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Srivastava A, Parambath HK, Ramdulari AV, Saxena H, Kumar R, Pandey S, Shalimar, Gupta S, Jee B. Is hepatocellular carcinoma complicated with portal vein tumor thrombosis potentially curable by radiotherapy in the form of stereotactic body radiation therapy? Int J Radiat Biol 2022; 98:1495-1509. [PMID: 35311612 DOI: 10.1080/09553002.2022.2055800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal. Despite best treatment and care, the patients with this malignancy only showed 2.7-4 months of overall survival. It is debatable whether liver transplantation helps PVTT sufferers. The effectiveness of radiation therapy in treating HCC patients with PVTT should not be undervalued. By limiting the high dosage region to a small planning target volume, stereotactic radiation delivery has shifted toward hypofractionation, limiting the radiation exposure to healthy organs and tissues. Stereotactic body radiotherapy (SBRT) has a local control rate of 75-100%, depending on the treatment. The major limitation in SBRT for hepatocellular carcinoma with PVTT is the paucity of prospective evidence for longer periods beyond the first two years after treatment. More prospective studies/randomized clinical trials with a longer follow-up, larger sample size, and adequate statistical power are the dire need of the present situation to ascertain the curative effect of SBRT as primary therapy for advanced HCC with PVTT. CONCLUSION SBRT can improve survival, particularly for patients receiving multidisciplinary treatment. This review sums up our most current understanding of how radiation therapy, notably SBRT, can be used to treat hepatocellular carcinoma when combined with PVTT. Recent research has led us to believe that irradiation in the form of SBRT may cure hepatocellular carcinoma complicated by PVTT.
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Affiliation(s)
- Astha Srivastava
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Haresh Kunhi Parambath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali V Ramdulari
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Saxena
- Department of Medicine Trauma, All India Institute of Medical Sciences, New Delhi, India
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suyash Pandey
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Babban Jee
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Imano N, Kimura T, Kawahara D, Nishioka R, Fukumoto W, Kawano R, Kubo K, Katsuta T, Takeuchi Y, Nishibuchi I, Murakami Y, Horimasu Y, Masuda T, Fujitaka K, Hattori N, Nagata Y. Potential benefits of volumetric modulated arc therapy to reduce the incidence of ≥ grade 2 radiation pneumonitis in radiotherapy for locally advanced non-small cell lung cancer patients. Jpn J Clin Oncol 2021; 51:1729-1735. [PMID: 34625805 DOI: 10.1093/jjco/hyab163] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/29/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of volumetric modulated arc therapy is gradually widespread for locally advanced non-small cell lung cancer. The purpose of this study was to identify the factors that caused ≥ grade 2 radiation pneumonitis and evaluate the impact of using volumetric modulated arc therapy on the incidence of ≥ grade 2 radiation pneumonitis by comparing three-dimensional conformal radiation therapy. METHODS We retrospectively evaluated 124 patients who underwent radical radiotherapy for locally advanced non-small cell lung cancer in our institution between 2008 and 2019. The following variables were analysed to detect the factors that affected ≥ grade 2 radiation pneumonitis; age, sex, the presence of interstitial lung disease, pulmonary emphysema, tumour location, stage, PTV/lung volume, lung V20Gy, total dose, concurrent chemoradiotherapy, adjuvant immune checkpoint inhibitor, radiotherapy method. Radiation pneumonitis was evaluated using the common terminology criteria for adverse events (version 5.0). RESULTS A total of 84 patients underwent three-dimensional conformal radiation therapy (3D-CRT group) and 40 patients underwent volumetric modulated arc therapy (VMAT group). The cumulative incidence of ≥ grade 2 radiation pneumonitis at 12 months was significantly lower in the VMAT group than in the 3D-CRT group (25% vs. 49.1%). The use of volumetric modulated arc therapy was a significant factor for ≥ grade 2 radiation pneumonitis (HR:0.32, 95% CI: 0.15-0.65, P = 0.0017) in addition to lung V20Gy (≥ 24%, HR:5.72 (95% CI: 2.87-11.4), P < 0.0001) and total dose (≥ 70 Gy, HR:2.64 (95% CI: 1.39-5.03), P = 0.0031) even after adjustment by multivariate analysis. CONCLUSIONS We identified factors associated with ≥ grade 2 radiation pneumonitis in radiotherapy for patients with locally advanced non-small cell lung cancer. Volumetric modulated arc therapy has potential benefits to reduce the risk of ≥ grade 2 radiation pneumonitis.
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Affiliation(s)
- Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Radiation Oncology, Kochi Medical School, Kochi University, Nankoku-shi, Kochi, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Riku Nishioka
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Reo Kawano
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsumaro Kubo
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsuyoshi Katsuta
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Takeuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
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Piras A, Menna S, D'Aviero A, Marazzi F, Mazzini A, Cusumano D, Massaccesi M, Mattiucci GC, Daidone A, Valentini V, Boldrini L. New fractionations in breast cancer: a dosimetric study of 3D-CRT versus VMAT. J Med Radiat Sci 2021; 69:227-235. [PMID: 34551211 PMCID: PMC9163458 DOI: 10.1002/jmrs.530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/15/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Adjuvant radiation therapy (RT) following primary surgery in women affected by early breast cancer (EBC) plays a central role in reducing local recurrences and overall mortality. The FAST-FORWARD trial recently demonstrated that 1-week hypofractionated adjuvant RT is not inferior to the standard schedule in terms of local relapse, cosmetic outcomes and toxicity. The aim of this in silico study was to evaluate the dosimetric aspects of a 1-week RT course, administered through volumetric modulated arc therapy (VMAT), compared with traditional three-dimensional conformal radiation therapy (3D-CRT) with tangential fields. METHODS Patients affected by left-side EBC undergoing adjuvant RT were selected. ESTRO guidelines for the clinical target volume (CTV) delineation and FAST-FORWARD protocol for CTV to planning target volume (PTV) margin definition were followed. Total prescribed dose was 26 Gy in five fractions. The homogeneity index (HI) and the global conformity index (GCI) were taken into account for planning and dose distribution optimisation purposes. Both 3D-CRT tangential fields and VMAT plans were generated for each patient. RESULTS The analysis included 21 patients. PTV coverage comparison between 3D-CRT and VMAT plans showed significant increases for GCI (P < 0.05) in VMAT technique; no statistically significant differences were observed regarding HI. For organs at risks (OAR), statistically significant increases were observed in terms of skin V103% (P < 0.002) and ipsilateral lung V30% (P < 0.05) with 3D-CRT and of heart V5% (P < 0.05) with VMAT technique. CONCLUSIONS This in silico study showed that both 3D-CRT and VMAT are dosimetrically feasible techniques in the framework of 1-week hypofractionated treatments for left EBC.
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Affiliation(s)
- Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy
| | - Sebastiano Menna
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gian Carlo Mattiucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonino Daidone
- Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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Abdemanafi M, Tavakoli MB, Akhavan A, Abedi I. Evaluation of the Lung Dose in Three-dimensional Conformal Radiation Therapy of Left-Sided Breast Cancer: A Phantom Study. J Med Signals Sens 2020; 10:48-52. [PMID: 32166077 PMCID: PMC7038741 DOI: 10.4103/jmss.jmss_1_19] [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: 01/01/2019] [Revised: 05/07/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022]
Abstract
Background: Three-dimensional 3D-CRT: conformal radiation therapy is a selective modality in many radiotherapy centers for the treatment of breast cancer. One of the most common side effects of this method is radiation lung injury. Considering such an injury, lung dose deserves to be studied in depth. Methods: Computed tomography scan of a node-positive left-sided breast cancer woman was used for generating a thorax phantom. Ten thermoluminescent dosimeters (TLDs) were distributed evenly in the left lung of the phantom, and the phantom was scanned. The optimal plan, including supraclavicular and tangential fields, was created by the treatment planning system (TPS). The results of TLD dose measurements at the selected points in the phantom were compared to TPS dose calculations. Results: Lung doses calculated by TPS are significantly different from those measured by the TLDs (P = 0.007). The minimum and maximum differences were −0.91% and 4.46%, respectively. TLDs that were on the inner margin of the lung and breast tissue showed higher dose differences than the TLDs in the lung. Conclusion: The results of this study showed that TPS generally overestimated doses compared to TLD measurements due to incorrect beam modeling caused by contaminated electrons in the lung.
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Affiliation(s)
- Mahsa Abdemanafi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagher Tavakoli
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Akhavan
- Department of Radiotherapy Oncology, Seyed Alshohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iraj Abedi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Lin WC, Chang CL, Hsu HL, Yuan KSP, Wu ATH, Wu SY. Three-Dimensional Conformal Radiotherapy-Based or Intensity-Modulated Radiotherapy-Based Concurrent Chemoradiotherapy in Patients with Thoracic Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11101529. [PMID: 31658709 PMCID: PMC6826542 DOI: 10.3390/cancers11101529] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 01/05/2023] Open
Abstract
Background: To date, intensity-modulated radiation therapy (IMRT) with concurrent chemoradiotherapy (CCRT) and CCRT with standard fractionation three-dimensional conformal radiation therapy (3D-CRT) have not been compared. In this study, the outcomes of IMRT-based concurrent CCRT and those of 3D-CRT-based CCRT were compared in patients with thoracic esophageal squamous cell carcinoma (TESCC). Methods: We enrolled 2062 patients with TESCC who had received CCRT and categorized them into two groups on the basis of their treatment modality: Group 1 (3D-CRT-based CCRT) and Group 2 (IMRT-based CCRT). Results: Multivariate Cox regression analysis indicated that the American Joint Committee on Cancer advanced stages (≥IIIA) and 3D-CRT were significant independent predictors of poor outcomes in patients with TESCC who received definitive CCRT. Moreover, receiving IMRT-based CCRT (adjusted hazard ratio [aHR]: 0.88, 95% confidence interval [CI]: 0.78–0.98) was a significant independent prognostic factor for overall survival (p = 0.0223). In Group 2, aHRs (95% CIs) for overall mortality at early (IA–IIB) and advanced clinical stages were 0.91 (0.67–1.25, p = 0.5746) and 0.88 (0.77–0.99, p = 0.0368), respectively. Conclusion: IMRT-based CCRT resulted in higher survival rates in patients with advanced clinical stages of TESCC (i.e., IIIA–IIIC), namely, clinical T3, clinical T4, or lymph node involvement.
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Affiliation(s)
- Wei-Cheng Lin
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
| | - Chia-Lun Chang
- Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, 106 Taipei Medical University, Taipei 106, Taiwan.
| | - Han-Lin Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 106, Taiwan.
| | - Kevin Sheng-Po Yuan
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
| | - Alexander T H Wu
- Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei 106, Taiwan.
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan.
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan.
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 106, Taiwan.
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Fan XW, Wu JL, Wang HB, Liang F, Jiang GL, Wu KL. Three-dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10-year survival outcomes. Thorac Cancer 2019; 10:519-525. [PMID: 30648821 PMCID: PMC6397900 DOI: 10.1111/1759-7714.12968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/15/2018] [Accepted: 12/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Concurrent chemoradiation is the standard treatment for locally advanced esophageal squamous cell carcinoma (SCC). We conducted a phase II study to explore the effect of three‐dimensional conformal radiotherapy (3‐DCRT) alone for patients with locally advanced esophageal SCC. This study aimed to analyze the long‐term survival outcomes. Methods Between November 2004 and April 2007, 30 patients with thoracic esophageal SCC underwent late‐course sequential boost 3‐DCRT at Fudan University Shanghai Cancer Center. The planning target volume (PTV1) comprised a 1.2–1.5 cm lateral margin around the gross tumor volume and a 3.0 cm margin, superior and inferior to the gross tumor volume. PTV2 encompassed the gross tumor volume with a margin of 0.5–0.7 cm. The PTV1 dose delivered was 50 Gy, and the PTV2 dose was a boost dose of 16 Gy, resulting in a total dose of 66 Gy. No chemotherapy was administered. Results The median follow‐up time was 30 months for all patients, and 132 months for patients who were alive. The median overall survival was 27 months (95% confidence interval [CI] 18.9–35.0). The 2‐, 5‐, and 10‐year overall survival rates were 56.6%, 33.3%, and 26.6%, respectively. The median progression‐free survival was 14 months (95% CI 7.7–20.2 months), and the 2‐, 5‐, and 10‐year progression‐free survival rates were 33.3%, 30.0%, and 26.6%, respectively. No severe late toxicity was observed in long‐term survivors. Conclusion Late‐course sequential boost 3‐DCRT is safe and feasible with promising long‐term outcomes for esophageal SCC.
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Affiliation(s)
- Xing-Wen Fan
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun-Lan Wu
- Department of Oncology, Shanghai Armed Police Corps Hospital, Shanghai, China
| | - Hong-Bing Wang
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fei Liang
- Clinical Statistics Center, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - Guo-Liang Jiang
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kai-Liang Wu
- Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Rehman JU, Isa M, Ahmad N, Nasar G, Asghar HMNUHK, Gilani ZA, Chow JCL, Afzal M, Ibbott GS. Dosimetric, Radiobiological and Secondary Cancer Risk Evaluation in Head-and-Neck Three-dimensional Conformal Radiation Therapy, Intensity-Modulated Radiation Therapy, and Volumetric Modulated Arc Therapy: A Phantom Study. J Med Phys 2018; 43:129-135. [PMID: 29962691 PMCID: PMC6020619 DOI: 10.4103/jmp.jmp_106_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/02/2022] Open
Abstract
This analysis estimated secondary cancer risks after volumetric modulated arc therapy (VMAT) and compared those risks to the risks associated with other modalities of head-and-neck (H&N) radiotherapy. Images of H&N anthropomorphic phantom were acquired with a computed tomography scanner and exported via digital imaging and communications in medicine (DICOM) standards to a treatment planning system. Treatment plans were performed using a VMAT dual-arc technique, a nine-field intensity-modulated radiation therapy (IMRT) technique, and a four-field three-dimensional conformal therapy (3DCRT) technique. The prescription dose was 66.0 Gy for all three techniques, but to accommodate the range of dosimeter responses, we delivered a single dose of 6.60 Gy to the isocenter. The lifetime risk for secondary cancers was estimated according to National Council on Radiation Protection and Measurements (NCRP) Report 116. VMAT delivered the lowest maximum doses to esophagus (23 Gy), and normal brain (40 Gy). In comparison, maximum doses for 3DCRT were 74% and 40%, higher than those for VMAT for the esophagus, and normal brain, respectively. The normal tissue complication probability and equivalent uniform dose for the brain (2.1%, 0.9%, 0.8% and 3.8 Gy, 2.6 Gy, 2.3 Gy) and esophagus (4.2%, 0.7%, 0.4% and 3.7 Gy, 2.2 Gy, 1.8 Gy) were calculated for the 3DCRT, IMRT and VMAT respectively. Fractional esophagus OAR volumes receiving more than 20 Gy were 3.6% for VMAT, 23.6% for IMRT, and 100% for 3DCRT. The calculations for mean doses, NTCP, EUD and OAR volumes suggest that the risk of secondary cancer induction after VMAT is lower than after IMRT and 3DCRT.
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Affiliation(s)
- Jalil Ur Rehman
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Muhammad Isa
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, Ontario, Toronto, Canada
- Department of Physics, Hafiz Hayat Campus, University of Gujrat, Gujrat, Pakistan
| | - Nisar Ahmad
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Gulfam Nasar
- Department of Chemistry, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - H. M. Noor Ul Huda Khan Asghar
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Zaheer Abbas Gilani
- Department of Physics, Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - James C. L. Chow
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, Ontario, Toronto, Canada
| | - Muhammad Afzal
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Yan H, Cao X, Wang J. Application of intensity-modulated radiation therapy in the treatment of nasopharyngeal carcinoma. Oncol Lett 2017; 14:7773-7776. [PMID: 29344223 PMCID: PMC5755088 DOI: 10.3892/ol.2017.7186] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/18/2017] [Indexed: 11/07/2022] Open
Abstract
The objective of the present study was to investigate the application values of the intensity-modulated radiation therapy (IMRT) and the three-dimensional conformal radiation therapy (3D-CRT) in the treatment of nasopharyngeal carcinoma (NPC). A total of 124 patients diagnosed with nasopharyngeal carcinomas were included into the study and randomly divided into the control group and the observation group, with 62 patients in each group. The 3D-CRT combined with postoperative chemotherapy were performed on the control group and the observation group received IMRT combined with postoperative chemotherapy, and then were followed up for a median duration of 25.5 months. Comparison of the survival analysis of the two groups showed no differences between them in terms of the total effective rate and effectiveness (P>0.05), or radiotherapy complications (P>0.05). In addition, no significant differences between the two groups were found in the follow-up local tumor control probability (TCP), regional lymph node control rate, distant metastasis-free rate, tumor-free survival rate, recurrence rate and overall survival rate (P>0.05). Furthermore, there was no difference between the two groups in the overall score of quality of life (P>0.05). The present study concludes that the IMRT and the 3D-CRT have almost the same short-term and long-term clinical effects in the treatment of nasopharyngeal carcinoma and both of them have high effectiveness and safety.
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Affiliation(s)
- Hao Yan
- Department of Ear-Nose-Throat, Dezhou People's Hospital, Dezhou, Shandong 253045, P.R. China
| | - Xiaoming Cao
- Department of Ear-Nose-Throat, Dezhou People's Hospital, Dezhou, Shandong 253045, P.R. China
| | - Jinmei Wang
- Department of Ear-Nose-Throat, Dezhou People's Hospital, Dezhou, Shandong 253045, P.R. China
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Yang H, Feng C, Cai BN, Yang J, Liu HX, Ma L. Comparison of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy in the treatment of cervical esophageal carcinoma. Dis Esophagus 2017; 30:1-8. [PMID: 27629865 DOI: 10.1111/dote.12497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 12/11/2022]
Abstract
The aim of this study was to evaluate the effectiveness and toxicities of three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) in patients with cervical esophageal cancer. Specifically, we asked whether technological advances conferred an advantage with respect to the clinical curative effect. Seventy-eight patients with cervical esophageal cancer treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2007 and 2014 were enrolled in the study: 26 received 3DCRT, 30 were treated with IMRT, and 22 underwent VMAT. Kaplan-Meier analysis and the Cox proportional hazard model were used to analyze overall survival (OS) and failure-free survival (FFS). Treatment-related toxicity was also assessed. For all patients, the 2-year OS and FFS rates were 56.2 and 53.9%, respectively. The 2-year OS for the 3DCRT, IMRT, and VMAT groups was 53.6, 55.6, and 60.6%, respectively (P = 0.965). The corresponding 2-year FFS rates were 49.5, 56.7, and 60.1% (P = 0.998). A univariate analysis of the complete response to treatment showed an advantage of treatment modality with respect to OS (P < 0.001). The development of acute hematologic toxicity was not significantly different among the three groups. The survival rates of patients treated with IMRT and VMAT were comparable to the survival of patients administered 3DCRT, while lower lung mean dose, V20, maximum dose of brachial plexus and spinal cord. Grade 1 radiation pneumonitis occurred significantly less in patients treated with IMRT and VMAT than with 3DCRT (P = 0.011). A complete response was the most important prognostic factor of the patients with cervical esophageal cancer.
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Affiliation(s)
- Hao Yang
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.,Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Cong Feng
- Emergency Medicine , Chinese PLA General Hospital, Beijing, China
| | - Bo-Ning Cai
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Jun Yang
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Hai-Xia Liu
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Lin Ma
- Department of Radiation Oncology, Inner Mongolia Cancer Hospital and The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
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Rastogi K, Jain S, Bhatnagar AR, Bhaskar S, Gupta S, Sharma N. A Comparative Study of Hypofractionated and Conventional Radiotherapy in Postmastectomy Breast Cancer Patients. Asia Pac J Oncol Nurs 2017; 5:107-113. [PMID: 29379842 PMCID: PMC5763427 DOI: 10.4103/apjon.apjon_46_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/04/2022] Open
Abstract
Objective The aim of this study was to compare toxicity and locoregional control of short duration hypofractionated (HF) radiotherapy (RT) with conventional RT in breast cancer patients. Methods A total of 100 postmastectomy breast cancer patients were randomized for adjuvant RT in control group (comprising fifty patients who received the standard conventional dose of 50 Gy in 25 fractions with 2 Gy per fraction) and study group (comprising fifty patients who received HF RT with dose of 42.72 Gy in 16 fractions with 2.67 Gy per fraction). All patients were treated on linear accelerator with 3-dimensional conformal RT technique. Outcome was analyzed in terms of toxicity, tolerability, and locoregional control. Results In the present study, at a median follow-up of 20 months, almost similar results were seen in both the groups in terms of toxicity, tolerability, and locoregional control. Adjuvant postmastectomy HF RT was found to be well tolerated with mild-to-moderate side effects that neither reached statistical significance nor warranted any treatment interruption/hospitalization. Conclusions HF postmastectomy RT is comparable to conventional RT without evidence of higher adverse effects or inferior locoregional tumor control and has an added advantage of increased compliance because of short duration; hence, it can help in accommodating more breast cancer patients in a calendar year, ultimately resulting in decreased waiting list, increased turnover, and reduced cost of treatment.
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Affiliation(s)
- Kartick Rastogi
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Sandeep Jain
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Aseem Rai Bhatnagar
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Sandeep Bhaskar
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Shivani Gupta
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Neeraj Sharma
- Department of Radiotherapy, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
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11
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Verma V, Moreno AC, Lin SH. Advances in Radiotherapy Management of Esophageal Cancer. J Clin Med 2016; 5:E91. [PMID: 27775643 DOI: 10.3390/jcm5100091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 01/25/2023] Open
Abstract
Radiation therapy (RT) as part of multidisciplinary oncologic care has been marked by profound advancements over the past decades. As part of multimodality therapy for esophageal cancer (EC), a prime goal of RT is to minimize not only treatment toxicities, but also postoperative complications and hospitalizations. Herein, discussion commences with the historical approaches to treating EC, including seminal trials supporting multimodality therapy. Subsequently, the impact of RT techniques, including three-dimensional conformal RT, intensity-modulated RT, and proton beam therapy, is examined through available data. We further discuss existing data and the potential for further development in the future, with an appraisal of the future outlook of technological advancements of RT for EC.
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12
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Hawrylewicz L, Leszczyński W, Namysł-Kaletka A, Bronclik I, Wydmański J. Protection of organs at risk during neoadjuvant chemoradiotherapy for gastric cancer based on a comparison between conformal and intensity-modulated radiation therapy. Oncol Lett 2016; 12:692-698. [PMID: 27347202 DOI: 10.3892/ol.2016.4633] [Citation(s) in RCA: 8] [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: 02/09/2015] [Accepted: 02/16/2016] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to compare the techniques of dynamic intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) in patients with gastric cancer. Implementation of the IMRT technique does not significantly affect the minimum and maximum dose levels in the planning target volume (PTV), but more effectively protects the critical organs. The study group consisted of 25 patients. The results of the analysis of the conformity index (CI) and the homogeneity index (HI) showed that the doses in the PTV regions were at a comparable level. The CI for the PTV was 0.95 for the 2-field technique, 0.95 for the 3-field technique, 0.96 for the 4-field technique and 0.94 for the IMRT technique. The CIs for these techniques for the clinical target volume (CTV) were 0.96, 0.96, 0.97 and 0.96, respectively, and the CIs for the gross tumor volume (GTV) were 0.99, 0.99, 0.99 and 0.98, respectively. The HI values for the PTV were 1.12 for the 2-field technique, 1.12 for the 3-field technique, 1.09 for the 4-field technique and 1.09 for the IMRT technique, and the HI values for the CTV were 1.12, 1.12, 1.09 and 1.08 for the same techniques, respectively. The HI values for the GTV were 1.09, 1.09, 1.07 and 1.06, respectively, which indicated significantly superior performance in the regions of healthy tissue. Statistical study was based on Friedman's rank analysis of variance to determine the level of reliability of the tested groups of variables (P<0.001). The present study demonstrated that the IMRT technique in the pre-operative radiotherapy of gastric cancer patients results in superior treatment tolerance and reduces the risk of damage to healthy tissue that is in close proximity to the irradiated area.
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Affiliation(s)
- Leszek Hawrylewicz
- Department of Radiotherapy and Brachytherapy Planning, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Wojciech Leszczyński
- Department of Radiotherapy and Brachytherapy Planning, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Agnieszka Namysł-Kaletka
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Iwona Bronclik
- Department of Radiotherapy and Brachytherapy Planning, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Jerzy Wydmański
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
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Kinhikar RA, Ghadi YG, Sahoo P, Laskar SG, Deshpande DD, Shrivastava SK, Agarwal J. Dosimetric comparison of three-dimensional conformal radiotherapy, intensity modulated radiotherapy, and helical tomotherapy for lung stereotactic body radiotherapy. J Med Phys 2016; 40:190-7. [PMID: 26865754 PMCID: PMC4728889 DOI: 10.4103/0971-6203.170792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To compare the treatment plans generated with three-dimensional conformal radiation therapy (3DCRT), intensity modulated radiotherapy (IMRT), and helical tomotherapy (HT) for stereotactic body radiotherapy of lung, twenty patients with medically inoperable (early nonsmall cell lung cancer) were retrospectively reviewed for dosimetric evaluation of treatment delivery techniques (3DCRT, IMRT, and HT). A dose of 6 Gy per fraction in 8 fractions was prescribed to deliver 95% of the prescription dose to 95% volume of planning target volume (PTV). Plan quality was assessed using conformity index (CI) and homogeneity index (HI). Doses to critical organs were assessed. Mean CI with 3DCRT, IMRT, and HT was 1.19 (standard deviation [SD] 0.13), 1.18 (SD 0.11), and 1.08 (SD 0.04), respectively. Mean HI with 3DCRT, IMRT, and HT was 1.14 (SD 0.05), 1.08 (SD 0.02), and 1.07 (SD 0.04), respectively. Mean R50% values for 3DCRT, IMRT, and HT was 8.5 (SD 0.35), 7.04 (SD 0.45), and 5.43 (SD 0.29), respectively. D2cm was found superior with IMRT and HT. Significant sparing of critical organs can be achieved with highly conformal techniques (IMRT and HT) without compromising the PTV conformity and homogeneity.
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Affiliation(s)
| | - Yogesh G Ghadi
- Department of Medical Physics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Priyadarshini Sahoo
- Department of Medical Physics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Deepak D Deshpande
- Department of Medical Physics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shyam K Shrivastava
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaiprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Sale C, Moloney P, Mathlum M. Carcinoma of the anal canal: Intensity modulated radiation therapy (IMRT) versus three-dimensional conformal radiation therapy (3DCRT). J Med Radiat Sci 2013; 60:145-55. [PMID: 26229623 PMCID: PMC4175819 DOI: 10.1002/jmrs.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/10/2013] [Accepted: 10/10/2013] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Patients with anal canal carcinoma treated with standard conformal radiotherapy frequently experience severe acute and late toxicity reactions to the treatment area. Roohipour et al. (Dis Colon Rectum 2008; 51: 147-53) stated a patient's tolerance of chemoradiation to be an important prediction of treatment success. A new intensity modulated radiation therapy (IMRT) technique for anal carcinoma cases has been developed at the Andrew Love Cancer Centre aimed at reducing radiation to surrounding healthy tissue. METHODS A same-subject repeated measures design was used for this study, where five anal carcinoma cases at the Andrew Love Cancer Centre were selected. Conformal and IMRT plans were generated and dosimetric evaluations were performed. Each plan was prescribed a total of 54 Gray (Gy) over a course of 30 fractions to the primary site. RESULTS The IMRT plans resulted in improved dosimetry to the planning target volume (PTV) and reduction in radiation to the critical structures (bladder, external genitalia and femoral heads). Statistically there was no difference between the IMRT and conformal plans in the dose to the small and large bowel; however, the bowel IMRT dose-volume histogram (DVH) doses were consistently lower. CONCLUSION The IMRT plans were superior to the conformal plans with improved dose conformity and reduced radiation to the surrounding healthy tissue. Anecdotally it was found that patients tolerated the IMRT treatment better than the three-dimensional (3D) conformal radiation therapy. This study describes and compares the planning techniques.
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Affiliation(s)
- Charlotte Sale
- Andrew Love Cancer Centre, Geelong Hospital Geelong, Victoria, Australia
| | - Phillip Moloney
- Andrew Love Cancer Centre, Geelong Hospital Geelong, Victoria, Australia
| | - Maitham Mathlum
- Andrew Love Cancer Centre, Geelong Hospital Geelong, Victoria, Australia
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Kumar P. A new paradigm for the treatment of high-risk prostate cancer: radiosensitization with docetaxel. Rev Urol 2003; 5 Suppl 3:S71-7. [PMID: 16985954 PMCID: PMC1502339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Survival and biochemical outcome of patients with localized, high-risk prostate cancer treated with definitive three-dimensional conformal radiation therapy (3-D CRT) with or without hormonal therapy are poor. Other therapeutic strategies are needed to improve outcome in these poor-prognostic-group patients. One such strategy involves the use of chemotherapeutic agents to radiosensitize the effects of local 3-D CRT. Very few investigators have tested this novel concept of chemotherapeutic radiosensitization. Two studies evaluated the combination of estramustine phosphate and vinblastine (EV) with radiation therapy (RT). In both studies, the combination of EV and RT resulted in moderate to severe acute and late toxicity. A recently completed, phase I trial evaluated the maximally tolerated dose (MTD) of weekly docetaxel that could be concurrently delivered with 3-D CRT (70.2 Gy) in men with high-risk prostate cancer. The MTD of concurrent weekly docetaxel with 3-D CRT was determined to be 20 mg/m(2), and this combination was shown to be safe and well tolerated. This was the first trial to evaluate taxane radiosensitization in prostate cancer. Other phase I/II studies are needed to further assess chemotherapeutic radiosensitization in localized, high-risk prostate cancer.
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