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Canters R, Vaassen F, Lubken I, Cobben M, Murrer L, Peeters S, Berbee M, Ta B. Radiotherapy for mediastinal lymphoma in breath hold using surface monitoring and nasal high flow oxygen: Clinical experiences and breath hold stability. Radiother Oncol 2023; 183:109594. [PMID: 36870610 DOI: 10.1016/j.radonc.2023.109594] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/04/2022] [Revised: 02/11/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE In this study we describe the clinical introduction and evaluation of radiotherapy in mediastinal lymphoma in breath hold using surface monitoring combined with nasal high flow therapy (NHFT) to prolong breath hold duration. MATERIALS AND METHODS 11 Patients with mediastinal lymphoma were evaluated. 6 Patients received NHFT, 5 patients were treated in breath hold without NHFT. Breath hold stability as measured by a surface scanning system was evaluated, as well as internal movement based on cone beam computed tomography (CBCT) before and after treatment. Based on internal movement, margins were determined. In a parallel planning study we compared free breathing plans with breath hold plans using the determined margins. RESULTS Average inter breath hold stability was 0.6 mm for NHFT treatments, and 0.5 mm for non-NHFT treatments (p > 0.1). Intra breath hold stability was 0.8 vs. 0.6 mm (p > 0.1) on average. Using NHFT, average breath hold duration increased from 34 s to 60 s (p < 0.01). Residual CTV motion derived from CBCTs before and after each fraction was 2.0 mm for NHFT vs 2.2 mm for non-NHFT (p > 0.1). Combined with inter-fraction motion, a uniform mediastinal margin of 5 mm appears to be sufficient. In breath hold, mean lung dose is reduced by 2.6 Gy (p < 0.001), while mean heart dose is reduced by 2.0 Gy (p < 0.001). CONCLUSION Treatment of mediastinal lymphoma in breath hold is feasible and safe. The addition of NHFT approximately increases breath hold durations with a factor two while stability is maintained. By reducing breathing motion, margins can be decreased to 5 mm. A considerable dose reduction in heart, lungs, esophagus, and breasts can be achieved with this method.
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Affiliation(s)
- Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands.
| | - Femke Vaassen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Indra Lubken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Maud Cobben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Lars Murrer
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Stephanie Peeters
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
| | - Bastiaan Ta
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center, the Netherlands
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Berbee M, Vaassen F, Cobben M, Klugt van der K, Lubken I, Ta B, Murrer L, Canters R. PD-0170 Breath-hold proton therapy for mediastinal lymphomas: the expected effect on cardiac toxicity. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02775-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ta B, Hutschemaekers S, Crijns A, Pisciotta P, Canters R, Vilches Freixas G, Cambraia Lopes P, Niezink A. OC-0294 Proton therapy in mediastinal lymphoma patients in a nationwide cohort, using model-based selection. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neppelenbroek SI, Geurts YM, Aleman BM, Janus CP, Rademakers SE, de Weijer RJ, Van Der Maazen RW, Zijlstra JM, Beijert M, Verschueren KM, Ta B, Nijziel MR, Posthuma EF, Kersten MJ, Muller K, te Boome L, Bilgin Y, de Jongh E, Schaapveld M, Van Leeuwen F. Anthracycline exposure and breast cancer risk in female Hodgkin lymphoma survivors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12074] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12074 Background: Female Hodgkin lymphoma (HL) survivors treated with chest radiotherapy (RT) at a young age have a strongly increased risk of breast cancer (BC). Recently concern has been raised that anthracyclines may also increase BC risk, based on studies in childhood cancer survivors with/without a history of chest RT. So far, the association between anthracyclines and BC risk has not been examined in cancer survivors treated at adolescent/adult ages. Now that RT dose and volumes are decreasing, the potential contribution of anthracyclines to BC risk is an important issue. Methods: We assessed BC risk in a cohort of 2314 female 5-year HL survivors, treated at ages 15-50 years and diagnosed between 1965 and 2008 in 20 Dutch hospitals. Treatment factors were time-dependently included in the analysis, focusing on the effect of anthracycline exposure on BC risk. Results: After a median follow-up of 18.8 years, 258 women developed invasive BC or ductal carcinoma in situ as a subsequent malignancy. The 30-year cumulative incidence was 15.0% (95% Confidence Interval (CI) 12.8-17.4%). Mantle field RT (or other RT involving both axillae) was associated with increased risk of BC (Hazard ratio (HR) 1.9; 95% CI 1.2-2.8) compared to no supradiaphragmatic RT or RT to the neck only (Table 1). Gonadotoxic treatment (>4.2 g/m2 procarbazine or pelvic RT) significantly decreased this risk. In a multivariable analysis, anthracycline exposure was associated with increased BC risk (HR 1.8; 95% CI 1.3-2.5) in patients who received a cumulative dose of >200 mg/m2. Among patients exposed to gonadotoxic treatment, the HR of BC associated with >200mg/m2 anthracyclines was 3.8 (95% CI 2.0-7.2), with a trend for higher risk with higher anthracycline dose (HR 1.58 per 100mg/m2 anthracycline, p<0.001). Conclusions: Our results suggest an association of anthracyclines with BC risk in HL survivors. Also when accounting for the protective effect of gonadotoxic treatment on RT-associated BC risk, anthracyclines significantly contributed to a higher BC risk.[Table: see text]
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Affiliation(s)
| | - Yvonne M. Geurts
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Berthe M.P. Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - Roel J. de Weijer
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Josée M. Zijlstra
- Department of Hematology, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Max Beijert
- University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Marten R. Nijziel
- Catharina Cancer Institute, Department of Hemato-Oncology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Marie José Kersten
- Department of Hematology, Amsterdam UMC location AMC, Amsterdam, Netherlands
| | | | | | - Yavuz Bilgin
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, Netherlands
| | - Eva de Jongh
- Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Flora Van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
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Beijert M, Soubeyran P, El Badawy S, Specht L, Verschueren K, Ong C, Maazen R, Aurer I, Ta B, Neven A, Meulemans B, Fortpied C, Aleman B. OC-0374: Does low-dose TBI improve outcome in patients with early stage low grade NHL? (EORTC 20971-22997). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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SPOOR D, Peters F, Van den Bogaard V, Van der Schaaf A, Ta B, Vliegenthart R, Kierkels R, Langendijk H, Maduro J, Sijtsema M, Crijns A. PO-0764 The effect of automatic heart contouring on model performance in predicting acute coronary events. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rueter K, Ta B, Bear N, Borland ML, Lucas M, Prescott SL. P49: ARE TIME-TREND DATA SIGNIFICANTLY INFLUENCED BY IMPROVEMENT IN DIAGNOSING ANAPHYLAXIS OVER TIME? Intern Med J 2017. [DOI: 10.1111/imj.49_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Rueter
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Department of Paediatric Immunology, Princess Margaret Hospital for Children; Perth Australia
- Department of Paediatric Emergency Medicine, Princess Margaret Hospital for Children; Perth Australia
| | - B Ta
- Department of Paediatric Emergency Medicine, Princess Margaret Hospital for Children; Perth Australia
| | - N Bear
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Telethon Kids Institute; University of Western Australia; Australia
| | - ML Borland
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Department of Paediatric Emergency Medicine, Princess Margaret Hospital for Children; Perth Australia
| | - M Lucas
- Department of Paediatric Immunology, Princess Margaret Hospital for Children; Perth Australia
- School of Medicine and Pharmacology and School of Pathology and Laboratory Medicine; University of Western Australia; Australia
- Institute for Immunology and Infectious Diseases; Murdoch University; Perth Australia
- Department of Immunology, Pathwest and Sir Charles Gardiner Hospital; Perth Australia
| | - SL Prescott
- School of Paediatrics and Child Health; University of Western Australia; Australia
- Department of Paediatric Immunology, Princess Margaret Hospital for Children; Perth Australia
- Department of Paediatric Emergency Medicine, Princess Margaret Hospital for Children; Perth Australia
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