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Rao X, Liu H, Zhang Y, Xie Y, Wang G, Zhang S, Wu G, Wang Y, Zhou R. The relationship of body mass index to setup errors, dosimetric parameters and incidence of radiation pneumonitis in non-small cell lung cancer patients undergoing intensity-modulated radiation therapy: a single-center observational study. Int J Radiat Biol 2024; 100:248-255. [PMID: 37747796 DOI: 10.1080/09553002.2023.2261549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The relationship among body mass index (BMI), setup error and radiation pneumonitis is not clearly illustrated. OBJECTIVE The present study aimed to investigate the role of BMI in non-small cell lung cancer (NSCLC) patients' radiation treatment, focusing on its relationship with setup error of patient positioning, the dosimetric parameters of intensity-modulated radiation therapy (IMRT) and the incidence of radiation pneumonitis. METHODS This prospective observational study included 523 cases of NSCLC patients during 2020-2022. Patients were divided into different groups by different BMI. The setup error was obtained by cone beam CT (CBCT) at three positions, lateral (LAT), longitudinal (LNG) and vertical (VRT). IMRT dosimetric parameters of V5, V20, and mean dose were collected. RESULTS Patients with BMI ≥28 kg/m2 showed significantly higher absolute values of LAT, LNG and VRT, higher V5, V20, mean dose, as well as higher total incidence of radiation pneumonitis and grade III radiation pneumonitis compared with patients with BMI <24 kg/m2 or 24-28 kg/m2. Spearman's analysis demonstrated that the absolute values of LAT, LNG and VRT were positively correlated with BMI, and positive correlation existed among BMI, dosimetric parameters and setup errors. ROC curves showed that LAT in setup errors and V5 in dosimetric parameters had the best diagnostic value for prediction of radiation pneumonitis. Only BMI, LAT, V5 and V20 were the independent risk factors for radiation pneumonitis. CONCLUSIONS Setup error caused by higher BMI might be associated with the dosimetric parameters, as well as the incidence of radiation pneumonitis in NSCLC patients.
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Affiliation(s)
- Xinrui Rao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Hongyuan Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Yuewen Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Yaqiong Xie
- Oncology Department, Jianli People's Hospital, Jingzhou, PR China
| | - Geng Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Ye Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Rui Zhou
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Fallone CJ, Summers C, Cwajna W, Syme A. Assessing the impact of intrafraction motion correction on PTV margins and target and OAR dosimetry for single-fraction free-breathing lung stereotactic body radiation therapy. Med Dosim 2023:S0958-3947(23)00041-9. [PMID: 37164788 DOI: 10.1016/j.meddos.2023.04.002] [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: 11/25/2022] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
The objective of this research is to investigate intrafraction motion correction on planning target volume (PTV) margin requirements and target and organ-at-risk (OAR) dosimetry in single-fraction lung stereotactic body radiation therapy (SBRT). Sixteen patients (15 with upper lobe lesions, 1 with a middle lobe lesion) were treated with single-fraction lung SBRT. Cone-beam computed tomography (CBCT) images were acquired before the treatment, between the arcs, and after the delivery of the treatment fraction. Shifts from the reference images were recorded in anterior-posterior (AP), superior-inferior (SI), and lateral (LAT) dimensions. The deviations from the reference image were calculated for 3 clinical scenarios: not applying intratreatment couch shifts and not correcting for pretreatment deviations < 3 mm ( scenario 1), not applying intratreatment couch shifts and correcting for pretreatment deviations < 3 mm ( scenario 2), and applying all pre- and intratreatment couch shifts (scenario 3). PTV margins were determined using the van Herk formalism for each scenario and maximum and average deviations were assessed. The clinical scenarios were modelled in the treatment planning system based on each patient dataset to assess target and OAR dosimetry. Calculated lower-bound PTV margins in the AP, SI, and LAT dimensions were [4.6, 3.5, 2.3] mm in scenario 1, [4.6, 2.4, 2.2] mm in scenario 2, and [1.7, 1.2, 1.0] mm in scenario 3. The margins are lower bounds because they do not include contributions from nonmotion related errors. Average and maximum intrafraction deviations were larger in the AP dimension compared to the SI and LAT dimensions for all scenarios. A unidimensional movement (several mm) in the negative AP dimension was observed in clinical scenarios 1 and 2 but not scenario 3. Average intrafraction deviation vectors were 1.2, 1.1, and 0.3 mm for scenarios 1, 2, and 3, respectively. Modelled clinical scenarios revealed that using scenario 3 yields significantly fewer treatment plan objective failures compared to scenarios 1 and 2 using a Wilcoxon signed-rank test. Intratreatment motion correction between each arc may enable reductions PTV margin requirements. It may also compensate for unidimensional negative AP movement, and improve target and OAR dosimetry.
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Affiliation(s)
- Clara J Fallone
- Department of Medical Physics, Nova Scotia Health (NSH), Halifax, Nova Scotia, B3H2Y9 Canada; Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, B3H2Y9 Canada.
| | - Clare Summers
- Department of Radiation Oncology, Nova Scotia Health, Halifax, Nova Scotia, B3H2Y9 Canada
| | - Wladyslawa Cwajna
- Department of Radiation Oncology, Nova Scotia Health, Halifax, Nova Scotia, B3H2Y9 Canada; Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, B3H2Y9 Canada
| | - Alasdair Syme
- Department of Medical Physics, Nova Scotia Health (NSH), Halifax, Nova Scotia, B3H2Y9 Canada; Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, B3H2Y9 Canada; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, B3H2Y9 Canada
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Sammer M, Dombrowsky AC, Schauer J, Oleksenko K, Bicher S, Schwarz B, Rudigkeit S, Matejka N, Reindl J, Bartzsch S, Blutke A, Feuchtinger A, Combs SE, Dollinger G, Schmid TE. Normal Tissue Response of Combined Temporal and Spatial Fractionation in Proton Minibeam Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 109:76-83. [PMID: 32805301 DOI: 10.1016/j.ijrobp.2020.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Proton minibeam radiation therapy, a spatial fractionation concept, widens the therapeutic window. By reducing normal tissue toxicities, it allows a temporally fractionated regime with high daily doses. However, an array shift between daily fractions can affect the tissue-sparing effect by decreasing the total peak-to-valley dose ratio. Therefore, combining temporal fractions with spatial fractionation raises questions about the impact of daily applied dose modulations, reirradiation accuracies, and total dose modulations. METHODS AND MATERIALS Healthy mouse ear pinnae were irradiated with 4 daily fractions of 30 Gy mean dose, applying proton pencil minibeams (pMB) of Gaussian σ = 222 μm in 3 different schemes: a 16 pMB array with a center-to-center distance of 1.8 mm irradiated the same position in all sessions (FS1) or was shifted by 0.9 mm to never hit the previously irradiated tissue in each session (FS2), or a 64 pMB array with a center-to-center distance of 0.9 mm irradiated the same position in all sessions (FS3), resulting in the same total dose distribution as FS2. Reirradiation positioning and its accuracy were obtained from image guidance using the unique vessel structure of ears. Acute toxicities (swelling, erythema, and desquamation) were evaluated for 153 days after the first fraction. Late toxicities (fibrous tissue, inflammation) were analyzed on day 153. RESULTS Reirradiation of highly dose-modulated arrays at a positioning accuracy of 110 ± 52 μm induced the least severe acute and late toxicities. A shift of the same array in FS2 led to significantly inducted acute toxicities, a higher otitis score, and a slight increase in fibrous tissue. FS3 led to the strongest increase in acute and late toxicities. CONCLUSIONS The highest normal-tissue sparing is achieved after accurate reirradiation of a highly dose modulated pMB array, although high positioning accuracies are challenging in a clinical environment. Nevertheless, the same integral dose applied in highly dose-modulated fractions is superior to low daily dose-modulated fractions.
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Affiliation(s)
- Matthias Sammer
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Annique C Dombrowsky
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany.
| | - Jannis Schauer
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Kateryna Oleksenko
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Sandra Bicher
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Benjamin Schwarz
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Sarah Rudigkeit
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Nicole Matejka
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Judith Reindl
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Stefan Bartzsch
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Andreas Blutke
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Annette Feuchtinger
- Research Unit Analytical Pathology, Helmholtz Zentrum München GmbH, Neuherberg, Germany
| | - Stephanie E Combs
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Günther Dollinger
- Institute for Applied Physics and Metrology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Thomas E Schmid
- Institute of Radiation Medicine, Helmholtz Zentrum München GmbH, Neuherberg, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany
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