 7 weeks. Concurrent radiotherapy was administered more than 7 weeks to a total dose of 63 Gy in 35 fractions. Consolidation docetaxel (75 mg/m) was administered every 3 weeks for 3 doses 4 weeks after chemoradiotherapy. The primary end point was objective response rate by RECIST. RESULTS Complete responses occurred in 4 patients and partial responses occurred in 14, for an objective response rate of 56.3% (95% confidence interval [CI], 37.7-73.6%). Median progression-free survival was 6.5 months (95% CI, 4.6-13.5); median duration of survival was 14.8 months (95% CI, 6.9-27.3). The most common hematologic toxicity was leukopenia, which were grade 3 or 4 in 16 patients (50%). Radiation pneumonitis (grade >or=2) occurred in 13 of 31 treated patients (42%). CONCLUSIONS These findings suggested that concurrent chemoradiotherapy with carboplatin and irinotecan followed by consolidation docetaxel is clinically active based on median survival in patients with unresectable stage III NSCLC; however, the 42% incidence of clinical radiation pneumonitis was unexpected and warrants further investigation to determine the mechanism and preventive strategies.
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Saynak M, Higginson DS, Morris DE, Marks LB. Current Status of Postoperative Radiation for Non–Small-Cell Lung Cancer. Semin Radiat Oncol 2010; 20:192-200. [DOI: 10.1016/j.semradonc.2010.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Impact of Toxicity Grade and Scoring System on the Relationship Between Mean Lung Dose and Risk of Radiation Pneumonitis in a Large Cohort of Patients With Non–Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2010; 77:691-8. [DOI: 10.1016/j.ijrobp.2009.05.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 05/12/2009] [Accepted: 05/21/2009] [Indexed: 11/19/2022]
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Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys 2010; 76:S70-6. [PMID: 20171521 DOI: 10.1016/j.ijrobp.2009.06.091] [Citation(s) in RCA: 737] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 06/22/2009] [Accepted: 06/27/2009] [Indexed: 12/12/2022]
Abstract
The three-dimensional dose, volume, and outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold "tolerance dose-volume" levels. There are strong volume and fractionation effects.
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Krasin MJ, Constine LS, Friedman DL, Marks LB. Radiation-related treatment effects across the age spectrum: differences and similarities or what the old and young can learn from each other. Semin Radiat Oncol 2010; 20:21-9. [PMID: 19959028 DOI: 10.1016/j.semradonc.2009.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation related effects in children and adults limit the delivery of effective radiation doses and result in long-term morbidity affecting function and quality of life. Improvements in our understanding of the etiology and biology of these effects, including the influence of clinical variables, dosimetric factors, and the underlying biological processes have made treatment safer and more efficacious. However, the approach to studying and understanding these effects differs between children and adults. Using the pulmonary and skeletal organ systems as examples, comparisons are made across the age spectrum for radiation related effects, including pneumonitis, pulmonary fibrosis, osteonecrosis, and fracture. Methods for dosimetric analysis, incorporation of imaging and biology as well a length of follow-up are compared, contrasted, and discussed for both organ systems in children and adults. Better understanding of each age specific approach and how it differs may improve our ability to study late effects of radiation across the ages.
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Affiliation(s)
- Matthew J Krasin
- Division of Radiation Oncology, Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN 38105-3678, USA.
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Zhang J, Ma J, Zhou S, Hubbs JL, Wong TZ, Folz RJ, Evans ES, Jaszczak RJ, Clough R, Marks LB. Radiation-Induced Reductions in Regional Lung Perfusion: 0.1–12 Year Data From a Prospective Clinical Study. Int J Radiat Oncol Biol Phys 2010; 76:425-32. [DOI: 10.1016/j.ijrobp.2009.02.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 01/28/2009] [Accepted: 02/03/2009] [Indexed: 11/27/2022]
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Kobayashi H, Uno T, Isobe K, Ueno N, Watanabe M, Harada R, Takiguchi Y, Tatsumi K, Ito H. Radiation pneumonitis following twice-daily radiotherapy with concurrent carboplatin and paclitaxel in patients with stage III non-small-cell lung cancer. Jpn J Clin Oncol 2010; 40:464-9. [PMID: 20085905 DOI: 10.1093/jjco/hyp190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the effects of dose-volume factors on the development of radiation pneumonitis in patients with non-small-cell lung cancer who received twice-daily radiotherapy concurrently with carboplatin and paclitaxel chemotherapy. METHODS Radiotherapy consisted of twice-daily fractionation of 1.2 Gy, to a total dose of 60 Gy. Weekly carboplatin and paclitaxel were used as a concurrent chemotherapy. Effects of radiotherapy parameters on the development of radiation pneumonitis were retrospectively analyzed. RESULTS Fourteen of 37 patients developed Grade 2 or worse (> or = G2) radiation pneumonitis. Grade 2 or worse radiation pneumonitis occurred in all 5 patients with V5 >40%, all 4 patients with V10 >35%, all 4 patients with V13 >32%, 9 of 14 patients with V20 >24% and 8 of 11 patients with V30 >22%, whereas 9 of 32 patients with V5 <40%, 10 of 33 patients with V10 <35%, 10 of 33 patients with V13 <32%, 5 of 23 patients with V20 <24% and 6 of 26 patients with V30 <22%, with respective P values of 0.0045, 0.015, 0.015, 0.015 and 0.008. Eight of 11 patients with a mean lung dose of >14 Gy developed > or = G2 radiation pneumonitis in contrast to 6 of 26 patients with a mean lung dose of <14 Gy (P = 0.008). CONCLUSIONS Several cut-off values in the V(dose) and the mean lung dose differentiating probabilities of developing > or = G2 radiation pneumonitis were identified in this combination therapy.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Radiology, Graduate School of Medicine, Chiba University, Chiba-City, Chiba 260-8670, Japan
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Taurine attenuates radiation-induced lung fibrosis in C57/Bl6 fibrosis prone mice. Ir J Med Sci 2009; 179:99-105. [DOI: 10.1007/s11845-009-0389-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 06/21/2009] [Indexed: 10/20/2022]
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Tsougos I, Grout I, Theodorou K, Kappas C. A free software for the evaluation and comparison of dose response models in clinical radiotherapy (DORES). Int J Radiat Biol 2009; 85:227-37. [DOI: 10.1080/09553000902748567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McCurdy M, McAleer MF, Wei W, Ezhil M, Johnson V, Khan M, Baker J, Luo D, Ajani J, Guerrero T. Induction and concurrent taxanes enhance both the pulmonary metabolic radiation response and the radiation pneumonitis response in patients with esophagus cancer. Int J Radiat Oncol Biol Phys 2009; 76:816-23. [PMID: 19525073 DOI: 10.1016/j.ijrobp.2009.02.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 02/25/2009] [Accepted: 02/27/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE The primary aim of this study was to assess pulmonary radiation toxicity quantitatively in patients who received thoracic radiotherapy combined with induction and/or concurrent chemotherapy with or without taxanes for esophageal cancer. METHODS AND MATERIALS The study subjects were 139 patients treated at the University of Texas M.D. Anderson Cancer Center for esophageal cancer and who had undergone [(18)F]-fluorodeoxyglucose positron emission tomography/computed tomography between November 1, 2003 and December 15, 2007 for disease restaging after chemoradiotherapy. The patients were grouped into those who had not received taxanes (Group 1), those who had received induction or concurrent taxanes (Group 2), and those who had received both induction and concurrent taxanes (Group 3). Clinical pulmonary toxicity was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. Linear regression was applied to the fluorodeoxyglucose uptake vs. radiation dose to determine the pulmonary metabolic radiation response (PMRR) for each case. The clinical toxicity scores and PMRR among the groups were evaluated for significance differences. RESULTS The crude rate of pneumonitis symptoms was 46%, 62%, and 74% for Group 1, 2, and 3, respectively. The analysis of variance test of log(PMRR) by treatment was significant (p = .0046). Group 3 had a 61% greater PMRR compared with Group 1 (p = .002). Group 2 had a 38% greater PMRR compared with Group 1 (p = .015). Finally, Group 3 had a 17% greater PMRR compared with Group 2 (p = .31). A PMRR enhancement ratio of 1.60 (95% confidence interval, 1.19-2.14) was observed for Group 3 vs. Group 1. CONCLUSION Patients given induction and concurrent taxane chemotherapy had a significantly greater PMRR and clinical pneumonitis symptoms compared with the patients whose chemotherapy regimen did not include taxanes.
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Affiliation(s)
- Matthew McCurdy
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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De Ruysscher D, Houben A, Aerts HJWL, Dehing C, Wanders R, Ollers M, Dingemans AMC, Hochstenbag M, Boersma L, Borger J, Dekker A, Lambin P. Increased 18F-deoxyglucose uptake in the lung during the first weeks of radiotherapy is correlated with subsequent Radiation-Induced Lung Toxicity (RILT): A prospective pilot study. Radiother Oncol 2009; 91:415-20. [PMID: 19195730 DOI: 10.1016/j.radonc.2009.01.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 12/17/2008] [Accepted: 01/03/2009] [Indexed: 12/01/2022]
Affiliation(s)
- Dirk De Ruysscher
- Department of Radiation Oncology (Maastro clinic), Maastricht University Medical Center(+), Maastricht, The Netherlands
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Yuan X, Liao Z, Liu Z, Wang LE, Tucker SL, Mao L, Wang XS, Martel M, Komaki R, Cox JD, Milas L, Wei Q. Single nucleotide polymorphism at rs1982073:T869C of the TGFbeta 1 gene is associated with the risk of radiation pneumonitis in patients with non-small-cell lung cancer treated with definitive radiotherapy. J Clin Oncol 2009; 27:3370-8. [PMID: 19380441 DOI: 10.1200/jco.2008.20.6763] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In search of reliable biologic markers to predict the risk of normal tissue damage by radio(chemo)therapy before treatment, we investigated the association between single nucleotide polymorphisms (SNPs) in the transforming growth factor 1 (TGFbeta1) gene and risk of radiation pneumonitis (RP) in patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Using 164 available genomic DNA samples from patients with NSCLC treated with definitive radio(chemo)therapy, we genotyped three SNPs of the TGFbeta1 gene (rs1800469:C-509T, rs1800471:G915C, and rs1982073:T869C) by polymerase chain reaction restriction fragment length polymorphism method. We used Kaplan-Meier cumulative probability to assess the risk of grade > or = 3 RP and Cox proportional hazards analyses to evaluate the effect of TGFbeta1 genotypes on such risk. RESULTS There were 90 men and 74 women in the study, with median age of 63 years. Radiation doses ranging from 60 to 70 Gy (median = 63 Gy) in 30 to 58 fractions were given to 158 patients (96.3%) and platinum-based chemotherapy to 147 (89.6%). Grade > or = 2 and grade > or = 3 RP were observed in 74 (45.1%) and 36 patients (22.0%), respectively. Multivariate analysis found CT/CC genotypes of TGFbeta1 rs1982073:T869C to be associated with a statistically significantly lower risk of RP grades > or = 2 (hazard ratio [HR] = 0.489; 95% CI, 0.227 to 0.861; P = .013) and grades > or = 3 (HR = 0.390; 95% CI, 0.197 to .774; P = 0.007), respectively, compared with the TT genotype, after adjustment for Karnofsky performance status, smoking status, pulmonary function, and dosimetric parameters. CONCLUSION Our results showed that CT/CC genotypes of TGFbeta1 rs1982073:T869C gene were associated with lower risk of RP in patients with NSCLC treated with definitive radio(chemo)therapy and thus may serve as a reliable predictor of RP.
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Affiliation(s)
- Xianglin Yuan
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Rosenzweig KE, Movsas B, Bradley J, Gewanter RM, Gopal RS, Komaki RU, Kong FM, Lee HK, Feins RH, Langer CJ. ACR Appropriateness Criteria® on Nonsurgical Treatment for Non–Small-Cell Lung Cancer: Poor Performance Status or Palliative Intent. J Am Coll Radiol 2009; 6:85-95. [DOI: 10.1016/j.jacr.2008.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Indexed: 12/25/2022]
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