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Şenkesen Ö, Tezcanlı E, Alkaya F, İspir B, Çatlı S, Yeşil A, Bezirganoglu E, Turan S, Köksal C, Güray G, Hacıislamoğlu E, Durmuş İF, Çavdar Ş, Aksu T, Çolak N, Küçükmorkoç E, Doğan M, Ercan T, Karaköse F, Alpan V, Ceylan C, Poyraz G, Nalbant N, Kınay Ş, İpek S, Kayalılar N, Tatlı H, Zhu M. Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis. Radiat Oncol 2024; 19:49. [PMID: 38627747 PMCID: PMC11022438 DOI: 10.1186/s13014-024-02435-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution. METHODS Anonymized CT scans of adult and pediatric patients, alongside target volumes and organ-at-risk (OAR) structures, were shared with 25 local radiotherapy centers. They were tasked to develop optimal treatment plans delivering 36 Gy in 20 fractions with 95% PTV coverage, while minimizing OAR exposure. The same CT data was sent to a US proton therapy center for comparison. Various planning systems and treatment techniques (3D conformal RT, IMRT, VMAT, tomotherapy) were utilized. Elekta Proknow software was used to analyze parameters, assess dose distributions, mean doses, conformity index (CI), and homogeneity index (HI) for both target volumes and OARs. Comparisons were made against proton therapy. RESULTS All techniques consistently achieved excellent PTV coverage (V95 > 98%) for both adult and pediatric patients. Tomotherapy closely approached ideal Dmean doses for all PTVs, while 3D-CRT had higher Dmean for PTV_brain. Tomotherapy excelled in CI and HI for PTVs. IMRT resulted in lower pediatric heart, kidney, parotid, and eye doses, while 3D-CRT achieved the lowest adult lung doses. Tomotherapy approached proton therapy doses for adult kidneys and thyroid, while IMRT excelled for adult heart, kidney, parotid, esophagus, and eyes. CONCLUSION Modern radiotherapy techniques offer improved target coverage and OAR protection. However, 3D techniques are continued to be used for CSI. Notably, proton therapy stands out as the most efficient approach, closely followed by Tomotherapy in terms of achieving superior target coverage and OAR protection.
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Affiliation(s)
- Öznur Şenkesen
- Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
- Department of Radiation Oncology, Acıbadem Ataşehir Hospital, Acıbadem Mehmet Ali Aydınlar University, Kayışdağı Cad. No:32, Ataşehir, Istanbul, Turkey.
| | - Evrim Tezcanlı
- Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
- Department of Radiation Oncology, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Fadime Alkaya
- Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey
| | - Burçin İspir
- Department of Radiation Oncology, Acıbadem Adana Hospital, Adana, Turkey
| | - Serap Çatlı
- Radiation Oncology Department, Gazi University, Ankara, Turkey
| | - Abdullah Yeşil
- Department of Radiation Oncology, Medicana Bursa Hospital, Bursa, Turkey
| | | | - Sezgi Turan
- Department of Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Canan Köksal
- Department of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Gülay Güray
- Department of Radiation Oncology, Medikal Park Bahçelievler Hospital, Istanbul, Turkey
| | - Emel Hacıislamoğlu
- Department of Radiation Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
| | - İsmail Faruk Durmuş
- Department of Radiation Oncology, Yeni Yuzyıl University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Şeyma Çavdar
- Department of Radiation Oncology, Medicana Ankara Hospital, Ankara, Turkey
| | - Telat Aksu
- Department of Radiation Oncology, Ondokuz Mayıs University, Samsun, Turkey
| | - Nurten Çolak
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Esra Küçükmorkoç
- Department of Radiation Oncology, Anadolu Medical Center, Istanbul, Turkey
| | - Mustafa Doğan
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
| | - Tülay Ercan
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Fatih Karaköse
- Department of Radiation Oncology, Koc University Hospital, Istanbul, Turkey
| | - Vildan Alpan
- Department of Radiation Oncology, American Hospital, Istanbul, Turkey
| | - Cemile Ceylan
- Department of Radiation Oncology, Istanbul Onkology Hospital, Istanbul, Turkey
| | - Gökhan Poyraz
- Department of Radiation Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Nilgül Nalbant
- Department of Radiation Oncology, Basaksehir Cam Ve Sakura City Hospital, Istanbul, Turkey
| | - Şeyda Kınay
- Department of Radiation Oncology, Dokuz Eylul University, İzmir, Turkey
| | - Servet İpek
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Namık Kayalılar
- Department of Radiation Oncology, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Hamza Tatlı
- Elekta Instrument AB, Barbaros Mah. Begonya Sok. Nidakule, Ataşehir, Istanbul, Turkey
| | - Mingyao Zhu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Quan KR, Lin WR, Hong JB, Lin YH, Chen KQ, Chen JH, Cheng PJ. A machine learning approach for predicting radiation-induced hypothyroidism in patients with nasopharyngeal carcinoma undergoing tomotherapy. Sci Rep 2024; 14:8436. [PMID: 38600141 PMCID: PMC11006930 DOI: 10.1038/s41598-024-59249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
The purpose of this study was to establish an integrated predictive model that combines clinical features, DVH, radiomics, and dosiomics features to predict RIHT in patients receiving tomotherapy for nasopharyngeal carcinoma. Data from 219 patients with nasopharyngeal carcinoma were randomly divided into a training cohort (n = 175) and a test cohort (n = 44) in an 8:2 ratio. RIHT is defined as serum thyroid-stimulating hormone (TSH) greater than 5.6 μU/mL, with or without a decrease in free thyroxine (FT4). Clinical features, 27 DVH features, 107 radiomics features and 107 dosiomics features were extracted for each case and included in the model construction. The least absolute shrinkage and selection operator (LASSO) regression method was used to select the most relevant features. The eXtreme Gradient Boosting (XGBoost) was then employed to train separate models using the selected features from clinical, DVH, radiomics and dosiomics data. Finally, a combined model incorporating all features was developed. The models were evaluated using receiver operating characteristic (ROC) curves and decision curve analysis. In the test cohort, the area under the receiver operating characteristic curve (AUC) for the clinical, DVH, radiomics, dosiomics and combined models were 0.798 (95% confidence interval [CI], 0.656-0.941), 0.673 (0.512-0.834), 0.714 (0.555-0.873), 0.698 (0.530-0.848) and 0.842 (0.724-0.960), respectively. The combined model exhibited higher AUC values compared to other models. The decision curve analysis demonstrated that the combined model had superior clinical utility within the threshold probability range of 1% to 79% when compared to the other models. This study has successfully developed a predictive model that combines multiple features. The performance of the combined model is superior to that of single-feature models, allowing for early prediction of RIHT in patients with nasopharyngeal carcinoma after tomotherapy.
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Affiliation(s)
- Ke-Run Quan
- Department of Radiation Oncology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Wen-Rong Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Jia-Biao Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Yu-Hao Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Kai-Qiang Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Ji-Hong Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
| | - Pin-Jing Cheng
- School of Nuclear Science and Technology, University of South China, Hengyang, 421001, Hunan, China.
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Akdeniz Y, Ispir B. Whole-brain radiotherapy with hippocampus sparing and simultaneous integrated boost to metastases: A plan quality comparison study between Ethos, HyperArc, VMAT and Tomotherapy. Med Dosim 2023:S0958-3947(23)00112-7. [PMID: 38101995 DOI: 10.1016/j.meddos.2023.11.004] [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: 08/13/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
This study provides a concise and structured overview of a dosimetric comparison study conducted to assess the feasibility and effectiveness of 4 advanced radiotherapy techniques in treating brain metastases with hippocampus sparing and simultaneous integrated boost (HS-WBRT+SIB). Eleven patients with brain metastases previously treated with radiotherapy were included in the study. Planning CT scans with 2 mm slice thickness and MR imaging were used for contouring and dose prescription. The bilateral hippocampus and other organs at risk (OARs) were automatically contoured, and hippocampal avoidance regions (HAR) were defined as a 7 mm 3D expansion around the hippocampus. Gross tumor volume for each metastasis (GTVmet) and planning target volume for metastases (PTVmet) were delineated. The whole-brain CTV (CTVWB) and planning target volume for whole brain (PTVWB) were defined accordingly. Treatment planning and optimization were conducted using state-of-the-art radiotherapy techniques: Ethos, HyperArc, VMAT, and Tomotherapy. Tomotherapy achieved the highest D98% for PTVmet, indicating the best metastasis coverage. HyperArc plans showed the highest D98% for PTVWB, suggesting superior whole-brain coverage. Tomotherapy demonstrated significantly lower D98%, D2%, and Dmean values for the hippocampus, indicating its superiority in sparing the hippocampus. VMAT resulted in the lowest D2% values for the eyes, optic nerves, brainstem, and hypophysis, showing the best sparing of these critical structures. Tomotherapy consistently achieved lower Dmean values for parotids, oral cavity, and lips compared to the other techniques. The dosimetric comparison revealed distinct strengths and weaknesses for each radiotherapy technique. Tomotherapy excelled in sparing the hippocampus, while VMAT showed promise in sparing OARs. HyperArc plans demonstrated the best overall whole-brain coverage. These findings should guide clinicians in selecting the most suitable technique based on patient characteristics and institutional resources.
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Affiliation(s)
- Yucel Akdeniz
- Radiation Oncology Department, Acıbadem Adana Hospital, Adana, Turkey.
| | - Burcin Ispir
- Radiation Oncology Department, Acıbadem Ataşehir Hospital, İstanbul, Turkey
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Sargos P, Stoeckle E, Ducassou A, Giraud A, Mervoyer A, Italiano A, Albert S, Ferron G, Bellera C, Kantor G. High dose (54 Gy) pre-operative helical tomotherapy for retroperitoneal liposarcoma: Results of a phase II multicenter study. Radiother Oncol 2023; 186:109791. [PMID: 37437608 DOI: 10.1016/j.radonc.2023.109791] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To evaluate efficacy and feasibility of high-dose intensity-modulated radiotherapy (RT) with pre-operative helical tomotherapy, delivering 54 Gy/30 fractions in patients with retroperitoneal liposarcomas (RPLS). MATERIALS AND METHODS Patients with operable, biopsy-proven, RPLS were included in this phase II multicenter study (ClinicalTrials.gov: NCT01841047). The primary objectives were to analyze loco-regional relapse free survival (LRFS), overall survival (OS) and toxicities, graded according to CTCAE V3.0. RESULTS From April 2009 to September 2013, 48 patients were included. Histological types were: 20 well differentiated and 28 dedifferentiated liposarcomas. Median clinical target volume (CTV) was 2570 cc (range, 230-8734 cc). The radio-surgical schedule was completed as planned in all patients apart from one. A monobloc wide excision was achieved for all patients. Surgical margins were R0 (16; 34%), R1 (28; 60%), R2 (2; 4%) or missing (1, 2%).With a median follow-up of 5.5 years, 3-year LRFS rate was 74.2% (95%CI: [59.1%; 84.5%]). At 5 years, cumulative incidence of loco-regional relapse for well differentiated and dedifferentiated RPLS was 10% and 18%, respectively. The 5-year OS was 73.9% [95%CI: 58.7-84.3%]. During RT, the most common grade 3-4 adverse events were hematological (N = 20; 41.6%). After surgery and during follow-up, 17 patients (35.4%) presented a grade 3-4 toxicity. Two patients (4.1%) died due to a duodenal toxicity. Nine second cancers were observed. CONCLUSION From this phase II trial of preoperative RT in RPLS patients, the dose level proposed cannot be considered safe, leading to non-negligible toxicity and second cancers rates. Our results, combined with STRASS-1 study, suggest that the ideal indication of RT for patients with RPLS still remains to be determined.
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Affiliation(s)
- Paul Sargos
- Department of Radiotherapy, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France.
| | - Eberhard Stoeckle
- Department of Surgery, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France
| | - Anne Ducassou
- Department of Radiotherapy, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Antoine Giraud
- Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Augustin Mervoyer
- Department of Radiotherapy, Institut de Cancerologie de l'Ouest, Nantes, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France
| | - Sabrina Albert
- Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Gwenael Ferron
- Department of Surgical Oncology, INSERM CRCT19 (Oncogenesis of Sarcoma), Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, F-33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France.
| | - Guy Kantor
- Department of Radiotherapy, Institut Bergonie, 229 cours de l'Argonne, 33076 Bordeaux, France
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Gallio E, Sardo A, Badellino S, Mantovani C, Levis M, Fiandra C, Guarneri A, Arcadipane F, Richetto V, Ricardi U, Giglioli FR. Helical tomotherapy and two types of volumetric modulated arc therapy: dosimetric and clinical comparison for several cancer sites. Radiol Phys Technol 2023; 16:272-283. [PMID: 37084071 DOI: 10.1007/s12194-023-00716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023]
Abstract
Radiotherapy accelerators have undergone continuous technological developments. We investigated the differences between Radixact™ and VMAT treatment plans. Sixty patients were included in this study. Dosimetric comparison between the Radixact™ and VMAT plans was performed for six cancer sites: whole-brain, head and neck, lymphoma, lung, prostate, and rectum. The VMAT plans were generated with two Elekta linear accelerators (Synergy® and Versa HD™). The planning target volume (PTV) coverage, organs-at-risk dose constraints, and four dosimetric indexes were considered. The deliverability of the plans was assessed using quality assurance (gamma index evaluation) measurements; clinical judgment was included in the assessment. The mean AAPM TG218 (3%-2 mm, global normalization) gamma index values were 99.4%, 97.8%, and 96.6% for Radixact™, Versa HD™, and Synergy®, respectively. Radixact™ performed better than Versa HD™ in terms of dosimetric indexes, hippocampi D100%, spinal cord Dmax, rectum V38.4 Gy, bladder V30 Gy, and V40 Gy. Versa HD™ saved more of the (lungs-PTV) V5 Gy and (lungs-PTV) Dmean, heart Dmean, breasts V4 Gy, and bowel V45 Gy. Regarding Synergy®, the head and neck Radixact™ plan saved more of the parotid gland, oral cavity, and supraglottic larynx. From a clinical point of view, for the head and neck, prostate, and rectal sites, the Radixact™ and Versa HD™ plans were similar; Radixact™ plans were preferable for the head and neck and rectum to Synergy® plans. The quality of linac plans has improved, and differences with tomotherapy have decreased. However, tomotherapy continues to be an essential add-on in multi-machine departments.
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Affiliation(s)
- Elena Gallio
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy.
| | - Anna Sardo
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy
| | - Serena Badellino
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Cristina Mantovani
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Mario Levis
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Christian Fiandra
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Alessia Guarneri
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Francesca Arcadipane
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Veronica Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Francesca Romana Giglioli
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy
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Tu KY, Huang YS, Lau J, Lee HH. Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review. Front Oncol 2022; 12:1045752. [PMID: 36452486 PMCID: PMC9702327 DOI: 10.3389/fonc.2022.1045752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/16/2022] [Accepted: 10/25/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Pancreatic neuroendocrine tumor (NET) is rare, and the majority presents late in their clinical course. Here, we present a huge locally advanced pancreatic NET having Hi-Art helical Tomotherapy that resulted in a 68% reduction in target volume during adaptive image-guided radiotherapy (IGRT). CASE SUMMARY A 63-year-old man without any history of systemic disease developed voiding difficulty for several months. Associated symptoms included poor appetite, nausea, distended abdomen, and body weight loss. Further magnetic resonance imaging showed a large multilobulated tumor in the left upper abdomen. Tumor biopsy revealed well-differentiated, grade 2, neuroendocrine tumor. Complete resection was unattainable. Therefore, Lanreotide was prescribed initially. However, tumor progression up to the greatest diameter of 18 cm was noted on computed tomography 5 months later. Thus, he stopped Lanreotide and commenced on concurrent chemoradiotherapy (CCRT). With a total dose of 70 Gy in 35 fractions, we generated two adaptive treatment plans during the whole course. Laparoscopic subtotal pancreatectomy with spleen preservation was performed after neoadjuvant CCRT. It has been more than 3 years after IGRT, and he remains cancer free and reports no side effects during regular follow-ups. CONCLUSION Tomotherapy caused tumor size reduction and hence facilitated surgical possibility for this originally unresectable pancreatic NET. Neoadjuvant IGRT incorporated with adaptive treatment planning enhanced delivery accuracy. In this case of pancreatic NET resistant to Lanreotide, inter-fractional tumor regression from 1910 to 605 cc (68%) was documented.
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Affiliation(s)
- Kuan-Yi Tu
- School of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Shuo Huang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Juntiong Lau
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Lee
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Ju SG, Ahn YC, Kim YB, Kim JM, Kwon DY, Park BS, Yang K. Dosimetric comparison between VMAT plans using the fast-rotating O-ring linac with dual-layer stacked MLC and helical tomotherapy for nasopharyngeal carcinoma. Radiat Oncol 2022; 17:155. [PMID: 36096874 PMCID: PMC9465858 DOI: 10.1186/s13014-022-02124-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the dosimetric profiles of volumetric modulated arc therapy (VMAT) plans using the fast-rotating O-ring linac (the Halcyon system) based on a dual-layer stacked multi-leaf collimator and helical tomotherapy (HT) for nasopharyngeal cancer (NPCa). METHODS For 30 NPCa patients, three sets of RT plans were generated, under the same policy of contouring and dose constraints: HT plan; Halcyon VMAT plan with two arcs (HL2arc); and Halcyon VMAT plan with four arcs (HL4arc), respectively. The intended dose schedule was to deliver 67.2 Gy to the planning gross target volume (P-GTV) and 56.0 Gy to the planning clinical target volume (P-CTV) in 28 fractions using the simultaneously integrated boost concept. Target volumes and organ at risks dose metrics were evaluated for all plans. Normal tissue complication probabilities (NTCP) for esophagus, parotid glands, spinal cord, and brain stem were compared. RESULTS The HT plan achieved the best dose homogeneity index for both P_GTV and P_CTV, followed by the HL4arc and L2arc plans. No significant difference in the dose conformity index (CI) for P_GTV was observed between the HT plan (0.80) and either the HL2arc plan (0.79) or the HL4arc plan (0.83). The HL4arc plan showed the best CI for P_CTV (0.88), followed by the HL2arc plan (0.83) and the HT plan (0.80). The HL4arc plan (median, interquartile rage (Q1, Q3): 25.36 (22.22, 26.89) Gy) showed the lowest Dmean in the parotid glands, followed by the HT (25.88 (23.87, 27.87) Gy) and HL2arc plans (28.00 (23.24, 33.99) Gy). In the oral cavity (OC) dose comparison, the HT (22.03 (19.79, 24.85) Gy) plan showed the lowest Dmean compared to the HL2arc (23.96 (20.84, 28.02) Gy) and HL4arc (24.14 (20.17, 27.53) Gy) plans. Intermediate and low dose regions (40-65% of the prescribed dose) were well fit to the target volume in HL4arc, compared to the HT and HL2arc plans. All plans met the dose constraints for the other OARs with sufficient dose margins. The between-group differences in the median NTCP values for the parotid glands and OC were < 3.47% and < 1.7% points, respectively. CONCLUSIONS The dosimetric profiles of Halcyon VMAT plans were comparable to that of HT, and HL4arc showed better dosimetric profiles than HL2arc for NPCa.
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Affiliation(s)
- Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| | - Yeong-Bi Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jin Man Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Dong Yeol Kwon
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Byoung Suk Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea
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Yang B, Geng H, Chang TYA, Tse MY, Lam WW, Huang CY, Wu T, Lau KK, Cheung KY, Chiu G, Yu SK. Clinical implementation of kVCT-guided tomotherapy with ClearRT. Phys Eng Sci Med 2022; 45:915-924. [PMID: 35925545 DOI: 10.1007/s13246-022-01162-y] [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: 02/28/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
A helical fan-beam kilovoltage computed tomography (kVCT) was recently introduced into Tomotherapy units. This study aims to share the initial experience of kVCT in clinical workflow, compare its performance with that of the existing megavoltage computed tomography (MVCT), and explore its potential in adaptive planning. We retrospectively enrolled 23 patients who underwent both MVCT and kVCT scans. The clinical performance data regarding image acquisition time, nominal dose length product (DLP), registration time and registration corrections were extracted and compared. Image quality was scored by six experienced radiation therapists and quantified based on phantom measurements. CT number stability and the implementation of adaptive radiotherapy were dosimetrically evaluated by performing the dose recalculation on kVCT. Compared to MVCT, kVCT significantly reduced DLP (except the highest kVp protocol), image acquisition and registration time. KVCT obtained higher scores than MVCT on all criteria except artifacts. Phantom measurements also revealed a better image performance characterization of kVCT except for image uniformity. The CT number variation could lead to a dose difference of 0.5% for D95% of target and Dmean of organ-at-risk. For the treatment planning with kVCT, a systematic dose difference (> 1%) in PTV dose metrics was observed at regions with large longitudinal density discontinuities compared to the reference plans. The new kVCT imaging provides enhanced soft-tissue visualization. The improved efficiency with kVCT-guided treatment will allow more patients to be treated each day. In most cases, the dose calculation accuracy of kVCT images is acceptable except for regions with severe artifacts.
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Affiliation(s)
- Bin Yang
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China.
| | - Hui Geng
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Tien Yee Amy Chang
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Mei Yan Tse
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Wai Wang Lam
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Chen-Yu Huang
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Tungho Wu
- TMU Proton Center, Taipei Medical University Hospital, 252 Wuxing Street, Xinyi District, Taipei, Taiwan
| | - Ka Ki Lau
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - George Chiu
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, China
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9
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Cheng YK, Kuo SH, Yen HH, Wu JH, Chen YC, Huang MY. The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric modulated arc therapy. Radiat Oncol 2022; 17:91. [PMID: 35549962 PMCID: PMC9097430 DOI: 10.1186/s13014-022-02063-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/09/2021] [Accepted: 05/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background To analyze the prognostic factors associated with stage IB-IVA cervical cancer in patients who underwent concurrent chemoradiation therapy (CCRT) and to compare the clinical toxicities and dosimetric parameters of organs at risk between the different radiotherapy techniques. Methods This retrospective study enrolled 93 patients with stage IB-IVA cervical cancer who underwent definitive CCRT between April 2009 and December 2017. Nine patients (9.7%) received 3DCRT, 43 patients (46.2%) underwent VMAT, and 41 patients (44.1%) received tomotherapy, and all of them followed by brachytherapy using a 2D planning technique. The treatment outcomes and related prognostic factors were analyzed. We also compared the clinical toxicities and dosimetric parameters between the different techniques used for the last 30 patients. Results With a median follow-up of 52.0 months, the 5-year overall survival (OS), progression-free survival (PFS), locoregional recurrence–free survival (LRRFS), and distant metastases–free survival (DMFS) were analyzed. In a Cox proportional hazards regression model, pretreatment SCC Ag > 10 ng/mL was a significant prognostic factor for PFS (hazard ratio [HR] 2.20; 95% confidence interval [CI] 1.03–4.70; P = 0.041), LRRFS (HR, 3.48; 95% CI 1.07–11.26; P = 0.038), and DMFS (HR 2.80; 95% CI 1.02–7.67; P = 0.045). Increasing the rectal volume receiving a radiation dose exceeding 30 Gy (V30 of rectum; odds ratio [OR] 1.15; 95% CI 1.10–1.30; P = 0.03) was associated with a higher possibility of ≥ Grade 2 acute radiation therapy (RT)-related diarrhea. The median rectal V30 values were 56.4%, 97.5%, and 86.5% for tomotherapy, 3-dimensional conformal radiation therapy (3DCRT), and volumetric modulated arc therapy (VMAT), respectively (P < 0.001). In addition, the chance of experiencing ≥ Grade 2 acute diarrhea were 10.0%, 66.7%, and 54.5% for tomotherapy, 3DCRT, and VMAT, respectively (P = 0.029). Conclusions Patients with pretreatment SCC Ag ≤ 10 ng/mL have better PFS, LRRFS, and DMFS than those with pretreatment SCC Ag > 10 ng/mL. The rectal V30 is a significant predictor of severe acute diarrhea. Tomotherapy significantly decreased the rectal V30, reducing the severity of acute RT-related diarrhea during external beam RT. Trial registration This study was approved by the institutional review board at Kaohsiung Medical University Hospital. The registration number is KMUHIRB-E(I)-20190054 and retrospectively registered on 2019/3.
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Affiliation(s)
- Yuan-Kai Cheng
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Hsun Kuo
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Heng-Hsuan Yen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jing-Hu Wu
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chieh Chen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan.
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10
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Liu Y, Chen Z, Wang J, Wang X, Qu B, Ma L, Zhao W, Zhang G, Xu S. Dose Prediction Using a Three-Dimensional Convolutional Neural Network for Nasopharyngeal Carcinoma With Tomotherapy. Front Oncol 2021; 11:752007. [PMID: 34858825 PMCID: PMC8631763 DOI: 10.3389/fonc.2021.752007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose This study focused on predicting 3D dose distribution at high precision and generated the prediction methods for nasopharyngeal carcinoma patients (NPC) treated with Tomotherapy based on the patient-specific gap between organs at risk (OARs) and planning target volumes (PTVs). Methods A convolutional neural network (CNN) is trained using the CT and contour masks as the input and dose distributions as output. The CNN is based on the "3D Dense-U-Net", which combines the U-Net and the Dense-Net. To evaluate the model, we retrospectively used 124 NPC patients treated with Tomotherapy, in which 96 and 28 patients were randomly split and used for model training and test, respectively. We performed comparison studies using different training matrix shapes and dimensions for the CNN models, i.e., 128 ×128 ×48 (for Model I), 128 ×128 ×16 (for Model II), and 2D Dense U-Net (for Model III). The performance of these models was quantitatively evaluated using clinically relevant metrics and statistical analysis. Results We found a more considerable height of the training patch size yields a better model outcome. The study calculated the corresponding errors by comparing the predicted dose with the ground truth. The mean deviations from the mean and maximum doses of PTVs and OARs were 2.42 and 2.93%. Error for the maximum dose of right optic nerves in Model I was 4.87 ± 6.88%, compared with 7.9 ± 6.8% in Model II (p=0.08) and 13.85 ± 10.97% in Model III (p<0.01); the Model I performed the best. The gamma passing rates of PTV60 for 3%/3 mm criteria was 83.6 ± 5.2% in Model I, compared with 75.9 ± 5.5% in Model II (p<0.001) and 77.2 ± 7.3% in Model III (p<0.01); the Model I also gave the best outcome. The prediction error of D95 for PTV60 was 0.64 ± 0.68% in Model I, compared with 2.04 ± 1.38% in Model II (p<0.01) and 1.05 ± 0.96% in Model III (p=0.01); the Model I was also the best one. Conclusions It is significant to train the dose prediction model by exploiting deep-learning techniques with various clinical logic concepts. Increasing the height (Y direction) of training patch size can improve the dose prediction accuracy of tiny OARs and the whole body. Our dose prediction network model provides a clinically acceptable result and a training strategy for a dose prediction model. It should be helpful to build automatic Tomotherapy planning.
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Affiliation(s)
- Yaoying Liu
- Department of Radiation Oncology, the First Medical Center of the People's Liberation Army General Hospital, Beijing, China.,School of Physics, Beihang University, Beijing, China
| | | | - Jinyuan Wang
- Department of Radiation Oncology, the First Medical Center of the People's Liberation Army General Hospital, Beijing, China
| | - Xiaoshen Wang
- Department of Radiation Oncology, the First Medical Center of the People's Liberation Army General Hospital, Beijing, China
| | - Baolin Qu
- Department of Radiation Oncology, the First Medical Center of the People's Liberation Army General Hospital, Beijing, China
| | - Lin Ma
- Department of Radiation Oncology, the First Medical Center of the People's Liberation Army General Hospital, Beijing, China
| | - Wei Zhao
- School of Physics, Beihang University, Beijing, China
| | - Gaolong Zhang
- School of Physics, Beihang University, Beijing, China
| | - Shouping Xu
- Department of Radiation Oncology, the First Medical Center of the People's Liberation Army General Hospital, Beijing, China
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11
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Höfel S, Gandalini M, Fix MK, Drescher M, Zwicker F. Prospective superficial EPR in-vivo dosimetry study during hypofractionated radiotherapy of breast cancer patients treated with helical tomotherapy. Radiat Oncol 2021; 16:209. [PMID: 34717680 PMCID: PMC8557483 DOI: 10.1186/s13014-021-01938-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In-vivo dosimetry (IVD) is a patient specific measure of quality control and safety during radiotherapy. With regard to current reporting thresholds for significant occurrences in radiotherapy defined by German regulatory authorities, the present study examines the clinical feasibility of superficial electron paramagnetic resonance (EPR) IVD of cumulative total doses applied to breast cancer patients treated with helical intensity-modulated radiotherapy (tomotherapy). METHODS In total, 10 female patients with left- or right-sided breast cancer were enrolled in this prospective IVD study. Each patient received a hypofractionated whole breast irradiation. A total median dose of 42.4 Gy in 16 fractions (5 fractions per week) was prescribed to the planning target volume. The treatments were completely delivered using helical tomotherapy and daily image guidance via megavoltage CT (MVCT). For each patient, three EPR dosimeters were prepared and placed at distinct locations on the patient's skin during the delivery of all fractions. Two dosimeters were placed next to the ipsilateral and contralateral mammilla and one dosimeter was placed ventrally to the thyroid (out-of-primary-beam). The total doses delivered to the dosimeters were readout after all fractions had been administered. The measured total dose values were compared to the planned dose values derived from the treatment planning system (TPS). Daily positional variations (displacement vectors) of the ipsilateral mammilla and of the respective dosimeter were analyzed with respect to the planned positions using the daily registered MVCT image. RESULTS Averaged over all patients, the mean absolute dose differences between measured and planned total dose values (± standard deviation (SD)) were: 0.49 ± 0.85 Gy for the ipsilateral dosimeter, 0.17 ± 0.49 Gy for the contralateral dosimeter and -0.12 ± 0.30 Gy for the thyroid dosimeter. The mean lengths of the ipsilateral displacement vectors (± SD) averaged over all patients and fractions were: 10 ± 7 mm for the dosimeter and 8 ± 4 mm for the mammilla. CONCLUSION Superficial EPR IVD is suitable as additional safeguard for dose delivery during helical tomotherapy of breast cancer. Despite positional uncertainties in clinical routine, the observed dose deviations at the ipsilateral breast were on average small compared to national reporting thresholds for total dose deviations (i.e. 10%/4 Gy). EPR IVD may allow for the detection of critical dose errors during whole breast irradiations.
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Affiliation(s)
- Sebastian Höfel
- Department of Chemistry and Konstanz Research School Chemical Biology, University of Konstanz, Konstanz, Germany.
- Klinik und Praxis für Strahlentherapie am Klinikum Konstanz, Konstanz, Germany.
- Department of Chemistry, AG Drescher, University of Konstanz, Universitätsstraße 10, Box 706, 78457, Konstanz, Germany.
| | - Matteo Gandalini
- Klinik und Praxis für Strahlentherapie am Klinikum Konstanz, Konstanz, Germany
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Malte Drescher
- Department of Chemistry and Konstanz Research School Chemical Biology, University of Konstanz, Konstanz, Germany
| | - Felix Zwicker
- Klinik und Praxis für Strahlentherapie am Klinikum Konstanz, Konstanz, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Höfel S, Fix MK, Drescher M, Zwicker F. Suitability of superficial electron paramagnetic resonance dosimetry for in vivo measurement and verification of cumulative total doses during IMRT: A proof of principle. Z Med Phys 2021; 31:365-377. [PMID: 34210537 DOI: 10.1016/j.zemedi.2021.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The present study investigates superficial in vivo dosimetry (IVD) by means of a previously proposed electron paramagnetic resonance (EPR) dosimetry system aiming at measuring and verifying total doses delivered by complex radiotherapy treatments. In view of novel regulatory requirements in Germany, differences between measured and planned total doses to the EPR dosimeters are analyzed and compared to reporting thresholds for significant occurrences. METHODS EPR dosimeters, each consisting of one lithium formate monohydrate (LFM) and one polycrystalline l-alanine (ALA) pellet, were attached to the surface of an anthropomorphic head phantom. Three head and neck treatments with total target doses ranging from 30 to 64Gy were fully delivered to the phantom by helical tomotherapy. During each treatment, eight EPR dosimeters were placed at distinct spots: (i) within or next to the planning target volume (PTV), (ii) near to organs at risk including the parotids and the lenses, (iii) at the thyroid lying out-of-field. EPR read out was always performed after all fractions were delivered. EPR results were compared to thermoluminescence dosimeter (TLD) measurements and to the planned total doses derived from the treatment planning system (TPS). Planned total doses to the EPR dosimeters ranged from about 2 to 64Gy. RESULTS By taking uncertainties into account, the measured and planned doses were in good agreement. Exceptions occurred mainly at the thyroid (out-of-field) and lenses (extreme sparing). The maximum total dose difference between EPR results and corresponding planned doses was 1.3Gy occurring at the lenses. Remarkably, each LFM and ALA pellet placed within or next to the PTV provided dose values that were within ±4% of the planned dose. Dose deviations from planned dose values were comparable for EPR and TLD measurements. CONCLUSION The results of this proof of principle study suggests that superficial EPR-IVD is applicable in a wide dose range and in various irradiation conditions - being a valuable tool for monitoring cumulative total doses delivered by complex IMRT treatments. EPR-IVD in combination with helical tomotherapy is suitable to reliably detect local dose deviations at superficial dosimeter spots in the order of current national reporting thresholds for significant occurrences (i.e. 10%/4Gy).
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Affiliation(s)
- Sebastian Höfel
- Department of Chemistry and Konstanz Research School Chemical Biology, University of Konstanz, Germany; Klinik und Praxis fr Strahlentherapie am Klinikum Konstanz, Konstanz, Germany.
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Malte Drescher
- Department of Chemistry and Konstanz Research School Chemical Biology, University of Konstanz, Germany
| | - Felix Zwicker
- Klinik und Praxis fr Strahlentherapie am Klinikum Konstanz, Konstanz, Germany; Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Okada W, Doi H, Tanooka M, Sano K, Nakamura K, Sakai Y, Shibata M, Tanaka M. A first report of tumour-tracking radiotherapy with helical tomotherapy for lung and liver tumours: A double case report. SAGE Open Med Case Rep 2021; 9:2050313X211023688. [PMID: 34178347 PMCID: PMC8202334 DOI: 10.1177/2050313x211023688] [Citation(s) in RCA: 2] [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: 11/23/2020] [Accepted: 05/18/2021] [Indexed: 12/31/2022] Open
Abstract
There are only a limited number of previous reports on clinical cases using tumour tracking with tomotherapy. Therefore, we present two cases of patients treated with tumour tracking with tomotherapy. First, a 74-year-old man with an inoperable lung cancer type T1bN0M0 underwent stereotactic body radiotherapy at a total dose of 48 Gy in four fractions. Second, a 68-year-old man with hepatocellular carcinoma with a portal venous tumour thrombosis and history of liver stereotactic body radiotherapy with fiducial marker implantation received radiotherapy at a total dose of 48 Gy in 20 fractions. The results of patient-specific quality assurance and tracking radiotherapy were sufficient to irradiate tumours. Tumour tracking with tomotherapy successfully delivered radiation in a total of 24 treatment fractions in both patients. Tumour tracking with tomotherapy is feasible in lung and liver cancer treatment. This study's findings suggest the clinical use of tumour tracking with tomotherapy.
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Affiliation(s)
- Wataru Okada
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
| | - Hiroshi Doi
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan.,Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masao Tanooka
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
| | - Keisuke Sano
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
| | - Kenji Nakamura
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
| | - Yusuke Sakai
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
| | - Mayuri Shibata
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
| | - Masahiro Tanaka
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Japan
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14
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Haraldsson A, Wichert S, Engström PE, Lenhoff S, Turkiewicz D, Warsi S, Engelholm S, Bäck S, Engellau J. Organ sparing total marrow irradiation compared to total body irradiation prior to allogeneic stem cell transplantation. Eur J Haematol 2021; 107:393-407. [PMID: 34107104 DOI: 10.1111/ejh.13675] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (HSCT) in myeloablative conditioning regimens. However, TBI may be replaced by total marrow irradiation (TMI) at centres with access to Helical TomoTherapy, a modality that has the advantage of delivering intensity-modulated radiotherapy to long targets such as the entire bone marrow compartment. Toxicity after organ sparing TMI prior to HSCT has not previously been reported compared to TBI or with regard to engraftment data. METHODS We conducted a prospective observational study on 37 patients that received organ sparing TMI prior to HSCT and compared this cohort to retrospective data on 33 patients that received TBI prior to HSCT. RESULTS The 1-year graft-versus-host disease-free, relapse-free survival (GRFS) was 67.5% for all patients treated with TMI and 80.5% for patients with matched unrelated donor and treated with TMI, which was a significant difference from historical data on TBI patients with a hazard ratio of 0.45 (P = .03) and 0.24 (P < .01). Engraftment with a platelet count over 20 [K/µL] and 50 [K/µL] was significantly shorter for the TMI group, and neutrophil recovery was satisfactory in both treatment cohorts. There was generally a low occurrence of other treatment-related toxicities. CONCLUSIONS Despite small cohorts, some significant differences were found; TMI as part of the myeloablative conditioning yields a high 1-year GRFS, fast and robust engraftment, and low occurrence of acute toxicity.
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Affiliation(s)
- André Haraldsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of medical radiation physics, Clinical Sciences, Lund university, Lund, Sweden
| | - Stina Wichert
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Stig Lenhoff
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Dominik Turkiewicz
- Department of Pediatric Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Sarah Warsi
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Division of Molecular Medicine and Gene Therapy, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of medical radiation physics, Clinical Sciences, Lund university, Lund, Sweden
| | - Jacob Engellau
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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15
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Pang T, Yang B, Liu X, Castle JR, Yu L, Liu N, Li W, Dong T, Qiu J, Chen Q. Investigation of absolute dose calibration accuracy for TomoTherapy using real water. J Appl Clin Med Phys 2021; 22:139-145. [PMID: 34060222 PMCID: PMC8200510 DOI: 10.1002/acm2.13311] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
A systematic bias in TomoTherapy output calibration was reported by the Imaging and Radiation Oncology Core Houston (IROC‐H) after analyzing intensity‐modulated radiation therapy (IMRT) credentialing results from hundreds of TomoTherapy units. Multiple theories were developed to explain this observation. One theory was that the use of a solid water “cheese” phantom instead of real water in the calibration measurement was the culprit. A phantom filled with distilled water was built to investigate whether our TomoTherapy was miscalibrated due to the use of a solid water phantom. A miscalibration of −1.47% was detected on our TomoTherapy unit. It is found that despite following the vendor's updated recommendation on computed tomography (CT) number to density calibration, the cheese phantom was still mapped to a density of 1.028 g/cm3, rather than the 1.01 g/cm3 value reported in literature. When the density of the cheese phantom was modified to 1.01 g/cm3 in the treatment planning system, the measurement also indicated that our TomoTherapy machine was miscalibrated by −1.52%, agreeing with the real water phantom findings. Our single‐institution finding showed that the cheese phantom density assignment can introduce greater than 1% errors in the TomoTherapy absolute dose calibration. It is recommended that the absolute dose calibration for TomoTherapy be performed either in real water or in the cheese phantom with the density in TPS overridden as 1.01 g/cm3.
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Affiliation(s)
- Tingtian Pang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Bo Yang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Xia Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - James R Castle
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Lang Yu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Nan Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Wenbo Li
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Tingting Dong
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Jie Qiu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Quan Chen
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
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16
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Peet SC, Kairn T, Lancaster CM, Trapp JV, Sylvander SR, Crowe SB. Measuring foetal dose from tomotherapy treatments. Med Dosim 2021; 46:342-346. [PMID: 33934977 DOI: 10.1016/j.meddos.2021.03.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/26/2021] [Accepted: 03/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Treating pregnant women in the radiotherapy clinic is a rare occurrence. When it does occur, it is vital that the dose received by the developing embryo or foetus is understood as fully as possible. This study presents the first investigation of foetal doses delivered during helical tomotherapy treatments. Six treatment plans were delivered to an anthropomorphic phantom using a tomotherapy machine. These included treatments of the brain, unilateral and bilateral head-and-neck, chest wall, and upper lung. Measurements of foetal dose were made with an ionisation chamber positioned at various locations longitudinally within the phantom to simulate a variety of patient anatomies. All measurements were below the established limit of 100 mGy for a high risk of damage during the first trimester. The largest dose encountered was 75 mGy (0.125% of prescription dose). The majority of treatments with measurement positions less than 30 cm fell into the range of uncertain risk (50 - 100 mGy). All treatments with measurement positions beyond 30 cm fell into the low risk category (< 50 mGy). For the cases in this study, tomotherapy resulted in foetal doses that are at least on par with, if not significantly lower than, similar 3D conformal or intensity-modulated treatments delivered with other devices. Recommendations were also provided for estimating foetal doses from tomotherapy plans.
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Affiliation(s)
- Samuel C Peet
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia.
| | - Tanya Kairn
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia
| | - Craig M Lancaster
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia
| | - Jamie V Trapp
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia
| | - Steven R Sylvander
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia
| | - Scott B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia
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17
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Ma M, Men K, Dai J. A patient risk model to determine the optimal output constancy check frequency for a radiotherapy machine. Phys Med 2021; 84:192-197. [PMID: 33901864 DOI: 10.1016/j.ejmp.2021.04.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/06/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The output constancy check, a basic quality control (QC) item for radiotherapy machines, is performed daily according to suggestions in technical reports by experienced experts. In this study, a patient risk model was built to determine the optimal frequency of an output constancy check for a specific radiotherapy machine. METHODS AND MATERIALS The method was based on the patient risk model and comprised three steps: 1) the power function graph was used to select a proper QC rule and the average number of QC measurements per QC rule evaluation. 2) The optimal QC frequency was determined by the minimum integer value of expected patients treated between QC measurements. 3) The individual control chart (I-Chart) was used to evaluate the effectiveness of the model. The model was implemented on the output constancy check of a Tomotherapy machine. RESULTS The QC rule with the limits set to the mean ± 3 standard deviations and 5 measurements per QC were selected according to the power function graph. The optimal frequency was observed every 21 patients. The I-Chart showed that the optimal frequency detected the machine failure earlier compared to the conventional daily frequency. The model could monitor whether Tomotherapy machine was in good condition and predicted the time to adjust the machine. CONCLUSIONS The optimal output constancy check frequency of a radiotherapy machine is determined by the number of patients, which uses patient risk model. The optimal frequency is superior to the conventional daily frequency in identifying machine failure earlier.
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Affiliation(s)
- Min Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kuo Men
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Öztunali A, Elsayad K, Scobioala S, Channaoui M, Haverkamp U, Grauer O, Sträter R, Brentrup A, Stummer W, Kerl K, Eich HT. Toxicity Reduction after Craniospinal Irradiation via Helical Tomotherapy in Patients with Medulloblastoma: A Unicentric Retrospective Analysis. Cancers (Basel) 2021; 13:cancers13030501. [PMID: 33525583 PMCID: PMC7865289 DOI: 10.3390/cancers13030501] [Citation(s) in RCA: 2] [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: 12/23/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Recent trials with craniospinal irradiation (CSI) via helical Tomotherapy (HT) demonstrated encouraging medulloblastoma results. In this study, we assess the toxicity profile of different radiation techniques and estimate survival rates. Materials and Methods: We reviewed the records of 46 patients who underwent irradiation for medulloblastoma between 1999 and 2019 (27 conventional radiotherapy technique (CRT) and 19 HT). Patient, tumor, and treatment characteristics, as well as treatment outcomes-local control rate (LCR), event-free survival (EFS), and overall survival (OS)-were reviewed. Acute and late adverse events (AEs) were evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results: In total, 43 courses of CSI and three local RT were administered to the 46 patients: 30 were male, the median age was 7 years (range 1-56). A median total RT dose of 55 Gy (range 44-68) and a median CSI dose of 35 Gy (range, 23.4-40) was delivered. During follow-up (median, 99 months), six patients (13%) developed recurrence. The EFS rate after 5 years was 84%. The overall OS rates after 5 and 10 years were 95% and 88%, respectively. There were no treatment-related deaths. Following HT, a trend towards lower grade 2/3 acute upper gastrointestinal (p = 0.07) and subacute CNS (p = 0.05) toxicity rates was detected compared to CRT-group. The risk of late CNS toxicities, mainly grade 2/3, was significantly lower following HT technique (p = 0.003). Conclusion: CSI via HT is an efficacious treatment modality in medulloblastoma patients. In all, we detected a reduced rate of several acute, subacute, and chronic toxicities following HT compared to CRT.
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Affiliation(s)
- Anil Öztunali
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Khaled Elsayad
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
- Correspondence: ; Tel.: +49-0-2518347384
| | - Sergiu Scobioala
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Mohammed Channaoui
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Uwe Haverkamp
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
| | - Oliver Grauer
- Neuro-Oncology Department, University Hospital Muenster, 48149 Muenster, Germany;
| | - Ronald Sträter
- Pediatric Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (R.S.); (K.K.)
| | - Angela Brentrup
- Department of Neurosurgery, University Hospital Muenster, 48149 Muenster, Germany; (A.B.); (W.S.)
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Muenster, 48149 Muenster, Germany; (A.B.); (W.S.)
| | - Kornelius Kerl
- Pediatric Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (R.S.); (K.K.)
| | - Hans Theodor Eich
- Radiation Oncology Department, University Hospital Muenster, 48149 Muenster, Germany; (A.Ö.); (S.S.); (M.C.); (U.H.); (H.T.E.)
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Liu X, Liu Z, Pang T, Dong T, Qiu J. Dosimetric comparison of tomotherapy and volumetric-modulated arc therapy for children with neuroblastoma. Pediatr Investig 2020; 4:186-191. [PMID: 33150312 PMCID: PMC7520106 DOI: 10.1002/ped4.12215] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/20/2020] [Indexed: 01/18/2023] Open
Abstract
Importance Irradiation treatment for pediatric patients with neuroblastoma represents a major challenge due to the pediatric dose limits for critical structures and the necessity of sufficient dose coverage of the clinical target volume for local control. Objective To investigate dosimetric differences between tomotherapy (TOMO) and volumetric‐modulated arc therapy (VMAT) as retroperitoneal radiotherapy for children with neuroblastoma. Methods Eight patients who received retroperitoneal radiotherapy for neuroblastoma were selected for comparison of TOMO and VMAT treatment plans. The Dmin, Dmax, Dmean, D95, D2, and D98 of planning target volume (PTV), conformity index (CI), heterogeneity index (HI), and organs at risk (OARs) parameters were compared. Delivery machine unit (MU) and image‐guide radiotherapy solution results were also compared. Results All patients received a cumulative dose of 19.5 Gy to the PTV. VMAT showed higher CI (0.93 ± 0.02), compared with TOMO (0.87 ± 0.03, P < 0.001). Notably, the average PTV HI was significantly better using TOMO (1.05 ± 0.01) than VMAT (1.08 ± 0.02, P = 0.003). Compared with VMAT, the Dmin, D95, and D98 all exhibited increases in TOMO; Dmax variation was less than 1% in TOMO. The D0.1cc for the spinal cord and D2cc for the small intestine were better in TOMO in terms of OARs. However, TOMO had more MUs and required a longer delivery time. Interpretation Both planning techniques are capable of producing high‐ quality treatment plans. TOMO is superior for PTV coverage, but inferior for CI. TOMO requires extra treatment time; its cost is greater than the cost of VMAT.
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Affiliation(s)
- Xia Liu
- Department of Radiotherapy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Zhikai Liu
- Department of Radiotherapy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Tingtian Pang
- Department of Radiotherapy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Tingting Dong
- Department of Radiotherapy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Jie Qiu
- Department of Radiotherapy Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
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20
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Mayorov K, Ali E. Magnitude and dosimetric impact of inter-fractional positional variations of the metal port of tissue expanders in postmastectomy patients treated with radiation. Phys Imaging Radiat Oncol 2020; 16:37-42. [PMID: 33458342 PMCID: PMC7807575 DOI: 10.1016/j.phro.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/24/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND PURPOSE Postmastectomy breast reconstruction involves the insertion of a temporary tissue expander, which contains a metal injection port. The purpose of this study was to determine the magnitude and dosimetric impact of the inter-fractional positional variations of the port for patients treated with radiation. MATERIALS AND METHODS For nine breast cases treated on Tomotherapy, the deviation of the port in the daily MVCT from its reference position was measured in the three cardinal directions. The dosimetric effects of the measured errors were evaluated for two classes of error: Internal Port Error (IPE) and Patient Registration Error (PRE). For each class, dose accumulation was done for daily measured errors and a systematic error. RESULTS Inter-fractional positional errors of the port were small, with 87% of the deviations below 5 mm, but errors larger than 1.5 cm were observed. The cumulative effect of the daily measured and systematic IPE decreased target coverage by as much as 2.8% and 3.5%, respectively. The cumulative effect of the daily measured PRE decreased target coverage by an average of 3.5%. The cumulative effect of a systematic PRE significantly decreased target coverage by an average of 16%. CONCLUSION The presence of IPE over the course of treatment had minimal clinical impact while PRE had a greater impact on clinically-relevant regions. The robustness of treatment delivery can be improved by assigning the port its appropriate density during planning despite contouring uncertainties due to metal artefacts, and by prioritizing anatomical alignment over port alignment during daily registration.
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Affiliation(s)
- Keren Mayorov
- Department of Physics, Carleton University, 1125 Colonel By Drive, Ottawa, Canada
| | - Elsayed Ali
- Department of Physics, Carleton University, 1125 Colonel By Drive, Ottawa, Canada
- The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, Canada
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21
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Ju SG, Ahn YC, Kim YB, Park SG, Choi YM, Na CH, Hong CS, Oh D, Kwon DY, Kim CC, Kim DH. Development of a Tongue Immobilization Device Using a 3D Printer for Intensity Modulated Radiation Therapy of Nasopharyngeal Cancer Patients. Cancer Res Treat 2020; 53:45-54. [PMID: 32972044 PMCID: PMC7812000 DOI: 10.4143/crt.2020.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/12/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose This study aimed to reduce radiation doses to the tongue, a patient-specific semi-customized tongue immobilization device (SCTID) was developed using a 3D printer for helical tomotherapy (HT) of nasopharyngeal cancer (NPCa). Dosimetric characteristics and setup stability of the SCTID were compared with those of a standard mouthpiece (SMP). Materials and Methods For displacement and robust immobilization of the tongue, the SCTID consists of four parts: upper and lower tooth stoppers, tongue guider, tongue-tip position guide bar, and connectors. With the SCTID and SMP, two sets of planning computed tomography and HT plans were obtained for 10 NPCa patients. Dosimetric and geometric characteristics were compared. Position reproducibility of the tongue with SCTID was evaluated by comparing with planned dose and adaptive accumulated dose of the tongue and base of the tongue based on daily setup mega-voltage computed tomography. Results Using the SCTID, the tongue was effectively displaced from the planning target volume compared to the SMP. The median mucosa of the tongue (M-tongue) dose was significantly reduced (20.7 Gy vs. 27.8 Gy). The volumes of the M-tongue receiving a dose of 15 Gy, 30 Gy, and 45 Gy and the volumes of the mucosa of oral cavity and oropharynx (M-OC/OP) receiving a dose of 45 Gy and 60 Gy were significantly lower than using the SMP. No significant differences was observed between the planned dose and the accumulated adaptive dose in any dosimetric characteristics of the tongue and base of tongue. Conclusion SCTID can not only reduce the dose to the M-tongue and M-OC/OP dramatically, when compared to SMP, but also provide excellent reproducibility and easy visual verification.
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Affiliation(s)
- Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yeong-Bi Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Gyu Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Mi Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Cho Hee Na
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Yeol Kwon
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Chong Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyeon Kim
- Institute of Advanced Convergence Technology, Kyungpook National University, Daegu, Korea
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22
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Salfelder MEA, Kessel KA, Thiel U, Burdach S, Kampfer S, Combs SE. Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy. Strahlenther Onkol 2020; 196:1103-1115. [PMID: 32748147 PMCID: PMC7686189 DOI: 10.1007/s00066-020-01670-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
Background and purpose Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a focus on multitarget RT (mtRT). Materials and methods From 2008 to 2017, 38 children diagnosed with sarcoma were treated with tomotherapy. The median age was 15 years (6–19 years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0–6 months) and late (>6 months) after RT, and long-term sideeffects (>24 months). Results The main histologies were Ewing sarcoma (n = 23 [61%]) and alveolar rhabdomyosarcoma (n = 5 [13%]). RT was performed with a median total dose of 54 Gy (40.5–66.0 Gy) and a single dose of 2 Gy (1.80–2.27 Gy). Twenty patients (53%) received mtRT. Median follow-up was 29.7 months (95% confidence interval 15.3–48.2 months) with a 5-year survival of 55.2% (±9.5%). The 5‑year survival rate of patients with mtRT (n = 20) was 37.1 ± 13.2%, while patients who received single-target RT (n = 18) had a 5-year survival rate of 75 ± 10.8%. Severe toxicities (grade 3 and 4) emerged in 14 patients (70%) with mtRT and 7 patients (39%) with single-target RT. Two non-hematological grade 4 toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5 patients had grade 3 toxicities acute and after single-target RT 4 patients. One patient had acute non-hematological grade 4 toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2 patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared. Conclusion Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation. Electronic supplementary material The online version of this article (10.1007/s00066-020-01670-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria-Elena A. Salfelder
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
| | - Kerstin A. Kessel
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
- DKTK Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Uwe Thiel
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Technical University of Munich School for Medicine, Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Technical University of Munich School for Medicine, Munich, Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
- DKTK Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
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23
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Falcinelli L, Mendichi M, Chierchini S, Tenti MV, Bellavita R, Saldi S, Ingrosso G, Reggioli V, Bini V, Aristei C. Pulmonary function in stereotactic body radiotherapy with helical tomotherapy for primary and metastatic lung lesions. Radiol Med 2020; 126:163-169. [PMID: 32415475 DOI: 10.1007/s11547-020-01223-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/01/2019] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
AIMS This retrospective study reports outcomes after stereotactic body radiation therapy (SBRT) as delivered by helical tomotherapy (HT) for lung lesions. It promotes a dose escalation program. METHODS Histological and/or radiological findings and/or case histories identified 41 primary and 15 metastatic lesions. Thirty patients received 40 Gy in 5 fractions (BED 72 Gy10Gy) and 26 50 Gy in 5 fractions (BED 100Gy10Gy). Primary end point was lung toxicity. Secondary end points were respiratory function, local control and local progression-free survival. RESULTS Acute toxicity developed in 18/56 patients and late toxicity in 8/54. Median FEV-1 variations versus baseline were - 0.5% (range - 16 to + 43%) at 6 months and - 4.00% (range - 42 to + 18%) at 24 months. Median DLCO variations versus baseline were - 1% (range - 38 to + 36%) at 6 months and - 12.2% (range - 48 to + 11%) at 24 months. At 6 months, a significant positive correlation emerged between FEV-1 change and KPS (p = 0.047). At 24 months, a significant negative correlation emerged between FEV-1 change and the ipsilateral lung V5 (p = 0.006). A low baseline DLCO correlated with more marked DLCO worsening at 6 months (p = 0.012). At 24 months, DLCO worsening correlated significantly with the median contralateral lung dose (p = 0.003). At the last checkup, 23 patients were in complete remission, 16 were in partial remission, 5 had stable disease, and 7 were in relapse. Median follow-up was 12 months (range 5-56). CONCLUSIONS In patients with lung disease, SBRT, as delivered by HT, was well tolerated and provided good local control.
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Affiliation(s)
| | - Monia Mendichi
- Radiation Oncology Unit, University of Perugia, Perugia, Italia
| | - Sara Chierchini
- Radiation Oncology Unit, University of Perugia, Perugia, Italia.
| | | | - Rita Bellavita
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italia
| | - Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italia
| | - Gianluca Ingrosso
- Radiation Oncology Unit, University of Perugia and Perugia General Hospital, Perugia, Italia
| | | | - Vittorio Bini
- Endocrine and Metabolic Science Unit, University of Perugia, Perugia, Italia
| | - Cynthia Aristei
- Radiation Oncology Unit, University of Perugia and Perugia General Hospital, Perugia, Italia
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Cheng HW, Chang CC, Shiau AC, Wang MH, Tsai JT. Dosimetric comparison of helical tomotherapy, volumetric-modulated arc therapy, intensity-modulated radiotherapy, and field-in-field technique for synchronous bilateral breast cancer. Med Dosim 2020; 45:271-277. [PMID: 32122694 DOI: 10.1016/j.meddos.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/10/2019] [Revised: 11/25/2019] [Accepted: 01/30/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the dosimetric characteristics of helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), intensity-modulated radiotherapy (IMRT), and tangential field-in-field technique (FIF) for the treatment of synchronous bilateral breast cancer (SBBC). METHODS AND MATERIALS Ten patients with early-stage unilateral breast cancer were selected for simulating the patients with SBBC in this retrospective analysis. Treatment plans with HT, VMAT, IMRT, and FIF were generated for each patient with a total dose of 50.4 Gy in 28 fractions to the target. Plan quality, namely conformity index (CI), homogeneity index (HI), dose-volume statistics of organs at risk (OARs), and beam-on time (BOT), were evaluated. RESULTS HT plans showed a lower mean heart dose (3.53 ± 0.31Gy) compared with the other plans (VMAT = 5.6 ± 1.36 Gy, IMRT = 3.80 ± 0.76 Gy, and FIF = 4.84 ± 2.13 Gy). Moreover, HT plans showed a significantly lower mean lung dose (p < 0.01) compared with the other plans: mean right lung doses were 6.81 ± 0.67, 10.32 ± 1.04, 9.07 ± 1.21, and 10.03 ± 1.22 Gy and mean left lung doses were 6.33 ± 0.87, 8.82 ± 0.91, 7.84 ± 1.07, and 8.64 ± 0.99 Gy for HT, VMAT, IMRT, and FIF plans, respectively. The mean dose to the left anterior descending artery was significantly lower in HT plans (p < 0.01) than in the other plans: HT = 19.41 ± 0.51 Gy, VMAT = 25.77 ± 7.23 Gy, IMRT = 27.87 ± 6.48 Gy, and FIF = 30.95 ± 10.17 Gy. FIF plans showed a worse CI and HI compared with the other plans. VMAT plans showed shorter BOT (average, 3.9 ± 0.2 minutes) than did HT (average, 11.0 ± 3.0 minutes), IMRT (average, 6.1 ± 0.5 minutes), and FIF (average, 4.6 ± 0.7 minutes) plans. CONCLUSIONS In a dosimetric comparison for SBBC, HT provided the most favorable dose sparing of OARs. However, HT with longer BOT may increase patient discomfort and treatment uncertainty. VMAT enabled shorter BOT with acceptable doses to OARs and had a better CI than did FIF and IMRT.
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Affiliation(s)
- Hao-Wen Cheng
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Chieh Chang
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - An-Cheng Shiau
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan; Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Ming-Hua Wang
- Department of Radiation Oncology, Landseed Hospital, Taoyuan, Taiwan
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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25
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Biston MC, Jarril J, Dupuis P, Boisbouvier S, Gassa F, Cervellera M, Chabaud S, Racadot S. Comparison among four immobilization devices for whole breast irradiation with Helical Tomotherapy. Phys Med 2020; 69:205-211. [PMID: 31918372 DOI: 10.1016/j.ejmp.2019.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/30/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the repositioning accuracy of 4 immobilization devices (ID) used for whole breast Helical Tomotherapy treatments: arm float with VacFix® (Par Scientific, Denmark), all-in-one® (AIO®) system (Orfit, Belgium), MacroCast thermoplastic mask (Macromedics, The Netherlands) and BlueBag® system with Arm-Shuttle (Elekta, Sweden). MATERIALS AND METHODS Twenty four women with breast cancer with PTV including the breast/chest wall and lymph nodes were involved in this study (6 women per group). Pretreatment registration results were first collected using automatic bone registration + manual adjustment on the vertebra followed by independent registrations on different ROIs representing each treated area (axillary, mammary chain, clavicular, breast/chest wall). The differences in translations and rotations between reference registration and the above mentionned ROIs were calculated. A total of 120 MVCT images were analyzed. RESULTS Significant differences were found between IDs (p < 0.0001), ROIs (p = 0.0002) and the session number (p < 0.0001) on the observed shifts, when examining 3D translation vectors. 3D-vectors were significantly lower for the BlueBag® than for the VacFix® or for the AIO® (p < 0.0001), but differences were not significant compared to the mask (p = 0.674). Finally, setup margins were overall smaller for the BlueBag® than for other IDs, with values ranging from 1.53 to 1.91 mm on the mammary chain area, 4.52-6.07 mm on the clavicular area, 2.71-4.62 mm on the axillary area, and 3.39-5.10 mm on the breast. CONCLUSION We demonstrated in this study that the BlueBag® combined with arm shuttle is a robust solution for breast and nodes immobilization during HT treatments.
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Affiliation(s)
- Marie-Claude Biston
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
| | - Jimmy Jarril
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | - Pauline Dupuis
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | | | - Frédéric Gassa
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | | | - Sylvie Chabaud
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | - Séverine Racadot
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
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Losert C, Shpani R, Kießling R, Freislederer P, Li M, Walter F, Niyazi M, Reiner M, Belka C, Corradini S. Novel rotatable tabletop for total-body irradiation using a linac-based VMAT technique. Radiat Oncol 2019; 14:244. [PMID: 31888680 PMCID: PMC6937701 DOI: 10.1186/s13014-019-1445-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/12/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Volumetric Modulated Arc Therapy (VMAT) techniques have recently been implemented in clinical practice for total-body irradiation (TBI). To date, most techniques still use special couches, translational tables, or other self-made immobilization devices for dose delivery. Aim of the present study was to report the first results of a newly developed rotatable tabletop designed for VMAT-TBI. METHODS The VMAT-TBI technique theoretically allows the use of any standard positioning device at the linear accelerator. Nevertheless, the main problem is that patients taller than 120 cm cannot be treated in one position due to the limited cranial-caudal couch shift capacities of the linac. Therefore, patients are usually turned from a head-first supine position (HFS) to a feet-first supine position (FFS) to overcome this limitation. The newly developed rotatable tabletop consists completely of carbon fiber, including the ball bearing within the base plate of the rotation unit. The patient can be turned 180° from a HFS to a FFS position within a few seconds, without the need of repositioning. RESULTS The first 20 patients had a median age of 47 years, and received TBI before bone marrow transplantation for acute myeloid leukemia. Most patients (13/20) received a TBI dose of 4 Gy in 2 fractions, twice daily. The mean number of applied monitor units (MU) was 6476 MU using a multi-arcs and multi-isocenter VMAT-TBI technique. The tabletop has been successfully used in daily clinical practice and helped to keep the treatment times at an acceptable level. During the first treatment fraction, the mean overall treatment time (OTT) was 57 min. Since no additional image guidance was used in fraction 2 of the same day, the OTT was reduced to mean 38 min. CONCLUSIONS The easy and reproducible rotation of the patient on the treatment couch using the rotatable tabletop, is time-efficient and overcomes the need of repositioning the patient after turning from a HFS to a FFS position during VMAT TBI. Furthermore, it prevents couch-gantry collisions, incorrect isocenter shifts and beam mix-up due to predicted absolute table coordinates, which are recorded to the R + V system with the corresponding beams.
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Affiliation(s)
- Christoph Losert
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Roel Shpani
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Robert Kießling
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Barelkowski T, Wust P, Kaul D, Zschaeck S, Wlodarczyk W, Budach V, Ghadjar P, Beck M. Image-guided dose-escalated radiation therapy for localized prostate cancer with helical tomotherapy. Strahlenther Onkol 2019; 196:229-242. [PMID: 31873779 DOI: 10.1007/s00066-019-01562-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/23/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate treatment outcomes for patients with localized prostate cancer who were treated with dose-escalated primary image-guided radiation therapy (IGRT). METHODS We retrospectively analyzed 88 consecutive patients treated using helical tomotherapy with daily megavoltage CTs (MVCT). Patients were prescribed daily doses of 1.8 Gy to the planning target volume (PTV) and 2 Gy to the clinical target volume (CTV). Low- and favorable intermediate-risk patients received a minimum total dose of 72 Gy to the PTV and up to 80 Gy to the CTV. Unfavorable intermediate-risk and high-risk patients received a minimum total dose of 75.6 Gy to the PTV and up to 84 Gy to the CTV. We assessed freedom from biochemical relapse (FFBF), 5‑year biochemical recurrence-free survival (5-bRFS), distant metastasis-free survival (5-dMFS), and cancer-specific survival (5-CSS) as well as acute and late genitourinary (GU) and gastrointestinal (GI) toxicity. RESULTS Among our cohort, 11.4% were low-risk, 50% intermediate-risk, and 38.6% high-risk patients according to the D'Amico criteria. Median follow-up was 66 months (range 8-83 months). FFBF was 100%, 97.7%, and 90.7%; 5‑bRFS was 100%, 92.8%, and 70.4%; 5‑dMFS was 100%, 92.7%, and 70.4%; and 5‑CSS was 100%, 97.4%, and 89.8% for low-, intermediate-, and high-risk patients, respectively. Grades 2 and 3 toxicity occurred at the following rates: acute GU toxicity 39.8% and 1.1%, acute GI toxicity 12.5% and 0%, late GU toxicity 19.3% and 4.5%, and late GI toxicity 4.5% and 1.1% of patients, respectively. No toxicity >grade 3 was observed. CONCLUSION Risk-adapted dose-escalated IGRT with helical tomotherapy of up to 84 Gy is a feasible and well-tolerable treatment scheme with promising oncological results.
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Affiliation(s)
- Tomasz Barelkowski
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Praxis Strahlentherapie Berlin Südwest, Berlin, Germany.
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Waldemar Wlodarczyk
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Hong CS, Kim MJ, Kim J, Chang KH, Park K, Kim DW, Han MC, Yoon HI, Kim JS, Lee H. Feasibility of hybrid TomoHelical- and TomoDirect-based volumetric gradient matching technique for total body irradiation. Radiat Oncol 2019; 14:233. [PMID: 31856870 PMCID: PMC6924057 DOI: 10.1186/s13014-019-1435-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tomotherapy-based total body irradiation (TBI) is performed using the head-first position (HFP) and feet-first position (FFP) due to treatment length exceeding the 135 cm limit. To reduce the dosimetric variation at the match lines, we propose and verify a volumetric gradient matching technique (VGMT) by combining TomoHelical (TH) and TomoDirect (TD) modes. METHODS Two planning CT image sets were acquired with HFP and FFP using 15 × 55 × 18 cm3 of solid water phantom. Planning target volume (PTV) was divided into upper, lower, and gradient volumes. The junction comprised 2-cm thick five and seven gradient volumes (5-GVs and 7-GVs) to create a dose distribution with a gentle slope. TH-IMRT and TD-IMRT plans were generated with 5-GVs and 7-GVs. The setup error in the calculated dose was assessed by shifting dose distribution of the FFP plan by 5, 10, 15, and 20 mm in the longitudinal direction and comparing it with the original. Doses for 95% (D95) and 5% of the PTV (D5) were calculated for all simulated setup error plans. Absolute dose measurements were performed using an ionization chamber in the junction. RESULTS The TH&TD plan produced a linear gradient in junction volume, comparable to that of the TH&TH plan. D5 of the PTV was 110% of the prescribed dose when the FFP plan was shifted 0.7 cm and 1.2 cm in the superior direction for 5-GVs and 7-GVs. D95 of the PTV decreased to < 90% of the prescribed dose when the FF plan was shifted 1.1 cm and 1.3 cm in the inferior direction for 5-GVs and 7-GVs. The absolute measured dose showed a good correlation with the calculated dose in the gradient junction volume. The average percent difference (±SD) in all measured points was - 0.7 ± 1.6%, and the average dose variations between depths was - 0.18 ± 1.07%. CONCLUSION VGMT can create a linear dose gradient across the junction area in both TH&TH and TH&TD and can minimize the dose sensitivity to longitudinal setup errors in tomotherapy-based TBI.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Min-Joo Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Kyung Hwan Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea.
| | - Ho Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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Mori M, Dell'Oca I, Branchini M, Foti S, Broggi S, Perna L, Cattaneo GM, Calandrino R, Di Muzio NG, Fiorino C. Monitoring skin dose changes during image-guided helical tomotherapy for head and neck cancer patients. Strahlenther Onkol 2019; 196:243-251. [PMID: 31586231 DOI: 10.1007/s00066-019-01520-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE An increase of skin dose during head and neck cancer (HNC) radiotherapy is potentially dangerous. Aim of this study was to quantify skin dose variation and to assess the need of planning adaptation (ART) to counteract it. METHODS Planning CTs of 32 patients treated with helical tomotherapy (HT) according to a Simultaneous Integrated Boost (SIB) technique delivering 54/66 Gy in 30 fractions were deformably co-registered to MVCTs taken at fractions 15 and 30; in addition, the first fraction was also considered. The delivered dose-of-the-day was calculated on the corresponding deformed images. Superficial body layers (SL) were considered as a surrogate for skin, considering a layer thickness of 2 mm. Variations of SL DVH (∆SL) during therapy were quantified, focusing on ∆SL95% (i.e., 62.7 Gy). RESULTS Small changes (within ± 1 cc for ∆SL95%) were seen in 15/32 patients. Only 2 patients experienced ∆SL95% > 1 cc in at least one of the two monitored fractions. Negative ∆SL95% > 1 cc (up to 17 cc) were much more common (15/32 patients). The trend of skin dose changes was mostly detected at the first fraction. Negative changes were correlated with the presence of any overlap between PTV and SL at planning and were explained in terms of how the planning system optimizes the PTV dose coverage near the skin. Acute toxicity was associated with planning DVH and this association was not improved if considering DVHs referring to fractions 15/30. CONCLUSION About half of the patients treated with SIB with HT for HNC experienced a skin-sparing effect during therapy; only 6% experienced an increase. Our findings do not support skin-sparing ART, while suggesting the introduction of improved skin-sparing planning techniques.
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Affiliation(s)
- Martina Mori
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy.
| | - Italo Dell'Oca
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Marco Branchini
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Silvia Foti
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | | | - Riccardo Calandrino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
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Akbaba S, Heusel A, Mock A, Held T, Lang K, Hoerner-Rieber J, Forster T, Katayama S, Kargus S, Rieken S, Plinkert P, Herfarth K, Debus J, Adeberg S. The impact of age on the outcome of patients treated with radiotherapy for mucoepidermoid carcinoma (MEC) of the salivary glands in the head and neck: A 15-year single-center experience. Oral Oncol 2019; 97:115-123. [PMID: 31494395 DOI: 10.1016/j.oraloncology.2019.08.018] [Citation(s) in RCA: 5] [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: 06/11/2019] [Revised: 08/02/2019] [Accepted: 08/25/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Data regarding treatment and survival outcome of patients with mucoepidermoid carcinoma of the head and neck are limited to case reports and case series. As a consequence of lacking evidence, treatment guidelines do not exist. We aimed to analyze the effect of modern radiotherapy in form of intensity modulated radiotherapy (IMRT) either with simultaneously integrated boost or carbon ion boost on local control and survival for a relatively large patient collective. MATERIALS AND METHODS Patient records of 62 consecutive patients treated with postoperative (n = 53, 85%) or definitive (n = 9, 15%) radiotherapy between 2004 and 2019 were analyzed retrospectively. Kaplan-Meier estimates for overall survival (OS), distant progression-free survival (PFS), local control (LC) and locoregional control (LRC) were statistically calculated and prognostic factors were identified using the log-rank test. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The median follow-up was 47 months (range, 4-188 months). The 3-year OS, DPFS, LC and LRC, estimated by Kaplan-Meier curves, were 82%, 87%, 89% and 92%, the estimated 5-year OS, DPFS, LC and LRC were 78%, 87%, 84% and 88%, respectively. In univariate analysis, age >56 years (vs. age ≤56 years) was identified as the only independent negative prognostic factor for decreased OS (HR = 1.078; 95%-CI = 1.029-1.130; p = 0.001), DPFS (HR = 1.055; 95%-CI = 1.000-1.114; p = 0.051) and LC (HR = 1.087; 95%-CI = 1.022-1.157; p = 0.008). Treatment was well tolerated without any grade ≥4 toxicity. Acute and late grade 3 toxicities were rare with 16% acute (n = 10) and 13% late toxicities (n = 8). CONCLUSION Radiotherapy with intensity modulated radiotherapy including either simultaneously integrated photon boost or active raster-scanning carbon ion boost for mucoepidermoid carcinomas of the head and neck resulted in excellent survival outcome and locoregional control with moderate toxicity. However, patients older than 56 years seem to have a disadvantage in all calculated endpoints (OS, DPFS, LRC) due to frequent local and distant relapses. CONDENSED ABSTRACT Modern radiotherapy with intensity modulated radiotherapy including either a simultaneously integrated photon boost or carbon ion boost for mucoepidermoid carcinoma results in excellent survival outcome and locoregional control with moderate toxicity. The 5-year OS, DPFS, LC and LRC, estimated by Kaplan-Meier curves, were 89%, 75%, 84% and 80%, respectively. Patients older than 56 years seem to have a disadvantage in all calculated endpoints (OS, DPFS, LRC).
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Affiliation(s)
- Sati Akbaba
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Astrid Heusel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Andreas Mock
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Juliane Hoerner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Sonja Katayama
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Peter Plinkert
- Department of Otorhinolaryngology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
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Mayinger M, Borm KJ, Dreher C, Dapper H, Duma MN, Oechsner M, Kampfer S, Combs SE, Habermehl D. Incidental dose distribution to locoregional lymph nodes of breast cancer patients undergoing adjuvant radiotherapy with tomotherapy - is it time to adjust current contouring guidelines to the radiation technique? Radiat Oncol 2019; 14:135. [PMID: 31370876 PMCID: PMC6676557 DOI: 10.1186/s13014-019-1328-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/17/2018] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose/objective(s) Along with breast-conserving surgery (BCS), adjuvant radiotherapy (RT) of patients with early breast cancer plays a crucial role in the oncologic treatment concept. Conventionally, irradiation is carried out with the aid of tangentially arranged fields. However, more modern and more complex radiation techniques such as IMRT (intensity-modulated radio therapy) are used more frequently, as they improve dose conformity and homogeneity and, in some cases, achieve better protection of adjacent risk factors. The use of this technique has implications for the incidental- and thus unintended- irradiation of adjacent loco regional lymph drainage in axillary lymph node levels I-III and internal mammary lymph nodes (IMLNs). A comparison of a homogeneous “real-life” patient collective, treated with helical tomotherapy (TT), patients treated with 3D conformal RT conventional tangentially arranged fields (3DCRT) and deep inspiration breath hold (3DCRT-DIBH), was conducted. Materials/methods This study included 90 treatment plans after BCS, irradiated in our clinic from January 2012 to August 2016 with TT (n = 30) and 3D-CRT (n = 30), 3DCRT DIBH (n = 30). PTVs were contoured at different time points by different radiation oncologists (> 7). TT was performed with a total dose of 50.4 Gy and a single dose of 1.8 Gy with a simultaneous integrated boost (SIB) to the tumor cavity (TT group). Patients irradiated with 3DCRT/3DCRT DIBH received 50 Gy à 2 Gy and a sequential boost. Contouring of lymph drainage routes was performed retrospectively according to RTOG guidelines. Results Average doses (DMean) in axillary lymph node Level I/Level II/Level III were 31.6 Gy/8.43 Gy/2.38 Gy for TT, 24.0 Gy/11.2 Gy/3.97 Gy for 3DCRT and 24.7 Gy/13.3 Gy/5.59 Gy for 3DCRT-DIBH patients. Internal mammary lymph nodes (IMLNs) Dmean were 27.8 Gy (TT), 13.5 Gy (3DCRT), and 18.7 Gy (3DCRT-DIBH). Comparing TT to 3DCRT-DIBH dose varied significantly in all axillary lymph node levels and the IMLNs. Comparing TT to 3DCRT significant dose difference in Level I and IMLNs was observed. Conclusion Dose applied to locoregional lymph drainage pathways varies comparing tomotherapy plans to conventional tangentially arranged fields. Studies are warranted whether dose variations influence loco-regional spread and must have implications for target volume definition guidelines.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany. .,Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland.
| | - Kai Joachim Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Constantin Dreher
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Marciana-Nona Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764, Oberschleißheim, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Stephanie Elisabeth Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764, Oberschleißheim, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764, Oberschleißheim, Germany
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Schiller K, Geier M, Duma MN, Nieder C, Molls M, Combs SE, Geinitz H. Definitive, intensity modulated tomotherapy with a simultaneous integrated boost for prostate cancer patients - Long term data on toxicity and biochemical control. Rep Pract Oncol Radiother 2019; 24:315-321. [PMID: 31193851 DOI: 10.1016/j.rpor.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/09/2019] [Revised: 03/29/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
Abstract
Aim To report long-term data regarding biochemical control and late toxicity of simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) with tomotherapy in patients with localized prostate cancer. Background Dose escalation improves cancer control after curative intended radiation therapy (RT) to patients with localized prostate cancer, without increasing toxicity, if IMRT is used. Materials and methods In this retrospective analysis, we evaluated long-term toxicity and biochemical control of the first 40 patients with intermediate risk prostate cancer receiving SIB-IMRT. Primary target volume (PTV) 1 including the prostate and proximal third of the seminal vesicles with safety margins was treated with 70 Gy in 35 fractions. PTV 2 containing the prostate with smaller safety margins was treated as SIB to a total dose of 76 Gy with 2.17 Gy per fraction. Toxicity was evaluated using an adapted CTCAE-Score (Version 3). Results Median follow-up of living patients was 66 (20-78) months. No late genitourinary toxicity higher than grade 2 has been reported. Grade 2 genitourinary toxicity rates decreased from 58% at the end of the treatment to 10% at 60 months. Late gastrointestinal (GI) toxicity was also moderate, though the prescribed PTV Dose of 76 Gy was accepted at the anterior rectal wall. 74% of patients reported any GI toxicity during follow up and no toxicity rates higher than grade 2 were observed. Grade 2 side effects were reported by 13% of the patients at 60 months. 5-year freedom from biochemical failure was 95% at our last follow up. Conclusion SIB-IMRT using daily MV-CT guidance showed excellent long-term biochemical control and low toxicity rates.
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Affiliation(s)
- Kilian Schiller
- Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Technische Universität München, München, Germany
| | - Michael Geier
- Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Technische Universität München, München, Germany.,Abteilung für Radioonkologie; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Marciana Nona Duma
- Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Technische Universität München, München, Germany.,Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum, Friedrich-Schiller-Universität, Jena, Germany
| | - Carsten Nieder
- Department of Oncology and Palliative Care, Nordland Hospital, Nordland Hospital Trust, Bodø, Norway.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Michael Molls
- Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Technische Universität München, München, Germany
| | - Stephanie E Combs
- Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Technische Universität München, München, Germany.,Institut für Innovative Radiotherapie (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Oberschleißheim, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Germany
| | - Hans Geinitz
- Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Technische Universität München, München, Germany.,Abteilung für Radioonkologie; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
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Xie Y, Bourgeois D, Guo B, Zhang R. Postmastectomy radiotherapy for left-sided breast cancer patients: Comparison of advanced techniques. Med Dosim 2020; 45:34-40. [PMID: 31129035 DOI: 10.1016/j.meddos.2019.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 12/25/2022]
Abstract
Postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival for invasive breast cancer patients, and many advanced radiotherapy technologies were adopted for PMRT. The purpose of our study is to compare various advanced PMRT techniques including fixed-beam intensity-modulated radiotherapy (IMRT), non-coplanar volumetric modulated arc therapy (NC-VMAT), multiple arc VMAT (MA-VMAT), and tomotherapy (TOMO). Results of standard VMAT and mixed beam therapy that were published by our group previously were also included in the plan comparisons. Treatment plans were produced for nine PMRT patients previously treated in our clinic. The plans were evaluated based on planning target volume (PTV) coverage, dose homogeneity index (DHI), conformity index (CI), dose to organs at risk (OARs), normal tissue complication probability (NTCP) of pneumonitis, lifetime attributable risk (LAR) of second cancers, and risk of coronary events (RCE). All techniques produced clinically acceptable PMRT plans. Overall, fixed-beam IMRT delivered the lowest mean dose to contralateral breast (1.56 ± 0.4 Gy) and exhibited lowest LAR (0.6 ± 0.2%) of secondary contralateral breast cancer; NC-VMAT delivered the lowest mean dose to lungs (7.5 ± 0.8 Gy), exhibited lowest LAR (5.4 ± 2.8%) of secondary lung cancer and lowest NTCP (2.1 ± 0.4%) of pneumonitis; mixed beam therapy delivered the lowest mean dose to heart (7.1 ± 1.3 Gy) and exhibited lowest RCE (8.6 ± 7.1%); TOMO plans provided the most optimal target coverage while delivering higher dose to OARs than other techniques. Both NC-VMAT and MA-VMAT exhibited lower values of all OARs evaluation metrics compare to standard VMAT. Fixed-beam IMRT, NC-VMAT, and mixed beam therapy could be the optimal radiation technique for certain breast cancer patients after mastectomy.
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Hong CS, Oh D, Ju SG, Ahn YC, Na CH, Kwon DY, Kim CC. Development of a semi-customized tongue displacement device using a 3D printer for head and neck IMRT. Radiat Oncol 2019; 14:79. [PMID: 31088472 PMCID: PMC6515618 DOI: 10.1186/s13014-019-1289-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/03/2018] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To reduce radiation doses to the tongue, a patient-specific semi-customized tongue displacement device (SCTDD) was developed using a 3D printer (3DP) for head and neck (H&N) radiation therapy (RT). Dosimetric characteristics of the SCTDD were compared with those of a standard mouthpiece (SMP). Materials and methods The SCTDD consists of three parts: a mouthpiece, connector with an immobilization mask, and tongue displacer, which can displace the tongue to the contralateral side of the planning target volume. Semi-customization was enabled by changing the thickness and length of the SCTDD. The instrument was printed using a 3DP with a biocompatible material. With the SCTDD and SMP, two sets of planning computed tomography (CT) and tomotherapy plans were obtained for seven H&N cancer patients. Dosimetric and geometric characteristics were compared. Results Using the SCTDD, the tongue was effectively displaced from the planning target volume without significant tongue volume change compared to the SMP. The median tongue dose was significantly reduced (29.6 Gy vs. 34.3 Gy). The volumes of the tongue receiving a dose of 15 Gy, 30 Gy, 35 Gy, 45 Gy, and 60 Gy were significantly lower than using the SMP. Conclusion The SCTDD significantly decreased the radiation dose to the tongue compared to the SMP, which may potentially reduce RT-related tongue toxicity.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.,Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Cho Hee Na
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Yeol Kwon
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Cheol Chong Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea
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Haraldsson A, Engellau J, Lenhoff S, Engelholm S, Bäck S, Engström PE. Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy - A practical guide. Phys Med 2019; 60:162-167. [PMID: 31000078 DOI: 10.1016/j.ejmp.2019.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/22/2019] [Accepted: 03/30/2019] [Indexed: 11/16/2022] Open
Abstract
Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and back-up planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. MATERIAL & METHODS Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CT-scanning and treatment were performed in two parts with field matching at the upper thigh. Target consisted of marrow containing bone and sanctuary sites. Lungs, kidneys, bowel, heart and liver were defined as organs at risk (OAR). A fast surface scanning system was used to position parts of the body not covered by the imaging system (MVCT) as well as to reduce treatment time. RESULTS All patients completed their treatment and could proceed with SCT/BMT. Doses to OARs were significantly reduced and target dose homogeneity was improved compared to TBI. Robustness tests performed on field matching and patient positioning support that the field junction technique is adequate. Replacing MVCT with optical surface scanning reduced the treatment time by 25 min per fraction. CONCLUSION The methodology presented here has shown to provide a safe, robust and reproducible treatment for Total Marrow Irradiation using Tomotherapy.
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Affiliation(s)
- André Haraldsson
- Medical Radiation Physics, Lund University, Lund, Sweden; Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
| | - Jacob Engellau
- Medical Radiation Physics, Lund University, Lund, Sweden; Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Stig Lenhoff
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Silke Engelholm
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Jiang A, Sun W, Zhao F, Wu Z, Shang D, Yu Q, Wang S, Zhu J, Yang F, Yuan S. Dosimetric evaluation of four whole brain radiation therapy approaches with hippocampus and inner ear avoidance and simultaneous integrated boost for limited brain metastases. Radiat Oncol 2019; 14:46. [PMID: 30876444 PMCID: PMC6419811 DOI: 10.1186/s13014-019-1255-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/10/2018] [Accepted: 03/07/2019] [Indexed: 01/31/2023] Open
Abstract
AIMS To perform a dosimetric evaluation of four different simultaneous integrated boost whole brain radiotherapy modalities with hippocampus and inner ear avoidance in the treatment of limited brain metastases. METHODS Computed tomography/magnetic resonance imaging data of 10 patients with limited (1-5) brain metastases were used to replan step-and-shoot intensity-modulated radiotherapy (sIMRT), dynamic intensity-modulated radiation therapy (dIMRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (Tomo). The prescribed doses of 40-50 Gy in 10 fractions and 30 Gy in 10 fractions were simultaneously delivered to the metastatic lesions and the whole-brain volume, respectively. The hippocampal dose met the RTOG 0933 criteria for hippocampal avoidance (Dmax ≤17 Gy, D100% ≤10 Gy). The inner ear dose was restrained to Dmean ≤15 Gy. Target coverage (TC), homogeneity index (HI), conformity index (CI), maximum dose (Dmax), minimum dose (Dmin) and dose to organs at risk (OARs) were compared. RESULTS All plans met the indicated dose restrictions. The mean percentage of planning target volume of metastases (PTVmets) coverage ranged from 97.1 to 99.4%. For planning target volume of brain (PTVbrain), Tomo provided the lowest average D2% (37.5 ± 2.8 Gy), the highest average D98% (25.2 ± 2.0 Gy), and the best TC (92.6% ± 2.1%) and CI (0.79 ± 0.06). The two fixed gantry IMRT modalities (step and shot, dynamic) provided similar PTVbrain dose homogeneity (both 0.76). Significant differences across the four approaches were observed for the maximum and minimum doses to the hippocampus and the maximum doses to the eyes, lens and optic nerves. CONCLUSION All four radiotherapy modalities produced acceptable treatment plans with good avoidance of the hippocampus and inner ear. Tomo obtained satisfactory PTVbrain coverage and the best homogeneity index. TRIAL REGISTRATION Clinicaltrials.gov, NCT03414944 . Registered 29 January 2018.
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Affiliation(s)
- Aijun Jiang
- Shandong University, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Weipeng Sun
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Zhenxuan Wu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Dongping Shang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingxi Yu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Suzhen Wang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Fengchang Yang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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Zhao J, Liu X, Wang W, Hu K, Zhang F, Hou X, Meng Q. Concomitant dose escalation with image-guided Tomotherapy in locally advanced mid-low rectal cancer: a single-center study. Cancer Manag Res 2019; 11:1579-1586. [PMID: 30863168 PMCID: PMC6388983 DOI: 10.2147/cmar.s193657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the efficacy and toxicity of concomitant dose-escalated Tomotherapy in locally advanced mid–low rectal cancer. Patients and methods Patients with locally advanced (T3/T4 or N+), low–mid (≤10 cm from anal verge) rectal carcinoma treated with neoadjuvant chemoradiotherapy followed by surgery between May 2012 and October 2017 in Peking Union Medical College Hospital were included in this study. A dose of 45/50 Gy in 25 fractions was delivered to the pelvis with Tomotherapy, and 55 Gy was prescribed for the primary tumor with a simultaneous, integrated boost. Megavolt computed tomography was performed before every delivery. The concurrent chemotherapy regimen included capecitabine alone and XELOX. Results A total of 141 patients were enrolled; 129 patients (91.5%) had stage cT3 or cT4, and 121 patients (85.8%) had positive lymph nodes. The location of the tumors was in the lower rectum in 88 patients (62.4%). After neoadjuvant chemoradiotherapy, 113 patients (80.1%) underwent sphincter-preserving resection. Downstaging was observed in 121 patients (85.8%), including 80 patients (56.7%) with T downstaging and 101 patients (83.5%) with N downstaging. Thirty-two patients (22.7%) obtained pathological complete response (pCR). The median follow-up was 38.5 months (range, 9.3–73.6 months). Only 36 patients (25.5%) experienced treatment failure, including distant metastasis in 29 patients (20.6%) and pelvic recurrent in 7 patients (5.0%). The estimated 5-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates of patients were 75.1%, 70.9%, and 95.5%, respectively. pCR was an independent prognostic factor for DFS (HR 0.13, 95% CI: 0.02–0.93, P = 0.043), but it did not improve OS or LC. Grade 3 or greater acute leukopenia and diarrhea rates were 5.7% and 7.8%, respectively, and 15 patients (10.6%) developed postoperative complications. Conclusion This study indicates that neoadjuvant, image-guided Tomotherapy with 55 Gy boosted to the primary tumor was well tolerated and resulted in high rates of sphincter-preserving surgery, pCR, LC, and DFS for locally advanced rectal cancer.
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Affiliation(s)
- Jing Zhao
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Qingyu Meng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China, ;
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De Marco P, Abdi Osman I, Castellini F, Ricotti R, Leonardi MC, Miglietta E, Cambria R, Origgi D, Jereczek-Fossa BA, Garibaldi C, Cattani F. Image quality and dose evaluation of MVCT TomoTherapy acquisitions: A phantom study. Phys Med 2019; 57:200-6. [PMID: 30738526 DOI: 10.1016/j.ejmp.2019.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the dose delivered and the image quality of pre-treatment MVCT images with Hi-Art TomoTherapy system, varying acquisition and reconstruction parameters. MATERIALS AND METHODS Catphan 500 MVCT images were acquired with all acquisition pitch and reconstruction intervals; image quality was evaluated in terms of noise, uniformity, contrast linearity, contrast-to-noise ratio (CNR) and spatial resolution with the Modulation Transfer Function (MTF). Dose was evaluated as Multi Slice Average Dose (MSADw) and measurements were performed with the Standard TomoTherapy® Quality Assurance Kit composed by the TomoTherapy Phantom, the Exradin A1SL ion chamber and TomoElectrometer. For each pitch-reconstruction interval, acquisitions were repeated 5 times. RESULTS Differences in noise and uniformity, though statistically significant in some cases, were very small: noise ranged from 2.3% for Coarse - 3 mm to 2.4% for Coarse - 6 mm, while uniformity passed from 99.5% for Coarse - 6 mm to 99.8% for Normal - 4 mm. No differences at all were found for CNR for high and low density inserts, while MTF was higher for pitch Coarse, even if no differences in spatial resolution were observed visually (spatial resolution was up to 4 lp/cm for all combinations of pitch and reconstruction interval). Dose was dependent on pitch, being 1.0 cGy for Coarse, 1.5 cGy for Normal and 2.85 cGy for Fine. CONCLUSIONS We observed negligible differences in image quality among different pitch and reconstruction interval, thus, considerations regarding pre-treatment imaging modalities should be based only on dose delivered and on the desired resolution along the cranio-caudal axis for image-guided radiotherapy and adaptive radiotherapy purposes.
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Peeken JC, Knie C, Kessel KA, Habermehl D, Kampfer S, Dapper H, Devecka M, von Eisenhart-Rothe R, Specht K, Weichert W, Wörtler K, Knebel C, Wilkens JJ, Combs SE. Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas - a single center experience. Radiat Oncol 2019; 14:2. [PMID: 30626408 PMCID: PMC6327451 DOI: 10.1186/s13014-019-1207-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/13/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Advanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS. Methods Between 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5 cm in longitudinal direction and 1.0 cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5 mm was added to receive the planning target volume. The full total dose of 50 Gy in 2 Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology. Results Thirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5 months cumulative OS, local PFS and systemic PFS at 2 years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates. Conclusions IMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins. Electronic supplementary material The online version of this article (10.1186/s13014-019-1207-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany. .,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Christoph Knie
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Michal Devecka
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Katja Specht
- Department of Pathology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Wilko Weichert
- Department of Pathology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Klaus Wörtler
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Usui K, Isobe A, Hara N, Shikama N, Sasai K, Ogawa K. Appropriate treatment planning method for field joint dose in total body irradiation using helical tomotherapy. Med Dosim 2018; 44:344-353. [PMID: 30598391 DOI: 10.1016/j.meddos.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/13/2018] [Revised: 10/21/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Total body irradiation (TBI) using helical tomotherapy (HT) has advantages over the standard linear accelerator-based approach to the conditioning regimen for hematopoietic cell transplantation. However, the radiation field has to be divided into two independent irradiation plans to deliver a homogeneous dose to the whole body. A clinical target volume near the skin increases the skin surface dose; therefore, high- or low-dose regions arise depending on the set-up position accuracy because the two radiation fields are somewhat overlapped or separated. We aimed to determine an adequate treatment planning method robust to the set-up accuracy for the field joint dose distribution using HT-TBI. We calculated treatment plans reducing target volumes at the interface between the upper and lower body irradiations and evaluated these joint dose distributions via simulation and experimental studies. Target volumes used for the optimization calculation were reduced by 0, 0.5, 1.0, 2.0, 2.5, and 3.0 cm from the boundary surface on the upper and lower sides. Combined dose distributions with set-up error simulated by modifying coordinate positions were investigated to find the optimal planning method. In the ideal set-up position, the target volume without a gap area caused field junctional doses of up to approximately 200%; therefore, target volumes reduced by 2.0-3.0 cm could suppress the maximum dose to within 150%. However, with set-up error, high-dose areas exceeding 150% and low-dose areas below 100% were found with 2.0 and 3.0 cm target volume reduction. Using the dynamic jaw (DJ) system, dose deviations caused by set-up error reached approximately 20%, which is not suitable for HT-TBI. Moreover, these dose distributions can be easily adjusted when combined with the intensity modulation technique for field boundary regions. The results of a simulation and experimental study using a film dosimetry were almost identical, which indicated that reducing the target volume at the field boundary surface by 2.5 cm produces the most appropriate target definition.
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Affiliation(s)
- Keisuke Usui
- Department of Radiation Oncology, Juntendo University, Bunkyo-ku, Tokyo, Japan.
| | - Akira Isobe
- Department of Radiology, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Naoya Hara
- Department of Radiology, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Koichi Ogawa
- Faculty of Science and Engineering, Hosei University, Koganei, Tokyo, Japan
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41
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Vega-Carrillo HR, Esparza-Hernandez A, Garcia-Reyna MG, Rivera ER, Hernandez-Adame L, Rivera T. H*(10) due to scattered radiation on the cancer-patient bodies treated with Tomotherapy. Appl Radiat Isot 2018; 141:206-209. [PMID: 29699933 DOI: 10.1016/j.apradiso.2018.04.015] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/05/2018] [Indexed: 01/01/2023]
Abstract
The ambient dose equivalent has been measured on the walls of a bunker with a 6 MV TomoLINAC, which was designed to have a conventional 18 MV LINAC. The ambient dose equivalent is due to scattered photons on patient bodies during cancer treatment. Measurements were carried out with thermoluminescent dosimeters that were fixed, at the isocentre plane, on the primary and secondary barriers, the maze, and on the TomoLINAC surface. Measurements were repeated three times, in each time dosimeters were on place during seven working days, where approximately 50 patients were treated per day. Ambient dose equivalent at each location was normalized to the total dose applied during the measuring time. The primary and secondary concrete barriers are thick enough to reduce the dose to safe values.
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Affiliation(s)
- Hector Rene Vega-Carrillo
- Unidad Academica de Estudios Nucleares, Universidad Autonoma de Zacatecas, Cipres 10, Fracc. La Peñuela, 98060 Zacatecas, Zac., Mexico; Unidad Academica de Ingenieria Electrica, Universidad Autonoma de Zacatecas, Av. Ramón López Velarde s/n, 98068 Zacatecas, Zac., Mexico.
| | - Angelica Esparza-Hernandez
- Unidad Academica de Estudios Nucleares, Universidad Autonoma de Zacatecas, Cipres 10, Fracc. La Peñuela, 98060 Zacatecas, Zac., Mexico
| | - Mayra G Garcia-Reyna
- Programa de Doctorado en Ingenieria y Tecnologia Aplicada, Unidad Académica de Ingenieria Electrica, Universidad Autonoma de Zacatecas, Av. Ramón López Velarde s/n, 98068 Zacatecas, Zac., Mexico
| | - Eric Reyes Rivera
- División de Ciencias e Ingenierias CampusLeon, Universidad de Guanajuato, Loma del Bosque 103, Col. Lomas del Campestre, Gto, 37150 Leon, Mexico; UNEME-Oncología, Guadalupe, Zac., Mexico
| | - Luis Hernandez-Adame
- Centro de Investigaciones Biologicas del Noroeste, S.C. Instituto Politecnico Nacional 195, Col. Playa de Santa Rita, 23096 La Paz, BCS, Mexico
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Dautruche A, Bolle S, Feuvret L, Le Tourneau C, Jouffroy T, Goudjil F, Zefkili S, Nauraye C, Rodriguez J, Herman P, Calugaru V. Three-year results after radiotherapy for locally advanced sinonasal adenoid cystic carcinoma, using highly conformational radiotherapy techniques proton therapy and/or Tomotherapy. Cancer Radiother 2018; 22:411-6. [PMID: 30064829 DOI: 10.1016/j.canrad.2017.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE We report the patient outcomes of a treatment combining proton therapy and Tomotherapy in sinonasal adenoid cystic carcinoma involving skull base. MATERIALS AND METHODS We included patients treated at Curie Institute, Paris, France, between March 2010 and February 2014 for an advanced adenoid cystic carcinoma involving skull base. Patients received Tomotherapy, proton therapy or both. We evaluated treatment toxicity (according to CTCAE V4), local control, distant metastasis-free survival and overall survival. RESULTS Thirteen patients were included, with a median follow-up of 34 months. Radiation therapy followed surgery for 77% of the patients and margins were positive in all those cases. Median dose was 73.8Gy. Local control, distant metastasis-free survival and overall survival at 3 years were respectively 60%, 48% and 60%. One-sided grade 3 hearing impairment occurred in 46% of the patients. CONCLUSION Combining high-dose proton therapy and Tomotherapy is effective and has moderate toxicity in the treatment of T4 sinonasal adenoid cystic carcinoma involving skull base.
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Abstract
RaySearch Laboratories is a world leader in the field of advanced software and creator of the RayStation treatment planning system for radiation therapy. The aim with RayStation is to deliver an unmatched user experience and leading functionality. Unique features described here include multiatlas based autosegmentation for contouring, deformable registration with 2 different algorithms, multicriteria optimization, Plan Explorer, fallback planning, ultrafast computation speed, and 4-dimensional (4D) adaptive radiation therapy. RayStation can be used to plan for electrons and photons on traditional linacs, for protons on various delivery systems, and for Accuray's helical TomoTherapy system. This paper describes some of these modalities, with reference to clinical cases and including descriptions of the impact on workflow.
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44
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Meyer E, Goudjil F, Tamburini J, Dendale R, Kirova Y. Proton beam therapy for the management of mediastinal Hodgkin lymphoma in a young female patient. Cancer Radiother 2018; 22:296-298. [PMID: 29606542 DOI: 10.1016/j.canrad.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 11/26/2022]
Affiliation(s)
- E Meyer
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Goudjil
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - J Tamburini
- Department of haematology, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - R Dendale
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of haematology, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Abstract
The helical tomotherapy is a technologically advanced radiation dose delivery system designed to perform intensity-modulated radiation therapy (IMRT). It is mechanistically unique, based on a small 6-MV linear accelerator mounted on a ring gantry that rotates around the patient while the patient moves through a bore, ultimately yielding a helical path of radiation dose delivery. The helical pattern of dose delivery differentiated tomotherapy from other contemporary radiation therapy systems at the time of its inception. The accompanying 3-dimensional (3D) treatment planning system has been developed to solely support this specific type of dose delivery system. The treatment planning system has 2 modules identified as TomoHelical and TomoDirect to perform IMRT and conformal radiation therapy, respectively. The focus of this work within the scope of this special issue on 3D treatment planning systems is to assess the use of planning tools to generate treatment plans for helical tomotherapy. Clinical examples are used throughout to demonstrate the quality and differences of various clinical scenarios planned with tomotherapy.
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Affiliation(s)
- Cheng B Saw
- Northeast Radiation Oncology Centers (NROC), Dunmore, PA 18512.
| | - Leah Katz
- Hudson Valley Radiation Oncology Associates, Cortlandt Manor, NY 10567
| | - Carol Gillette
- Hudson Valley Radiation Oncology Associates, Cortlandt Manor, NY 10567
| | - Lawrence Koutcher
- Hudson Valley Radiation Oncology Associates, Cortlandt Manor, NY 10567
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46
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Orecchia R, Rojas DP, Cattani F, Ricotti R, Santoro L, Morra A, Cambria R, Luraschi R, Dicuonzo S, Ronchi S, Surgo A, Dell' Acqua V, Veronesi P, De Lorenzi F, Fodor C, Leonardi MC, Jereczek-Fossa BA. Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation. Med Oncol 2018; 35:39. [PMID: 29442173 DOI: 10.1007/s12032-018-1095-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II-III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012-2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0-35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.
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Affiliation(s)
- Roberto Orecchia
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Samantha Dicuonzo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Sara Ronchi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Alessia Surgo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Veronica Dell' Acqua
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - Francesca De Lorenzi
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Maria Cristina Leonardi
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
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Paix A, Antoni D, Waissi W, Ledoux MP, Bilger K, Fornecker L, Noel G. Total body irradiation in allogeneic bone marrow transplantation conditioning regimens: A review. Crit Rev Oncol Hematol 2018; 123:138-148. [PMID: 29482775 DOI: 10.1016/j.critrevonc.2018.01.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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: 07/03/2017] [Revised: 09/28/2017] [Accepted: 01/24/2018] [Indexed: 12/30/2022] Open
Abstract
Hematologic malignancies may require, at one point during their treatment, allogeneic bone marrow transplantation. Total body irradiation combined with chemotherapy or radiomimetic used in allogeneic bone marrow transplantation is known to be very toxic. Total body irradiation (TBI) induces immunosuppression to prevent the rejection of donor marrow. TBI is also used to eradicate malignant cells and is in sanctuary organs that are not reached by chemotherapy drugs. TBI has evolved since its introduction in the late fifties, but acute and late toxicities remain. Helical tomotherapy, which is widely used for some solid tumors, is a path for the improvement of outcomes and toxicities in TBI because of its sparing capacities. In this article, we first review the practical aspects of TBI with patient positioning, radiobiological considerations and total dose and fractionation prescriptions. Second, we review the use of intensity modulated radiation therapy in bone marrow transplantation with a focus on helical tomotherapy TBI, helical tomotherapy total marrow irradiation (TMI) and total marrow and lymphoid irradiation (TMLI) and their dosimetric and clinical outcomes. Finally, we review the perspective of dose escalation and the extension to older patients and patients with comorbidity who do not benefit from a standard bone marrow transplantation conditioning regimen.
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Affiliation(s)
- Adrien Paix
- Radiation Oncology Department, Centre Paul Strauss 3 rue de la Porte de l'hôpital, 67065, Strasbourg Cedex, France
| | - Delphine Antoni
- Radiation Oncology Department, Centre Paul Strauss 3 rue de la Porte de l'hôpital, 67065, Strasbourg Cedex, France; Radiobiology Laboratory, EA3430, Strasbourg University, 3 rue de la Porte de l'hôpital, 67000, Strasbourg, France
| | - Waisse Waissi
- Radiation Oncology Department, Centre Paul Strauss 3 rue de la Porte de l'hôpital, 67065, Strasbourg Cedex, France; Radiobiology Laboratory, EA3430, Strasbourg University, 3 rue de la Porte de l'hôpital, 67000, Strasbourg, France
| | - Marie-Pierre Ledoux
- Hematology Department, CHU Hautepierre, 1, rue Molière, 67000, Strasbourg, France
| | - Karin Bilger
- Hematology Department, CHU Hautepierre, 1, rue Molière, 67000, Strasbourg, France
| | - Luc Fornecker
- Hematology Department, CHU Hautepierre, 1, rue Molière, 67000, Strasbourg, France
| | - Georges Noel
- Radiation Oncology Department, Centre Paul Strauss 3 rue de la Porte de l'hôpital, 67065, Strasbourg Cedex, France; Radiobiology Laboratory, EA3430, Strasbourg University, 3 rue de la Porte de l'hôpital, 67000, Strasbourg, France.
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48
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Leitzen C, Wilhelm-Buchstab T, Müdder T, Heimann M, Koch D, Schmeel C, Simon B, Stumpf S, Vornholt S, Garbe S, Röhner F, Schoroth F, Schild HH, Schüller H. Patient positioning in head and neck cancer : Setup variations and safety margins in helical tomotherapy. Strahlenther Onkol 2018; 194:386-391. [PMID: 29372290 DOI: 10.1007/s00066-018-1265-7] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the interfractional variations of patient positioning during intensity-modulated radiotherapy (IMRT) with helical tomotherapy in head and neck cancer and to calculate the required safety margins (sm) for bony landmarks resulting from the necessary table adjustments. MATERIALS AND METHODS In all, 15 patients with head and neck cancer were irradiated using the Hi-Art II tomotherapy system between April and September 2016. Before therapy sessions, patient position was frequently checked by megavolt computed tomography (MV-CT). Necessary table adjustments (ta) in the right-left (rl), superior-inferior (si) and anterior-posterior (ap) directions were recorded for four anatomical points: second, fourth and sixth cervical vertebral body (CVB), anterior nasal spine (ANS). Based upon these data sm were calculated for non-image-guided radiotherapy, image-guided radiotherapy (IGRT) and image guidance limited to a shortened area (CVB 2). RESULTS Based upon planning CT the actual treatment required ta from -0.05 ± 1.31 mm for CVB 2 (ap) up to 2.63 ± 2.39 mm for ANS (rl). Considering the performed ta resulting from image control (MV-CT) we detected remaining ta from -0.10 ± 1.09 mm for CVB 4 (rl) up to 1.97 ± 1.64 mm for ANS (si). After theoretical adjustment of patients position to CVB 2 the resulting ta ranged from -0.11 ± 2.44 mm for CVB6 (ap) to 2.37 ± 2.17 mm for ANS (si). These data imply safety margins: uncorrected patient position: 3.63-9.95 mm, corrected positioning based upon the whole target volume (IGRT): 1.85-6.63 mm, corrected positioning based upon CVB 2 (IGRT): 3.13-6.66 mm. CONCLUSIONS The calculated safety margins differ between anatomic regions. Repetitive and frequent image control of patient positioning is necessary that, however, possibly may be focussed on a limited region.
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Affiliation(s)
- Christina Leitzen
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Timo Wilhelm-Buchstab
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Thomas Müdder
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Martina Heimann
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - David Koch
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christopher Schmeel
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Birgit Simon
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Sabina Stumpf
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Susanne Vornholt
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stephan Garbe
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Fred Röhner
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Felix Schoroth
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Hans Heinz Schild
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Heinrich Schüller
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Kumar SS, Hall L, Li X, Downes L, Shearer A, Shelton BJ, Gerring S, McGarry RC. Comparison of outcomes of stereotactic body radiation therapy delivered with three different technologies to the lung. J Radiosurg SBRT 2018; 5:209-216. [PMID: 29988318 PMCID: PMC6018041] [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] [Grants] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE/OBJECTIVES Since the inception of stereotactic body radiation therapy (SBRT), treatment delivery has been performed with volumetric modulated arc therapy (VMAT), helical tomotherapy (HT) and noncoplanar static fields (SF). The purpose of this study is to compare SBRT delivery among these treatment modalities to the lung. MATERIALS/METHODS A retrospective review of SBRT treatments of 30 to 60 Gy in 1 to 5 fractions from 2007 to 2015 was performed. Dosimetric parameters included V5, V20, D2cm, gross tumor volume (GTV) and planning target volume (PTV) size and coverage, rib/esophageal minimum/maximum doses, R30Gy, R50%, and the conformality index (CI). Clinical outcomes evaluated included local control, pneumonitis and other toxicities. ANOVA, Student's t-test and Kruskal-Wallis test were used to compare the parameters among modalities. Kaplan-Meier estimates of time-to-local failure were produced. RESULTS 176 Treatments included 106 SF, 36 VMAT and 34 HT. HT had better PTV coverage (p=0.0166) but higher lung V5 and esophageal doses (p<0.001 and p=0.0032). R30Gy, R50%, and CI were significantly better with VMAT SBRT (p<0.001). Clinically, Grade 2+ pneumonitis was associated with larger median GTV's of 21.39 cc versus 7.65 cc (p=0.0016), larger median PTV's of 65.62 cc versus 31.75 cc (p=0.0030), and higher V20 6.62% versus 4.08% (p=0.0408). For patients surviving >1 year, overall local failure rate was 9.4%. Actuarial control rates trended toward statistical significance with time to local failure with VMAT being the most favorable group on the Kaplan-Meier curve (p=0.0733). CONCLUSION VMAT showed superior conformality compared to the other modalities. Among the modalities examined, HT had higher values for parameters associated with toxicity such as V5 and maximum esophageal dose, but all were within acceptable limits. There was a trend to better local control with VMAT.
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Affiliation(s)
- Sameera S. Kumar
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Logan Hall
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Xingzhe Li
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Laura Downes
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Andrew Shearer
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Brent J. Shelton
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA
| | - Samuel Gerring
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ronald C. McGarry
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
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Hong CS, Ju SG, Ahn YC, Yoo GS, Noh JM, Oh D, Chung K, Pyo H, Jo K. Normal lung sparing Tomotherapy technique in stage III lung cancer. Radiat Oncol 2017; 12:167. [PMID: 29110732 PMCID: PMC5674800 DOI: 10.1186/s13014-017-0905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/14/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Radiation pneumonitis (RP) has been a challenging obstacle in treating stage III lung cancer patients. Beam angle optimization (BAO) technique for Tomotherapy was developed to reduce the normal lung dose for stage III non-small cell lung cancer (NSCLC). Comparative analyses on plan quality by 3 different Intensity-modulated radiation therapy (IMRT) methods with BAO were done. MATERIALS AND METHODS Ten consecutive stage IIIB NSCLC patients receiving linac-based static IMRT (L-IMRT) with total 66 Gy in 33 fractions to the PTV were selected. Two additional Tomotherapy-based IMRT plans (helical beam (TH-IMRT) and static beam (TD-IMRT)) were generated on each patient. To reduce the normal lung dose, Beam angles were optimized by using complete and directional block functions in Tomotherapy based on knowledge based statistical analysis. Plan quality was compared with target coverage, normal organ sparing capability, and normal tissue complication probability (NTCP). Actual beam delivery times and risk of RP related with planning target volume (PTV) were also evaluated. RESULTS The best PTV coverage measured by conformity index and homogeneity index was achievable by TH-IMRT (0.82 and 1.06), followed by TD-IMRT (0.81 and 1.07) and L-IMRT (0.75 and 1.08). Mean lung dose was the lowest in TH-IMRT plan followed by TD-IMRT and L-IMRT, all of which were ≤20 Gy. TH-IMRT plan could significantly lower the lung volumes receiving low to medium dose levels: V5~30 when compared to L-IMRT plan; and V5~20 when compared to TD-IMRT plan, respectively. TD-IMRT plan was significantly better than L-IMRT with respects to V20 and V30 and there was no significant difference with respect to V40 among three plans. The NTCP of the lung was the lowest in TH-IMRT plan, followed by TD-IMRT and L-IMRT (6.42% vs. 6.53% vs. 8.11%). Beam delivery time was the shortest in TD-IMRT plan followed by L-IMRT. As PTV length increased, NTCP and Mean lung dose proportionally increased significantly in all three plans. CONCLUSION Advantageous profiles by TH-IMRT could be achieved by BAO by complete and directional block functions. Current observation could help radiation oncologists to make wise selection of IMRT method for stage IIIB NSCLC.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea.
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Kwangzoo Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
| | - Kwanghyun Jo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, South Korea
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