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Barrett S, Thirion P, Harper D, Simpkin AJ, Leech M, Hickey K, Ryan L, Marignol L. Dosimetric impact of uncorrected systematic yaw rotation in VMAT for peripheral lung SABR. Rep Pract Oncol Radiother 2019; 24:520-527. [PMID: 31516398 DOI: 10.1016/j.rpor.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022] Open
Abstract
Aim This study aimed to evaluate the dosimetric impact of uncorrected yaw rotational error on both target coverage and OAR dose metrics in this patient population. Background Rotational set up errors can be difficult to correct in lung VMAT SABR treatments, and may lead to a change in planned dose distributions. Materials and methods We retrospectively applied systematic yaw rotational errors in 1° degree increments up to -5° and +5° degrees in 16 VMAT SABR plans. The impact on PTV and OARs (oesophagus, spinal canal, heart, airway, chest wall, brachial plexus, lung) was evaluated using a variety of dose metrics. Changes were assessed in relation to percentage deviation from approved planned dose at 0 degrees. Results Target coverage was largely unaffected with the largest mean and maximum percentage difference being 1.4% and 6% respectively to PTV D98% at +5 degrees yaw.Impact on OARs was varied. Minimal impact was observed in oesophagus, spinal canal, chest wall or lung dose metrics. Larger variations were observed in the heart, airway and brachial plexus. The largest mean and maximum percentage differences being 20.77% and 311% respectively at -5 degrees yaw to airway D0.1cc, however, the clinical impact was negligible as these variations were observed in metrics with minimal initial doses. Conclusions No clinically unacceptable changes to dose metrics were observed in this patient cohort but large percentage deviations from approved dose metrics in OARs were noted. OARs with associated PRV structures appear more robust to uncorrected rotational error.
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Affiliation(s)
- Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | | | - Dean Harper
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
| | - Kim Hickey
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Laoise Ryan
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Laure Marignol
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Ireland
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102
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Giuranno L, Ient J, De Ruysscher D, Vooijs MA. Radiation-Induced Lung Injury (RILI). Front Oncol 2019; 9:877. [PMID: 31555602 PMCID: PMC6743286 DOI: 10.3389/fonc.2019.00877] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
Radiation pneumonitis (RP) and radiation fibrosis (RF) are two dose-limiting toxicities of radiotherapy (RT), especially for lung, and esophageal cancer. It occurs in 5-20% of patients and limits the maximum dose that can be delivered, reducing tumor control probability (TCP) and may lead to dyspnea, lung fibrosis, and impaired quality of life. Both physical and biological factors determine the normal tissue complication probability (NTCP) by Radiotherapy. A better understanding of the pathophysiological sequence of radiation-induced lung injury (RILI) and the intrinsic, environmental and treatment-related factors may aid in the prevention, and better management of radiation-induced lung damage. In this review, we summarize our current understanding of the pathological and molecular consequences of lung exposure to ionizing radiation, and pharmaceutical interventions that may be beneficial in the prevention or curtailment of RILI, and therefore enable a more durable therapeutic tumor response.
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Affiliation(s)
- Lorena Giuranno
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jonathan Ient
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marc A Vooijs
- Department of Radiotherapy, GROW School for Oncology Maastricht University Medical Centre, Maastricht, Netherlands
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103
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[Lung cancer and elective nodal irradiation: A solved issue?]. Cancer Radiother 2019; 23:701-707. [PMID: 31501024 DOI: 10.1016/j.canrad.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 12/25/2022]
Abstract
Lung cancer treatment is a heavy workload for radiation oncologist and that field showed many evolutions over the last two decades. The issue about target volume was raised when treatment delivery became more precise with the development of three-dimensional conformal radiotherapy. Initially based upon surgical series, numerous retrospective and prospective studies aimed to evaluate the risk of elective nodal failure of involved-field radiotherapy compared to standard large field elective nodal irradiation. In every setting, locally advanced non-small cell lung cancer, localized non-small cell lung cancer, localized small cell lung cancer, exclusive chemoradiation or postoperative radiotherapy, most of the studies showed no significant difference between involved-field radiotherapy or elective nodal irradiation with elective nodal failure rate under 5% at 2 years, provided staging had been done with modern imaging and diagnostic techniques (positron emission tomography scan, endoscopy, etc.). Moreover, if reducing irradiated volumes are safe regarding recurrences, involved-field radiotherapy allowed dose escalation while reducing acute and late oesophageal, cardiac and pulmonary toxicities. Consequently, major clinical trials involving radiotherapy initiated in the last two decades and international clinical guidelines recommended omission of elective nodal irradiation in favour of in-field radiotherapy.
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104
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Pasquier D, Lacornerie T, Mirabel X, Brassart C, Vanquin L, Lartigau E. [Stereotactic body radiotherapy. How to better protect normal tissues?]. Cancer Radiother 2019; 23:630-635. [PMID: 31447339 DOI: 10.1016/j.canrad.2019.07.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022]
Abstract
The use of stereotactic body radiotherapy (SBRT) has increased rapidly over the past decade. Optimal preservation of normal tissues is a major issue because of their high sensitivity to high doses per session. Extreme hypofractionation can convert random errors into systematic errors. Optimal preservation of organs at risk requires first of all a rigorous implementation of this technique according to published guidelines. The robustness of the imaging modalities used for planning, and training medical and paramedical staff are an integral part of these guidelines too. The choice of SBRT indications, dose fractionation, dose heterogeneity, ballistics, are also means of optimizing the protection of normal tissues. Non-coplanarity and tracking of moving targets allow dosimetric improvement in some clinical settings. Automatic planning could also improve normal tissue protection. Adaptive SBRT, with new image guided radiotherapy modalities such as MRI, could further reduce the risk of toxicity.
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Affiliation(s)
- D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France.
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - C Brassart
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - L Vanquin
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - E Lartigau
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France
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105
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Dess RT, Sun Y, Muenz DG, Paximadis PA, Dominello MM, Grills IS, Kestin LL, Movsas B, Masi KJ, Matuszak MM, Radawski JD, Moran JM, Pierce LJ, Hayman JA, Schipper MJ, Jolly S. Cardiac Dose in Locally Advanced Lung Cancer: Results From a Statewide Consortium. Pract Radiat Oncol 2019; 10:e27-e36. [PMID: 31382026 DOI: 10.1016/j.prro.2019.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/17/2019] [Accepted: 07/23/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The heart has been identified as a potential significant organ at risk in patients with locally advanced non-small cell lung cancer treated with radiation. Practice patterns and radiation dose delivered to the heart in routine practice in academic and community settings are unknown. METHODS AND MATERIALS Between 2012 and 2017, 746 patients with stage III non-small cell lung cancer were treated with radiation within the statewide Michigan Radiation Oncology Quality Consortium (MROQC). Cardiac radiation dose was characterized, including mean and those exceeding historical or recently proposed Radiation Therapy Oncology Group and NRG Oncology constraints. Sites were surveyed to determine dose constraints used in practice. Patient-, anatomic-, and treatment-related associations with cardiac dose were analyzed using multivariable regression analysis and inverse probability weighting. RESULTS Thirty-eight percent of patients had a left-sided primary, and 80% had N2 or N3 disease. Median prescription was 60 Gy (interquartile range, 60-66 Gy). Twenty-two percent of patients were prescribed 60 Gy in 2012, which increased to 62% by 2017 (P < .001). Median mean heart dose was 12 Gy (interquartile range, 5-19 Gy). The volume receiving 30 Gy (V30 Gy) exceeded 50% in 5% of patients, and V40 Gy was >35% in 3% of cases. No heart dose constraint was uniformly applied. Intensity modulated radiation therapy (IMRT) usage increased from 33% in 2012 to 86% in 2017 (P < .001) and was significantly associated with more complex cases (larger planning target volume, higher stage, and preexisting cardiac disease). In multivariable regression analysis, IMRT was associated with a lower percent of the heart receiving V30 Gy (absolute reduction = 3.0%; 95% confidence interval, 0.5%-5.4%) and V50 Gy (absolute reduction = 3.6%; 95% confidence interval, 2.4%-4.8%) but not mean dose. In inverse probability weighting analysis, IMRT was associated with 29% to 48% relative reduction in percent of the heart receiving V40-V60 Gy without increasing lung or esophageal dose or compromising planning target volume coverage. CONCLUSIONS Within MROQC, historical cardiac constraints were met in most cases, yet 1 in 4 patients received a mean heart dose exceeding 20 Gy. Future work is required to standardize heart dose constraints and to develop treatment approaches that allow for constraints to be met without compromising other planning goals.
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Affiliation(s)
- Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Yilun Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Daniel G Muenz
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Larry L Kestin
- MHP Radiation Oncology Institute, Farmington Hills, Michigan
| | | | | | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Distefano G, Garikipati S, Grimes H, Hatton M. Current status of stereotactic ablative body radiotherapy in the UK: six years of progress. BJR Open 2019; 1:20190022. [PMID: 33178949 PMCID: PMC7592489 DOI: 10.1259/bjro.20190022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To update the 2012 UK stereotacticablative radiotherapy (SABR) Consortium survey and assess the development of SABR services across the UK over the past 6 years. Use the results to share practice and continue to drive forward technique development, aid standardization and by highlighting issues, improve access to SABR services and trials across the UK. METHODS In January 2018, an online questionnaire was sent by the UK SABR Consortium to 65 UK radiotherapy institutions covering current service provision and collecting data on immobilization, motion management, scanning protocols, target/OAR delineation, planning, image-guidance, quality assurance and future plans. RESULTS 50 (77%) institutions responded, 38 ( vs 15 in 2012) indicated they had an active SABR programme with the remaining 12 centres intending to develop a SABR programmeDocumented changes include the development of Linac delivered SABR to non-lung sites, an increase in centres using abdominal compression (14 vs 2) and the introduction of four-dimensional cone beam CBCT. Current practice is broadly in line with UK SABR Consortium and European guidelines. CONCLUSION This 2018 survey shows a welcome increase in SABR provision, surpassing 2012 projections. However, it is clear that the UK SABR program needs to continue to expand to ensure that patients with oligometastatic disease have access and SABR for early stage lung cancer is available in all centres. Updated guidance that addresses variability in target delineation, image guidance and reduces patient specific quality assurance is warranted. ADVANCES IN KNOWLEDGE Documented progress of UK SABR across all treatment sites over the last six years, barriers to implementation and future plans.
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107
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Abstract
CLINICAL ISSUE Gross tumor volume (GTV) denotes the macroscopic tumor which as the central target volume needs to be correctly identified for successful radiotherapy. STANDARD RADIOLOGICAL METHODS AND METHODICAL INNOVATIONS In precision radiotherapy, GTV is outlined on 3D tomographic images. The basis is computed tomography (CT), which is often supplemented by additional diagnostic information, e. g. magnetic resonance imaging (MRI) and positron emission tomography (PET). New developments like dual-energy CT, functional MRI and specific PET tracers facilitate a continuously better differentiation between tumor and surrounding normal tissue. ACHIEVEMENTS The concept of GTV is a central part of radiotherapy and the basis of radiation treatment planning. Studies regarding the interobserver variability are performed in order to analyze the impact of different imaging modalities, interventions and observer qualifications, and to deduce steps to constantly improve the practical realization. Each tumor entity presents specific challenges which are demonstrated here using examples.
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108
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Does 5 + 5 Equal Better Radiation Treatment Plans in Head and Neck Cancers? Adv Radiat Oncol 2019; 4:683-688. [PMID: 31673661 PMCID: PMC6817533 DOI: 10.1016/j.adro.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/10/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose Accurate contouring in head and neck cancer (HNC) is critical. International consensus guidelines recommend the 5 + 5 mm rule for expansions around the primary tumor, wherein high- and low-dose clinical target volumes (CTV-P1 and CTV-P2, respectively) are created using successive 5 mm expansions on the gross tumor volume. To our knowledge, the necessity of a low-dose CTV-P2 has never been assessed; therefore, we evaluated the dosimetric impact of adding a CTV-P2 expansion using the 5 + 5 mm rule compared with contouring with a high-dose CTV-P1 alone. Methods and materials A retrospective study of clinically delivered (chemo)radiation therapy treatment plans for HNC was conducted. All patients were treated with 70 Gy in 35 fractions using volumetric modulated arc therapy in a single phase. CTV-P2 was retrospectively contoured per guidelines as a 5 mm expansion on CTV-P1 from the clinical plan, carving off specified barriers to spread. We used a 5 mm planning target volume (PTV) expansion. Our primary outcome was whether 95% of the volume of the PTV for the CTV-P2 contour (ie, PTV-P2) received at least 56 Gy. To assess dose falloff, the coverage of a PTV ring structure was created by subtracting PTV-P1 from PTV-P2. Results Twenty-seven patients from 4 HNC subsites (base of tongue, tonsil, hypopharynx, and supraglottic larynx) were included. In all 108 treatment plans, at least 95% of the PTV-P2 structure received at least 56 Gy. The minimum volume of the PTV-P2 structure receiving at least 56 Gy was 97.4%. Eight of 108 treatment plans had borderline coverage of the PTV ring substructure alone. Conclusions Adding a CTV-P2 structure using the 5 + 5 mm rule had no dosimetric impact, adds contouring time, adds treatment planning complexity, and could potentially introduce errors. The 5 + 5 mm rule may have value in other settings, such as when smaller PTV margins are used, and warrants further evaluation with prospective or randomized studies.
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109
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Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer. Clin Transl Oncol 2019; 22:21-36. [PMID: 31172444 DOI: 10.1007/s12094-019-02134-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/11/2019] [Indexed: 12/17/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.
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110
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Beasley M, Brown S, McNair H, Faivre-Finn C, Franks K, Murray L, van Herk M, Henry A. The advanced radiotherapy network (ART-NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance. Br J Radiol 2019; 92:20180988. [PMID: 30924682 PMCID: PMC6592085 DOI: 10.1259/bjr.20180988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Stereotactic ablative radiotherapy (SABR) has become the standard of care for suitable patients with peripherally located early stage non-small cell lung cancer. Lung SABR requires strict image-guided radiotherapy (IGRT) protocols to ensure its safe delivery. The aim of this survey was to provide an assessment of current lung SABR practice in the UK. METHODS An online semi-structured survey containing a maximum of 32 questions regarding lung SABR, focussing on treatment image verification processes was piloted, developed and disseminated to the radiotherapy managers of 62 National Health Service centres across the UK. RESULTS The survey had a 100% complete response from NHS centres. 36 centres (58%) currently deliver lung SABR, with half treating fewer than 50 patients per year. Six centres deliver SABR despite not being commissioned by the NHS to provide this service. There is wide variation in the use of IGRT. Eight different permutations of cone beam CT order within the workflow were reported. Almost half of lung centres (17/36, 47%) believe there is a need to update national image guidance associated with lung SABR, such as the use of 'day zero', mid treatment and post treatment cone beam CTs. CONCLUSION Our results demonstrate wide variation in IGRT for lung SABR. There is an opportunity to develop existing IGRT workflows and the optimal approach to image guidance. Further work is required to investigate lung SABR provision and potential barriers to its implementation. ADVANCES IN KNOWLEDGE This survey represents the most comprehensive and accurate assessment of lung SABR practice in the UK since the 2014 SABR consortium survey.
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Affiliation(s)
- Matthew Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Sean Brown
- The Christie Hospital, The Christie Hospital NHS Foundation Trust, Manchester, England
| | - Helen McNair
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, England
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EGCG, a green tea polyphenol, as one more weapon in the arsenal to fight radiation esophagitis? Radiother Oncol 2019; 137:192-193. [PMID: 31133342 DOI: 10.1016/j.radonc.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 12/25/2022]
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112
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Advanced PET imaging in oncology: status and developments with current and future relevance to lung cancer care. Curr Opin Oncol 2019; 30:77-83. [PMID: 29251666 DOI: 10.1097/cco.0000000000000430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW This review highlights the status and developments of PET imaging in oncology, with particular emphasis on lung cancer. We discuss the significance of PET for diagnosis, staging, decision-making, monitoring of treatment response, and drug development. The PET key advantage, the noninvasive assessment of functional and molecular tumor characteristics including tumor heterogeneity, as well as PET trends relevant to cancer care are exemplified. RECENT FINDINGS Advances of PET and radiotracer technology are encouraging for multiple fields of oncological research and clinical application, including in-depth assessment of PET images by texture analysis (radiomics). Whole body PET imaging and novel PET tracers allow assessing characteristics of most types of cancer. However, only few PET tracers in addition to F-fluorodeoxyglucose have sufficiently been validated, approved, and are reimbursed for a limited number of indications. Therefore, validation and standardization of PET parameters including tracer dosage, image acquisition, post processing, and reading are required to expand PET imaging as clinically applicable approach. SUMMARY Considering the potential of PET imaging for precision medicine and drug development in lung and other types of cancer, increasing efforts are warranted to standardize PET technology and to provide evidence for PET imaging as a guiding biomarker in nearly all areas of cancer treatment.
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Development and internal validation of a multinomial NTCP model for the severity of acute dyspnea after radiotherapy for lung cancer. Radiother Oncol 2019; 136:176-184. [PMID: 31015122 DOI: 10.1016/j.radonc.2019.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/22/2019] [Accepted: 03/29/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Dyspnea evolution after radiotherapy for lung cancer is complex with potential symptom deterioration and improvement from baseline. We developed and internally validated a multinomial normal tissue complication probability (NTCP) model predicting dyspnea grade. MATERIALS AND METHODS Patient-reported dyspnea was collected pre-treatment and during 6 months follow-up for 182 stage I-IV lung cancer patients treated with radical (chemo)radiotherapy. Dyspnea changes (ΔDys) from the baseline grade (Dys0) to the follow-up grade (Dys) were evaluated. A multinomial logistic regression model simultaneously predicting 3 grades of Dys (Dys ≥ 3, Dys = 2 and Dys ≤ 1 (reference level)) was optimized. Reference NTCP models predicting Dys ≥ 2 and Dys ≥ 3 risks irrespective of Dys0 were generated for comparison. Models were shrunken and performance was assessed using optimism-corrected AUC (bootstrapping). RESULTS Rates of ΔDys ≥ 1 (deterioration) and ΔDys ≤ -1 (improvement) at 6 months were 31.9% and 12.6%. Dys ≥ 3, Dys = 2 and Dys ≤ 1 rates were 13.7%, 20.9% and 65.4%, respectively. The multinomial model (combining the risk factors Dys0 and MLD and the protective factor chemotherapy treatment) predicted Dys ≥ 3, Dys = 2 and Dys ≤ 1 with AUC (95% CI) of 0.72 (0.65-0.75) 0.76 (0.72-0.79) and 0.78 (0.74-0.80), respectively. Reference Dys ≥ 2 and Dys ≥ 3 models showed worse AUC: 0.64 (0.59-0.67) and 0.66 (0.50-0.70), respectively. CONCLUSIONS Dyspnea grade could be predicted with high accuracy using a multinomial NTCP model, yielding personalized dyspnea symptom improvement and deterioration risks.
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De Ruysscher D, Dingemans AM, Vooijs M, Heymans S. PD-(L)1 Inhibition and Cardiac Damage: A Relevant Toxicity? J Thorac Oncol 2019; 13:478-479. [PMID: 29576288 DOI: 10.1016/j.jtho.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Dirk De Ruysscher
- Department Radiation Oncology (Maastro Clinic), GROW, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Experimental Radiation Oncology, Leuven University, Leuven, Belgium.
| | - Anne-Marie Dingemans
- Department of Pulmonology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc Vooijs
- Department of Radiotherapy, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephane Heymans
- Department of Cardiology, Maastricht University Medical Center, CARIM, Maastricht, The Netherlands; Department of Cardiovascular Sciences, Leuven University, Leuven, Belgium; Netherlands Heart Institute, Utrecht, The Netherlands
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Abstract
Radiotherapy is used in >50% of patients with cancer, both for curative and palliative purposes. Radiotherapy uses ionizing radiation to target and kill tumour tissue, but normal tissue can also be damaged, leading to toxicity. Modern and precise radiotherapy techniques, such as intensity-modulated radiotherapy, may prevent toxicity, but some patients still experience adverse effects. The physiopathology of toxicity is dependent on many parameters, such as the location of irradiation or the functional status of organs at risk. Knowledge of the mechanisms leads to a more rational approach for controlling radiotherapy toxicity, which may result in improved symptom control and quality of life for patients. This improved quality of life is particularly important in paediatric patients, who may live for many years with the long-term effects of radiotherapy. Notably, signs and symptoms occurring after radiotherapy may not be due to the treatment but to an exacerbation of existing conditions or to the development of new diseases. Although differential diagnosis may be difficult, it has important consequences for patients.
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Chipko C, Ojwang J, Gharai LR, Deng X, Mukhopadhyay N, Weiss E. Characterization of Chest Wall Toxicity During Long-term Follow Up After Thoracic Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2019; 9:e338-e346. [PMID: 30731275 DOI: 10.1016/j.prro.2019.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/28/2018] [Accepted: 01/27/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Chest wall (CW) pain and rib fractures are frequently diagnosed after stereotactic body radiation therapy (SBRT) for malignant lung tumors. We hypothesize that multiple risk factors, including bone mineral density (BMD), are associated with CW toxicity, and that CW pain and rib fractures often evolve into chronic clinical problems. METHODS AND MATERIALS A total of 118 lung tumors treated with SBRT in 100 patients with a minimum follow-up period of 2 years were retrospectively analyzed. The incidence, clinical course, and related demographic, clinical, and dosimetric factors of CW pain and rib fractures were analyzed. In addition, BMD was assessed, and the radiographic appearance of radiation-induced rib fractures and their healing process were characterized. RESULTS The median follow-up was 49 months (range, 24-106 months). CW pain developed in 33 of 118 treatments (28%) after, on average, 12.5 months (range, 0-50 months), and was more common in women (P = .04). The mean duration of CW pain was 25 months (range, 2-63 months), and 36% of patients never had resolution of CW pain. A total of 34 of 118 treatments (29%) resulted in rib fractures at a mean time of 22 months (range, 3-46 months); rib fractures were more common in women, African Americans, upper/middle lobe tumors, and patients with lower BMD (P < .05). The mean duration of rib fractures was 25 months (range, 5-41 months), and only 16 rib fractures (47%) healed. Shorter CW planning target volume distance resulted in a higher risk for both rib fractures and CW pain (P = .01). Sixty-seven percent of fractures developed surrounding soft tissue fibrosis, and 62% (21 of 34 fractures) heterotopic ossification. Diabetes, body mass index, and steroid use were not associated with CW pain or rib fracture. CONCLUSIONS Several factors were associated with a higher risk of SBRT-related CW toxicity. Optimal CW sparing (eg, volumetric modulated arc therapy, lower dose per fraction) should be considered in this patient group without compromising tumor control. SBRT-induced rib fractures commonly heal abnormally and result in potential chronic CW pain.
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Affiliation(s)
- Christopher Chipko
- Department of Radiation Oncology, Virginia Commonwealth University Health Systems, Richmond, Virginia.
| | - Julius Ojwang
- Department of Radiation Oncology, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Leila Rezai Gharai
- Department of Diagnostic Radiology, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Xiaoyan Deng
- Department of Biostatistics, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Nitai Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health Systems, Richmond, Virginia
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Radiation Therapy in Non-small-Cell Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_34-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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118
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OPPORTUNITIES OF POSITRON-EMMISION TOMOGRAPHY IN RADIATION THERAPY OF LUNG CANCER PATIENTS. WORLD OF MEDICINE AND BIOLOGY 2019. [DOI: 10.26724/2079-8334-2019-4-70-163-167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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119
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Wu VWC, Ng APL, Cheung EKW. Intrafractional motion management in external beam radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1071-1086. [PMID: 31476194 DOI: 10.3233/xst-180472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The recent advancements in radiotherapy technologies have made delivery of the highly conformal dose to the target volume possible. With the increasing popularity of delivering high dose per fraction in modern radiotherapy schemes such as in stereotactic body radiotherapy and stereotactic body ablative therapy, high degree of treatment precision is essential. In order to achieve this, we have to overcome the potential difficulties caused by patient instability due to immobilization problems; patient anxiety and random motion due to prolonged treatment time; tumor deformation and baseline shift during a treatment course. This is even challenging for patients receiving radiotherapy in the chest and abdominal regions because it is affected by the patient's respiration which inevitably leads to tumor motion. Therefore, monitoring of intrafractional motion has become increasingly important in modern radiotherapy. Major intrafractional motion management strategies including integration of respiratory motion in treatment planning; breath-hold technique; forced shallow breathing with abdominal compression; respiratory gating and dynamic real-time tumor tracking have been developed. Successful intrafractional motion management is able to reduce the planning target margin and ensures planned dose delivery to the target and organs at risk. Meanwhile, the emergency of MRI-linear accelerator has facilitated radiation-free real-time monitoring of soft tissue during treatment and could be the future modality in motion management. This review article summarizes the various approaches that deal with intrafractional target, organs or patient motion with discussion of their advantages and limitations. In addition, the potential future advancements including MRI-based tumor tracking are also discussed.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amanda P L Ng
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Emily K W Cheung
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Lambrecht M, Clementel E, Sonke JJ, Nestle U, Adebahr S, Guckenberger M, Andratschke N, Weber DC, Verheij M, Hurkmans CW. Radiotherapy quality assurance of SBRT for patients with centrally located lung tumours within the multicentre phase II EORTC Lungtech trial: Benchmark case results. Radiother Oncol 2018; 132:63-69. [PMID: 30825971 DOI: 10.1016/j.radonc.2018.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 09/14/2018] [Accepted: 10/23/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To report on the benchmark case (BC) study performed in the context of the European Organisation for Research and Treatment of Cancer prospective multicentre Lungtech trial of SBRT for patients with inoperable centrally located lung tumours. METHODS AND MATERIALS Target volume and organs at risk (OARs) delineations first needed to be acceptable before the treatment plan was reviewed. Retrospectively, Dice similarity coefficients of the OARs and the target volumes were calculated and a set of gold standard contours adapted for each institution margins was applied on the accepted dose submissions to evaluate the influence of acceptable delineation variations on dosimetry. RESULTS Twenty-five institutions participated. Five BCs were accepted at the first attempt. Twenty institutions had to revise their delineation at least once and seven had to revise their planning once. The V60 Gy dose coverage improved significantly (p = 0.05) between the first and final submissions from median (range) 94.8% (22.5-97.8) to 95.3% (70.5-99.3). The median Dice coefficient varied significantly between OARs: The lowest values were found for the brachial plexus 0.25 (0.01-0.54) and the highest for the spinal cord 0.89 (0.71-0.95). The mean PTV Dice coefficient was 0.82 (0.48-0.92). Applying the gold standard contours, only one institution remained compliant with the dose coverage criteria with V60 Gy median (range) of 83.4% (54.2-93.9). CONCLUSIONS Clinical guidelines and radiotherapy protocols are not a substitute for timely radiotherapy quality assurance procedures, which improve dose coverage significantly. Delineation remains the main source of BC rejection and plan review without first reviewing delineation may not be efficient. Our results show that delineation variations seem to have a larger influence on PTV coverage than variations in planning and irradiation techniques and thus suggest that dose tolerance criteria should preferably take into account the accuracy of delineation.
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Affiliation(s)
- Marie Lambrecht
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands; Department of Radiation Oncology, The Netherland Cancer Institute, Amsterdam, The Netherlands.
| | - Enrico Clementel
- Department of Quality Assurance, EORTC Headquarters, Brussels, Belgium
| | - Jan-Jacob Sonke
- Department of Radiation Oncology, The Netherland Cancer Institute, Amsterdam, The Netherlands
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf GmbH Mönchengladbach, Germany; Department of Radiation Oncology Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Sonja Adebahr
- Department of Radiation Oncology Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Damien C Weber
- Department of Radiation Oncology, University Hospital Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Marcel Verheij
- Department of Radiation Oncology, The Netherland Cancer Institute, Amsterdam, The Netherlands
| | - Coen W Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
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Josipovic M, Persson GF, Rydhög JS, Smulders B, Thomsen JB, Aznar MC. Advanced dose calculation algorithms in lung cancer radiotherapy: Implications for SBRT and locally advanced disease in deep inspiration breath hold. Phys Med 2018; 56:50-57. [PMID: 30527089 DOI: 10.1016/j.ejmp.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Evaluating performance of modern dose calculation algorithms in SBRT and locally advanced lung cancer radiotherapy in free breathing (FB) and deep inspiration breath hold (DIBH). METHODS For 17 patients with early stage and 17 with locally advanced lung cancer, a plan in FB and in DIBH were generated with Anisotropic Analytical Algorithm (AAA). Plans for early stage were 3D-conformal SBRT, 45 Gy in 3 fractions, prescribed to 95% isodose covering 95% of PTV and aiming for 140% dose centrally in the tumour. Locally advanced plans were volumetric modulated arc therapy, 66 Gy in 33 fractions, prescribed to mean PTV dose. Calculation grid size was 1 mm for SBRT and 2.5 mm for locally advanced plans. All plans were recalculated with AcurosXB with same MU as in AAA, for comparison on target coverage and dose to risk organs. RESULTS Lung volume increased in DIBH, resulting in decreased lung density (6% for early and 13% for locally-advanced group). In SBRT, AAA overestimated mean and near-minimum PTV dose (p-values < 0.01) compared to AcurosXB, with largest impact in DIBH (differences of up to 11 Gy). These clinically relevant differences may be a combination of small targets and large dose gradients within the PTV. In locally advanced group, AAA overestimated mean GTV, CTV and PTV doses by median less than 0.8 Gy and near-minimum doses by median 0.4-2.7 Gy. No clinically meaningful difference was observed for lung and heart dose metrics between the algorithms, for both FB and DIBH. CONCLUSIONS AAA overestimated target coverage compared to AcurosXB, especially in DIBH for SBRT.
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Affiliation(s)
- Mirjana Josipovic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej17, 2100 Copenhagen, Denmark.
| | - Gitte Fredberg Persson
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jonas Scherman Rydhög
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej17, 2100 Copenhagen, Denmark; Department of Radiation Physics, Skåne University Hospital, Lund University, 221 85 Lund, Sweden.
| | - Bob Smulders
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jakob Borup Thomsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Marianne Camille Aznar
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; Manchester Cancer Research Centre, Division of Cancer Science, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK; Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
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Rich AL, Baldwin DR, Beckett P, Berghmans T, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hansen NCG, Hardavella G, Jakobsen E, Jovanovic D, Konsoulova A, Massard G, McPhelim J, Meert AP, Milroy R, Mutti L, Paesmans M, Peake MD, Putora PM, de Ruysscher DK, Sculier JP, Schepereel A, Subotic DR, Van Schil P, Blum T. ERS statement on harmonised standards for lung cancer registration and lung cancer services in Europe. Eur Respir J 2018; 52:13993003.00610-2018. [DOI: 10.1183/13993003.00610-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/03/2018] [Indexed: 12/25/2022]
Abstract
The European Respiratory Society (ERS) task force for harmonised standards for lung cancer registration and lung cancer services in Europe recognised the need to create a single dataset for use in pan-European data collection and a manual of standards for European lung cancer services.The multidisciplinary task force considered evidence from two different sources, reviewing existing national and international datasets alongside the results of a survey of clinical data collection on lung cancer in 35 European countries. A similar process was followed for the manual of lung cancer services, with the task force using existing guidelines and national or international recommendations for lung cancer services to develop a manual of standards for services in Europe.The task force developed essential and minimum datasets for lung cancer registration to enable all countries to collect the same essential data and some to collect data with greater detail. The task force also developed a manual specifying standards for lung cancer services in Europe.Despite the wide variation in the sociopolitical landscape across Europe, the ERS is determined to encourage the delivery of high-quality lung cancer care. Both the manual of lung cancer services and the minimum dataset for lung cancer registration will support this aspiration.
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van Hoorn JE, Dahele M, Daniels JMA. Bronchoscopic Manifestations of Airway Toxicity After Radiotherapy. Clin Lung Cancer 2018; 19:e875-e878. [PMID: 30197260 DOI: 10.1016/j.cllc.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/02/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Juliët E van Hoorn
- Department of Pulmonary Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Max Dahele
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
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124
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Wang L, Wu Z, Xie D, Zeng R, Cheng W, Hu J, Huang S, Zhou S, Zhong R, Su Y. Reduction of Target Volume and the Corresponding Dose for the Tumor Regression Field after Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma. Cancer Res Treat 2018; 51:685-695. [PMID: 30121968 PMCID: PMC6473261 DOI: 10.4143/crt.2018.250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aims to investigate the feasibility of contouring target volume according to residual tumor and decreasing the dose to the tumor regression field after induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC). Materials and Methods From August 2009 to August 2013, patients with stage III–IVB NPC were treated with IC and concurrent chemoradiotherapy. Gross tumor volume of nasopharynx (GTVnx)–residual and gross tumor volume of cervical lymph node (GTVnd)–residual were contoured according to post-IC residual primary tumor and any N+ disease, respectively. The tumor regression field was included in CTVnx1/CTVnd1 and prescribed a dose of 60 Gy. Outcomes and toxicities of all patients were evaluated. Results A total of 57 patients were enrolled. At a median follow-up of 68 months, three cases displayed locoregional recurrence and one case showed both distant metastasis and locoregional recurrence. All locoregional recurrences were in the GTVnx-residual/GTVnd-residual and in-field. The 5-year overall, locoregional relapse-free, distant metastasis-free, and progression-free survival rates were 82.2%, 87.7%, 85.8% and 80.3%, respectively. Conclusion After IC, contouring of GTVnx-residual/GTVnd-residual as residual tumor volume and distribution 60 Gy ofradiation dose to the tumorregression field may be feasible and need further investigation.
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Affiliation(s)
- Lei Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zheng Wu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Dehuan Xie
- 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, Guangzhou, China
| | - Ruifang Zeng
- Department of Radiotherapy, TCM-Integrated Cancer Center of Southern Medical University, Guangzhou, China
| | - Wanqin Cheng
- Department of Oncology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Jiang Hu
- 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, Guangzhou, China
| | - Shaomin Huang
- 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, Guangzhou, China
| | - Shu Zhou
- 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, Guangzhou, China
| | - Rui Zhong
- 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, Guangzhou, China
| | - Yong Su
- 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, Guangzhou, China
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Defraene G, La Fontaine M, van Kranen S, Reymen B, Belderbos J, Sonke JJ, De Ruysscher D. Radiation-Induced Lung Density Changes on CT Scan for NSCLC: No Impact of Dose-Escalation Level or Volume. Int J Radiat Oncol Biol Phys 2018; 102:642-650. [PMID: 30244882 DOI: 10.1016/j.ijrobp.2018.06.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Dose-escalation for patients with non-small cell lung cancer (NSCLC) in the positron emission tomography (PET)-boost trial (NCT01024829) exposes portions of normal lung tissue to high radiation doses. The relationship between lung parenchyma dose and density changes on computed tomography (CT) was analyzed. MATERIALS AND METHODS The CT scans of 59 patients with stage IB to III NSCLC, randomized between a boost to the whole primary tumor and an integrated boost to its 50% SUVmax (maximum standardized uptake value) volume. Patients were treated with concurrent or sequential chemoradiation or radiation only. Deformable registration mapped the 3-month follow-up CT to the planning CT. Hounsfield unit differences (ΔHU) were extracted to assess lung parenchyma density changes. Equivalent dose in 2 Gy fractions (EQD2)-ΔHU response was described sigmoidally, and regional response variation was studied by polar analysis. Prognostic factors of ΔHU were obtained through generalized linear modeling. RESULTS Saturation of ΔHU was observed above 60 Gy. No interaction was found between boost dose distribution (D1cc and V70Gy) and ΔHU at lower doses. ΔHU was lowest peripherally from the tumor and peaked posteriorly at 3 cm from the tumor border (3.1 HU/Gy). Right lung location was an independent risk factor for ΔHU (P = .02). CONCLUSIONS No apparent increase of lung density changes at 3-month follow-up was observed above 60 Gy EQD2 for patients with NSCLC treated with (concurrent or sequential chemo) radiation. The mild response observed peripherally in the lung parenchyma might be exploited in plan optimization routines minimizing lung damage.
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Affiliation(s)
- Gilles Defraene
- Department of Oncology, Experimental Radiation Oncology, KU Leuven-University of Leuven, Belgium.
| | - Matthew La Fontaine
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon van Kranen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bart Reymen
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk De Ruysscher
- Department of Oncology, Experimental Radiation Oncology, KU Leuven-University of Leuven, Belgium; Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiation Oncology (Maastro Clinic), GROW School for Developmental Biology and Oncology, Maastricht, The Netherlands
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Kępka L, Socha J. Addressing the challenge of proper delineation of lymph node stations in modern radiotherapy for lung cancer. JOURNAL OF RADIATION RESEARCH 2018; 59:521-523. [PMID: 29528427 PMCID: PMC6054267 DOI: 10.1093/jrr/rrx077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/31/2017] [Indexed: 06/08/2023]
Abstract
We greatly appreciate the recent publication of a Japan Lung Cancer Society and Japanese Society for Radiation Oncology consensus-based computed tomographic atlas for defining regional lymph node stations (LNSs) for radiotherapy for lung cancer. This atlas is based on the International Association for the Study of Lung Cancer (IASLC) consensus lymph node map, which resolved differences between the Japanese and American classification and was incorporated into the seventh edition of the TNM staging system. The authors must be commended for providing a very clear, comprehensive presentation of the borders of the mediastinal and hilar LNSs, using a multidisciplinary approach. The Atlas created by Itazawa et al. is the second published consensus-based atlas for defining the LNSs for lung cancer radiotherapy according to the IASLC-endorsed LNS map. The differences between the two published atlases of LNS delineation in radiation oncology are discussed.
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Affiliation(s)
- Lucyna Kępka
- Department of Radiation Oncology; Military Institute of Medicine, Warsaw, ul. Szaserów 128, Poland
| | - Joanna Socha
- Department of Radiation Oncology; Military Institute of Medicine, Warsaw, ul. Szaserów 128, Poland
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Wink KC, Roelofs E, Simone CB, Dechambre D, Santiago A, van der Stoep J, Dries W, Smits J, Avery S, Ammazzalorso F, Jansen N, Jelen U, Solberg T, de Ruysscher D, Troost EG. Photons, protons or carbon ions for stage I non-small cell lung cancer – Results of the multicentric ROCOCO in silico study. Radiother Oncol 2018; 128:139-146. [DOI: 10.1016/j.radonc.2018.02.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 12/27/2022]
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Dose escalation to 84 Gy with concurrent chemotherapy in stage III NSCLC appears excessively toxic: Results from a prematurely terminated randomized phase II trial. Lung Cancer 2018; 122:180-186. [PMID: 30032828 DOI: 10.1016/j.lungcan.2018.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Concurrent chemoradiotherapy is the mainstay treatment for NSCLC stage III disease. To investigate whether radiation dose escalation based on individual normal tissue constraints can improve outcome, the Swedish lung cancer study group launched this randomized phase II trial. MATERIALS AND METHODS NSCLC patients with stage III disease, good performance status (0-1) and adequate lung function (FEV1 > 1.0 L and CO diffusion capacity > 40%) received three cycles of cisplatin (75 mg/m2 day 1) and vinorelbine (25 mg/m2 day 1 and 8) every third week. Radiotherapy started concurrently with the second cycle, with either 2 Gy daily, 5 days a week, to 68 Gy (A) or escalated therapy (B) based on constraints to the spinal cord, esophagus and lungs up to 84 Gy by adding an extra fraction of 2 Gy per week. RESULTS A pre-planned safety analysis revealed excessive toxicity and decreased survival in the escalated arm, and the study was stopped. Thirty-six patients were included during 2011-2013 (56% male, 78% with adenocarcinoma, 64% with PS 0 and 53% with stage IIIB). The median progression-free survival (PFS) and overall survival (OS) were 11 and 17 months in arm B compared to the encouraging results of 28 and 45 months in the standard arm. The 1- and 3-year survival rates were 56% and 33% (B) and 72% and 56% (A), respectively. There were seven toxicity-related deaths due to esophageal perforations and pneumonitis: five in the escalated group and two with standard treatment. CONCLUSION Dose-escalated concurrent chemoradiotherapy to 84 Gy to primary tumor and nodal disease is hazardous, with a high risk of excessive toxicity, whereas modern standard dose chemoradiotherapy with proper staging given in the control arm shows a promising outcome with a median survival of 45 months and a 3-year survival of 56% (NCT01664663).
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Fleckenstein J, Boda-Heggemann J, Siebenlist K, Gudzheva T, Prakofyeva N, Lohr F, Wenz F, Simeonova-Chergou A. Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT. Strahlenther Onkol 2018; 194:815-823. [PMID: 29802434 DOI: 10.1007/s00066-018-1316-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In this retrospective treatment planning study, the effect of a uniform and non-uniform planning target volume (PTV) dose coverage as well as a coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery approach for lung stereotactic body radiation therapy (SBRT) in deep inspiration breath-hold (DIBH) were compared. MATERIALS AND METHODS For 46 patients with lesions in the peripheral lungs, three different treatment plans were generated: First, a coplanar 220° VMAT sequence with a uniform PTV dose prescription (UC). Second, a coplanar 220° VMAT treatment plan with a non-uniform dose distribution in the PTV (nUC). Third, a non-coplanar VMAT dose delivery with four couch angles (0°, ±35°, 90°) and a non-uniform prescription (nUnC) was used. All treatment plans were optimized for pareto-optimality with respect to PTV coverage and ipsilateral lung dose. Treatment sequences were delivered on a flattening-filter-free linear accelerator and beam-on times were recorded. Dosimetric comparison between the three techniques was performed. RESULTS For the three scenarios (UC, nUC, nUnC), median gross tumor volume (GTV) doses were 63.4 ± 2.5, 74.4 ± 3.6, and 77.9 ± 3.8 Gy, and ipsilateral V10Gy lung volumes were 15.7 ± 6.1, 13.9 ± 4.7, and 12.0 ± 5.1%, respectively. Normal tissue complication probability of the ipsilateral lung was 3.9, 3.1, and 2.8%, respectively. The number of monitor units were 5141 ± 1174, 4104 ± 786, and 3657 ± 710 MU and the corresponding beam-on times were 177 ± 54, 143 ± 29, and 148 ± 26 s. CONCLUSION For SBRT treatments in DIBH, a non-uniform dose prescription in the PTV, combined with a non-coplanar VMAT arc arrangement, significantly spares the ipsilateral lung while increasing dose to the GTV without major treatment time increase.
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Affiliation(s)
- Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tanya Gudzheva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Natallia Prakofyeva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Lohr
- Unita Operativa di Radioterapia, Department of Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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131
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Schild SE, Pang HH, Fan W, Stinchcombe TE, Vokes EE, Ramalingam SS, Bradley JD, Kelly K, Wang X. Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC. J Thorac Oncol 2018; 13:1171-1182. [PMID: 29689435 DOI: 10.1016/j.jtho.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Concurrent chemoradiotherapy (CRT) is standard therapy for locally advanced NSCLC (LA-NSCLC) patients. This study was performed to examine thoracic radiotherapy (TRT) parameters and their impact on patient survival. METHODS We collected individual patient data from 3600 LA-NSCLC patients participating in 16 cooperative group trials of concurrent CRT. The primary TRT parameters examined included field design strategy (elective nodal irradiation [ENI] compared to involved-field TRT (IF-TRT)), total dose, and biologically effective dose (BED). Hazard ratios (HRs) for overall survival were calculated with univariable and multivariable Cox models. RESULTS TRT doses ranged from 60 Gy to 74 Gy with most treatments administered once-daily. ENI was associated with poorer survival than IF-TRT (univariable HR = 1.37, 95% confidence interval [CI]: 1.24-1.51, p < 0.0001; multivariable HR = 1.31, 95% CI: 1.08-1.59, p = 0.002). The median survival times of the IF and ENI patients were 24 months and 16 months, respectively. Patients were divided into three dose groups: low total dose (60 Gy), medium total dose (>60 Gy to 66 Gy), and high total dose (>66 Gy to 74 Gy). With reference to the low-dose group, the multivariable HRs were 1.08 for the medium-dose group (95% CI: 0.93-1.25) and 1.12 for the high-dose group (95% CI: 0.97-1.30).The univariate p = 0.054 and multivariable p = 0.17. BED was grouped as follows: low (<55.5 Gy10), medium (55.5 Gy10), or high (>55.5 Gy10). With reference to the low-BED group, the HR was 1.00 (95% CI: 0.85-1.18) for the medium-BED group and 1.10 (95% CI: 0.93-1.31) for the high-BED group. The univariable p = 0.076 and multivariable p = 0.16. CONCLUSIONS For LA-NSCLC patients treated with concurrent CRT, IF-TRT was associated with significantly better survival than ENI-TRT. TRT total and BED dose levels were not significantly associated with patient survival. Future progress will require research focusing on better systemic therapy and TRT.
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Affiliation(s)
- Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
| | - Herbert H Pang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; School of Public Health, HKU Li Ka Shing Faculty of Medicine, Hong Kong SAR, China
| | - Wen Fan
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | | | - Everett E Vokes
- Department of Medical Oncology, University of Chicago, Chicago, Illinois
| | | | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Karen Kelly
- Department of Medical Oncology, University of California, Davis, California
| | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; Alliance Statistics and Data Center, Durham, North Carolina
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Nestle U, De Ruysscher D, Ricardi U, Geets X, Belderbos J, Pöttgen C, Dziadiuszko R, Peeters S, Lievens Y, Hurkmans C, Slotman B, Ramella S, Faivre-Finn C, McDonald F, Manapov F, Putora PM, LePéchoux C, Van Houtte P. ESTRO ACROP guidelines for target volume definition in the treatment of locally advanced non-small cell lung cancer. Radiother Oncol 2018; 127:1-5. [PMID: 29605476 DOI: 10.1016/j.radonc.2018.02.023] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022]
Abstract
Radiotherapy (RT) plays a major role in the curative treatment of locally advanced non-small cell lung cancer (NSCLC). Therefore, the ACROP committee was asked by the ESTRO to provide recommendations on target volume delineation for standard clinical scenarios in definitive (chemo)radiotherapy (RT) and adjuvant RT for locally advanced NSCLC. The guidelines given here are a result of the evaluation of a structured questionnaire followed by a consensus discussion, voting and writing procedure within the committee. Hence, we provide advice for methods and time-points of diagnostics and imaging before the start of treatment planning and for the mandatory and optional imaging to be used for planning itself. Concerning target volumes, recommendations are given for GTV delineation of primary tumour and lymph nodes followed by issues related to the delineation of CTVs for definitive and adjuvant radiotherapy. In the context of PTV delineation, recommendations about the management of geometric uncertainties and target motion are given. We further provide our opinions on normal tissue delineation and organisational and responsibility questions in the process of target volume delineation. This guideline intends to contribute to the standardisation and optimisation of the process of RT treatment planning for clinical practice and prospective studies.
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Affiliation(s)
- Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany.
| | - Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro clinic), GROW School for Oncology and Developmental Biology, The Netherlands; KU Leuven, Radiation Oncology, Belgium
| | | | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, MIRO - IREC Lab, UCL, Belgium
| | - Jose Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany
| | - Rafal Dziadiuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Stephanie Peeters
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro clinic), GROW School for Oncology and Developmental Biology, The Netherlands
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - Coen Hurkmans
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Corinne Faivre-Finn
- University of Manchester & The Christie NHS Foundation Trust, Manchester, UK
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland; Medical Faculty, University of Bern, Switzerland
| | - Cécile LePéchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Paul Van Houtte
- Department Radiation Oncology, Institut Bordet, Université Libre Bruxelles, Belgium
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133
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Calais J, Cao M, Nickols NG. The Utility of PET/CT in the Planning of External Radiation Therapy for Prostate Cancer. J Nucl Med 2018; 59:557-567. [PMID: 29301928 PMCID: PMC6910632 DOI: 10.2967/jnumed.117.196444] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/01/2017] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy and radical prostatectomy are the definitive treatment options for patients with localized prostate cancer. A rising level of prostate-specific antigen after radical prostatectomy indicates prostate cancer recurrence, and these patients may still be cured with salvage radiotherapy. To maximize chance for cure, the irradiated volumes should completely encompass the extent of disease. Therefore, accurate estimation of the location of disease is critical for radiotherapy planning in both the definitive and the salvage settings. Current first-line imaging for prostate cancer has limited sensitivity for detection of disease both at initial staging and at biochemical recurrence. Integration of PET into routine evaluation of prostate cancer patients may improve both staging accuracy and radiotherapy planning. 18F-FDG PET/CT is now routinely used in radiation planning for several cancer types. However, 18F-FDG PET/CT has low sensitivity for prostate cancer. Additional PET probes evaluated in prostate cancer include 18F-sodium fluoride, 11C-acetate, 11C- or 18F-choline, 18F-fluciclovine, and 68Ga- or 18F-labeled ligands that bind prostate-specific membrane antigen (PSMA). PSMA ligands appear to be the most sensitive and specific but have not yet received Food and Drug Administration New Drug Application approval for use in the United States. Retrospective and prospective investigations suggest a potential major impact of PET/CT on prostate radiation treatment planning. Prospective trials randomizing patients to routine radiotherapy planning versus PET/CT-aided planning may show meaningful clinical outcomes. Prospective clinical trials evaluating the addition of 18F-fluciclovine PET/CT for planning of salvage radiotherapy with clinical endpoints are under way. Prospective trials evaluating the clinical impact of PSMA PET/CT on prostate radiation planning are indicated.
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Affiliation(s)
- Jeremie Calais
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
| | - Minsong Cao
- Department of Radiation Oncology, UCLA, Los Angeles, California; and
| | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA, Los Angeles, California; and
- Department of Radiation Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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134
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Spetz J, Moslehi J, Sarosiek K. Radiation-Induced Cardiovascular Toxicity: Mechanisms, Prevention, and Treatment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:31. [PMID: 29556748 PMCID: PMC7325164 DOI: 10.1007/s11936-018-0627-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Ionizing radiation is a highly effective treatment for a wide range of malignancies, yet the cardiovascular (CV) toxicity that can result from chest radiotherapy impairs the long-term health of cancer survivors and can be a limiting factor for its use. Despite over 100 years of successful clinical use, the mechanisms by which high-energy photons damage critical components within cells of the heart's myocardium, pericardium, vasculature, and valves remain unclear. RECENT FINDINGS Recent studies exploring the acute and chronic effects of radiation therapy on cardiac and vascular tissue have provided new insights into the development and progression of heart disease, including the identification and understanding of age- and complication-associated risk factors. However, key questions relating to the connection from upstream signaling to fibrotic changes remain. In addition, advances in the delivery of chest radiotherapy have helped to limit heart exposure and damage, but additional refinements to delivery techniques and cardioprotective therapeutics are absolutely necessary to reduce patient mortality and morbidity. Radiation therapy (RT)-driven CV toxicity remains a major issue for cancer survivors and more research is needed to define the precise mechanisms of toxicity. However, recent findings provide meaningful insights that may help improve patient outcomes.
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Affiliation(s)
- Johan Spetz
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, 220 Longwood Avenue, Goldenson 553, Boston, MA, 02115, USA
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Javid Moslehi
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
- Division of Hematology-Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
- Cardio-Oncology Program, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kristopher Sarosiek
- John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, 220 Longwood Avenue, Goldenson 553, Boston, MA, 02115, USA.
- Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems Biology, Harvard Medical School, Boston, MA, USA.
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135
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Progress in Radiotherapy for Regional and Oligometastatic Disease in 2017. J Thorac Oncol 2018; 13:488-496. [PMID: 29452269 DOI: 10.1016/j.jtho.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
This review highlights key publications and abstracts in the field of radiation oncology for lung cancer in 2017 and attempts to place these in the context of developments for the broader thoracic oncology community.
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136
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Jouglar E, Isnardi V, Goulon D, Ségura-Ferlay C, Ayadi M, Dupuy C, Douillard JY, Mahé MA, Claude L. Patterns of locoregional failure in locally advanced non-small cell lung cancer treated with definitive conformal radiotherapy: Results from the Gating 2006 trial. Radiother Oncol 2017; 126:291-299. [PMID: 29203290 DOI: 10.1016/j.radonc.2017.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 10/09/2017] [Accepted: 11/09/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the patterns of locoregional failure (LRF) in patients with locally advanced non-small cell lung cancer treated with definitive radiotherapy (RT). PATIENTS AND METHODS One hundred and fifty-four patients from the Gating 2006 prospective randomized trial were treated with conformal RT with or without respiratory motion management. For patients with a LRF as first event, treatment planning with simulation CT, pre-treatment 18FDG PET-CT and post-treatment images demonstrating recurrence were registered and analyzed. Measurable LRF was contoured (rGTV) and classified as in-field, marginal, or out-of-field. RESULTS Median follow-up was 27.8 months. Forty-eight patients presented with LRF. One-year and 2-year locoregional disease-free survival rates were 77% (95% CI 70-83) and 72% (95% CI 64-79) respectively. 79% of the patients with LRF as first event relapsed within the RT field (55% isolated), 30% had marginal LRF component. Isolated out-of-field failure occurred in only 3% of all patients. The regions of highest FDG-uptake on pre-treatment PET-CT were located within the recurrence in 91% of patients with in-field LRF. CONCLUSION In-field failure was the most common pattern of failure. Escalated dose RT with high-dose fractions guided by PET parameters warrants further investigation.
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Affiliation(s)
- Emmanuel Jouglar
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France.
| | - Vanina Isnardi
- Department of Nuclear Medicine, Centre Léon Bérard, Lyon, France
| | - Dorothée Goulon
- Department of Nuclear Medicine, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Myriam Ayadi
- Department of Medical Physics, Centre Léon Bérard, Lyon, France
| | - Claire Dupuy
- Department of Medical Physics, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Jean-Yves Douillard
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Marc-André Mahé
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Line Claude
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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ESTRO ACROP consensus guideline on implementation and practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer. Radiother Oncol 2017; 124:11-17. [DOI: 10.1016/j.radonc.2017.05.012] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/19/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
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