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Mishra A, Pathak R, Mittal KK, Srivastava AK, Dayashankar MS, Mishra SP, Singh SK. Efficacy of the collapsed cone algorithm calculated radiotherapy plans in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT): A comparative dosimetric study in tumors of thorax. J Cancer Res Ther 2024; 20:383-388. [PMID: 38554350 DOI: 10.4103/jcrt.jcrt_2171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 04/01/2024]
Abstract
AIM In this study, efficacy of collapsed cone algorithm-generated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) were evaluated for treatment of thoracic esophageal cancer. MATERIALS AND METHODS Ten previously treated patients with VMAT were considered for evaluation. The planning parameters were evaluated in terms of max dose, mean dose, Homogeneity Index, Conformity Index for planning target volume, and organ at risk doses. Total monitor unit, treatment time, and gamma passing index were also reported. RESULTS The target dose coverage of the VMAT and IMRT plans achieved the clinical dosimetric criteria for all ten patients in the evaluation. Under the condition of equivalent target dose distribution, the VMAT plan's Conformity Index, monitor unit, treatment time, and gamma passing index rate were superior than in the IMRT plan, and the result was statistically significant. CONCLUSION Collapsed cone algorithm-based VMAT can have a more effective and better approach for esophageal cancer than IMRT.
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Affiliation(s)
- Atul Mishra
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
- Department of Radiation Oncology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Ramji Pathak
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
- Department of Physics, D.A.V. Degree College, Lucknow, Uttar Pradesh, India
| | - Kailash Kumar Mittal
- Department of Radiation Oncology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Anoop Kumar Srivastava
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Maurya Surendrakumar Dayashankar
- Department of Applied Physics, Amity University Gwalior, Madhya Pradesh, India
- Department of Radiation Oncology, Shalby Hospitals Indore, Madhya Pradesh, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudesh Kumar Singh
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
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Hsu CX, Lin KH, Wang SY, Tsai WT, Chang CH, Tien HJ, Shueng PW, Wu TH, Mok GSP. Planning evaluation of a novel volume-based algorithm for personalized optimization of lung dose in VMAT for esophageal cancer. Sci Rep 2022; 12:2513. [PMID: 35169144 PMCID: PMC8847643 DOI: 10.1038/s41598-021-04571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Radiotherapy treatment planning (RTP) is time-consuming and labor-intensive since medical physicists must devise treatment plans carefully to reduce damage to tissues and organs for patients. Previously, we proposed the volume-based algorithm (VBA) method, providing optimal partial arcs (OPA) angle to achieve the low-dose volume of lungs in dynamic arc radiotherapy. This study aimed to implement the VBA for esophageal cancer (EC) patients and compare the lung dose and delivery time between full arcs (FA) without using VBA and OPA angle using VBA in volumetric modulated arc therapy (VMAT) plans. We retrospectively included 30 patients diagnosed with EC. RTP of each patient was replanned to 4 VMAT plans, including FA plans without (FA-C) and with (FA + C) dose constraints of OARs and OPA plans without (OPA-C) and with (OPA + C) dose constraints of OARs. The prescribed dose was 45 Gy. The OARs included the lungs, heart, and spinal cord. The dose distribution, dose-volume histogram, monitor units (MUs), delivery time, and gamma passing rates were analyzed. The results showed that the lung V5 and V10 in OPA + C plans were significantly lower than in FA + C plans (p < 0.05). No significant differences were noted in planning target volume (PTV) coverage, lung V15, lung V20, mean lung dose, heart V30, heart V40, mean heart dose, and maximal spinal cord dose between FA + C and OPA + C plans. The delivery time was significantly longer in FA + C plans than in OPA + C plans (237 vs. 192 s, p < 0.05). There were no significant differences between FA + C and OPA + C plans in gamma passing rates. We successfully applied the OPA angle based on the VBA to clinical EC patients and simplified the arc angle selection in RTP. The VBA could provide a personalized OPA angle for each patient and effectively reduce lung V5, V10, and delivery time in VMAT.
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Affiliation(s)
- Chen-Xiong Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Industrial Ph.D. Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Ta Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiu-Han Chang
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hui-Ju Tien
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, SAR, China
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Zhang Y, Jabbour SK, Zhang A, Liu B, Yue NJ, Biswal NC. Proton beam therapy can achieve lower vertebral bone marrow dose than photon beam therapy during chemoradiation therapy of esophageal cancer. Med Dosim 2021; 46:229-235. [PMID: 33454170 DOI: 10.1016/j.meddos.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/17/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023]
Abstract
Chemoradiation therapy plays an important role in both the neoadjuvant and definitive management of esophageal cancer (EC). Prior studies have suggested that advanced planning techniques can better spare organs at risk including the heart. Although multiple toxicities can result from esophageal radiotherapy, one less studied acute toxicity is that of myelosuppression, which can result, in part, from the combination of chemotherapy and incidental radiotherapy administration to the vertebral bodies (VBs), which abut the posterior aspect of the esophagus, especially in the lower thoracic esophagus. Traditionally, VB bone marrow doses are not accounted during EC radiation therapy planning. We sought to compare the doses to VBs between proton and photon radiation therapy as part of chemoradiation therapy for EC treatment. By reducing doses to the vertebrae, radiation therapy can decrease treatment-related myelosuppression, which can avoid delays or chemotherapy dose reductions in therapy, which likely affect long-term patient survival. Dose constraints are not routinely employed for bone marrow in radiation treatment planning. In our previous work, we identified thresholds to avoid grade ≥3 leukopenia, including VB V10Gy, VB V20Gy, and a mean VB dose (MVD) of 18.8 Gy. Herein we perform a retrospective dosimetric planning study comparing passive- or double-scattering proton beam therapy (PS-PBT), volumetric-modulated arc therapy (VMAT) (photon-based), and intensity-modulated radiation therapy (IMRT) (photon-based) in 25 patients with locally advanced EC who were treated originally with photon RT at our institution between 2011 and 2016. The aforementioned dose constraints were included in the retrospective planning process for PS-PBT, VMAT, and IMRT to determine the feasibility of achieving these VB constraints while maintaining reasonable target coverage and planned, consistent constraints to other organs at risk including lungs, spinal cord, and stomach. PS-PBT plans were found to achieve lower doses for VB V10Gy, V20Gy, and MVD than VMAT and static IMRT plans while achieving the same target coverage. PS-PBT resulted in lower organs at risk dosimetric parameters than the photon plans, with p < 0.0001. Student's paired t-test p-values in favor of proton therapy's ability to spare organs were as follows: for PS-PBT vs VMAT and PS-PBT vs IMRT in mean doses for lung, liver, and VB and VB V10Gy and VB V20Gy were all <0.001 (Bonferroni corrected α=0.017). One-way ANOVA found that VB doses (VB V10Gy, VB V20Gy, and MVD) were significantly lower for proton therapy (p < 0.006) among the 3 planning techniques.
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Affiliation(s)
- Yin Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Andrew Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Bo Liu
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Nrusingh C Biswal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Xu H, Lu J, Wang J, Fan J, Hu W. Implement a knowledge-based automated dose volume histogram prediction module in Pinnacle 3 treatment planning system for plan quality assurance and guidance. J Appl Clin Med Phys 2019; 20:134-140. [PMID: 31343821 PMCID: PMC6698760 DOI: 10.1002/acm2.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/18/2018] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose This work aims to develop a knowledge‐based automated dose volume histogram (DVH) prediction module that serves as a plan quality evaluation tool and treatment planning guidance in commercial Pinnacle3 treatment planning system (Philips Radiation Oncology Systems, Fitchburg, WI, USA). Methods The knowledge‐based automated DVH prediction module was developed with kernel density estimation (KDE) method and applied for Pinnacle3 treatment planning system. Treatment plan data from 20 esophageal cancer cases were used for creating a module to predict DVHs. Twenty additional esophageal clinical plans were evaluated on the developed module. Predicted DVHs were compared with manual ones. Differences between the predicted and achieved DVHs were analyzed. Results The plan evaluation module was successfully implemented in Pinnacle3 treatment planning system. Strong linear correlations were found between predicted and achieved DVH for organs at risk. Suboptimal treatment plan quality could be improved according to the predicted DVHs by the module. Conclusion The knowledge‐based automated DVH prediction module implemented in Pinnacle3 could be used to efficiently evaluate the treatment plan quality and as guidance for further plan optimization.
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Affiliation(s)
- Hao Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiayu Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiawei Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Shimizu H, Sasaki K, Ito M, Aoyama T, Tachibana H, Tomita N, Makita C, Tanaka H, Koide Y, Iwata T, Kodaira T. Impact of treatment planning using a structure block function on the target and organ doses related to patient movement in cervical esophageal cancer: A phantom study. J Appl Clin Med Phys 2019; 20:75-83. [PMID: 30997729 PMCID: PMC6523256 DOI: 10.1002/acm2.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/06/2022] Open
Abstract
Helical tomotherapy (HT) can restrict beamlets passing through the virtual contour on computed tomography (CT) image in dose optimization, reducing the dose to organs at risk (OARs). Beamlet restriction limits the incident beamlet angles; thus, the proper planning target volume (PTV) margin may differ from that of the standard treatment plan without beamlet restriction, depending on the patient's movement during dose delivery. Dose distribution changes resulting from patient movement have not been described for treatment plans with beamlet restriction. This study quantified changes in dose distribution to the target and OARs when beamlet restriction is applied to cervical esophageal cancer treatment plan using HT by systematically shifting a phantom. Treatment plans for cervical esophageal cancers with and without beamlet restriction modes [directional block (DB) and nonblock (NB), respectively] were designed for CT images of the RANDO phantom. The PTV margin for the DB mode was set to be the same as that for the NB mode (5 mm). The CT image was intentionally shifted by ±1, ±2, and ±3 voxels in the left–right, anterior–posterior, and superior–inferior directions, and the dose distribution was recalculated for each position using the fluence for the NB or DB mode. When the phantom shift was within the same PTV margin as the NB mode, changes in doses to the targets, lungs, heart, and spinal cord in the DB mode were small as those in the NB mode. In conclusion, the virtual contour shape used in this study would provide safe delivery even with patient movement within the same PTV margin as for the NB mode.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Maebashi Gunma Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Maebashi Gunma Japan
| | - Makoto Ito
- Department of Radiology Aichi Medical University Hospital Nagakute Aichi Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Natsuo Tomita
- Department of Radiology Nagoya City University Hospital Nagoya Aichi Japan
| | - Chiyoko Makita
- Department of Radiation Oncology Gifu Prefectural General Medical Center Gifu City Gifu Japan
| | - Hiroshi Tanaka
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Yutaro Koide
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Tohru Iwata
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
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Lin JC, Tsai JT, Chou YC, Li MH, Liu WH. Compared with intensity-modulated radiotherapy, image-guided radiotherapy reduces severity of acute radiation-induced skin toxicity during radiotherapy in patients with breast cancer. Cancer Med 2018; 7:3622-3629. [PMID: 29968974 PMCID: PMC6089195 DOI: 10.1002/cam4.1630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 11/11/2022] Open
Abstract
Radiotherapy (RT) is an effective treatment for breast cancer. The side effects of breast irradiation, including skin toxicity in the irradiation field, cause considerable discomfort. This study compared the severity of skin toxicity caused by image-guided RT (IGRT) and intensity-modulated RT (IMRT) combined with an electronic portal imaging device (EPID) in breast cancer. This study retrospectively analyzed 458 patients with breast cancer who had received RT. The patients were divided into two groups: 302 and 156 patients in the IMRT and IGRT groups. In the IGRT group, 8 and 148 patients had received helical tomotherapy irradiation and IMRT with cone-beam computed tomography. Simple and multiple logistic regression analyses were used to estimate the relationship between RT technique and the severity of radiation skin toxicity. In our study, 284, 97, and 6 patients exhibited grades I, II, and III radiation dermatitis (RD). Moreover, 75 patients in the IMRT group (24.80%) and 22 patients in the IGRT group (14.10%) exhibited grade II RD. All patients with grade III RD were in the IMRT group (2.00%). No patient exhibited grade IV RD. The patients in the IGRT group exhibited less severity of RD than in the IMRT group. The severity of acute RD due to IGRT is significantly lower than that due to IMRT with EPID.
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Affiliation(s)
- Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Hsien Li
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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Zhang Y, Wang H, Huang X, Zhang Q, Ren R, Sun R, Zheng Z, Dong S, Zheng A. Dosimetric comparison of TomoDirect, helical tomotherapy, VMAT, and ff-IMRT for upper thoracic esophageal carcinoma. Med Dosim 2018; 44:167-172. [PMID: 29950277 DOI: 10.1016/j.meddos.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/08/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The new TomoDirect (TD) modality offers a nonrotational option with discrete beam angles. We aim to compare dosimetric parameters of TD, helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), and fixed-field intensity-modulated radiotherapy (ff-IMRT) for upper thoracic esophageal carcinoma (EC). METHODS Twenty patients with cT2-4N0-1M0 upper thoracic esophageal squamous cell carcinoma (ESCC) were enrolled. Four plans were generated using the same dose objectives for each patient: TD, HT, VMAT with a single arc, and ff-IMRT with 5 fields (5F). The prescribed doses were used to deliver 50.4 Gy/28F to the planning target volume (PTV50.4) and then provided a 9 Gy/5F boost to PTV59.4. Dose-volume histogram (DVH) statistics, dose uniformity, and dose homogeneity were analyzed to compare treatment plans. RESULTS For PTV59.4, the D2, D98, Dmean, and V100% values in HT were significantly lower than other plans (all p < 0.05), and those in TD were significantly lower than VMAT and ff-IMRT (all p < 0.05). However, there was no significant difference in the D2 and Dmean values between VMAT and ff-IMRT techniques (p > 0.05). The homogeneity index (HI) differed significantly for the 4 techniques of TD, HT, VMAT, and ff-IMRT (0.03 ± 0.01, 0.02 ± 0.01, 0.06 ± 0.02, and 0.05 ± 0.01, respectively; p < 0.001). The HI for TD was similar to HT (p = 0.166), and had statistically significant improvement compared to VMAT (p < 0.001) and ff-IMRT (p = 0.003). In comparison with the 4 conformity indices (CIs), there was no significant difference (p > 0.05). For PTV50.4, the D2 and Dmean values in HT were significantly lower than other plans (all p < 0.05), and those in TD were significantly lower than VMAT and ff-IMRT (all p < 0.05). However, there was no significant difference in the D2 and Dmean values between VMAT and ff-IMRT techniques (p > 0.05). No D98 and V100% parameters differed significantly among the 4 treatment types (p > 0.05). HT plans were provided for statistically significant improvement in HI (0.03 ± 0.01) compared to TD plans (0.05 ± 0.01, p = 0.003), VMAT (0.08 ± 0.03, p < 0.001), ff-IMRT (0.08 ± 0.01, p < 0.001). The HI revealed that TD was superior to VMAT and ff-IMRT (p < 0.05). The CI differed significantly for the 4 techniques of TD, HT, VMAT, and ff-IMRT (0.59 ± 0.10, 0.69 ± 0.11, 0.64 ± 0.09, and 0.64 ± 0.11, respectively; p = 0.035). The best CI was yielded by HT. We found no significant difference for the V5, V10, V15, V30, and the mean lung dose (MLD) among the 4 techniques (all p > 0.05). However, the V20 differed significantly among TD, HT, VMAT, and ff-IMRT (21.50 ± 7.20%, 19.50 ± 5.55%, 17.65 ± 5.45%, and 16.35 ± 5.70%, respectively; p = 0.047). Average V20 for the lungs was significantly improved by the TD plans compared to VMAT (p = 0.047), and ff-IMRT (p = 0.008). The V5 value of the lung in TD was 49.30 ± 13.01%, lower than other plans, but there was no significant difference (p > 0.05). The D1 of the spinal cord showed no significant difference among the 4 techniques (p = 0.056). CONCLUSIONS All techniques are able to provide a homogeneous and highly conformal dose distribution. The TD technique is a good option for treating upper thoracic EC involvement. It could achieve optimal low dose to the lungs and spinal cord with acceptable PTV coverage. HT is a good option as it could achieve quality dose conformality and uniformity, while TD generated superior conformality.
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Affiliation(s)
- Yaowen Zhang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Huitao Wang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Xiao Huang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Qiang Zhang
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Runchuan Ren
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Ronggang Sun
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Zhiyong Zheng
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China
| | - Shangwen Dong
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
| | - Anping Zheng
- Department of Radiation Oncology, Anyang Cancer Hospital, Anyang, Henan, China.
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8
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Ito M, Shimizu H, Aoyama T, Tachibana H, Tomita N, Makita C, Koide Y, Kato D, Ishiguchi T, Kodaira T. Efficacy of virtual block objects in reducing the lung dose in helical tomotherapy planning for cervical oesophageal cancer: a planning study. Radiat Oncol 2018; 13:62. [PMID: 29618353 DOI: 10.1186/s13014-018-1012-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/26/2018] [Indexed: 12/03/2022] Open
Abstract
Background Intensity-modulated radiotherapy is useful for cervical oesophageal carcinoma (CEC); however, increasing low-dose exposure to the lung may lead to radiation pneumonitis. Nevertheless, an irradiation technique that avoids the lungs has never been examined due to the high difficulty of dose optimization. In this study, we examined the efficacy of helical tomotherapy that can restrict beamlets passing virtual blocks during dose optimization computing (block plan) in reducing the lung dose. Methods Fifteen patients with CEC were analysed. The primary/nodal lesion and prophylactic nodal region with adequate margins were defined as the planning target volume (PTV)-60 Gy and PTV-48 Gy, respectively. Nineteen plans per patient were made and compared (total: 285 plans), including non-block and block plans with several shapes and sizes. Results The most appropriate block model was semi-circular, 8 cm outside of the tracheal bifurcation, with a significantly lower lung dose compared to that of non-block plans; the mean lung volumes receiving 5 Gy, 10 Gy, 20 Gy, and the mean lung dose were 31.3% vs. 48.0% (p < 0.001), 22.4% vs. 39.4% (p < 0.001), 13.2% vs. 16.0% (p = 0.028), and 7.1 Gy vs. 9.6 Gy (p < 0.001), respectively. Both the block and non-block plans were comparable in terms of the homogeneity and conformity indexes of PTV-60 Gy: 0.05 vs. 0.04 (p = 0.100) and 0.82 vs. 0.85 (p = 0.616), respectively. The maximum dose of the spinal cord planning risk volume increased slightly (49.4 Gy vs. 47.9 Gy, p = 0.002). There was no significant difference in the mean doses to the heart and the thyroid gland. Prolongation of the delivery time was less than 1 min (5.6 min vs. 4.9 min, p = 0.010). Conclusions The block plan for CEC could significantly reduce the lung dose, with acceptable increment in the spinal dose and a slightly prolonged delivery time.
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Choi KH, Kim J, Lee SW, Kang YN, Jang H. Dosimetric comparison between modulated arc therapy and static intensity modulated radiotherapy in thoracic esophageal cancer: a single institutional experience. Radiat Oncol J 2017; 36:63-70. [PMID: 29262672 PMCID: PMC5903360 DOI: 10.3857/roj.2017.00241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/03/2017] [Accepted: 09/27/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose The objective of this study was to compare dosimetric characteristics of three-dimensional conformal radiotherapy (3D-CRT) and two types of intensity-modulated radiotherapy (IMRT) which are step-and-shoot intensity modulated radiotherapy (s-IMRT) and modulated arc therapy (mARC) for thoracic esophageal cancer and analyze whether IMRT could reduce organ-at-risk (OAR) dose. Materials and Methods We performed 3D-CRT, s-IMRT, and mARC planning for ten patients with thoracic esophageal cancer. The dose-volume histogram for each plan was extracted and the mean dose and clinically significant parameters were analyzed. Results Analysis of target coverage showed that the conformity index (CI) and conformation number (CN) in mARC were superior to the other two plans (CI, p = 0.050; CN, p = 0.042). For the comparison of OAR, lung V5 was lowest in s-IMRT, followed by 3D-CRT, and mARC (p = 0.033). s-IMRT and mARC had lower values than 3D-CRT for heart V30 (p = 0.039), V40 (p = 0.040), and V50 (p = 0.032). Conclusion Effective conservation of the lung and heart in thoracic esophageal cancer could be expected when using s-IMRT. The mARC was lower in lung V10, V20, and V30 than in 3D-CRT, but could not be proven superior in lung V5. In conclusion, low-dose exposure to the lung and heart were expected to be lower in s-IMRT, reducing complications such as radiation pneumonitis or heart-related toxicities.
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Affiliation(s)
- Kyu Hye Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jina Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Nam Kang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - HongSeok Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hansen CR, Nielsen M, Bertelsen AS, Hazell I, Holtved E, Zukauskaite R, Bjerregaard JK, Brink C, Bernchou U. Automatic treatment planning facilitates fast generation of high-quality treatment plans for esophageal cancer. Acta Oncol 2017; 56:1495-1500. [PMID: 28840767 DOI: 10.1080/0284186x.2017.1349928] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The quality of radiotherapy planning has improved substantially in the last decade with the introduction of intensity modulated radiotherapy. The purpose of this study was to analyze the plan quality and efficacy of automatically (AU) generated VMAT plans for inoperable esophageal cancer patients. MATERIAL AND METHODS Thirty-two consecutive inoperable patients with esophageal cancer originally treated with manually (MA) generated volumetric modulated arc therapy (VMAT) plans were retrospectively replanned using an auto-planning engine. All plans were optimized with one full 6MV VMAT arc giving 60 Gy to the primary target and 50 Gy to the elective target. The planning techniques were blinded before clinical evaluation by three specialized oncologists. To supplement the clinical evaluation, the optimization time for the AU plan was recorded along with DVH parameters for all plans. RESULTS Upon clinical evaluation, the AU plan was preferred for 31/32 patients, and for one patient, there was no difference in the plans. In terms of DVH parameters, similar target coverage was obtained between the two planning methods. The mean dose for the spinal cord increased by 1.8 Gy using AU (p = .002), whereas the mean lung dose decreased by 1.9 Gy (p < .001). The AU plans were more modulated as seen by the increase of 12% in mean MUs (p = .001). The median optimization time for AU plans was 117 min. CONCLUSIONS The AU plans were in general preferred and showed a lower mean dose to the lungs. The automation of the planning process generated esophageal cancer treatment plans quickly and with high quality.
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Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | | | - Irene Hazell
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Eva Holtved
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ruta Zukauskaite
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jon Kroll Bjerregaard
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Uffe Bernchou
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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So B, Marcu LG, Olver I, Gowda R, Bezak E. Cocktail without hangover: in search for the optimal chemotherapy in the combined management of non-operable esophageal carcinomas. Acta Oncol 2017; 56:899-908. [PMID: 28375694 DOI: 10.1080/0284186x.2017.1307518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The worldwide incidence of esophageal cancer has greatly increased over the past few decades making it the sixth deadliest cancer. The disease is often detected in advanced stages when surgery is no longer an option. The standard treatment in these situations is combined chemoradiotherapy, by employing drug cocktails that lead to optimal treatment outcomes both from the perspective of tumor control and normal tissue toxicity. METHODS The aim of this work was to collate the existing trials and clinical studies reported on non-operable esophageal cancer and to analyze the results based on treatment outcomes after various drug combinations. RESULTS Of all drug combinations, cisplatin/5-FU is the most well established chemotherapy regimen for esophageal cancer as both neoadjuvant therapy, an alternative option to surgery, and for palliative purposes. Although this regimen is associated with the most toxicity, it also appears to have the best survival benefit and relief of symptoms. CONCLUSIONS More research is warranted to further increase the therapeutic ratio in non-operable esophageal cancers.
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Affiliation(s)
- Bianca So
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Loredana G. Marcu
- Department of Physics, Faculty of Science, University of Oradea, Oradea, Romania
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
| | - Ian Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Department of Physics, Faculty of Science, University of Oradea, Oradea, Romania
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Abstract
INTRODUCTION Radiotherapy is an important component of the standard of care for esophageal cancer. In the past decades, significant improvements in the planning and delivery of radiation techniques have led to better dose conformity to the target volume and improved normal tissue sparing. Areas covered: This review focuses on the advances in radiotherapy techniques and summarizes the availably dosimetric and clinical outcomes of intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy, proton therapy, and four-dimensional radiotherapy for esophageal cancer, and discusses the challenges and future development of proton therapy. Expert commentary: Although three-dimensional conformal radiotherapy is the standard radiotherapy technique in esophageal cancer, the retrospectively comparative studies strongly suggest that the dosimetric advantage of IMRT over three-dimensional conformal radiotherapy can translate into improved clinical outcomes, despite the lack of prospective randomized evidence. As a novel form of conventional IMRT technique, volumetric modulated arc therapy can produce equivalent or superior dosimetric quality with significantly higher treatment efficiency in esophageal cancer. Compared with photon therapy, proton therapy has the potential to achieve further clinical improvement due to their physical properties; however, prospective clinical data, long-term results, and cost-effectiveness are needed.
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Affiliation(s)
- Mian Xi
- a Department of Radiation Oncology, Cancer Center , Sun Yat-Sen University, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine , Guangzhou , Guangdong , China
| | - Steven H Lin
- b Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Yu J, Hu T, Chen Y. Small-arc volumetric-modulated arc therapy: A new approach that is superior to fixed-field IMRT in optimizing dosimetric and treatment-relevant parameters for patients undergoing whole-breast irradiation following breast-conserving surgery. Medicine (Baltimore) 2016; 95:e4609. [PMID: 27559956 PMCID: PMC5400323 DOI: 10.1097/md.0000000000004609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Volumetric-modulated arc therapy (VMAT) is considered to deliver a better dose distribution and to shorten treatment time. There is a lack of research regarding breast irradiation after breast-conserving surgery (BCS) using VMAT with prone positioning. We developed a new small-arc VMAT methodology and compared it to conventional (fixed-field) intensity-modulated radiation therapy (IMRT) in the dosimetric and treatment relevant parameters for breast cancer patients in the prone position.Ten early-stage breast cancer patients were included in this exploratory study. All patients underwent computed tomography (CT) simulation scan in the prone position and for each patient, IMRT and VMAT plans were generated using the Monaco planning system. Two symmetrical partial arcs were applied in the VMAT plans. The angle ranges of the 2 arcs were set to approximately 60° to 100° and 220° to 260°, with small adjustments to maximize target coverage, while minimizing lung and heart exposure. The IMRT plans used 4 fixed fields. Prescribed doses were 50 Gy in 25 fractions. The target coverage, homogeneity, conformity, dose to organs at risk (OAR), treatment time, and monitor units (MU) were evaluated.Higher median conformal index (CI) and lower homogeneity index (HI) of the planning target volume (PTV) were respectively observed in VMAT and plans group (CI, 95% vs 91%; HI, 0.09 vs 0.12; P < 0.001). The volumes of ipsilateral lung receiving 30, 20, 10, and 5 Gy were lower for VMAT (P < 0.01), being 10%, 14.9%, 25.9%, and 44.9%, respectively, compared to 11.79%, 17.32%, 30.27%, and 50.58% for the IMRT plans. The mean lung dose was also reduced from 10.6 ± 1.8 to 9.6 ± 1.4 Gy (P = 0.001). The volumes of the heart receiving 30 and 40 Gy were similar for the 2 methods. In addition, the median treatment time (161 vs 412 seconds; P < 0.001) and the mean MU (713 vs 878; P < 0.001) were lower for VMAT.Small-arc VMAT plan improved CI and HI for the target, spared the dose of lung, and reduced treatment time and MU, compared to IMRT. It is a more promising irradiation technique for post-BCS radiotherapy.
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Affiliation(s)
- Jing Yu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Tao Hu
- Department of Oncology, the Central Hospital of Wuhan
| | - Yeshan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
- Correspondence: Yeshan Chen, Cancer Center, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wujiadun Road 156, Wuhan 430022, P.R. China (e-mail: )
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