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Nakanishi D, Oita M, Fukunaga JI, Hirose TA, Yoshitake T, Sasaki M. Investigation of uncertainty in internal target volume definition for lung stereotactic body radiotherapy. Radiol Phys Technol 2023; 16:497-505. [PMID: 37713060 PMCID: PMC10665452 DOI: 10.1007/s12194-023-00737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Abstract
This study evaluated the validity of internal target volumes (ITVs) defined by three- (3DCT) and four-dimensional computed tomography (4DCT), and subsequently compared them with actual movements during treatment. Five patients with upper lobe lung tumors were treated with stereotactic body radiotherapy (SBRT) at 48 Gy in four fractions. Planning 3DCT images were acquired with peak-exhale and peak-inhale breath-holds, and 4DCT images were acquired in the cine mode under free breathing. Cine images were acquired using an electronic portal imaging device during irradiation. Tumor coverage was evaluated based on the manner in which the peak-to-peak breathing amplitude on the planning CT covered the range of tumor motion (± 3 SD) during irradiation in the left-right, anteroposterior, and cranio-caudal (CC) directions. The mean tumor coverage of the 4DCT-based ITV was better than that of the 3DCT-based ITV in the CC direction. The internal margin should be considered when setting the irradiation field for 4DCT. The proposed 4DCT-based ITV can be used as an efficient approach in free-breathing SBRT for upper-lobe tumors of the lung because its coverage is superior to that of 3DCT.
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Affiliation(s)
- Daiki Nakanishi
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi Higashi-Ku, Fukuoka, 812-8582, Japan
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsushima-Naka, Kita-Ku, Okayama, 700-8530, Japan
| | - Masataka Oita
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsushima-Naka, Kita-Ku, Okayama, 700-8530, Japan.
| | - Jun-Ichi Fukunaga
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taka-Aki Hirose
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tadamasa Yoshitake
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Motoharu Sasaki
- Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
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SHIRATO H. Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2023; 99:389-426. [PMID: 37821390 PMCID: PMC10749389 DOI: 10.2183/pjab.99.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Biomedical advances of external-beam radiotherapy (EBRT) with improvements in physical accuracy are reviewed. High-precision (±1 mm) three-dimensional radiotherapy (3DRT) can utilize respective therapeutic open doors in the tumor control probability curve and in the normal tissue complication probability curve instead of the one single therapeutic window in two-dimensional EBRT. High-precision 3DRT achieved higher tumor control and probable survival rates for patients with small peripheral lung and liver cancers. Four-dimensional radiotherapy (4DRT), which can reduce uncertainties in 3DRT due to organ motion by real-time (every 0.1-1 s) tumor-tracking and immediate (0.1-1 s) irradiation, have achieved reduced adverse effects for prostate and pancreatic tumors near the digestive tract and with similar or better tumor control. Particle beam therapy improved tumor control and probable survival for patients with large liver tumors. The clinical outcomes of locally advanced or multiple tumors located near serial-type organs can theoretically be improved further by integrating the 4DRT concept with particle beams.
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Affiliation(s)
- Hiroki SHIRATO
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Chen Y, Luo H, Liu R, Tan M, Wang Q, Wu X, Du T, Liu Z, Sun S, Zhang Q, Wang X. Efficacy and safety of particle therapy for inoperable stage II-III non-small cell lung cancer: a systematic review and meta-analysis. Radiat Oncol 2023; 18:86. [PMID: 37217970 DOI: 10.1186/s13014-023-02264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND AND PURPOSE Particle therapy, mainly including carbon-ion radiotherapy (CIRT) and proton beam therapy (PBT), has dose distribution advantages compared to photon radiotherapy. It has been widely reported as a promising treatment method for early non-small cell lung cancer (NSCLC). However, its application in locally advanced non-small cell lung cancer (LA-NSCLC) is relatively rare, and its efficacy and safety are inconclusive. This study aimed to provide systematic evidence for evaluating the efficacy and safety of particle therapy for inoperable LA-NSCLC. METHODS To retrieve published literature, a systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library until September 4, 2022. The primary endpoints were local control (LC) rate, overall survival (OS) rate, and progression-free survival (PFS) rate at 2 and 5 years. The secondary endpoint was treatment-related toxicity. The pooled clinical outcomes and 95% confidence intervals (CIs) were calculated by using STATA 15.1. RESULTS Nineteen eligible studies with a total sample size of 851 patients were included. The pooled data demonstrated that the OS, PFS, and LC rates at 2 years of LA-NSCLC treated by particle therapy were 61.3% (95% CI = 54.7-68.7%), 37.9% (95% CI = 33.8-42.6%) and 82.2% (95% CI = 78.7-85.9%), respectively. The pooled 5-year OS, PFS, and LC rates were 41.3% (95% CI = 27.1-63.1%), 25.3% (95% CI = 16.3-39.4%), and 61.5% (95% CI = 50.7-74.6%), respectively. Subgroup analysis stratified by treatment type showed that the concurrent chemoradiotherapy (CCRT, PBT combined with concurrent chemotherapy) group had better survival benefits than the PBT and CIRT groups. The incidence rates of grade 3/4 esophagitis, dermatitis, and pneumonia in LA-NSCLC patients after particle therapy were 2.6% (95% CI = 0.4-6.0%), 2.6% (95% CI = 0.5-5.7%) and 3.4% (95% CI = 1.4-6.0%), respectively. CONCLUSIONS Particle therapy demonstrated promising efficacy and acceptable toxicity in LA-NSCLC patients.
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Affiliation(s)
- Yanliang Chen
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Hongtao Luo
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China
- Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China
| | - Ruifeng Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China
- Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China
| | - Mingyu Tan
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Qian Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Xun Wu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Tianqi Du
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Zhiqiang Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China
- Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China
| | - Shilong Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China
- Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China
- Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China
| | - Qiuning Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China.
- Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China.
- Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China.
| | - Xiaohu Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, 730000, Gansu Province, China.
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
- Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China.
- Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China.
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Srivastava A, Parambath HK, Ramdulari AV, Saxena H, Kumar R, Pandey S, Shalimar, Gupta S, Jee B. Is hepatocellular carcinoma complicated with portal vein tumor thrombosis potentially curable by radiotherapy in the form of stereotactic body radiation therapy? Int J Radiat Biol 2022; 98:1495-1509. [PMID: 35311612 DOI: 10.1080/09553002.2022.2055800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal. Despite best treatment and care, the patients with this malignancy only showed 2.7-4 months of overall survival. It is debatable whether liver transplantation helps PVTT sufferers. The effectiveness of radiation therapy in treating HCC patients with PVTT should not be undervalued. By limiting the high dosage region to a small planning target volume, stereotactic radiation delivery has shifted toward hypofractionation, limiting the radiation exposure to healthy organs and tissues. Stereotactic body radiotherapy (SBRT) has a local control rate of 75-100%, depending on the treatment. The major limitation in SBRT for hepatocellular carcinoma with PVTT is the paucity of prospective evidence for longer periods beyond the first two years after treatment. More prospective studies/randomized clinical trials with a longer follow-up, larger sample size, and adequate statistical power are the dire need of the present situation to ascertain the curative effect of SBRT as primary therapy for advanced HCC with PVTT. CONCLUSION SBRT can improve survival, particularly for patients receiving multidisciplinary treatment. This review sums up our most current understanding of how radiation therapy, notably SBRT, can be used to treat hepatocellular carcinoma when combined with PVTT. Recent research has led us to believe that irradiation in the form of SBRT may cure hepatocellular carcinoma complicated by PVTT.
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Affiliation(s)
- Astha Srivastava
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Haresh Kunhi Parambath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali V Ramdulari
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Saxena
- Department of Medicine Trauma, All India Institute of Medical Sciences, New Delhi, India
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suyash Pandey
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Babban Jee
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Zhang S, Lv B, Zheng X, Li Y, Ge W, Zhang L, Mo F, Qiu J. Dosimetric Study of Deep Learning-Guided ITV Prediction in Cone-beam CT for Lung Stereotactic Body Radiotherapy. Front Public Health 2022; 10:860135. [PMID: 35392465 PMCID: PMC8980420 DOI: 10.3389/fpubh.2022.860135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the accuracy of a lung stereotactic body radiotherapy (SBRT) treatment plan with the target of a newly predicted internal target volume (ITVpredict) and the feasibility of its clinical application. ITVpredict was automatically generated by our in-house deep learning model according to the cone-beam CT (CBCT) image database. Method A retrospective study of 45 patients who underwent SBRT was involved, and Mask R-CNN based algorithm model helped to predict the internal target volume (ITV) using the CBCT image database. The geometric accuracy of ITVpredict was verified by the Dice Similarity Coefficient (DSC), 3D Motion Range (R3D), Relative Volume Index (RVI), and Hausdorff Distance (HD). The PTVpredict was generated by ITVpredict, which was registered and then projected on free-breath CT (FBCT) images. The PTVFBCT was margined from the GTV on FBCT images gross tumor volume on free-breath CT (GTVFBCT). Treatment plans with the target of Predict planning target volume on CBCT images (PTVpredict) and planning target volume on free-breath CT (PTVFBCT) were respectively re-established, and the dosimetric parameters included the ratio of the volume of patients receiving at least the prescribed dose to the volume of PTV (R100%), the ratio of the volume of patients receiving at least 50% of the prescribed dose to the volume of PTV in the Radiation Therapy Oncology Group (RTOG) 0813 Trial (R50%), Gradient Index (GI), and the maximum dose 2 cm from the PTV (D2cm), which were evaluated via Plan4DCT, plan which based on PTVpredict (Planpredict), and plan which based on PTVFBCT (PlanFBCT). Result The geometric results showed that there existed a good correlation between ITVpredict and ITV on the 4-dimensional CT [ITV4DCT; DSC= 0.83 ±0.18]. However, the average volume of ITVpredict was 10% less than that of ITV4DCT (p = 0.333). No significant difference in dose coverage was found in V100% for the ITV with 99.98 ± 0.04% in the ITV4DCT vs. 97.56 ± 4.71% in the ITVpredict (p = 0.162). Dosimetry parameters of PTV, including R100%, R50%, GI and D2cm showed no statistically significant difference between each plan (p > 0.05). Conclusion Dosimetric parameters of Planpredict are clinically comparable to those of the original Plan4DCT. This study confirmed that the treatment plan based on ITVpredict produced by our model could automatically meet clinical requirements. Thus, for patients undergoing lung SBRT, the model has great potential for using CBCT images for ITV contouring which can be used in treatment planning.
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Duan Y, Lin Y, Wang H, Kang B, Feng A, Ma K, Chen H, Huang Y, Gu H, Shao Y, Zhou T, Kong Q, Xu Z. How Does the Gradient Measure of the Lung SBRT Treatment Plan Depend on the Tumor Volume and Shape? Front Oncol 2021; 11:781302. [PMID: 34869034 PMCID: PMC8636139 DOI: 10.3389/fonc.2021.781302] [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: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Gradient measure (GM) is a critical index related to normal tissue sparing in radiosurgery. This study aims to describe the dependence of GM on target volume and target shape for lung stereotactic body radiation therapy (SBRT) treatment plans. Methods A total of 307 peripheral and 119 central lung SBRT treatment plans were enrolled for this study. A least-squares regression was used for data analysis. First, the equations with different functional forms were established to determine the dependence of GM on a univariaty (VP or Sp) and bivariaty (VP and Sp), respectively. Then, the correlation coefficients and p-values of variables for all equations were compared and analyzed to determine the dependence of GM on PTV volume (VP) and sphericity (Sp). Results The power equations had the highest coefficient of determination (R2) in the dependence results of GM on univariate VP. The equations were GM = 0.674 V P 0.178 and GM = 0.660 V P 0.185 for peripheral and central lesions, respectively. On the other hand, the R2 of all functional forms were less than 0.25 when the relationship of GM versus univariate Sp was analyzed. Similarly, the power equation also obtained the highest R2 in bivariaty VP and Sp analysis, whether for central or peripheral. However, the R2 of the bivariate equations were not improved compared with those of univariate equations. Moreover, the p-values of the variable Sp were greater than 0.05. Conclusions The GM of the lung SBRT plan is shape-independent and volume-dependent. The dependence of GM on PTV volume for peripheral and central lung cancer can be described by two different power equations. The results of this study can be used as a potential tool to assist dosimetric quality control during the radiosurgery process.
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Affiliation(s)
- Yanhua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Lin
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bodong Kang
- Pekoe Team, MIM Software Inc., Cleveland, OH, United States
| | - Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kui Ma
- Clinical Helpdesk, Varian Medical Systems, Beijing, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Zhou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Yang Y, Li G, Li S, Wang Y, Zhao Y, Dong B, Wang J, Zhu R, Chen M. CT Appearance Pattern After Stereotactic Body Radiation Therapy Predicts Outcomes in Early-Stage Non-Small-Cell Lung Cancer. Front Oncol 2021; 11:746785. [PMID: 34707992 PMCID: PMC8542883 DOI: 10.3389/fonc.2021.746785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
Backgrounds Computed tomography (CT) appearance pattern after lung tumor stereotactic body radiation therapy(SBRT) might predicts survival. This study aimed to investigate the correlation between CT appearance pattern after SBRT and outcomes in patients with early-stage non-small-cell lung cancer (NSCLC). Methods Clinical data of inoperable patients with early-stage NSCLC undergoing SBRT were retrospectively analyzed from 2012 to 2015 at the Zhejiang Cancer Hospital. The relationship between CT appearance pattern after SBRT and patient’s survival was analyzed. Results The data from 173 patients with early-stage lung cancer treated with SBRT were analyzed. One month after SBRT, diffuse consolidation was seen in 17 patients, patchy consolidation in 28 patients, diffuse ground-glass opacity (GGO) in 10 patients, and patchy GGO in 22 patients. The survival time was significantly longer in the “no evidence of increased density” group compared with the “consolidation or GGO” group [2-year overall survival (OS) rate, 96.1% vs 89.3%; hazard ratio (HR), 0.36; 95% confidence interval (CI), 0.16–0.85; P = 0.015]. A similar trend was found in the progression-free survival (PFS) analysis (2-year PFS rate, 91.3% vs 85.0%; HR, 0.35; 95% CI, 0.13–0.95; P = 0.015) and distant metastasis free survival(DMFS) (2-year DMFS rate, 93.3% vs 87.1%; HR, 0.41; 95% CI, 0.20–0.86; P = 0.031). However, no significant difference was found in recurrence-free survival between the two groups (P = 0.212). Conclusions One month after SBRT, the radiological change “no evidence of increased density” was prevalent. The OS, PFS, and DMFS were significantly longer in the “no evidence of increased density” group compared with the “consolidation or GGO” group. Further studies are needed to validate these findings.
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Affiliation(s)
- Yan Yang
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Gaohua Li
- Department of Neurology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Shuyuan Li
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Yuanhang Wang
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Yanbo Zhao
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Baiqiang Dong
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Jin Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Ruiwu Zhu
- Department of Thoracic Surgery, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Ming Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China
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Duan Y, Zhou L, Wang H, Chen H, Gu H, Shao Y, Feng A, Huang Y, Fu X, Yue NJ, Ma K, Kong Q, Xu Z. A novel CRT-IMRT-combined (Co-CRIM) planning technique for peripheral lung stereotactic body radiotherapy in pinnacle treatment planning system. J Appl Clin Med Phys 2021; 22:97-107. [PMID: 34699670 PMCID: PMC8664147 DOI: 10.1002/acm2.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives This study attempts to explore a novel peripheral lung stereotactic body radiotherapy (SBRT) planning technique that can balance the pros and cons of three‐dimensional conformal radiotherapy (CRT) and intensity‐modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT). Methods Treatment plans were retrospectively designed based on CRT, IMRT, VMAT, and the proposed CRT‐IMRT‐combined (Co‐CRIM) techniques using Pinnacle treatment planning system (TPS) for 20 peripheral lung cancer patients. Co‐CRIM used an inverse optimization algorithm available in Pinnacle TPS. To develop a Co‐CRIM plan, the number of segments in each field was limited to one, the minimum segment area was set to the internal target volume (ITV), and the minimum monitor units (MU) of the segment was the quotient of fractional dose divided by twice the number of total fields. The performance of Co‐CRIM was then compared with other techniques. Results For conformity index (CI), Co‐CRIM performed comparably to IMRT/VMAT but better than CRT. For gradient index (GI), Co‐CRIM was similar to IMRT/VMAT or CRT. For heterogeneity index (HI), Co‐CRIM was comparable to IMRT/VMAT, higher than CRT. The dosimetric results of spinal cord and lung with Co‐CRIM were better than CRT, comparable to IMRT, but inferior to VMAT. The MU resulted from Co‐CRIM was lower than IMRT/VMAT but higher than CRT. For plan verification γ passing rate, Co‐CRIM was higher than IMRT/VMAT, comparable to CRT. For planning time, Co‐CRIM was shorter than CRT or VMAT but similar to IMRT. Conclusions The proposed Co‐CRIM technique on Pinnacle TPS is an effective planning technique for peripheral lung SBRT.
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Affiliation(s)
- YanHua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - LiJun Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - HengLe Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - AiHui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - XiaoLong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Jeff Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Jersey, USA
| | - Kui Ma
- Clinical helpdesk, Varian Medical Systems, Beijing, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - ZhiYong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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9
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Tanaka M, Koji I, Fujioka I, Sato M, Hirose K, Kawaguchi H, Hatayama Y, Takai Y, Tsushima E, Aoki M. Impact of low iodine density tumor area ratio on the local control of non-small cell lung cancer through stereotactic body radiotherapy. JOURNAL OF RADIATION RESEARCH 2021; 62:448-456. [PMID: 33823009 PMCID: PMC8127655 DOI: 10.1093/jrr/rrab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/06/2021] [Indexed: 05/09/2023]
Abstract
Lung cancer with low average iodine density measured via contrast-enhanced computed tomography (CT) using dual-energy CT technology has shown a reduced local control rate after stereotactic body radiotherapy (SBRT). The current study therefore investigated the relationship between low iodine density tumor area and its ratio and local recurrence after SBRT. Dual-energy CT was performed on the day before SBRT initiation, with a low iodine density tumor area being defined as that with an iodine density of <1.81 mg cm-3. The low iodine density tumor area, the ratio between the low iodine density tumor area and the entire tumor, and the local recurrence rate were then determined. No correlation was observed between the low iodine density tumor area and the local recurrence rate. However, tumors with a large low iodine density tumor area ratio showed an increased local recurrence rate, with the prognostic accuracy almost similar to that in previous studies using average iodine densities. Our results therefore suggest that the low iodine density tumor area ratio was a useful prognostic index after SBRT, with an accuracy comparable with that of the average iodine density.
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Affiliation(s)
- Mitsuki Tanaka
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
| | - Ichise Koji
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
| | - Ichitaro Fujioka
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
| | - Mariko Sato
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama, Fukushima, 963-8052 Japan
| | - Katsumi Hirose
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama, Fukushima, 963-8052 Japan
| | - Hideo Kawaguchi
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
| | - Yoshiomi Hatayama
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
| | - Yoshihiro Takai
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 036-8216 Japan
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, Koriyama, Fukushima, 963-8052 Japan
| | - Eiki Tsushima
- Department of Physical Therapy, Graduate School of Health Sciences, Hirosaki University, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564 Japan
| | - Masahiko Aoki
- Corresponding author. Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan. Tel: +81-172-39-5103; Fax: +81-172-33-5627; E-mail:
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10
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Masuda H, Kawahara D, Saito A, Kimura T, Ozawa S, Nakashima T, Nagata Y. Reduction of margin to compensate the respiratory tumor motion by the analysis of dosimetric internal target volume in lung SBRT with nonuniform volume prescription method. Med Phys 2021; 48:3200-3207. [PMID: 33792065 DOI: 10.1002/mp.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To develop a dosimetric internal target volume (ITV) margin (DIM) for respiratory motion in lung stereotactic body radiotherapy (SBRT) and to evaluate DIM with a nonuniform volume prescription (NVP) and the point prescription (PP). METHODS Volumetric modulated arc therapy (VMAT) treatment plans with PP and NVP were created on a heterogeneous programmable respiratory motion phantom, with a tumor (30-mm diameter) inside a cylindrical lung insert. The tumor was defined as the gross tumor volume (GTV), equal to the clinical target volume (CTV). Five-millimeter and 0-mm margins were used for the ITV and setup margins, respectively. The phantom was moved in cranio-caudal direction with a biquadratic sinusoidal waveform with a 4-s cycle and an amplitude of ±5-10 mm. The interplay effect was evaluated by measuring the dose profile with a film in the sagittal plane for different respiratory periods and different initial respiratory phases. DIM was based on the respiratory motion amplitude that satisfied 100% and 95% coverage of the prescribed dose by the minimum dose of the CTV. Moreover, the absolute dose was measured with and without respiratory motion for NVP by a pinpoint chamber. RESULTS The dose difference in the tumor region due to the interplay effect was within 1.0%. The gamma passing rate was over 95.1% for different respiratory periods and 98.6% for different initial respiratory phases. DIM with PP was almost equivalent to the margin of the respiratory motion. However, DIM with NVP was 2.0 and 1.8 times larger than the margin of the respiratory motion for the 100% and 95% coverage of the prescribed doses, respectively. CONCLUSION The interplay effects experienced between the MLC sequence and tumor motion were negligible for NVP. The DIM analysis revealed that the margin to compensate the respiratory tumor motion could be reduced by more than 44-50% for NVP in SBRT.
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Affiliation(s)
- Hirokazu Masuda
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Hiroshima, 734-8551, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Akito Saito
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shuichi Ozawa
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, 732-0057, Japan
| | - Takeo Nakashima
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Hiroshima, 734-8551, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima, 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, 732-0057, Japan
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11
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Liu G, Zhao L, Qin A, Grills I, Deraniyagala R, Stevens C, Zhang S, Yan D, Li X, Ding X. Lung Stereotactic Body Radiotherapy (SBRT) Using Spot-Scanning Proton Arc (SPArc) Therapy: A Feasibility Study. Front Oncol 2021; 11:664455. [PMID: 33968770 PMCID: PMC8100671 DOI: 10.3389/fonc.2021.664455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose We developed a 4D interplay effect model to quantitatively evaluate breathing-induced interplay effects and assess the feasibility of utilizing spot-scanning proton arc (SPArc) therapy for hypo-fractionated lung stereotactic body radiotherapy (SBRT). The model was then validated by retrospective application to clinical cases. Materials and Methods A digital lung 4DCT phantoms was used to mimic targets in diameter of 3cm with breathing motion amplitudes: 5, 10, 15, and 20 mm, respectively. Two planning groups based on robust optimization were generated: (1) Two-field Intensity Modulated Proton Therapy (IMPT) plans and (2) SPArc plans via a partial arc. 5,000 cGy relative biological effectiveness (RBE) was prescribed to the internal target volume (ITV) in five fractions. To quantitatively assess the breathing induced interplay effect, the 4D dynamic dose was calculated by synchronizing the breathing pattern with the simulated proton machine delivery sequence, including IMPT, Volumetric repainting (IMPTvolumetric), iso-layered repainting (IMPTlayer) and SPArc. Ten lung patients’ 4DCT previously treated with VMAT SBRT, were used to validate the digital lung tumor model. Normal tissue complicated probability (NTCP) of chestwall toxicity was calculated. Result Target dose were degraded as the tumor motion amplitude increased. The 4D interplay effect phantom model indicated that motion mitigation effectiveness using SPArc was about five times of IMPTvolumetric or IMPTlayer using maximum MU/spot as 0.5 MU at 20 mm motion amplitude. The retrospective study showed that SPArc has an advantage in normal tissue sparing. The probability of chestwall’s toxicity were significantly improved from 40.2 ± 29.0% (VMAT) (p = 0.01) and 16.3 ± 12.0% (IMPT) (p = 0.01) to 10.1 ± 5.4% (SPArc). SPArc could play a significant role in the interplay effect mitigation with breathing-induced motion more than 20 mm, where the target D99 of 4D dynamic dose for patient #10 was improved from 4,514 ± 138 cGy [RBE] (IMPT) vs. 4,755 ± 129 cGy [RBE] (SPArc) (p = 0.01). Conclusion SPArc effectively mitigated the interplay effect for proton lung SBRT compared to IMPT with repainting and was associated with normal tissue sparing. This technology may make delivery of proton SBRT more technically feasible and less complex with fewer concerns over underdosing the target compared to other proton therapy techniques.
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Affiliation(s)
- Gang Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - An Qin
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Rohan Deraniyagala
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
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12
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Dosimetric evaluation of SBRT treatment plans of non-central lung tumours: clinical experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s146039692000103x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:Lung cancer is the most commonly diagnosed cancer in Canada and the leading cause of cancer-related mortality in both men and women in North America. Surgery is usually the primary treatment option for early-stage non-small cell lung cancer (NSCLC). However, for patients who may not be suitable candidates for surgery, stereotactic body radiation therapy (SBRT) is an alternative method of treatment. SBRT has proven to be an effective technique for treating NSCLC patients by focally administering high radiation dose to the tumour with acceptable risk of toxicity to surrounding healthy tissues. The goal of this comprehensive retrospective dosimetric study is to compare the dosimetric parameters between three-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT) lung SBRT treatment plans for two prescription doses.Methods:We retrospectively analysed and compared lung SBRT treatment plans of 263 patients treated with either a 3DCRT non-coplanar or with 2–3 VMAT arcs technique at 48 Gy in 4 fractions (48 Gy/4) or 50 Gy in 5 fractions (50 Gy/5) prescribed to the planning target volume (PTV), typically encompassing the 80% isodose volume. All patients were treated on either a Varian 21EX or TrueBeam linear accelerator using 6-MV or 10-MV photon beams.Results:The mean PTV V95% and V100% for treatment plans at 48 Gy/4 are 99·4 ± 0·6% and 96·0 ± 1·0%, respectively, for 3DCRT and 99·7 ± 0·4% and 96·4 ± 3·4%, respectively, for VMAT. The corresponding mean PTV V95% and V100% at 50 Gy/5 are 99·0 ± 1·4% and 95·5 ± 2·5% for 3DCRT and 99·5 ± 0·8% and 96·1 ± 1·6% for VMAT. The CIRI and HI5/95 for the PTV at 48 Gy/4 are 1·1 ± 0·1 and 1·2 ± 0·0 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The corresponding CIRI and HI5/95 at 50 Gy/5 are 1·1 ± 0·1 and 1·3 ± 0·1 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The mean R50% and D2cm at 48 Gy/4 are 5·0 ± 0·8 and 61·2 ± 7·0% for 3DCRT and 4·9 ± 0·8 and 57·8 ± 7·9% for VMAT. The corresponding R50% and D2cm at 50 Gy/5 are 4·7 ± 0·5 and 65·5 ± 9·4% for 3DCRT and 4·7 ± 0·7 and 60·0 ± 7·2% for VMAT.Conclusion:The use of 3DCRT or VMAT technique for lung SBRT is an efficient and reliable method for achieving dose conformity, rapid dose fall-off and minimising doses to the organs at risk. The VMAT technique resulted in improved dose conformity, rapid dose fall-off from the PTV compared to 3DCRT, although the magnitude may not be clinically significant.
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13
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Koiwai K, Endo Y, Mizuhata K, Ina H, Fukazawa A, Ozawa T, Fujinaga Y. Ten-Year Experience of Stereotactic Body Radiotherapy at a Single Institution: Impact of Technological Development on the Outcome of Patients With Early Lung Cancer. Technol Cancer Res Treat 2020; 19:1533033820979163. [PMID: 33267715 PMCID: PMC7720300 DOI: 10.1177/1533033820979163] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose: Advanced radiotherapeutic techniques and apparatus have been developed and widely applied in stereotactic body radiation therapy for early-stage non-small cell lung cancer, but their clinical benefits have not necessarily been confirmed. This study was performed to review our 10-year experience with therapy for the disease and to evaluate whether the advanced radiotherapeutic system implemented in our hospital 5 years after we began the therapy improved the clinical outcomes of patients. Materials and Methods: Patients who underwent the therapy at our hospital between April 2008 and March 2018 were retrospectively reviewed. They were divided into 2 groups treated with the conventional system or the advanced system, and the characteristics and clinical outcomes were compared between the groups. The same analyses were also performed in propensity-matched patients from the 2 groups. Results: Among the 73 patients eligible for this study, 42 were treated with the conventional system and 31 with the advanced system. All were treated as planned, and severe adverse events were rare. The local progression-free survival rate in the advanced system group was significantly higher than in the conventional system group (P = 0.025). In the propensity-matched patients, both the local progression-free survival rate and the overall survival rate were significantly higher compared in the advanced system group than the conventional system group (P = 0.089 and 0.080, respectively). Conclusion: The advanced system improved the outcomes of patients with the disease, suggesting that technological development has had a strong impact on clinical outcomes.
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Affiliation(s)
- Keiichiro Koiwai
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Yuuki Endo
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Kai Mizuhata
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Hironobu Ina
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Ayumu Fukazawa
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Takesumi Ozawa
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Yasunari Fujinaga
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
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14
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Onishi H, Shioyama Y, Matsumoto Y, Shibamoto Y, Miyakawa A, Suzuki G, Nishimura Y, Sasaki R, Miyawaki D, Kuriyama K, Komiyama T, Marino K, Aoki S, Saito R, Araya M, Maehata Y, Nonaka H, Tominaga L, Saito M, Sano N, Yamada S. Stereotactic body radiotherapy in patients with lung tumors composed of mainly ground-glass opacity. JOURNAL OF RADIATION RESEARCH 2020; 61:426-430. [PMID: 32219316 PMCID: PMC7299254 DOI: 10.1093/jrr/rraa015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/07/2020] [Indexed: 06/10/2023]
Abstract
We retrospectively reviewed the effect of stereotactic body radiation therapy (SBRT) in patients with stage I lung cancer whose lung tumor showed a nodular appearance of ground glass opacity, so-called ground glass nodule (GGN). A total of 84 patients (42 men, 42 women; mean age, 75 years) with stage I lung cancer with GGN accompanying a solid component <50% in diameter of the tumor and no metastases were studied. Concerning histology, 32 tumors were adenocarcinoma, 1 was squamous cell carcinoma, 2 were unclassified carcinoma and 49 cases were histology-unproven but increased in size or had a positive finding in 18F-FDG positron emission tomography (PET) examination. The median tumor size was 20 mm (range, 10-41 mm). All of the patients were treated with SBRT, and the total prescribed dose at the isocenter ranged between 48 Gy in four fractions and 84 Gy in ten fractions. Median follow-up duration was 33 months. No patient had local failure nor regional lymph node failure. The 3-year rate of distant failure was 2.6%. Two patients who experienced distant metastases had a past surgical history of initial lung cancer before SBRT. The rates of cause-specific and overall survival at 3 years were 98.2 and 94.6%, respectively. Treatment-related adverse events of ≥grade 4 were not reported. Although more cases and longer follow-ups are mandatory, SBRT may be one of the radical treatment options for patients with GGN.
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Affiliation(s)
- Hiroshi Onishi
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | | | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Japan
| | - Yuta Shibamoto
- Department of Radiology, School of Medicine, Nagoya City University, Japan
| | - Akifumi Miyakawa
- Department of Radiology, School of Medicine, Nagoya City University, Japan
| | - Gen Suzuki
- Department of Radiation Oncology, School of Medicine, Kurume University, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, School of Medicine, Kobe University, Japan
| | - Daisuke Miyawaki
- Department of Radiation Oncology, School of Medicine, Kobe University, Japan
| | - Kengo Kuriyama
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Takafumi Komiyama
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Kan Marino
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Shinichi Aoki
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Ryo Saito
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Masayuki Araya
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Yoshiyasu Maehata
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Hotaka Nonaka
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Licht Tominaga
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Masahide Saito
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Naoki Sano
- Department of Radiology, School of Medicine, University of Yamanashi, Japan
| | - Shogo Yamada
- Department of Radiation Oncology, School of Medicine, Tohoku University, Japan
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15
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Giaj-Levra N, Borghetti P, Bruni A, Ciammella P, Cuccia F, Fozza A, Franceschini D, Scotti V, Vagge S, Alongi F. Current radiotherapy techniques in NSCLC: challenges and potential solutions. Expert Rev Anticancer Ther 2020; 20:387-402. [PMID: 32321330 DOI: 10.1080/14737140.2020.1760094] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Radiotherapy is an important therapeutic strategy in the management of non-small cell lung cancer (NSCLC). In recent decades, technological implementations and the introduction of image guided radiotherapy (IGRT) have significantly increased the accuracy and tolerability of radiation therapy.Area covered: In this review, we provide an overview of technological opportunities and future prospects in NSCLC management.Expert opinion: Stereotactic body radiotherapy (SBRT) is now considered the standard approach in patients ineligible for surgery, while in operable cases, it is still under debate. Additionally, in combination with systemic treatment, SBRT is an innovative option for managing oligometastatic patients and features encouraging initial results in clinical outcomes. To date, in inoperable locally advanced NSCLC, the radical dose prescription has not changed (60 Gy in 30 fractions), despite the median overall survival progressively increasing. These results arise from technological improvements in precisely hitting target treatment volumes and organ at risk sparing, which are associated with better treatment qualities. Finally, for the management of NSCLC, proton and carbon ion therapies and the recent development of MR-Linac are new, intriguing technological approaches under investigation.
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Affiliation(s)
- Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Paolo Borghetti
- Dipartimento di Radioterapia Oncologica, Università e ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Patrizia Ciammella
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, AUSL-IRCCS, Reggio, Emilia, Italy
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Alessandra Fozza
- Department of Radiation Oncology, SS.Antonio e Biagio e C.Arrigo Hospital Alessandria, Alessandria, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center- IRCCS - Rozzano (MI), Milano, Italy
| | - Vieri Scotti
- Radiation Therapy Unit, Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Stefano Vagge
- Radiation oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy.,University of Brescia, Italy
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16
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Kawahara D, Nakano H, Saito A, Ozawa S, Nagata Y. Dose compensation based on biological effectiveness due to interruption time for photon radiation therapy. Br J Radiol 2020; 93:20200125. [PMID: 32356450 DOI: 10.1259/bjr.20200125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the biological effectiveness of dose associated with interruption time; and propose the dose compensation method based on biological effectiveness when an interruption occurs during photon radiation therapy. METHODS The lineal energy distribution for human salivary gland tumor was calculated by Monte Carlo simulation using a photon beam. The biological dose (Dbio) was estimated using the microdosimetric kinetic model. The dose compensating factor with the physical dose for the difference of the Dbio with and without interruption (Δ) was derived. The interruption time (τ) was varied to 0.1, 0.2, 0.3, 0.4, 0.5, 1, 2, 3, 4, 5, 10, 20, 30, 40, 50, 75, and 120 min. The dose per fraction and dose rate varied from 2 to 8 Gy and 0.1 to 24 Gy/min, respectively. RESULTS The maximum Δ with 1 Gy/min occurred when the interruption occurred at half the dose. The Δ with 1 Gy/min at half of the dose was over 3% for τ >= 20 min for 2 Gy, τ = 10 min for 5 Gy, and τ = 10 min for 8 Gy. The maximum difference of the Δ due to the dose rate was within 3% for 2 and 5 Gy, and achieving values of 4.0% for 8 Gy. The dose compensating factor was larger with a high dose per fraction and high-dose rate beams. CONCLUSION A loss of biological effectiveness occurs due to interruption. Our proposal method could correct for the unexpected decrease of the biological effectiveness caused by interruption time. ADVANCES IN KNOWLEDGE For photon radiotherapy, the interruption causes the sublethal damage repair. The current study proposed the dose compensation method for the decrease of the biological effect by the interruption.
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Affiliation(s)
- Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan
| | - Hisashi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata, Niigata, 951-8122, Japan
| | - Akito Saito
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichi Ozawa
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, 732-0057, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan.,Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, 755-0046, Japan
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17
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Kong C, Zhu X, Shi M, Wang L, Chen C, Tao H, Jiang N, Yan P, Zhao L, Song X, He X. Survival and Toxicity of Hypofractionated Intensity Modulated Radiation Therapy in 4 Gy Fractions for Unresectable Stage III Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2020; 107:710-719. [PMID: 32275994 DOI: 10.1016/j.ijrobp.2020.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the survival, local and distant control, and toxicity in patients with unresectable locally advanced non-small cell lung cancer treated with radical-intent hypofractionated radiation therapy delivering approximately 60 Gy in 4-Gy fractions. METHODS AND MATERIALS Consecutive patients with unresectable stage III non-small cell lung cancer (n = 42) who received hypofractionated intensity modulated radiation therapy were retrospectively analyzed (2012-2016). Treatments consisted of first-line platinum-based doublet induction chemotherapy followed by an intended dose of 60 Gy in 15 fractions. RESULTS During a median follow-up period of 46 months (95% confidence interval, 41-59) the median overall survival was 47 months (95% confidence interval, 31 to not reached). The 1-, 2-, 3-, and 5-year overall survival rates were 81%, 69%, 64%, and 32%, respectively. The 1-, 2-, 3-, and 5-year progression-free survival rates were 58%, 35%, 25%, and 25%, respectively. An isolated locoregional recurrence was seen in 12% of the patients (n = 5). The incidence of grade (G) 3 or higher treatment-related lung toxicity was 14% (n = 6), among which G3 toxicity was 9.5% (n = 4) and G5 toxicity was 4.8% (n = 2). Twelve percent of patients (n = 5) experienced G3 radiation esophagitis, and 2% (n = 1) had G4 esophageal toxicity. CONCLUSIONS Patients with unresectable locally advanced non-small cell lung cancer treated with hypofractionated intensity modulated radiation therapy in doses up to 60 Gy at 4 Gy per fraction had promising survival, although high-grade esophageal and lung toxicities were seen. Our findings deserve further evaluation in prospective studies.
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Affiliation(s)
- Cheng Kong
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Xiangzhi Zhu
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China.
| | - Meiqi Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Li Wang
- Department of Medical Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Cheng Chen
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Hua Tao
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Ning Jiang
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Pengwei Yan
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Lijun Zhao
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Xue Song
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
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18
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Koba A, Hayashi K, Suzuki O, Kawaguchi Y, Ogawa K, Chatani M. Stereotactic body radiotherapy feasibility for patients with peripheral stage I lung cancer and poor pulmonary function. Oncol Lett 2020; 19:2515-2521. [PMID: 32194753 DOI: 10.3892/ol.2020.11333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022] Open
Abstract
The aim of the present study was to evaluate the toxicity and investigate the prognostic factors of stereotactic body radiotherapy (SBRT) for peripheral stage I lung cancer in patients with poor pulmonary function. Data from 95 patients with stage I lung cancer with poor pulmonary function treated using SBRT at Osaka Rosai Hospital were retrospectively analyzed. Poor pulmonary function was defined as the forced expiratory volume %/sec (FEV1/FVC) <70% or percentage of vital capacity (%VC) <80% during pretreatment spirometry testing. The median FEV1/FVC and %VC of the patients were 59.1 and 78.8%, respectively. The most commonly prescribed dose of SBRT was 50 Gy in four fractions (68 patients, 72%). The median follow-up period was 34 months. Four patients developed adverse effects of grade ≥3, one patient developed grade 5 radiation pneumonitis, one grade 5 hemoptysis, one grade 3 radiation pneumonitis and one grade 3 chest wall pain. The 3-year local control and overall survival (OS) rates were 78.8 and 59.9%, respectively. Univariate analysis revealed that Karnofsky performance status (KPS) significantly predicted OS (P=0.037). Thus, SBRT in patients with stage I lung cancer with poor pulmonary function may be effective with acceptable toxicity. A KPS score ≥80 indicated good prognosis.
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Affiliation(s)
- Aiko Koba
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kazuhiko Hayashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.,Osaka Heavy Ion Therapy Center, Osaka, Osaka 540-0008, Japan
| | - Osamu Suzuki
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yoshifumi Kawaguchi
- Department of Radiation Oncology, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Masashi Chatani
- Osaka Heavy Ion Therapy Center, Osaka, Osaka 540-0008, Japan
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19
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Heinzerling JH, Hampton CJ, Robinson M, Bright M, Moeller BJ, Ruiz J, Prabhu R, Burri SH, Foster RD. Use of surface-guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen. J Appl Clin Med Phys 2020; 21:48-55. [PMID: 32196944 PMCID: PMC7286017 DOI: 10.1002/acm2.12852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/08/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Multiple techniques can be used to assist with more accurate patient setup and monitoring during Stereotactic body radiation therapy (SBRT) treatment. This study analyzes the accuracy of 3D surface mapping with Surface‐guided radiation therapy (SGRT) in detecting interfraction setup error and intrafraction motion during SBRT treatments of the lung and abdomen. Materials and Methods Seventy‐one patients with 85 malignant thoracic or abdominal tumors treated with SBRT were analyzed. For initial patient setup, an alternating scheme of kV/kV imaging or SGRT was followed by cone beam computed tomography (CBCT) for more accurate tumor volumetric localization. The CBCT six degree shifts after initial setup with each method were recorded to assess interfraction setup error. Patients were then monitored continuously with SGRT during treatment. If an intrafractional shift in any direction >2 mm for longer than 2 sec was detected by SGRT, then CBCT was repeated and the recorded deltas were compared to those detected by SGRT. Results Interfractional shifts after SGRT setup and CBCT were small in all directions with mean values of <5 mm and < 0.5 degrees in all directions. Additionally, 25 patients had detected intrafraction motion by SGRT during a total of 34 fractions. This resulted in 25 (73.5%) additional shifts of at least 2 mm on subsequent CBCT. When comparing the average vector detected shift by SGRT to the resulting vector shift on subsequent CBCT, no significant difference was found between the two. Conclusions Surface‐guided radiation therapy provides initial setup within 5 mm for patients treated with SBRT and can be used in place of skin marks or planar kV imaging prior to CBCT. In addition, continuous monitoring with SGRT during treatment was valuable in detecting potentially clinically meaningful intrafraction motion and was comparable in magnitude to shifts from additional CBCT scans. PTV margin reduction may be feasible for SBRT in the lung and abdomen when using SGRT for continuous patient monitoring during treatment.
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Affiliation(s)
- John H Heinzerling
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Carnell J Hampton
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Myra Robinson
- Levine Cancer Institute, Department of Biostatistics, Atrium Health, Charlotte, NC, USA
| | - Megan Bright
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Benjamin J Moeller
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Justin Ruiz
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Roshan Prabhu
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Stuart H Burri
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Ryan D Foster
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
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20
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Kawahara D, Saito A, Ozawa S, Shiinoki T, Kimura T, Tsubouchi K, Nagata Y. Assessment of biological dosimetric margin for stereotactic body radiation therapy. J Appl Clin Med Phys 2020; 21:31-41. [PMID: 32141684 PMCID: PMC7170295 DOI: 10.1002/acm2.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To develop a novel biological dosimetric margin (BDM) and to create a biological conversion factor (BCF) that compensates for the difference between physical dosimetric margin (PDM) and BDM, which provides a novel scheme of a direct estimation of the BDM from the physical dose (PD) distribution. Methods The offset to isocenter was applied in 1‐mm steps along left‐right (LR), anterior‐posterior (AP), and cranio‐caudal (CC) directions for 10 treatment plans of lung stereotactic body radiation therapy (SBRT) with a prescribed dose of 48 Gy. These plans were recalculated to biological equivalent dose (BED) by the linear‐quadratic model for the dose per fraction (DPF) of d = 3–20 Gy/fr and α/β=3-10. BDM and PDM were defined so that the region that satisfied that the dose covering 95% (or 98%) of the clinical target volume was greater than or equal to the 90% of the prescribed PD and BED, respectively. An empirical formula of the BCF was created as a function of the DPF. Results There was no significant difference between LR and AP directions for neither the PDM nor BDM. On the other hand, BDM and PDM in the CC direction were significantly larger than in the other directions. BCFs of D95% and D98% were derived for the transverse (LR and AP) and longitudinal (CC) directions. Conclusions A novel scheme to directly estimate the BDM using the BCF was developed. This technique is expected to enable the BED‐based SBRT treatment planning using PD‐based treatment planning systems.
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Affiliation(s)
- Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akito Saito
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shuichi Ozawa
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kento Tsubouchi
- Section of Radiation Therapy, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
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21
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Hasan MT, Campbell E, Sizova O, Lyle V, Akkaraju G, Kirkpatrick DL, Naumov AV. Multi-Drug/Gene NASH Therapy Delivery and Selective Hyperspectral NIR Imaging Using Chirality-Sorted Single-Walled Carbon Nanotubes. Cancers (Basel) 2019; 11:E1175. [PMID: 31416250 PMCID: PMC6721580 DOI: 10.3390/cancers11081175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/10/2019] [Accepted: 08/11/2019] [Indexed: 01/21/2023] Open
Abstract
Single-walled carbon nanotubes (SWCNTs) can serve as drug delivery/biological imaging agents, as they exhibit intrinsic fluorescence in the near-infrared, allowing for deeper tissue imaging while providing therapeutic transport. In this work, CoMoCAT (Cobalt Molybdenum Catalyst) SWCNTs, chirality-sorted by aqueous two-phase extraction, are utilized for the first time to deliver a drug/gene combination therapy and image each therapeutic component separately via chirality-specific SWCNT fluorescence. Each of (7,5) and (7,6) sorted SWCNTs were non-covalently loaded with their specific payload: the PI3 kinase inhibitor targeting liver fibrosis or CCR5 siRNA targeting inflammatory pathways with the goal of addressing these processes in nonalcoholic steatohepatitis (NASH), ultimately to prevent its progression to hepatocellular carcinoma. PX-866-(7,5) SWCNTs and siRNA-(7,6) SWCNTs were each imaged via characteristic SWCNT emission at 1024/1120 nm in HepG2 and HeLa cells by hyperspectral fluorescence microscopy. Wavelength-resolved imaging verified the intracellular transport of each SWCNT chirality and drug release. The therapeutic efficacy of each formulation was further demonstrated by the dose-dependent cytotoxicity of SWCNT-bound PX-866 and >90% knockdown of CCR5 expression with SWCNT/siRNA transfection. This study verifies the feasibility of utilizing chirality-sorted SWCNTs for the delivery and component-specific imaging of combination therapies, also suggesting a novel nanotherapeutic approach for addressing the progressions of NASH to hepatocellular carcinoma.
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Affiliation(s)
- Md Tanvir Hasan
- Department of Physics and Astronomy, Texas Christian University, TCU Box 298840, Fort Worth, TX 76129, USA
| | - Elizabeth Campbell
- Department of Physics and Astronomy, Texas Christian University, TCU Box 298840, Fort Worth, TX 76129, USA
| | - Olga Sizova
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Veronica Lyle
- Department of Physics and Astronomy, Texas Christian University, TCU Box 298840, Fort Worth, TX 76129, USA
| | - Giridhar Akkaraju
- Department of Biology, Texas Christian University, 2955 South University Drive, Fort Worth, TX 76129, USA
| | | | - Anton V Naumov
- Department of Physics and Astronomy, Texas Christian University, TCU Box 298840, Fort Worth, TX 76129, USA.
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22
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Mohideen N, Kavanagh BD. Model Insurance Coverage Policies: The Power of Suggestion, the Force of Evidence. Int J Radiat Oncol Biol Phys 2019; 104:745-747. [PMID: 31204660 DOI: 10.1016/j.ijrobp.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/29/2019] [Accepted: 04/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Najeeb Mohideen
- Department of Radiation Oncology, Northwest Community Hospital, Arlington Heights, Illinois.
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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23
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Chen G, Dong B, Shan G, Zhang X, Tang H, Li Y, Wang Z, Xu W, Xu G, Yan G, Zhang F, Hu X, Yang J, Xu Y, Chen M, Wang J. Choice of immobilization of stereotactic body radiotherapy in lung tumor patient by BMI. BMC Cancer 2019; 19:583. [PMID: 31200687 PMCID: PMC6570957 DOI: 10.1186/s12885-019-5767-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate, reproducible, and comfortable immobilization device is essential for stereotactic radiotherapy (SBRT) in patients with lung cancer. This study compared thermoplastic masks (TMP) and vacuum cushion (VCS) system to assess the differences in interfraction and intrafraction setup accuracy and the impact of body mass index (BMI) with respect to the immobilization choice. METHODS This retrospective study was conducted on patients treated with lung SBRT between 2012 and 2015 at the Zhejiang cancer hospital. The treatment setup accuracy was analyzed in 121 patients. A total of 687 cone beam computed tomography (CBCT) scans before treatment and 126 scans after treatment were recorded to determine the uncertainties, and plan target volume margins. Data were further stratified and analyzed by immobilization methods and patients' BMI. The t-test (Welch) was used to assess the differences between the two immobilization systems when stratified by the patients' BMI. RESULTS For patients with BMI ≥ 24, the mean displacements for the TMP and VCS systems were 1.4 ± 1.2 vs. 2.4 ± 2.0 mm at medial-lateral (ML) direction (p < 0.001); 2.0 ± 1.9 vs. 2.0 ± 1.9 mm at cranial-caudal (CC) direction (p = 0.917); and 2.4 ± 1.4 vs. 2.6 ± 2.1 mm at anterior-posterior (AP) direction, (p = 0.546). The rate of acceptable errors increased dramatically when immobilized by TMP. In the case of patients with BMI < 24, the mean displacements for the TMP and VCS systems were 1.8 ± 1.4 vs. 2.1 ± 1.8 mm at ML direction (p = 0.098); 2.9 ± 2.3 vs. 2.2 ± 2.2 mm at CC direction (p = 0.001); and 1.8 ± 1.8 vs. 2.3 ± 2.0 mm at CC direction, (p = 0.006). The proportion of acceptable errors increased after immobilization by VCS. No difference was detected in the intrafraction setup error by different immobilization methods. CONCLUSIONS The immobilization choice of SBRT for lung tumors depends on the BMI of the patients. For patients with BMI ≥ 24, TMP offers a better reproducibility with significantly less interfractional setup displacement than VCS, resulting in fewer CBCT scans. However, VCS may be preferred over TMP for the patients with BMI < 24. Therefore, an optimal immobilization system needs to be considered in different BMI groups for lung SBRT.
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Affiliation(s)
- Guofu Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Baiqiang Dong
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China.,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China
| | - Guoping Shan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Xiuqin Zhang
- People's hospital of Yuxi city in Yunnan province, Yuxi, 653100, China
| | - Huarong Tang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Yuchen Li
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Zhenhua Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Wei Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Gang Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Guiming Yan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Feiyan Zhang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Xiao Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China.,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China
| | - Jun Yang
- Yitu Healthcare, Shanghai, China
| | - Yujin Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China.,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China. .,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China.
| | - Jin Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China. .,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China.
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24
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Stereotactic body radiotherapy in patients with chronic obstructive pulmonary disease and interstitial pneumonia: a review. Int J Clin Oncol 2019; 24:899-909. [PMID: 30937620 DOI: 10.1007/s10147-019-01432-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/19/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) can yield excellent local tumor control, as well as survival benefit comparable to that of surgery for early-stage lung cancer. However, in terms of toxicity, SBRT might lead to fatal radiation pneumonitis. Lung diseases, such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), are major risk factors for lung cancer. However, these patients are typically not candidates for the gold-standard treatment option, lobectomy, because of the perioperative risks. In addition, patients with poor respiratory function can be excluded in prospective clinical trials. Thus, SBRT for patients with pulmonary diseases is still challenging, but there appears to be a clinical role for this modality as an alternative treatment. However, there are few well-documented review articles on SBRT for patients with pulmonary diseases. Therefore, we aimed to review SBRT in the context of important patient-related factors, including COPD and ILD. SBRT is an acceptable alternative treatment option for patients with lung cancer who also have COPD with an equivalent risk of radiation pneumonitis to normal lung. However, latent ILD should be detected prior to treatment. The indication for SBRT should be decided by carefully considering the risks and benefit for patients with ILD.
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25
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Liu G, Hu F, Ding X, Li X, Shao Q, Wang Y, Yang J, Quan H. Simulation of dosimetry impact of 4DCT uncertainty in 4D dose calculation for lung SBRT. Radiat Oncol 2019; 14:1. [PMID: 30621744 PMCID: PMC6323842 DOI: 10.1186/s13014-018-1191-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Due to the heterogeneity of patient’s individual respiratory motion pattern in lung stereotactic body radiotherapy (SBRT), treatment planning dose assessment using a traditional four-dimensional computed tomography (4DCT_traditional) images based on a uniform breathing curve may not represent the true treatment dose delivered to the patient. The purpose of this study was to evaluate the accumulated dose discrepancy between based on the 4DCT_traditional and true 4DCT (4DCT_true) that incorporated with the patient’s real entire breathing motion. The study also explored a novel 4D robust planning strategy to compensate for such heterogeneity respiratory motion uncertainties. Methods Simulated and measured patient specific breathing curves were used to generate 4D targets motion CT images. Volumetric-modulated arc therapy (VMAT) was planned using two arcs. Accumulated dose was obtained by recalculating the plan dose on each individual phase image and then deformed the dose from each phase image to the reference image. The “4 D dose” (D4D) and “true dose” (Dtrue) were the accumulated dose based on the 4DCT_traditional and 4DCT_true respectively. The average worse case dose discrepancy (\documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta D} $$\end{document}ΔD¯) between D4D and Dtrue in all treatment fraction was calculated to evaluate dosimetric /planning parameters and correlate them with the heterogeneity of respiratory-induced motion patterns. A novel 4D robust optimization strategy for VMAT (4D Ro-VMAT) based on the probability density function(pdf) of breathing curve was proposed to improve the target coverage in the presence of heterogeneity respiratory motion. The data were assessed with a paired t-tests. Results With increasing breathing amplitude from 5 to 20 mm, target \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta {D}_{95}} $$\end{document}ΔD95¯ increased from 1.59,1.39 to 10.15%,8.66% respectively. When the standard deviation of breathing amplitude increased from 15 to 35% of the mean amplitude, \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\Delta {D}_{95}} $$\end{document}ΔD95¯ increased from 4.06,3.48 to 10.25%,6.63% respectively. The 4D Ro-VMAT plan significantly improve the target dose compared to VMAT plan. Conclusion When the breathing curve amplitude is more than 10 mm and standard deviation of amplitude is higher than 25% of mean amplitude, special care is needed to choose an appropriated dose accumulation approach to evaluate lung SBRT plan target coverage robustness. The proposed 4D Ro_VMAT strategy based on the pdf of patient specific breathing curve could effectively compensate such uncertainties.
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Affiliation(s)
- Gang Liu
- Key Laboratory of Artificial Micro- and Nano- structures of Ministry of Education and Center for Electronic Microscopy, School of Physics and Technology, Wuhan University, Wuhan, 430072, China.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fala Hu
- School of Mathematics and Statistics, Wuhan University, Wuhan, 430072, China
| | - Xuanfeng Ding
- Proton Therapy Center Beaumont Health, Royal Oak, MI, 48074, USA
| | - Xiaoqiang Li
- Proton Therapy Center Beaumont Health, Royal Oak, MI, 48074, USA
| | - Qihong Shao
- Wuhan Zhongyuan Electronics Group Co. LTD, Wuhan, 430205, China
| | - Yuenan Wang
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, 518000, China
| | - Jing Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hong Quan
- Key Laboratory of Artificial Micro- and Nano- structures of Ministry of Education and Center for Electronic Microscopy, School of Physics and Technology, Wuhan University, Wuhan, 430072, China.
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Dreyer J, Bremer M, Henkenberens C. Comorbidity indexing for prediction of the clinical outcome after stereotactic body radiation therapy in non-small cell lung cancer. Radiat Oncol 2018; 13:213. [PMID: 30390700 PMCID: PMC6215615 DOI: 10.1186/s13014-018-1156-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine the prognostic impact of comorbidity and age in medically inoperable early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT) using the age-adjusted Charlson Comorbidity Index (aCCI). Patients and methods Between November 2008 and January 2015, 196 consecutive patients with medically inoperable NSCLC were treated with SBRT at a single institution. The prescribed isocenter dose was either 60.0 Gray (Gy) in six fractions for central lung cancer or 56.25 Gy in three fractions for peripheral lung cancer. Baseline comorbidities were retrospectively retrieved according to available outclinic medical records as well as the hospital information system. The aCCI was scored for each patient and subjected according to outcome and toxicity as well as all of the single items of the aCCI and other clinical parameters using univariate and multivariate analysis. Results Thirty-one point 6 % (62/196) of patients were deceased, of whom 17.3% (34/196) died due to lung cancer and 14.3% (28/196) due to comorbidities. The median overall survival (OS) was 15.0 months (95% CI [11.9–18.1]), whereas the median cancer-specific survival (CSS) was not reached. An aCCI ≥7 compared with an aCCI ≤6 was significantly associated with an increased risk of death (HR 1.79, 95% CI [1.02–2.80], p = 0.04) and cancer-specific death (HR 9.26, 95% CI [4.83–24.39], p < 0.001), respectively. Neither OS nor CCS were significantly associated with age, sex, side (left vs. right), lobe, localization (central vs. peripheral), packyears, TNM, or any item of the aCCI. Considering the 14.3% (28/196) of deceased patients who died due to comorbidities, aCCI ≥9 was significantly associated with non-cancer-related death (HR 3.12, 95% CI [1.22–8.33], p = 0.02). The observed cumulative rate of radiation pneumonitis (RP) ≥2 was 12.7% (25/196). The aCCI had no statistical association with RP. Conclusion Advanced age and numerous comorbidities characterizing this patient population were successfully assessed using the aCCI in terms of survival. Therefore, we recommend that age and comorbidity be indexed using the aCCI as a simple scoring system for all patients treated with SBRT for lung cancer.
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Affiliation(s)
- Julia Dreyer
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Bremer
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Abreu CECV, Moraes FY, Miranda FA, Siqueira GSM, Gadia R, Haddad CK, Carvalho HA. Stereotactic Body Radiation Therapy for Biopsy-Proven Primary Non-Small-Cell Lung Cancer: Experience of Patients With Inoperable Cancer at a Single Brazilian Institution. J Glob Oncol 2018; 4:1-8. [PMID: 30085881 PMCID: PMC6223518 DOI: 10.1200/jgo.18.00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for patients with non–small-cell lung cancer (NSCLC). We report the clinical outcomes and toxicity for patients with inoperable primary NSCLC treated with SBRT. Methods Between 2007 and 2015, 102 consecutive lung lesions were treated with SBRT at our center, of which 59 primary NSCLC lesions (from 54 patients with inoperable disease) were retrospectively reviewed (43 lesions were excluded because of metastases or because there was no biopsy specimen). We report infield local control (LC) per SBRT target, regional or distant failure-free survival, and overall survival (OS) per patient, using Kaplan-Meier estimates. Serious toxicity was retrospectively scored using Common Terminology Criteria for Adverse Events, version 4. Results Most of the 54 patients were men (n = 41; 76%), median age was 75 years; stage IA (n = 36; 66%) and adenocarcinoma (n = 43; 80%) were the most common stage and histologic diagnosis, respectively. Five patients had two lung lesions. A median of three fractions (range, 3 to 5 fractions) and a total median dose of 54 Gy (range, 45 to 60 Gy) per lesion were prescribed. The median follow-up was 17.8 months (range, 4 to 56.4 months). The 2-year rates of LC, regional or distant failure-free survival, and OS were 89.1% (95% CI, 72.2% to 96%), 79% (95% CI, 59.8% to 89.8%), and 80% (95% CI, 64% to 89.8%), respectively. Grade 3 to 4 toxicities were observed in two patients (3%): grade 3 pneumonitis (n = 1) and grade 4 skin toxicity (n = 1). Conclusion SBRT results in high rates of 2-year LC, regional or distant failure-free survival, and OS with low rates of severe toxicity in patients with inoperable primary NSCLC disease.
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Affiliation(s)
- Carlos E C V Abreu
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Fabio Y Moraes
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Fabiana A Miranda
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Gabriela S M Siqueira
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Rafael Gadia
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Cecilia K Haddad
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Heloisa A Carvalho
- Carlos E.C.V. Abreu, Fabio Y. Moraes, Fabiana A. Miranda, Gabriela S.M. Siqueira, Rafael Gadia, Cecilia K. Haddad, and Heloisa A. Carvalho, Hospital Sírio-Libanês; Heloisa A. Carvalho, Universidade de São Paulo, São Paulo, Brazil; Fabio Y. Moraes, University of Toronto, and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
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Vellayappan BA, Chao ST, Foote M, Guckenberger M, Redmond KJ, Chang EL, Mayr NA, Sahgal A, Lo SS. The evolution and rise of stereotactic body radiotherapy (SBRT) for spinal metastases. Expert Rev Anticancer Ther 2018; 18:887-900. [DOI: 10.1080/14737140.2018.1493381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Health System, Singapore
| | - Samuel T. Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Eric L. Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Nina A. Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Simon S. Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
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Nagata Y, Kimura T. Stereotactic body radiotherapy (SBRT) for Stage I lung cancer. Jpn J Clin Oncol 2018; 48:405-409. [PMID: 29635536 DOI: 10.1093/jjco/hyy034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) is a newly developed technique currently in clinical use. SBRT originated from stereotactic radiosurgery (SRS) for intracranial tumors. Since the 1990s, SBRT has been widely used in clinical settings for the treatment of lung cancer. We review the history and current standard techniques. Previous clinical studies of lung cancer showed high local control rates with acceptable toxicities. Past and on-going clinical trials are also reviewed.
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Affiliation(s)
- Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Changes in Treatment Patterns and Overall Survival in Patients With Early-Stage Non–Small Cell Lung Cancer in the United States After the Incorporation of Stereotactic Ablative Radiation Therapy. Am J Clin Oncol 2018; 41:259-266. [DOI: 10.1097/coc.0000000000000265] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Aznar MC, Warren S, Hoogeman M, Josipovic M. The impact of technology on the changing practice of lung SBRT. Phys Med 2018; 47:129-138. [PMID: 29331227 PMCID: PMC5883320 DOI: 10.1016/j.ejmp.2017.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/20/2017] [Accepted: 12/23/2017] [Indexed: 02/09/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) for lung tumours has been gaining wide acceptance in lung cancer. Here, we review the technological evolution of SBRT delivery in lung cancer, from the first treatments using the stereotactic body frame in the 1990's to modern developments in image guidance and motion management. Finally, we discuss the impact of current technological approaches on the requirements for quality assurance as well as future technological developments.
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Affiliation(s)
- Marianne Camille Aznar
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
| | - Samantha Warren
- Hall Edwards Radiotherapy Group, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mischa Hoogeman
- MC-Daniel den Hoed Cancer Center, Erasmus University, Rotterdam, Netherlands
| | - Mirjana Josipovic
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark; Department of Oncology, Section for Radiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Chiu TD, Parsons D, Zhang Y, Hrycushko B, Zhao B, Chopra R, Kim N, Spangler A, Rahimi A, Timmerman R, Jiang SB, Lu W, Gu X. Prototype volumetric ultrasound tomography image guidance system for prone stereotactic partial breast irradiation: proof-of-concept. Phys Med Biol 2018; 63:055004. [PMID: 29405123 DOI: 10.1088/1361-6560/aaad1f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Accurate dose delivery in stereotactic partial breast irradiation (S-PBI) is challenging because of the target position uncertainty caused by breast deformation, the target volume changes caused by lumpectomy cavity shrinkage, and the target delineation uncertainty on simulation computed tomography (CT) images caused by poor soft tissue contrast. We have developed a volumetric ultrasound tomography (UST) image guidance system for prone position S-PBI. The system is composed of a novel 3D printed rotation water tank, a patient-specific resin breast immobilization cup, and a 1D array ultrasound transducer. Coronal 2D US images were acquired in 5° increments over a 360° range, and planes were acquired every 2 mm in elevation. A super-compounding technique was used to reconstruct the image volume. The image quality of UST was evaluated with a BB-1 breast phantom and BioZorb surgical marker, and the results revealed that UST offered better soft tissue contrast than CT and similar image quality to MR. In the evaluated plane, the size and location of five embedded objects were measured and compared to MR, which is considered as the ground truth. Objects' diameters and the distances between objects in UST differ by approximately 1 to 2 mm from those in MR, which showed that UST offers the image quality required for S-PBI. In future work we will develop a robotic system that will be ultimately implemented in the clinic.
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Affiliation(s)
- Tsuicheng D Chiu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America. Tsuicheng Chiu and David Parsons contributed equally to this study
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Weder W, Moghanaki D, Stiles B, Siva S, Rocco G. The great debate flashes: surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Eur J Cardiothorac Surg 2017; 53:295-305. [DOI: 10.1093/ejcts/ezx410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/25/2022] Open
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Moghanaki D, Simone CB, Rimner A, Karas TZ, Donington J, Shirvani SM, Daly M, Videtic GM, Movsas B. The value of collaboration between thoracic surgeons and radiation oncologists while awaiting evidence in operable stage i non-small cell lung cancer. J Thorac Cardiovasc Surg 2017; 155:429-431. [PMID: 29245205 DOI: 10.1016/j.jtcvs.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/20/2017] [Accepted: 09/02/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, Va
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland, Baltimore, Md
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tomer Z Karas
- Department of Cardiothoracic Surgery, Miami VA Healthcare System, Miami, Fla
| | - Jessica Donington
- Department of Cardiothoracic Surgery, New York University, New York, NY
| | - Shervin M Shirvani
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Phoenix, Ariz
| | - Megan Daly
- Department of Radiation Oncology, University of California, Davis, Sacramento, Calif
| | | | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Mich
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Abstract
Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is a technique of external beam radiation that delivers precisely targeted, ablative doses to extracranial sites. It has become an integral component of the management of early-stage non-small cell lung cancer (NSCLC). In this review, we discuss the technology and techniques used in treatment planning and delivery, the efficacy and toxicity of SBRT for medically inoperable early-stage NSCLC, and the preliminary investigations into the role of SBRT for operable early-stage NSCLC.
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Awano N, Ikushima S, Izumo T, Tone M, Fukuda K, Miyamoto S, Bae Y, Kumasaka T, Terada Y, Furuhata Y, Nomura R, Sato K. Efficacy and safety of stereotactic body radiotherapy using CyberKnife in Stage I primary lung tumor. Jpn J Clin Oncol 2017; 47:969-975. [DOI: 10.1093/jjco/hyx100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/27/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center
| | - Soichiro Ikushima
- Department of Respiratory Medicine, Japanese Red Cross Medical Center
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center
| | - Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center
| | - Kensuke Fukuda
- Department of Respiratory Medicine, Japanese Red Cross Medical Center
| | - Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center
| | - Yuan Bae
- Department of Pathology, Japanese Red Cross Medical Center
| | | | - Yuriko Terada
- Department of Thoracic Surgery, Japanese Red Cross Medical Center
| | | | - Ryutaro Nomura
- CyberKnife Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kengo Sato
- CyberKnife Center, Japanese Red Cross Medical Center, Tokyo, Japan
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Zhou C, Bennion N, Ma R, Liang X, Wang S, Zvolanek K, Hyun M, Li X, Zhou S, Zhen W, Lin C, Wahl A, Zheng D. A comprehensive dosimetric study on switching from a Type-B to a Type-C dose algorithm for modern lung SBRT. Radiat Oncol 2017; 12:80. [PMID: 28476138 PMCID: PMC5420128 DOI: 10.1186/s13014-017-0816-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/01/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Type-C dose algorithms provide more accurate dosimetry for lung SBRT treatment planning. However, because current dosimetric protocols were developed based on conventional algorithms, its applicability for the new generation algorithms needs to be determined. Previous studies on this issue used small sample sizes and reached discordant conclusions. Our study assessed dose calculation of a Type-C algorithm with current dosimetric protocols in a large patient cohort, in order to demonstrate the dosimetric impacts and necessary treatment planning steps of switching from a Type-B to a Type-C dose algorithm for lung SBRT planning. METHODS Fifty-two lung SBRT patients were included, each planned using coplanar VMAT arcs, normalized to D95% = prescription dose using a Type-B algorithm. These were compared against three Type-C plans: re-calculated plans (identical plan parameters), re-normalized plans (D95% = prescription dose), and re-optimized plans. Dosimetric endpoints were extracted and compared among the four plans, including RTOG dosimetric criteria: (R100%, R50%, D2cm, V105%, and lung V20), PTV Dmin, Dmax, Dmean, V% and D90%, PTV coverage (V100%), homogeneity index (HI), and Paddick conformity index (PCI). RESULTS Re-calculated Type-C plans resulted in decreased PTV Dmin with a mean difference of 5.2% and increased Dmax with a mean difference of 3.1%, similar or improved RTOG dose compliance, but compromised PTV coverage (mean D95% and V100% reduction of 2.5 and 8.1%, respectively). Seven plans had >5% D95% reduction (maximum reduction = 16.7%), and 18 plans had >5% V100% reduction (maximum reduction = 60.0%). Re-normalized Type-C plans restored target coverage, but yielded degraded plan conformity (average PCI reduction 4.0%), and RTOG dosimetric criteria deviation worsened in 11 plans, in R50%, D2cm, and R100%. Except for one case, re-optimized Type-C plans restored RTOG compliance achieved by the original Type-B plans, resulting in similar dosimetric values but slightly higher target dose heterogeneity (mean HI increase = 13.2%). CONCLUSIONS Type-B SBRT lung plans considerably overestimate target coverage for some patients, necessitating Type-C re-normalization or re-optimization. Current RTOG dosimetric criteria appear to remain appropriate.
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Affiliation(s)
- Christina Zhou
- School of Biological Sciences, University of Chicago, Chicago, IL, USA
| | - Nathan Bennion
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Rongtao Ma
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Xiaoying Liang
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Kristina Zvolanek
- Department of Biological Systems Engineering, University of Nebraska Lincoln, Lincoln, NE, USA
| | - Megan Hyun
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Xiaobo Li
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA.,Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Sumin Zhou
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Andrew Wahl
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE, 68198, USA.
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Eriguchi T, Takeda A, Sanuki N, Tsurugai Y, Aoki Y, Oku Y, Hara Y, Akiba T, Shigematsu N. Stereotactic body radiotherapy for operable early-stage non-small cell lung cancer. Lung Cancer 2017; 109:62-67. [PMID: 28577952 DOI: 10.1016/j.lungcan.2017.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze outcomes of stereotactic body radiotherapy (SBRT) for operable patients with early-stage non-small cell lung cancer (NSCLC) and to evaluate factors associated with outcomes. METHODS We retrospectively analyzed operable patients with NSCLC, staged as cT1-2N0M0, treated with SBRT between 2006 and 2015. Both biopsy-proven and clinically diagnosed NSCLC were included. Local control and survival rates were calculated and compared between subsets of patients. We investigated factors associated with outcomes. RESULTS We identified 88 operable patients among 661 patients with cT1-2N0M0 NSCLC. The median age was 79 years (range: 55-88). The median follow-up time after SBRT was 40 months (range: 4-121). Fifty-nine patients had been pathologically diagnosed and the other 29 had been clinically diagnosed as having NSCLC. Local control, cause-specific survival (CSS) and overall survival (OS) at 3 years were 91%, 97% and 90% for T1, and 100%, 82% and 74% for T2, respectively. The CSS and OS at 3 years were 100% and 100% for GGO and 83% and 59% for solid tumors, respectively (p=0.005). On univariate analysis, age and T stage were significantly associated with CSS, and age, the Charlson Comorbidity Index (CCI), and opacity were significantly associated with OS. On multivariate analysis, age and CCI were significantly associated with OS. As for toxicities, Grades 0, 1, 2 and 3 radiation pneumonitis occurred in 37.5%, 47.7%, 13.6% and 1.1% of patients, respectively. No Grade 4 or 5 radiation pneumonitis occurred, and no other toxicities of Grade 2 or above were observed. CONCLUSION Outcomes of SBRT for operable early stage NSCLC were as good as previous SBRT and surgery studies. Further investigation for selecting good SBRT candidates is warranted in high-risk operable patients.
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Affiliation(s)
- Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan; Department of Radiation Oncology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-0016, Japan.
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan.
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan.
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan.
| | - Yousuke Aoki
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan.
| | - Yohei Oku
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan.
| | - Yu Hara
- Department of Respiratory Medicine, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura, Kanagawa 247-0056, Japan; Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Japan.
| | - Takeshi Akiba
- Department of Radiation Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Naoyuki Shigematsu
- Department of Radiation Oncology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-0016, Japan.
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Rajan Radha R, Chandrasekharan G. Pulmonary injury associated with radiation therapy - Assessment, complications and therapeutic targets. Biomed Pharmacother 2017; 89:1092-1104. [PMID: 28298070 DOI: 10.1016/j.biopha.2017.02.106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022] Open
Abstract
Pulmonary injury is more common in patients undergoing radiation therapy for lungs and other thoracic malignancies. Recently with the use of most-advanced technologies powerful doses of radiation can be delivered directly to tumor site with exquisite precision. The awareness of technical and clinical parameters that influence the chance of radiation induced lung injury is important to guide patient selection and toxicity minimization strategies. At the cellular level, radiation activates free radical production, leading to DNA damage, apoptosis, cell cycle changes, and reduced cell survival. Preclinical research shows the potential for therapies targeting transforming growth factor-β (TGF-B), Toll like receptor (TLRs), Tumour necrosis factor-alpha (TNF-alpha), Interferon gamma (IFN-γ) and so on that may restore lung function. At present Amifostine (WR-2721) is the only approved broad spectrum radioprotector in use for patients undergoing radiation therapy. Newer techniques also offer the opportunity to identify new biomarkers and new targets for interventions to prevent or ameliorate these late effects of lung damage.
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Affiliation(s)
- Rasmi Rajan Radha
- Laboratory of Immunopharmacology and Experimental Therapeutics, Division of Cancer Research, Regional Cancer Centre, Trivandrum 695 011, Kerala, India
| | - Guruvayoorappan Chandrasekharan
- Laboratory of Immunopharmacology and Experimental Therapeutics, Division of Cancer Research, Regional Cancer Centre, Trivandrum 695 011, Kerala, India.
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Adenovirus-mediated Foxp3 expression in lung epithelial cells ameliorates acute radiation-induced pneumonitis in mice. Gene Ther 2016; 24:104-112. [PMID: 27996966 DOI: 10.1038/gt.2016.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/11/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022]
Abstract
Forkhead transcription factor 3 (Foxp3) has a critical role in regulatory T cells (Treg). There are an increasing number of researches concerning the functions of Foxp3 in other cells, including lung epithelial cells besides Treg. However, the roles of Foxp3 in lung epithelial cells remain poorly understood. To examine the potential therapeutic benefits of Foxp3 for lung inflammation, this study investigates the effect of adenovirus-mediated Foxp3 overexpression in a radiation-induced lung damage model. Foxp3-EGFP expressing adenovirus was administered by intratracheal injection three times over 14 days after focal X-ray irradiation. To evaluate effects of Foxp3 overexpression in radiation-induced lung inflammation, immune cell profiles of bronchoalveolar lavage (BAL) fluid were analyzed. Foxp3 gene-delivered mice showed significant inhibition of immune cell infiltration, such as eosinophils, lymphocytes, macrophages and neutrophils in BAL fluid. Histopathological analysis also showed that Foxp3 overexpression inhibits inflammatory cell recruitment and collagen deposition in lung tissues. In addition, expression of inflammatory and fibrosis-related genes was decreased in the Foxp3 expression adenovirus-infected group. These results suggest that Foxp3 expression in lungs holds considerable therapeutic potential for attenuating inflammation and fibrosis in radiation-induced lung injury.
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Guckenberger M. SBRT versus lobectomy in stage I NSCLC: knowns, unknowns and its interpretation. J Thorac Dis 2016; 8:2305-2309. [PMID: 27746961 DOI: 10.21037/jtd.2016.08.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, CH - 8091 Zurich, Switzerland
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Hatayama Y, Nakamura T, Suzuki M, Azami Y, Ono T, Yabuuchi T, Hayashi Y, Kimura K, Hirose K, Wada H, Hareyama M, Kikuchi Y, Takai Y. Clinical Outcomes and Prognostic Factors of High-Dose Proton Beam Therapy for Peripheral Stage I Non-Small-Cell Lung Cancer. Clin Lung Cancer 2016; 17:427-432. [DOI: 10.1016/j.cllc.2015.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 12/25/2022]
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Bhandari RP, Stanford JD, Packianathan S, Duggar WN, Kanakamedala MR, Zhang X, Giri SP, Kumar PP, Harrell LM, Mangana SH, Yang C, Vijayakumar S. Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Retrospective, Single-Center Study of 55 Patients. Oncology 2016; 91:194-204. [PMID: 27427761 DOI: 10.1159/000447540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) is an effective treatment for patients with early-stage non-small cell lung cancer (NSCLC) who are not surgical candidates or who refuse surgical management. In this study, we report on our clinical outcomes and toxicity in the treatment of early-stage NSCLC with SBRT. METHODS AND MATERIALS Fifty-five patients with 59 T1-2N0M0 NSCLC lesions were treated at our institution between December 2009 and August 2014. The majority of the patients [38 (69%)] were treated with 50 Gy in 5 fractions, 7 patients (13%) with 48 Gy in 4 fractions, 8 patients (14%) with 60 Gy in 3 fractions, 1 patient (2%) with 62.5 Gy in 10 fractions, and 1 patient (2%) with 54 Gy in 3 fractions. Tumor response was evaluated using RECIST 1.1, and toxicity was graded using the CTCAE (Common Terminology Criteria for Adverse Events) version 3.0. The primary endpoints of this retrospective review included rates of overall survival, disease-free and progression-free survival, local failure, regional failure, and distant failure. A secondary endpoint included radiation-related toxicities. RESULTS The median follow-up was 23.8 months (range 1.1-57.6). The 3-year local control, progression-free survival, and overall survival rates were 91, 55, and 71%, respectively. The median age at diagnosis was 67.9 years (range 51.4-87.1). There were a total of 54 T1N0 tumors (92%) and 5 T2N0 lesions (8%). Adenocarcinoma was the most common pathology, comprising 54% of the lesions. A total of 16 of the patients (29%) failed. Among these, 5 local (9%), 14 regional (25%), and 4 distant failures (7%) were observed. On follow-up, one patient had grade 2 and another had grade 5 pneumonitis. Three patients experienced grade 2 chest wall tenderness. Two patients had grade 1 rib fractures, one of which could not be discerned from radiation-induced toxicity versus a traumatic fall. CONCLUSION The University of Mississippi Medical Center SBRT experience has shown that SBRT provides satisfactory local control and overall survival rates with minimal toxicity in early-stage NSCLC patients.
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Affiliation(s)
- Rahul P Bhandari
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Miss., USA
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Zheng D, Zhang Q, Liang X, Zhu X, Verma V, Wang S, Zhou S. Effect of the normalized prescription isodose line on the magnitude of Monte Carlo vs. pencil beam target dose differences for lung stereotactic body radiotherapy. J Appl Clin Med Phys 2016; 17:48-58. [PMID: 27455476 PMCID: PMC5690053 DOI: 10.1120/jacmp.v17i4.5965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/15/2016] [Accepted: 02/14/2016] [Indexed: 12/26/2022] Open
Abstract
In lung stereotactic body radiotherapy (SBRT) cases, the pencil beam (PB) dose calculation algorithm is known to overestimate target dose as compared to the more accurate Monte Carlo (MC) algorithm. We investigated whether changing the normalized prescription isodose line affected the magnitude of MC vs. PB target dose differences. Forty‐eight patient plans and twenty virtual‐tumor phantom plans were studied. For patient plans, four alternative plans prescribed to 60%, 70%, 80%, and 90% isodose lines were each created for 12 patients who previously received lung SBRT treatments. Using 6 MV dynamic conformal arcs, the plans were individually optimized to achieve similar dose coverage and conformity for all plans of the same patient, albeit at the different prescription levels. These plans, having used a PB algorithm, were all recalculated with MC to compare the target dose differences. The relative MC vs. PB target dose variations were investigated by comparing PTV D95, Dmean, and D5 loss at the four prescription levels. The MC‐to‐PB ratio of the plan heterogeneity index (HI) was also evaluated and compared among different isodose levels. To definitively demonstrate the cause of the isodose line dependence, a simulated phantom study was conducted using simple, spherical virtual tumors planned with uniform block margins. The tumor size and beam energy were also altered in the phantom study to investigate the interplay between these confounding factors and the isodose line effect. The magnitude of the target dose overestimation by PB was greater for higher prescription isodose levels. The MC vs. PB reduction in the target dose coverage indices, D95 and V100 of PTV, were found to monotonically increase with increasing isodose lines from 60% to 90%, resulting in more pronounced target dose coverage deficiency at higher isodose prescription levels. No isodose level‐dependent trend was observed for the dose errors in the target mean or high dose indices, Dmean or D5. The phantom study demonstrated that the observed isodose level dependence was caused by different beam margins used for the different isodose levels: a higher prescription line required a larger beam margin, leading to more low‐density lung tissues in the field and, therefore, larger dose errors at the target periphery (when calculated with PB). The phantom study also found that the observed isodose level dependence was greater for smaller targets and for higher beam energies. We hereby characterized the effect of normalized prescription isodose line on magnitude of PTV dose coverage as calculated by MC vs. PB. When comparing reported MC dose deficiency values for different patients, the selection of prescription isodose line should be considered in addition to other factors known to affect differences in calculated doses between various algorithms. PACS number(s): 87.55.kh, 87.55.dk, 87.55.de
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Aoki M, Hirose K, Sato M, Akimoto H, Kawaguchi H, Hatayama Y, Fujioka I, Tanaka M, Ono S, Takai Y. Prognostic impact of average iodine density assessed by dual-energy spectral imaging for predicting lung tumor recurrence after stereotactic body radiotherapy. JOURNAL OF RADIATION RESEARCH 2016; 57:381-6. [PMID: 26826198 PMCID: PMC4973636 DOI: 10.1093/jrr/rrv100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to investigate the prognostic significance of average iodine density as assessed by dual-energy computed tomography (DE-CT) for lung tumors treated with stereotactic body radiotherapy (SBRT). From March 2011 to August 2014, 93 medically inoperable patients with 74 primary lung cancers and 19 lung metastases underwent DE-CT prior to SBRT of a total dose of 45-60 Gy in 5-10 fractions. Of these 93 patients, nine patients had two lung tumors. Thus, 102 lung tumors were included in this study. DE-CT was performed for pretreatment evaluation. Regions of interest were set for the entire tumor, and average iodine density was obtained using a dedicated imaging software and evaluated with regard to local control. The median follow-up period was 23.4 months (range, 1.5-54.5 months). The median value of the average iodine density was 1.86 mg/cm(3) (range, 0.40-9.27 mg/cm(3)). Two-year local control rates for the high and low average iodine density groups divided by the median value of the average iodine density were 96.9% and 75.7% (P = 0.006), respectively. Tumors with lower average iodine density showed a worse prognosis, possibly reflecting a hypoxic cell population in the tumor. The average iodine density exhibited a significant impact on local control. Our preliminary results indicate that iodine density evaluated using dual-energy spectral CT may be a useful, noninvasive and quantitative assessment of radio-resistance caused by presumably hypoxic cell populations in tumors.
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Affiliation(s)
- Masahiko Aoki
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Katsumi Hirose
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, 963-8052 Koriyama, Fukushima, Japan
| | - Mariko Sato
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Hiroyoshi Akimoto
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Hideo Kawaguchi
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Yoshiomi Hatayama
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Ichitaro Fujioka
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Mitsuki Tanaka
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Shuichi Ono
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Yoshihiro Takai
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
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Shi A, Zhu G. [Current Status of Stereotactic Ablative Radiotherapy (SABR) for Early-stage
Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:389-93. [PMID: 27335303 PMCID: PMC6015206 DOI: 10.3779/j.issn.1009-3419.2016.06.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
目前比较立体定向消融放疗(stereotactic ablative radiotherapy, SABR)与手术治疗早期非小细胞肺癌(non-small cell lung cancer, NSCLC)的随机研究证据尚不多,高水平的循证医学证据更是缺乏。尽管STARS和ROSEL两项随机研究结果荟萃分析显示SABR较手术耐受性更好,生存不劣于手术,但是目前仍仅推荐拒绝手术或不可手术的早期NSCLC首选SABR,期待着正在进行的随机研究VALOR(Veterans Affairs Lung Cancer Surgery or Stereotactic Radiotherapy in the US)和SABRTooth(SABRTooth study in the United Kingdom)的结果。许多回顾性的研究和病例对照研究显示了SABR治疗的安全性和有效性(局部控制率达90%以上,5年生存率达70%),但是由于肿瘤分期定义、如何决定可否手术及手术患者采用手术方式(开胸或胸腔镜辅助)等不同,很难比较SABR和手术的优劣,尽管大部分结论是两种方法疗效相似,但难以成为循证医学证据,因此争论热点是哪一种方法更安全、创伤更小。本文将就以上争论热点进行述评。
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Affiliation(s)
- Anhui Shi
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Guangying Zhu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
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Ding GX, Duggan DM, Lu B, Hallahan DE, Cmelak A, Malcolm A, Newton J, Deeley M, Coffey CW. Impact of inhomogeneity corrections on dose coverage in the treatment of lung cancer using stereotactic body radiation therapy. Med Phys 2016; 34:2985-94. [PMID: 17822007 DOI: 10.1118/1.2745923] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study is to assess the real target dose coverage when radiation treatments were delivered to lung cancer patients based on treatment planning according to the RTOG-0236 Protocol. We compare calculated dosimetric results between the more accurate anisotropic analytical algorithm (AAA) and the pencil beam algorithm for stereotactic body radiation therapy treatment planning in lung cancer. Ten patients with non-small cell lung cancer were given 60 Gy in three fractions using 6 and 10 MV beams with 8-10 fields. The patients were chosen in accordance with the lung RTOG-0236 protocol. The dose calculations were performed using the pencil beam algorithm with no heterogeneity corrections (PB-NC) and then recalculated with the pencil beam with modified Batho heterogeneity corrections (PB-MB) and the AAA using an identical beam setup and monitor units. The differences in calculated dose to 95% or 99% of the PTV, between using the PB-NC and the AAA, were within 10% of prescribed dose (60 Gy). However, the minimum dose to 95% and 99% of PTV calculated using the PB-MB were consistently overestimated by up to 40% and 36% of the prescribed dose, respectively, compared to that calculated by the AAA. Using the AAA as reference, the calculated maximum doses were underestimated by up to 27% using the PB-NC and overestimated by 19% using the PB-MB. The calculations of dose to lung from PB-NC generally agree with that of AAA except in the small high-dose region where PB-NC underestimates. The calculated dose distributions near the interface using the AAA agree with those from Monte Carlo calculations as well as measured values. This study indicates that the real minimum PTV dose coverage cannot be guaranteed when the PB-NC is used to calculate the monitor unit settings in dose prescriptions.
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Affiliation(s)
- George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Vanderbilt-Ingram Cancer Center, B-902, TVC, Preston Research Building, Nashville, Tennessee 37232-5671, USA.
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Moghanaki D, Chang JY. Is surgery still the optimal treatment for stage I non-small cell lung cancer? Transl Lung Cancer Res 2016; 5:183-9. [PMID: 27183993 PMCID: PMC4858582 DOI: 10.21037/tlcr.2016.04.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/31/2016] [Indexed: 12/25/2022]
Abstract
There is debate about what is the optimal treatment for operable stage I non-small cell lung cancer (NSCLC). Although surgery has been the standard of care for centuries, recent retrospective and prospective randomized studies indicated that stereotactic ablative radiotherapy (SABR) could be an option for this group of patients with similar survival and less toxicities. However, to change the standard of care, more studies are needed and participating ongoing larger randomized studies is the best approach to resolve this controversy.
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Siva S, Ball D. Curing Operable Stage I Non-Small Cell Lung Cancer With Stereotactic Ablative Body Radiotherapy: The Force Awakens. Oncologist 2016; 21:393-8. [PMID: 26984447 PMCID: PMC4828125 DOI: 10.1634/theoncologist.2015-0477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/02/2016] [Indexed: 12/25/2022] Open
Abstract
In 2016, surgery is the standard of care for peripheral stage I non-small cell lung cancer. However, recent thought-provoking randomized evidence suggests stereotactic ablative body radiotherapy (SABR) has survival outcomes similar to those of surgery. Albeit limited, patient-reported outcomes and quality of life suggest that SABR compares favorably to surgery because it is noninvasive and associated with relatively few treatment-related complications. This article explores the current scientific landscape of surgery and SABR in this patient cohort.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Aoki M, Hatayama Y, Kawaguchi H, Hirose K, Sato M, Akimoto H, Fujioka I, Ono S, Tsushima E, Takai Y. Clinical outcome of stereotactic body radiotherapy for primary and oligometastatic lung tumors: a single institutional study with almost uniform dose with different five treatment schedules. Radiat Oncol 2016; 11:5. [PMID: 26791943 PMCID: PMC4719671 DOI: 10.1186/s13014-016-0581-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/04/2016] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate clinical outcomes of stereotactic body radiotherapy (SBRT) for localized primary and oligometastatic lung tumors by assessing efficacy and safety of 5 regimens of varying fraction size and number. Methods One-hundred patients with primary lung cancer (n = 69) or oligometastatic lung tumors (n = 31), who underwent SBRT between May 2003 and August 2010, were included. The median age was 75 years (range, 45–88). Of them, 98 were judged to have medically inoperable disease, predominantly due to chronic illness or advanced age. SBRT was performed using 3 coplanar and 3 non-coplanar fixed beams with a standard linear accelerator. Fraction sizes were escalated by 1 Gy, and number of fractions given was decreased by 1 for every 20 included patients. Total target doses were between 50 and 56 Gy, administered as 5–9 fractions. The prescribed dose was defined at the isocenter, and median overall treatment duration was 10 days (range, 5–22). Results The median follow-up was 51.1 months for survivors. The 3-year local recurrence rates for primary lung cancer and oligometastasis was 6 % and 3 %, respectively. The 3-year local recurrence rates for tumor sizes ≤3 cm and >3 cm were 3 % and 14 %, respectively (p = 0.124). Additionally, other factors (fraction size, total target dose, and BED10) were not significant predictors of local control. Radiation pneumonia (≥ grade 2) was observed in 2 patients. Radiation-induced rib fractures were observed in 22 patients. Other late adverse events of greater than grade 2 were not observed. Conclusion Within this dataset, we did not observe a dose response in BED10 values between 86.4 and 102.6 Gy. SBRT with doses between 50 and 56 Gy, administered over 5–9 fractions achieved acceptable tumor control without severe complications.
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Affiliation(s)
- Masahiko Aoki
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Yoshiomi Hatayama
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Hideo Kawaguchi
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Katsumi Hirose
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, 963-8052, Koriyama, Fukushima, Japan.
| | - Mariko Sato
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Hiroyoshi Akimoto
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Ichitaro Fujioka
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Shuichi Ono
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
| | - Eiki Tsushima
- Department of Physical Therapy, Graduate School of Health Sciences, Hirosaki University, 66-1 Hon-cho, 036-8564, Hirosaki, Aomori, Japan.
| | - Yoshihiro Takai
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan.
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