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Nakayama M, Sekii S, Miyazaki E, Oya T, Nishikawa R, Geso M. Dosimetric impact of VMAT delivery angles for early glottic cancer treatment. Med Dosim 2024:S0958-3947(24)00022-0. [PMID: 38729843 DOI: 10.1016/j.meddos.2024.04.001] [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: 11/17/2023] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024]
Abstract
This study investigates the dosimetric effects of different gantry rotation angles used in volumetric modulated arc therapy (VMAT) for early glottic carcinoma. VMAT treatment plans using full-arc, half-arc, and partial-arc gantry rotation angles were generated from 22 computed tomography datasets of early-stage (T1-2N0) glottic laryngeal cancer. Dosimetric parameters associated with the planning target volume (PTV) and organs at risk (OARs), specifically the carotid arteries and thyroid, were compared. To assess the robustness of the VMAT plans, dose variations were analyzed by introducing positional shifts of 1, 3, and 5 mm from the isocenter of each plan along the superior-inferior, left-right, and anterior-posterior axes. Furthermore, we examined the size of the PTV, the air cavity volume within the PTV, and the variability of the beam path length through the gantry angles to investigate their correlations with PTV dose variations in the presence of positioning errors. Compared to full-arc and half-arc plans, the dosimetric parameters of partial-arc plans were found to be higher in PTV (D2%, D5%, D50%, and Dmean) and lower in OARs, while their dose variations of OAR parameters were greater for positioning errors. In addition, a correlation was observed between PTV size and PTV dose variations. Air cavity volume and depth variability were also correlated with some PTV parameters, depending on the arc plan. The results presented in this study suggest that the partial-arc gantry angles can allow higher PTV doses while minimizing OAR doses in VMAT treatment planning for early glottic cancer. However, the small delivery angles may lead to greater dose variations in the OARs when positioning errors occur.
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Affiliation(s)
- Masao Nakayama
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan; Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan; Discipline of Medical Radiations, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia.
| | - Shuhei Sekii
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan; Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan
| | - Eiichi Miyazaki
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan
| | - Tomohiko Oya
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan
| | - Ryo Nishikawa
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan; Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan
| | - Moshi Geso
- Discipline of Medical Radiations, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia
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Yokota T, Zenda S, Kodaira T, Kiyota N, Fujimoto Y, Wasano K, Takahashi R, Mizowaki T, Homma A, Sasaki K, Machida R, Sekino Y, Fukuda H. Novel approach of prophylactic radiation to reduce toxicities comparing 2-step40 with 56-Gy simultaneous integrated boost intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the head and neck, an intergroup phase III trial (JCOG1912, NEW BRIDGE). BMC Cancer 2023; 23:1068. [PMID: 37932681 PMCID: PMC10626703 DOI: 10.1186/s12885-023-11503-z] [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: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Chemoradiotherapy (CRT) with concurrent cisplatin is the standard of care as a nonsurgical definitive treatment for patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, CRT is associated with increased severe late adverse events, including swallowing dysfunction, xerostomia, ototoxicity, and hypothyroidism. Few strategies aimed at less invasive CRT without compromising treatment outcomes have been successful. The purpose of this study is to confirm the non-inferiority of reduced dose prophylactic radiation with 40 Gy compared to standard dose prophylactic radiation with 56 Gy in terms of the time to treatment failure (TTF) among patients with clinical stage III-IVB LA-SCCHN. METHODS This study is a multicenter, two-arm, open-label, randomized phase III trial. Patients with LA-SCCHN excluding p16 positive oropharynx cancer are randomized to the standard arm or experimental arm. A total dose of 70 Gy for tumors with concurrent cisplatin at 100 mg/m2 are administered in both arms. For prophylactic field, patients in the standard arm receive a total dose of 56 Gy in 35 fractions for 7 weeks using simultaneous integrated boost (SIB56) and those in the experimental arm receive 40 Gy in 20 fractions using two-step methods for 4 weeks (2-step40). A total of 400 patients will be enrolled from 52 Japanese institutions within 5 years. The primary endpoint is TTF, and the secondary endpoints are overall survival, complete response rate, progression-free survival, locoregional relapse-free survival, acute and late adverse events, quality of life score, and swallowing function score. DISCUSSION If the experimental arm is non-inferior to the standard arm in terms of TTF and superior on the safety endpoints, the 2-step40 procedure is the more useful treatment than SIB56 for definitive CRT. TRIAL REGISTRATION This trial has been registered in the Japan Registry of Clinical Trials as jRCTs031210100 ( https://jrct.niph.go.jp/latest-detail/jRCTs031210100 ). Date of Registration: May 2021.
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Affiliation(s)
- Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan, 1-1 Kanoko-den, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Yasushi Fujimoto
- Department of Otolaryngology, Aichi Medical University, Nagakute, Japan
| | - Koichiro Wasano
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Ryo Takahashi
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Mizowaki
- Departments of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Sekino
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
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Xiang G, Xu C, Chai G, Lyu B, Li Z, Wang B, Shi M, Zhao L. Re-irradiation for local primary-recurrence esophageal squamous cell carcinoma treated with IMRT/VMAT. Radiat Oncol 2023; 18:114. [PMID: 37430276 DOI: 10.1186/s13014-023-02265-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/15/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Local primary-recurrence of esophageal squamous cell carcinoma (ESCC) after definitive treatment has the potential for increasing overall survival with re-irradiation (Re-RT), especially with advanced technique. This study aimed to evaluate the efficacy and toxicities of Re-RT using intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) for local primary-recurrence of ESCC. MATERIALS AND METHODS A total of 130 ESCC patients with local primary-recurrence from Xijing hospital between 2008 and 2021 were enrolled and 30 patients underwent IMRT/VMAT based salvage Re-RT. Cox regression analysis was used to analyze the prognostic factors for overall survival (OS) and after recurrence survival (ARS). The toxicities of 30 patients receiving Re-RT were also assessed. RESULTS The median OS and ARS of the 130 recurrent patients were 21 months (1-164 months) and 6 months (1-142 months). The 1-, 2-, and 3-year OS rates were 81.5%, 39.2%, and 23.8%, respectively. Besides, the 1-, 2-, and 3-year ARS rates were 30.0%, 10%, and 6.2%. Multivariate analysis showed that Re-RT ± chemotherapy (p = 0.043) and chemotherapy alone (p < 0.001) and esophageal stents (p = 0.004) were independent prognostic factors for OS. The median OS of 30 patients treated with Re-RT were significantly better than that of 29 patients treated with chemotherapy (34.5 months vs. 22 months, p = 0.030). Among 30 ESCC patients treated with Re-RT, the median OS and ARS were 34.5 months (range 12-163 months) and 6 months (range 1-132 months), respectively. The recurrence-free interval (RFI) (> 12 months) and initial radiation dose (> 60 Gy) were significantly associated with improved OS. Radiation esophagitis (Grade 1-2) occurred in 16 patients and myelosuppression (Grade1-2) occurred in 10 patients. Grade 3 toxicities (radiation esophagitis and myelosuppression) were only 13.3%. There were no grade 4 toxicities. CONCLUSION Our results demonstrated that IMRT/VMAT-based Re-RT was an effective therapeutic option for ESCC patients with local primary-recurrence compared with chemotherapy alone or without any treatment. Re-RT had improved OS but unfavorable ARS.
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Affiliation(s)
- Geng Xiang
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Chunsheng Xu
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Guangjin Chai
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Bo Lyu
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Zhaohui Li
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Bin Wang
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
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Patidar Y, Kumar HS, Sharma N, Mayilvaganan A. A plan comparison study between rapid arc and conventional intensity-modulated radiation treatment plans in nasopharyngeal carcinoma patients. J Cancer Res Ther 2023; 19:543-547. [PMID: 37470572 DOI: 10.4103/jcrt.jcrt_2191_21] [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] [Indexed: 07/21/2023]
Abstract
Introduction Head and neck cancers are one of the common malignancies in Indian population. It's entity, nasopharyngeal carcinoma is among the aggressive malignancies with its location and spread near very critical structures. Thus requires a highly conformal radiotherapy delivery techniques. Purpose The aim of the study is to dosimetrically evaluate and to compare Intensity modulated radiation therapy (IMRT) plans and RAPID ARC plans for irradiation of nasopharyngeal carcinoma. Material and Method A retrospective study is done on 10 nasopharyngeal carcinoma patients, who were treated with Radiotherapy at ATRCTRI Bikaner. Radiotherapy was delivered by IMRT technique (Total of 70 Gy in 33 fractions). Same patients are now planned on Rapid arc technique. Dosimetric comparison is done in terms of PTV coverage, OAR dose, conformity index, homogeneity index. Result PTV coverage is similar with both the plans. Homogeneity index is higher for IMRT plans 0.119+/- 0.020 compared to 0.104 +/- 0.018 for Rapid arc plans (statistically significant).The Rapid arc plans achieved slightly better conformity 1.018+/-0.09, whereas 1.105+/-0.12 for IMRT plans. Rapid arc achieved better results for OAR, statistically significant for Brainstem (54.4 +/-10.4 Gy for IMRT and 49.7+/-4.2 Gy for Rapid Arc, Lens (Left lens and Right lens received 10.55+/-5.8 Gy and 9.44+/-9.08 by IMRT and 6.12+/-6.1 Gy and 5.45+/-6.05 Gy for Rapid Arc), optic nerves (Right and Left optic nerve received 34.36 and 35.01 Gy for IMRT plans and 30.06 and 30.05 Gy for Rapid Arc plans. However the gains are statistically insignificant for spinal cord and vestibulocochlear nerve. No major difference found for Right and left parotid between both the arms. Conclusions Rapid Arc is better technique compared to IMRT for Nasopharyngeal carcinoma treatment, that provides better dose conformity, more homogeneous coverage and OAR sparing. However study is retrospective and has lesser patients, thus requires prospective study with more number of patients along with comparison of clinical outcome.
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Affiliation(s)
- Yaman Patidar
- Department of Radiation Oncology, Atrctri, Bikaner, Rajasthan, India
| | - H S Kumar
- Department of Radiation Oncology, Atrctri, Bikaner, Rajasthan, India
| | - Neeti Sharma
- Department of Radiation Oncology, Atrctri, Bikaner, Rajasthan, India
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Anderson B, Arthur D, Hannoun-Levi JM, Kamrava M, Khan A, Kuske R, Scanderbeg D, Shah C, Shaitelman S, Showalter T, Vicini F, Wazer D, Yashar C. Partial breast irradiation: An updated consensus statement from the American brachytherapy society. Brachytherapy 2022; 21:726-747. [PMID: 36117086 DOI: 10.1016/j.brachy.2022.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/26/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE In recent years, results with mature follow-up have been reported for several Phase III trials randomizing women to receive whole breast irradiation (WBI) versus varying modalities of partial breast irradiation (PBI). It is important to recognize that these methods vary in terms of volume of breast tissue treated, dose per fraction, and duration of therapy. As such, clinical and technical guidelines may vary among the various PBI techniques. METHODS Members of the American Brachytherapy Society with expertise in PBI performed an extensive literature review focusing on the highest quality data available for the numerous PBI options offered in the modern era. Data were evaluated for strength of evidence and published outcomes were assessed. RESULTS The majority of women enrolled on randomized trials of WBI versus PBI have been age >45 years with tumor size <3 cm, negative margins, and negative lymph nodes. The panel also concluded that PBI can be offered to selected women with estrogen receptor negative and/or Her2 amplified breast cancer, as well as ductal carcinoma in situ, and should generally be avoided in women with extensive lymphovascular space invasion. CONCLUSIONS This updated guideline summarizes published clinical trials of PBI methods. The panel also highlights the role of PBI for women facing special circumstances, such as history of cosmetic breast augmentation or prior breast irradiation, and discusses promising novel modalities that are currently under study, such as ultrashort and preoperative PBI. Updated consensus guidelines are also provided to inform patient selection for PBI and to characterize the strength of evidence to support varying PBI modalities.
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Affiliation(s)
- Bethany Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | | | | | - Atif Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Kuske
- Arizona Breast Cancer Specialists, Scottsdale, AZ
| | - Daniel Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - Simona Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Timothy Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | | | - David Wazer
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
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Shen J, Tao Y, He L, Guan H, Zhen H, Liu Z, Zhang F. Clinical application of radiotherapy in patients with oligometastatic ovarian cancer: a sharp tool to prolong the interval of systemic treatment. Discov Oncol 2022; 13:82. [PMID: 36006491 PMCID: PMC9411494 DOI: 10.1007/s12672-022-00540-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With the advances of radiation technology, treatment of oligometastatic disease, with limited metastatic burden, have more chances to achieve long-term local control. Here we aim to evaluate the efficacy and safety of radiotherapy (RT) in oligometastatic ovarian cancer patients. METHODS A retrospective analysis collecting 142 patients (189 lesions) with oligometastatic ovarian cancer were included in the study. All pateints received radiotherapy and the curative effect and response rate were evaluated by diagnostic imaging after 1-3 months of radiotherapy with RECIST. Endpoints were the rate of complete response (CR), chemotherapy-free interval (CFI), local control (LC) rate and overall survival (OS) rate. Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG). Logistic and Cox regression were used for the uni- and multivariate analysis of factors influencing survival outcomes. RESULTS From 2013.1.1 to 2020.12.30, a total of 142 ovarian cancer patients (189 oligometastasis lesions) were included in the analysis. Prescribed doses to an average GTV of 3.10 cm were 1.8-8 Gy/fraction, median BED (28-115, a/b = 10 Gy), 5-28 fractions. For 179 evaluable lesions, the cases of CR, partial response (PR), stable disease (SD) and progressive disease (PD) after radiotherapy were 22,39,38 and 80 respectively. The disease control rate (DCR): CR + PR + SD was 55.31%, and the objective response rate (ORR): CR + PR was 34.08%. No patient developed grade 3 or higher side effect. The median CFI was 14 months (1-99 months), and the LC rate was 69.7%, 54.3% and 40.9% in 1 year, 2 years and 5 years respectively. GTV < 3 cm before treatment, platinum sensitivity, time from the last treatment ≥ 6 months, single lesion and BED(a/b = 10 Gy) ≥ 60 are the factors of good LC (p < 0.05). The total OS of 1 year, 2 years and 5 years were 67.1%, 52.6% and 30.3%, respectively. Single lesion (HR 0.598, 95%CI 0.405-0.884), DCR (HR 0.640, 95% CI 0.448-0.918) and ORR(HR 0.466, 95% CI 0.308-0.707) were the significant factors influencing 5-year OS. CONCLUSION For patients with oligometastatic ovarian cancer, radiotherapy has high LC, long chemotherapy-free interval, and survival benefits. Subgroup analysis shows that patients with single lesion and good local treatment results have higher overall survival rate, suggesting that active treatment is also beneficial for oligometastatic ovarian cancer patients.
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Affiliation(s)
- Jing Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yinjie Tao
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Lei He
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Hui Guan
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Hongnan Zhen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 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, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
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Boldrini L, Lenkowicz J, Orlandini LC, Yin G, Cusumano D, Chiloiro G, Dinapoli N, Peng Q, Casà C, Gambacorta MA, Valentini V, Lang J. Applicability of a pathological complete response magnetic resonance-based radiomics model for locally advanced rectal cancer in intercontinental cohort. Radiat Oncol 2022; 17:78. [PMID: 35428267 PMCID: PMC9013126 DOI: 10.1186/s13014-022-02048-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/11/2021] [Accepted: 04/04/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Predicting pathological complete response (pCR) in patients affected by locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) is a challenging field of investigation, but many of the published models are burdened by a lack of reliable external validation. Aim of this study was to evaluate the applicability of a magnetic resonance imaging (MRI) radiomic-based pCR model developed and validated in Europe, to a different cohort of patients from an intercontinental cancer center. METHODS The original model was based on two clinical and two radiomics features extracted from T2-weighted 1.5 T MRI of 161 LARC patients acquired before nCRT, considered as training set. Such model is here validated using the T2-w 1.5 and 3 T staging MRI of 59 LARC patients with different clinical characteristics consecutively treated in mainland Chinese cancer center from March 2017 to January 2018. Model performance were evaluated in terms of area under the receiver operator characteristics curve (AUC) and relative parameters, such as accuracy, specificity, negative and positive predictive value (NPV and PPV). RESULTS An AUC of 0.83 (CI 95%, 0.71-0.96) was achieved for the intercontinental cohort versus a value of 0.75 (CI 95%, 0.61-0.88) at the external validation step reported in the original experience. Considering the best cut-off threshold identified in the first experience (0.26), the following predictive performance were obtained: 0.65 as accuracy, 0.64 as specificity, 0.70 as sensitivity, 0.91 as NPV and 0.28 as PPV. CONCLUSIONS Despite the introduction of significant different factors, the proposed model appeared to be replicable on a real-world data extra-European patients' cohort, achieving a TRIPOD 4 level.
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Affiliation(s)
- Luca Boldrini
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Lucia Clara Orlandini
- grid.54549.390000 0004 0369 4060Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Gang Yin
- grid.54549.390000 0004 0369 4060Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Davide Cusumano
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Nicola Dinapoli
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Qian Peng
- grid.54549.390000 0004 0369 4060Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Calogero Casà
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Vincenzo Valentini
- grid.414603.4Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Jinyi Lang
- grid.54549.390000 0004 0369 4060Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Wang X, Hobbs B, Gandhi SJ, Muijs CT, Langendijk JA, Lin SH. Current status and application of proton therapy for esophageal cancer. Radiother Oncol 2021; 164:27-36. [PMID: 34534613 DOI: 10.1016/j.radonc.2021.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/10/2020] [Revised: 08/11/2021] [Accepted: 09/07/2021] [Indexed: 12/25/2022]
Abstract
Esophageal cancer remains one of the leading causes of death from cancer across the world despite advances in multimodality therapy. Although early-stage disease can often be treated surgically, the current state of the art for locally advanced disease is concurrent chemoradiation, followed by surgery whenever possible. The uniform midline tumor location puts a strong importance on the need for precise delivery of radiation that would minimize dose to the heart and lungs, and the biophysical properties of proton beam makes this modality potential ideal for esophageal cancer treatment. This review covers the current state of knowledge of proton therapy for esophageal cancer, focusing on published retrospective single- and multi-institutional clinical studies, and emerging data from prospective clinical trials, that support the benefit of protons vs photon-based radiation in reducing postoperative complications, cardiac toxicity, and severe radiation induced immune suppression, which may improve survival outcomes for patients. In addition, we discuss the incorporation of immunotherapy to the curative management of esophageal cancers in the not-too-distant future. However, there is still a lack of high-level evidence to support proton therapy in the treatment of esophageal cancer, and proton therapy has its limitations in clinical application. It is expected to see the results of future large-scale randomized clinical trials and the continuous improvement of proton radiotherapy technology.
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Affiliation(s)
- Xin Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, China
| | - Brian Hobbs
- Department of Population Health, University of Texas, Austin, USA
| | - Saumil J Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Christina T Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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9
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Mukherjee K, Small W, Duszak R. Trends and variations in utilization and costs of radiotherapy for prostate cancer: A SEER medicare analysis from 2007 through 2016. Brachytherapy 2021; 21:12-21. [PMID: 34380592 DOI: 10.1016/j.brachy.2021.06.148] [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: 04/15/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess recent changes and disparities in utilization and costs of radiotherapy in Medicare beneficiaries with prostate cancer. METHODS Surveillance, Epidemiology and End Results (SEER) -Medicare linked data from 2006-2016 were used to identify continuously enrolled Medicare beneficiaries with a first-time diagnosis of prostate cancer who, within 12 months of diagnosis, underwent at least one radiotherapy related service. Trends in the utilization of different radiotherapy techniques over time, yearly changes in per-patient costs of radiotherapy, and effect of socio-demographic and clinical characteristics on total cost were measured. Per patient annual costs, annual incidence of prostate cancer, and utilization of radiotherapy were used to estimate total costs of radiotherapy to the Medicare program. RESULTS For Medicare beneficiaries with a first-time diagnosis of prostate cancer, the utilization of intensity modulated radiation therapy (IMRT), proton therapy, and stereotactic body radiation therapy (SBRT) increased 23.62%, 0.74% and 1.61% respectively (p <0.0001) while brachytherapy decreased 17.04% (p <0.0001). Cost per beneficiary decreased $340.24 (95% CI: $136.05 - $544.43) annually (p = 0.0065). Age, registry region, and Gleason score were all associated with expenditures. The total cost to the Medicare program was estimated at US $1.16 billion in the year 2016. DISCUSSION In Medicare beneficiaries with prostate cancer treated with radiotherapy, IMRT is the primary mode of treatment. Utilization of brachytherapy decreased significantly despite the efficacy and cost-effectiveness. Although per patient costs have decreased, the share of patient responsibility remained unaltered across years. The current costs to Medicare of radiotherapy for newly diagnosed prostate cancer patients is substantial.
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Affiliation(s)
- Kumar Mukherjee
- Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024.
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, 60153 USA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322
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10
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Roy A, Brenneman RJ, Hogan J, Barnes JM, Huang Y, Morris R, Goddu S, Altman M, Garcia-Ramirez J, Li H, Zoberi JE, Bullock A, Kim E, Smith Z, Figenshau R, Andriole GL, Baumann BC, Michalski JM, Gay HA. Does the sequence of high-dose rate brachytherapy boost and IMRT for prostate cancer impact early toxicity outcomes? Results from a single institution analysis. Clin Transl Radiat Oncol 2021; 29:47-53. [PMID: 34136665 PMCID: PMC8182264 DOI: 10.1016/j.ctro.2021.05.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022] Open
Abstract
The optimal sequence of HDR-BT boost and EBRT for prostate cancer is unclear. We compared early toxicity based on the timing of HDR-BT boost. The timing of HDR-BT was not based on any specific patient or clinical factors. We found no difference in early GI/GU toxicity between the two groups. Longer follow-up is needed to evaluate late toxicity and long-term disease control.
Background We present the first report comparing early toxicity outcomes with high-dose rate brachytherapy (HDR-BT) boost upfront versus intensity modulated RT (IMRT) upfront combined with androgen deprivation therapy (ADT) as definitive management for intermediate risk or higher prostate cancer. Methods and Materials We reviewed all non-metastatic prostate cancer patients who received HDR-BT boost from 2014 to 2019. HDR-BT boost was offered to patients with intermediate-risk disease or higher. ADT use and IMRT target volume was based on NCCN risk group. IMRT dose was typically 45 Gy in 25 fractions to the prostate and seminal vesicles ± pelvic lymph nodes. HDR-BT dose was 15 Gy in 1 fraction, delivered approximately 3 weeks before or after IMRT. The sequence was based on physician preference. Biochemical recurrence was defined per ASTRO definition. Gastrointestinal (GI) and Genitourinary (GU) toxicity was graded per CTCAE v5.0. Pearson Chi-squared test and Wilcoxon tests were used to compare toxicity rates. P-value < 0.05 was significant. Results Fifty-eight received HDR-BT upfront (majority 2014–2016) and 57 IMRT upfront (majority 2017–2018). Median follow-up was 26.0 months. The two cohorts were well-balanced for baseline patient/disease characteristics and treatment factors. There were differences in treatment sequence based on the year in which patients received treatment. Overall, rates of grade 3 or higher GI or GU toxicity were <1%. There was no significant difference in acute or late GI or GU toxicity between the two groups. Conclusion We found no significant difference in GI/GU toxicity in intermediate-risk or higher prostate cancer patients receiving HDR-BT boost upfront versus IMRT upfront combined with ADT. These findings suggest that either approach may be reasonable. Longer follow-up is needed to evaluate late toxicity and long-term disease control.
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Affiliation(s)
- Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Randall J. Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacob Hogan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Yi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Morris
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sreekrishna Goddu
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael Altman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacqueline E. Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Arnold Bullock
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric Kim
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Zachary Smith
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Figenshau
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Gerald L. Andriole
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
- Corresponding author at: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, LL, Campus Box 8224, St. Louis, MO 63110, United States.
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11
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Yang Y, Ran J, Wang Y, Zhou Z, Chen D, Feng Q, Liang J, Xiao Z, Hui Z, Lv J, Gao Y, He J, Bi N, Wang L. Intensity modulated radiation therapy may improve survival for tracheal-bronchial adenoid cystic carcinoma: A retrospective study of 133 cases. Lung Cancer 2021; 157:116-23. [PMID: 34020823 DOI: 10.1016/j.lungcan.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
PURPOSES This study aimed to evaluate the role of radiotherapy (RT) and intensity modulated radiation therapy (IMRT) in adjuvant and definitive settings of tracheal-bronchial adenoid cystic carcinoma (TACC) treatment. MATERIALS/METHODS TACC patients (n = 133) treated with surgery and/or RT curatively in our institution between January 1st, 1984 and December 31st, 2017 were analyzed retrospectively. RESULTS Among the 116 patients undergoing surgery, 50 (43.1 %) achieved complete resections and 66 (56.9 %) had positive surgical margins. For patients with positive margins, overall adjuvant RT was correlated with no significantly improved OS (10-year: 58.0 % vs. 47.9 %; P = 0.340) and a slight LRFS benefit (5-year: 81.9 % vs.75.6 %; P = 0.056), but adjuvant IMRT showed significant superiority in both OS (10-year: 82.9 % vs. 47.9 %; P = 0.031) and LRFS (5-year: 100.0 % vs. 75.6 %; P = 0.001) in comparison with no postoperative RT. Multivariate analysis also identified adjuvant IMRT as a significant favorable factor with OS (HR = 0.186, 95 %CI: 0.039-0.883; P = 0.034). For 17 patients receiving definitive RT, IMRT achieved promising 5-year OS of 88.9 % and LRFS of 64.3 %, yet no significant difference from non-IMRT group was reached (P = 0.447 and 0.706). Different therapies presented no significantly different impact on DMFS, whilst DMFS explained more of the OS variances (P < 0.001, R2 = 0.480) than LRFS (P < 0.001, R2 = 0.323). CONCLUSION IMRT could confer greatly improved OS and LRFS in postoperative setting for TACC patients with positive surgical margins. IMRT was also a good therapeutic option for definitive TACC with promising survival and local control.
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12
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Mazonakis M, Lyraraki E, Damilakis J. Lifetime radiation-induced sarcoma risk in patients subjected to IMRT or VMAT for uterine cervix carcinoma. Phys Eng Sci Med 2021; 44:573-9. [PMID: 33909230 DOI: 10.1007/s13246-021-01002-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
This study was conducted to estimate the lifetime radiation-induced bone and soft tissue sarcoma risks from intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for uterine cervix carcinoma. 13 cervical cancer patients were included. The bone and soft tissue structures were defined on patients' treatment planning computed tomography (CT) scans. Both CT-based IMRT and VMAT plans with 6 MV photons delivering 45 Gy to the target site were designed for each patient. The organ equivalent dose (OED) and the lifetime attributable risk (LAR) for developing bone or soft tissue sarcoma were estimated using treatment planning data and a non-linear mechanistic model. The estimation method did not consider the survival rates following radiotherapy and the use of brachytherapy treatments. The patient-specific OEDs of the bone structure from IMRT and VMAT were 2.33-2.83 and 2.34-2.82 Gy, respectively. The corresponding values for the soft tissue structure were 1.27-1.70 and 1.32-1.73 Gy. An insignificant difference was found between the patient-specific OEDs and the directly proportional sarcoma risks (bone: P = 0.07; soft tissue: P = 0.38). The LAR for the development of a bone sarcoma varied from 0.05 to 0.16% by the patient's age during irradiation and the applied treatment delivery technique. The corresponding LAR range for radiation-induced soft-tissue sarcoma was 0.08-0.27%. The above LARs resulted in a relative risk of more than 1.20 indicating that IMRT or VMAT may lead to a considerable risk increase of developing bone or soft tissue sarcoma exceeding 20% in respect to the current incidence of these malignancies in unexposed population.
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13
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Witulla B, Ziegler M, Brandt T, Prasetio H, Fietkau R, Bert C. Quality assurance for dynamic tumor tracking. Z Med Phys 2021; 31:388-393. [PMID: 33622568 DOI: 10.1016/j.zemedi.2021.01.002] [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: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
The purpose of this work was to develop a treatment plan verification routine for a linear accelerator dedicated to SBRT treatments with gimbal based dynamic tumor tracking using three commercially available phantoms. The accelerator system has two special features: It operates with a rotation of the ring shaped gantry instead of a couch rotation and target motion can be compensated for via a gimbal system (dynamic tumor tracking, DTT). DTT plans were each measured with the three different phantoms. Afterwards the measured dose distribution was compared with the calculated dose distribution via global Gamma Index analysis (3mm / 3%, threshold: 10%). The global gamma pass rates were on average (93.5±7.2) % for ArcCHECK, (98.0±2.6) % for OCTAVIUS® 4D and (98.4±4.2) % for MatriXX Evolution. All three systems could be used for quality assurance with ring rotations and DTT, however, each with limitations.
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Affiliation(s)
- Barbara Witulla
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Marc Ziegler
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Tobias Brandt
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Heru Prasetio
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
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14
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Loap P, Kirova Y. Evaluating cardiac substructure radiation exposure in breast rotational intensity modulated radiation therapy: Effects of cancer laterality, fractionation and deep inspiration breath-hold. Cancer Radiother 2020; 25:13-20. [PMID: 33288407 DOI: 10.1016/j.canrad.2020.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/08/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Rotational intensity-modulated radiation therapy currently has a growing role in breast cancer radiation therapy, since this radiation technique reduces cardiac radiation exposure while homogeneously covering target volumes. This study aims to evaluate radiation exposure of cardiac substructures across a broad spectrum of breast cancer cases differing by cancer laterality, fractionation regimen and addition of deep-inspiration breath hold. MATERIALS AND METHODS Cardiac substructures were delineated following guidelines endorsed by the European Society for Radiotherapy and Oncology (ESTRO) for forty-four breast cancer patients having undergone conserving surgery and adjuvant rotational intensity-modulated radiation therapy. Target volumes consisted of the whole breast with a boost, axillary and internal mammary nodes. Patients were treated using free-breathing technique for left-sided or right-sided, normofractionated or hypofractionated helical tomotherapy or volumetric modulated arc therapy, or using deep-inspiration breath hold for left-sided normofractionated volumetric modulated arc therapy. Mean and maximum doses to cardiac substructures were retrieved. Correlations were performed between mean- and maximum radiation doses to cardiac substructures. RESULTS Left-sided and right-sided irradiations were associated with different cardiac substructure exposure patterns despite comparable mean heart dose: 7.21Gy for left-sided normofractionated regimen, 6.28Gy for right-sided normofractionated regimen. Deep-inspiration breath hold reduced mean doses to almost all cardiac substructures for left-sided irradiation, but did not decrease maximum doses to coronary arteries. Correlations between mean- and maximum doses to cardiac substructures were usually moderate, but stronger for right-sided irradiation. CONCLUSION Despite comparable mean heart dose, cardiac substructure radiation exposure patterns with rotational intensity-modulated radiation therapy strongly depend on the breast side, which could trigger clinically different long-term cardiotoxicity events. Deep-inspiration breath hold improves cardiac substructure dosimetry. Mean- and maximum heart dose could probably not be used as surrogate markers for precise cardiac substructure evaluation. In a near future, clinical practice and cardiotoxicity studies could possibly gain by considering cardiac substructure in a more systematic manner, possibly relying on cardiac autosegmentation algorithms.
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Affiliation(s)
- P Loap
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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15
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Turna M, Akboru H, Ermis E, Oskeroglu S, Dincer S, Altin S. Stereotactic body radiotherapy as a boost after external beam radiotherapy for high-risk prostate cancer patients. Indian J Cancer 2020; 58:518-524. [PMID: 33402584 DOI: 10.4103/ijc.ijc_377_19] [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] [Indexed: 11/04/2022]
Abstract
Background The effect of high-dose-rate (HDR) brachytherapy after external radiation in high-risk prostate cancer patients has been proven. Stereotactic body radiotherapy as a less invasive method has similar dosimetric results with HDR brachytherapy. This study aims to evaluate the prostate-specific antigen (PSA) response, acute side effects, and quality of life of patients who underwent stereotactic body radiotherapy (SBRT) as a boost after pelvic radiotherapy (RT). Methods A total of 34 patients diagnosed with high-risk prostate cancer treated with SBRT boost (21 Gy in three fractions) combined with whole pelvic RT (50 Gy in 25 fractions) were evaluated. Biochemical control has been evaluated with PSA before, and after treatment, acute adverse events were evaluated with radiation therapy oncology group (RTOG) grading scale and quality of life with the Expanded Prostate Cancer Index Composite (EPIC) scoring system. Results The mean follow-up of 34 patients was 41.2 months (range 7-52). The mean initial PSA level was 22.4 ng/mL. None of the patients had experienced a biochemical or clinical relapse of the disease. Grade 2 and higher acute gastrointestinal (GI) was observed in 14%, and genitourinary (GU) toxicity was observed in 29%. None of the patients had grade 3-4 late toxicity. Conclusions SBRT boost treatment after pelvic irradiation has been used with a good biochemical control and acceptable toxicity in high-risk prostate cancer patients. More extensive randomized trial results are needed on the subject.
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Affiliation(s)
- Menekse Turna
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Halil Akboru
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Ekin Ermis
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Sedenay Oskeroglu
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Selvi Dincer
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
| | - Suleyman Altin
- Radiation Oncology Department, Okmeydani Research and Education Hospital, Sisli, Istanbul, Turkey
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16
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Yamauchi R, Mizuno N, Itazawa T, Kawamori J. The influence of respiratory motion on dose distribution in accelerated partial breast irradiation using volumetric modulated arc therapy. Phys Med 2020; 80:23-33. [PMID: 33075732 DOI: 10.1016/j.ejmp.2020.09.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Accelerated partial breast irradiation (APBI) is alternative treatment option for patients with early stage breast cancer. The interplay effect on volumetric modulated arc therapy APBI (VMAT-APBI) has not been clarified. This study aimed to evaluate the feasibility of VMAT-APBI for patients with small breasts and investigate the amplitude of respiratory motion during VMAT-APBI delivery that significantly affects dose distribution. METHODS The VMAT-APBI plans were generated with 28.5 Gy in five fractions. We performed patient-specific quality assurance using Delta4 phantom under static conditions. We also measured point dose and dose distribution using the ionization chamber and radiochromic film under static and moving conditions of 2, 3 and 5 mm. We compared the measured and calculated point doses and dose distributions by dose difference and gamma passing rates. RESULTS A total of 20 plans were generated; the dose distributions were consistent with those of previous reports. For all measurements under static conditions, the measured and calculated point doses and dose distributions showed good agreement. The dose differences for chamber measurement were within 3%, regardless of moving conditions. The mean gamma passing rates with 3%/2 mm criteria in the film measurement under static conditions and with 2 mm, 3 mm, and 5 mm of amplitude were 95.0 ± 2.0%, 93.3 ± 3.3%, 92.1 ± 6.2% and 84.8 ± 7.8%, respectively. The difference between 5 mm amplitude and other conditions was statistically significant. CONCLUSIONS Respiratory management should be considered for the risk of unintended dose distribution if the respiratory amplitude is >5 mm.
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Affiliation(s)
- Ryohei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan.
| | - Norifumi Mizuno
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
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17
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Nomura E, Kayano H, Machida T, Izumi H, Yamamoto S, Sugawara A, Mukai M, Hasebe T. Neoadjuvant chemoradiotherapy for locally advanced gastric cancer with bulky lymph node metastasis: Five case reports. World J Clin Cases 2020; 8:4177-4185. [PMID: 33024776 PMCID: PMC7520762 DOI: 10.12998/wjcc.v8.i18.4177] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/01/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (NACRT) has not been accepted as a general therapy for gastric cancer because of its localized effect and toxicity for radiosensitive organs. However, if radiation therapy could compensate for the limited or inadequate treatment choices available for elderly patients and/or those at high risk, the available therapeutic options for advanced gastric cancer might increase. From this perspective, we present our experiences of five patients with advanced gastric cancer in whom we used NACRT therapy with interesting results. CASE SUMMARY We admitted five patients with clinical Stage III gastric cancer and bulky lymph node metastasis or adjacent organ invasion at the time of diagnosis. A total of 50 Gy of preoperative intensity modulated radiation therapy was delivered to the patients in doses of 2.0 Gy/d, together with a regimen of concomitant chemotherapy comprising two courses of oral tegafur/gimeracil/oteracil (S-1; 65 mg/m2 per day) for three consecutive weeks followed by two weeks of rest, starting at the same time as radiotherapy. All patients underwent no residual tumor resection and a pathological complete response of the primary tumors was achieved in two patients. The incidence of hematological toxicity was low, although the digestive toxicities of anorexia and diarrhea developed in three of the five patients, necessitating termination of radiation therapy at 30 Gy and S-1 at three weeks. However, even 30 Gy of irradiation and half the dose of S-1 resulted in sufficient downstaging, indicating that even a reduced amount of NACRT could confer considerable effects. CONCLUSION Slightly reduced NACRT might be useful and safe for patients with locally advanced gastric cancer.
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Affiliation(s)
- Eiji Nomura
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Hajime Kayano
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Takashi Machida
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Hideki Izumi
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Soichiro Yamamoto
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Akitomo Sugawara
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Masaya Mukai
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji 192-0032, Tokyo, Japan
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18
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Palmer JD, Gamez ME, Ranta K, Ruiz-Garcia H, Peterson JL, Blakaj DM, Prevedello D, Carrau R, Mahajan A, Chaichana KL, Trifiletti DM. Radiation therapy strategies for skull-base malignancies. J Neurooncol 2020; 150:445-462. [PMID: 32785868 DOI: 10.1007/s11060-020-03569-7] [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: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The management of skull base malignancies continues to evolve with improvements in surgical technique, advances in radiation delivery and novel systemic agents. METHODS In this review, we aim to discuss in detail the management of common skull base pathologies which typically require multimodality therapy, focusing on the radiotherapeutic aspects of care. RESULTS Technological advances in the administration of radiation therapy have led to a wide variety of different treatment strategies for the treatment of skull base malignances, with outcomes summarized herein. CONCLUSION Radiation treatment plays a key and critical role in the management of patients with skull base tumors. Recent advancements continue to improve the risk/benefit ratio for radiotherapy in this setting.
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Affiliation(s)
- J D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M E Gamez
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - K Ranta
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Blakaj
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Prevedello
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R Carrau
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - K L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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Chao M, Wei J, Lo YC, Peñagarícano JA. Dose cluster model parameterization of the parotid gland in irradiation of head and neck cancer. Australas Phys Eng Sci Med 2019; 43:10.1007/s13246-019-00829-3. [PMID: 31792724 DOI: 10.1007/s13246-019-00829-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
To explore the parotid normal tissue complication probability (NTCP) modeling with percolation-based dose clusters for head-and-neck patients receiving concomitant chemotherapy and radiation therapy. Cluster models incorporating the spatial dose distribution in the parotid gland were developed to evaluate the radiation induced complication. Cluster metrics including the mean cluster size (NMCS) and the largest cluster size both normalized by the gland volume (NSLC) were evaluated and scrutinized against the benchmark NTCP. Two fitting strategies to the Lyman-Kutcher-Burman (LKB) model using the maximum likelihood method were devised: the volume parameter n fixed at 1.0 (mean dose model) and unrestricted (full LKB model). The fitted parameters TD50 and m were assessed with the LKB NTCP models with the available xerostomia data. NSLC was a better metric than NMCS with reference to the LKB model and strong correlation (r ~ 0.95) was observed between NTCP and NSLC. The mean dose model returned the parameter TD50 (39.9 Gy) and m (0.4) from the NSLC of threshold dose at around 40 Gy. Drastically different TD50 and m values were obtained from the fittings via the full LKB model, where the threshold dose would be near 27 Gy. Bootstrapping analyses further confirmed the fitting outcomes. Strong correlation with the traditional NTCP models revealed that the cluster model could achieve what NTCP models attain and may offer additional information. Parameterization of the model indicated that the model could have different predictions from current clinical recommendations. Further investigation using toxicity data is under way to validate the cluster model.
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Affiliation(s)
- Ming Chao
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, 10029, USA.
| | - Jie Wei
- Department of Computer Science, City College of New York, New York, NY, 10031, USA
| | - Yeh-Chi Lo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - José A Peñagarícano
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Santos T, Lopes MDC, Gershkevitsh E, Vinagre F, Faria D, Carita L, Pontes M, Vieira S, Poli E, Faustino S, Ribeiro F, Trindade M, Ponte F, Marcelino C, Batista C, Oliveira S, Figueira R, Lencart J, Diaz EG, Jacob K, Brás S, Pirraco R, Izewska J. IMRT national audit in Portugal. Phys Med 2019; 65:128-36. [PMID: 31450123 DOI: 10.1016/j.ejmp.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/22/2019] [Revised: 07/25/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The IAEA newly developed "end-to-end" audit methodology for on-site verification of IMRT dose delivery has been carried out in Portugal in 2018. The main goal was to evaluate the physical aspects of the head and neck (H&N) cancer IMRT treatments. This paper presents the national results. METHODS All institutions performing IMRT treatments in Portugal, 20 out of 24, have voluntarily participated in this audit. Following the adopted methodology, a Shoulder, Head and Neck End-to-End phantom (SHANE) - that mimics an H&N region, underwent all steps of an IMRT treatment, according to the local practices. The measurements using an ionization chamber placed inside the SHANE phantom at four reference locations (three in PTVs and one in the spinal cord) and an EBT3 film positioned in a coronal plane were compared with calculated doses. FilmQA Pro software was used for film analysis. RESULTS For ionization chamber measurements, the percent difference was within the specified tolerances of ±5% for PTVs and ±7% for the spinal cord in all participating institutions. Considering film analysis, gamma passing rates were on average 96.9%±2.9% for a criterion of 3%/3 mm, 20% threshold, all above the acceptance limit of 90%. CONCLUSIONS The national results of the H&N IMRT audit showed a compliance between the planned and the delivered doses within the specified tolerances, confirming no major reasons for concern. At the same time the audit identified factors that contributed to increased uncertainties in the IMRT dose delivery in some institutions resulting in recommendations for quality improvement.
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21
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Zhang F, Du XM, Huang MN. [Recurrence pattern and influencing factors of intensity-modulated radiotherapy for cervical cancer]. Zhonghua Zhong Liu Za Zhi 2019; 41:569-572. [PMID: 31434446 DOI: 10.3760/cma.j.issn.0253-3766.2019.08.003] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the rapid development of precise radiotherapy technology, the use of intensity-modulated radiation therapy (IMRT) in gynecological malignant tumor has been gradually increased. IMRT could result in a good local control rate as well as superior clinical outcome in patients with cervical cancer after radical radiotherapy. The recurrence pattern of radiotherapy includes in-field recurrence, out-of-field and combined failure. The recurrence pattern of radical IMRT for cervical cancer is mainly out-of-field recurrence. Out-of-field recurrence may be related to inadequate imaging evaluation before treatment. In-field recurrence may be related to insufficient radiation dose in target area and differences of tumor sensitivity.
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Affiliation(s)
- F Zhang
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - X M Du
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
| | - M N Huang
- Department of Gynecologic Oncology, 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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22
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Frenzel T, Albers D, Grohmann M, Krüll A. Results of a multicenter intensity modulated radiation therapy treatment planning comparison study for a sample prostate cancer case. Strahlenther Onkol 2019; 195:913-922. [PMID: 31342106 DOI: 10.1007/s00066-019-01496-9] [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: 01/24/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the influence of different medical physicists, photon energies, treatment planning systems and treatment machines on the resulting external beam radiotherapy dose distribution for a sample prostate cancer case. METHODS A pre-contoured computed tomography (CT) dataset containing planning target volume 1 (PTV1) prostate and seminal vesicles (single dose [SD] 1.8 Gy, total dose [TD] 59.4 Gy), PTV2 prostate (simultaneously integrated boost [SIB], SD 2.0 Gy, TD 66 Gy), PTV3 prostate and seminal vesicles approach (SD 1.8 Gy, TD 73.8 Gy/80.4 Gy SIB) as well as organs at risk (OAR: rectum, bladder, femoral heads, bowel, anus) was offered to the members of the task group IMRT (intensity-modulated radiation therapy) of the German Society for Medical Physics. The purpose was to calculate one combined treatment plan (TP) for PTV1 and PTV2, as well as a separate one for PTV3. Dose volume histograms (DVH), different dose values, conformity index (CI), homogeneity index (HI), gradient index (GI) and a new "better than average score" were used to analyse the dose distributions. RESULTS Altogether 44 institutions took part in this study and submitted acceptable dose distributions for the PTVs. However, there were statistically significant differences, especially for the doses administered to the OAR, such as rectum, bladder and femoral heads. Differences between the treatment plans were not easily detectable by visual inspection of the isodose distribution. Dose maxima may occur outside the PTV. Even though scoring indices are already published, the new "better than average score" was needed to identify a plan that minimises dose to all OAR simultaneously. CONCLUSION Different medical physicists or dosimetrists, photon energies, treatment planning systems, and treatment machines have an impact on the resulting dose distribution. However, the differences only become apparent when comparing DVH, analysing dose values, comparing CI, HI, GI, as well as reviewing the dose distribution in every single plane. A new score was introduced to identify treatment plans that simultaneously deliver a low dose to all OAR. Such inter- and intra-institutional comparison studies are needed to explore different treatment planning strategies; however, there is still no automatic solution for an "optimal" treatment plan.
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Affiliation(s)
- Thorsten Frenzel
- Outpatient Center of the UKE GmbH, Department for Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dirk Albers
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Krüll
- Outpatient Center of the UKE GmbH, Department for Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Park SY, Kim S, Sung W, Kim ST. Modeling scattered radiation from multi-leaf collimators (MLCs) to improve calculation accuracy of in-air output ratio. Australas Phys Eng Sci Med 2019; 42:719-731. [PMID: 31332725 PMCID: PMC6718367 DOI: 10.1007/s13246-019-00781-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/24/2019] [Indexed: 11/30/2022]
Abstract
This study aims to model an extra-focal source for the scattered radiation from multi-leaf collimators (MLCs), namely an MLC scatter source, and to correct in-air output ratio (Sc) calculated using the conventional dual source model (DSM) to achieve better accuracy of point dose calculation. To develop the MLC scatter source, a 6 MV photon beam from a Varian Clinac® iX linear accelerator with millennium 120 MLCs was used. It was assumed that the position for the MLC scatter source was located at the center of the MLC, consisting of line-based and area-based sources to consider the characteristics of the scattered radiation from the MLCs empirically. Based on the measured Sc values for MLC-defined fields, optimal parameters for the line-based and area-based sources were calculated using optimization process. For evaluation of proposed method, measurements were taken for various MLC-defined square and irregular fields. The Sc values calculated using the proposed MLC scatter source and conventional DSM were compared with the measured data. For MLC-defined square fields, the measured Sc values showed better agreement with those calculated using the MLC scatter source (the mean difference was − 0.03%) compared with those calculated using the DSM (the mean difference was 0.18%). For MLC-defined irregular fields, the maximum dose differences between measurements and calculations using the MLC scatter source and DSM were 0.54% and 1.45%, respectively. The developed MLC scatter source could improve the accuracy of Sc calculation for both square and irregular fields defined by MLCs.
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Affiliation(s)
- So-Yeon Park
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Siyong Kim
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wonmo Sung
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sang-Tae Kim
- Radiation Protection and Emergency Preparedness Bureau, Nuclear Safety and Security Commission, Seoul, Republic of Korea.
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Liu F, Luo T, Jin T, Zhang J, Xiang Z, Yan R, Xie L, Wu X, Zhang H, Wang F, Li P, Liu L. Advantages of using reduced-volume intensity modulated radiation therapy for the treatment of nasopharyngeal carcinoma: a retrospective paired study. BMC Cancer 2019; 19:554. [PMID: 31176358 PMCID: PMC6556221 DOI: 10.1186/s12885-019-5774-2] [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: 11/14/2018] [Accepted: 05/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The definition of clinical target volume (CTV) in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) has not been addressed. We performed this study to assess the feasibility and efficacy of using IMRT with reduced-volume CTV for the treatment of nasopharyngeal carcinoma. METHODS We retrospectively reviewed 293 non-metastatic NPC patients treated with IMRT from 2002 to 2013. A total of 180 matched cases finally included with 90 received conventional-volume IMRT (CV-IMRT) and 90 received reduced-volume IMRT (RV-IMRT). Kaplan-Meier method and log-rank tests were used to compare NPC-specific survival. Multivariate analyses using the Cox proportional hazards model were conducted to detect independent predictors. RESULTS With a median follow-up of 70 months, the 3-year overall survival, progression-free survival, distant metastasis-free survival, local recurrence-free survival, regional recurrence-free survival, locoregional recurrence-free survival rates were 88.9, 84.4, 92.2, 91.1, 98.9, 91.1% for the CV-IMRT arm and 92.2, 85.6, 90.0, 93.3, 98.9, 93.3% for the RV-IMRT arm, respectively. None significant survival difference was observed. Additionally, RV-IMRT was associated with reduced risk of late xerostomia (P = 0.039) and hearing loss (P = 0.008), compared versus CV-IMRT. CONCLUSIONS The use of RV-IMRT for the treatment of NPC led to comparable survival condition and truly reduced toxicity reactions compared versus CV-IMRT.
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Affiliation(s)
- Fang Liu
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ting Luo
- Mammary Oncology and Department of Medical Oncology, Clinical Research Center for Breast, Cancer Center, Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tao Jin
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiahui Zhang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhongzheng Xiang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruonan Yan
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Xie
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xin Wu
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Zhang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Feng Wang
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ping Li
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lei Liu
- Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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25
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Ozyigit G, Onal C, Igdem S, Alicikus ZA, Iribas A, Akin M, Yalman D, Cetin I, Aksu MG, Atalar B, Dincbas F, Hurmuz P, Guler OC, Aydin B, Sert F, Yildirim C, Gorken IB, Agaoglu FY, Korcum AF, Yuce D, Ozkok S, Darendeliler E, Akyol F. Treatment outcomes of prostate cancer patients with Gleason score 8-10 treated with definitive radiotherapy : TROD 09-001 multi-institutional study. Strahlenther Onkol 2019; 195:882-893. [PMID: 31143994 DOI: 10.1007/s00066-019-01476-z] [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: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8-10 disease treated with external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) in the modern era. METHODS Institutional databases of biopsy proven 641 patients with GS 8-10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1-T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT. RESULTS The median follow-up time was 5.9 years (range 0.4-18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9-10. CONCLUSIONS Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9-10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving 'non-optimal treatment' (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.
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Affiliation(s)
- Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey.
| | - Cem Onal
- Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, İstanbul Bilim University, Faculty of Medicine, Istanbul, Turkey
| | - Zumre Arican Alicikus
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Ayca Iribas
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | | | - Deniz Yalman
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Ilknur Cetin
- Department of Radiation Oncology, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Melek Gamze Aksu
- Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem University, Faculty of Medicine, Istanbul, Turkey
| | - Fazilet Dincbas
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Ozan Cem Guler
- Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
| | - Barbaros Aydin
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fatma Sert
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Cumhur Yildirim
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilknur Birkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fulya Yaman Agaoglu
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Deniz Yuce
- Department of Prevantive Oncology, Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey
| | - Serdar Ozkok
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Emin Darendeliler
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
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Brahimi Y, Antoni D, Srour R, Wagner P, Proust F, Thiery A, Labani A, Noël G. [Skull base meningioma: Clinical and radiological efficacy based on a quantitative volumetric analysis]. Cancer Radiother 2019; 23:290-295. [PMID: 31128988 DOI: 10.1016/j.canrad.2018.11.005] [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: 05/19/2017] [Revised: 06/23/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To date, no correlation has been found between clinical and radiological efficacy after irradiation of skull base meningiomas. However, the evaluation of the radiological response was most often made by questionable methods that may have underestimated the radiological effectiveness of radiotherapy. The objective of this work is to verify this hypothesis by quantitative volumetric analysis. MATERIAL AND METHODS Data from 35 patients treated with either helical tomotherapy (45.7%) or fractionated stereotactic radiotherapy (54.3%) were retrospectively analysed. These were mainly women (94%) aged 59 (43-81) with lesions mainly of the cavernous sinus (60%). There was a median of 2 (1-4) symptoms and the main symptoms were visual impairment (39%), cranial nerve deficits (23.4%) and headaches (17.2%). RESULTS Median tumour volume decreased significantly (P<0.05) from 9.6mL (0.3-36.6) to 6.8mL (0.1-26.5) after median follow-up of 44 months (24-77). Sixty-three percent of patients had an improvement of at least one symptom. In univariate analysis, clinical efficacy (P<0.05), radiotherapy technique (P<0.05), tumor topography (P<0.05) and initial tumor volume (P<0.05) were predictive factors for radiological response. In multivariate analysis, only the inverse correlation between radiological response and initial tumor volume remained significant (ρ: -0.47 95% CI -3.2 to 5.7; P<0.05). CONCLUSION The quantitative volumetric monitoring demonstrates a major radiological efficiency of radiotherapy. However, no clear correlation between clinical and radiological efficacy was found.
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Affiliation(s)
- Y Brahimi
- University radiation oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - D Antoni
- University radiation oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratory of radiobiology, EA 3430, Federation of translational medicine, Strasbourg (FMTS), Strasbourg university, 67000 Strasbourg, France
| | - R Srour
- Neurosurgery department, hôpital Pasteur, 39, avenue de la Liberté, 68000 Colmar, France
| | - P Wagner
- Department of radiology, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - F Proust
- Neurosurgery department, CHU de Strasbourg, 1, rue Molière, 67000 Strasbourg, France
| | - A Thiery
- Epidemiology and biostatistics department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - A Labani
- Department of radiology, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Noël
- University radiation oncology department, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratory of radiobiology, EA 3430, Federation of translational medicine, Strasbourg (FMTS), Strasbourg university, 67000 Strasbourg, France.
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Mai Y, Kong F, Yang Y, Zhou L, Li Y, Song T. Voxel-based automatic multi-criteria optimization for intensity modulated radiation therapy. Radiat Oncol 2018; 13:241. [PMID: 30518381 PMCID: PMC6280392 DOI: 10.1186/s13014-018-1179-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Automatic multi-criteria optimization is necessary for intensity modulated radiation therapy (IMRT) because of low planning efficiency and large plan quality uncertainty in current clinical practice. Most studies focused on imitating dosimetrists’ planning procedures to automate this process and ignored the fact that organ-based objective functions typically used in commercial treatment planning systems (such as dose-volume function) usually lead to sub-optimal plans. To guarantee the optimum results and to automate this process, we incorporate an improved automation strategy and a voxel-based optimization algorithm to generate a novel automatic multi-criteria optimization framework. We then evaluate it in clinical cases. Methods This novel automatic multi-criteria optimization framework incorporates a ranked priority-list based automatic constraints adjustment strategy and an in-house developed voxel-based optimization algorithm. Constraints are sequentially adjusted following a pre-defined priority list. Afterward, a voxel-based fluence map optimization (FMO) with an orientation to the newly updated constraints is launched to find a Pareto optimal solution. Loops of constraints adjustment are repeated until each of them could not be relaxed or tightened. The feasibility of the framework is evaluated with 10 automatic generated gynecology (GYN) cancer IMRT cases by comparing the dosimetric performance with the original. Results Plan quality improvement is observed for our automatic multi-criteria optimization method. Comparable DVHs are found for the planning target volume (PTV), but with better organs-at-risk (OAR) dose sparing. Among 13 evaluated dosimetric endpoints, 5 of them show significant improvements in automatically generated plans compared with the original plans. Investigation of improvement tendency during optimization exhibits gradual change as the optimization stage proceeds. An initial voxel-based optimization stage and in-low-priority dosimetric criteria tighten can significantly contribute to the optimization procedure. Conclusions We have successfully developed an automatic multi-criteria optimization framework that can dramatically reduce the current trial-and-error patterned planning workload while affording an efficient method to assure high plan quality consistency. This optimization framework is expected to greatly facilitate precise radiation therapy because of its advantages of planning efficiency and plan quality improvement.
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Affiliation(s)
- Yanhua Mai
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Fantu Kong
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yiwei Yang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, 310022, Hangzhou, China
| | - Linghong Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Yongbao Li
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - Ting Song
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Orlandi E, Iacovelli NA, Rancati T, Cicchetti A, Bossi P, Pignoli E, Bergamini C, Licitra L, Fallai C, Valdagni R, Cavallo A. Multivariable model for predicting acute oral mucositis during combined IMRT and chemotherapy for locally advanced nasopharyngeal cancer patients. Oral Oncol 2018; 86:266-72. [PMID: 30409311 DOI: 10.1016/j.oraloncology.2018.10.006] [Citation(s) in RCA: 18] [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: 07/02/2018] [Revised: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/OBJECTIVE Oral and oropharyngeal mucositis (OM) represents amultifactorialand complexinterplayof patient-, tumor-, and treatment-related factors. We aimed to build a predictive model for acute OM for locally advanced nasopharyngeal carcinoma (NPC) patients by combining clinical and dosimetric factors. MATERIALS/METHODS A series of consecutive NPC patients treated curatively with IMRT/VMAT + chemotherapy at 70 Gy (2-2.12 Gy/fr) was considered. For each patient, clinical- tumor- and treatment-related data were retrospectively collected. oral cavity (OC) and parotid glands (PG, considered as a single organ) were selected as organs-at-risk (OARs). Acute OM was assessed according to CTCAE v4.0 at baseline and weekly during RT. Two endpoints were considered: grade ≥3 and mean grade ≥1.5. DVHs were reduced to Equivalent Uniform Dose (EUD). Dosimetric and clinical/treatment features selected via LASSO were inserted into a multivariable logistic model. Goodness of fit was evaluated through Hosmer-Lemeshow test and calibration plot. RESULTS Data were collected for 132 patients. G ≥ 3 and mean G ≥ 1.5 OM were reported in 40 patients (30%). Analyses resulted in a 3-variables model for G ≥ 3 OM, including OC EUD with n = 0.05 (OR = 1.02), PG EUD with n = 1 (OR = 1.06), BMI ≥ 30 (OR = 3.8, for obese patients), and a single variable model for mean G ≥ 1.5 OM, i.e. OC EUD with n = 1 (mean dose) (OR = 1.07). Calibration was good in both cases. CONCLUSION OC mean dose was found to impact most on OM duration (mean G ≥ 1.5), while G ≥ 3 OM was associated to a synergic effect between PG mean dose and high dose received by small OC volumes, with BMI acting as a dose-modifying factor.
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Lu L, Sheng Y, Zhang G, Li Y, OuYang PY, Ge Y, Xie T, Chang H, Deng X, Wu JQ. Temporal lobe injury patterns following intensity modulated radiotherapy in a large cohort of nasopharyngeal carcinoma patients. Oral Oncol 2018; 85:8-14. [PMID: 30220323 DOI: 10.1016/j.oraloncology.2018.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/25/2018] [Revised: 07/24/2018] [Accepted: 07/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To analyze the correlation between dose-volume-histograms (DVHs) with three patterns (edema, enhancement, and necrosis) of temporal lobe injury (TLI) in patients receiving intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and to determine optimal thresholds to predict the incidence of each TLI pattern, with particular emphasis on the relationship between edema volume and the risk of enhancement and necrosis. MATERIALS AND METHODS A cohort of 4186 NPC patients treated with IMRT was retrospectively reviewed with TLI presenting in 188 patients. The atlases of complication incidence (ACI) for each pattern were constructed using DVH curves of temporal lobes. Optimal threshold for predicting incidence of each pattern was determined using the point closest to top-left of the plot. The accuracy of using edema volume to predict enhancement and necrosis incidence was evaluated via area under curve (AUC) of receiver operator characteristics (ROC). RESULTS All DVH parameters, Dmean, Dmax, D0.25cc, D0.5cc, D1cc, D3cc, D6cc, V20Gy, V30Gy, V40Gy, V50Gy, V60Gy, and V70Gy, except Dmin showed statistically significant differences between subgroups of each pattern (p < 0.05). For predicting incidence of each pattern, optimal DVH thresholds over the range of D0.25-D1cc, Dmean and V20-V70 were derived. The optimal thresholds of edema volume for predicting enhancement were 0.96 and 2.2cc and for predicting necrosis were 0.94 and 11.5cc. CONCLUSION Optimal DVH thresholds were generated for limiting risk of each injury pattern. Edema volume was a strong predictor for risk of enhancement and necrosis, which could potentially be reduced by lowering edema volume below threshold.
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Affiliation(s)
- Lixia Lu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, China
| | - Yang Sheng
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
| | - Guangshun Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, China
| | - Yizhuo Li
- Department of Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, China
| | - Pu-Yun OuYang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, China
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Tianyi Xie
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
| | - Hui Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, China
| | - Xiaowu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, China.
| | - Jackie Q Wu
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA.
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Chen L, Peng YL, Gu SY, Shen H, Zhang DD, Sun WZ, Wu JH, Deng XW. Dosimetric Effects of Head and Neck Immobilization Devices on Multi-field Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma. J Cancer 2018; 9:2443-2450. [PMID: 30026841 PMCID: PMC6036882 DOI: 10.7150/jca.24887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/01/2018] [Indexed: 11/11/2022] Open
Abstract
Background: In practice, the dose perturbation effect of head and neck immobilization devices is often overlooked in intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Purpose of this study is to verify and analyze the dosimetric effect of head and neck immobilization devices on NPC multi-field IMRT. Methods: Ten patients with nasopharyngeal carcinoma were randomly selected. Two sets of body contours were established for each patient. One set of body contours did not contain the immobilization device, and the other contour set included the immobilization device. For each patient, dose calculations were conducted for the two sets of contours using the same 9-field IMRT plan, which were recorded as Plan- and Plan+. The dose difference caused by the head and neck immobilization devices was assessed by comparing the dose-volume histogram (DVH) parameter results and by plan subtraction. The gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results: The target coverage and average dose of Plan+ were lower than those of Plan- : the prescription dose coverage rates for PTVnx, PTVnd, PTV1 and PTV2 decreased by 2.4%, 9.9%, 1.5%, and 3.6%, respectively, and the mean doses were reduced by 0.9%, 1.9%, 1.1%, and 1.5%, respectively. Doses in the organs at risk showed no significant differences or slight reductions (the maximum reduction in mean dose was 1.7%). From the EBT3 measurements, the skin dose on the posterior neck was increased by approximately 53%. Conclusion: The attenuation and bolus effects of the head and neck immobilization device reduce dose coverage rate and average dose of the planning target volumes in nasopharyngeal carcinoma and lead to an increase in the skin dose. During treatment planning and dose calculation, the immobilization device should be included within body contour to account for the dose attenuation and skin dose increment.
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Affiliation(s)
- Li Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ying-Lin Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shi-Yong Gu
- Department of Radiation Oncology, Wuhan General Hospital of Guangzhou Military, No. 627, Wuluo Road, Hongshan District, Wuhan 430064, China
| | - Hui Shen
- Department of Radiation Oncology, Yangjiang Hospital, No.42, Dongshan Road, Jiangcheng District, Yangjiang 529599, China
| | - Dan-Dan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Wen-Zhao Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jian-Hua Wu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiao-Wu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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Kusumoto S, Fujiwara H, Sagawa M, Nobuzane T, Nishida T, Akagi Y, Hirokawa Y, Katsube Y. Successful radiotherapy for endometrial serous carcinoma with local repeated recurrence. Int Cancer Conf J 2018; 7:71-75. [PMID: 31149518 PMCID: PMC6498359 DOI: 10.1007/s13691-018-0323-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 01/31/2023] Open
Abstract
The incidence of endometrial serous carcinoma (ESC) has been increasing, and ESC is resistant to treatment. We report a patient with ESC who responded to radiotherapy for multiple recurrences. The first recurrence was detected in the vaginal wall and left internal iliac lymph node 5 months after the initial treatment. Concurrent chemoradiotherapy (CCRT) was administered. Radiation was delivered using the intensity modulated radiation therapy technique. The second recurrent tumor was detected in the right internal iliac lymph node after 4 months, and CCRT was conducted. After 4 months, the third recurrence was detected in the right common iliac node, and CCRT was performed. After 8 months, the fourth recurrence was detected in the horizontal portion of the duodenum, and radiotherapy was administered. After 9 months, the fifth recurrence was detected in the vaginal wall. Interstitial brachytherapy was conducted. Grade 2 gastrointestinal injury, nausea and radiodermatitis were observed. During the subsequent 13-month follow-up, there has been no recurrence. Although ESC is resistant to treatment, radiotherapy could be effective in some cases. Even when multiple recurrences occur, radiotherapy may be considered a treatment option if the irradiation level is permissible.
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Affiliation(s)
- Shinya Kusumoto
- 1Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, 1-5-1 Hiro Tagaya, Kure, Hiroshima 737-0193 Japan
| | - Hisaya Fujiwara
- 1Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, 1-5-1 Hiro Tagaya, Kure, Hiroshima 737-0193 Japan
| | - Maiko Sagawa
- 1Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, 1-5-1 Hiro Tagaya, Kure, Hiroshima 737-0193 Japan
| | - Takahiro Nobuzane
- 1Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, 1-5-1 Hiro Tagaya, Kure, Hiroshima 737-0193 Japan
| | - Toshihiro Nishida
- 2Department of Pathology, Chugoku Rosai Hospital, 1-5-1 Hiro Tagaya, Kure, Hiroshima 737-0193 Japan
| | - Yukio Akagi
- Hiroshima Heiwa Clinic, State of the Art Treatment Center, 1-31 Kawara-machi, Naka-ku, Hiroshima, 730-0856 Japan
| | - Yutaka Hirokawa
- Hiroshima Heiwa Clinic, State of the Art Treatment Center, 1-31 Kawara-machi, Naka-ku, Hiroshima, 730-0856 Japan
| | - Yasuhiro Katsube
- 1Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, 1-5-1 Hiro Tagaya, Kure, Hiroshima 737-0193 Japan
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Paulino AC, Mahajan A, Ye R, Grosshans DR, Fatih Okcu M, Su J, McAleer MF, McGovern S, Mangona VA, Chintagumpala M. Ototoxicity and cochlear sparing in children with medulloblastoma: Proton vs. photon radiotherapy. Radiother Oncol 2018; 128:128-132. [PMID: 29373195 DOI: 10.1016/j.radonc.2018.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 09/13/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare ototoxicity rates between medulloblastoma patients treated with protons vs. photons. MATERIALS AND METHODS The study included 84 children diagnosed with medulloblastoma treated with either passively scattered protons (n = 38) or photons (n = 46). Patients underwent maximal safe resection followed by craniospinal irradiation, posterior fossa and/or tumor bed boost and chemotherapy according to one of 3 multi-institutional trials. Median audiogram follow-up was 56 months for protons and 66 months for photons. RESULTS Mean cochlear dose (Dmc) was lower in patients treated with protons for both standard (p < 0.0001) and high-risk disease (p < 0.001). Grade 3 and 4 ototoxicity was seen in 7 of 75 (9.3%) and 9 of 91 (9.9%) ears (Brock, p = 0.91), 13 of 75 (17.3%) and 19 of 91 (20.9%) ears (POG, p = 0.56), and 15 of 75 (20.0%) and 21 of 91 (23.1%) ears (SIOP Boston, p = 0.63) with protons and photons respectively. CONCLUSIONS While cochlear doses were lower in the proton group, patients treated with either protons or photons had similar Grade 3 and 4 ototoxicity rates.
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Affiliation(s)
- Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA.
| | - Anita Mahajan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - Rong Ye
- Department of Biostatistics, MD Anderson Cancer Center, Houston, USA
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - M Fatih Okcu
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, USA
| | - Jack Su
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, USA
| | | | - Susan McGovern
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - Victor A Mangona
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
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Shiraishi Y, Fang P, Xu C, Song J, Krishnan S, Koay EJ, Mehran RJ, Hofstetter WL, Blum-Murphy M, Ajani JA, Komaki R, Minsky B, Mohan R, Hsu CC, Hobbs BP, Lin SH. Severe lymphopenia during neoadjuvant chemoradiation for esophageal cancer: A propensity matched analysis of the relative risk of proton versus photon-based radiation therapy. Radiother Oncol 2017; 128:154-160. [PMID: 29248170 DOI: 10.1016/j.radonc.2017.11.028] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [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: 08/13/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Circulating lymphocytes are exquisitely sensitive to radiation exposure, even to low scattered doses which can vary drastically between radiation modalities. We compared the relative risk of radiation-induced lymphopenia between intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT) in esophageal cancer (EC) patients undergoing neoadjuvant chemoradiation therapy (nCRT). MATERIAL AND METHODS EC patients treated with IMRT and PBT were propensity matched based on key clinical variables. Treatment-associated lymphopenia was graded using CTCAE v.4.0. Using matched cohorts, univariate and multivariable multiple logistic regression was used to identify factors associated with increased risk of grade 4 lymphopenia as well as characterize their relative contributions. RESULTS Among the 480 patients treated with nCRT, 136 IMRT patients were propensity score matched with 136 PBT patients. In the matched groups, a greater proportion of the IMRT patients (55/136, 40.4%) developed grade 4 lymphopenia during nCRT compared with the PBT patients (24/136, 17.6%, P < 0.0001). On multivariable analysis, PBT was significantly associated with a reduction in grade 4 lymphopenia risk (odds ratio, 0.29; 95% confidence interval, 0.16-0.52; P < 0.0001). CONCLUSION PBT is associated with significant risk reduction in grade 4 lymphopenia during nCRT in esophageal cancer.
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Affiliation(s)
- Yutaka Shiraishi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Penny Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Cai Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, China
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Eugene J Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Reza J Mehran
- Department of Cardiovascular and Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Wayne L Hofstetter
- Department of Cardiovascular and Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mariela Blum-Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bruce Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Radhe Mohan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Charles C Hsu
- Department of Radiation Oncology, The University of Arizona, Tucson, USA
| | - Brian P Hobbs
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Xu T, Zhou X, Shen C, Hu C. Suggestions for surveillance and radiation strategy in nasopharyngeal carcinoma treated with IMRT: Based on hazard-rate and patterns of recurrence. Oral Oncol 2017; 76:61-67. [PMID: 29290287 DOI: 10.1016/j.oraloncology.2017.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/21/2017] [Revised: 11/01/2017] [Accepted: 11/20/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The study was designed to appraise the locoregional recurrence patterns using conventional two-dimensional radiotherapy (2D-RT) and intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC) in order to better establish the scenario of the modern radiotherapy and the duration of surveillance. MATERIALS AND METHODS We reviewed the institutional database to identify patients with pathologically confirmed, non-metastatic NPC who completed radical 2D-RT or IMRT at our center from 2000 to 2011. We collected data on clinicopathologic features, treatments and outcomes. Statistical analyses were performed using SPSS 20.0 or STATASE 14.0. RESULTS The median follow-up was 60.1 months. Of 2315 patients, 1289 (53%) were treated with 2D-RT and 1026 (47%) with IMRT. IMRT group achieved better locoregional control rate, with the 5-year locoregional relapse-free survival (LRRFS) were 84.9% and 87.7% among patients received 2D-RT and IMRT, respectively (P = 0.050). IMRT was superior to 2D technique in terms of local relapse-free survival (LRFS) (88.4% vs 91.1%, P = 0.047) and the advantage was only significant in T3-4 subgroup (81.6% vs 90.2%, P = 0.000). Similar neck control rates were observed using different RT techniques. And the recurrence time appeared to be postponed by IMRT, with peaks accounting for the year 1.5 and year 3-4 compared to which was predominant at the first two years using 2D-RT in nature. CONCLUSIONS IMRT provided an improved LRRFS in overall stage and LRFS in advanced T stage for NPC compared with 2D-RT. Annual hazard of recurrence also changed with RT techniques.
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Affiliation(s)
- Tingting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China.
| | - Xin Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China.
| | - Chunying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China.
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China.
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Cosper PF, Olsen J, DeWees T, Van Tine BA, Hawkins W, Michalski J, Zoberi I. Intensity modulated radiation therapy and surgery for Management of Retroperitoneal Sarcomas: a single-institution experience. Radiat Oncol 2017; 12:198. [PMID: 29216884 PMCID: PMC5721605 DOI: 10.1186/s13014-017-0920-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 06/20/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peri-operative radiation of retroperitoneal sarcomas (RPS) is an important component of multidisciplinary treatment. All retrospective series thus far included patients treated with older radiation therapy (RT) techniques including 2D and 3DRT. Intensity modulated radiation therapy (IMRT) allows for selective dose escalation while sparing adjacent organs. We therefore report the first series of patients with RPS treated solely with IMRT, surgery and chemotherapy. We hypothesized that IMRT would permit safe dose escalation and superior rates of local control (LC) in this high-risk patient population. METHODS Thirty patients with RPS treated with curative intent between 2006 and 2015 were included in this retrospective study. RT was administered either pre- or post-operatively and IMRT was used in all patients. Statistical comparisons, LC, distant metastasis (DM), and overall survival (OS) were calculated by Kaplan-Meier analysis and univariate Cox regression. RESULTS Median follow-up time after completion of RT was 36 months (range 1.4-112). Median tumor size was 14 cm (range 3.6 - 28 cm). The most prevalent histologies were liposarcoma in 10 (33%) patients and leiomyosarcoma in 10 (33%) with 21 patients (70%) having high-grade disease. Twenty-eight (93%) patients had surgical resection with 47% having positive margins. Chemotherapy was administered in 9 (30%) patients. RT was delivered pre-operatively in 11 (37%) patients, and post-operatively in 19 (63%) with 60% of patients receiving a simultaneous integrated boost. Pre-operative median RT dose to the high-risk area was 55 Gy (range, 43-66 Gy) while median post-operative dose was 60.4 Gy (range, 45-66.6 Gy). There was one acute grade 3 and one late grade 3 toxicity and no grade 4 or 5 toxicities. Three year actuarial LC, freedom from DM, and OS rates were 84%, 64%, and 68% respectively. Positive surgical margins were associated with a higher risk of local recurrence (p = 0.02) and decreased OS (p = 0.04). Pre-operative RT was associated with improved LC (p = 0.1) with a 5-year actuarial LC of 100%. Administration of chemotherapy, timing of RT, histology or grade was not predictive of OS. CONCLUSIONS Patients with RPS treated with peri-operative IMRT at our institution had excellent local control and low incidences of toxicity.
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Affiliation(s)
- Pippa F Cosper
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Olsen
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Van Tine
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - William Hawkins
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
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Shah BA, Qureshi MM, Logue JM, Cooley TP, Zaner KS, Jalisi S, Truong MT. Assessing cumulative acute toxicity of chemoradiotherapy in head and neck cancer with or without induction chemotherapy. Am J Otolaryngol 2017; 38:456-61. [PMID: 28427799 DOI: 10.1016/j.amjoto.2017.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/09/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND To compare cumulative acute toxicity in head and neck cancer patients treated with concurrent chemoradiotherapy alone (CCRT) versus induction chemotherapy (IC) followed by CCRT (I/CCRT). METHODS 77 patients underwent definitive CCRT (30 I/CCRT and 47 CCRT). Toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0. Using the TAME adverse event reporting system, short-term toxicity (T) scores were generated for IC (TIC), CCRT (TCCRT), total treatment duration (TRx), post-treatment period (TPT) and an overall score (Toverall) from treatment start to post treatment period. RESULTS Acute toxicity other than dysphagia, odynophagia, or dermatitis was reported in 90.0% and 66.0% of I/CCRT and CCRT patients, respectively (P=0.02). Compared to CCRT group, I/CCRT patients reported greater mean TRx (TRx: 2.11 vs. 2.87, P=0.01) and Toverall (Toverall: 2.60 vs. 3.70, P=0.003). CONCLUSION I/CCRT patients reported more cumulative acute toxicity during treatment compared to CCRT patients using the TAME reporting system.
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Osborn VW, Leaf A, Lee A, Garay E, Safdieh J, Schwartz D, Schreiber D. Bilateral diffuse grade 5 radiation pneumonitis after intensity modulated radiation therapy for localized lung cancer. World J Clin Oncol 2017; 8:285-288. [PMID: 28638799 PMCID: PMC5465019 DOI: 10.5306/wjco.v8.i3.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/07/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
We are reporting a case of fatal radiation pneumonitis that developed six months following chemoradiation for limited stage small cell lung cancer. The patient was a 67-year-old man with a past medical history of Hashimoto’s thyroiditis and remote suspicion for CREST, neither of which were active in the years leading up to treatment. He received 6600 cGy delivered in 200 cGy daily fractions via intensity modulated radiation therapy with concurrent cisplatin/etoposide followed by additional chemotherapy with dose-reduced cisplatin/etoposide and carboplatin/etoposide and then received prophylactic cranial irradiation. The subsequent months were notable for progressively worsening episodes of respiratory compromise despite administration of prolonged steroids and he ultimately expired. Imaging demonstrated bilateral interstitial and airspace opacities. Autopsy findings were consistent with pneumonitis secondary to chemoradiation as well as lymphangitic spread of small cell carcinoma. The process was diffuse bilaterally although his radiation was delivered focally to the right lung and mediastinum.
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Wang J, Hu W, Yang Z, Chen X, Wu Z, Yu X, Guo X, Lu S, Li K, Yu G. Is it possible for knowledge-based planning to improve intensity modulated radiation therapy plan quality for planners with different planning experiences in left-sided breast cancer patients? Radiat Oncol 2017; 12:85. [PMID: 28532508 PMCID: PMC5440994 DOI: 10.1186/s13014-017-0822-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 09/13/2016] [Accepted: 05/15/2017] [Indexed: 12/25/2022] Open
Abstract
Background Knowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency. However, no attempts have been made to extend the domain of KBP for planners with different planning experiences so far. The purpose of this study was to quantify the potential gains for planners with different planning experiences after implementing KBP in intensity modulated radiation therapy (IMRT) plans for left-sided breast cancer patients. Methods The model libraries were populated with 80 expert clinical plans from treated patients who previously received left-sided breast-conserving surgery and IMRT with simultaneously integrated boost. The libraries were created on the RapidPlanTM. 6 planners with different planning experiences (2 beginner planners, 2 junior planners and 2 senior planners) generated manual and KBP optimized plans for additional 10 patients, similar to those included in the model libraries. The plan qualities were compared between manual and KBP plans. Results All plans were capable of achieving the prescription requirement. There were almost no statistically significant differences in terms of the planning target volume (PTV) coverage and dose conformality. It was demonstrated that the doses for most of organs-at-risk (OARs) were on average lower or equal in KBP plans compared to manual plans except for the senior planners, where the very small differences were not statistically significant. KBP data showed a systematic trend to have superior dose sparing at most parameters for the heart and ipsilateral lung. The observed decrease in the doses to these OARs could be achieved, particularly for the beginner and junior planners. Many differences were statistically significant. Conclusions It is feasible to generate acceptable IMRT plans after implementing KBP for left-sided breast cancer. KBP helps to effectively improve the quality of IMRT plans against the benchmark of manual plans for less experienced planners without any manual intervention. KBP showed promise for homogenizing the plan quality by transferring planning expertise from more experienced to less experienced planners.
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Affiliation(s)
- Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Xiaohui Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqiang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Saiquan Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kaixuan Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gongyi Yu
- 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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Doi H, Masai N, Uemoto K, Suzuki O, Shiomi H, Tatsumi D, Oh RJ. Validation of the liver mean dose in terms of the biological effective dose for the prevention of radiation-induced liver damage. Rep Pract Oncol Radiother 2017; 22:303-309. [PMID: 28507460 DOI: 10.1016/j.rpor.2017.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/24/2016] [Revised: 12/18/2016] [Accepted: 02/27/2017] [Indexed: 02/07/2023] Open
Abstract
AIM The purpose of this study was to determine the optimal mean liver biologically effective dose (BED) to prevent radiation-induced liver disease (RILD) in stereotactic body radiation therapy (SBRT). BACKGROUND The actual mean doses appropriate for liver irradiation in modern radiotherapy techniques have not been adequately investigated, although SBRT is sometimes alternatively performed using fractionated regimens. MATERIALS AND METHODS SBRT treatment plans for liver tumors in 50 patients were analyzed. All distributions of the physical doses were transformed to BED2 using the linear-quadratic model. The relationship between physical doses and the BED2 for the liver were then analyzed, as was the relationship between the mean BED2 for the liver and the planning target volume (PTV). RESULTS A significantly positive correlation was observed between the mean physical dose for the background liver and the mean BED2 for the whole liver (P < 0.0001, r = 0.9558). Using the LQ model, a mean BED2 of 73 and 16 Gy for the whole liver corresponded to the hepatic tolerable mean physical dose of 21 and 6 Gy for Child-Pugh A- and B-classified patients, respectively. Additionally, the PTV values were positively correlated with the BEDs for the whole liver (P < 0.0001, r = 0.8600), and the background liver (P < 0.0001, r = 0.7854). CONCLUSION A mean BED2 of 73 and 16 Gy for the whole liver appeared appropriate to prevent RILD in patients with Child-Pugh classes A and B, respectively. The mean BED2 for the liver correlated well with the PTV.
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Affiliation(s)
- Hiroshi Doi
- Miyakojima IGRT Clinic, Osaka, Japan.,Department of Radiology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Kenji Uemoto
- Miyakojima IGRT Clinic, Osaka, Japan.,Division of Health Sciences, Osaka University Graduate School of Medicine and Health Science, Osaka, Japan
| | - Osamu Suzuki
- Miyakojima IGRT Clinic, Osaka, Japan.,Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
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Matsuzaki H, Tanaka-Matsuzaki K, Miyazaki F, Aoyama H, Ihara H, Katayama N, Katsui K, Himei K, Takeuchi T, Onoda T, Kimata Y, Asaumi JI. The role of dentistry other than oral care in patients undergoing radiotherapy for head and neck cancer. Jpn Dent Sci Rev 2017; 53:46-52. [PMID: 28479935 PMCID: PMC5405201 DOI: 10.1016/j.jdsr.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 07/15/2016] [Accepted: 09/23/2016] [Indexed: 11/24/2022] Open
Abstract
The usefulness of dental approaches, such as oral management, has gained recognition among patients treated for head and neck cancer. In particular, oral management plays a very important role before, during, and after treatment in patients undergoing radiotherapy, chemotherapy, or a combination of both. However, specialized dentistry knowledge and techniques that are useful for patients undergoing radiotherapy for head and neck cancer have yet to be reported. Therefore, in this review article, our aim is to introduce dental approaches in radiotherapy for patients with head and neck cancer that have been developed and are currently being used at our institute.
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Affiliation(s)
- Hidenobu Matsuzaki
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Japan
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Corresponding author at: Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 5-1, Shikata-cho, 2-Chome, Kita-ku, Okayama-city, Okayama 700-8558, Japan. Fax: +81 86 235 6709.
| | - Kumiko Tanaka-Matsuzaki
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Caries Department, Okayama University Hospital, Japan
| | - Fuminobu Miyazaki
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Room for Dental Laboratory, Okayama University Hospital, Japan
| | - Hideki Aoyama
- Central Division of Radiology, Okayama University Hospital, Japan
| | - Hiroki Ihara
- Department of Radiology, Okayama University Hospital, Japan
| | | | - Kuniaki Katsui
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Department of Radiology, Okayama University Hospital, Japan
| | - Kengo Himei
- Department of Radiology, Japanese Red Cross Society Okayama Hospital, Japan
| | - Tetsuo Takeuchi
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Room for Dental Laboratory, Okayama University Hospital, Japan
| | - Tomoo Onoda
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Department of Head and Neck Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama, Japan
| | - Yoshihiro Kimata
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, University of Okayama, Japan
| | - Jun-ichi Asaumi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Japan
- Okayama University Hospital Head and Neck Cancer Center, Japan
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, University of Okayama, Japan
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Doi H, Tanooka M, Ishida T, Moridera K, Ichimiya K, Tarutani K, Kitajima K, Fujiwara M, Kishimoto H, Kamikonya N. Utility of intraoral stents in external beam radiotherapy for head and neck cancer. Rep Pract Oncol Radiother 2017; 22:310-8. [PMID: 28515675 DOI: 10.1016/j.rpor.2017.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/25/2017] [Accepted: 03/16/2017] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to assess the utility and stability of intraoral stent during intensity-modulated radiation therapy (IMRT). BACKGROUND The benefits of intraoral stents in radiotherapy are unclear. MATERIALS AND METHODS We analyzed 386 setup errors in 12 patients who received IMRT for head and neck cancers without intraoral stents (intraoral stent [-]) and 183 setup errors in 6 patients who received IMRT with intraoral stents (intraoral stent [+]). All patients were matched according to the immobilization method (masks and boards). Setup errors were measured as the distance from the initial setup based on the marking on the skin and mask to the corrected position based on bone matching on cone beam computed tomography. RESULTS The mean interfractional setup errors in the right-left, craniocaudal, anterior-posterior (AP), and three-dimensional (3D) directions were -0.33, 0.08, -0.25, and 2.75 mm in the intraoral stent (-) group and -0.37, 0.24, -0.63, and 2.42 mm in the intraoral stent (+) group, respectively (P = 0.50, 0.65, 0.01, and 0.02, respectively). The systematic errors for the same directions were 0.89, 1.46, 1.15, and 0.88 mm in the intraoral stent (-) group and 0.62, 1.69, 0.68, and 0.56 mm in the intraoral stents (+) group, respectively. The random errors were 1.43, 1.43, 1.44, and 1.22 mm in the intraoral stent (-) group and 1.06, 1.11, 1.05, and 0.92 mm in the intraoral stents (+) group, respectively. CONCLUSION Setup errors can be significantly reduced in the AP and 3D-directions by using intraoral stents.
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Back M, LeMottee M, Crasta C, Bailey D, Wheeler H, Guo L, Eade T. Reducing radiation dose to normal brain through a risk adapted dose reduction protocol for patients with favourable subtype anaplastic glioma. Radiat Oncol 2017; 12:46. [PMID: 28253929 PMCID: PMC5335728 DOI: 10.1186/s13014-017-0782-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
AIM In patients with isocitrate dehydrogenase (IDH) mutated anaplastic glioma determine the dosimetric benefits of delivering radiation therapy using a PET guided integrated boost IMRT technique (ib-IMRT) compared with standard IMRT (s-IMRT) in reducing dose to normal brain. METHODS Ten patients with anaplastic glioma, identified as a favourable molecular subgroup through presence of IDH mutation, and managed with radiation therapy using an ib-IMRT were enrolled into a dosimetric study comparing two RT techniques: s-IMRT to 59.4Gy or ib-IMRT with 59.4/54Gy regions. Gross Tumour volume (GTV) and Clinical Target Volumes (CTV) were determined by MRI, 18F-Fluoroethyltyrosine (FET) and 18F-Fluorodeoxyglucose (FDG) PET imaging. A standard risk Planning Target Volume (PTVsr) receiving 59.4Gy (PTV59.4) in the s-IMRT technique was determined by MRI T2Flair and FET PET. For the ib-IMRT technique this PTVsr volume was treated to 54Gy, and the high-risk PTV (PTVhr) receiving 59.4Gy was determined as a higher risk region by FDG PET and MRI gadolinium enhancement. Standard dosimetric criteria and normal tissue constraints based on recent clinical trials were used in target delineation and planning. Normal Brain was defined as Brain minus CTV. Endpoints for dosimetric evaluation related to mean Brain dose (mBrainDose), brain volume receiving 40Gy (Brainv40) and 20Gy (Brainv20). The variation between the dosimetric endpoints for both techniques was examined using Wilcoxon analysis. RESULTS The 10 patients had tumours located in temporal (1), parietal (3), occipital (2) and bifrontal (4) regions. In ib-IMRT technique the median volume of PTVhr was 25.5 cm3 compared with PTVsr of 300.0 cm3. For dose to PTVhr the two treatments were equivalent (p = 0.33), and although the ibIMRT had a prescribed 10% dose reduction from 59.4Gy to 54Gy the median reduction was only 5.9%. The ib-IMRT dosimetry was significantly improved in normal brain endpoints specifically mBrainDose (p = 0.007), Brainv40 (p = 0.005) and Brainv20 (p = 0.001), with a median reduction of 9.3%, 19.0 and 10.8% respectively. After a median follow-up of 38 months two patients have progressed, with no isolated relapse in the dose reduction region. CONCLUSION An approach using ib-IMRT for anaplastic glioma produces significant dosimetric advantages in relation to normal brain dose compared with s-IMRT plan. This is achieved without a significant reduction to the target volume dose despite the reduction in prescribed dose. This technique has advantages to minimise potential late neurocognitive effects from high dose radiation in patients with favorable subtype anaplastic glioma with predicted median survival beyond ten years.
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Affiliation(s)
- M Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia. .,Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia. .,Sydney Neuro-Oncology Group, Sydney, NSW, Australia. .,Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
| | - M LeMottee
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia
| | - C Crasta
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - D Bailey
- Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia.,Department of PET and Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - H Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Sydney Neuro-Oncology Group, Sydney, NSW, Australia
| | - L Guo
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - T Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
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Chevalier C, Bertaut A, Quivrin M, Vulquin N, Desandes C, Folia M, Duvillard C, Truc G, Crehange G, Maingon P. Impact of waiting time on nodal staging in head and neck squamous-cell carcinoma treated with radical intensity modulated radiotherapy. Clin Transl Radiat Oncol 2016; 1:27-32. [PMID: 29657991 PMCID: PMC5893481 DOI: 10.1016/j.ctro.2016.11.002] [Citation(s) in RCA: 2] [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: 10/21/2016] [Revised: 10/22/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the influence of delays for radiotherapy on survival, recurrence and upstaging for head and neck squamous-cell carcinoma (HNSCC) with no nodal involvement treated with intensity modulated radiotherapy (IMRT). MATERIAL AND METHODS This retrospective study included 63 consecutive patients with HNSCC located in the pharynx and larynx and treated with exclusive IMRT with or without chemotherapy. Survival, loco-regional or distant failure and upstaging were analyzed according to the waiting time. RESULTS Mean waiting time for treatment was 62.5 days for the hypopharynx subgroup (range = 37-102), 63 days for the larynx subgroup (range = 19-128) and 58.5 days for the oropharynx subgroup (range = 29-99) (p = 0.725). Nine patients (14%) experienced upstaging. Loco-regional or distant failure occurred in 18 patients. Beyond a delay of 50 days, 19% of patients had local failure, 17% nodal recurrence and 11% distant failure. Within a delay of 50 days, no nodal or distant failure was observed and only 1 patient experienced local recurrence. Upstaging and overall survival were not significantly affected by an increased waiting time. CONCLUSION For N0 patients treated with IMRT for HNSCC, waiting time around 50 days after the diagnosis was not significantly associated with an excessive risk of upstaging or recurrence.
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Affiliation(s)
- Cédric Chevalier
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Aurélie Bertaut
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - Magali Quivrin
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Noémie Vulquin
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Cédric Desandes
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Mireille Folia
- Ear Nose and Throat Department, University Hospital of Dijon, Dijon, France
| | | | - Gilles Truc
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Gilles Crehange
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Philippe Maingon
- Radiation Oncology Department, GHU La Pitié Salpêtrière, Paris, France
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Sung W, Kim JI, Kim HS, Kim HJ, Lee YH, Ye SJ. Performance of the irregular surface compensator compared with four-field box and intensity modulated radiation therapy for gynecologic cancer. Phys Med 2016; 32:1537-1542. [PMID: 27866896 DOI: 10.1016/j.ejmp.2016.10.025] [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: 06/22/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE A retrospective planning study was undertaken to evaluate the dosimetric advantages of the irregular surface compensator (ISC) technique, a forward planning technique with electronic compensation algorithm available on Varian Eclipse treatment planning system. This was extensively compared to the conventional four-field box (4FB) and intensity modulated radiation therapy using 5 fields (IMRT5F) on gynecologic cancer patients. METHODS Twenty-two patients were enrolled. The prescribed dose was 50.4Gy in 28 fractions to the primary target including pelvic lymph nodes. 4FB treatment plans were generated, then fluence of anterior and posterior fields were modified to generate ISC plans. IMRT5F were inversely optimized with equally spaced five coplanar fields. Dose-volume parameters were evaluated for the comparison of three planning techniques. The MU and delivery time were also estimated. RESULTS In terms of target coverage, the conformity and homogeneity index of ISC (1.67 and 1.03, respectively) were superior to those of 4FB (2.43 and 1.06, respectively) but slightly inferior to those of IMRT5F (1.10 and 1.02, respectively). ISC also illustrated an overall improvement in normal organ saving. Compared to 4FB, the mean dose of the rectum was reduced by about 4.0-5.0Gy with ISC and IMRT5F. The volume receiving large doses was reduced for bladder with statistical significance with ISC and more with IMRT5F relative to 4FB. The mean number of MU per fraction were 200.86 (4FB), 446.09 (ISC) and 895.59 (IMRT5F). CONCLUSION The ISC technique has the superior target coverage and healthy tissue sparing in comparison with conventional 4FB and comparable normal organ saving compared to IMRT5F. The ISC can be an available option for gynecologic radiotherapy.
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Affiliation(s)
- Wonmo Sung
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-In Kim
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea.
| | - Hyun Suk Kim
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yang Hoon Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Joon Ye
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
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Jouglar E, Thomas L, de la Rochefordière A, Noël G, Le Blanc-Onfroy M, Delpon G, Campion L, Mahé MA. Toxicity and early clinical outcomes in cervical cancer following extended field helical tomotherapy to para-aortic lymph nodes. Cancer Radiother 2016; 20:794-800. [PMID: 28270323 DOI: 10.1016/j.canrad.2016.06.007] [Citation(s) in RCA: 10] [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: 03/17/2016] [Revised: 06/10/2016] [Accepted: 06/25/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate toxicity and early disease outcome among patients treated for cervical cancer with extended-field helical tomotherapy to the para-aortic nodes. PATIENTS AND METHODS Thirty-eight patients (International Federation of Gynecology and Obstetrics [FIGO] stage IB2-IVA) from four institutions received extended-field helical tomotherapy and were retrospectively evaluated. All had nodal disease. Para-aortic lymph nodes were involved in 31 patients. Patients were assessed for toxicity using version 4 of the National Cancer Institute's common terminology criteria for adverse events. Survival curves were plotted using Kaplan-Meier estimates. RESULTS All patients underwent radiation to the tumor region (median dose: 45Gy; range: 44-66Gy), pelvic lymph nodes and para-aortic lymph nodes (median dose: 45Gy; range: 44-60Gy). The median dose to positive lymph nodes was 55Gy (range: 45-65Gy). All received platinum-based chemotherapy (31 concurrently). The median follow-up was 15months. Acute toxicity events observed included one patient with grade 5 febrile neutropenia, 11 patients (29%) with grade 3 hematologic complications. Grades 3-4 gastrointestinal and genitourinary toxicities occurred in six (16%) and four (11%) patients, respectively. Three patients had grade 3 pelvic pain (8%). The 6- and 18-month overall survival rates were 94.7 and 63.9%, respectively. The 18-month locoregional control, disease-free survival, and late grade 3 toxicity rates were 60.2, 43.3 and 7.3%, respectively. CONCLUSION Extended-field helical tomotherapy was associated with low rates of acute gastrointestinal and genitourinary toxicities with early survival and locoregional control similar to other published series.
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Affiliation(s)
- E Jouglar
- Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
| | - L Thomas
- Department of Radiation Oncology, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - A de la Rochefordière
- Department of Radiation Oncology, institut Curie, 26, rue de l'Ulm, 75005 Paris, France
| | - G Noël
- Department of Radiation Oncology, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | - M Le Blanc-Onfroy
- Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - G Delpon
- Department of Medical Physics, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - L Campion
- Department of Statistics, Institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M-A Mahé
- Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
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Margalit DN, Rawal B, Catalano PJ, Haddad RI, Goguen LA, Annino DJ, Limaye SA, Lorch JH, Lavigne AW, Schoenfeld JD, Sher DJ, Tishler RB. Patterns of failure after reirradiation with intensity-modulated radiation therapy and the competing risk of out-of-field recurrences. Oral Oncol 2016; 61:19-26. [PMID: 27688100 DOI: 10.1016/j.oraloncology.2016.07.012] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe patterns of failure (POF) after reirradiation (reRT) with intensity modulated radiation therapy (IMRT) for recurrent/second primary squamous cell carcinoma of the head and neck. METHODS From 08/2004-02/2013, 75 consecutive patients received reRT with IMRT. Gross tumor was generally treated with a 5mm planning target volume (PTV) margin. For postoperative cases, a 5mm PTV was added to the clinical target volume which included the postoperative bed. Elective neck coverage was not standard. POF were characterized by correlating the recurrent tumor location on CT-imaging with the reRT IMRT plan. RESULTS Patients received definitive reRT (55%) or postoperative reRT (45%) to a median 60Gy (range, 59.4-70Gy). Most patients (88%) received concurrent chemotherapy including induction (16%). The median overall survival was 1.8years. Isolated local-regional recurrence (LRR) was the most common failure-type (2-year cumulative incidence [CI] 22.5% [95% C.I. 13.6-32.7%]), but concurrent LRR and distant-failure occurred frequently (2-year CI LRR+distant-failure 19.6% [95% C.I. 11.3-29.5%]); isolated distant-failure was rare (2-year CI 5.7% [95% C.I. 1.8-12.8%]). The 2-year in-field control was 65% (95% C.I. 52-81%) reflecting encouraging control within the irradiated target. Patients with gross disease were more likely to recur in-field (p=0.02), whereas postoperative patients were more likely to recur out-of-field/marginally than in-field (p=0.02). CONCLUSIONS POF after reRT differ when treating gross disease or postoperatively and should be considered when delineating reRT targets. Aggressive local therapy resulted in favorable in-field control, yet there remains a high competing risk of regional and distant micrometastatic disease. Better systemic agents are needed to control clinically occult local-regional and distant disease.
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Affiliation(s)
- Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States.
| | - Bhupendra Rawal
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Laura A Goguen
- Division of Otolaryngology, Department of Surgery, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States
| | - Donald J Annino
- Division of Otolaryngology, Department of Surgery, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States
| | - Sewanti A Limaye
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Annie W Lavigne
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States
| | - David J Sher
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States
| | - Roy B Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA, United States
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Margalit DN, Schoenfeld JD, Tishler RB. Radiation Oncology--New Approaches in Squamous Cell Cancer of the Head and Neck. Hematol Oncol Clin North Am 2015; 29:1093-106. [PMID: 26568550 DOI: 10.1016/j.hoc.2015.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The many advances in radiotherapy for squamous cell cancer of the head and neck described in this article will have significant effects on the ultimate outcomes of patients who receive this treatment. The technological and clinical advances should allow one to maintain or improve disease control, while moderating the toxicity associated with head and neck radiation therapy.
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Lauche O, Kirova YM, Fenoglietto P, Costa E, Lemanski C, Bourgier C, Riou O, Tiberi D, Campana F, Fourquet A, Azria D. Helical tomotherapy and volumetric modulated arc therapy: New therapeutic arms in the breast cancer radiotherapy. World J Radiol 2016; 8:735-742. [PMID: 27648167 PMCID: PMC5002504 DOI: 10.4329/wjr.v8.i8.735] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/05/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse clinical and dosimetric results of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) in complex adjuvant breast and nodes irradiation.
METHODS Seventy-three patients were included (31 HT and 42 VMAT). Dose were 63.8 Gy (HT) and 63.2 Gy (VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes (SCN) and internal mammary chain (IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort (7 mm vs 5 mm).
RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC: 96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5% (HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2% (VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1% (HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9% (VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy (HT) and 4.6 ± 0.9 Gy (VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.
CONCLUSION HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.
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Orlandi E, Iacovelli NA, Bonora M, Cavallo A, Fossati P. Salivary Gland. Photon beam and particle radiotherapy: Present and future. Oral Oncol 2016; 60:146-56. [PMID: 27394087 DOI: 10.1016/j.oraloncology.2016.06.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 02/10/2016] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/12/2022]
Abstract
Salivary gland cancers (SGCs) are rare diseases and their treatment depends upon histology, stage and site of origin. Radical surgery is the mainstay of treatment but radiotherapy (RT) plays a key role in both the postoperative and the inoperable setting, as well as in recurrent disease. In the absence of prospective randomized trials, a wide retrospective literature suggests postoperative RT (PORT) in patients with high risk pathological features. SGCs, and adenoid cystic carcinoma (ACC) in particular, are known to be radio-resistant tumors and should therefore respond well to particle beam therapy. Recently, excellent outcome has been reported with radical carbon ion RT (CIRT) in particular for ACC. Both modern photon- and hadron-based treatments are effective and are characterized by a favourable toxicity profile. But it is not clear whether one modality is superior to the other for disease control, due to the differences in patients' selection, techniques, fractionation schedules and outcome measurements among clinical experiences. In this paper, we review the role of photon and particle RT for malignant SGCs, discussing the difference between modalities in terms of biological and technical characteristics. RT dose and target volumes for different histologies (ACC versus non-ACC) have also been taken into consideration.
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Affiliation(s)
- Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | | | - Maria Bonora
- Clinical Department, CNAO (National Center for Oncological Hadrontherapy), Pavia, Italy
| | - Anna Cavallo
- Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Piero Fossati
- Clinical Department, CNAO (National Center for Oncological Hadrontherapy), Pavia, Italy; Radiotherapy Division, European Institute of Oncology, Milan, Italy
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Zeng M, Aguila FN, Patel T, Knapp M, Zhu XQ, Chen XL, Price PD. Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma. World J Gastrointest Oncol 2016; 8:474-480. [PMID: 27190587 PMCID: PMC4865715 DOI: 10.4251/wjgo.v8.i5.474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/09/2015] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost (IMRT-SIB).
METHODS: We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIB-based neoadjuvant chemoradiation protocol. During the concurrent chemoradiation therapy, radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume, with a regimen at the discretion of the treating medical oncologist. This was followed by surgical tumor resection. We analyzed pathological completion response (pCR) rates its relationship with overall survival and event-free survival.
RESULTS: Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis. Among the IMRT-SIB-treated patients, the toxicity appeared mild, the most common side effects were grade 1-3 esophagitis (46%) and pneumonitis (11.7%). There were no cardiac events. The Ro resection rate was 94% (n = 16), the pCR rate was 47% (n = 8), and the postoperative morbidity was zero. There was one mediastinal failure found, one patient had local failure at the anastomosis site, and the majority of failures were distant in the lung or bone. The 3-year disease-free survival and overall survival rates were 41% (n = 7) and 53% (n = 9), respectively.
CONCLUSION: The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.
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