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Mazonakis M, Lyraraki E, Tolia M, Damilakis J. Risk for second bladder and rectal malignancies from cervical cancer irradiation. J Appl Clin Med Phys 2021; 22:103-109. [PMID: 34021692 PMCID: PMC8292701 DOI: 10.1002/acm2.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
The objective of this study was to estimate the risk of developing second malignancies to partially in‐field organs from volumetric modulated arc therapy (VMAT) of cervical cancer and to compare the above risks with those from the conventional three‐dimensional conformal radiotherapy (3D‐CRT). Seventeen consecutive patients with uterine cervix carcinoma were selected. VMAT and 3D‐CRT plans were generated with 6 and 10 MV photons, respectively. The prescribed tumor dose was 45 Gy given in 25 fractions. Differential dose‐volume histogram data from the treatment plans were obtained for the partially in‐field organs such as bladder and rectum. These data were used to estimate the patient‐specific lifetime attributable risk (LAR) for bladder and rectal cancer induction with a non‐linear model based on a mixture of plateau and bell‐shaped dose–response relationships. The estimated risks per 10000 people were compared with the baseline risks for unexposed population. The patient‐specific rectal cancer risk estimates from VMAT were significantly lower than those from 3D‐CRT (P = 0.0144). The LARs for developing bladder malignancies from VMAT were significantly high compared to those from conventional irradiation (P = 0.0003). The mean difference between the patient‐specific LARs for radiation‐induced bladder and rectal malignancies as derived from 3D‐CRT and VMAT plans was 6.6% and 2.0%, respectively. The average LAR for developing bladder and rectal malignant diseases due to VMAT was 9.2 × 10‐4 and 43.7 × 10‐4, respectively. The corresponding risks following 3D‐CRT were 8.6 × 10‐4 and 44.6 × 10‐4. These average risks showed that pelvic irradiation increases the baseline probability for cancer induction by 12.6‐19.1%. The differences in the second cancer risks associated with the VMAT and 3D‐CRT for cervical cancer were found to be small. Both treatment techniques resulted in considerable increased probabilities for developing bladder and rectal malignancies relative to those of unirradiated population.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece
| | - Efrosyni Lyraraki
- Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete, Greece
| | - Maria Tolia
- Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete, Greece
| | - John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece
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102
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Placidi L, Nardini M, Cusumano D, Boldrini L, Chiloiro G, Romano A, Votta C, Antonelli MV, Valentini V, Indovina L. VMAT-like plans for magnetic resonance guided radiotherapy: Addressing unmet needs. Phys Med 2021; 85:72-78. [PMID: 33979726 DOI: 10.1016/j.ejmp.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/29/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE VMAT delivery technique is currently not applicable to Magnetic Resonance-guided radiotherapy (MRgRT) hybrid systems. Aim of this study is to evaluate an innovative VMAT-like (VML) delivery technique. MATERIAL AND METHODS First, planning and dosimetric evaluation of the MRgRT VML treatment have been performed on 10 different disease sites and the results have been compared with the corresponding IMRT plans. Then, in the second phase, 10 of the most dosimetrically challenging locally advanced pancreas treatment plans have been retrospectively re-planned using the VML approach to explore the potentiality of this new delivery technique. Finally, VML robustness was evaluated and compared with the IMRT plans, considering a lateral positioning error of ± 5 mm. RESULTS In phase one, all VML plans were within constraint for all OARs. When PTV coverage is considered, in the 50% of the cases VML PTV coverage is equal or higher than in IMRT plan. In the remaining 50%, the highest target under coverage difference in comparison with IMRT plan is -1.71%. The mean and maximum treatment time differences (VML-IMRT) is 0.2 min and 3.1 min respectively. In phase two, the treatment time variation (VML-IMRT), shows a mean, maximum and minimum variations of 1.3, 4.6 and -0.6 min respectively. All VML plans have a better target coverage if compared with IMRT plans, keeping in any case the OARs constraints within tolerance. VML doesn't increase plan robustness. CONCLUSION VMAT-like treatment approach appeared to be an efficient planning solution and it was decided to clinically implement it in daily practice, especially in the frame of hypo fractionated treatments.
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Affiliation(s)
- L Placidi
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Nardini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Cusumano
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy.
| | - L Boldrini
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - G Chiloiro
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - A Romano
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - C Votta
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - M V Antonelli
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - V Valentini
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Indovina
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
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Collie D, Wright SH, Del-Pozo J, Kay E, Schwarz T, Parys M, Lawrence J. Regional and organ-level responses to local lung irradiation in sheep. Sci Rep 2021; 11:9553. [PMID: 33953285 PMCID: PMC8099861 DOI: 10.1038/s41598-021-88863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Lung is a dose-limiting organ in radiotherapy. This may limit tumour control when effort is made in planning to limit the likelihood of radiation-induced lung injury (RILI). Understanding the factors that dictate susceptibility to radiation-induced pulmonary fibrosis will aid in the prevention and management of RILI, and may lead to more effective personalized radiotherapy treatment. As the interaction of regional and organ-level responses may shape the chronic consequences of RILI, we sought to characterise both aspects of the response in an ovine model. A defined volume of left pulmonary parenchyma was prescribed 5 fractions of 6 Gy within 14 days while the contralateral lung dose was constrained. Radiographic changes via computed tomography (CT) were documented to define differences in radio-exposed lung relative to non-exposed lung at d21, d63 and d171 (n = 2), and at d21, d147 and d227 (n = 2). Gross and histologic lung changes were evaluated in samples derived at necropsy examination to define the chronic pulmonary response to radiation. Irradiated lung demonstrated reduced radio-density and increased homogeneity as evidenced from texture based radiomic feature analysis, relative to the control lung. At necropsy, the radiation field was readily defined by pallor on the pleural surface, which was also evident on the cut surface of fixed lung specimens. The degree and homogeneity of pallor reflected the sparse presence of erythrocytes in alveolar septal capillaries of radiation-exposed lung. These changes contrasted with dilated and congested microvasculature in the contralateral control lung. Referencing data to measurements made in control lung volumes of sheep experiencing acute RILI indicated that interstitial collagen continues to deposit in the radio-exposed lung field. Overall lung vascularity increased during the chronic response, as evidenced by increased expression of endothelial cell marker (CD31); however, vascularity was consistently decreased in irradiated lung and was negatively correlated with lung collagen. Other organ-level responses included increased expression of alpha smooth muscle actin (ASMA), increased numbers of proliferating cells (Ki67 positive), and cells expressing the dendritic cell-lysosomal associated membrane protein (DC-LAMP) antigen. The chronic response to RILI in this model is effected at both the whole organ and local lung level. Whilst the long-term consequences of exposure to radiation involved the continued deposition of collagen in the radiation field, organ-level responses also included increased vascularization and increased expression of ASMA, Ki67 and DC-LAMP. Interrupting the interplay between these aspects may influence susceptibility to pulmonary fibrosis after radiotherapy. We advocate for the importance of large animal model systems in pursuing these opportunities to target local, organ-level and systemic mechanisms in parallel within the same subject over time.
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Affiliation(s)
- David Collie
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK.
| | - Steven H Wright
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Jorge Del-Pozo
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Elaine Kay
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
- Small Animal Clinical Sciences, School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Tobias Schwarz
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Magdalena Parys
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
| | - Jessica Lawrence
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, Edinburgh, EH25 9RG, UK
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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104
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Mul J, Seravalli E, Bosman ME, van de Ven CP, Littooij AS, van Grotel M, van den Heuvel-Eibrink MM, Janssens GO. Estimated clinical benefit of combining highly conformal target volumes with Volumetric-Modulated Arc Therapy (VMAT) versus conventional flank irradiation in pediatric renal tumors. Clin Transl Radiat Oncol 2021; 29:20-26. [PMID: 34027140 PMCID: PMC8134033 DOI: 10.1016/j.ctro.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
Recently, flank target volumes adjusted for organ shift/motion have been defined. Highly conformal volumes with VMAT were compared to conventional volumes/beams. The new approach prevented a dose constraint violation of ≥ 1 OARs in 60% of cases. VMAT reduced the irradiated Total Body Volume receiving > 10% of the prescribed dose.
Background For decades, Anterior-Posterior/Posterior-Anterior (AP/PA) photon beams were standard-of-care for flank irradiation in children with renal cancer. Recently, highly conformal flank target volumes were defined correcting for postoperative organ shift and intra-fraction motion. By radiotherapy treatment plan comparison, this study aims to estimate the clinical benefits and potential risks of combining highly conformal target volumes with Volumetric-Modulated Arc Therapy (VMAT) versus conventional target volumes with AP/PA beams for flank irradiation. Materials and Methods Twenty consecutive renal tumor cases (left/right-sided:10/10; median age:3.2 years) were selected. Highly conformal flank target volumes were generated for VMAT, while conventional target volumes were used for AP/PA. For each case, the dose to the organs at risk (OARs) and Total Body Volume (TBV) was calculated to compare VMAT with AP/PA treatment plans for a prescribed dose (PD) of 14.4/1.8 Gy. Dose constraint violation of the tail of the pancreas and spleen (Dmean < 10 Gy), heart (D50 < 5 Gy) or mammary buds (Dmean < 10 Gy) were prioritized as potentially beneficial for clinics. Results Highly conformal Planning Target Volumes (PTV) were smaller than conventional volumes (mean ΔPTVAP/PA-PTVVMAT: 555 mL, Δ60%, p=<0.01). A mean dose reduction favoring VMAT was observed for almost all OARs. Dose constraints to the tail of the pancreas, spleen, heart and mammary buds were fulfilled in 8/20, 12/20, 16/20 and 19/20 cases with AP/PA, versus 14/20, 17/20, 20/20 and 20/20 cases with VMAT, respectively. In 12/20 cases, VMAT prevented the dose constraint violation of one or more OARs otherwise exceeded by AP/PA. VMAT increased the TBV receiving 10% of the PD, but reduced the amount of irradiated TBV for all higher doses. Conclusion Compared to 14.4 Gy flank irradiation using conventional AP/PA photon beams, an estimated clinical benefit by dose reduction to the OARs can be expected in 60% of the pediatric renal tumor cases using highly conformal flank target volumes combined with VMAT.
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Key Words
- 95% CI, 95% Confidence Interval
- AP/PA, Anterior-Posterior/Posterior-Anterior
- CT, Computed Tomography
- CTV, Clinical Target Volume
- Conformal radiotherapy
- GTV, Gross Tumor Volume
- ID, integral dose
- IMRT, Intensity-Modulated Radiotherapy
- ITV, Internal Target Volume
- MRI, Magnetic Resonance Imaging
- OARs, organs at risk
- Organs at risk
- PD, Prescribed Dose
- PTV, Planning Target Volume
- Pediatric renal tumors
- RT, radiotherapy
- SIOP-RTSG, International Society of Pediatric Oncology – Renal Tumor Study Group
- Side-effects
- TBV, Total Body Volume
- VMAT
- VMAT, Volumetric-Modulated Arc Therapy
- Wilms tumor
- vs, versus
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Affiliation(s)
- Joeri Mul
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Mirjam E Bosman
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Cornelis P van de Ven
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Annemieke S Littooij
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Martine van Grotel
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | | | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
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105
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Khanna L, Prasad SR, Yedururi S, Parameswaran AM, Marcal LP, Sandrasegaran K, Tirumani SH, Menias CO, Katabathina VS. Second Malignancies after Radiation Therapy: Update on Pathogenesis and Cross-sectional Imaging Findings. Radiographics 2021; 41:876-894. [PMID: 33891523 DOI: 10.1148/rg.2021200171] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A wide spectrum of second cancers occur as late complications of radiation therapy (RT) used to treat various malignancies. In addition to the type and dose of radiation, lifestyle, environmental, and genetic factors are important to the development of second malignancies in cancer survivors. Typically, RT-induced malignancies (RTIMs) are biologically aggressive cancers with a variable period of 5-10 years for hematologic malignancies and 10-60 years for solid tumors between RT and the development of the second cancer. Although carcinomas and leukemias commonly develop after low-dose RT, sarcomas occur in tissues or organs that receive high-dose RT. Angiosarcomas and unclassified pleomorphic sarcomas are the two most common RT-associated sarcomas; other sarcomas include malignant peripheral nerve sheath tumors, leiomyosarcomas, osteosarcomas, chondrosarcomas, and dedifferentiated or pleomorphic liposarcomas. Select RTIMs show tumor genetic characteristics that allow accurate diagnosis. Nearly all cutaneous angiosarcomas after RT for breast cancer and 90% of RT-associated malignant peripheral nerve sheath tumors are characterized by MYC gene amplifications and loss of H3 K27me3 expression, respectively. Classic papillary thyroid carcinomas that develop after RT frequently harbor RET/PTC rearrangements and have a favorable prognosis, despite their advanced stage at patient presentation. Select RTIMs demonstrate characteristic imaging findings and typically develop in the prior radiation field. Imaging is essential to early diagnosis, characterization, localization, and staging of RTIMs. Familiarity of radiologists with the diverse spectrum of RTIMs is essential for early diagnosis and optimal management. An invited commentary by Shapiro is available online. ©RSNA, 2021.
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Affiliation(s)
- Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Sireesha Yedururi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Anand M Parameswaran
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Leonardo P Marcal
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Kumar Sandrasegaran
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Sree Harsha Tirumani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
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106
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Shapiro A. Invited Commentary: Secondary Malignancies in Patients Treated with Radiation Therapy. Radiographics 2021; 41:E90-E91. [PMID: 33900119 DOI: 10.1148/rg.2021210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Shapiro
- From the Department of Radiation Oncology, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY 13210-2306
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Iorio GC, Salvestrini V, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on radiation-induced late sequelae: Focus on early-stage mediastinal classical Hodgkin Lymphoma. A critical review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Crit Rev Oncol Hematol 2021; 161:103326. [PMID: 33862247 DOI: 10.1016/j.critrevonc.2021.103326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/07/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The historically feared radiation-induced secondary cancers and cardiac toxicities observed among mediastinal classical Hodgkin Lymphoma (cHL) patients may still negatively burden the benefit of radiotherapy among long-term survivors. Modern radiotherapy (RT) delivery techniques, including intensity-modulated RT (IMRT) and deep inspiration breath-hold (DIBH) solutions, are drastically changing this scenario. Results of a literature overview are reported and discussed in this paper. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of organs-at-risk dose-volume metrics linked with radiation-induced toxicities in cHL patients. CONCLUSIONS The scenario of early-stage cHL presents long-life expectancies, thus the goal of treatment should aim at maintaining high cure rates and limiting the onset of late complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.
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Affiliation(s)
| | - Viola Salvestrini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili, Brescia, Italy
| | - Francesca De Felice
- Department of Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Valerio Nardone
- Department of Radiation Oncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence, Italy
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Hafeez N, Musunuru HB, Keller A, Beriwal S. Feasibility of breast radiation therapy in a Fanconi Anemia patient diagnosed with breast cancer: A case report and review of literature. Clin Transl Radiat Oncol 2021; 28:129-132. [PMID: 33981866 PMCID: PMC8085781 DOI: 10.1016/j.ctro.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 11/19/2022] Open
Abstract
We present the journey of an FA patient who developed metachronous bilateral breast cancers and was successfully treated with breast conserving therapy with no significant treatment related toxicity.
Fanconi Anemia (FA) is a rare inherited autosomal recessive disease that results in impaired double stranded DNA repair. This leads to both increased susceptibility to various cancers, as well as hypersensitivity to radiotherapy and systemic therapy; thus, increasing the complexity of oncological treatment paradigm. Here, we present an FA patient who initially developed invasive breast cancer for which she received breast conserving treatment with no significant treatment related toxicity. This was followed by a diagnosis of high-grade ductal carcinoma-in-situ in the contralateral breast, which was managed successfully by surgery and meticulously planned adjuvant radiotherapy, with no treatment interruptions.
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Affiliation(s)
- Neha Hafeez
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Andrew Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Corresponding author at: Department of Radiation Oncology, UPMC Hillman Cancer Center, 300 Halket Street, Pittsburgh, PA 15213, USA.
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109
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Su H, Zhao M, Zhang J, Dai Z. Dosimetric effects related to collimator angle optimization in intensity‐modulated radiotherapy planning for gastric cancer. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Huan‐fan Su
- Department of Medical Imaging Jiangxi Medical College Shangrao China
| | - Man Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Shenzhen China
| | - Jun Zhang
- Department of Radiotherapy Zhongnan Hospital of Wuhan University Wuhan China
| | - Zhi‐tao Dai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Shenzhen China
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110
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Suzuki S, Kato T, Murakami M. Impact of lifetime attributable risk of radiation-induced secondary cancer in proton craniospinal irradiation with vertebral-body-sparing for young pediatric patients with medulloblastoma. JOURNAL OF RADIATION RESEARCH 2021; 62:186-197. [PMID: 33341899 PMCID: PMC7948862 DOI: 10.1093/jrr/rraa118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/31/2020] [Indexed: 06/12/2023]
Abstract
We used the method proposed by Schneider et al. Theor Biol Med Model 2011;8:27, to clarify how the radiation-induced secondary cancer incidence rate changes in patients after proton craniospinal irradiation (CSI) without and with vertebral-body-sparing (VBS). Eight patients aged 3-15 years who underwent proton CSI were enrolled in the study. For each case, two types of plan without and with VBS in the target were compared. The prescribed doses were assumed to be 23.4 Gy relative biological effectiveness (RBE) and 36 Gy (RBE). Using the dose-volume histograms of the two plans, the lifetime attributable risk (LAR) was calculated by both methods for each patient based on the dose data calculated using an XiO-M treatment planning system. Eight organs were analyzed as follows: lung, colon, stomach, small intestine, liver, bladder, thyroid and bone. When the prescribed dose used was 23.4 Gy (RBE), the average LAR differences and the average number needed to treat (NNT) between proton CSI without and with VBS were 4.04 and 24.8, respectively, whereas the average LAR difference and the average NNT were larger at 8.65 and 11.6, respectively, when the prescribed dose of 36 Gy (RBE) was used. The LAR for radiation-induced secondary cancer was significantly lower in proton CSI with VBS than without VBS in pediatric patients, especially for the colon, lung, stomach and thyroid. The results of this study could serve as reference data when considering how much of vertebral bodies should be included when performing proton CSI according to age in clinical settings.
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Affiliation(s)
- Shunsuke Suzuki
- Corresponding author. Hokkaido Ohno Memorial Hospital, 2-16-1 Miyanosawa, Nishi-ku, Sapporo City, Hokkaido, 063-0052, Japan. Tel: +81-011-665-0020;
| | - Takahiro Kato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
- Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
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111
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Shahmohammadi Beni M, Krstic D, Nikezic D, Yu KN. A comparative study on dispersed doses during photon and proton radiation therapy in pediatric applications. PLoS One 2021; 16:e0248300. [PMID: 33690664 PMCID: PMC7946309 DOI: 10.1371/journal.pone.0248300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 02/23/2021] [Indexed: 12/05/2022] Open
Abstract
The Monte Carlo method was employed to simulate realistic treatment situations for photon and proton radiation therapy for a set of Oak Ridge National Laboratory (ORNL) pediatric phantoms for 15, 10, 5 and 1-year olds as well as newborns. Complete radiotherapy situations were simulated using the previously developed NRUrad input code for Monte Carlo N-Particle (MCNP) code package. Each pediatric phantom was irradiated at five different positions, namely, the testes, colon, liver, left lung and brain, and the doses in targeted organs (Dt) were determined using the track length estimate of energy. The dispersed photon and proton doses in non-targeted organs (Dd), namely, the skeleton, skin, brain, spine, left and right lungs were computed. The conversion coefficients (F = Dd/Dt) of the dispersed doses were used to study the dose dispersion in different non-targeted organs for phantoms for 15, 10, 5 and 1-year olds as well as newborns. In general, the F values were larger for younger patients. The F values for non-targeted organs for phantoms for 1-year olds and newborns were significantly larger compared to those for other phantoms. The dispersed doses from proton radiation therapy were also found to be significantly lower than those from conventional photon radiation therapy. For example, the largest F values for the brain were 65.6% and 0.206% of the dose delivered to the left lung (P4) for newborns during photon and proton radiation therapy, respectively. The present results demonstrated that dispersion of photons and generated electrons significantly affected the absorbed doses in non-targeted organs during pediatric photon therapy, and illustrated that proton therapy could in general bring benefits for treatment of pediatric cancer patients.
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Affiliation(s)
| | - Dragana Krstic
- Faculty of Science, University of Kragujevac, Kragujevac, Serbia
| | - Dragoslav Nikezic
- Department of Physics, City University of Hong Kong, Kowloon Tong, Hong Kong
- Faculty of Science, University of Kragujevac, Kragujevac, Serbia
| | - Kwan Ngok Yu
- Department of Physics, City University of Hong Kong, Kowloon Tong, Hong Kong
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112
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Xie Y, Guo B, Zhang R. Cost-effectiveness analysis of radiotherapy techniques for whole breast irradiation. PLoS One 2021; 16:e0248220. [PMID: 33684139 PMCID: PMC7939353 DOI: 10.1371/journal.pone.0248220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background The current standard of care (SOC) for whole breast radiotherapy (WBRT) in the US is conventional tangential photon fields. Advanced WBRT techniques may provide similar tumor control and better normal tissue sparing, but it is controversial whether the medical benefits of an advanced technology are significant enough to justify its higher cost. Objective To analyze the cost-effectiveness of six advanced WBRT techniques compared with SOC. Methods We developed a Markov model to simulate health states for one cohort of women (65-year-old) with early-stage breast cancer over 15 years after WBRT. The cost effectiveness analyses of field-in-field (FIF), hybrid intensity modulated radiotherapy (IMRT), full IMRT, standard volumetric modulated arc therapy (STD-VMAT), multiple arc VMAT (MA-VMAT), non-coplanar VMAT (NC-VMAT) compared with SOC were performed with both tumor control and radiogenic side effects considered. Transition probabilities and utilities for each health state were obtained from literature. Costs incurred by payers were adopted from literature and Medicare data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. One-way sensitivity analyses and probabilistic sensitivity analyses (PSA) were performed to evaluate the impact of uncertainties on the final results. Results FIF has the lowest ICER value of 1,511 $/QALY. The one-way analyses show that the cost-effectiveness of advanced WBRT techniques is most sensitive to the probability of developing contralateral breast cancer. PSAs show that SOC is more cost effective than almost all advanced WBRT techniques at a willingness-to-pay (WTP) threshold of 50,000 $/QALY, while FIF, hybrid IMRT and MA-VMAT are more cost-effective than SOC with a probability of 59.2%, 72.3% and 72.6% at a WTP threshold of 100,000 $/QALY, respectively. Conclusions FIF might be the most cost-effective option for WBRT patients at a WTP threshold of 50,000 $/QALY, while hybrid IMRT and MA-VMAT might be the most cost-effective options at a WTP threshold of 100,000 $/QALY.
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Affiliation(s)
- Yibo Xie
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Beibei Guo
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Rui Zhang
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana, United States of America
- Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana, United States of America
- * E-mail:
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113
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De B, Ng SP, Liu AY, Avila S, Tao R, Holliday EB, Brownlee Z, Kaseb A, Lee S, Raghav K, Vauthey JN, Minsky BD, Herman JM, Das P, Smith GL, Taniguchi CM, Krishnan S, Crane CH, Grassberger C, Hong TS, Lin SH, Koong AC, Mohan R, Koay EJ. Radiation-Associated Lymphopenia and Outcomes of Patients with Unresectable Hepatocellular Carcinoma Treated with Radiotherapy. J Hepatocell Carcinoma 2021; 8:57-69. [PMID: 33688489 PMCID: PMC7937383 DOI: 10.2147/jhc.s282062] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background The immune system plays a crucial role in cancer surveillance. Previous studies have shown that lymphopenia associated with radiotherapy (RT) portends a poor prognosis. We sought to differentiate the effects of proton and photon RT on changes in absolute lymphocyte count (ALC) for patients with hepatocellular carcinoma (HCC). Patients and Methods Patients with HCC treated with definitive RT from 2006 to 2016 were studied. Serial ALCs were graded according to CTCAE v4.0. Overall survival (OS), disease-free survival, and distant metastasis-free survival were analyzed using the Kaplan-Meier method. Univariable and multivariable Cox-proportional hazards analyses were used to identify predictors of OS. A cohort analysis matched for treatment volume was performed to investigate differences in ALC dynamics between photon and proton therapy. Results Of 143 patients identified, the median age was 66 (range, 19-90) years. The treatment modality was photon in 103 (72%) and proton in 40 (28%). Median follow-up was 17 months (95% confidence interval, 13-25 months). The median time to ALC nadir after initiation of RT was 17 days with a median relative decrease of 67%. Those who received proton RT had a higher median ALC nadir (0.41 vs 0.32 k/µL, p=0.002) and longer median OS (33 vs 13 months, p=0.002) than those who received photon RT. Matched cohort analyses revealed a larger low-dose liver volume in the photon group, which correlated with lower ALC. On multivariable Cox analysis, Grade 3 or higher lymphopenia prior to or after RT, portal venous tumor thrombus, larger planning target volumes, Child-Pugh (CP) Class B, and increased CP score after RT were associated with a higher risk of death, whereas the use of proton therapy was associated with lower risk. Conclusion Grade 3 or higher lymphopenia may be associated with poorer outcomes in patients receiving RT for HCC. Protons may mitigate lymphopenia compared with photons, potentially due to reduced dose exposure of sites of lymphopoiesis.
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Affiliation(s)
- Brian De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Austin Health, Melbourne, Victoria, Australia
| | - Amy Y Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Santiago Avila
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zachary Brownlee
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA, USA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunyoung Lee
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph M Herman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cullen M Taniguchi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | - Christopher H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Radhe Mohan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eugene J Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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114
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Estimation of monitor unit through analytical method for dynamic IMRT using control points as an effective parameter. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction:
The control points (CP) play a significant role in the delivery of segmented based Intensity-Modulated Radiation Therapy (IMRT) delivery, particularly in dynamic mode. The number of segments is determined by control points and these segments will transfer from one to the other either during beam ON called dynamic delivery or during beam OFF called static delivery or step and shoot. This study was aimed at indirect estimation of the total monitor units (MU) to be delivered per field by exploiting the control points and also to find the MUs at any nth segment.
Materials and methods:
This study was performed in the Eclipse treatment planning software version 13.8.0. The details of control points, metre set weight per segment, leaf positions for each segment, field size, etc. were taken into consideration.
Results:
TPS calculated MU value and analytically estimated MU value were compared and the percentage of difference was estimated. The overall mean percentage of deviation was 1·03% between the TPS calculated method and the analytical method. The paired sample t-test was performed and, p-value <0·05, no significant difference was found. The analytical relationship determined to estimate the total number of MU delivered for any nth control point was also evaluated.
Conclusion:
The control points are a potential parameter in the conventional IMRT delivery. Through this study, we have addressed the indirect method to estimate the monitor units delivered per segment.
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115
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Gallagher KJ, Youssef B, Georges R, Mahajan A, Feghali JA, Nabha R, Ayoub Z, Jalbout W, Taddei PJ. Proton Radiotherapy Could Reduce the Risk of Fatal Second Cancers for Children with Intracranial Tumors in Low- and Middle-Income Countries. Int J Part Ther 2021; 7:1-10. [PMID: 33829068 PMCID: PMC8019578 DOI: 10.14338/ijpt-20-00041.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To test our hypothesis that, for young children with intracranial tumors, proton radiotherapy in a high-income country does not reduce the risk of a fatal subsequent malignant neoplasm (SMN) compared with photon radiotherapy in low- and middle-income countries. MATERIALS AND METHODS We retrospectively selected 9 pediatric patients with low-grade brain tumors who were treated with 3-dimensional conformal radiation therapy in low- and middle-income countries. Images and contours were deidentified and transferred to a high-income country proton therapy center. Clinically commissioned treatment planning systems of each academic hospital were used to calculate absorbed dose from the therapeutic fields. After fusing supplemental computational phantoms to the patients' anatomies, models from the literature were applied to calculate stray radiation doses. Equivalent doses were determined in organs and tissues at risk of SMNs, and the lifetime attributable risk of SMN mortality (LAR) was predicted using a dose-effect model. Our hypothesis test was based on the average of the ratios of LARs from proton therapy to that of photon therapy ()(H0: = 1; H A : < 1). RESULTS Proton therapy reduced the equivalent dose in organs at risk for SMNs and LARs compared with photon therapy for which the for the cohort was 0.69 ± 0.10, resulting in the rejection of H0 (P < .001, α = 0.05). We observed that the younger children in the cohort (2-4 years old) were at a factor of approximately 2.5 higher LAR compared with the older children (8-12 years old). CONCLUSION Our findings suggest that proton radiotherapy has the strong potential of reducing the risk of fatal SMNs in pediatric patients with intracranial tumors if it were made available globally.
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Affiliation(s)
- Kyle J. Gallagher
- Oregon Health and Science University, Portland, OR, USA
- Oregon State University, Corvallis, OR, USA
| | - Bassem Youssef
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Georges
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- Radiation Oncology Department, Mayo Clinic, Rochester, MN, USA
| | | | - Racile Nabha
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Ayoub
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Jalbout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Phillip J. Taddei
- American University of Beirut Medical Center, Beirut, Lebanon
- Radiation Oncology Department, Mayo Clinic, Rochester, MN, USA
- University of Washington School of Medicine, Seattle, WA, USA
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116
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A novel inverse optimization based three-dimensional conformal radiotherapy technique in craniospinal irradiation. Phys Eng Sci Med 2021; 44:265-275. [PMID: 33559040 DOI: 10.1007/s13246-021-00976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Our aim was to develop a novel inverse optimization-based three-dimensional conformal radiotherapy (i3DCRT) technique for craniospinal irradiation. The imaging data of 20 patients with medulloblastoma were used retrospectively. The first group included 10 pediatric patients with supine position treated under anesthesia/sedation, and the second group included 10 young adult/adult patients treated with prone position. Three different treatment plans were created for each patient via i3DCRT, forward-planned three-dimensional conformal radiotherapy (f3DCRT) and intensity-modulated radiotherapy (IMRT) techniques. A total dose of 36 Gy was prescribed in 20 fractions for all plans. The comparative evaluation was conducted by using the parameters of conformity-index, homogeneity-index, and doses to the target volumes and organs at risk (OARs). The plans created with i3DCRT technique achieved better conformity and homogeneity compared to f3DCRT. In terms of OARs sparing, we found pronounced dose reductions in esophagus and heart in i3DCRT compared to f3DCRT plans. i3DCRT technique also provided a well-conformed dose distribution not superior, but comparable, to IMRT without increase in the total monitor unit per fraction (MU/fx) with respect to f3DCRT. The average monitor unit per fraction (MU/fx) for i3DCRT, f3DCRT and IMRT plans were found as 379.3, 378.0 and 1051.7 MU for the first group and 577.4, 563.5 and 1368.7 MU for the second group, respectively. Novel i3DCRT technique solves the problems associated with field junctions and beam edge matching encountered in f3DCRT plans. Additionally, i3DCRT technique can create almost similar plans as with IMRT with lower total MU/fx.
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117
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Guan X, Wei R, Yang R, Lu Z, Liu E, Zhao Z, Chen H, Yang M, Liu Z, Jiang Z, Wang X. Risk and Prognosis of Secondary Bladder Cancer After Radiation Therapy for Rectal Cancer: A Large Population-Based Cohort Study. Front Oncol 2021; 10:586401. [PMID: 33569344 PMCID: PMC7868538 DOI: 10.3389/fonc.2020.586401] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Although radiation therapy (RT) improves local control for rectal cancer (RC), the long-term risks from RT, including development of a secondary malignancy, are controversial. The risk and prognosis of secondary bladder cancer (SBC) in RC patients undergoing RT have not been adequately studied. Our goal is to investigate the impact of RT on the risk of developing SBC and assess their survival outcomes. Methods This large population-based study included RC patients as their initial primary cancer from nine registries of the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015. The cumulative incidence of SBC was assessed by using Fine and Gray's competing risk regression. The standardized incidence ratio (SIR) was used to compare the incidence of SBC in RC survivors to the US general population. The Kaplan-Meier method was used to evaluate the 10-year overall survival (OS) and 10-year cancer specific survival (CSS) for patients with SBC. Results Of 74,646 RC patients, 24,522 patients were treated with surgery and RT and 50,124 patients were treated with surgery alone. The incidence of SBC was 1.85% among patients who received RT and 1.24% among patients who did not. The incidence of SBC in RC patients who received RT was higher than the US general population (SIR, 1.35; 95% CI, 1.19-1.53, P<0.05), and decreased with increasing age at diagnosis, and increased with time since diagnosis. In competing risk regression analysis, undergoing RT was associated with a higher risk of SBC (hazard ratio [HR], 1.443, 95% confidence interval [CI], 1.209-1.720; P<0.001). The results of the dynamic SIR for SBC revealed that a slightly increased risk of SBC was observed after RT in the early latency, and was significantly related to the variations of age at RC diagnosis and decreased with time progress. The 10-year OS and CSS among SBC patients after RT were comparable to SBC patients after NRT. Conclusion Radiation was associated with an increased risk of developing SBC in RC patients, and special attention should be paid to the surveillance of these patients.
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Affiliation(s)
- Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Wei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runkun Yang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhao Lu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Enrui Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixun Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haipeng Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Ito T, Tamura M, Monzen H, Matsumoto K, Nakamatsu K, Harada T, Fukui T. [Impact of Aperture Shape Controller on Knowledge-based VMAT Planning of Prostate Cancer]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:23-31. [PMID: 33473076 DOI: 10.6009/jjrt.2021_jsrt_77.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Knowledge-based planning (KBP) has disadvantages of high monitor unit (MU) and complex multi-leaf collimator (MLC) motion. We investigated the optimal aperture shape controller (ASC) level for the KBP to reduce these factors in volumetric modulated arc therapy (VMAT) for prostate cancer. METHODS The KBP model was created based on 51 clinical plans (CPs) of patients who underwent the VMAT for prostate cancer. Another 10 CPs were selected randomly, and the KBPs with/without ASC, changed stepwise from very low (KBP-VL) to very high (KBP-VH), were performed with a single auto-optimization. The parameters of dose-volume histograms (DVHs) and MLC performance metrics were evaluated. We obtained the modulation complexity score for VMAT (MCSv), closed leaf score (CLS), small aperture score (SAS), leaf travel (LT), and total MU. RESULTS The ASC did not affect the DVH parameters negatively. The following comparisons of MLC performance were obtained (KBP vs. KBP-VL vs. KBP-VH, respectively): 0.25 vs. 0.27 vs. 0.30 (MCSv), 0.19 vs. 0.18 vs. 0.16 (CLS), 0.50 vs. 0.45 vs. 0.40 (SAS10 mm), 0.73 vs. 0.68 vs. 0.63 (SAS20 mm), 768.35 mm vs. 671.50 mm vs. 551.32 mm (LT), and 672.87 vs. 642.36 vs. 607.59 (MU). There were significant differences between KBP and KBP-VH for MCSv and LT (p<0.05). CONCLUSIONS The KBP using an ASC set to the very high level could reduce the complexity of MLC motion significantly more without deterioration of the DVH parameters compared with the KBP in VMAT for prostate cancer.
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Affiliation(s)
- Takaaki Ito
- Department of Radiological Technology, Kobe City Nishi-Kobe Medical Center
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University
| | - Kenji Matsumoto
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University.,Department of Radiology, Kindai University Hospital
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Faculty of Medicine, Kindai University
| | - Tomoko Harada
- Department of Radiological Technology, Kobe City Nishi-Kobe Medical Center
| | - Tatsuya Fukui
- Department of Radiological Technology, Kobe City Nishi-Kobe Medical Center
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119
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[Diffusion prophylactic axillary irradiation in breast cancer - Literature review]. Cancer Radiother 2021; 25:191-199. [PMID: 33402287 DOI: 10.1016/j.canrad.2020.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/24/2019] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE In breast cancer, radiotherapy is an essential component of the treatment. However, indications of irradiation of the internal mammary chain and axillary area are debatables. Axillary recurrence in patients with invasive breast carcinoma remains an issue. Currently, the substitution of axillary lymph node dissection by sentinel node biopsy leads to revisit the role of axillary irradiation. Breast irradiation including level I, II and III might decrease the risk of axillary recurrence. MATERIAL AND METHODS A literature search was performed in PubMed and the Cochrane library to identify articles publishing data regarding dose-volume analysis of axillary levels in breast irradiation aiming to determine the potential therapeutic implications. RESULTS Eleven articles were retained. A total of 375 treatment plans were analyzed. The results concerning the irradiation technique, initial dose prescribed to breast, delineated volumes and dose received at axillary levels were heterogeneous. The average dose delivered to axilla levels I-III with 3D-conformal radiotherapy using standard fields were between 24Gy and 43.5Gy, 3Gy and 32.5Gy and between 1.0Gy and 20.5Gy respectively. The average doses delivered to axilla levels I-III with 3D-conformal radiotherapy using high tangential fields were between 38Gy and 49.7Gy, 11Gy and 47.1Gy and 5Gy 38.7Gy, 32.1Gy and 5Gy (result available for only one study) respectively. Finally, the average doses delivered to axilla levels I-III with intensity modulated radiation therapy were between 14.5Gy and 42.6Gy, 3.4Gy and 35Gy and between 1.2Gy and 25.5Gy respectively. CONCLUSIONS Incidental axillary dose seems insufficient to be therapeutic regardless of the irradiation technique. There are meaningful differences between intensity modulated radiation therapy and 3D-conformal radiotherapy.
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Puranik A, Dev I, Rangarajan V, Purandare N, Agrawal A, Shah S, Choudhury S. Rare presentation of radiation-induced sarcoma detected on F-18 FDG positron emission tomography/computed tomography in a treated case of giant cell tumor. Indian J Nucl Med 2021; 36:429-431. [PMID: 35125762 PMCID: PMC8771068 DOI: 10.4103/ijnm.ijnm_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/04/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
Giant cell tumors (GCTs) are benign bone lesions which are treated with curettage and bone grafting. Infrequently, GCTs show local site recurrences which are then treated with either surgical excision or radiation therapy. Radiation-induced sarcoma is rarely seen as a late complication of radiation therapy which needs to be differentiated from recurrent GCT. We report one such rare case of radiation-induced sarcoma detected on Flourine-18 fluorodeoxyglucose (18F FDG) positron emission tomography/computed tomography in a 40-year-old male who was treated with radiation therapy for recurrent GCT 9 years ago.
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Malikova H, Burghardtova M, Fejfarova K, Nadova K, Weichet J. Advanced cervical cancer in young women: imaging study of late and very late radiation-related side effects after successful treatment by combined radiotherapy. Quant Imaging Med Surg 2021; 11:21-31. [PMID: 33392008 DOI: 10.21037/qims-20-553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Radical combined radiotherapy (RT) is a standard treatment for advanced cervical cancer. The aim of our study was to identify morphological late (≥6 months) and very late (≥5 years) radiation-related comorbidities on computed tomography (CT), positron emission tomography/computerized tomography (PET/CT) or magnetic resonance imaging (MRI) scans in young females who survived ≥5 years since RT and were considered as successfully treated. Secondly, we studied a rate of clinically silent radiation-related toxicities apparent on imaging scans that might influenced on future well-being of survived females. Thirdly, we analyzed reasons why patients underwent imaging scans. Methods We included 41 subjects aged under 50 years (mean 41.8±7.2 years, median 41 years), who survived ≥5 years since RT, with at least one available imaging scan ≥3 years since RT. The mean time between RT and the last available scan was 12.3±7.9 years (median 9 years); the mean time of clinical follow-up was 15.4±7.1 years (median 14 years). Results Fourteen (34.1%) females underwent the first imaging scan in emergency situation and 27 (65.9%) patients due to variable chronic complaints. Grade III-V radiation-related comorbidities occurred in 19 (46.3%) females including one case of death due to radiation-induced osteosarcoma. In 14 of 19 patients, comorbidities were multiple. Four (9.8%) females suffered from life-threatening complications (grade IV): one from an uretero-arterial fistula with massive hematuria and 3 from bowel perforations. Eleven (26.8%) subjects suffered from bowel strictures with ileus development, they underwent mean 1.7±0.8 surgery (median 1.5). The mean time since RT to the first surgery for intestinal complications was 5.4±6.0 years (median 3 years), to the second 12.0±9.6 years (median 11.5 years) and to the third surgery 9.0±4.2 years (median 9 years). Late fistulas formations (vesico-recto-vaginal) were seen in 6 (14.6%) patients. Bone complications were diagnosed in 9 (22.0%) of treated females, one case of osteosarcoma included, 4 of 9 bone complications were clinically silent. In 5 (12.2%) subjects, toxicities grade III-IV first time manifested >5 years since RT, majority of them were multiple. The bowel perforation and fistulas formations were the earliest manifested grade III-IV toxicities, with median time 3 years since RT, the bone complications were the latest manifested with median time 16 years since RT. Conclusions Our study is not able to bring information about the incidence of late and very late radiation related comorbidities, according to International Federation of Gynecology and Obstetrics (FIGO) recommendations patients are clinically followed only for 5 years and imaging cross-sectional scans are not recommended. However, our study shows that if females successfully treated for advanced cervical cancer report abdominal/pelvic clinical problems, it is highly probable their imaging scans will reveal late radiation related side-effects that may affect the rest of their life. It puts forward question whether females after radical RT should been regularly followed by cross-sectional imaging methods.
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Affiliation(s)
- Hana Malikova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Institute of Anatomy, Second Medical Faculty, Charles University, Prague, Czech Republic
| | - Miroslava Burghardtova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Klara Fejfarova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Katarina Nadova
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Jiri Weichet
- Radiology Department, Third Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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Kang S, Wu J, Liu X, Wang P, Li J, Wu F, Tang B. Dosimetric and delivery comparison of helical tomotherapy with dynamic jaw and fixed jaw for cervical carcinoma. J Cancer Res Ther 2021; 17:1626-1630. [DOI: 10.4103/jcrt.jcrt_393_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jahreiß MC, Aben KKH, Hoogeman MS, Dirkx MLP, de Vries KC, Incrocci L, Heemsbergen WD. The Risk of Second Primary Cancers in Prostate Cancer Survivors Treated in the Modern Radiotherapy Era. Front Oncol 2020; 10:605119. [PMID: 33282746 PMCID: PMC7691574 DOI: 10.3389/fonc.2020.605119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Concerns have been raised that modern intensity modulated radiotherapy (IMRT) may be associated with increased second primary cancer risks (SPC) compared to previous three-dimensional conformal radiation techniques (3DCRT), due to increased low dose volumes and more out-of-field ionizing dose to peripheral tissue further away from the target. We assessed the impact of treatment technique on SPC risks in a cohort of prostate cancer (PCa) survivors. Material and Methods The study cohort comprised 1,561 PCa survivors aged 50–79 years at time of radiotherapy, treated between 2006–2013 (N=707 IMRT, N=854 3DCRT). Treatment details were extracted from radiotherapy systems and merged with longitudinal data of the Netherlands Cancer Registry to identify SPCs. Primary endpoint was the development of a solid SPC (excluding skin cancer) in peripheral anatomical regions, i.e. non-pelvic. Applied latency period was 12 months. SPC rates in the IMRT cohort (total cohort and age subgroups) were compared to 1) the 3DCRT cohort by calculating Sub-Hazard Ratios (sHR) using a competing risk model, and 2) to the general male population by calculating Standardized Incidence Ratios (SIR). Models were adjusted for calendar period and age. Results Median follow-up was 8.0 years (accumulated 11,664 person-years at-risk) with 159 cases developing ≥1 non-pelvic SPC. For IMRT vs 3DCRT we observed a significantly (p=0.03) increased risk (sHR=1.56, 95% Confidence Interval (CI) 1.03–2.36, corresponding estimated excess absolute risk (EAR) of +7 cases per 10,000 person-years). At explorative analysis, IMRT was in particular associated with increased risks within the subgroup of active smokers (sHR 2.94, p=0.01). Within the age subgroups 50–69 and 70–79 years, the sHR for non-pelvic SPC was 3.27 (p=0.001) and 0.96 (p=0.9), respectively. For pelvic SPC no increase was observed (sHR=0.8, p=0.4). Compared to the general population, IMRT was associated with significantly increased risks for non-pelvic SPC in the 50–69 year age group (SIR=1.90, p<0.05) but not in the 70–79 years group (SIR=1.08). Conclusion IMRT is associated with increased SPC risks for subjects who are relatively young at time of treatment. Additional research on aspects of IMRT that may cause this effect is essential to minimize risks for future patients receiving modern radiotherapy.
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Affiliation(s)
| | - Katja K H Aben
- Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands.,Research Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Mischa S Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Maarten L P Dirkx
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Kim C de Vries
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Luca Incrocci
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Wilma D Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Volumetric modulated arc therapy: a dosimetric comparison with dynamic IMRT and step-and-shoot IMRT. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAim:The aim of this study was to compare volumetric modulated arc therapy (VMAT) with dynamic intensity-modulated radiation therapy (dIMRT) and step-and-shoot IMRT (ssIMRT) for different treatment sites.Materials and methods:Twelve patients were selected for the planning comparison study. This included three head and neck, three brain, three rectal and three cervical cancer patients. Total dose of 50 Gy was given for all the plans. Plans were done for Elekta synergy with Monaco treatment planning system. All plans were generated with 6 MV photons beam. Plan evaluation was based on the ability to meet the dose volume histogram, dose homogeneity index, conformity index and radiation delivery time, and monitor unit needs to deliver the prescribed dose.Results:The VMAT and dIMRT plans achieved the better conformity (CI98% = 0·965 ± 0·023) and (CI98% = 0·939 ± 0·01), respectively, while ssIMRT plans were slightly inferior (CI98% = 0·901 ± 0·038). The inhomogeneity in the planning target volume (PTV) was highest with ssIMRT with HI equal to 0·097 ± 0·015 when compared to VMAT with HI equal to 0·092 ± 0·0369 and 0·095 ± 0·023 with dIMRT. The integral dose is found to be inferior with VMAT 105·31 ± 53·6 (Gy L) when compared with dIMRT 110·75 ± 52·9 (Gy L) and ssIMRT 115 38 ± 55·1(Gy L). All the techniques respected the planning objective for all organs at risk. The delivery time per fraction for VMAT was much lower than dIMRT and ssIMRT.Findings:Our results indicate that dIMRT and VMAT provide better sparing of normal tissue, homogeneity and conformity than ssIMRT with reduced treatment delivery time.
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Takata T, Shiraishi K, Kumagai S, Arai N, Kobayashi T, Oba H, Okamoto T, Kotoku J. Calculating and estimating second cancer risk from breast radiotherapy using Monte Carlo code with internal body scatter for each out-of-field organ. J Appl Clin Med Phys 2020; 21:62-73. [PMID: 33128332 PMCID: PMC7769416 DOI: 10.1002/acm2.13060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/03/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
Out-of-field organs are not commonly designated as dose calculation targets during radiation therapy treatment planning, but they might entail risks of second cancer. Risk components include specific internal body scatter, which is a dominant source of out-of-field doses, and head leakage, which can be reduced by external shielding. Our simulation study quantifies out-of-field organ doses and estimates second cancer risks attributable to internal body scatter in whole-breast radiotherapy (WBRT) with or without additional regional nodal radiotherapy (RNRT), respectively, for right and left breast cancer using Monte Carlo code PHITS. Simulations were conducted using a complete whole-body female model. Second cancer risk was estimated using the calculated doses with a concept of excess absolute risk. Simulation results revealed marked differences between WBRT alone and WBRT plus RNRT in out-of-field organ doses. The ratios of mean doses between them were as large as 3.5-8.0 for the head and neck region and about 1.5-6.6 for the lower abdominal region. Potentially, most out-of-field organs had excess absolute risks of less than 1 per 10,000 persons-year. Our study surveyed the respective contributions of internal body scatter to out-of-field organ doses and second cancer risks in breast radiotherapy on this intact female model.
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Affiliation(s)
- Takeshi Takata
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Kenshiro Shiraishi
- Department of RadiologyTeikyo University School of Medicine2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Shinobu Kumagai
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Norikazu Arai
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Takenori Kobayashi
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Hiroshi Oba
- Department of RadiologyTeikyo University School of Medicine2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Takahide Okamoto
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Jun’ichi Kotoku
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
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Dosimetric comparison of intensity-modulated radiotherapy (IMRT) and RapidArc in low grade mucoepidermoid carcinoma of the salivary gland: a single institutional experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurpose:To report a single-institution experience of intensity-modulated radiotherapy (IMRT) and RapidArc treatment plans for the patients treated with low grade mucoepidermoid carcinoma (MEC) of the salivary gland while sparing the organs at risk (OARs) within tolerance limits.Material and Methods:Twenty-five patients with MEC were selected to develop and analyse the treatment plans using both of the techniques. Dose distributions were calculated using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA). Plans were generated to deliver the dose of 6000 cGy in 30 fractions. For IMRT, seven angle plans were used and for RapidArc, two half arcs were used with the same 6 MV photon beam. Quality of treatment plans was evaluated by using parameters such as, coverage, conformity index (CI), homogeneity index (HI), gradient index (GI), unified dosimetry index (UDI), dose volume histogram, delivery time and OARs sparing for IMRT and RapidArc plans.Results:The analysis revealed that IMRT and RapidArc coverages are 0·90 and 0·94, respectively; CIs are 1·15 and 1·10, respectively; HIs are 1·12 and 1·07, respectively; GIs are 0·94 and 0·98, respectively. Average UDI values for RapidArc and IMRT are 1·09 and 1·11, respectively. Integral dose comparison shows better OAR sparing for RapidArc. RapidArc plans have the shorter beam on time (45%) in comparison with IMRT plans.Conclusion:Planning constraints were achieved in both techniques. However, RapidArc showed better quality treatment plan, OARs sparing and shorter delivery time as compared to IMRT.
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Hird AE, Magee DE, Matta R, Saskin R, Dvorani E, Kulkarni GS, Kodama R, Herschorn S, Narod SA, Nam RK. Assessment of Secondary Sarcomas Among Patients With Cancer of the Abdomen or Pelvis Who Received Combinations of Surgery, Radiation, and Chemotherapy vs Surgery Alone. JAMA Netw Open 2020; 3:e2013929. [PMID: 33006617 PMCID: PMC7532387 DOI: 10.1001/jamanetworkopen.2020.13929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE The association of radiation and chemotherapy with the development of secondary sarcoma is known, but the contemporary risk has not been well characterized for patients with cancers of the abdomen and pelvis. OBJECTIVE To compare the risk of secondary sarcoma among patients treated with combinations of surgery, radiation, or chemotherapy with patients treated with surgery alone and the general population. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 173 580 patients in Ontario, Canada, with nonmetastatic cancer of the prostate, bladder, colon, rectum or anus, cervix, uterus, or testis. Patients were enrolled from January 1, 2002, to January 31, 2017. Data analysis was conducted from March 1, 2019, to January 31, 2020. EXPOSURES Treatment combinations of radiation, chemotherapy, and surgery. MAIN OUTCOME AND MEASURES Diagnosis of sarcoma based on histologic codes from the Ontario Cancer Registry. Time to sarcoma was compared using a cause-specific proportional hazard model. RESULTS Of 173 580 patients, most were men (125 080 [72.1%]), and the largest group was aged between 60 and 69 years (58 346 [33.6%]). Most patients had genitourinary cancer (86 235 [51.4%]) or colorectal cancer (69 241 [39.9%]). Overall, 64 301 (37.1%) received surgery alone, 51 220 (29.5%) received radiation alone, 15 624 (9.0%) were treated with radiation and chemotherapy, 15 252 (8.8%) received radiation with surgery, and 11 822 (6.8%) received all 3 treatments. A total of 332 patients (0.2%) had sarcomas develop during a median (interquartile range) follow-up of 5.7 (2.2-8.9) years. The incidence of sarcoma was 0.3% among those who underwent radiation alone (138 of 51 220) and radiation with chemotherapy (40 of 15 624), 0.2% among those who received radiation and surgery (36 of 15 252) and all 3 modalities (25 of 11 822), and 0.1% among those who received surgery with chemotherapy (13 of 14 861) and surgery alone (80 of 64 801). Compared with a reference group of patients who had surgery alone, the greatest risk of sarcoma was found among patients who underwent a combination of radiation and chemotherapy (cause-specific relative hazard [csRH], 4.07; 95% CI, 2.75-6.01; P < .001), followed by patients who had radiation alone (csRH, 2.35; 95% CI, 1.77-3.12; P < .001), radiation with surgery (csRH, 2.33; 95% CI, 1.57-3.46; P < .001), and all 3 modalities (csRH, 2.27; 95% CI, 1.44-3.58; P < .001). In the general population, 7987 events occurred during 46 554 803 person-years (17.2 events per 100 000 person-years). The standardized incidence ratio for sarcoma among patients treated with radiation compared with the general population was 2.41 (95% CI, 1.57-3.69; 41.3 events per 100 000 person-years). The annual number of cases of sarcoma increased from 2009 (15 per 100 000 persons) to 2016 (32 per 100 000 persons), but the annual rate did not change during the study period. CONCLUSIONS AND RELEVANCE In this cohort study, patients treated with radiation or chemotherapy for abdominopelvic cancers had an increased rate of sarcoma. Although the absolute rate is low, patients and physicians should be aware of this increased risk of developing sarcoma.
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Affiliation(s)
- Amanda E. Hird
- Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Diana E. Magee
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Erind Dvorani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Kodama
- Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert K. Nam
- Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Inal A, Duman E, Ozkan EE. Evaluating different radiotherapy treatment plans, in terms of critical organ scoring index, conformity index, tumor control probability, and normal tissue complication probability calculations in early glottic larynx carcinoma. J Cancer Res Ther 2020; 16:485-493. [PMID: 32719255 DOI: 10.4103/jcrt.jcrt_888_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose In this study, it is aimed to compare three different radiotherapy treatment planning techniques in terms of critical organ scoring index (COSI), two different conformity index (CI), tumor control probability (TCP), and normal tissue complication probability (NTCP) calculations in early (T1) glottic larynx carcinoma (T1GL). Furthermore, it is aimed to investigate these parameters compliance with dose-volume histograms (DVH) parameters. Materials and Methods Ten T1GL patients were immobilized in a supine position with a head and neck thermoplastic mask. Treatment plans were created with opposed lateral fields (OLAFs) and intensity-modulated radiation therapy (IMRT) techniques with a total dose of 66 Gy in 33 fraction with 2 Gy/day. IMRT fields were selected as five fields (5IMRT) and seven fields (7IMRT). Dosimetric evaluation of three different treatment plans for T1GL carcinoma was performed in two consequential steps. First step was the assessment of planning target volume (PTV), all organs at risks (OARs), and normal tissue (NT) dose calculations according to given dose constraint directions and comparing the plans via DVH. In the second step, for PTV, the compatibility of DVH data with CIs-TCP was investigated where COSI-NTCP was compared with DVH for OARs. The DVH data were considered as reference in all evaluations. Results The CIRTOG mean values were significantly closer to 1 with IMRT plans when compared to OLAF plans (P = 0.005). The CIPADDICK mean values revealed that OLAF plans were significantly worse than IMRT plans (P = 0.005). No statistically significant difference was found between all three plans in terms of homogeneity index mean values (P = 0.076). The calculated mean TCP values were significantly better for 7IMRT plans when compared to OLAF and 5IMRT plans (P = 0.007 and P = 0.017, respectively). Both NTCP and COSI evaluations, which is compatible with DVH, significantly favored OLAF plan for spinal cord and 7IMRT for thyroid gland. The COSI evaluations, which are compatible with DVH, significantly favored 7IMRT plan for carotid arteries and 5IMRT plan for NT. Conclusion Our results demonstrated that CIPADDICK-TCP calculations for PTV and COSI-NTCP calculations for OARs were compatible with DVH in T1 GL plans. Therefore, we suggest such parameters as valuable tools for choosing the feasible one among multiple plans and even with different treatment machines.
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Affiliation(s)
- Aysun Inal
- Department of Radiation Oncology, Medical Physics Division, Antalya Research and Treatment Hospital, Medical Sciences University, Antalya, Turkey
| | - Evrim Duman
- Department of Radiation Oncology, Antalya Research and Treatment Hospital, Medical Sciences University, Antalya, Turkey
| | - Elif E Ozkan
- Department of Radiation Oncology, Suleyman Demirel University, Isparta, Turkey
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Sharma A, Bahl A. Intensity-modulated radiation therapy in head-and-neck carcinomas: Potential beyond sparing the parotid glands. J Cancer Res Ther 2020; 16:425-433. [PMID: 32719246 DOI: 10.4103/jcrt.jcrt_880_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Head-and-neck cancer (HNC) is in close proximity to several critical structures. Intensity-modulated radiation therapy (IMRT) has the potential of generating highly conformal and concave dose distributions around complex target and is ideally suited for HNC treatment. Conventionally, the focus of IMRT for HNC patients has been on prevention of radiation-induced parotid dysfunction. In the present article, we review the potential of IMRT to reduce the risk of posttreatment aspiration and dysphagia and spare submandibular gland. We also discuss the impact of IMRT on overall survival and quality of life (QoL) for HNC patients. Small retrospective and prospective studies show that reducing dose to adjoining organs at risks is feasible and decreases the risk of posttreatment dysphagia and aspiration without compromising local control. IMRT is associated with improved QoL in several important domains including swallowing, dry mouth, sticky saliva, social eating, and opening of the mouth; however, improvement in global QoL is inconsistent. Delivery of IMRT for HNC is associated with improved survival at nasopharyngeal subsite. Small studies demonstrate improved treatment outcomes with swallowing-sparing IMRT. These results now need validation within the prospective multicenter randomized controlled trial setting.
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Affiliation(s)
- Aman Sharma
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Amit Bahl
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
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Is 5 mm breath-hold window (BHW) sufficient to treat carcinoma left breast patients post-conservative surgery: a comparative study using forward intensity-modulated radiotherapy (FIMRT) and volumetric modulated arc therapy (VMAT). JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurpose:The purpose of the study was to evaluate the impact of changes in breathing pattern inside the breath-hold window (BHW) during deep inspiration breath hold treatment for carcinoma left breast patients post-conservative surgery.Methods:Ten patients of carcinoma left breast post-conservative surgery were prospectively selected. Three sets of CT plain images were acquired, one with 5 mm deep inspiration BHW (DIBHR) and the other one with 1 mm BHW matching the lower threshold (DIBHL) and the third one with 1 mm BHW matching the upper threshold (DIBHH) as DIBHR. For all patients, forward intensity-modulated radiotherapy (FIMRT) and volumetric modulated arc therapy (VMAT) plans were generated in the 5 mm BHW CT series and the same plan being copy and pasted in other series. Target volume doses and critical structure doses were tabulated.Results:Planning target volume coverage was adequate and no significant differences were found in any CT series. Significant differences noted in average left lung V5%, V10% and V18% doses between DIBHR versus DIBHH (p values = 0·0461, 0·0283 and 0·0213, respectively) and DIBHL versus DIBHH (p values = 0·0434, 0·0484 and 0·0334, respectively) for FIMRT plans and V18% doses in DIBHR versus DIBHH (p = 0·0067) in VMAT. No differences in heart and apex of heart doses were found. Left anterior descending artery (LAD) mean doses were significant in DIBHL versus DIBHR, DIBHR versus DIBHH and DIBHL versus DIBHH (p = 0·0012, 0·0444 and 0·0048, respectively) series for FIMRT plans and DIBHR versus DIBHH and DIBHL versus DIBHH (p = 0·0341, 0·0001) for VMAT plans.Finding:The changes in the breathing pattern inside DIBH window level cause some variation in LAD doses and no other significant differences in any parameters noted, so care should be taken while treating patients with preexisting cardiac conditions.
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Gupta T, Sinha S, Ghosh-Laskar S, Budrukkar A, Mummudi N, Swain M, Phurailatpam R, Prabhash K, Agarwal JP. Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial. Radiat Oncol 2020; 15:218. [PMID: 32938468 PMCID: PMC7493335 DOI: 10.1186/s13014-020-01666-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare long-term disease-related outcomes and late radiation morbidity between intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in head and neck squamous cell carcinoma (HNSCC) in the setting of a prospective randomized controlled trial. Methods Previously untreated patients with early to moderately advanced non-metastatic squamous carcinoma of the oropharynx, larynx, or hypopharynx (T1-T3, N0-N2b, M0) planned for comprehensive irradiation of primary site and bilateral neck nodes were randomly assigned to either IMRT or 3D-CRT after written informed consent. Patients were treated with 6MV photons to a total dose of 70Gy/35 fractions over 7 weeks (3D-CRT) or 66Gy/30 fractions over 6 weeks (IMRT). A sample size of 60 patients was estimated to demonstrate 35% absolute difference in the incidence of ≥grade 2 acute xerostomia between the two arms. All time-to-event outcomes were calculated from date of randomization until the defined event using the Kaplan-Meier method. Results At a median follow-up of 140 months for surviving patients, 10-year Kaplan-Meier estimates of loco-regional control (LRC); progression-free survival (PFS); and overall survival (OS) with 95% confidence interval (95%CI) were 73.6% (95%CI: 61.2–86%); 45.2% (95%CI: 32–58.4%); and 50.3% (95%CI: 37.1–63.5%) respectively. There were no significant differences in 10-year disease-related outcomes between 3D-CRT and IMRT for LRC [79.2% (95%CI: 62.2–96.2%) vs 68.7% (95%CI: 51.1–86.3%), p = 0.39]; PFS [41.3% (95%CI: 22.3–60.3%) vs 48.6% (95%CI: 30.6–66.6%), p = 0.59]; or OS [44.9% (95%CI: 25.7–64.1%) vs 55.0% (95%CI: 37–73%), p = 0.49]. Significantly lesser proportion of patients in the IMRT arm experienced ≥grade 2 late xerostomia and subcutaneous fibrosis at all time-points. However, at longer follow-up, fewer patients remained evaluable for late radiation toxicity reducing statistical power and precision. Conclusions IMRT provides a clinically meaningful and sustained reduction in the incidence of moderate to severe xerostomia and subcutaneous fibrosis compared to 3D-CRT without compromising disease-related outcomes in long-term survivors of non-nasopharyngeal HNSCC.
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Affiliation(s)
- Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India.
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India
| | - Reena Phurailatpam
- Department of Medical Physics, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Education & Research in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Mumbai, 410210, India
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Phantom dosimetry and cancer risks estimation undergoing 6 MV photon beam by an Elekta SL-25 linac. Appl Radiat Isot 2020; 163:109232. [PMID: 32561064 DOI: 10.1016/j.apradiso.2020.109232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/25/2020] [Accepted: 05/17/2020] [Indexed: 01/15/2023]
Abstract
The High-energy linear accelerator (linac) is a valuable tool and the most commonly used devices for external beam radiation treatments in subjects suffer from cancer. To estimate the dose deposited in several organs of a female patient due to pelvic irradiation by an Elekta SL-25 linac in 6 MV photon beam mode, the MCNPX code is used considering the most details of linac. The equivalent dose in different organs is computed according to the face down position (prone) of MIRD and UFRO phantoms. The data obtained using MCNPX show that the received dose in all commons organs of MIRD and UFRO phantoms is 535.73 and 433.09 mSv/Gyx, respectively. The risks of second cancer incidence and mortality during radiotherapy treatment are compared between MIRD and UFRO phantoms. The results indicated that bladder has the maximum risk of secondary cancer incidence risk of 142.85 and 135.34 per 105 persons based on MIRD and UFRO phantoms, respectively; while the total risk is about 1 in 163 and about 1 in 101 in these phantoms.
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133
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Xie Y, Guo B, Zhang R. Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:26. [PMID: 32774176 PMCID: PMC7398314 DOI: 10.1186/s12962-020-00222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Prior cost-effectiveness studies of post-mastectomy radiotherapy (PMRT) only compared conventional radiotherapy versus no radiotherapy and only considered tumor control. The goal of this study was to perform cost-effectiveness analyses of standard of care (SOC) and advanced PMRT techniques including intensity-modulated radiotherapy (IMRT), standard volumetric modulated arc therapy (STD-VMAT), non-coplanar VMAT (NC-VMAT), multiple arc VMAT (MA-VMAT), Tomotherapy (TOMO), mixed beam therapy (MIXED), and intensity-modulated proton therapy (IMPT). Methods Using a Markov model, we estimated the cost-effectiveness of various techniques over 15 years. A cohort of women (55-year-old) was simulated in the model, and radiogenic side effects were considered. Transition probabilities, utilities, and costs for each health state were obtained from literature and Medicare data. Model outcomes include quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Results For the patient cohort, STD-VMAT has an ICER of $32,617/QALY relative to SOC; TOMO is dominated by STD-VMAT; IMRT has an ICER of $19,081/QALY relative to STD-VMAT; NC-VMAT, MA-VMAT, MIXED are dominated by IMRT; IMPT has an ICER of $151,741/QALY relative to IMRT. One-way analysis shows that the probability of cardiac toxicity has the most significant impact on the model outcomes. The probability sensitivity analyses show that all advanced PMRT techniques are more cost-effective than SOC at a willingness-to-pay (WTP) threshold of $100,000/QALY, while almost none of the advanced techniques is more cost-effective than SOC at a WTP threshold of $50,000/QALY. Conclusion Advanced PMRT techniques are more cost-effective for breast cancer patients at a WTP threshold of $100,000/QALY, and IMRT might be a cost-effective option for PMRT patients.
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Affiliation(s)
- Yibo Xie
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA USA
| | - Beibei Guo
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA USA
| | - Rui Zhang
- Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA USA.,Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA USA
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134
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Scaggion A, Fusella M, Agnello G, Bettinelli A, Pivato N, Roggio A, Rossato MA, Sepulcri M, Paiusco M. Limiting treatment plan complexity by applying a novel commercial tool. J Appl Clin Med Phys 2020; 21:27-34. [PMID: 32436656 PMCID: PMC7484888 DOI: 10.1002/acm2.12908] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE A recently introduced commercial tool is tested to assess whether it is able to reduce the complexity of a treatment plan and improve deliverability without compromising overall quality. METHODS Ten prostate and ten oropharynx plans of previously treated patients were reoptimized using the aperture shape controller (ASC) tool recently introduced in Eclipse TPS (Varian Medical Systems, Palo Alto, CA). The performance of ASC was assessed in terms of the overall plan quality using a plan quality metric, the reduction in plan complexity through the analysis of 14 of the most common plan complexity metrics, and the change in plan deliverability through 3D dosimetric measurements. Similarly, plans optimized limiting the total number of delivered monitor units was assessed and compared. The two strategies were also combined to assess their potential combination. RESULTS The plans optimized by exploiting the ASC generally show a reduced number of total Monitor Units, a more constant gantry rotation and a MLC modulation characterized by larger and less complicated shapes with leaves traveling shorter overall lengths. CONCLUSIONS This first experience suggests that the ASC is an effective tool to reduce the unnecessary complexity of a plan. This turns into an increased plan deliverability with no loss of plan quality.
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Affiliation(s)
| | - Marco Fusella
- Medical Physics DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
| | | | - Andrea Bettinelli
- Medical Physics DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
| | - Nicola Pivato
- Medical Physics DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
| | - Antonella Roggio
- Medical Physics DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
| | - Marco A. Rossato
- Medical Physics DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
| | - Matteo Sepulcri
- Radiation Oncology DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
| | - Marta Paiusco
- Medical Physics DepartmentVeneto Institute of Oncology IOV‐IRCCSPadovaItaly
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135
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Haciislamoglu E, Gungor G, Aydin G, Canyilmaz E, Guler OC, Zengin AY, Yenice KM. Estimation of secondary cancer risk after radiotherapy in high-risk prostate cancer patients with pelvic irradiation. J Appl Clin Med Phys 2020; 21:82-89. [PMID: 32671989 PMCID: PMC7497909 DOI: 10.1002/acm2.12972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/13/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022] Open
Abstract
We aimed to estimate the risk of secondary cancer after radiotherapy (RT) in high‐risk prostate cancer (HRPC) patients with pelvic irradiation. Computed tomography data of five biopsy‐proven HRPC patients were selected for this study. Two different planning target volumes (PTV1 and PTV2) were contoured for each patient. The PTV1 included the prostate, seminal vesicles, and pelvic lymphatics, while the PTV2 included only the prostate and seminal vesicles. The prescribed dose was 54 Gy for the PTV1 with a sequential boost (24 Gy for the PTV2). Intensity‐modulated RT (IMRT) and volumetric modulated arc therapy (VMAT) techniques were used to generate treatment plans with 6 and 10 MV photon energies with the flattening filter (FF) or flattening filter‐free (FFF) irradiation mode. The excess absolute risks (EARs) were calculated and compared for the bladder, rectum, pelvic bone, and soft tissue based on the linear‐exponential, plateau, full mechanistic, and specific mechanistic sarcoma dose‐response model. According to the models, all treatment plans resulted in similar risks of secondary bladder or rectal cancer and pelvic bone or soft tissue sarcoma except for the estimated risk of the bladder according to the full mechanistic model using IMRT(6MV;FF) technique compared with VMAT techniques with FFF options. The overall estimation of EAR indicated that the radiation‐induced cancer risk due to RT in HRPC was lower for bladder than the rectum. EAR values ranged from 1.47 to 5.82 for bladder and 6.36 to 7.94 for rectum, depending on the dose–response models used. The absolute risks of the secondary pelvic bone and soft tissue sarcoma were small for the plans examined. We theoretically predicted the radiation‐induced secondary cancer risk in HRPC patients with pelvic irradiation. Nevertheless, prospective clinical trials, with larger patient cohorts with a long‐term follow‐up, are needed to validate these model predictions.
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Affiliation(s)
- Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey
| | - Gokhan Aydin
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Ahmet Yasar Zengin
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Kamil Mehmet Yenice
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, IL, USA
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136
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de Angelis de Carvalho N, Niitsuma BN, Kozak VN, Costa FD, de Macedo MP, Kupper BEC, Silva MLG, Formiga MN, Volc SM, Aguiar Junior S, Palmero EI, Casali-da-Rocha JC, Carraro DM, Torrezan GT. Clinical and Molecular Assessment of Patients with Lynch Syndrome and Sarcomas Underpinning the Association with MSH2 Germline Pathogenic Variants. Cancers (Basel) 2020; 12:E1848. [PMID: 32659967 PMCID: PMC7408879 DOI: 10.3390/cancers12071848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022] Open
Abstract
Lynch syndrome (LS) is a hereditary cancer-predisposing syndrome associated most frequently with epithelial tumors, particularly colorectal (CRC) and endometrial carcinomas (EC). The aim of this study was to investigate the relationship between sarcomas and LS by performing clinical and molecular characterization of patients presenting co-occurrence of sarcomas and tumors from the LS spectrum. We identified 27 patients diagnosed with CRC, EC, and other LS-associated tumors who had sarcomas in the same individuals or families. Germline genetic testing, mismatch repair (MMR) protein immunohistochemistry, microsatellite instability (MSI), and other molecular analyses were performed. Five LS patients presenting personal or family history of sarcomas were identified (3 MSH2 carriers and 2 MLH1), with 2 having Muir-Torre phenotypes. For two MSH2 carriers we confirmed the etiology of the sarcomas (one liposarcoma and two osteosarcomas) as LS-related, since the tumors were MSH2/MSH6-deficient, MSI-high, or presented a truncated MSH2 transcript. Additionally, we reviewed 43 previous reports of sarcomas in patients with LS, which revealed a high frequency (58%) of MSH2 alterations. In summary, sarcomas represent a rare clinical manifestation in patients with LS, especially in MSH2 carriers, and the analysis of tumor biological characteristics can be useful for definition of tumor etiology and novel therapeutic options.
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Affiliation(s)
- Nathália de Angelis de Carvalho
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
| | - Bianca Naomi Niitsuma
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
| | - Vanessa Nascimento Kozak
- Oncogenetics Service, Hospital Erasto Gaertner, Curitiba 81520-060, Brazil; (V.N.K.); (J.C.C.-d.-R.)
- Postgraduate Program in Genetics, Federal University of Parana, Curitiba 81530-000, Brazil
| | - Felipe D’almeida Costa
- Anatomic Pathology Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (F.D.C.); (M.P.d.M.)
| | - Mariana Petaccia de Macedo
- Anatomic Pathology Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (F.D.C.); (M.P.d.M.)
| | - Bruna Elisa Catin Kupper
- Colorectal Cancer Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (B.E.C.K.); (S.A.J.)
| | | | | | - Sahlua Miguel Volc
- Faculdades Pequeno Principe, Curitiba 80230-020, Brazil; (S.M.V.); (E.I.P.)
- Oncogenetics Department, Barretos Cancer Hospital, Barretos 14784-400, Brazil
| | - Samuel Aguiar Junior
- Colorectal Cancer Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (B.E.C.K.); (S.A.J.)
| | - Edenir Inez Palmero
- Faculdades Pequeno Principe, Curitiba 80230-020, Brazil; (S.M.V.); (E.I.P.)
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-384, Brazil
- Instituto de Pesquisa Pelé Pequeno Principe, Curitiba 80250-060, Brazil
| | - José Cláudio Casali-da-Rocha
- Oncogenetics Service, Hospital Erasto Gaertner, Curitiba 81520-060, Brazil; (V.N.K.); (J.C.C.-d.-R.)
- Oncogenetics Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil;
| | - Dirce Maria Carraro
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
- National Institute of Science and Technology in Oncogenomics (INCITO), São Paulo 01508-010, Brazil
| | - Giovana Tardin Torrezan
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
- National Institute of Science and Technology in Oncogenomics (INCITO), São Paulo 01508-010, Brazil
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137
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König L, Haering P, Lang C, Splinter M, von Nettelbladt B, Weykamp F, Hoegen P, Lischalk JW, Herfarth K, Debus J, Hörner-Rieber J. Secondary Malignancy Risk Following Proton vs. X-ray Treatment of Mediastinal Malignant Lymphoma: A Comparative Modeling Study of Thoracic Organ-Specific Cancer Risk. Front Oncol 2020; 10:989. [PMID: 32733794 PMCID: PMC7358352 DOI: 10.3389/fonc.2020.00989] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose: Proton radiotherapy (PRT) is potentially associated with a lower risk for secondary malignancies due to a decreased integral dose to the surrounding organs at risk (OARs). Prospective trials confirming this are lacking due to the need for long-term follow-up and the ethical complexities of randomizing patients between modalities. The objective of the current study is to calculate the risk for secondary malignancies following PRT and photon-based intensity-modulated radiotherapy (IMRT). Materials and Methods: Twenty-three patients (16 female and seven male), previously treated with active scanning PRT for malignant mediastinal lymphoma at Heidelberg Ion Beam Therapy Center, were retrospectively re-planned using helical photon IMRT. The risk for radiation-induced secondary malignancies was estimated and evaluated using two distinct prediction models (1–4). Results: According to the Dasu model, the median absolute total risk for tumor induction following IMRT was 4.4% (range, 3.3–5.8%), 9.9% (range, 2.0–27.6%), and 1.0% (range, 0.5–1.5%) for lung, breast, and esophageal cancer, respectively. For PRT, it was significantly lower for the aforementioned organs at 1.6% (range, 0.7–2.1%), 4.5% (range, 0.0–15.5), and 0.8% (range, 0.0–1.6%), respectively (p ≤ 0.01). The mortality risk from secondary malignancies was also significantly reduced for PRT relative to IMRT at 1.1 vs. 3.1% (p ≤ 0.001), 0.9 vs. 1.9% (p ≤ 0.001), and 0.7 vs. 1.0% (p ≤ 0.001) for lung, breast, and esophageal tumors, respectively. Using the Schneider model, a significant risk reduction of 54.4% (range, 32.2–84.0%), 56.4% (range, 16.0–99.4%), and 24.4% (range, 0.0–99.0%) was seen for secondary lung, breast, and esophageal malignancies, favoring PRT vs. X-ray-based IMRT (p ≤ 0.01). Conclusion: Based on the two prediction models, PRT for malignant mediastinal lymphoma is expected to reduce the risk for radiation-induced secondary malignancies compared with the X-ray-based IMRT. The young age and the long natural history of patients diagnosed with mediastinal lymphoma predisposes them to a high risk of secondary malignancies following curative radiotherapy treatment and, as a consequence, potentially reducing this risk by utilizing advanced radiation therapy techniques such as PRT should be considered.
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Affiliation(s)
- Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Haering
- Department for Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Clemens Lang
- Department for Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Mona Splinter
- Department for Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Bastian von Nettelbladt
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jonathan W Lischalk
- Department of Radiation Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department for Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department for Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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138
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Nithya L, Goel V, Sharma D, Vittal K, Marjara N. Dosimetric Comparison of Different Planning Techniques in Left-sided Whole-Breast Irradiation: A Planning Study. J Med Phys 2020; 45:148-155. [PMID: 33487927 PMCID: PMC7810142 DOI: 10.4103/jmp.jmp_49_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose: This planning study compared the various dosimetric parameters of different types of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques for left-sided breast cancer radiotherapy. Materials and Methods: Treatment of 22 left-sided breast cases was planned using two IMRT and VMAT techniques for the prescription of 40 Gy in 15 fractions. For tangential IMRT (Tan_IMRT), five beams were placed as conventional tangential beams. For equally spaced IMRT (Equi_IMRT), six beams were placed equidistantly at 40° interval from 300° to 140°. For tangential VMAT (Tan_VMAT), two arcs were used with the avoidance sector in such a way that the beam covered like tangential fields. For full-arc VMAT (Full_VMAT), similar arcs as Tan_VMAT were used, without avoidance sector. All treatment plans were generated using Eclipse planning system for TrueBeam STx linear accelerator. For planning target volume (PTV), dose parameters including D95%, D99%, V105% homogeneity index (HI), and conformity index (CI) were analyzed. Different dose parameters for the left lung, heart, left anterior descending artery (LAD), right lung, and right breast were also analyzed. In addition, low-dose spillage in the normal tissues and the number of monitor units (MUs) required for the treatment were compared. Results: IMRT technique exhibited superior D95% and D99% for PTV compared with VMAT techniques. VMAT plans provided more V105% (6%) compared with that of IMRT plans (approximately 1%). HI was better in IMRT plans (Tan_IMRT, 0.085 ± 0.015; Equi_IMRT, 0.094 ± 0.011) than in VMAT plans. CI was better in VMAT plans. The mean lung dose (7.7 Gy ± 1.788 Gy) and V5Gy (34.99% ± 6.799%) were better achieved in Tan_IMRT plan than other plans. Right lung, heart, and right breast sparing were better achieved in Tan_IMRT plan. Moreover, low-dose spillage was very less in the Tan_IMRT compared with all other techniques. Conclusion: Dosimetric comparison in this study showed that tangential IMRT technique is superior in terms of target coverage, sparing of lung, heart, and right breast, and low-dose spillage control in the left-sided breast-only radiotherapy.
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Affiliation(s)
- L Nithya
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
| | - Vineeta Goel
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
| | - Deepti Sharma
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India.,Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karthik Vittal
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
| | - Nidhi Marjara
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
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139
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Liu C, Liao L, Wu G, Yan H, Chen X, Wang C, Zheng X, Zeng Z, Zhao Z, Wu D, Liu X. Radiation-induced second primary squamous cell carcinoma of the oral cavity after radiotherapy for nasopharyngeal carcinoma. Oral Oncol 2020; 109:104863. [PMID: 32604060 DOI: 10.1016/j.oraloncology.2020.104863] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/10/2020] [Accepted: 06/14/2020] [Indexed: 12/08/2022]
Abstract
BACKGROUND The increasing occurrence of radiation-induced second primary squamous cell carcinoma of the oral cavity (RISCCO) after radiotherapy for nasopharyngeal carcinoma (NPC) has become a noteworthy complication that can influence long-term survival. This study aimed to analyze the associations of clinicopathologic characteristics with prognostic factors among patients who developed RISCCO after radiotherapy for NPC. METHODS A total of 41,446 NPC patients admitted to Sun Yat-sen University Cancer Center (SYSUCC) between August 1989 and January 2019 were reviewed. Among these patients, 88 RISCCO patients who satisfied the inclusion criteria were included in the study. RESULTS During our study, the incidence of RISCCO after radiotherapy was 0.21% (88/41,446) among NPC patients at SYSUCC. The latency period ranged from 1.0 to 34.0 years (median, 9.0 years), and the latency of RISCCO was notably shorter for patients who received intensity-modulated radiation therapy than that for patients who received conventional radiotherapy using cobalt-60 or 6-MV X-rays (median, 4.0 years vs. 11.0 years, P = 0.013). The 1-, 3-, and 5-year overall survival (OS) rates for the entire cohort of 88 patients were 79.0%, 46.6%, and 35.2%, respectively. The 5-year OS rate for the 79 patients who received treatment was 45.7%, and the 5-year OS rate for the 9 patients who refused treatment was 0%. T classification and surgery were identified as independent prognostic factors associated with a high OS rate. CONCLUSIONS Surgery as the first-choice treatment may improve survival and prognosis. A long-term follow-up is needed for early detection of RISCCO in NPC patients.
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Affiliation(s)
- Chao Liu
- School of Stomatology, Jilin University, Changchun 130041, Jilin, PR China
| | - Lieqiang Liao
- Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, PR China
| | - Guoying Wu
- Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, PR China
| | - Honghong Yan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Xiaoqi Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Chao Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Xiajing Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Ziyi Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Zheng Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Di Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Xuekui Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China.
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140
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Wong G, Lam E, Karam I, Yee C, Drost L, Tam S, Lam H, McCarvell A, McKenzie E, Chow E. The impact of smoking on adjuvant breast cancer radiation treatment: A systematic review. Cancer Treat Res Commun 2020; 24:100185. [PMID: 32593846 DOI: 10.1016/j.ctarc.2020.100185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The influence of cigarette smoking on cancer risk has been well-studied. Similarly, exposure to ionizing radiation from radiotherapy (RT) can produce detrimental effects on an individual's health. In patients administered RT, there has been an observed relationship in other primary carcinomas. The purpose of this systematic review was to summarize the influence of cigarette smoking on outcomes post adjuvant RT in breast cancer patients. METHODS OVID Medline, Cochrane and Embase were searched and 1893 articles were identified. A total of 71 articles were included in the review. Study type, published year and sample size, age, systemic therapies, RT techniques and treatment side effects were collected if available. RESULTS The review found 198 different outcomes which fell into 7 categories and similar outcomes were recorded. 40% of skin reaction outcomes, 50% of cardiovascular outcomes, 71% of reconstruction outcomes, 29% of pulmonary function outcomes, 33% of mortality outcomes and 42% of secondary recurrence outcomes reported significant differences between smokers and non-smokers. None of the articles reported non-smokers to have a higher risk than smokers. CONCLUSION Cigarette smoking can pose a higher risk of post-treatment complications that can influence an individual's quality of life, survival rate and/or recurrence risk. This review further assessed the impact of smoking on various patient outcomes and side-effects in the adjuvant breast RT setting. The information provided in this review suggest that smoking cessation programs would help educate patients to understand their risks of being a current or former smoker when undergoing RT.
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Affiliation(s)
- Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caitlin Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Tam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alyson McCarvell
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin McKenzie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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141
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Han C, Liu A, Wong JYC. Estimation of radiation-induced, organ-specific, secondary solid-tumor occurrence rates with total body irradiation and total marrow irradiation treatments. Pract Radiat Oncol 2020; 10:e406-e414. [PMID: 32302694 DOI: 10.1016/j.prro.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE We aimed to predict and compare radiation-induced, organ-specific, secondary solid-tumor occurrence risks from conventional total body irradiation (TBI) and total marrow irradiation (TMI) for patients undergoing hematopoietic cell transplant. METHODS AND MATERIALS We retrospectively selected 20 patients who received TMI treatments before hematopoietic cell transplant. Ten patients (5 men; 5 women) received 12 Gy to the skeletal bones, lymph nodes, and spleen, and the other 10 patients (5 men; 5 women) received an escalated dose of 20 Gy to the same targets and 12 Gy to the brain and liver. A conventional TBI treatment plan was generated for each patient with a prescription dose of 12 Gy, using anterior-posterior and posterior-anterior photon beams with lung shielding and a chest wall boost with electron beams. Secondary cancer risks were estimated using linear-exponential and plateau models for major organs. RESULTS At the 12 Gy dose level, using the linear-exponential model, the total radiation-induced secondary solid-tumor risks for major organs were 159.3 ± 8.7 for men and 221.5 ± 14.4 for women per 10,000 people per year with the TMI plans, which is a reduction of 38.8% and 32.9%, respectively, compared with those with the TBI plans. At the 20 Gy dose level, the risks were 220.3 ± 8.3 for men and 298.5 ± 9.3 for women with the TMI plans, which is a reduction of 14.6% and 9.2%, respectively, compared with those with the 12 Gy TBI plans. Significant risk reductions were also found with the TMI plans using the plateau risk model. CONCLUSIONS At both the 12 Gy and 20 Gy prescription dose levels, a conditioning regimen using TMI could significantly lower overall radiation-induced secondary solid-tumor risks for major organs compared with a conditioning regimen with standard 12 Gy TBI. Clinical data from long-term follow-up studies are needed to verify the model predictions.
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Affiliation(s)
- Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
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Kumawat N, Shrotriya AK, Heigrujam MS, Kumar S, Semwal MK, Bansal AK, Munjal RK, Mittal DK, Garg C, Anand AK. The Composite Planning Technique in Left Sided Breast Cancer Radiotherapy: A Dosimetric Study. Eur J Breast Health 2020; 16:137-145. [PMID: 32285036 DOI: 10.5152/ejbh.2020.5370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/09/2020] [Indexed: 11/22/2022]
Abstract
Objective The aim of this retrospective study is to reduce the dose of heart, both lung and opposite breast and left anterior descending artery (LAD) and avoid long term complication and radiation induced secondary malignancies in radiotherapy left breast/chest wall without losing homogeneity and conformity of the Planning Target Volume (PTV), contoured using Radiotherapy Oncology Group (RTOG 1005) guideline. Materials and Methods The treatment plans were generated retrospectively by TFIF, VMAT and Composite techniques for 30 patients. Dose-Volume Histograms (DVHs) were evaluated for PTV and organs at risk (OAR's) and analyzed in two groups BCS and MRM using Wilcoxon signed rank test. Results The homogeneity index (HI) was improved in Composite technique by 32.72% and 21.81% of VMAT, 50.66% and 49.41% of TFIF in BCS and MRM group respectively. The Conformity Index (CI) for composite plan was statistically same as VMAT and superior by 27.94% and 41.37% of TFIF in BCS and MRM group respectively. The low dose volume V5Gy and V10Gy of the heart were improved in Composite plan by 47.9% and 26.1% of VMAT respectively in BCS group and in MRM group, improved by 21.2% and 45.6% of VMAT. The V5Gy and V10Gy of ipsilateral lung were improved in Composite plan by 16% and 13.7% of VMAT respectively in BCS and 8.4% and 3% of VMAT respectively in MRM group. Conclusion The Composite plan consisting of VMAT and TFIF plan with an optimum selection of fractions can achieve lower low dose exposure to the OAR's without compromising coverage compared to VMAT.
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Affiliation(s)
- Naveen Kumawat
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | | | | | - Satendra Kumar
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Manoj Kumar Semwal
- Department of Radiotherapy, Radiotherapy Army Hospital (Research and Referral), New Delhi, India
| | - Anil Kumar Bansal
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Ram Kishan Munjal
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Deepak Kumar Mittal
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Charu Garg
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Anil Kumar Anand
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
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143
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Haciislamoglu E, Cinar Y, Eren M, Canyilmaz E, Gurcan F, Serdar L, Yoney A. Comparison of Radiation-Induced Secondary Malignancy Risk Between Sequential and Simultaneous Integrated Boost for the Treatment of Nasopharyngeal Carcinoma: Intensity-Modulated Radiotherapy versus Volumetric-Modulated Arc Therapy. Cancer Manag Res 2020; 12:2513-2521. [PMID: 32308488 PMCID: PMC7152539 DOI: 10.2147/cmar.s244901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/19/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This study aimed to compare the secondary cancer risk (SCR) between the sequential boost (SEQ) technique and simultaneous integrated boost (SIB) technique in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with nasopharyngeal carcinoma (NPC) using the concepts of organ equivalent dose (OED) and excess absolute risk (EAR). PATIENTS AND METHODS IMRT-SEQ, VMAT-SEQ, IMRT-SIB, and VMAT-SIB plans were created with identical objective functions for five patients with early-stage NPC. Three different planning tumor volumes (PTVs; PTV1, PTV2, and PTV3) were delineated for each patient, and the prescribed doses were 50 Gy, 60 Gy, and 70 Gy (2 Gy/fraction), respectively, for the SEQ technique and 52.8 Gy, 59.4 Gy, and 69.3 Gy (33 fractions), respectively, for the SIB technique. RESULTS All plans were clinically acceptable. There was no difference in most OED-based SCRs between IMRT and VMAT when the same fractionation scheme was used. Compared with the SEQ technique, the SIB technique in IMRT and VMAT was associated with the lowest OEDs for the oral cavity, pharynx, parotids, and submandibular glands, resulting in SCR reduction. SCR for the parotids was much lower than that for the other assessed organs when the SIB technique was used. CONCLUSION Our findings suggest that OED-based SCRs are lower with the SIB technique than with the SEQ technique in IMRT and VMAT in most organs for which SCR was calculated; furthermore, SCR for the parotids is much lower than that for other organs when the SIB technique is used in patients with NPC.
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Affiliation(s)
- Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yunus Cinar
- Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mehmet Eren
- Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Fatih Gurcan
- Department of Computer Engineering, Faculty of Engineering, Karadeniz Technical University, Trabzon, Turkey
| | - Lasif Serdar
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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144
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Vogel J, Carmona R, Ainsley CG, Lustig RA. The Promise of Proton Therapy for Central Nervous System Malignancies. Neurosurgery 2020; 84:1000-1010. [PMID: 30476191 DOI: 10.1093/neuros/nyy454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 08/28/2018] [Indexed: 11/15/2022] Open
Abstract
Radiation therapy plays a significant role in management of benign and malignant diseases of the central nervous system. Patients may be at risk of acute and late toxicity from radiation therapy due to dose deposition in critical normal structures. In contrast to conventional photon delivery techniques, proton therapy is characterized by Bragg peak dose deposition which results in decreased exit dose beyond the target and greater sparing of normal structure which may reduce the rate of late toxicities from treatment. Dosimetric studies have demonstrated reduced dose to normal structures using proton therapy as compared to photon therapy. In addition, clinical studies are being reported demonstrating safety, feasibility, and low rates of acute toxicity. Technical challenges in proton therapy remain, including full understanding of depth of proton penetration and the biological activity in the distal Bragg peak. In addition, longer clinical follow-up is required to demonstrate reduction in late toxicities as compared to conventional photon-based radiation techniques. In this review, we summarize the current clinical literature and areas of active investigation in proton therapy for adult central nervous system malignancies.
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Affiliation(s)
- Jennifer Vogel
- Department of Rad-iation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruben Carmona
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Christopher G Ainsley
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Robert A Lustig
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
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145
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Murtaza G, Mehmood S, Silvia Favretto M, Cora S. Optimal VMAT Delivery for Elekta MLC Beam Modulator: A Study of Collimator Rotation for Head and Neck Planning. J Med Imaging Radiat Sci 2020; 51:289-298. [PMID: 32229103 DOI: 10.1016/j.jmir.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Well-optimized treatment planning parameters are vital for optimum beam delivery in advanced radiotherapy techniques. The Elekta "Beam-Modulator" (BM) is a high-resolution multileaf collimation system where each individual leaf is 4 mm wide at the isocentre, without backup diaphragms and jaws. Its maximum aperture is 21 × 16 cm2, which results in a limited clinical use for the target geometry of maximum 20 cm in length. The collimator rotation provides an opportunity to treat slightly extended treatment length with optimal target coverage. The study aims to observe the collimator rotation influence on volumetric modulated arc therapy (VMAT) plan quality for different head and neck target geometries using limited field collimator of BM. METHODS Ten patients with head and neck cancer were planned by means of simultaneous integrated boost to deliver VMAT for five patients with three dose levels (70/60/56) and five patients with two dose levels (60/54). The single arc, dual arc, and combined two independent single arcs of 356° each were well optimized for four collimator angles (C) 15°,30°, 45°, and 90°. The plans were prepared for BM with SmartArc module of Pinnacle³ treatment planning system. Statistical significance (P ≤ .05) among collimator angles for planning target volume dose-volume indices was calculated with Student's t-test. Organ-at-risk doses were compared and monitor units were also evaluated as a parameter for dose-delivery efficiency and out-of-field dose index. RESULTS The dual arc and combined two independent single arcs achieved planning objectives for C15°, C30°, and C45°. Single arc for all collimator angles and C90° for all VMAT schemes failed to achieve planning objectives. The spread of low dose bath 20, 35, and 40 Gy and deterioration of doses were higher towards periphery at C90° and statistically significant. CONCLUSION The small and medium collimator angles for dual-arc VMAT scheme(s) are suitable, whereas single arc and C90° are not suitable in VMAT implementation for Elekta Beam-Modulator collimation system.
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Affiliation(s)
- Ghulam Murtaza
- Medical Imaging Department, School of Health Sciences, University of Management & Technology, Lahore, Pakistan.
| | - Shahid Mehmood
- Medical Imaging Department, School of Health Sciences, University of Management & Technology, Lahore, Pakistan; Medical Physics Oncology Department, Combined Military Hospital, Rawalpindi, Pakistan
| | | | - Stefania Cora
- Medical Physics Department, San Bortolo Hospital, Vicenza, Italy
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146
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Allam O, Park KE, Chandler L, Mozaffari MA, Ahmad M, Lu X, Alperovich M. The impact of radiation on lymphedema: a review of the literature. Gland Surg 2020; 9:596-602. [PMID: 32420295 PMCID: PMC7225495 DOI: 10.21037/gs.2020.03.20] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022]
Abstract
Radiation therapy (RT) is a common adjunct therapy in oncology. However, it carries a significant risk of lymphedema when utilized in some anatomic locations. Recent studies have provided insight into lymphedema pathophysiology, diagnostic techniques, and RT. This review will examine the role of RT in upper and lower extremity lymphedema. Radiation's role in increasing the risk of lymphedema through decreased lymphatic proliferation potential, interstitial fibrosis compressing lymphatic vessels, and mechanical insufficiency of the lymphatic system will be reviewed.
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Affiliation(s)
- Omar Allam
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Kitae E Park
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Ludmila Chandler
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | | | - Maham Ahmad
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Yale University, New Haven, CT, USA
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147
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Ibbott GS. Patient doses from image-guided radiation therapy. Phys Med 2020; 72:30-31. [PMID: 32197219 DOI: 10.1016/j.ejmp.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
Abstract
Recent publications show that some patients receive high cumulative radiation doses from recurrent CT examinations. Most of these patients had a diagnosis of malignancy, meaning that there was a likelihood that they would receive radiation therapy, possibly with image guidance. Patients receiving X-ray-based image-guided radiation therapy (IGRT) receive even more imaging dose, including to volumes of tissue outside the tumor target volume. The benefits of IGRT must be considered in light of the additional dose received. Monitoring and recording of the imaging dose should be considered, as should techniques to reduce both the dose and volume irradiated.
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148
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Jo IY, Kim ES, Kim WC, Min CK, Yeo S. Dosimetric comparison of incidental axillary irradiation between three‑dimensional conformal and volumetric modulated arc techniques for breast cancer. Mol Clin Oncol 2020; 12:551-556. [DOI: 10.3892/mco.2020.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 02/04/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Chul Kee Min
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Seung‑Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
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149
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Mullins J, Renaud MA, Heng V, Ruo R, DeBlois F, Seuntjens J. Trajectory-based VMAT for cranial targets with delivery at shortened SAD. Med Phys 2020; 47:3103-3112. [PMID: 32198933 DOI: 10.1002/mp.14151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Trajectory-based volumetric modulated arc therapy (tr-VMAT) treatment plans enable the option for noncoplanar delivery yielding steeper dose gradients and increased sparing of critical structures compared to conventional treatment plans. The addition of translational couch motion to shorten the effective source-to-axis distance (SAD) may result in improved delivery precision and an increased effective dose rate. In this work, tr-VMAT treatment plans using a noncoplanar "baseball stitch" trajectory were implemented, applied to patients presented with cranial targets, and compared to the clinical treatment plans. METHODS A treatment planning workflow was implemented: (a) beamlet doses were calculated for control points defined along a baseball stitch trajectory using a collapsed-cone convolution-superposition algorithm; (b) VMAT treatment plans were optimized using the column generation approach; (c) a final dose distribution was calculated in Varian Eclipse using the analytical anisotropic algorithm by importing the optimized treatment plan parameters. Tr-VMAT plans were optimized for ten patients presented with cranial targets at both standard and shortened SAD, and compared to the clinical treatment plans through isodose distributions, dose-volume histograms, and dosimetric indices. The control point specifications of the optimized tr-VMAT plans were used to estimate the delivery time. RESULTS The optimized tr-VMAT plans with both shortened and standard SAD delivery yielded a comparable plan quality to the clinical treatment plans. A statistically significant benefit was observed for dose gradient index and monitor unit efficiency for shortened SAD tr-VMAT plans, while improved target volume conformity was observed for the clinical treatment plan (P ≤ 0.05). A clear dosimetric benefit was not demonstrated between tr-VMAT delivery at shortened SAD compared to standard SAD, but shortened SAD delivery yielded a fraction size-dependent reduction in the estimated delivery time. CONCLUSION The implementation of "baseball stitch" tr-VMAT treatment plans to patients presented with cranial targets demonstrated comparable plan quality to clinical treatment plans. The delivery at shortened SAD produced a fraction size-dependent decrease in estimated delivery time.
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Affiliation(s)
- Joel Mullins
- Department of Physics & Medical Physics Unit, McGill University, Montréal, QC, H4A 3J1, Canada
| | - Marc-André Renaud
- Department of Mathematics and Industrial Engineering, Polytechnique Montréal, Montréal, QC, H3T 1J4, Canada
| | - Veng Heng
- Department of Physics & Medical Physics Unit, McGill University, Montréal, QC, H4A 3J1, Canada
| | - Russell Ruo
- Medical Physics Unit, McGill University Health Centre, Montréal, QC, H4A 3J1, Canada
| | - François DeBlois
- Centre Hospitalier de l'Université de Montréal & Département de Physique, Université de Montréal, Montréal, QC, H2X 3E4, Canada.,McGill University, Montréal, QC, H4A 3J1, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University & Research Institute of the McGill University Health Centre, Montréal, QC, H4A 3J1, Canada
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Callanan GF, Curran KM, Parachini-Winter C, Bracha S, Spagnoli S, Russell DS, Stieger-Vanegas SM, Griffin L, Leeper H. Nasal adenocarcinoma as a suspected secondary malignant neoplasm in a cat previously treated for nasal lymphoma. JFMS Open Rep 2020; 6:2055116920908351. [PMID: 32166040 PMCID: PMC7052471 DOI: 10.1177/2055116920908351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Case summary A case of nasal adenocarcinoma as a suspected secondary malignant neoplasm
following definitive radiation therapy and multiagent chemotherapy for nasal
lymphoma is described. An 11-year-old spayed female domestic shorthair cat
was presented for a 3-week history of progressive facial swelling located
over the nasal planum and extending to the medial canthus of the right eye.
The cat was previously diagnosed with nasal lymphoma and treated with
chemotherapy and definitive radiation 2.5 years prior. Although a definitive
diagnosis could not be obtained via cytology, recurrent lymphoma was
suspected based on the cat’s history and recurrent clinical signs. A
lymphoma-directed chemotherapy protocol was attempted, but no clinical
response was achieved. The cat was euthanased owing to progressive clinical
signs and a diagnosis of nasal adenocarcinoma was made on necropsy
examination. Both the original diagnosis of nasal lymphoma and the secondary
diagnosis of nasal adenocarcinoma were confirmed with
immunohistochemistry. Relevance and novel information Secondary malignant neoplasm following radiation therapy is infrequently
reported in the veterinary literature. In the few reports that exist, most
have described sarcoma development in the dog following radiation therapy.
In the present report, we describe a cat with a suspected radiation-induced
nasal adenocarcinoma that developed 2.5 years after definitive radiation
treatment for nasal lymphoma.
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Affiliation(s)
- Gabrielle F Callanan
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Kaitlin M Curran
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Cyril Parachini-Winter
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Shay Bracha
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Sean Spagnoli
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Duncan S Russell
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Susanne M Stieger-Vanegas
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
| | - Lynn Griffin
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Haley Leeper
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, USA
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