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Bauckneht M, Miceli A, Signori A, Albano D, Capitanio S, Piva R, Laudicella R, Franchini A, D'Amico F, Riondato M, Chiola S, Marini C, Fornarini G, Scarale A, Muni A, Bertagna F, Burger IA, Sambuceti G, Morbelli S. Combined forced diuresis and late acquisition on [ 68Ga]Ga-PSMA-11 PET/CT for biochemical recurrent prostate cancer: a clinical practice-oriented study. Eur Radiol 2023; 33:3343-3353. [PMID: 36892650 PMCID: PMC10121525 DOI: 10.1007/s00330-023-09516-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/22/2022] [Accepted: 02/03/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Increased detection of prostate cancer (PCa) recurrences using [68Ga]Ga-PSMA-11 PET/CT has been reported by adding forced diuresis or late-phase imaging to the standard protocol. However, the combination of these procedures in the clinical setting is still not standardized. METHODS One hundred prospectively recruited biochemical recurrent PCa patients were restaged with dual-phase [68Ga]Ga-PSMA-11 PET/CT from September 2020 to October 2021. All patients received a standard scan (60 min), followed by diuretics (140 min) and a late-phase abdominopelvic scan (180 min). PET readers with low (n = 2), intermediate (n = 2), or high (n = 2) experience rated (i) standard and (ii) standard + forced diuresis late-phase images in a stepwise fashion according to E-PSMA guidelines, scoring their level of confidence. Study endpoints were (i) accuracy against a composite reference standard, (ii) reader's confidence level, and (iii) interobserver agreement. RESULTS Forced diuresis late-phase imaging increased the reader's confidence category for local and nodal restaging (both p < 0.0001), and the interobserver agreement in identifying nodal recurrences (from moderate to substantial, p < 0.01). However, it significantly increased diagnostic accuracy exclusively for local uptakes rated by low-experienced readers (from 76.5 to 84%, p = 0.05) and for nodal uptakes rated as uncertain at standard imaging (from 68.1 to 78.5%, p < 0.05). In this framework, SUVmax kinetics resulted in an independent predictor of PCa recurrence compared to standard metrics, potentially guiding the dual-phase PET/CT interpretation. CONCLUSIONS The present results do not support the systematic combination of forced diuresis and late-phase imaging in the clinical setting, but allow the identification of patients-, lesions-, and reader-based scenarios that might benefit from it. KEY POINTS • Increased detection of prostate cancer recurrences has been reported by adding diuretics administration or an additional late abdominopelvic scan to the standard [68Ga]Ga-PSMA-11 PET/CT procedure. • We verified the added value of combined forced diuresis and delayed imaging, showing that this protocol only slightly increases the diagnostic accuracy of [68Ga]Ga-PSMA-11 PET/CT, thus not justifying its systematic use in clinics. • However, it can be helpful in specific clinical scenarios, e.g., when PET/CT is reported by low-experienced readers. Moreover, it increased the reader's confidence and the agreement among observers.
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Affiliation(s)
- Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.
| | - Alberto Miceli
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Selene Capitanio
- Nuclear Medicine ASST, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberta Piva
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Riccardo Laudicella
- Nuclear Medicine, Cantonal Hospital Baden, Baden, Switzerland.,Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Annalisa Franchini
- Nuclear Medicine ASST, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesca D'Amico
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Mattia Riondato
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Chiola
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,CNR Institute of Molecular Bioimaging and Physiology, Milan, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Scarale
- Nuclear Medicine ASST, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alfredo Muni
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Irene A Burger
- Nuclear Medicine, Cantonal Hospital Baden, Baden, Switzerland.,Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
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Ma CY, Zhou JY, Xu XT, Qin SB, Han MF, Cao XH, Gao YZ, Xu L, Zhou JJ, Zhang W, Jia LC. Clinical evaluation of deep learning-based clinical target volume three-channel auto-segmentation algorithm for adaptive radiotherapy in cervical cancer. BMC Med Imaging 2022; 22:123. [PMID: 35810273 PMCID: PMC9271246 DOI: 10.1186/s12880-022-00851-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Accurate contouring of the clinical target volume (CTV) is a key element of radiotherapy in cervical cancer. We validated a novel deep learning (DL)-based auto-segmentation algorithm for CTVs in cervical cancer called the three-channel adaptive auto-segmentation network (TCAS). Methods A total of 107 cases were collected and contoured by senior radiation oncologists (ROs). Each case consisted of the following: (1) contrast-enhanced CT scan for positioning, (2) the related CTV, (3) multiple plain CT scans during treatment and (4) the related CTV. After registration between (1) and (3) for the same patient, the aligned image and CTV were generated. Method 1 is rigid registration, method 2 is deformable registration, and the aligned CTV is seen as the result. Method 3 is rigid registration and TCAS, method 4 is deformable registration and TCAS, and the result is generated by a DL-based method. Results From the 107 cases, 15 pairs were selected as the test set. The dice similarity coefficient (DSC) of method 1 was 0.8155 ± 0.0368; the DSC of method 2 was 0.8277 ± 0.0315; the DSCs of method 3 and 4 were 0.8914 ± 0.0294 and 0.8921 ± 0.0231, respectively. The mean surface distance and Hausdorff distance of methods 3 and 4 were markedly better than those of method 1 and 2. Conclusions The TCAS achieved comparable accuracy to the manual delineation performed by senior ROs and was significantly better than direct registration.
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Affiliation(s)
- Chen-Ying Ma
- Department of Radiation Oncology, 1st Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215123, China
| | - Ju-Ying Zhou
- Department of Radiation Oncology, 1st Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215123, China.
| | - Xiao-Ting Xu
- Department of Radiation Oncology, 1st Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215123, China
| | - Song-Bing Qin
- Department of Radiation Oncology, 1st Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215123, China
| | - Miao-Fei Han
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, 201807, China
| | - Xiao-Huan Cao
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, 201807, China
| | - Yao-Zong Gao
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, 201807, China
| | - Lu Xu
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, 201807, China
| | - Jing-Jie Zhou
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, 201807, China
| | - Wei Zhang
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, 201807, China
| | - Le-Cheng Jia
- United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, 518045, China
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Rao S, Abbas N, Fernandes D, Shridhar CH, Babu A, Shankar S, Santhmayer S. Estimation of pelvic lymph node dose contribution from HDR ICBT in cervical cancer. JOURNAL OF RADIATION AND CANCER RESEARCH 2022. [DOI: 10.4103/jrcr.jrcr_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Khaw P, Do V, Lim K, Cunninghame J, Dixon J, Vassie J, Bailey M, Johnson C, Kahl K, Gordon C, Cook O, Foo K, Fyles A, Powell M, Haie-Meder C, D'Amico R, Bessette P, Mileshkin L, Creutzberg CL, Moore A. Radiotherapy Quality Assurance in the PORTEC-3 (TROG 08.04) Trial. Clin Oncol (R Coll Radiol) 2021; 34:198-204. [PMID: 34903431 DOI: 10.1016/j.clon.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/09/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
AIMS Quality assurance in radiotherapy (QART) is essential to ensure the scientific integrity of a clinical trial. This paper reports the findings of the retrospective QART assessment for all centres that participated in PORTEC-3; a randomised controlled trial that compared pelvic radiotherapy with concurrent chemoradiotherapy to the pelvis followed by adjuvant chemotherapy. The trial showed an overall survival benefit for the addition of the chemotherapy in the management of women with high-risk endometrial cancer. MATERIALS AND METHODS Clinicians were invited to upload a randomly selected case/s treated at each of the participating sites. Panel reviewers analysed the contours to certify that the target volumes and organ at risk structures were contoured according to guidelines. The results were categorised into acceptable, minor variation, major variation or unevaluable. The radiotherapy plans were dosimetrically evaluated using the well-established Trans-Tasman Radiation Oncology Group (TROG) protocol. RESULTS Between August 2010 and January 2018, data from 146 patients of 686 consecutively treated patients were retrospectively reviewed. All 16 Australia and New Zealand and 71 of 77 international centres uploaded data for evaluation. In total, 3514 dosimetric and contour variables were reviewed. Of these, 3136 variables were deemed acceptable (89.2%), with 335 minor (9.6%) and 43 major variations (1.2%). Major contour variations included the clinical target volume vaginal vault, clinical target volume parametria and differential planning target volume vault expansion. CONCLUSION The results of the QART assessment confirmed high uniformity and low rates of both minor and major deviations in contouring and dosimetry in all sites. This supports the safe introduction of the PORTEC-3 treatment protocol into routine clinical practice.
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Affiliation(s)
- P Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
| | - V Do
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - K Lim
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J Cunninghame
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J Dixon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - J Vassie
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Bailey
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - C Johnson
- Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - K Kahl
- Shoalhaven Cancer Care Centre, Nowra, New South Wales, Australia
| | - C Gordon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - O Cook
- Trans-Tasman Radiation Oncology Group (TROG), Waratah, New South Wales, Australia
| | - K Foo
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - A Fyles
- Canadian Cancer Trials Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - C Haie-Meder
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - R D'Amico
- Division of Radiation Oncology, ASST-Lecco, Ospedale A. Manzoni, Lecco, Italy
| | - P Bessette
- Gynaecologic Oncology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - L Mileshkin
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A Moore
- Trans-Tasman Radiation Oncology Group (TROG), Waratah, New South Wales, Australia
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Ma CY, Zhou JY, Xu XT, Guo J, Han MF, Gao YZ, Du H, Stahl JN, Maltz JS. Deep learning-based auto-segmentation of clinical target volumes for radiotherapy treatment of cervical cancer. J Appl Clin Med Phys 2021; 23:e13470. [PMID: 34807501 PMCID: PMC8833283 DOI: 10.1002/acm2.13470] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives Because radiotherapy is indispensible for treating cervical cancer, it is critical to accurately and efficiently delineate the radiation targets. We evaluated a deep learning (DL)‐based auto‐segmentation algorithm for automatic contouring of clinical target volumes (CTVs) in cervical cancers. Methods Computed tomography (CT) datasets from 535 cervical cancers treated with definitive or postoperative radiotherapy were collected. A DL tool based on VB‐Net was developed to delineate CTVs of the pelvic lymph drainage area (dCTV1) and parametrial area (dCTV2) in the definitive radiotherapy group. The training/validation/test number is 157/20/23. CTV of the pelvic lymph drainage area (pCTV1) was delineated in the postoperative radiotherapy group. The training/validation/test number is 272/30/33. Dice similarity coefficient (DSC), mean surface distance (MSD), and Hausdorff distance (HD) were used to evaluate the contouring accuracy. Contouring times were recorded for efficiency comparison. Results The mean DSC, MSD, and HD values for our DL‐based tool were 0.88/1.32 mm/21.60 mm for dCTV1, 0.70/2.42 mm/22.44 mm for dCTV2, and 0.86/1.15 mm/20.78 mm for pCTV1. Only minor modifications were needed for 63.5% of auto‐segmentations to meet the clinical requirements. The contouring accuracy of the DL‐based tool was comparable to that of senior radiation oncologists and was superior to that of junior/intermediate radiation oncologists. Additionally, DL assistance improved the performance of junior radiation oncologists for dCTV2 and pCTV1 contouring (mean DSC increases: 0.20 for dCTV2, 0.03 for pCTV1; mean contouring time decrease: 9.8 min for dCTV2, 28.9 min for pCTV1). Conclusions DL‐based auto‐segmentation improves CTV contouring accuracy, reduces contouring time, and improves clinical efficiency for treating cervical cancer.
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Affiliation(s)
- Chen-Ying Ma
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ju-Ying Zhou
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao-Ting Xu
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Guo
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Miao-Fei Han
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, China
| | - Yao-Zong Gao
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, China
| | - Hui Du
- Shanghai United Imaging Healthcare, Co. Ltd., Jiading, China
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Oonk MHM, Slomovitz B, Baldwin PJW, van Doorn HC, van der Velden J, de Hullu JA, Gaarenstroom KN, Slangen BFM, Vergote I, Brännström M, van Dorst EBL, van Driel WJ, Hermans RH, Nunns D, Widschwendter M, Nugent D, Holland CM, Sharma A, DiSilvestro PA, Mannel R, Boll D, Cibula D, Covens A, Provencher D, Runnebaum IB, Luesley D, Ellis P, Duncan TJ, Tjiong MY, Cruickshank DJ, Kjølhede P, Levenback CF, Bouda J, Kieser KE, Palle C, Spirtos NM, O'Malley DM, Leitao MM, Geller MA, Dhar K, Asher V, Tamussino K, Tobias DH, Borgfeldt C, Lea JS, Bailey J, Lood M, Eyjolfsdottir B, Attard-Montalto S, Tewari KS, Manchanda R, Jensen PT, Persson P, Van Le L, Putter H, de Bock GH, Monk BJ, Creutzberg CL, van der Zee AGJ. Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II. J Clin Oncol 2021; 39:3623-3632. [PMID: 34432481 PMCID: PMC8577685 DOI: 10.1200/jco.21.00006] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN). METHODS GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter < 4 cm) without signs of lymph node involvement at imaging, who had primary surgical treatment (local excision with SN biopsy). Where the SN was involved (metastasis of any size), inguinofemoral radiotherapy was given (50 Gy). The primary end point was isolated groin recurrence rate at 24 months. Stopping rules were defined for the occurrence of groin recurrences. RESULTS From December 2005 until October 2016, 1,535 eligible patients were registered. The SN showed metastasis in 322 (21.0%) patients. In June 2010, with 91 SN-positive patients included, the stopping rule was activated because the isolated groin recurrence rate in this group went above our predefined threshold. Among 10 patients with an isolated groin recurrence, nine had SN metastases > 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (> 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (≤ 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL. CONCLUSION Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL.
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Affiliation(s)
- Maaike H M Oonk
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Peter J W Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Helena C van Doorn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | | | | | | | - Mats Brännström
- Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | | | - Willemien J van Driel
- Center of Gynecological Oncology Amsterdam, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - David Nunns
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Martin Widschwendter
- UCL EGA Institute for Women's Health, University College London, London, United Kingdom
| | - David Nugent
- Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, United Kingdom
| | - Cathrine M Holland
- Manchester University NHS Foundation Trust-St Marys Hospital, Manchester, United Kingdom
| | - Aarti Sharma
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Robert Mannel
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
| | - Dorry Boll
- Catharina Ziekenhuis Eindhoven, the Netherlands
| | - David Cibula
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Al Covens
- University of Toronto, Toronto, Ontario, Canada
| | | | - Ingo B Runnebaum
- Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - David Luesley
- University of Birmingham, Birmingham, United Kingdom
| | - Patricia Ellis
- Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Timothy J Duncan
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Ming Y Tjiong
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Derek J Cruickshank
- James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | | | - Jiri Bouda
- University Hospital Pilsen, Charles University, Faculty of Medicine, Pilsen, Czech Republic
| | | | | | | | - David M O'Malley
- Ohio State University Comprehensive Cancer Center-James Cancer Hospital, Columbus, OH
| | | | | | | | - Viren Asher
- University Hospitals of Derby and Burton, Derby, United Kingdom
| | | | | | | | | | - Jo Bailey
- St Michaels Hospital, Bristol, United Kingdom
| | | | | | | | | | - Ranjit Manchanda
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | | | | | | | - Hein Putter
- Leiden University Medical Center, Leiden, the Netherlands
| | - Geertruida H de Bock
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Ate G J van der Zee
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Jayatilakebanda I, Tsang YM, Hoskin P. High dose simultaneous integrated boost for node positive cervical cancer. Radiat Oncol 2021; 16:92. [PMID: 34001158 PMCID: PMC8130443 DOI: 10.1186/s13014-021-01818-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/10/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Lymph node metastases presenting with locally advanced cervical cancer are poor prognostic features. Modern radiotherapy approaches enable dose escalation to radiologically abnormal nodes. This study reports the results of a policy of a simultaneous integrated boost (SIB) in terms of treatment outcomes. MATERIALS AND METHODS Patients treated with radical chemoradiation with weekly cisplatin for locally advanced cervical cancer including an SIB to radiologically abnormal lymph nodes were analysed. All patients received a dose of 45 Gy in 25 fractions and a SIB dose of 60 Gy in 25 fractions using intensity modulated radiotherapy/volumetric modulated arc therapy, followed by high dose rate brachytherapy of 28 Gy in 4 fractions. A control cohort with radiologically negative lymph nodes was used to compare impact of the SIB in node positive patients. Treatment outcomes were measured by overall survival (OS), post treatment tumour response and toxicities. The tumour response was based on cross sectional imaging at 3 and 12 months and recorded as local recurrence free survival (LRFS), regional recurrence free survival (RRFS) and distant recurrence free survival (DRFS). RESULTS In between January 2015 and June 2017, a total of 69 patients with a median follow up of 30.9 months (23 SIB patients and 46 control patients) were identified. The complete response rate at 3 months was 100% in the primary tumour and 83% in the nodal volume receiving SIB. The OS, LRFS, RRFS and DRFS at 3 years of the SIB cohort were 69%, 91%, 79% and 77% respectively. High doses can be delivered to regional pelvic lymph nodes using SIB without excessive toxicity. CONCLUSION Using a SIB, a total dose of 60 Gy in 25 fractions chemoradiation can be delivered to radiologically abnormal pelvic nodes with no increase in toxicity compared to node negative patients. The adverse impact of positive nodal status may be negated by high dose deposition using SIB, but larger prospective studies are required to confirm this observation.
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Affiliation(s)
| | - Yat Man Tsang
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, UK.
- University of Manchester, Manchester, UK.
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P. Matylevich O, B. Shushkevich A, A. Suslova V, A. Perevoschikov P, A. Mavrichev S. Modified combined radiotherapy for cervical cancer in kidney transplant recipient. Clin Case Rep 2021; 9:2088-2093. [PMID: 33936645 PMCID: PMC8077414 DOI: 10.1002/ccr3.3950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 02/07/2021] [Indexed: 12/22/2022] Open
Abstract
The management of locally advanced cervical cancer in patients with a pelvic kidney transplant is challenging because standard chemoradiotherapy may increase the risk of ureteral stenosis and obstruction or vascular damage of the graft. In the absence of clear guidelines, these patients should be treated using high-precision modern radiotherapy technique.
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Affiliation(s)
- Olga P. Matylevich
- Gynecologic Oncology DepartmentNN Alexandrov National Cancer Centre of BelarusMinskBelarus
| | | | - Valentina A. Suslova
- Radiation Oncology DepartmentNN Alexandrov National Cancer Centre of BelarusMinskBelarus
| | | | - Siarhei A. Mavrichev
- Gynecologic Oncology DepartmentNN Alexandrov National Cancer Centre of BelarusMinskBelarus
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Ballari N, Rai B, Bahl A, Mittal BR, Ghoshal S. Prospective observational study evaluating acute and delayed treatment related toxicities of prophylactic extended field volumetric modulated arc therapy with concurrent cisplatin in cervical cancer patients with pelvic lymph node metastasis. Tech Innov Patient Support Radiat Oncol 2021; 17:48-56. [PMID: 33748442 PMCID: PMC7970137 DOI: 10.1016/j.tipsro.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the treatment related acute and delayed toxicities of extended field Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients of locally advanced cervical cancer with pelvic lymph nodes. MATERIAL AND METHODS From 2014 to 2016, 15 patients of locally advanced cervical cancer with Fluoro-deoxyglucose positron emission tomography (FDG-PET) positive pelvic lymph nodes were treated with extended field Simultaneous integrated boost (SIB)-VMAT 45 Gy/55 Gy/25#/5weeks and concurrent cisplatin. Acute toxicities were documented according to common terminology criteria for adverse events version 4 (CTCAE v.4). Dose volume parameters and patient characteristics were analyzed for association with toxicities. RESULTS Median age of patients at diagnosis was 48 years. 40% (6 patients) were stage IIB & 60% (9 patients) were stage IIIB. Median number of involved pelvic lymph nodes was 2 (range, 1-4), commonest location was external iliac lymph node region (86%). Median number of concurrent chemotherapy cycles received was five. Treatment was well tolerated and there were no grade ≥ 3 acute toxicities. Commonest acute toxicities observed were vomiting (≥grade2 -13.3%) followed by & nausea (grade ≥ 2 in 6%) and were associated with volume of bowel bag receiving 45 Gy. Constitutional symptoms (≥grade 2) were observed in 6% patients and had no dosimetric associations. At a median follow up of 43 months, delayed ≥ grade1, 2, 3 toxicity were observed in 80%, 0%, and 0% respectively with diarrhea being the commonest. CONCLUSION Prophylactic para aortic extended field VMAT with concurrent chemotherapy for locally advanced cervical cancer is well tolerated with acceptable acute toxicity profile. Significant grade 3 acute/delayed toxicities were not observed in this cohort of patients.
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Affiliation(s)
- N Ballari
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B Rai
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Bahl
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B R Mittal
- Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Ghoshal
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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External Beam Radiation Therapy (EBRT) and High-Dose-Rate (HDR) Brachytherapy for Intermediate and High-Risk Prostate Cancer: The Impact of EBRT Volume. Int J Radiat Oncol Biol Phys 2020; 106:525-533. [DOI: 10.1016/j.ijrobp.2019.09.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022]
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Farolfi A, Ilhan H, Gafita A, Calais J, Barbato F, Weber M, Afshar-Oromieh A, Spohn F, Wetter A, Rischpler C, Hadaschik B, Pianori D, Fanti S, Haberkorn U, Eiber M, Herrmann K, Fendler WP. Mapping Prostate Cancer Lesions Before and After Unsuccessful Salvage Lymph Node Dissection Using Repeat PSMA PET. J Nucl Med 2019; 61:1037-1042. [PMID: 31806773 DOI: 10.2967/jnumed.119.235374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with prostate-specific antigen (PSA) persistence after salvage lymph node dissection (SLND) and pre-procedure and post-procedure prostate-specific membrane antigen (PSMA) ligand PET. Methods: Sixteen patients were included in this multicenter study. The inclusion criteria were PSMA PET performed for biochemical recurrence before SLND (pre-SLND PET) and repeat PSMA PET performed for a persistently elevated PSA level (≥0.1 ng/mL) at least 6 wk after SLND (post-SLND PET). Image analysis was performed by 3 independent nuclear medicine physicians applying the molecular imaging TNM system PROMISE. Lesions were confirmed by histopathology, presence on correlative CT/MRI/bone scanning, or PSA response after focal therapy. Results: Post-SLND PET identified prostate cancer lesions in 88% (14/16) of patients with PSA persistence after SLND. Median PSA was 1.2 ng/mL (interquartile range, 0.6-2.8 ng/mL). Disease was confined to the pelvis in 56% of patients (9/16), and most of these men had common iliac (6/16, 38%) and internal iliac lymph node metastases (6/16, 38%). Extrapelvic disease was detected in 31% of patients (5/16). In pre- and post-SLND PET comparison, 10 of 16 had at least one lesion already detected at baseline (63% PET persistence), 4 of 16 had new lesions only (25% PET recurrence), and 2 had no disease on post-SLND PET. All validated regions (11 regions in 9 patients) were true-positive. Nine of 14 (64%) patients underwent repeat local therapies after SLND (7/14 radiotherapy, 2/14 surgery). Conclusion: SLND of pelvic nodal metastases was often not complete according to PSMA PET. About two thirds of patients had PET-positive nodal disease after SLND already seen on pre-SLND PSMA PET. Notably, about one quarter of patients had new lesions, not detected by presurgical PSMA PET.
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Affiliation(s)
- Andrea Farolfi
- Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy.,Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andrei Gafita
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Francesco Barbato
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Department of Nuclear Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Spohn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Davide Pianori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; and
| | - Stefano Fanti
- Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital, Bologna, Italy
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany .,Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
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de Boer P, Mandija S, Werensteijn-Honingh AM, van den Berg CAT, de Leeuw AAC, Jürgenliemk-Schulz IM. Cervical cancer apparent diffusion coefficient values during external beam radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 9:77-82. [PMID: 33458429 PMCID: PMC7807732 DOI: 10.1016/j.phro.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/22/2023]
Abstract
Background and purpose Apparent diffusion coefficient (ADC) reflects micro-enviromental changes and therefore might be useful in predicting recurrence prior to brachytherapy. The purpose of this study is to evaluate change in ADC of the primary tumour and pathologic lymph nodes during treatment and to correlate this with clinical outcome. Material and methods Twenty patients were included who received chemoradiation for locally advanced cervical cancer between July 2016 and November 2017. All patients underwent magnetic resonance imaging (MRI) prior to treatment, and three MRIs in weeks 1/2, 3 and 4 of treatment, including T2 and diffusion weighted imaging (b-values 0, 200, 800 s/mm2) for determining an ADC-map. Primary tumour was delineated on T2 and ADC-map and pathologic lymph nodes were delineated only on ADC-map. Results At time of analysis median follow-up was 15 (range 7-22) months. From MRI one to four, primary tumour on ADC-map showed a significant signal increase of 0.94 (range 0.74-1.46) × 10-3 mm2/s to 1.13 (0.98-1.49) × 10-3 mm2/s (p < 0.001). When tumour was delineated on T2, ADC-value signal increase (in tumour according to T2) was similar. All 46 delineated pathologic lymph nodes showed an ADC-value increase on average from 0.79 (range 0.33-1.12) × 10-3 mm2/s to 1.14 (0.59-1.75) × 10-3 mm2/s (p < 0.001). The mean tumour/suspected lymph node volumes decreased respectively 51/40%. Four patients developed relapse (one local and three nodal), without clear relation with ΔADC. However, the median volume decrease of the primary tumour was substantially lower in the failing patients compared to the group without relapse (19 vs. 57%). Conclusions ADC values can be acquired using T2-based tumour delineations unless there are substantial shifts between ADC-mapping and T2 acquisition. It remains plausible that ΔADC is a predictor for response to EBRT. However, the correlation in this study was not statistically significant.
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Affiliation(s)
- Peter de Boer
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands.,Department of Radiation Oncology, Amsterdam University Medical Centres (Amsterdam UMC) - University of Amsterdam (UvA), The Netherlands
| | - Stefano Mandija
- Centre for Image Sciences, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | | | - Cornelis A T van den Berg
- Centre for Image Sciences, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Astrid A C de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
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Added value of diffusion-weighted MRI for nodal radiotherapy planning in pelvic malignancies. Clin Transl Oncol 2019; 21:1383-1389. [DOI: 10.1007/s12094-019-02068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/15/2019] [Indexed: 02/08/2023]
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Björeland U, Jonsson J, Alm M, Beckman L, Nyholm T, Thellenberg-Karlsson C. Inter-fraction movements of the prostate and pelvic lymph nodes during IGRT. ACTA ACUST UNITED AC 2018; 7:357-366. [PMID: 30595810 PMCID: PMC6290663 DOI: 10.1007/s13566-018-0366-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022]
Abstract
Objectivities The aim of this study was to evaluate inter-fraction movements of lymph node regions that are commonly included in the pelvic clinical target volume (CTV) for high-risk prostate cancer patients. We also aimed to evaluate if the movements affect the planning target volumes. Methods Ten prostate cancer patients were included. The patients underwent six MRI scans, from treatment planning to near end of treatment. The CTV movements were analyzed with deformable registration technique with the CTV divided into sections. The validity of the deformable registration was assessed by comparing the results for individual lymph nodes that were possible to identify in all scans. Results Using repetitive MRI, measurements showed that areas inside the CTV (lymph nodes) in some extreme cases were as mobile as the prostate and not fixed to the bones. The lymph node volumes closest to the prostate did not tend to follow the prostate motion. The more cranial lymph node volumes moved less, but still independently, and they were not necessarily fixed to the pelvic bones. In 95% of the cases, the lymph node motion in the R-L direction was 2–4 mm, in the A-P direction 2–7 mm, and in the C-C direction 2–5 mm depending on the CTV section. Conclusion Lymph nodes and prostate were most mobile in the A-P direction, followed by the C-C and R-L directions. This movement should be taken into account when deciding the margins for the planning target volumes (PTV). Electronic supplementary material The online version of this article (10.1007/s13566-018-0366-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrika Björeland
- Department of Radiation Sciences, Umeå University, Sjukhusfysik, Sundsvallssjukhus, 85186 Sundsvall, Sweden
| | - Joakim Jonsson
- Department of Radiation Sciences, Umeå University, Sjukhusfysik, Sundsvallssjukhus, 85186 Sundsvall, Sweden
| | - Magnus Alm
- Department of Radiation Sciences, Umeå University, Sjukhusfysik, Sundsvallssjukhus, 85186 Sundsvall, Sweden
| | - Lars Beckman
- Department of Radiation Sciences, Umeå University, Sjukhusfysik, Sundsvallssjukhus, 85186 Sundsvall, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, Umeå University, Sjukhusfysik, Sundsvallssjukhus, 85186 Sundsvall, Sweden
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An atlas to aid delineation of para-aortic lymph node region in cervical cancer: Design and validation of contouring guidelines. Radiother Oncol 2018. [PMID: 29523410 DOI: 10.1016/j.radonc.2018.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Previous studies have investigated the anatomical distribution of para-aortic lymph nodes (PAN) in patients with cervical cancer. However, an atlas for accurate clinical target volume (CTV) delineation has yet to be defined. The purpose of this study was to design and verify a computerized tomography (CT) atlas to provide guidance for contouring the PAN CTV in patients with cervical cancer. MATERIALS AND METHODS This prospective study included 21 cervical cancer patients (design cohort) with 39 pathological PAN identified on (18)F-FDG PET-CT. PAN [left lateral para-aortic (LLPA), aorto-caval (AC), right para-caval (RPC) nodes] were delineated on CT simulation scans. Measurements were taken from the volumetric centre of the nodes to the edge of aorta and inferior vena-cava (IVC). Initially the aorta and IVC were expanded by the mean distance to the lymph node centre to create a CTV. Expansion margins were then increased asymmetrically until the CTV resulted in a clinically acceptable number of PAN included. The CTV was validated on a further 10 patients (validation cohort) with 29 PAN. A detailed contouring guide and accompanying visual atlas for elective PAN CTV delineation was created based on the validated margins. RESULTS For the design cohort (n = 21 patients, 39 PAN), the mean distance from the centre of the node to the aorta was 8 mm (range 4-17) for both LLPA (range 4-17) and AC (range 4-15) regions. Mean distance from the IVC to the centre of the nodes was 5 mm (range 4-6) in the RPC region and 6 mm (range 3-15) in the AC region. No PAN was superior to the T12-L1 interspace or the left renal vein or inferior to the L5-S1 interspace. For validation cohort (n = 10 patients, 29 PAN), mean distance from centre of the node to the aorta was 9 mm (range 5-15) in the LLPA region, 7 mm (range 6.5-14) in the AC region. Mean distance from the ICV to the centre of the nodes was 3 mm (range 2.5-4) in the RPC region and 5 mm (range 3-10) in the AC region. A CTV expansion from the aorta of 10 mm circumferentially and 15 mm laterally, and from the IVC of 8 mm anteromedially and 6 mm posterolaterally resulted in coverage of 97% (38/39) of PAN in the design cohort. On prospective validation, the described CTV included 97% (28/29) of PAN in the validation cohort. CONCLUSION We propose the following PAN CTV; expansion from aorta of 10 mm circumferentially except 15 mm laterally, expansion from the IVC of 8 mm anteromedial and 6 mm posterolaterally. The suggested CTV includes 97% (28/29) PAN in a validated patient cohort. A detailed guide and accompanying visual atlas is provided to aid delineation of the PAN CTV in patients with cervical cancer.
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Kwak YK, Lee SW, Kay CS, Park HH. Intensity-modulated radiotherapy reduces gastrointestinal toxicity in pelvic radiation therapy with moderate dose. PLoS One 2017; 12:e0183339. [PMID: 28846718 PMCID: PMC5573121 DOI: 10.1371/journal.pone.0183339] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022] Open
Abstract
This retrospective study was performed to evaluate and compare gastrointestinal (GI) toxicities caused by conventional radiotherapy (cRT) and intensity modulated radiotherapy (IMRT) in 136 cancer patients treated with pelvic radiotherapy (RT) with moderate radiation dose in a single institution. A matched-pair analysis of the two groups was performed; each group included 68 patients. Conventional RT was delivered using the four-field box technique and IMRT was delivered with helical tomotherapy. The median daily dose was 1.8 Gy and the median total dose was 50.4 Gy (range 25.2–56 Gy). Primary end point was GI toxicity during and after RT. Secondary end point was factors that affect toxicity. Patients treated with IMRT had lower incidence of grade ≥ 2 acute GI toxicity compared to the patients treated with cRT (p = 0.003). The difference remained significant in multivariate analysis (p = 0.01). The incidence of chronic GI toxicity was not statistically different between the two groups, but the cRT group had higher incidence of grade 3 chronic GI toxicity. Based on our results, IMRT can reduce GI toxicity compared to cRT in the treatment of pelvic radiotherapy even with moderate radiation dose and this will enhance patients’ quality of life and treatment compliance.
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Affiliation(s)
- Yoo-Kang Kwak
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| | - Hee Hyun Park
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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Chua GWY, Foo YW, Tay GH, Tan DBH. Assessing dose contribution to pelvic lymph nodes in intracavitary brachytherapy for cervical cancer. J Contemp Brachytherapy 2017; 9:345-353. [PMID: 28951754 PMCID: PMC5611454 DOI: 10.5114/jcb.2017.69237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/29/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE In radical radiotherapy for cervical cancer, high-dose-rate (HDR) brachytherapy is commonly used after external beam radiation therapy (EBRT) to deliver a cumulative EQD2 of 80 to 90 Gy to the primary tumor. However, there is less certainty regarding brachytherapy dose contribution to the pelvic lymph nodes. This poses a challenge as to how high a preceding EBRT dose should be prescribed to gross nodal disease, in order to achieve a cumulative tumoricidal effect. Hence, this study aims to quantify brachytherapy dose contribution to individual pelvic nodal groups, using computed tomography (CT) planning with the Manchester system. MATERIAL AND METHODS This is a single institution retrospective dosimetric study. CT planning datasets from 40 patients who received EBRT followed by intracavitary HDR brachytherapy (5 or 6 Gy fractions) were retrieved. The external iliac (EI), internal iliac (II), and obturator (OB) lymph node groups were contoured on each CT dataset. Applying the initial brachytherapy plan, mean doses to each nodal group were calculated for every patient, and averaged across the respective (5 or 6 Gy) study populations. RESULTS With a brachytherapy dose of 5 Gy to Manchester point A, the mean absolute doses received by the EI, II, and OB groups were 0.79, 1.12, and 1.34 Gy respectively, corresponding to EQD2s (α/β = 10) of 0.71, 1.04, and 1.27 Gy respectively. With a brachytherapy dose of 6 Gy, the mean absolute doses received by the EI, II, and OB groups were 1.16, 1.56, and 1.80 Gy respectively, corresponding to EQD2s of 1.08, 1.49, and 1.77 Gy, respectively. CONCLUSIONS Our study demonstrates that pelvic lymph nodes receive substantial dose contributions from HDR brachytherapy in cervical cancer. This should be taken into account by the radiation oncologist during EBRT planning, and adequate external beam boost doses calculated to achieve cumulative tumoricidal doses to pelvic nodal disease.
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Affiliation(s)
| | - Yong Wee Foo
- Division of Radiation Oncology, National Cancer Centre Singapore
| | - Guan Heng Tay
- Division of Radiation Oncology, National Cancer Centre Singapore
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de Boer P, Jürgenliemk-Schulz IM, Westerveld H, de Leeuw AAC, Dávila-Fajardo R, Rasch CRN, Pieters BR, Stalpers LJA. Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer. Radiother Oncol 2017; 123:306-311. [PMID: 28434797 DOI: 10.1016/j.radonc.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Regarding latest developments, the need of a radiotherapy 'Patterns of Care' survey was expressed by the Dutch National Platform Radiotherapy for Gynaecological Cancer (LPRGT). Therefore, this study investigated current practice for cervical cancer in all 16 radiation oncology centres in the Netherlands specialised in gynaecological oncology. MATERIAL AND METHODS A structured 'patterns of care' questionnaire was completed and followed by an in-depth interview with radiation oncologists from all radiotherapy centres specialised in gynaecological oncology. Specific topics addressed were: definition of target volumes, treatment preparation, imaging for treatment planning, treatment planning, and image-guided adaptive radiotherapy for external beam radiotherapy and brachytherapy. RESULTS Current radiotherapy practice in the Netherlands for cervical cancer appears to be in accordance with international standards. However, at the time of the survey some differences were revealed that might have relevant clinical impact. For instance: 1) Half of the centres acquired positron emission tomography combined with CT (PET-CT) for staging and target delineation for every patient, 2) The definition of upper border of the para-aortal lymph node area and dose prescription for external beam radiotherapy varied between the centres, and 3) 12 centres used a single treatment plan for delivering EBRT, and four used a plan-of-the-day strategy with a library of 3-4 treatment plans. CONCLUSIONS Most differences were found at the cutting edge of clinical evidence. However, the majority of these uncertainties are topics being addressed in current and planned (inter)national studies.
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Affiliation(s)
- Peter de Boer
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands.
| | | | - Henrike Westerveld
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| | - Astrid A C de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Raquel Dávila-Fajardo
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| | - Bradley R Pieters
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Academic Medical Centre (AMC) - University of Amsterdam, The Netherlands
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Fendler WP, Calais J, Allen-Auerbach M, Bluemel C, Eberhardt N, Emmett L, Gupta P, Hartenbach M, Hope TA, Okamoto S, Pfob CH, Pöppel TD, Rischpler C, Schwarzenböck S, Stebner V, Unterrainer M, Zacho HD, Maurer T, Gratzke C, Crispin A, Czernin J, Herrmann K, Eiber M. 68Ga-PSMA-11 PET/CT Interobserver Agreement for Prostate Cancer Assessments: An International Multicenter Prospective Study. J Nucl Med 2017; 58:1617-1623. [PMID: 28408531 DOI: 10.2967/jnumed.117.190827] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/03/2017] [Indexed: 12/31/2022] Open
Abstract
The interobserver agreement for 68Ga-PSMA-11 PET/CT study interpretations in patients with prostate cancer is unknown. Methods:68Ga-PSMA-11 PET/CT was performed in 50 patients with prostate cancer for biochemical recurrence (n = 25), primary diagnosis (n = 10), biochemical persistence after primary therapy (n = 5), or staging of known metastatic disease (n = 10). Images were reviewed by 16 observers who used a standardized approach for interpretation of local (T), nodal (N), bone (Mb), or visceral (Mc) involvement. Observers were classified as having a low (<30 prior 68Ga-PSMA-11 PET/CT studies; n = 5), intermediate (30-300 studies; n = 5), or high level of experience (>300 studies; n = 6). Histopathology (n = 25, 50%), post-external-beam radiation therapy prostate-specific antigen response (n = 15, 30%), or follow-up PET/CT (n = 10, 20%) served as a standard of reference. Observer groups were compared by overall agreement (% patients matching the standard of reference) and Fleiss' κ with mean and corresponding 95% confidence interval (CI). Results: Agreement among all observers was substantial for T (κ = 0.62; 95% CI, 0.59-0.64) and N (κ = 0.74; 95% CI, 0.71-0.76) staging and almost perfect for Mb (κ = 0.88; 95% CI, 0.86-0.91) staging. Level of experience positively correlated with agreement for T (κ = 0.73/0.66/0.50 for high/intermediate/low experience, respectively), N (κ = 0.80/0.76/0.64, respectively), and Mc staging (κ = 0.61/0.46/0.36, respectively). Interobserver agreement for Mb was almost perfect irrespective of prior experience (κ = 0.87/0.91/0.88, respectively). Observers with low experience, when compared with intermediate and high experience, demonstrated significantly lower median overall agreement (54% vs. 66% and 76%, P = 0.041) and specificity for T staging (73% vs. 88% and 93%, P = 0.032). Conclusion: The interpretation of 68Ga-PSMA-11 PET/CT for prostate cancer staging is highly consistent among observers with high levels of experience, especially for nodal and bone assessments. Initial training on at least 30 patient cases is recommended to ensure acceptable performance.
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Affiliation(s)
- Wolfgang Peter Fendler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California .,Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University of Paris VII, Paris, France
| | - Martin Allen-Auerbach
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christina Bluemel
- Department of Nuclear Medicine, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University, Ulm, Germany
| | - Louise Emmett
- Department of Diagnostic Imaging, St. Vincent's Public Hospital, Sydney, Australia, and University of New South Wales, Sydney, New South Wales, Australia
| | - Pawan Gupta
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Markus Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Shozo Okamoto
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Christian Helmut Pfob
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thorsten D Pöppel
- Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sarah Schwarzenböck
- Department of Nuclear Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Vanessa Stebner
- Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Helle D Zacho
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany; and
| | - Alexander Crispin
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Germany
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Matthias Eiber
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Herlemann A, Wenter V, Kretschmer A, Thierfelder KM, Bartenstein P, Faber C, Gildehaus FJ, Stief CG, Gratzke C, Fendler WP. 68Ga-PSMA Positron Emission Tomography/Computed Tomography Provides Accurate Staging of Lymph Node Regions Prior to Lymph Node Dissection in Patients with Prostate Cancer. Eur Urol 2016; 70:553-557. [PMID: 26810345 DOI: 10.1016/j.eururo.2015.12.051] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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Hashimoto S, Shibamoto Y, Iwata H, Ogino H, Shibata H, Toshito T, Sugie C, Mizoe JE. Whole-pelvic radiotherapy with spot-scanning proton beams for uterine cervical cancer: a planning study. JOURNAL OF RADIATION RESEARCH 2016; 57:524-532. [PMID: 27380800 PMCID: PMC5045079 DOI: 10.1093/jrr/rrw052] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/05/2016] [Accepted: 03/31/2016] [Indexed: 05/20/2023]
Abstract
The aim of this study was to compare the dosimetric parameters of whole-pelvic radiotherapy (WPRT) for cervical cancer among plans involving 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), or spot-scanning proton therapy (SSPT). The dose distributions of 3D-CRT-, IMRT-, and SSPT-based WPRT plans were compared in 10 patients with cervical cancer. All of the patients were treated with a prescribed dose of 50.4 Gy in 1.8-Gy daily fractions, and all of the plans involved the same planning target volume (PTV) constrictions. A 3D-CRT plan involving a four-field box, an IMRT plan involving seven coplanar fields, and an SSPT plan involving four fields were created. The median PTV D95% did not differ between the 3D-CRT, IMRT and SSPT plans. The median conformity index 95% and homogeneity index of the IMRT and SSPT were better than those of the 3D-CRT. The homogeneity index of the SSPT was better than that of the IMRT. SSPT resulted in lower median V20 values for the bladder wall, small intestine, colon, bilateral femoral heads, skin, and pelvic bone than IMRT. Comparing the Dmean values, SSPT spared the small intestine, colon, bilateral femoral heads, skin and pelvic bone to a greater extent than the other modalities. SSPT can reduce the irradiated volume of the organs at risk compared with 3D-CRT and IMRT, while maintaining excellent PTV coverage. Further investigations of SSPT are warranted to assess its role in the treatment of cervical cancer.
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Affiliation(s)
- Shingo Hashimoto
- Department of Radiation Oncology, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan Department of Radiation Oncology, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Hiroki Shibata
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Jun-Etsu Mizoe
- Department of Radiation Oncology, Nagoya Proton Therapy Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
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Eminowicz G, Hall-Craggs M, Diez P, McCormack M. Improving target volume delineation in intact cervical carcinoma: Literature review and step-by-step pictorial atlas to aid contouring. Pract Radiat Oncol 2016; 6:e203-e213. [DOI: 10.1016/j.prro.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
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Holliday E, Fuller CD, Kalpathy-Cramer J, Gomez D, Rimner A, Li Y, Senan S, Wilson LD, Choi J, Komaki R, Thomas CR. Quantitative assessment of target delineation variability for thymic cancers: Agreement evaluation of a prospective segmentation challenge. JOURNAL OF RADIATION ONCOLOGY 2016; 5:55-61. [PMID: 27570583 DOI: 10.1007/s13566-015-0230-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We sought to quantitatively determine the inter-observer variability of expert radiotherapy target-volume delineation for thymic cancers, as part of a larger effort to develop an expert-consensus contouring atlas. METHODS A pilot dataset was created consisting of a standardized case presentation with pre- and post-operative DICOM CT image sets from a single patient with Masaoka-Koga Stage III thymoma. Expert thoracic radiation oncologists delineated tumor targets on the pre- and post-operative scans as they would for a definitive and adjuvant case, respectively. Respondents completed a survey including recommended dose prescription and target volume margins for definitive and post-operative scenarios. Inter-observer variability was analyzed quantitatively with Warfield's simultaneous truth, performance level estimation (STAPLE) algorithm and Dice similarity coefficient (DSC). RESULTS Seven users completed contouring for definitive and adjuvant cases; of these, 5 completed online surveys. Segmentation performance was assessed, with high mean±SD STAPLE-estimated segmentation sensitivity for definitive case GTV and CTV at 0.77 and 0.80, respectively, and post-operative CTV sensitivity of 0.55; all volumes had specificity of ≥0.99. Inter-observer agreement was markedly higher for the definitive target volumes, with mean±SD DSC of 0.88±0.03 and 0.89±0.04 for GTV and CTV respectively, compared to post-op CTV DSC of 0.69±0.06 (Kruskal-Wallis p<0.01. CONCLUSION Expert agreement for definitive case volumes was exceptionally high, though significantly lower agreement was noted post-operatively. Technique and dose prescription between experts was substantively consistent, and these preliminary results will be utilized to create an expert-consensus contouring atlas to aid the non-expert radiation oncologist in the planning of these challenging, rare tumors.
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Affiliation(s)
- Emma Holliday
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Daniel Gomez
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Li
- Department of Radiation Oncology, The University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Suresh Senan
- Department of Radiation Oncology, University Medical Center, Amsterdam, The Netherlands
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale Cancer Center, New Haven, CT
| | - Jehee Choi
- Department of Radiation Oncology, Kaiser Permanente Southern California, Los Angeles, CA
| | - Ritsuko Komaki
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University Knight Cancer Center, Portland, OR
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van de Sande MAE, Creutzberg CL, van de Water S, Sharfo AW, Hoogeman MS. Which cervical and endometrial cancer patients will benefit most from intensity-modulated proton therapy? Radiother Oncol 2016; 120:397-403. [PMID: 27452411 DOI: 10.1016/j.radonc.2016.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/15/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
In this dosimetric comparison study it was shown that IMPT with robust planning reduces dose to surrounding organs in cervical and endometrial cancer treatment compared with IMRT. Especially for the para-aortic region, clinically relevant dose reductions were obtained for kidneys, spinal cord and bowel, justifying the use of proton therapy for this indication.
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Affiliation(s)
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
| | - Steven van de Water
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Abdul Wahab Sharfo
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Papadopoulou I, Stewart V, Barwick TD, Park WHE, Soneji N, Rockall AG, Bharwani N. Post–Radiation Therapy Imaging Appearances in Cervical Carcinoma. Radiographics 2016; 36:538-53. [DOI: 10.1148/rg.2016150117] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ponni TRA, Avinash HU, Janaki MG, Koushik ASK, Somashekar MK. Implication of Bifurcation of Abdominal Aorta for Radiotherapy Planning for Cervical Cancers. J Clin Diagn Res 2016; 9:XC01-XC03. [PMID: 26816980 DOI: 10.7860/jcdr/2015/15051.6902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/09/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION External Beam Radiotherapy plays a major role in the management of Carcinoma Cervix. The Radiotherapy treatment portals are designed to adequately cover the gross disease and areas of microscopic spread. The upper border of Radiotherapy field is traditionally placed at the level of L4-L5 intervertebral space to cover the common iliac nodal area. It is determined based on anatomical and surgical series which have shown that division of Abdominal aorta occurs at that level. AIM To study the level of the division of abdominal aorta in relation to the lumbar vertebral levels. To propose the change in the upper border of Radiotherapy portals used in the treatment of Cervical Cancers. MATERIALS AND METHODS Patients who underwent Radiotherapy for Cervical Cancer from December 2010 to January 2012 formed the subjects of this prospective study. All the patients underwent aquaplast immobilization in supine position and contrast enhanced Computed Tomography (CT) simulation for Radiotherapy planning following bladder protocol. The Radiotherapy planning was done on commercial treatment planning system, Prowess version 4.71. The level of division of Abdominal Aorta into right and left Common Iliac arteries with respect to vertebral level was determined and studied. RESULTS The division of abdominal aorta into common iliac arteries occurred at the level of L3-L4 intervertebral space, in front of body of L4 vertebra and L4-L5 intervertebral space in 53.84%, 30.76% and 15.40% of the patients respectively. CONCLUSION The division of abdominal aorta occurs at a higher level than L4-L5 intervertebral space in majority of patients. It is highly recommended to use CT scan based planning. However, in institutes where there are no facilities for CT based planning, it is advisable to shift the upper border of Radiotherapy treatment portal above the L3-L4 intervertebral space for delivering adequate doses to the common iliac lymphnodes.
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Affiliation(s)
- Thiru Raju Arul Ponni
- Associate Professor, Department of Radiation Oncology, M.S. Ramaiah Medical College Hospital , Bangalore, India
| | | | - Manur Gururajachar Janaki
- Professor, Department of Radiation Oncology, M.S. Ramaiah Medical College Hospital , Bangalore, India
| | | | - Mohan Kumar Somashekar
- Assistant Professor, Department of Radiation Oncology, M.S. Ramaiah Medical College Hospital , Bangalore, India
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Duska L, Shahrokni A, Powell M. Treatment of Older Women With Endometrial Cancer: Improving Outcomes With Personalized Care. Am Soc Clin Oncol Educ Book 2016; 35:164-174. [PMID: 27249697 DOI: 10.1200/edbk_158668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Endometrial cancer is the most common gynecologic cancer, and with a median age of 62 at diagnosis, it affects a significant number of older women. With increasing age and obesity rates in the world's population, there is an anticipated concomitant increase in older women with endometrial cancer. Older women are more likely to die of endometrial cancer compared with younger patients. Reasons for this include more aggressive tumor biology, less favorable clinicopathologic features, and more advanced disease. Other factors, however, such as reluctance to offer surgical treatment to the older patient and increased complications of treatment are likely to be important. Management of endometrial cancer requires multidisciplinary care (surgery, radiation therapy, and systemic therapy). For each treatment, the feasibility (related to technical aspect of the procedure/treatment), side effects and safety (related to older-patient factors), and the overall benefit as it pertains to older women with endometrial cancer should be assessed carefully with a multidisciplinary approach. Despite the importance of these issues, the data are limited to answer these issues with clarity. In this article, we will review each treatment modality for older women with endometrial cancer. We will introduce the components of comprehensive geriatric assessment and their practical implication for older women with cancer in general and older women with endometrial cancer specifically.
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Affiliation(s)
- Linda Duska
- From the Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY; Department of Clinical Oncology, Barts Health NHS Trust, St. Bartholomew's Hospital, London, United Kingdom
| | - Armin Shahrokni
- From the Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY; Department of Clinical Oncology, Barts Health NHS Trust, St. Bartholomew's Hospital, London, United Kingdom
| | - Melanie Powell
- From the Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, NY; Department of Clinical Oncology, Barts Health NHS Trust, St. Bartholomew's Hospital, London, United Kingdom
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Renard-Oldrini S, Guinement L, Salleron J, Brunaud C, Huger S, Grandgirard N, Villani N, Marchesi V, Oldrini G, Peiffert D. Comparaison entre arcthérapie volumétrique modulée et tomothérapie pour le cancer du col utérin, avec irradiation lomboaortique. Cancer Radiother 2015; 19:733-8. [DOI: 10.1016/j.canrad.2015.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/26/2015] [Accepted: 05/25/2015] [Indexed: 10/22/2022]
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Eminowicz G, McCormack M. Variability of clinical target volume delineation for definitive radiotherapy in cervix cancer. Radiother Oncol 2015; 117:542-7. [DOI: 10.1016/j.radonc.2015.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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Determination of optimal planning target volume margins in patients with gynecological cancer. Phys Med 2015; 31:708-13. [DOI: 10.1016/j.ejmp.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/09/2015] [Accepted: 05/07/2015] [Indexed: 11/23/2022] Open
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Macchia G, Cilla S, Deodato F, Legge F, Di Stefano A, Chiantera V, Scambia G, Valentini V, Morganti AG, Ferrandina G. Intensity-modulated extended-field chemoradiation plus simultaneous integrated boost in the pre-operative treatment of locally advanced cervical cancer: a dose-escalation study. Br J Radiol 2015; 88:20150385. [PMID: 26388108 DOI: 10.1259/bjr.20150385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and determine the recommended pre-operative intensity-modulated radiotherapy (IMRT) dose of extended-field chemoradiation along with simultaneous integrated boost (SIB) dose escalation. METHODS A radiation dose of 40 Gy over 4 weeks, 2 Gy/fraction, was delivered to the tumour and the lymphatic drainage (planning target volume, PTV3), which encompassed a volume larger than standard (common iliac lymphatic area up to its apex, in front of the L3 vertebra), concurrently with chemotherapy (cisplatin and 5-fluorouracil). Radiation dose was escalated to the pelvis (PTV2) and to the macroscopic disease (PTV1) with the SIB-IMRT strategy. Three dose levels were planned: Level 1 (PTV3: 40/2 Gy; PTV2: 40/2 Gy; PTV1: 45/2.25 Gy), Level 2 (PTV3: 40/2 Gy; PTV2: 45/2.25 Gy; PTV1: 45/2.25 Gy) and Level 3 (PTV3: 40/2 Gy; PTV2: 45/2.25 Gy; PTV1: 50/2.5 Gy). All treatments were delivered in 20 fractions. Patients were treated in cohorts of between three and six per group using a Phase I study design. The recommended dose was exceeded if two of the six patients in a cohort experienced dose-limiting toxicity within 3 months from treatment. RESULTS 19 patients [median age: 46 years; The International Federation of Gynecology and Obstetrics (FIGO) stage IB2: 3, IIB: 10, IIIA-IIIB: 6] were enrolled. Median follow-up was 24 months (9-60 months). The most common grade 3/4 toxicity was gastrointestinal (GI) (diarrhoea, mucous discharge, rectal/abdominal pain). At Levels 1 and 2, only one grade 3 GI toxicity per level was recorded, whereas at Level 3, two grade 3 GI toxicities (diarrhoea, emesis and nausea) were recorded. CONCLUSION The SIB-IMRT technique was found to be feasible and safe at the recommended doses of 45 Gy to PTV1 and PTV2 and 40 Gy to PTV3 in the pre-operative treatment of patients with locally advanced cervical cancer. Unfortunately, this complex technique was unable to safely escalate dose beyond levels already achieved with three-dimensional conformal radiotherapy technique given acute GI toxicity. ADVANCES IN KNOWLEDGE A Phase I radiotherapy dose-escalation trial with SIB-IMRT technique is proposed in cervical cancer. This complex technique is feasible and safe at the recommended doses.
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Affiliation(s)
- Gabriella Macchia
- 1 Radiotherapy Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Savino Cilla
- 2 Medical Physics Unit, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Francesco Deodato
- 1 Radiotherapy Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Francesco Legge
- 3 Gynecologic Oncology Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Aida Di Stefano
- 3 Gynecologic Oncology Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Vito Chiantera
- 3 Gynecologic Oncology Unit, Department of Oncology, "John Paul II" Foundation, Catholic University, Campobasso, Italy
| | - Giovanni Scambia
- 4 Department of Obstetrics and Gynecology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Vincenzo Valentini
- 5 Department of Radiotherapy, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Alessio G Morganti
- 6 Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, DIMES University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriella Ferrandina
- 4 Department of Obstetrics and Gynecology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
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Haijun Y, Qiuji W, Zhenming F, Yong H, Zhengkai L, Conghua X, Yunfeng Z, Yahua Z. A new approach to delineating lymph node target volumes for post-operative radiotherapy in gastric cancer: A phase II trial. Radiother Oncol 2015; 116:245-51. [PMID: 26228969 DOI: 10.1016/j.radonc.2015.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE In the context of gastric cancer, lymph node target volume delineation for post-operative radiotherapy is currently built on the traditional system of dividing the stomach and 2-D treatment methods. Here, we have proposed a new delineation approach with irradiation indications for lymph node stations. Its safety and efficacy were evaluated in a phase II clinical trial. MATERIALS AND METHODS Fifty-four gastric cancer patients with D2 lymph node dissection received 2 cycles of FOLFOX4. They subsequently received concurrent chemoradiotherapy (45 Gy at 1.8 Gy per fraction, 5 fractions per week for 5 weeks) with a 5-fluorouracil/leucovorin regimen, followed by 4 additional FOLFOX4 cycles. The target volume included the remnant stomach, anastomosis site, tumor bed, and regional lymph nodes selected through our new approach by taking gastric arteries as references. RESULTS The most common grade 3-4 adverse event was neutropenia (14.8%). Neutropenia, anemia, and nausea were common grade 1-2 toxicities. No treatment-related deaths occurred during treatment. The 3-year overall, disease-free, and locoregional recurrence-free survival rates were 81.6%, 70.2%, and 91.1%, respectively. Eight patients developed peritoneal or distant metastases. CONCLUSIONS Using our new approach and irradiation indications, delineation of the target volume of post-operative lymph node stations was feasible and well tolerated after D2 resection in patients with gastric cancer.
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Affiliation(s)
- Yu Haijun
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Wu Qiuji
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Fu Zhenming
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Huang Yong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Liao Zhengkai
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Xie Conghua
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Zhou Yunfeng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China
| | - Zhong Yahua
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, China; Hubei Cancer Clinical Study Center, Wuhan University, China.
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Murakami N, Okamoto H, Isohashi F, Murofushi K, Ohno T, Yoshida D, Saito M, Inaba K, Ito Y, Toita T, Itami J. A surveillance study of intensity-modulated radiation therapy for postoperative cervical cancer in Japan. JOURNAL OF RADIATION RESEARCH 2015; 56:735-41. [PMID: 25862699 PMCID: PMC4497393 DOI: 10.1093/jrr/rrv020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/08/2015] [Accepted: 03/10/2015] [Indexed: 05/22/2023]
Abstract
Intensity-modulated radiation therapy (IMRT) was recently introduced to the field of gynecologic malignancies; however, its value is not yet validated. A clinical trial is in preparation to investigate the efficacy and feasibility of IMRT for postoperative cervical cancer. The object of this study was to perform a surveillance study of IMRT for post-operative cervical cancer. A questionnaire regarding the precise methods of conducting IMRT was sent to six institutions that had already introduced IMRT for post-operative cervical cancer, and the data were analyzed. Half of the institutions used static IMRT and the others used volumetric-modulated arc therapy (VMAT). Most institutions used body-immobilizing devices for patient fixation. Most institutions instructed patients to fill their bladder before undergoing planning CT or daily treatment. While one institution inserted metallic markers and another one used radio-contrast-soaked gauze to visualize the vaginal cuff, the other institutions used nothing for vaginal cuff visualization. Most institutions defined the clinical target volumes according to the Japan Clinical Oncology Group or the Radiation Therapy Oncology Group guidelines. Only one institution used a prescribed dose based on 95% of the PTV (D(95)), while the rest used the mean dose (D(mean)). This valuable information from six leading institutions will be utilized in a future prospective clinical trial.
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, T5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, T5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Hospital, Suita, Osaka
| | - Keiko Murofushi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma
| | - Daisaku Yoshida
- Department of Radiology, Gunma Prefecture Cancer Center, Gunma
| | - Makoto Saito
- Department of Radiation Oncology, Chiba Cancer Center, Chiba
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, T5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, National Cancer Center Hospital, T5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takafumi Toita
- Department of Radiology, Graduate School of Medicine, University of Ryukyus, Okinawa
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, T5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Rai B, Bansal A, Patel F, Gulia A, Kapoor R, Sharma SC. Pelvic nodal CTV from L4-L5 or aortic bifurcation? An audit of the patterns of regional failures in cervical cancer patients treated with pelvic radiotherapy. Jpn J Clin Oncol 2014; 44:941-7. [PMID: 25104792 DOI: 10.1093/jjco/hyu107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the patterns of recurrence in cervical cancer patients treated with pelvic nodal clinical target volume at L4-L5 junction instead of aortic bifurcation. METHODS Records of patients with locally advanced cervical cancer treated with chemo-radiation were reviewed. Patients treated with standard pelvic fields (superior border of the field at L4/L5 junction), without any radiological evidence of regional lymphadenopathy (<10 mm) were included in the study. The level of aortic bifurcation was retrospectively documented on computed tomography. Patterns of recurrences were correlated to the aortic bifurcation and the superior border of the radiation fields (L4/L5). RESULTS Aortic bifurcation was above the radiation fields (above L4/5) in 82 of 116 (70.7%) patients. Of the nine patients that recurred above the radiation field, 5 (55%) were above L4/5 failures, i.e. between aortic bifurcation and L4/5, and 4 (45%) had para-aortic failures. On retrospective analysis, 16 patients were found to have subcentimeter lymph nodes and higher nodal failures (7/16) were observed in patients with subcentimeter regional lymph nodes at diagnosis. CONCLUSIONS Superior border of nodal clinical target volume should ideally include the aortic bifurcation instead of L4-L5 inter space in patients with locally advanced cervical cancer. Radiotherapy fields need to be defined cautiously in patients with subcentimeter pelvic lymph nodes.
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Affiliation(s)
- Bhavana Rai
- Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anshuma Bansal
- Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Firuza Patel
- Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Gulia
- Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh C Sharma
- Department of Radiotherapy and Oncology and Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Scher ED, Ahmed I, Yue NJ, Jabbour SK. Technical aspects of radiation therapy for anal cancer. J Gastrointest Oncol 2014; 5:198-211. [PMID: 24982768 DOI: 10.3978/j.issn.2078-6891.2014.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/22/2014] [Indexed: 01/26/2023] Open
Abstract
Historically treated with surgery, current practice recommends anal carcinoma to be treated with a combination of chemotherapy and radiation. This review will examine the anatomy, modes of disease spread and recurrence, and evaluate the existing evidence for treatment options for these tumors. An in-depth examination of specific radiation therapy (RT) techniques-such as conventional 3D-conformal RT and intensity-modulated RT-will be discussed along with modern dose constraints. RT field arrangement, patient setup, and recommended gross and clinical target volume (CTV) contours will be considered. Areas in need of further investigation, such as the role in treatment for positron emission tomography (PET) will be explored.
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Affiliation(s)
- Eli D Scher
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Inaya Ahmed
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Ning J Yue
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Salma K Jabbour
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
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Position shifts and volume changes of pelvic and para-aortic nodes during IMRT for patients with cervical cancer. Radiother Oncol 2014; 111:442-5. [DOI: 10.1016/j.radonc.2014.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 03/10/2014] [Accepted: 05/03/2014] [Indexed: 11/18/2022]
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Image guided adaptive brachytherapy for cervical cancer: dose contribution to involved pelvic nodes in two cancer centers. J Contemp Brachytherapy 2014; 6:21-7. [PMID: 24790618 PMCID: PMC4003428 DOI: 10.5114/jcb.2014.42021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/18/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The goal of this study was to determine the dose contributions from image guided adaptive brachytherapy (IGABT) to individual suspicious pelvic lymph nodes (pLNN) in cervical cancer patients. Data were collected in two cancer centers, University of Pittsburgh Cancer Institute (UPCI) and University Medical Center Utrecht (UMCU). MATERIAL AND METHODS 27 and 15 patients with node positive cervical cancer treated with HDR (high dose rate) or PDR (pulsed dose rate)-IGABT were analyzed. HDR-IGABT (UPCI) was delivered with CT/MRI compatible tandem-ring applicators with 5.0-6.0 Gy × five fractions. PDR-IGABT (UMCU) dose was delivered with Utrecht tandem-ovoid applicators with 32 × 0.6 Gy × two fractions. Pelvic lymph nodes with short axis diameter of ≥ 5 mm on pre-treatment MRI or PET-CT were contoured for all BT-plans. Dose contributions to individual pLNN expressed as D90 (dose to 90% of the volume) were calculated from dose-volume histograms as absolute and relative physical dose (% of the reference dose) for each fraction. For each node, the total dose from all fractions was calculated, expressed in EQD2 (equivalent total dose in 2 Gy fractions). RESULTS Fifty-seven (UPCI) and 40 (UMCU) individual pLNN were contoured. The mean D90 pLNN was 10.8% (range 5.7-25.1%) and 20.5% (range 6.8-93.3%), respectively, and therefore different in the two centers. These values translate into 2.7 Gy (1.3-6.6 Gy) EQD2 and 7.1 Gy (2.2-36.7 Gy) EQD2, respectively. Differences are caused by the location of the individual nodes in relation to the spatial dose distribution of IGABT, differences in total dose administered and radiobiology (HDR versus PDR). CONCLUSIONS The IGABT dose contribution to individual pelvic nodes depends on patient and treatment related factors, and varies considerably.
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Gulia A, Patel F, Rai B, Bansal A, Sharma SC. Conventional four field radiotherapy versus computed tomography-based treatment planning in cancer cervix: A dosimetric study. South Asian J Cancer 2014; 2:132-5. [PMID: 24455587 PMCID: PMC3892552 DOI: 10.4103/2278-330x.114116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: With advancements in imaging, wide variations in pelvic anatomy have been observed, thus raising doubts about adequate target volume coverage by conventional external radiotherapy fields based on bony landmarks. The present study evaluates the need for integrating computed tomography (CT)-based planning in the treatment of carcinoma cervix. Aims: To estimate inadequacies in target volume coverage when using conventional planning based on bony landmarks. Materials and Methods: The study consisted of 50 patients. Target volume delineation was done on planning CT scans, according to the guidelines given in literature. The volume of target receiving 95% of prescribed dose (V95) was calculated after superimposing a conventional four field box on digitally reconstructed radiograph. The geographic miss with conventional four field box technique was compared with the CT-based target volume delineation. Results: In 48 out of 50 patients, the conventional four field box failed to encompass the target volume. The areas of miss were at the superior and lateral borders of the anterior-posterior fields, and the anterior border of the lateral fields. The median V95 for conventional fields marked with bony landmarks was only 89.4% as compared to 93% for target delineation based on CT contouring. Conclusions: Our study shows inadequate target volume coverage with conventional four field box technique. We recommend routine use of CT-based planning for treatment with radiotherapy in carcinoma cervix.
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Affiliation(s)
- Abhishek Gulia
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Firuza Patel
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anshuma Bansal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh C Sharma
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sjöberg C, Lundmark M, Granberg C, Johansson S, Ahnesjö A, Montelius A. Clinical evaluation of multi-atlas based segmentation of lymph node regions in head and neck and prostate cancer patients. Radiat Oncol 2013; 8:229. [PMID: 24090107 PMCID: PMC3842681 DOI: 10.1186/1748-717x-8-229] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/28/2013] [Indexed: 11/26/2022] Open
Abstract
Background Semi-automated segmentation using deformable registration of selected atlas cases consisting of expert segmented patient images has been proposed to facilitate the delineation of lymph node regions for three-dimensional conformal and intensity-modulated radiotherapy planning of head and neck and prostate tumours. Our aim is to investigate if fusion of multiple atlases will lead to clinical workload reductions and more accurate segmentation proposals compared to the use of a single atlas segmentation, due to a more complete representation of the anatomical variations. Methods Atlases for lymph node regions were constructed using 11 head and neck patients and 15 prostate patients based on published recommendations for segmentations. A commercial registration software (Velocity AI) was used to create individual segmentations through deformable registration. Ten head and neck patients, and ten prostate patients, all different from the atlas patients, were randomly chosen for the study from retrospective data. Each patient was first delineated three times, (a) manually by a radiation oncologist, (b) automatically using a single atlas segmentation proposal from a chosen atlas and (c) automatically by fusing the atlas proposals from all cases in the database using the probabilistic weighting fusion algorithm. In a subsequent step a radiation oncologist corrected the segmentation proposals achieved from step (b) and (c) without using the result from method (a) as reference. The time spent for editing the segmentations was recorded separately for each method and for each individual structure. Finally, the Dice Similarity Coefficient and the volume of the structures were used to evaluate the similarity between the structures delineated with the different methods. Results For the single atlas method, the time reduction compared to manual segmentation was 29% and 23% for head and neck and pelvis lymph nodes, respectively, while editing the fused atlas proposal resulted in time reductions of 49% and 34%. The average volume of the fused atlas proposals was only 74% of the manual segmentation for the head and neck cases and 82% for the prostate cases due to a blurring effect from the fusion process. After editing of the proposals the resulting volume differences were no longer statistically significant, although a slight influence by the proposals could be noticed since the average edited volume was still slightly smaller than the manual segmentation, 9% and 5%, respectively. Conclusions Segmentation based on fusion of multiple atlases reduces the time needed for delineation of lymph node regions compared to the use of a single atlas segmentation. Even though the time saving is large, the quality of the segmentation is maintained compared to manual segmentation.
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Affiliation(s)
- Carl Sjöberg
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala SE-751 85, Sweden.
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Kuji S, Hirashima Y, Komeda S, Tanaka A, Abe M, Takahashi N, Takekuma M, Asakura H, Harada H, Nishimura T. Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2–IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review. Int J Clin Oncol 2013; 19:341-7. [DOI: 10.1007/s10147-013-0551-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
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Baalbergen A, Veenstra Y, Stalpers L. Primary surgery versus primary radiotherapy with or without chemotherapy for early adenocarcinoma of the uterine cervix. Cochrane Database Syst Rev 2013; 2013:CD006248. [PMID: 23440805 PMCID: PMC7387233 DOI: 10.1002/14651858.cd006248.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND For early squamous cell carcinoma of the uterine cervix, the outcome is similar after either primary surgery or primary radiotherapy. There are reports that this is not the case for early adenocarcinoma (AC) of the uterine cervix: some studies have reported that the outcome is better after primary surgery. There are no systematic reviews about surgery versus chemoradiation in the treatment of cervical cancer. This is an updated version of the original Cochrane review published in Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006248. DOI: 10.1002/14651858.CD006248. OBJECTIVES The objectives of this review were to compare the effectiveness and safety of primary surgery for early stage AC of the uterine cervix with primary radiotherapy or chemoradiation. SEARCH METHODS We searched Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2009, MEDLINE (1950 to July week 5, 2009), EMBASE (1980 to week 32, 2009) and we also searched the related articles feature of PubMed and the Web of Science. We also checked the reference lists of articles. For this update, the searches were re-run in June 2012: MEDLINE 2009 to June week 2, 2012, EMBASE 2009 to 2012 week 24, CENTRAL Issue 6, 2012, Cochrane Gynaecological Specialised Register June 2012. SELECTION CRITERIA Studies of treatment of patients with early AC of the uterine cervix were included. Treatment included surgery, surgery followed by radiotherapy, radiotherapy and chemoradiation. DATA COLLECTION AND ANALYSIS Forty-three studies were selected by the search strategy and 30 studies were excluded. Twelve studies were considered for inclusion. Except for one randomised controlled trial (RCT), all other studies were retrospective cohort studies with variable methodological quality and had limitations of a retrospective study. Comparing the results from these retrospective studies was not possible due to diverging treatment strategies. MAIN RESULTS Analysis of a subgroup of one RCT showed that surgery for early cervical AC was better than radiotherapy. However, the majority of operated patients required adjuvant radiotherapy, which is associated with greater morbidity. Furthermore, the radiotherapy in this study was not optimal, and surgery was not compared to chemoradiation, which is currently recommended in most centres. Finally, modern imaging techniques (i.e. magnetic resonance imaging (MRI) and positive emission tomography - computed tomography (PET-CT) scanning) allow better selection of patients and node-negative patients can now be more easily identified for surgery, thereby reducing the risk of 'double trouble' caused by surgery and adjuvant radiotherapy. AUTHORS' CONCLUSIONS We recommend surgery for early-stage AC of the uterine cervix in carefully staged patients. Primary chemoradiation remains a second best alternative for patients unfit for surgery; chemoradiation is probably first choice in patients with (MRI or PET-CT-suspected) positive lymph nodes. Since the last version of this review no new studies were found.
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Affiliation(s)
- Astrid Baalbergen
- Department of Obstetrics and Gynaecology, Reinier de Graaf Groep, Delft, Netherlands.
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Ray A, Sarkar B. Small bowel toxicity in pelvic radiotherapy for postoperative gynecological cancer: Comparison between conformal radiotherapy and intensity modulated radiotherapy. Asia Pac J Clin Oncol 2012; 9:280-4. [DOI: 10.1111/ajco.12049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Amitabh Ray
- Radiotherapy Department; Nilratan Sircar Medical College Medical College; Kolkata; India
| | - Biplab Sarkar
- Radiotherapy Department; Advanced Medicare and Research Institute & Hospital; Kolkata; India
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Bansal A, Kapoor R, Singh SK, Kumar N, Oinam AS, Sharma SC. Dosimetric comparison of standard three-dimensional conformal radiotherapy followed by intensity-modulated radiotherapy boost schedule (sequential IMRT plan) with simultaneous integrated boost-IMRT (SIB IMRT) treatment plan in patients with localized carcinoma prostate. Indian J Urol 2012. [PMID: 23204659 PMCID: PMC3507400 DOI: 10.4103/0970-1591.102707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims: Dosimeteric and radiobiological comparison of two radiation schedules in localized carcinoma prostate: Standard Three-Dimensional Conformal Radiotherapy (3DCRT) followed by Intensity Modulated Radiotherapy (IMRT) boost (sequential-IMRT) with Simultaneous Integrated Boost IMRT (SIB-IMRT). Material and Methods: Thirty patients were enrolled. In all, the target consisted of PTV P + SV (Prostate and seminal vesicles) and PTV LN (lymph nodes) where PTV refers to planning target volume and the critical structures included: bladder, rectum and small bowel. All patients were treated with sequential-IMRT plan, but for dosimetric comparison, SIB-IMRT plan was also created. The prescription dose to PTV P + SV was 74 Gy in both strategies but with different dose per fraction, however, the dose to PTV LN was 50 Gy delivered in 25 fractions over 5 weeks for sequential-IMRT and 54 Gy delivered in 27 fractions over 5.5 weeks for SIB-IMRT. The treatment plans were compared in terms of dose–volume histograms. Also, Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) obtained with the two plans were compared. Results: The volume of rectum receiving 70 Gy or more (V > 70 Gy) was reduced to 18.23% with SIB-IMRT from 22.81% with sequential-IMRT. SIB-IMRT reduced the mean doses to both bladder and rectum by 13% and 17%, respectively, as compared to sequential-IMRT. NTCP of 0.86 ± 0.75% and 0.01 ± 0.02% for the bladder, 5.87 ± 2.58% and 4.31 ± 2.61% for the rectum and 8.83 ± 7.08% and 8.25 ± 7.98% for the bowel was seen with sequential-IMRT and SIB-IMRT plans respectively. Conclusions: For equal PTV coverage, SIB-IMRT markedly reduced doses to critical structures, therefore should be considered as the strategy for dose escalation. SIB-IMRT achieves lesser NTCP than sequential-IMRT.
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Affiliation(s)
- A Bansal
- Department of Radiotherapy, PGIMER, Chandigarh, India
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Hoskin PJ, Díez P, Williams M, Lucraft H, Bayne M. Recommendations for the use of radiotherapy in nodal lymphoma. Clin Oncol (R Coll Radiol) 2012; 25:49-58. [PMID: 22889569 DOI: 10.1016/j.clon.2012.07.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 05/22/2012] [Accepted: 05/29/2012] [Indexed: 12/25/2022]
Abstract
These guidelines have been developed to define the use of radiotherapy for lymphoma in the current era of combined modality treatment taking into account increasing concern over the late side-effects associated with previous radiotherapy. The role of reduced volume and reduced doses is addressed, integrating modern imaging with three-dimensional planning and advanced techniques of treatment delivery. Both wide-field and involved-field techniques have now been supplanted by the use of defined volumes based on node involvement shown on computed tomography (CT) and positron emission tomography (PET) imaging and applying the International Commission on Radiation Units and Measurements concepts of gross tumour volume (GTV), clinical target volume (CTV) and planning target volume (PTV). The planning of lymphoma patients for radical radiotherapy should now be based upon contrast enhanced 3 mm contiguous CT with three-dimensional definition of volumes using the convention of GTV, CTV and PTV. The involved-site radiotherapy concept defines the CTV based on the PET-defined pre-chemotherapy sites of involvement with an expansion in the cranio-caudal direction of lymphatic spread by 1.5 cm, constrained to tissue planes such as bone, muscle and air cavities. The margin allows for uncertainties in PET resolution, image registration and changes in patient positioning and shape. There is increasing evidence in both Hodgkin and non-Hodgkin lymphoma that traditional doses are higher than necessary for disease control and related to the incidence of late effects. No more than 30 Gy for Hodgkin and aggressive non-Hodgkin lymphoma and 24 Gy for indolent lymphomas is recommended; lower doses of 20 Gy in combination therapy for early-stage low-risk Hodgkin lymphoma may be sufficient. As yet there are no large datasets validating the use of involved-site radiotherapy; these will emerge from the current generation of clinical trials. Radiotherapy remains the most effective single modality in the treatment of lymphoma. A reduction in both treatment volume and overall treatment dose should now be considered to minimise the risks of late sequelae. However, it is important that this is not at the expense of the excellent disease control currently achieved.
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Affiliation(s)
- P J Hoskin
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
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Clinical target volumes in anal cancer: Calculating what dose was likely to have been delivered in the UK ACT II trial protocol. Radiother Oncol 2012; 103:341-6. [DOI: 10.1016/j.radonc.2012.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 03/05/2012] [Accepted: 03/10/2012] [Indexed: 11/22/2022]
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A Dosimetric Planning Study Comparing Intensity-modulated Radiotherapy with Four-field Conformal Pelvic Radiotherapy for the Definitive Treatment of Cervical Carcinoma. Clin Oncol (R Coll Radiol) 2012; 24:e63-70. [DOI: 10.1016/j.clon.2011.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/24/2011] [Accepted: 05/05/2011] [Indexed: 12/11/2022]
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Gwynne S, Webster R, Adams R, Mukherjee S, Coles B, Staffurth J. Image-guided Radiotherapy for Rectal Cancer — A Systematic Review. Clin Oncol (R Coll Radiol) 2012; 24:250-60. [DOI: 10.1016/j.clon.2011.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/16/2011] [Accepted: 07/04/2011] [Indexed: 11/27/2022]
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Simonds HM, Wright JD, du Toit N, Neugut AI, Jacobson JS. Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)-positive and HIV-negative patients with locally advanced cervical carcinoma in South Africa. Cancer 2011; 118:2971-9. [PMID: 22072021 DOI: 10.1002/cncr.26639] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/27/2011] [Accepted: 09/27/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Very few published studies have dealt with the management of locally advanced cervix carcinoma among human immunodeficiency virus (HIV)-positive patients. The objective of this study was to compare the clinical characteristics, radiation and chemotherapy treatments, and outcomes in a cohort of HIV-positive and HIV-negative women with cervical cancer. METHODS The authors reviewed the charts of 59 HIV-positive patients and 324 HIV-negative patients who had stage IB1 to IIIB cervical carcinoma and who received radiation therapy. Demographic and clinical characteristics were compared at the time of diagnosis; and radiation doses, chemotherapy cycles, and responses were compared at the time of brachytherapy and at 6-week follow-up. Logistic regression models of response to treatment were developed. RESULTS Forty-nine HIV-positive patients (88.1%) but only 213 HIV-negative patients (65.7%) presented with stage IIIB disease (P = .009). Forty-seven HIV-positive patients (79.7%) and 291 HIV-negative patients (89.8%) completed the equivalent dose of 68 Grays (Gy) external-beam radiation and high-dose-rate brachytherapy. (P = .03). Of the 333 patients who commenced concurrent chemotherapy, 26 HIV-positive patients (53.1%) and 212 HIV-negative patients (74.6%) completed ≥4 weekly cycles of platinum-based treatment. Follow-up was censured at 6 weeks. In models that included age, disease stage, HIV status, and treatment, a poor response at 6 weeks was associated only with stage IIIB disease (odds ratio, 2.39; 95% confidence interval, 1.45-3.96) and receiving an equivalent radiation dose in 2-Gy fractions of <68 Gy (OR, 3.14; 95% CI, 1.24-7.94). CONCLUSIONS HIV-positive patients fared worse than HIV-negative patients because of later presentation and a decreased likelihood of completing treatment. The current findings emphasize the importance of completing irradiation therapy. Further studies will address the association of these variables with survival.
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Affiliation(s)
- Hannah M Simonds
- Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Tygerberg, South Africa.
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Toita T, Ohno T, Kaneyasu Y, Kato T, Uno T, Hatano K, Norihisa Y, Kasamatsu T, Kodaira T, Yoshimura R, Ishikura S, Hiraoka M. A Consensus-based Guideline Defining Clinical Target Volume for Primary Disease in External Beam Radiotherapy for Intact Uterine Cervical Cancer. Jpn J Clin Oncol 2011; 41:1119-26. [DOI: 10.1093/jjco/hyr096] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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