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Resteghini C, Castelnuovo P, Nicolai P, Orlandi E, Bossi P, Vischioni B, Schreiber A, Gambazza S, Iacovelli NA, Battaglia P, Guzzo M, Turri-Zanoni M, Mattavelli D, Facchinetti N, Calareso G, Ravanelli M, Facco C, Tartaro T, Licitra L. The SINTART 1 study. A phase II non-randomised controlled trial of induction chemotherapy, surgery, photon-, proton- and carbon ion-based radiotherapy integration in patients with locally advanced resectable sinonasal tumours. Eur J Cancer 2023; 187:185-194. [PMID: 37164774 DOI: 10.1016/j.ejca.2023.03.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Sinonasal tumours are rare diseases with poor prognosis. Multimodal approach including surgery is widely used, although no standard therapy has been established in prospective trials. This study assessed activity and safety of an innovative integration of multimodality treatment-induction chemotherapy (ICT), surgery and radiotherapy (RT)-modulated by histology and response to ICT. METHODS Patients with untreated, operable sinonasal tumours with selected histotypes (squamous cell carcinoma, intestinal-type adenocarcinoma, sinonasal undifferentiated and neuroendocrine carcinoma, olfactory neuroblastoma) were enrolled in a single-arm, phase II, multicenter clinical trial. Patients were treated with up to 5 ICT cycles, whose regimen was selected according to histotype, followed either by curative chemo-RT for pts with ≥80% reduction of initial tumour diameter or surgery and adjuvant (chemo)RT. Photon and/or proton/carbon ion-based RT was employed according to the disease site and stage. Primary end-point was 5-year progression-free survival (PFS), secondary end-points were overall survival (OS), ICT objective response rate (ORR) per RECIST 1.1 and safety. RESULTS Thirty-five patients were evaluable for primary end-point. Fourteen patients (40%) were treated with definitive (CT)RT and 20 (57%) underwent surgery. Five-year PFS was 38% (95% confidence interval [CI], 21-69), with a median PFS of 26 months. Five-year OS was 46% (95% CI, 28-75), with a median OS of 36 months. Three-year PFS-OS for pts achieving PR/CR versus stable disease (SD)/PD to ICT were 49.8-57% versus 43.2-53%, respectively. Three-year PFS for patients achieving major volumetric partial response (≥80% reduction of initial tumour volume, major partial volumetric response [mPRv]) versus non-mPRv were 82% versus 28% and 3-year OS were 92% versus 36% (p value 0.010 and 0.029, respectively). The ORR to ICT was 54% and 60% across all histotypes and in the sinonasal undifferentiated carcinoma (SNUC) subpopulation, respectively, with 6/15 SNUCs (40%) achieving mPRv. CONCLUSION Treatment of advanced sinonasal cancer with histology-driven ICT followed by (CT)RT in responsive patients was feasible. Overall, these findings suggest a possible role of ICT as the primary approach in newly diagnosed, resectable sinonasal tumours-especially SNUC-to select patients with favourable prognosis. Histology heterogeneity limits generalisation of trial results.
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Affiliation(s)
- Carlo Resteghini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, 'Azienda Ospedale Università di Padova', University of Padua, Padua, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, 'ASST Spedali Civili di Brescia', University of Brescia, Brescia, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, 'ASST Spedali Civili di Brescia', University of Brescia, Brescia, Italy
| | - Simone Gambazza
- Laboratory of Medical Statistics and Biometry, 'Giulio A. Maccacaro', Department of Clinical Sciences and Community Health, Campus Cascina Rosa, University of Milan, Milan, Italy
| | | | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Guzzo
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', University of Insubria, Varese, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, 'ASST Spedali Civili di Brescia', University of Brescia, Brescia, Italy
| | - Nadia Facchinetti
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - 'ASST Spedali Civili di Brescia', Brescia, Italy
| | - Carla Facco
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette-Laghi, University of Insubria, Varese, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, 'ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi', Varese, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Ferrari M, Mattavelli D, Tomasoni M, Raffetti E, Bossi P, Schreiber A, Orlandi E, Taboni S, Rampinelli V, Gualtieri T, Turri-Zanoni M, Battaglia P, Arosio AD, Bignami M, Tartaro T, Molteni M, Bertazzoni G, Fiaux-Camous D, Jourdaine C, Verillaud B, Eu D, Nair D, Moiyadi A, Shetty P, Ghosh-Laskar S, Budrukkar A, Magrini SM, Guillerm S, Faivre S, Piazza C, Gilbert RW, Irish JC, de Almeida JR, Pai P, Herman P, Castelnuovo P, Nicolai P. The MUSES∗: a prognostic study on 1360 patients with sinonasal cancer undergoing endoscopic surgery-based treatment: ∗MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers. Eur J Cancer 2022; 171:161-182. [PMID: 35724468 DOI: 10.1016/j.ejca.2022.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the last 2 decades, transnasal endoscopic surgery (TES) has become the most frequently employed surgical technique to treat sinonasal malignancies. The rarity and heterogeneity of sinonasal cancers have hampered large non-population-based analyses. METHODOLOGY All patients receiving TES-including treatment between 1995 and 2021 in 5 referral hospitals were included. A prognostic study was performed, and multivariable models were transformed into nomograms. Training and validation sets were based on results from 3 European and 2 non-European centres, respectively. RESULTS The training and validation set included 940 and 420 patients, respectively. The mean age at surgery, primary-versus-recurrent presentation, histology distribution, type of surgery, T category and type of adjuvant treatment were differently distributed in the training and validation set. In the training set, 5-year overall survival and recurrence-free survival with a 95%-confidence interval were 72.7% (69.5-76.0%) and 66.4% (63.1-69.8%), respectively, significantly varying with histology. At multivariable analyses, age, gender, previous treatment, the extent of resection on the cranial, lateral and posterolateral axes, grade/subtype, T category, nodal status, margin status and adjuvant treatment were all associated with different prognostic outcomes, displaying a heterogeneous significance and effect size according to histology. The internal and external validation of nomograms was satisfactory (optimism-corrected C-index >0.7 and cumulative area under curve >0.7) for all histologies but mucosal melanoma. CONCLUSIONS Outcomes of TES-based treatment of sinonasal cancers vary substantially with histology. This large, non-population-based study provides benchmark data on the prognosis of sinonasal cancers that are deemed suitable for treatment including TES.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto D Arosio
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Marinella Molteni
- Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | | | | | - Clement Jourdaine
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Benjamin Verillaud
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Donovan Eu
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Deepa Nair
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Stefano M Magrini
- Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Sophie Guillerm
- Department of Radiotherapy Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Sandrine Faivre
- Department of Medical Oncology Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Prathamesh Pai
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Philippe Herman
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
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3
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Mirandola A, Russo S, Bonora M, Vischioni B, Camarda AM, Ingargiola R, Molinelli S, Ronchi S, Rossi E, Vai A, Iacovelli NA, Thariat J, Ciocca M, Orlandi E. A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients. Cancers (Basel) 2022; 14:cancers14112678. [PMID: 35681661 PMCID: PMC9179408 DOI: 10.3390/cancers14112678] [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: 04/28/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 12/01/2022] Open
Abstract
(1) Background: In this work, we aim to provide selection criteria based on normal tissue complication probability (NTCP) models and additional explanatory dose-volume histogram parameters suitable for identifying locally advanced sinonasal cancer patients with orbital invasion benefitting from proton therapy. (2) Methods: Twenty-two patients were enrolled, and two advanced radiation techniques were compared: intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT). Plans were optimized with a simultaneous integrated boost modality: 70 and 56 Gy(RBE) in 35 fractions were prescribed to the high risk/low risk CTV. Several endpoints were investigated, classified for their severity and used as discriminating paradigms. In particular, when NTCP models were already available, a first selection criterion based on the delta-NTCP was adopted. Additionally, an overall analysis in terms of DVH parameters was performed. Furthermore, a second selection criterion based on a weighted sum of the ΔNTCP and ΔDVH was adopted. (3) Results: Four patients out of 22 (18.2%) were suitable for IMPT due to ΔNTCP > 3% for at least one severe toxicity, 4 (18.2%) due to ΔNTCP > 20% for at least three concurrent intermediate toxicities and 16 (72.7%) due to the mixed sum of ΔNTCP and ΔDVH criterion. Since, for some cases, both criteria were contemporary fulfilled, globally 17/22 patients (77.3%) would benefit from IMPT. (4) Conclusions: For this rare clinical scenario, the use of a strategy including DVH parameters and NTCPs when comparing VMAT and IMPT is feasible. We showed that patients affected by sinonasal cancer could profit from IMPT compared to VMAT in terms of optical and central nervous system organs at risk sparing.
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Affiliation(s)
- Alfredo Mirandola
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
- Correspondence: ; Tel.: +39-0382-078-514
| | - Stefania Russo
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Maria Bonora
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Barbara Vischioni
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Anna Maria Camarda
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Rossana Ingargiola
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Silvia Molinelli
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Sara Ronchi
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Eleonora Rossi
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Alessandro Vai
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | | | - Juliette Thariat
- Department of Radiation Oncology, Françoise Baclesse Center ARCHADE, Normandy University, 14000 Caen, France;
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Ester Orlandi
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
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Raturi VP, Motegi A, Zenda S, Nakamura N, Hojo H, Kageyama SI, Okumura M, Rachi T, Ohyoshi H, Tachibana H, Motegi K, Ariji T, Nakamura M, Hirano Y, Hirata H, Akimoto T. Comparison of a Hybrid IMRT/VMAT technique with non-coplanar VMAT and non-coplanar IMRT for unresectable olfactory neuroblastoma using the RayStation treatment planning system-EUD, NTCP and planning study. JOURNAL OF RADIATION RESEARCH 2021; 62:540-548. [PMID: 33839761 PMCID: PMC8127663 DOI: 10.1093/jrr/rrab010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/20/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to compare hybrid intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (Hybrid IMRT/VMAT), with non-coplanar (nc) IMRT and nc-VMAT treatment plans for unresectable olfactory neuroblastoma (ONB). Hybrid IMRT/VMAT, nc-IMRT and nc-VMAT plans were optimized for 12 patients with modified Kadish C stage ONB. Dose prescription was 65 Gy in 26 fractions. Dose-volume histogram parameters, conformation number (CN), homogeneity index (HI), integral dose and monitor units (MUs) delivered per fraction were assessed. Equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) based on the EUD model (NTCPLogit) and the Lyman-Kutcher-Burman model (NTCPLKB) were also evaluated. We found that the Hybrid IMRT/VMAT plan significantly improved the CN for clinical target volume (CTV) and planning treatment volume (PTV) compared with the nc-VMAT plan. In general, sparing of organs at risk (OARs) is similar with the three techniques, although the Hybrid IMRT/VMAT plan resulted in a significantly reduced Dmax to contralateral (C/L) optic nerve compared with the nc-IMRT plan. The Hybrid IMRT/VMAT plan significantly reduce EUD to the ipsilateral (I/L) and C/L optic nerve in comparison with the nc-IMRT plan and nc-VMAT plan, but the difference in NTCP between the three technique was <1%. We concluded that the Hybrid IMRT/VMAT technique can offer improvement in terms of target conformity and EUD for optic nerves, while achieving equal or better OAR sparing compared with nc-IMRT and nc-VMAT, and can be a viable radiation technique for treating unresectable ONB. However, the clinical benefit of these small differences in dosimetric data, EUD and NTCP of optic nerves may be minimal.
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Affiliation(s)
- Vijay P Raturi
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Course of Advanced Clinical Research of Cancer, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsushi Motegi
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Sadamoto Zenda
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naoki Nakamura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidehiro Hojo
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shin-Ichiro Kageyama
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masayuki Okumura
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Toshiya Rachi
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hajime Ohyoshi
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hidenobu Tachibana
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kana Motegi
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takaki Ariji
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masaki Nakamura
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yasuhiro Hirano
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hidenari Hirata
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tetsuo Akimoto
- Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Course of Advanced Clinical Research of Cancer, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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König M, Osnes T, Bruland Ø, Sundby Hall K, Bratland Å, Meling TR. The Role of Adjuvant Treatment in Craniofacial Malignancy: A Critical Review. Front Oncol 2020; 10:1402. [PMID: 32850452 PMCID: PMC7426725 DOI: 10.3389/fonc.2020.01402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Tumors originating from the craniofacial region usually present in a locally advanced stage with frequent involvement of adjacent sites and have a strong tendency for local recurrence in the absence of adjuvant therapy, even when the original surgical resection was presumed to be radical. In the past decades, several advances in the radiological diagnosis and treatment of craniofacial malignancies have been introduced. There are, however, no randomized trials that define the optimal multimodal treatment of these tumors because of their rarity as well as heterogeneity in both histology and site of origin. The aim of this study was to conduct a critical review of the role of adjuvant therapy in the treatment of craniofacial malignancy. Method: We conducted a critical review of the past and contemporary literature available, focusing on adjuvant oncological treatments of the most common craniofacial malignancies. Results: Preoperative radiotherapy can have a documented role in the treatment of olfactory neuroblastoma and soft tissue sarcoma, while preoperative chemotherapy can be advocated in the treatment of sinonasal undifferentiated carcinoma, neuroendocrine carcinoma, olfactory neuroblastoma, and craniofacial sarcoma (both soft-tissue and high-grade osteosarcoma). Postoperative radiotherapy has a well-established role in the treatment of most craniofacial malignancies. The role of postoperative chemotherapy is unclear in most histologies, but is commonly used during the treatment of well-selected cases of paranasal sinus carcinoma, olfactory neuroblastoma, mucosal melanoma, soft tissue sarcoma and high-grade craniofacial osteosarcoma. Discussion: Alongside developments in surgery, there have also been improvements in diagnostics, radiotherapy, and chemotherapy. Implementation of novel radiation techniques allows delivery of higher radiation doses while minimizing irradiation-related morbidity. Better understanding of tumor biology allows the construction of more complex treatment strategies, incorporating adjuvant chemotherapy either pre- or postoperatively. In the era of personalized targeted therapy, rapid strides are being made to identify specific tumor-targets for use of novel biologic agents, with the potential to change current management paradigms.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terje Osnes
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Øyvind Bruland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torstein R. Meling
- Service de Neurochirurgie, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Mohamed Ali A, Mathis T, Bensadoun RJ, Thariat J. Radiation induced optic neuropathy: Does treatment modality influence the risk? Bull Cancer 2019; 106:1160-1176. [PMID: 31757405 DOI: 10.1016/j.bulcan.2019.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/29/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
Radiation induced optic neuropathy (RION) is a rare but disastrous complication of radiation therapy in treatment of periorbital tumors. The objective of this study is to investigate the incidence of RION in series of patients treated from peri orbital tumors by recent photon and proton irradiation modalities. We searched the Pub Med database for studies in periorbital tumors including base of skull, sinonasal, pituitary, nasopharyngeal tumors and craniopharyngioma treated with Intensity modulated radiotherapy (IMRT) and with proton beam therapy (PBT) between 1992 and 2017 excluding metastatic tumors, lymphomas, pediatric series, those treated mainly with chemotherapy, target therapy and those written in languages other than English and French. The result retrieved 421 articles that were revised by the panel. Fourteen articles with IMRT and 27 with PBT reported usable data for the review from which 31studies that had pointed to the doses to the optic nerve (ON) and/or optic chiasm (OC) and incidence of RION have been analyzed. We have found that the incidence of RION had been reported fairly in both modalities and many other factors related to the patient, tumor, and irradiation process interplay in its development. We have concluded that proper treatment planning, good selection of treatment modality, adherence to dose constraints applied to critical structures all along with regular oncological and ophthalmological follow up, control of co-morbidities and early intervention, could help reducing its magnitude.
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Affiliation(s)
- Ali Mohamed Ali
- Sohag University, Sohag University Hospital, Department of Clinical Oncology, Sohag East, 82524 Sohag, Egypt
| | - Thibaud Mathis
- Croix-Rousse University Hospital, Department of Ophthalmology, 103, grande rue de la Croix-Rousse, Lyon, France; UMR-CNRS 5510, Mateis, Villeurbanne, Lyon, France
| | | | - Juliette Thariat
- Centre François-Baclesse/ARCHADE, Department of Radiation Oncology, 3, avenue General Harris, 14000 Caen, France; Unicaen - Normandie Université, laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534, boulevard du Marechal Juin, 14050 Caen, France
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König M, Osnes T, Bratland Å, Meling TR. Squamous Cell Carcinoma of the Paranasal Sinuses: A Single Center Experience. J Neurol Surg B Skull Base 2019; 81:664-672. [PMID: 33381371 DOI: 10.1055/s-0039-1694967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023] Open
Abstract
Objective Squamous cell carcinoma (SCC) of the paranasal sinuses is usually diagnosed at an advanced stage, making curative therapy difficult. The goal of this study was to evaluate the management and outcomes of patients with SCC treated at our institution. Methods In a population-based consecutive prospective cohort, we conducted an analysis of all patients treated for SCC between 1988 and 2017. Results A total of 72 patients were included, follow-up was 100%. Mean follow-up was 57 months for the entire cohort, and 108 months for patients with no evidence of disease. Eighty-two percent of all patients had high-stage (T4) disease. Fifty-seven patients underwent treatment with curative intent; consisting of surgery with or without oncologic treatment in 34, and of oncologic treatment only in 23 cases. Fifteen patients received palliative treatment. The rates of overall survival for the entire cohort were 55% at 2, 41% at 5, and 32% at 10 years, and corresponding disease-specific survival (DSS) rates were 55, 45, and 34%, respectively. DSS rates after surgical treatment with curative intent were 81% at 2, 65% at 5, and 54% at 10 years. Retromaxillary involvement and nonradical surgery were negative prognostic factors. Best survival was achieved with the combination of radical surgery and adjuvant oncologic treatment. Conclusion Surgical resection with a curative intent yielded 65% at 5-year DSS even in this cohort of patients with high-stage SCC and is still considered as the treatment of choice, preferably in combination with adjuvant radiation therapy and chemotherapy.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Terje Osnes
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Service de Neurochirurgie, Département des Neurosciences Cliniques, Hopitaux Universitaires de Genève, Genève, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Gabriele P, Macias V, Stasi M, Chauvie S, Munoz F, Delmastro E, Scielzo G. Feasibility of Intensity-Modulated Radiation Therapy in the Treatment of Advanced Cervical Chordoma. TUMORI JOURNAL 2018; 89:298-304. [PMID: 12908787 DOI: 10.1177/030089160308900313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Postoperative radiation is often given in cases of cervical chordoma because of the high incidence of local recurrence. The tumor mass usually surrounds the spinal cord and infiltrates vertebral bone. A combined technique using protons or electrons to boost the initial photon fields is generally applied. We evaluated the use of dynamic intensity-modulated radiation therapy as an alternative technique for treating advanced cervical chordoma. Methods and Study Design A female patient with incomplete resection of a vertebral chordoma surrounding C2-C3 was irradiated with a total dose of 58 Gy (ICRU point) in 2 Gy daily fractions for 29 days between December 2001 and January 2002. Beam arrangement consisted of seven 6 MV non-opposed coplanar fields. Pretreatment quality assurance included checking of the absolute dose at reference points and 2D dose map analysis. Treatment was delivered with a 120-leaf collimator in sliding window mode. To verify the daily setup, portal images at 0° and 90° were compared with the simulation images before treatment delivery (manual matching) and after treatment delivery (automatic anatomy matching). Results and Conclusions The mean dose to the planning target volume (PTV) was 57.6 ± 2.1 Gy covering 95% of the PTV per 95% isodose. The minimum dose to the PTV (D99) was 53.6 Gy in the overlapping area between the PTV and the spinal cord planning organ at risk volume (PRV). The maximum dose to the spinal cord was 42.2 Gy and to the spinal cord PRV (8 mm margin) 53.7 Gy. The mean dose to the parotid glands was 37.4 Gy (homolateral gland) and 19.5 Gy (contralateral gland). Average deviation in setup was -1.1 ± 2.5 mm (anterior-posterior), 2.4 ±1.3 mm (latero-lateral), 0.7 ± 0.9 mm (craniocaudal) and -0.43 ± 1° (rotation). Conclusions In the treatment of chordomas surrounding the spinal cord, intensity-modulated radiotherapy can provide high dose homogeneity and PTV coverage. Frequent digital portal image-based setup control is able to reduce random positioning errors for head and neck cancer patients immobilized with conventional thermoplastic masks.
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Affiliation(s)
- Pietro Gabriele
- Department of Radiation Oncology, Institute for Cancer Research and Treatment, Ordine Mauriziano, Turin, Italy
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Robin TP, Jones BL, Gordon OM, Phan A, Abbott D, McDermott JD, Goddard JA, Raben D, Lanning RM, Karam SD. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123:3040-3049. [PMID: 28369832 DOI: 10.1002/cncr.30686] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sinonasal malignancies are a rare and heterogeneous group of tumors for which there is a paucity of robust data with which to guide management decisions. The authors used the National Cancer Data Base to better understand the presenting characteristics of these tumors and to compare outcomes by treatment modality. METHODS The National Cancer Data Base was queried for sinonasal malignancies diagnosed between 2004 and 2012. Overall survival was assessed using multivariate analyses and propensity score matching. RESULTS A total of 11,160 patients were identified for the initial analysis. The majority were male, aged 40 to 69 years, with tumors of the nasal cavity or maxillary sinus. Squamous cell histology was most common. The majority of patients presented with advanced tumor stage but without locoregional lymph node or distant metastases. Treatment modalities were compared for squamous cell carcinomas. In multivariate analysis, compared with surgery alone, patients who received adjuvant radiotherapy (hazard ratio [HR], 0.658 [P<.001]), adjuvant chemoradiotherapy (HR, 0.696 [P = .002]), or neoadjuvant therapy (HR, 0.656 [P = .007]) had improved overall survival. Patients who received radiotherapy alone (HR, 1.294 [P = .001]) or chemotherapy alone (HR, 1.834 [P<.001]) had worse outcomes. These findings were validated in propensity score matching. It is important to note that neoadjuvant chemoradiotherapy was associated with achieving a negative surgical margin (odds ratio, 2.641 [P = .045]). CONCLUSIONS Surgery is the mainstay of therapy for patients with sinonasal malignancies, but multimodality therapy is associated with improved overall survival. Cancer 2017;123:3040-49. © 2017 American Cancer Society.
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Affiliation(s)
- Tyler P Robin
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Oren M Gordon
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Andy Phan
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Diana Abbott
- Department of Biostatistics and Informatics, Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado
| | - Jessica D McDermott
- Department of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado Cancer Center, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Ryan M Lanning
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
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Roy A, Das IJ, Nohadani O. On correlations in IMRT planning aims. J Appl Clin Med Phys 2016; 17:44-59. [PMID: 27929480 PMCID: PMC5690524 DOI: 10.1120/jacmp.v17i6.6411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/29/2016] [Accepted: 06/22/2016] [Indexed: 11/23/2022] Open
Abstract
The purpose was to study correlations amongst IMRT DVH evaluation points and how their relaxation impacts the overall plan. 100 head‐and‐neck cancer cases, using the Eclipse treatment planning system with the same protocol, are statistically analyzed for PTV, brainstem, and spinal cord. To measure variations amongst the plans, we use (i) interquartile range (IQR) of volume as a function of dose, (ii) interquartile range of dose as a function of volume, and (iii) dose falloff. To determine correlations for institutional and ICRU goals, conditional probabilities and medians are computed. We observe that most plans exceed the median PTV dose (average D50 = 104% prescribed dose). Furthermore, satisfying D50 reduced the probability of also satisfying D98, constituting a negative correlation of these goals. On the other hand, satisfying D50 increased the probability of satisfying D2, suggesting a positive correlation. A positive correlation is also observed between the PTV V105 and V110. Similarly, a positive correlation between the brainstem V45 and V50 is measured by an increase in the conditional median of V45, when V50 is violated. Despite the imposed institutional and international recommendations, significant variations amongst DVH points can occur. Even though DVH aims are evaluated independently, sizable correlations amongst them are possible, indicating that some goals cannot be satisfied concurrently, calling for unbiased plan criteria. PACS number(s): 87.55.dk, 87.53.Bn, 87.55.Qr, 87.55.de.
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Affiliation(s)
- Arkajyoti Roy
- Northwestern University; Bowling Green State University.
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11
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Paranasal sinus cancer. Crit Rev Oncol Hematol 2016; 98:45-61. [DOI: 10.1016/j.critrevonc.2015.09.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/15/2015] [Accepted: 09/30/2015] [Indexed: 01/29/2023] Open
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Nakamura T, Azami Y, Ono T, Yamaguchi H, Hayashi Y, Suzuki M, Hatayama Y, Tsukiyama I, Hareyama M, Kikuchi Y, Takayama K, Fuwa N. Preliminary results of proton beam therapy combined with weekly cisplatin intra-arterial infusion via a superficial temporal artery for treatment of maxillary sinus carcinoma. Jpn J Clin Oncol 2015; 46:46-50. [DOI: 10.1093/jjco/hyv160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
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Duru Birgi S, Teo M, Dyker KE, Sen M, Prestwich RJD. Definitive and adjuvant radiotherapy for sinonasal squamous cell carcinomas: a single institutional experience. Radiat Oncol 2015; 10:190. [PMID: 26377408 PMCID: PMC4574072 DOI: 10.1186/s13014-015-0496-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the disease outcomes of patients treated with definitive and adjuvant radiotherapy for squamous cell carcinomas of the nasal cavity and paranasal sinuses in a single institution. METHODS Between 2007-2012 patients were retrospectively identified from electronic databases who had undergone surgery and adjuvant radiotherapy or definitive radiotherapy for sinonasal squamous cell carcinomas with curative intent. RESULTS Fourty three patients with sinonasal squamous cell carcinoma were identified (22 nasal cavity, 21 paranasal sinuses). 31/43 (72%) had T3 or T4 disease; nodal stage was N0 in 38, N1 in 4, Na/b in 0 and N2c in 1 patient. Median age was 67 years (range 41-86). 18 (42%) received definitive and 25 (58%) adjuvant radiotherapy. Radiotherapy was delivered using either conventional radiotherapy (n = 39) or intensity modulated radiotherapy (n = 4). Elective neck radiotherapy was delivered to two patients. Chemotherapy was delivered to 6/43 (14%) of patients. Two-year local control, regional control, distant metastases free survival, progression free survival, cause specific survival and overall survival were 81%, 90%, 95%, 71%, 84% and 80% respectively. There was no significant difference in outcome comparing patients who underwent surgery and adjuvant radiotherapy with patients receiving definitive radiotherapy (2 year locoregional disease free survival 75% and 70% respectively, p = 0.98). Pooly differentiated tumours were significantly associated with inferior disease outcomes. Local, regional, combined local and regional, and distant failure occurred in 7 (16%), 3 (7%), 1 (2%) and 2 (5%) of patients; all 3 regional recurrences were in patients with nasal cavity squamous cell carcinomas who had not undergone elective neck treatment. CONCLUSIONS Definitive or adjuvant radiotherapy provides an effective treatment for sinonasal malignancies. The main pattern of failure remains local, suggesting the need for investigation of intensified local therapy. Whilst remaining uncommon, the cases of regional failure mean that the merits of elective lymph node treatment should be considered on an individual basis.
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Affiliation(s)
- Sumerya Duru Birgi
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mark Teo
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Karen E Dyker
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Mehmet Sen
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Robin J D Prestwich
- Department Of Clinical Oncology, St. James's Institute of Oncology, Level 4, Bexley Wing, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
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Radiotherapy for unresectable sinonasal cancers: Dosimetric comparison of intensity modulated radiation therapy with coplanar and non-coplanar volumetric modulated arc therapy. Radiother Oncol 2014; 113:260-6. [DOI: 10.1016/j.radonc.2014.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 02/05/2023]
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Coplanar VMAT vs. noncoplanar VMAT in the treatment of sinonasal cancer. Strahlenther Onkol 2014; 191:34-42. [PMID: 25293728 DOI: 10.1007/s00066-014-0760-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous studies showed that noncoplanar intensity-modulated radiotherapy (NC-IMRT) for sinonasal cancer is superior to coplanar intensity-modulated radiotherapy (IMRT). Volumetric-modulated arc therapy (VMAT) is a newly introduced treatment modality, and the performance of noncoplanar VMAT for sinonasal cancer has not been well described to date. PURPOSE To compare the dosimetry difference of noncoplanar VMAT (NC-VMAT), coplanar VMAT (co-VMAT), and NC-IMRT for sinonasal cancer. PATIENTS AND METHODS Ten postoperative patients with sinonasal cancer were randomly selected for planning with NC-VMAT, co-VMAT, and NC-IMRT. Two planning target volumes (PTVs) were contoured representing high-risk and low-risk regions set to receive a median absorbed dose (D50%) of 68 Gy and 59 Gy, respectively. The homogeneity index (HI), conformity index (CI), dose-volume histograms (DVHs), and delivery efficiency were all evaluated. RESULTS Both NC-VMAT and co-VMAT showed superior dose homogeneity and conformity in PTVs compared with NC-IMRT. There was no significant difference between NC-VMAT and co-VMAT in PTV coverage. Both VMAT plans provided a better protection for organs at risk (OARs) than NC-IMRT plans, and NC-VMAT showed a small improvement over co-VMAT in sparing of OARs. For peripheral doses, the doses to breast, thyroid, and larynx in the NC-IMRT plans were significantly higher than those in both VMAT plans. Compared to NC-VMAT, co-VMAT significantly reduced peripheral doses. NC-VMAT and co-VMAT reduced the average delivery time by 63.2 and 64.2%, respectively, in comparison with NC-IMRT. No differences in delivery efficiency were observed between the two VMAT plans. CONCLUSION Compared to NC-VMAT, co-VMAT showed similar PTV coverage and comparable OAR sparing but significantly reduced peripheral doses and positioning uncertainty. We propose to give priority to coplanar VMAT in the treatment of sinonasal cancer.
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Skórska M, Piotrowski T, Kaźmierska J, Adamska K. A dosimetric comparison of IMRT versus helical tomotherapy for brain tumors. Phys Med 2014; 30:497-502. [PMID: 24613513 DOI: 10.1016/j.ejmp.2014.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Helical tomotherapy (HT) can deliver highly conformal, uniform doses to the target volume. However, HT can only be delivered in a coplanar mode. The purpose of this study was to perform a dosimetric comparison of HT versus coplanar (cIMRT) and non-coplanar (n-cIMRT) beam arrangements on a conventional linear accelerator in a diverse group of brain tumors. MATERIALS AND METHODS A total of 45 treatment plans were calculated retrospectively for 15 cases. For each case, 3 different delivery techniques (n-cIMRT, cIMRT and HT) were used. The treatment plans were compared using the parameters of the target coverage (conformity index; CI) and homogeneity (HI) for the planning target volume (PTV) and the maximum and mean doses for organs at risk (OARs). RESULTS Median HI and CI were the best for HT plans and the worst for cIMRT. The largest reduction of maximum dose for lenses and mean dose for both eyes was achieved for n-cIMRT plans. Mean dose for chiasm and the ipsilateral optic nerve were the lowest for HT. The contralateral optic nerve was most spared with n-cIMRT. For D1% in the brain stem, there was no significant difference between HT and the IMRT plans. CONCLUSIONS Both HT and n-cIMRT are capable of producing conformal and homogeneous treatment plans with a good sparing of OARs. However, due to the non-coplanar capabilities of IMRT, n-cIMRT led to a superior dose reduction to the lenses.
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Affiliation(s)
- M Skórska
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland.
| | - T Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland; Department of Electroradiology, University of Medical Sciences, Poznan, Poland
| | - J Kaźmierska
- Department of Electroradiology, University of Medical Sciences, Poznan, Poland; Department of Radiotherapy II, Greater Poland Cancer Centre, Poznan, Poland
| | - K Adamska
- Second Radiotherapy Ward, Greater Poland Cancer Centre, Poznan, Poland
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De Neve W, Duthoy W. Intensity-modulated radiation therapy for head and neck cancer. Expert Rev Anticancer Ther 2014; 4:425-34. [PMID: 15161441 DOI: 10.1586/14737140.4.3.425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In head and neck cancer, intensity-modulated radiation therapy (IMRT) makes the use of electron beams for irradiation of the posterior neck obsolete, inherently performs missing tissue compensation, and allows concave and intentionally nonhomogeneous dose distributions. By clinical use of these physical characteristics, salivary or lacrimal glands, optic pathway and auditory structures can be selectively underdosed and good evidence of decreased radiation toxicity is available. Evidence for increased local control is still lacking. Recurrences are mainly located in the high-dose-prescription regions, suggesting the need for even higher doses in these areas. Image-aided design of IMRT dose distribution is an area of intense research. New positron emission tomography and magnetic resonance imaging developments might allow definition of volumes inside the tumor where treatment failure is most likely to occur. If these volumes are small, focused dose escalation of large magnitude can be attempted and the hypothesis of improved local control by IMRT can be tested.
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Affiliation(s)
- Wilfried De Neve
- Ghent University Hospital, Department of Radiotherapy, De Pintelaan 185, 9000 Gent, Belgium.
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Fontanarosa D, van der Laan HP, Witte M, Shakirin G, Roelofs E, Langendijk JA, Lambin P, van Herk M. An in silico comparison between margin-based and probabilistic target-planning approaches in head and neck cancer patients. Radiother Oncol 2013; 109:430-6. [DOI: 10.1016/j.radonc.2013.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 07/12/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
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Di Fulvio A, Tana L, Caresana M, D'Agostino E, de San Pedro M, Domingo C, d'Errico F. Clinical simulations of prostate radiotherapy using BOMAB-like phantoms: Results for neutrons. RADIAT MEAS 2013. [DOI: 10.1016/j.radmeas.2013.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chi A, Nguyen NP, Tse W, Sobremonte G, Concannon P, Zhu A. Intensity modulated radiotherapy for sinonasal malignancies with a focus on optic pathway preservation. J Hematol Oncol 2013; 6:4. [PMID: 23294673 PMCID: PMC3561126 DOI: 10.1186/1756-8722-6-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/31/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess if intensity-modulated radiotherapy (IMRT) can possibly lead to improved local control and lower incidence of vision impairment/blindness in comparison to non-IMRT techniques when treating sinonasal malignancies; what is the most optimal dose constraints for the optic pathway; and the impact of different IMRT strategies on optic pathway sparing in this setting. METHODS AND MATERIALS A literature search in the PubMed databases was conducted in July, 2012. RESULTS Clinical studies on IMRT and 2D/3D (2 dimensional/3 dimensional) RT for sinonasal malignancies suggest improved local control and lower incidence of severe vision impairment with IMRT in comparison to non-IMRT techniques. As observed in the non-IMRT studies, blindness due to disease progression may occur despite a lack of severe toxicity possibly due to the difficulty of controlling locally very advanced disease with a dose ≤ 70 Gy. Concurrent chemotherapy's influence on the the risk of severe optic toxicity after radiotherapy is unclear. A maximum dose of ≤ 54 Gy with conventional fractionation to the optic pathway may decrease the risk of blindness. Increased magnitude of intensity modulation through increasing the number of segments, beams, and using a combination of coplanar and non-coplanar arrangements may help increase dose conformality and optic pathway sparing when IMRT is used. CONCLUSION IMRT optimized with appropriate strategies may be the treatment of choice for the most optimal local control and optic pathway sparing when treating sinonasal malignancy.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, West Virginia University, 1 Medical Center Dr, Morgantown, Morgantown, WV 26506, USA.
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Sankaralingam M, Glegg M, Smith S, James A, Rizwanullah M. Quantitative comparison of volumetric modulated arc therapy and intensity modulated radiotherapy plan quality in sino-nasal cancer. J Med Phys 2012; 37:8-13. [PMID: 22363107 PMCID: PMC3283919 DOI: 10.4103/0971-6203.92715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/10/2011] [Accepted: 11/16/2011] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to compare various dosimetric parameters of dynamic mlc intensity modulated radiotherapy (IMRT) plans with volumetric modulated arc therapy (VMAT) plans for sino-nasal cancers, which are rare and complex tumors to treat with radiotherapy. IMRT using five fields, coplanar in the sagittal plane and VMAT employing two coplanar arc plans were created for five patients. The plans were assessed by comparing Conformity Index and Sigma Index (dose homogeneity) in the Planning Target Volume (PTV) and through comparison of dose-volume characteristics to the following organs at risk (OARs): Spinal cord, brainstem, eye, ipsilateral and contralateral optic nerve and the volume of brain receiving 10% of the prescribed dose (V10%). The total monitor units required to deliver the plan were also compared. Conformity Index was found to be superior in VMAT plans for three patients and in IMRT plans for two patients. Dose homogeneity within the PTV was better with VMAT plans for all five cases. The mean difference in Sigma Index was 0.68%. There was no significant difference in dose between IMRT and VMAT plans for any of the OARs assessed in these patients. The monitor units were significantly reduced in the VMAT plan in comparison to the IMRT plan for four out of five patients, with mean reduction of 66%. It was found in this study that for the treatment of sino-nasal cancer, VMAT produced minimal, and statistically insignificant improvement in dose homogeneity within the PTV when compared with IMRT. VMAT plans were delivered using significantly fewer monitor units. We conclude in this study that VMAT does not offer significant improvement of treatment for sino-nasal cancer over the existing IMRT techniques, but the findings may change with a larger sample of patients in this rare condition.
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Affiliation(s)
- Marimuthu Sankaralingam
- Radiotherapy Physics, Department of Clinical Physics and Bioengineering, Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, United Kingdom
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Prestwich RJD, Sykes J, Carey B, Sen M, Dyker KE, Scarsbrook AF. Improving target definition for head and neck radiotherapy: a place for magnetic resonance imaging and 18-fluoride fluorodeoxyglucose positron emission tomography? Clin Oncol (R Coll Radiol) 2012; 24:577-89. [PMID: 22592142 DOI: 10.1016/j.clon.2012.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 02/06/2012] [Accepted: 04/18/2012] [Indexed: 12/25/2022]
Abstract
Defining the target for head and neck radiotherapy is a critical issue with the introduction of steep dose gradients associated with intensity-modulated radiotherapy. Tumour delineation inaccuracies are a major source of error in radiotherapy planning. The integration of 18-fluoride fluorodeoxyglucose positron emission tomography ((18)FDG-PET) and magnetic resonance imaging directly into the radiotherapy planning process has the potential to greatly improve target identification/selection and delineation. This raises a range of new issues surrounding image co-registration, delineation methodology and the use of functional data and treatment adaptation. This overview will discuss the practical aspects of integrating (18)FDG-PET and magnetic resonance imaging into head and neck radiotherapy planning.
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Affiliation(s)
- R J D Prestwich
- Department of Nuclear Medicine, St. James's Institute of Oncology, Leeds, UK.
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Zenda S, Kohno R, Kawashima M, Arahira S, Nishio T, Tahara M, Hayashi R, Kishimoto S, Ogino T. Proton Beam Therapy for Unresectable Malignancies of the Nasal Cavity and Paranasal Sinuses. Int J Radiat Oncol Biol Phys 2011; 81:1473-8. [DOI: 10.1016/j.ijrobp.2010.08.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/23/2010] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
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Duprez F, Madani I, Morbée L, Bonte K, Deron P, Domján V, Boterberg T, De Gersem W, De Neve W. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys 2011; 83:252-9. [PMID: 22027259 DOI: 10.1016/j.ijrobp.2011.06.1977] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/15/2011] [Accepted: 06/17/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To report late ocular (primary endpoint) and other toxicity, disease control, and survival (secondary endpoints) after intensity-modulated radiotherapy (IMRT) for sinonasal tumors. METHODS AND MATERIALS Between 1998 and 2009, 130 patients with nonmetastatic sinonasal tumors were treated with IMRT at Ghent University Hospital. Prescription doses were 70 Gy (n = 117) and 60-66 Gy (n = 13) at 2 Gy per fraction over 6-7 weeks. Most patients had adenocarcinoma (n = 82) and squamous cell carcinoma (n = 23). One hundred and one (101) patients were treated postoperatively. Of 17 patients with recurrent tumors, 9 were reirradiated. T-stages were T1-2 (n = 39), T3 (n = 21), T4a (n = 38), and T4b (n = 22). Esthesioneuroblastoma was staged as Kadish A, B, and C in 1, 3, and 6 cases, respectively. RESULTS Median follow-up was 52, range 15-121 months. There was no radiation-induced blindness in 86 patients available for late toxicity assessment (≥6 month follow-up). We observed late Grade 3 tearing in 10 patients, which reduced to Grade 1-2 in 5 patients and Grade 3 visual impairment because of radiation-induced ipsilateral retinopathy and neovascular glaucoma in 1 patient. There was no severe dry eye syndrome. The worst grade of late ocular toxicity was Grade 3 (n = 11), Grade 2 (n = 31), Grade 1 (n = 33), and Grade 0 (n = 11). Brain necrosis and osteoradionecrosis occurred in 6 and 1 patients, respectively. Actuarial 5-year local control and overall survival were 59% and 52%, respectively. On multivariate analysis local control was negatively affected by cribriform plate and brain invasion (p = 0.044 and 0.029, respectively) and absence of surgery (p = 0.009); overall survival was negatively affected by cribriform plate and orbit invasion (p = 0.04 and <0.001, respectively) and absence of surgery (p = 0.001). CONCLUSIONS IMRT for sinonasal tumors allowed delivering high doses to targets at minimized ocular toxicity, while maintaining disease control and survival. Avoidance of severe dry eye syndrome and radiation-induced blindness suggests IMRT as a standard treatment for sinonasal tumors.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Wenyong T, Lu L, Jun Z, Weidong Y, Yun L. Dosimetric comparison between intensity-modulated with coplanar field and 3D conformal radiotherapy with noncoplanar field for postocular invasion tumor. Med Dosim 2009; 35:128-34. [PMID: 19931025 DOI: 10.1016/j.meddos.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/04/2009] [Accepted: 04/03/2009] [Indexed: 11/30/2022]
Abstract
This study presents a dosimetric optimization effort aiming to compare noncoplanar field (NCF) on 3 dimensions conformal radiotherapy (3D-CRT) and coplanar field (CF) on intensity-modulated radiotherapy (IMRT) planning for postocular invasion tumor. We performed a planning study on the computed tomography data of 8 consecutive patients with localized postocular invasion tumor. Four fields NCF 3D-CRT in the transverse plane with gantry angles of 0-10 degrees , 30-45 degrees , 240-270 degrees , and 310-335 degrees degrees were isocentered at the center of gravity of the target volume. The geometry of the beams was determined by beam's eye view. The same constraints were prepared with between CF IMRT optimization and NCF 3D-CRT treatment. The maximum point doses (D max) for the different optic pathway structures (OPS) with NCF 3D-CRT treatment should differ in no more than 3% from those with the NCF IMRT plan. Dose-volume histograms (DVHs) were obtained for all targets and organ at risk (OAR) with both treatment techniques. Plans with NCF 3D-CRT and CF IMRT constraints on target dose in homogeneity were computed, as well as the conformity index (CI) and homogeneity index (HI) in the target volume. The PTV coverage was optimal with both NCF 3D-CRT and CF IMRT plans in the 8 tumor sites. No difference was noted between the two techniques for the average D(max) and D(min) dose. NCF 3D-CRT and CF IMRT will yield similar results on CI. However, HI was a significant difference between NCF 3D-CRT and CF IMRT plan (p < 0.001). Physical endpoints for target showed the mean target dose to be low in the CF IMRT plan, caused by a large target dose in homogeneity (p < 0.001). The impact of NCF 3D-CRT versus CF IMRT set-up is very slight. NCF3D-CRT is one of the treatment options for postocular invasion tumor. However, constraints for OARs are needed.
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Affiliation(s)
- Tu Wenyong
- Nuclear Medicine Technology Institution, Southeast University, Nanjing, China
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Duprez F, Madani I, Bonte K, Boterberg T, Vakaet L, Derie C, De Gersem W, De Neve W. Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory. Radiother Oncol 2009; 93:563-9. [PMID: 19919885 DOI: 10.1016/j.radonc.2009.10.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 10/13/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate re-irradiation using IMRT for recurrent and second primary head and neck cancer in previously irradiated territory. MATERIALS AND METHODS Between 1997 and 2008, 84 patients with recurrent and second primary head and neck cancer were treated with IMRT to a median dose of 69 Gy. Median time interval between initial radiotherapy and re-irradiation was 49.5 (5.2-298.3) months. Salvage surgery preceded re-irradiation in 19 patients; 17 patients received concurrent chemotherapy. RESULTS Median follow-up of living patients was 19.8 (1.9-76.1) months. Five-year locoregional control and overall survival were 40% and 20%, respectively. Five-year disease-specific survival and disease-free survival were 29% and 15%, respectively. Stage T4 (p=0.015), time interval between initial treatment and re-irradiation (p=0.011) and hypopharyngeal cancer (p=0.013) were independent prognostic factors for worse overall survival in multivariate analysis. Twenty-six and 11 patients developed Grade 3 acute and late toxicity, respectively. No Grade 5 acute toxicity was encountered. There were 2 fatal vascular ruptures during follow-up. CONCLUSIONS High-dose IMRT for recurrent and second primary head and neck cancer in previously irradiated territory leads to approximately 20% long-term survival in a non-selected patient population. Identification of patients who would benefit most of curative IMRT is warranted.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Szutkowski Z, Kawecki A, Wasilewska-Teśluk E, Kraszewska E. [Results of treatment in patients with paranasal sinus carcinoma. Analysis of prognostic factors]. Otolaryngol Pol 2008; 62:37-43. [PMID: 18637419 DOI: 10.1016/s0030-6657(08)70206-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Analysis was based on the results of successful and unsuccessful treatment of 137 patients with paranasal sinus cancer at the Oncology Centre in Warsaw between 1987-2002. Patients with clinical stages T3 and T4 constituted 87% of cases (110 patients). Radical treatment was performed on 84 patients. Five-year overall survival in 137 cases amounted to 27%; and survival without recurrence was 24%. Five-year overall and recurrence-free survial among patients treated with surgery and radiotherapy were 36% and 32% retrospectively. Multivariate analysis of 61 patients with complete data, who were treated with radical surgery and radiotherapy, emphasized the influence of prognostic factors on survival. A worse prognosis correlated with advanced locoregional T and N stage. It is evident that total dose greater than 6000 cGy had a clear impact on the results of treatment. It was also shown that planning with the manually and hand-measured isodoses impacted negatively on the survival in comparison with 2D and 3D planning. Analysis of recurrence-free survival showed that metastatis to the lymph nodes, and a manually-planned treatment method, had a negative impact on the results of treatment. It is asserted that local recurrences are the main cause of failure in cases treated with surgery and radiotherapy.
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Affiliation(s)
- Zbigniew Szutkowski
- Klinika Nowotworów Głowy i Szyi Centrum Onkologii Instytutu im. M. Skłodowskiej-Curie w Warszawie.
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Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys 2008; 73:424-32. [PMID: 18755554 DOI: 10.1016/j.ijrobp.2008.04.037] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/26/2008] [Accepted: 04/21/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the long-term outcome of intensity-modulated radiotherapy (IMRT) for sinonasal tumors. METHODS AND MATERIALS Between July 1998 and November 2006, 84 patients with sinonasal tumors were treated with IMRT to a median dose of 70 Gy in 35 fractions. Of the 84 patients, 73 had a primary tumor and 11 had local recurrence. The tumor histologic type was adenocarcinoma in 54, squamous cell carcinoma in 17, esthesioneuroblastoma in 9, and adenoid cystic carcinoma in 4. The tumors were located in the ethmoid sinus in 47, maxillary sinus in 19, nasal cavity in 16, and multiple sites in 2. Postoperative IMRT was performed in 75 patients and 9 patients received primary IMRT. RESULTS The median follow-up of living patients was 40 months (range, 8-106). The 5-year local control, overall survival, disease-specific survival, disease-free survival, and freedom from distant metastasis rate was 70.7%, 58.5%, 67%, 59.3%, and 82.2%, respectively. No difference was found in local control and survival between patients with primary or recurrent tumors. On multivariate analysis, invasion of the cribriform plate was significantly associated with lower local control (p = 0.0001) and overall survival (p = 0.0001). Local and distant recurrence was detected in 19 and 10 patients, respectively. Radiation-induced blindness was not observed. One patient developed Grade 3 radiation-induced retinopathy and neovascular glaucoma. Nonocular late radiation-induced toxicity comprised complete lacrimal duct stenosis in 1 patient and brain necrosis in 3 patients. Osteoradionecrosis of the maxilla and brain necrosis were detected in 1 of the 5 reirradiated patients. CONCLUSION IMRT for sinonasal tumors provides low rates of radiation-induced toxicity without blindness with high local control and survival. IMRT could be considered as the treatment of choice.
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Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci 2008; 15:95-100. [DOI: 10.1016/j.jocn.2007.09.004] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 09/15/2007] [Indexed: 11/24/2022]
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Keum KC. Helical Tomotherapy: Image-guided Intensity Modulated Radiation Therapy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.7.619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Korea.
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Post-operative intensity-modulated radiotherapy for malignancies of the nasal cavity and paranasal sinuses. Radiother Oncol 2007; 85:385-91. [DOI: 10.1016/j.radonc.2007.10.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 09/21/2007] [Accepted: 10/03/2007] [Indexed: 11/23/2022]
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Serre A, Idri K, Fenoglietto P, Ailleres N, Santoro L, Lemanski C, Garrel R, Makeieff M, Allaw A, Dubois JB, Azria D. Dosimetric comparison between coplanar and non coplanar field radiotherapy for ethmoid sinus cancer. Radiat Oncol 2007; 2:35. [PMID: 17877793 PMCID: PMC2072954 DOI: 10.1186/1748-717x-2-35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 09/18/2007] [Indexed: 12/25/2022] Open
Abstract
Background To compare non coplanar field (NCF) with coplanar field (CF) -intensity-modulated radiotherapy (IMRT) planning for ethmoid cancer. Methods Seven patients treated with NCF IMRT for ethmoid cancer were studied. A CF IMRT optimization was prepared with the same constraints as for the NCF treatment. The maximum point doses (D max) obtained for the different optic pathway structures (OPS) should differ no more than 3% from those achieved with the NCF IMRT plan. The distribution of the dose in the target volume and in the critical structures was compared between the two techniques, as well as the Conformity (CI) and the Homogeneity Indexes (HI) in the target volume. Results We noted no difference between the two techniques in the OPS for the D1, D2, and D5%, in the inner ear and controlateral lens for the average Dmax, in the temporo-mandibular joints for the average mean dose, in the cord and brainstem for the average D1%. The dose-volume histograms were slightly better with the NCF treatment plan for the planning target volume (PTV) with a marginally better HI but no impact on CI. We found a great improvement in the PTV coverage with the CF treatment plan for two patients with T4 tumors. Conclusion IMRT is one of the treatment options for ethmoid cancer. The PTV coverage is optimal without compromising the protection of the OPS. The impact of non coplanar versus coplanar set up is very slight.
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Affiliation(s)
- Antoine Serre
- Department of Radiation Oncology, Val d'Aurelle Cancer Institute, Montpellier, France
| | - Katia Idri
- Radiophysics Unit, Val d'Aurelle Cancer Institute, Montpellier, France
| | | | - Norbert Ailleres
- Radiophysics Unit, Val d'Aurelle Cancer Institute, Montpellier, France
| | - Lore Santoro
- Radiophysics Unit, Val d'Aurelle Cancer Institute, Montpellier, France
| | - Claire Lemanski
- Department of Radiation Oncology, Val d'Aurelle Cancer Institute, Montpellier, France
| | - Renaud Garrel
- Department of Head and Neck Surgery, University Hospital Gui De Chauliac, Montpellier, France
| | - Marc Makeieff
- Department of Head and Neck Surgery, University Hospital Gui De Chauliac, Montpellier, France
| | - Ali Allaw
- Department of Radiation Oncology, Val d'Aurelle Cancer Institute, Montpellier, France
| | - Jean-Bernard Dubois
- Department of Radiation Oncology, Val d'Aurelle Cancer Institute, Montpellier, France
| | - David Azria
- Department of Radiation Oncology, Val d'Aurelle Cancer Institute, Montpellier, France
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Chen AM, Daly ME, Bucci MK, Xia P, Akazawa C, Quivey JM, Weinberg V, Garcia J, Lee NY, Kaplan MJ, El-Sayed I, Eisele DW, Fu KK, Phillips TL. Carcinomas of the Paranasal Sinuses and Nasal Cavity Treated With Radiotherapy at a Single Institution Over Five Decades: Are We Making Improvement? Int J Radiat Oncol Biol Phys 2007; 69:141-7. [PMID: 17459609 DOI: 10.1016/j.ijrobp.2007.02.031] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 01/31/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare clinical outcomes of patients with carcinomas of the paranasal sinuses and nasal cavity according to decade of radiation treatment. METHODS AND MATERIALS Between 1960 and 2005, 127 patients with sinonasal carcinoma underwent radiotherapy with planning and delivery techniques available at the time of treatment. Fifty-nine patients were treated by conventional radiotherapy; 45 patients by three-dimensional conformal radiotherapy; and 23 patients by intensity-modulated radiotherapy. Eighty-two patients (65%) were treated with radiotherapy after gross total tumor resection. Nineteen patients (15%) received chemotherapy. The most common histology was squamous cell carcinoma (83 patients). RESULTS The 5-year estimates of overall survival, local control, and disease-free survival for the entire patient population were 52%, 62%, and 54%, respectively. There were no significant differences in any of these endpoints with respect to decade of treatment or radiotherapy technique (p > 0.05, for all). The 5-year overall survival rate for patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s was 46%, 56%, 51%, 53%, and 49%, respectively (p = 0.23). The observed incidence of severe (Grade 3 or 4) late toxicity was 53%, 45%, 39%, 28%, and 16% among patients treated in the 1960s, 1970s, 1980s, 1990s, and 2000s, respectively (p = 0.01). CONCLUSION Although we did not detect improvements in disease control or overall survival for patients treated over time, the incidence of complications has significantly declined, thereby resulting in an improved therapeutic ratio for patients with carcinomas of the paranasal sinuses and nasal cavity.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Adenoid Cystic/mortality
- Carcinoma, Adenoid Cystic/radiotherapy
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Disease-Free Survival
- Female
- Humans
- Male
- Middle Aged
- Nasal Cavity
- Neoplasm Recurrence, Local
- Nose Neoplasms/mortality
- Nose Neoplasms/radiotherapy
- Nose Neoplasms/surgery
- Paranasal Sinus Neoplasms/mortality
- Paranasal Sinus Neoplasms/radiotherapy
- Paranasal Sinus Neoplasms/surgery
- Radiation Injuries/prevention & control
- Radiotherapy/adverse effects
- Radiotherapy/trends
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Intensity-Modulated/adverse effects
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, San Francisco (UCSF) Comprehensive Cancer Center, San Francisco, CA, USA.
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Daly ME, Chen AM, Bucci MK, El-Sayed I, Xia P, Kaplan MJ, Eisele DW. Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys 2007; 67:151-7. [PMID: 17189068 DOI: 10.1016/j.ijrobp.2006.07.1389] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 07/27/2006] [Accepted: 07/28/2006] [Indexed: 12/01/2022]
Abstract
PURPOSE To report the clinical outcome of patients treated with intensity-modulated radiation therapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. METHODS AND MATERIALS Between 1998 and 2004, 36 patients with malignancies of the sinonasal region were treated with IMRT. Thirty-two patients (89%) were treated in the postoperative setting after gross total resection. Treatment plans were designed to provide a dose of 70 Gy to 95% or more of the gross tumor volume (GTV) and 60 Gy to 95% or more of the clinical tumor volume (CTV) while sparing neighboring critical structures including the optic chiasm, optic nerves, eyes, and brainstem. The primary sites were: 13 ethmoid sinus, 10 maxillary sinus, 7 nasal cavity, and 6 other. Histology was: 12 squamous cell, 7 esthesioneuroblastoma, 5 adenoid cystic, 5 undifferentiated, 5 adenocarcinoma, and 2 other. Median follow-up was 51 months among surviving patients (range, 9-82 months). RESULTS The 2-year and 5-year estimates of local control were 62% and 58%, respectively. One patient developed isolated distant metastasis, and none developed isolated regional failure. The 5-year rates of disease-free and overall survival were 55% and 45%, respectively. The incidence of ocular toxicity was minimal with no patients reporting decreased vision. Late complications included xerophthalmia (1 patient), lacrimal stenosis (1 patient), and cataract (1 patient). CONCLUSION Although IMRT for malignancies of the sinonasal region does not appear to lead to significant improvements in disease control, the low incidence of complications is encouraging.
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Affiliation(s)
- Megan E Daly
- Department of Radiation Oncology, University of California, San Francisco (UCSF) Comprehensive Cancer Center, San Francisco, CA, USA
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Sheng K, Molloy JA, Larner JM, Read PW. A dosimetric comparison of non-coplanar IMRT versus Helical Tomotherapy for nasal cavity and paranasal sinus cancer. Radiother Oncol 2007; 82:174-8. [PMID: 17275112 DOI: 10.1016/j.radonc.2007.01.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 01/01/2007] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
PURPOSES To determine if there are clinically significant differences between the dosimetry of sinus tumors delivered by non-coplanar LINAC-based IMRT techniques and Helical Tomotherapy (HT). HT is capable of delivering highly conformal and uniform target dosimetry. However, HT lacks non-coplanar capability, which is commonly used for linear accelerator-based IMRT for nasal cavity and paranasal sinus tumors. METHODS AND MATERIALS We selected 10 patients with representative early and advanced nasal cavity and paranasal sinus malignancies treated with a preoperative dose of 50 Gy/25 fractions without coverage of the cervical lymphatics for dosimetric comparison. Each plan was independently optimized using either Corvus inverse treatment planning system, commissioned for a Varian 2300 CD linear accelerator with 1cm multileaf collimator (MLC) leaves, or the HT inverse treatment planning system. A non-coplanar seven field technique was used in all Corvus plans with five mid-sagittal fields and two anterior oblique fields as described by Claus et al. [F. Claus, W. De Gersem, C. De Wagter, et al., An implementation strategy for IMRT of ethmoid sinus cancer and bilateral sparing of the optic pathways, Int J Radiat Oncol Biol Phys 51 (2001) 318-331], whereas only coplanar beamlets were used in HT planning. Dose plans were compared using DVHs, the minimum PTV dose to 1cm3 of the PTV, a uniformity index of planned treatment volume (PTV), and a comprehensive quality index (CQI) based on the maximum dose to optical structures, parotids and the brainstem which were deemed as the most critical adjacent structures. RESULTS Both planning systems showed comparable PTV dose coverage, but HT had significantly higher uniformity (p<0.01) inside the PTV. The CQI for all organs at risk were equivalent except ipsilateral lenses and eyes, which received statistically lower dose from HT plans (p<0.01). CONCLUSIONS Overall HT provided equivalent or slightly better normal structure avoidance with a more uniform PTV dose for nasal cavity and paranasal sinus cancer treatment than non-coplanar LINAC-based IMRT. The disadvantage of coplanar geometry in HT is apparently counterbalanced by the larger number of fields.
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Affiliation(s)
- Ke Sheng
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA.
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Paelinck L, Smedt BD, Reynaert N, Coghe M, Gersem WD, Wagter CD, Vanderstraeten B, Thierens H, Neve WD. Comparison of dose-volume histograms of IMRT treatment plans for ethmoid sinus cancer computed by advanced treatment planning systems including Monte Carlo. Radiother Oncol 2006; 81:250-6. [PMID: 17113671 DOI: 10.1016/j.radonc.2006.10.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 09/12/2006] [Accepted: 10/27/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE To recompute clinical intensity-modulated treatment plans for ethmoid sinus cancer and to compare quantitatively the dose-volume histograms (DVHs) of the planning target volume (PTV) and the optic organs at risk. MATERIAL AND METHODS Ten step-and-shoot intensity-modulated treatment plans were enrolled in this study. Large natural and surgical air cavities challenged the calculation systems. Each optimized treatment plan was recalculated by two superposition convolution (TMS and Pinnacle) and a Monte Carlo system (MCDE). To compare the resulting DVHs, a one-way ANOVA for repeated measurements was performed and multiple pairwise comparisons were made. RESULTS The tails of the PTV-DVHs were significantly higher for the Monte Carlo system. The DVHs of the critical organs displayed some statistically but not always clinically significant differences. For the individual patients, the three planning systems sometimes reproduced clinically discrepant DVHs that were not significantly different when averaged over all patients. CONCLUSIONS Dose to air cavities contains computational uncertainty. As this dose is clinically irrelevant and optimizing it is meaningless, we recommended extracting the air from the PTV when constructing the PTV-DVH. The planning systems considered reproduce DVHs that are significantly different, especially in the tail region of PTV-DVHs.
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Affiliation(s)
- Leen Paelinck
- Department of Radiotherapy and Nuclear Medicine, University Hospital Ghent, Gent, Belgium.
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Weber DC, Chan AW, Lessell S, McIntyre JF, Goldberg SI, Bussiere MR, Fitzek MM, Thornton AF, Delaney TF. Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons. Radiother Oncol 2006; 81:243-9. [PMID: 17050017 DOI: 10.1016/j.radonc.2006.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 09/04/2006] [Accepted: 09/22/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the visual outcomes of patients with advanced sinonasal malignancies treated with proton/photon accelerated fractionated radiation (AFR). PATIENTS AND METHODS Between 1991 and 2001, AFR was used to treat 36 patients with advanced stage primary (n=33) or recurrent (n=3) nasal or paranasal malignant tumors. Full ophthalmologic follow-up was documented. The median dose to the gross tumor volume (GTV) was 69.6 CGE (range 60.8-77). Visual complications were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) and the late effects of normal tissue (LENT) scoring systems. The median follow-up was 52.4 months (range 17-122.8). RESULTS Thirteen patients developed late visual/ocular toxicity. Cataracts were LENT grade 1 and 3 in 2 patients and 1 patient, respectively. One LENT grade 1 vascular retinopathy and 1 optic neuropathy were also observed. Three and five patients presented with nasolacrimal duct stenosis (CTC grade 2, 2 patients; CTC grade 3, 1 patient) and dry-eye syndrome (CTC grade 1, 1 patient; CTC grade 2, 4 patients), respectively. The 3- and 5-year probability of LENT/CTC grade > or =2 visual toxicity were 15.8+/-6.7% and 20.7+/-7.8%, respectively. CONCLUSIONS AFR for locally advanced nasal cavity and paranasal sinus tumors enables delivery of 70 CGE to the tumor with acceptable ophthalmologic complications.
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Affiliation(s)
- Damien C Weber
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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De Smedt B, Fippel M, Reynaert N, Thierens H. Denoising of Monte Carlo dose calculations: smoothing capabilities versus introduction of systematic bias. Med Phys 2006; 33:1678-87. [PMID: 16872075 DOI: 10.1118/1.2198188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In order to evaluate the performance of denoising algorithms applied to Monte Carlo calculated dose distributions, conventional evaluation methods (rms difference, 1% and 2% difference) can be used. However, it is illustrated that these evaluation methods sometimes underestimate the introduction of bias, since possible bias effects are averaged out over the complete dose distribution. In the present work, a new evaluation method is introduced based on a sliding window superimposed on a difference dose distribution (reference dose-noisy/denoised dose). To illustrate its importance, a new denoising technique (ANRT) is presented based upon a combination of the principles of bilateral filtering and Savitzky-Golay filters. This technique is very conservative in order to limit the introduction of bias in high dose gradient regions. ANRT is compared with IRON for three challenging cases, namely an electron and photon beam impinging on heterogeneous phantoms and two IMRT treatment plans of head-and-neck cancer patients to determine the clinical relevance of the obtained results. For the electron beam case, IRON outperforms ANRT concerning the smoothing capabilities, while no differences in systematic bias are observed. However, for the photon beam case, although ANRT and IRON perform equally well on the conventional evaluation tests (rms difference, 1% and 2% difference), IRON clearly introduces much more bias in the penumbral regions while ANRT seems to introduce no bias at all. When applied to the IMRT patient cases, both denoising methods perform equally well regarding smoothing and bias introduction. This is probably caused by the summation of a large set of different beam segments, decreasing dose gradients compared to a single beam. A reduction in calculation time without introducing large systematic bias can shorten a Monte Carlo treatment planning process considerably and is therefore very useful for the initial trial and error phase of the treatment planning process.
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Affiliation(s)
- B De Smedt
- Department of Medical Physics, Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium.
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Sheng K, Molloy JA, Read PW. Intensity-modulated radiation therapy (IMRT) dosimetry of the head and neck: a comparison of treatment plans using linear accelerator-based IMRT and helical tomotherapy. Int J Radiat Oncol Biol Phys 2006; 65:917-23. [PMID: 16751074 DOI: 10.1016/j.ijrobp.2006.02.038] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 02/14/2006] [Accepted: 02/15/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To date, most intensity-modulated radiation therapy (IMRT) delivery has occurred using linear accelerators (linacs), although helical tomotherapy has become commercially available. To quantify the dosimetric difference, we compared linac-based and helical tomotherapy-based treatment plans for IMRT of the oropharynx. METHODS AND MATERIALS We compared the dosimetry findings of 10 patients who had oropharyngeal carcinoma. Five patients each had cancers in the base of the tongue and tonsil. Each plan was independently optimized using either the CORVUS planning system (Nomos Corporation, Sewickly, PA), commissioned for a Varian 2300 CD linear accelerator (Varian Medical Systems, Palo Alto, CA) with 1-cm multileaf collimator leaves, or helical tomotherapy. The resulting treatment plans were evaluated by comparing the dose-volume histograms, equivalent uniform dose (EUD), dose uniformity, and normal tissue complication probabilities. RESULTS Helical tomotherapy plans showed improvement of critical structure avoidance and target dose uniformity for all patients. The average equivalent uniform dose reduction for organs at risk (OARs) surrounding the base of tongue and the tonsil were 17.4% and 27.14% respectively. An 80% reduction in normal tissue complication probabilities for the parotid glands was observed in the tomotherapy plans relative to the linac-based plans. The standard deviation of the planning target volume dose was reduced by 71%. In our clinic, we use the combined dose-volume histograms for each class of plans as a reference goal for helical tomotherapy treatment planning optimization. CONCLUSIONS Helical tomotherapy provides improved dose homogeneity and normal structure dose compared with linac-based IMRT in the treatment of oropharyngeal carcinoma resulting in a reduced risk for complications from focal hotspots within the planning target volume and for the adjacent parotid glands.
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Affiliation(s)
- Ke Sheng
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
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Vanderstraeten B, Duthoy W, De Gersem W, De Neve W, Thierens H. [18F]fluoro-deoxy-glucose positron emission tomography ([18F]FDG-PET) voxel intensity-based intensity-modulated radiation therapy (IMRT) for head and neck cancer. Radiother Oncol 2006; 79:249-58. [PMID: 16564588 DOI: 10.1016/j.radonc.2006.03.003] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 02/16/2006] [Accepted: 03/02/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Focused dose escalation may improve local control in head and neck cancer. Planning results of [(18)F]fluoro-deoxy-glucose positron emission tomography ([(18)F]FDG-PET) voxel intensity-based intensity-modulated radiation therapy (IMRT) were compared with those of PET contour-based IMRT. PATIENTS AND METHODS PET contour-based IMRT aims to deliver a homogeneous boost dose to a PET-based subvolume of the planning target volume (PTV), called PTV(PET). The present PET voxel intensity-based planning study aims to prescribe the boost dose directly as a function of PET voxel intensity values, while leaving the dose distribution outside the PTV unchanged. Two escalation steps (2.5 and 3 Gy/fraction) were performed for 15 patients. RESULTS PTV(PET) was irradiated with a homogeneous dose in the contour-based approach. In the voxel intensity-based approach, one or more sharp dose peaks were created inside the PTV, following the distribution of PET voxel intensity values. CONCLUSIONS While PET voxel intensity-based IMRT had a large effect on the dose distribution within the PTV, only small effects were observed on the dose distribution outside this PTV and on the dose delivered to the organs at risk. Therefore both methods are alternatives for boosting subvolumes inside a selected PTV.
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d'Errico F. Dosimetric issues in radiation protection of radiotherapy patients. RADIATION PROTECTION DOSIMETRY 2006; 118:205-12. [PMID: 16581918 DOI: 10.1093/rpd/ncl034] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
As life expectancy increases, thanks to improving general medical practices, cancer treatments for the ageing population become evermore necessary. Radiation therapy is increasingly a treatment of choice, promoted by continuing improvements in dose delivery technologies. Some techniques, collectively referred to as intensity-modulated radiation therapy, are encountering widespread acceptance and implementation, promoted by reports of superior tumour control and reduced toxicity. However, these new techniques pose new challenges in terms of radiation protection of patients, as they cause a more extensive low-dose exposure of normal tissues compared with conventional radiation therapy. The related dosimetric challenges and the methods available to tackle them are reviewed in this paper, which also emphasises the need for standard radiation protection dosimetry procedures so that information may be consistently gathered for a comparative evaluation of the different treatment modalities.
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Affiliation(s)
- Francesco d'Errico
- Dipartimento di Ingegneria Meccanica, Nucleare e della Produzione, Università di Pisa, Italy.
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Pacholke HD, Amdur RJ, Louis DA, Yang H, Mendenhall WM. The role of intensity modulated radiation therapy for favorable stage tumor of the nasal cavity or ethmoid sinus. Am J Clin Oncol 2005; 28:474-8. [PMID: 16199987 DOI: 10.1097/01.coc.0000182600.51019.de] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare intensity-modulated radiation therapy (IMRT), 4-field conformal, and the standard 3-field conventional technique of radiotherapy for favorable stage tumors of the nasal cavity or ethmoid sinus. METHODS AND MATERIALS We compared the 3 techniques in 3 patients with tumors of the nasal cavity or ethmoid sinus that did not involve the eye or optic pathways. We required that each plan deliver the prescription dose (70.2 Gy at 1.8 Gy per fraction) to 95% of the planning target volume. We compared the maximum point dose to critical normal structures (brainstem, optic chiasm, optic nerves, retina, lens). RESULTS : IMRT and the 4-field conformal technique were clearly better than the 3-field conventional technique. The 4-field conformal plan was as good as IMRT. CONCLUSIONS The conventional 3-field technique is not the best way to treat most patients with tumors between the eyes. A 4-field conformal plan is an excellent alternative to IMRT for some patients with tumors of the nasal cavity or ethmoid sinus. Conformal radiotherapy with a noncoplaner field that exits into the low neck may make it difficult to electively irradiate the neck lymphatics. IMRT may be a better option in this situation.
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Affiliation(s)
- Heather D Pacholke
- University of Florida College of Medicine, Department of Radiation Oncology, Gainesville, FL 32610-0385, USA
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Duthoy W, Boterberg T, Claus F, Ost P, Vakaet L, Bral S, Duprez F, Van Landuyt M, Vermeersch H, De Neve W. Postoperative intensity-modulated radiotherapy in sinonasal carcinoma: clinical results in 39 patients. Cancer 2005; 104:71-82. [PMID: 15915466 DOI: 10.1002/cncr.21100] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Carcinoma of the paranasal sinuses is rare. Standard therapeutic modalities consist of surgery and radiotherapy (RT). Because of the often advanced stage and the vicinity of optic structures, RT-induced ocular toxicity is a feared side effect of conventional RT. Intensity-modulated radiotherapy (IMRT) is a relatively new technique, which is implemented with the hypothesis that, compared with conventional RT, it would result in a lower rate of ocular toxicity for an equal local control (LC). METHODS Between 1998 and 2003, 39 consecutive patients received postoperative irradiation by means of IMRT for an adenocarcinoma (n = 31) or squamous cell carcinoma (n = 8) of the paranasal sinuses (n = 36) or nasal cavity (n = 3). T-classification was T2 in 41%, T3 in 15%, T4a in 23%, and T4b in 21% of patients. Invasion through the cribriform plate was seen in 11 patients. Orbital invasion was present in 36% of patients. The median delivered dose was 70 gray (Gy) (range, 60-70 Gy). The authors compared the overall survival (OS) and LC of the patients with a historic cohort (HC) (n = 30), treated with conventional or 3-dimensional conformal RT. RESULTS The median follow-up was 31 months. The actuarial OS rates were 68% at 2 years and 59% at 4 years. The actuarial LC rates were 73% at 2 years and 68% at 4 years. Invasion through the cribriform plate was a significant prognostic factor for LC and OS, with a median time to local disease recurrence of 7 months if present, and a 2-year LC rate of 90% if not present. In the comparison between the IMRT and HC groups, no significant differences were found for LC and OS. Acute toxicity was mild. Two patients developed decreased vision after RT. No RT-induced blindness was observed. CONCLUSIONS Postoperative IMRT for sinonasal carcinoma resulted in good LC, with a low acute toxicity and no RT-induced blindness.
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Affiliation(s)
- Wim Duthoy
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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De Smedt B, Vanderstraeten B, Reynaert N, De Neve W, Thierens H. Investigation of geometrical and scoring grid resolution for Monte Carlo dose calculations for IMRT. Phys Med Biol 2005; 50:4005-19. [PMID: 16177526 DOI: 10.1088/0031-9155/50/17/006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Monte Carlo based treatment planning of two different patient groups treated with step-and-shoot IMRT (head-and-neck and lung treatments) with different CT resolutions and scoring methods is performed to determine the effect of geometrical and scoring voxel sizes on DVHs and calculation times. Dose scoring is performed in two different ways: directly into geometrical voxels (or in a number of grouped geometrical voxels) or into scoring voxels defined by a separate scoring grid superimposed on the geometrical grid. For the head-and-neck cancer patients, more than 2% difference is noted in the right optical nerve when using voxel dimensions of 4 x 4 x 4 mm3 compared to the reference calculation with 1 x 1 x 2 mm3 voxel dimensions. For the lung cancer patients, 2% difference is noted in the spinal cord when using voxel dimensions of 4 x 4 x 10 mm3 compared to the 1 x 1 x 5 mm3 calculation. An independent scoring grid introduces several advantages. In cases where a relatively high geometrical resolution is required and where the scoring resolution is less important, the number of scoring voxels can be limited while maintaining a high geometrical resolution. This can be achieved either by grouping several geometrical voxels together into scoring voxels or by superimposing a separate scoring grid of spherical voxels with a user-defined radius on the geometrical grid. For the studied lung cancer cases, both methods produce accurate results and introduce a speed increase by a factor of 10-36. In cases where a low geometrical resolution is allowed, but where a high scoring resolution is required, superimposing a separate scoring grid on the geometrical grid allows a reduction in geometrical voxels while maintaining a high scoring resolution. For the studied head-and-neck cancer cases, calculations performed with a geometrical resolution of 2 x 2 x 2 mm3 and a separate scoring grid containing spherical scoring voxels with a radius of 2 mm produce accurate results and introduce a speed increase by a factor of 13. The scoring grid provides an additional degree of freedom for limiting calculation time and memory requirements by selecting optimized scoring and geometrical voxel dimensions in an independent way.
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Affiliation(s)
- B De Smedt
- Department of Medical Physics, Ghent University, Proeftuinstraat 86, B-9000 Gent, Belgium
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Dragun AE, Harmon JF, Aguero EG. Defining targets and protecting normal tissues in inverse-planned IMRT for prostate, head and neck, and gynecologic cancers: a comparative review. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1548-5315(11)70898-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bhandare N, Monroe AT, Morris CG, Bhatti MT, Mendenhall WM. Does altered fractionation influence the risk of radiation-induced optic neuropathy? Int J Radiat Oncol Biol Phys 2005; 62:1070-7. [PMID: 15990010 DOI: 10.1016/j.ijrobp.2004.12.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 12/08/2004] [Accepted: 12/12/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the parameters that influence the risk of radiation-induced optic neuropathy (RION) after radiotherapy for head-and-neck tumors. METHODS AND MATERIALS Between 1964 and 2000, 273 patients with tumors of the nasopharynx, paranasal sinuses, nasal cavity, and hard palate adenoid cystic carcinomas were treated with curative intent and had radiation fields that included the optic nerves and/or chiasm. Patients were followed for at least 1 year after radiotherapy. RESULTS Radiation-induced optic neuropathy developed in 32 eyes of 24 patients (9%). The 5-year rates of freedom from RION according to the total dose and once- vs. twice-daily fractionation were as follows: < or =63 Gy once daily, 95%; < or =63 Gy twice daily, 98%; >63 Gy once daily, 78%; and >63 Gy twice daily, 91%. Multivariate analysis revealed that the total dose affected the risk of RION (p = 0.0047), with patient age (p = 0.0909), once-daily vs. twice-daily fractionation (p = 0.0684), and overall treatment time (p = 0.0972) were marginally significant. The use of adjuvant chemotherapy did not significantly influence the likelihood of developing RION. CONCLUSION The likelihood of developing RION is primarily influenced by the total dose. Hyperfractionation may reduce the risk of experiencing this complication.
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Affiliation(s)
- Niranjan Bhandare
- Department of Radiation Oncology, Health Science Center, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Abstract
This article focuses on selected key anatomic considerations in anterior skull base surgery, briefly reviews common pathologies of the paranasal sinuses, and provides an overview of surgical approaches, complications, and results.
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Affiliation(s)
- Michael J Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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Day TA, Beas RA, Schlosser RJ, Woodworth BA, Barredo J, Sharma AK, Gillespie MB. Management of paranasal sinus malignancy. Curr Treat Options Oncol 2005; 6:3-18. [PMID: 15610711 DOI: 10.1007/s11864-005-0009-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Malignancies of the nasal cavity and paranasal sinuses represent a wide spectrum of histologies, tissues of origin, and anatomic primary sites. The inherent difficulty in generalizing treatment approaches is obvious, given the numerous variables associated with the broadly-based term, paranasal sinus malignancy (PNSCa). Nevertheless, the majority of epithelial and salivary malignancies of this region (ie, squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, sinonasal undifferentiated carcinoma, and esthesioneuroblastoma) require surgical intervention as part of any treatment regimen. Recent trends have broadened the indications for chemotherapeutic and radiotherapeutic options in the management of advanced PNSCa. Nonepithelial malignancies, including the wide variety of sarcomas arising in this region, most commonly require multimodality treatment including chemotherapy, radiation, and/or surgery for definitive treatment. Moreover, the proximity of the nasal cavity and paranasal sinuses to structures including the orbit, dura, brain, cranial nerves, and carotid arteries mandates careful radiologic and neurologic evaluations throughout the course of the disease. Surgical advances now permit complex tumor removal and reconstruction surrounding these structures resulting in functional and cosmetic improvements when compared to earlier techniques. However, additional clinical trials are necessary to systematically evaluate the locoregional control, organ-preservation strategies, and survival related to the variety of treatments currently available.
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Affiliation(s)
- Terry A Day
- Head and Neck Tumor Program, Hollings Cancer Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
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Peñagarícano JA, Papanikolaou N, Yan Y, Ratanatharathorn V. Application of intensity-modulated radiation therapy for pediatric malignancies. Med Dosim 2005; 29:247-53. [PMID: 15528065 DOI: 10.1016/j.meddos.2004.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Accepted: 12/17/2003] [Indexed: 11/29/2022]
Abstract
Novel radiation therapy delivery techniques have moved very slowly in the field of pediatric oncology. Some collaborative groups allow new radiation therapy delivery techniques in their trials. In many instances, the option of using these techniques is not addressed. These newer techniques of radiation delivery have the potential to reduce the probability of the common late effects of radiation and at the same time, potentially improve upon control and survival. The purpose of this study is to show the feasibility of IMRT in pediatric patients. No treatment results or toxicities will be presented. Five patients with a variety of pediatric malignancies received intensity-modulated radiation therapy (IMRT) at our institution as part of their disease management. A rigid immobilization device was developed for each patient and a computed tomography (CT) simulation was performed in the treatment position. In 3 of the patients, magnetic resonance imaging (MRI) scans were coregistered with the planning CT to facilitate target and critical structure delineation. In all but 1 patient, coplanar beam arrangements were used in the IMRT planning process. All IMRT plans exhibited a high degree of conformality. Dose homogeneity inside the tumor and rapid dose falloff outside the target volume is characteristic of IMRT plans, which allows for improved normal tissue sparing. Dose distributions were obtained for all plans, as well as dose and volume relationship histograms, to evaluate the fitness of the plans. IMRT is a viable alternative to conventional treatment techniques for pediatric cancer patients. The improved dose distributions coupled with the ease of delivery of the IMRT fields make this technique very attractive, especially in view of the potential to increase local control and possibly improve on survival.
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Affiliation(s)
- José A Peñagarícano
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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