151
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Tumor histology and location predict deep nuclei toxicity: Implications for late effects from focal brain irradiation. Med Dosim 2012; 37:276-9. [DOI: 10.1016/j.meddos.2011.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/10/2011] [Accepted: 10/10/2011] [Indexed: 11/23/2022]
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152
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Intact performance of a cochlear implant following radiotherapy in a child with acute lymphoblastic leukemia. Pract Radiat Oncol 2012; 2:233-236. [DOI: 10.1016/j.prro.2011.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 06/17/2011] [Accepted: 06/20/2011] [Indexed: 11/22/2022]
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153
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Cuneo KC, Zagar TM, Brizel DM, Yoo DS, Hoang JK, Chang Z, Wang Z, Yin FF, Das SK, Green S, Ready N, Bhatti MT, Kaylie DM, Becker A, Sampson JH, Kirkpatrick JP. Stereotactic Radiotherapy for Malignancies Involving the Trigeminal and Facial Nerves. Technol Cancer Res Treat 2012; 11:221-8. [DOI: 10.7785/tcrt.2012.500290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Involvement of a cranial nerve caries a poor prognosis for many malignancies. Recurrent or residual disease in the trigeminal or facial nerve after primary therapy poses a challenge due to the location of the nerve in the skull base, the proximity to the brain, brainstem, cavernous sinus, and optic apparatus and the resulting complex geometry. Surgical resection caries a high risk of morbidity and is often not an option for these patients. Stereotactic radiosurgery and radiotherapy are potential treatment options for patients with cancer involving the trigeminal or facial nerve. These techniques can deliver high doses of radiation to complex volumes while sparing adjacent critical structures. In the current study, seven cases of cancer involving the trigeminal or facial nerve are presented. These patients had unresectable recurrent or residual disease after definitive local therapy. Each patient was treated with stereotactic radiation therapy using a linear accelerator based system. A multidisciplinary approach including neuroradiology and surgical oncology was used to delineate target volumes. Treatment was well tolerated with no acute grade 3 or higher toxicity. One patient who was reirradiated experienced cerebral radionecrosis with mild symptoms. Four of the seven patients treated had no evidence of disease after a median follow up of 12 months (range 2–24 months). A dosimetric analysis was performed to compare intensity modulated fractionated stereotactic radiation therapy (IM-FSRT) to a 3D conformal technique. The dose to 90% (D90) of the brainstem was lower with the IM-FSRT plan by a mean of 13.5 Gy. The D95 to the ipsilateral optic nerve was also reduced with IM-FSRT by 12.2 Gy and the D95 for the optic chiasm was lower with FSRT by 16.3 Gy. Treatment of malignancies involving a cranial nerve requires a multidisciplinary approach. Use of an IM-FSRT technique with a micro-multileaf collimator resulted in a lower dose to the brainstem, optic nerves and chiasm for each case examined.
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Affiliation(s)
- K. C. Cuneo
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - T. M. Zagar
- Department of Radiation Oncology, University of North Carolina School of Medicine Chapel Hill, NC, 27514 USA
| | - D. M. Brizel
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
- Department of Surgery, Division of Otolaryngology, Duke University Medical Center
| | - D. S. Yoo
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - J. K. Hoang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
- Department of Radiology, Division of Neuroradiology, Duke University Medical Center
| | - Z. Chang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - Z. Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - F. F. Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - S. K. Das
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - S. Green
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
| | - N. Ready
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center
| | - M. T. Bhatti
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Duke Eye Center, Duke University Medical Center
| | - D. M. Kaylie
- Department of Surgery, Division of Otolaryngology, Duke University Medical Center
| | - A. Becker
- Department of Surgery, Division of Otolaryngology, Duke University Medical Center
| | - J. H. Sampson
- Department of Surgery, Division of Neurosurgery, Duke University Medical Center Durham, NC, 27710 USA
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center
| | - J. P. Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center
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154
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Hansasuta A, Choi CYH, Gibbs IC, Soltys SG, Tse VCK, Lieberson RE, Hayden MG, Sakamoto GT, Harsh GR, Adler JR, Chang SD. Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases. Neurosurgery 2012; 69:1200-9. [PMID: 21558974 DOI: 10.1227/neu.0b013e318222e451] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Single-session stereotactic radiosurgery (SRS) treatment of vestibular schwannomas results in excellent tumor control. It is not known whether functional outcomes can be improved by fractionating the treatment over multiple sessions. OBJECTIVE To examine tumor control and complication rates after multisession SRS. METHODS Three hundred eighty-three patients treated with SRS from 1999 to 2007 at Stanford University Medical Center were retrospectively reviewed. Ninety percent were treated with 18 Gy in 3 sessions, targeting a median tumor volume of 1.1 cm3 (range, 0.02-19.8 cm3). RESULTS During a median follow-up duration of 3.6 years (range, 1-10 years), 10 tumors required additional treatment, resulting in 3- and 5-year Kaplan-Meier tumor control rates of 99% and 96%, respectively. Five-year tumor control rate was 98% for tumors < 3.4 cm3. Neurofibromatosis type 2-associated tumors were associated with worse tumor control (P = .02). Of the 200 evaluable patients with pre-SRS serviceable hearing (Gardner-Robertson grade 1 and 2), the crude rate of serviceable hearing preservation was 76%. Smaller tumor volume was associated with hearing preservation (P = .001). There was no case of post-SRS facial weakness. Eight patients (2%) developed trigeminal dysfunction, half of which was transient. CONCLUSION Multisession SRS treatment of vestibular schwannomas results in an excellent rate of tumor control. The hearing, trigeminal nerve, and facial nerve function preservation rates reported here are promising.
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Affiliation(s)
- Ake Hansasuta
- Division of Neurological Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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155
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Franco P, Numico G, Migliaccio F, Catuzzo P, Cante D, Ceroni P, Sciacero P, Carassai P, Canzi P, La Porta MR, Girelli G, Borca VC, Pasquino M, Tofani S, Ozzello F, Ricardi U. Head and neck region consolidation radiotherapy and prophylactic cranial irradiation with hippocampal avoidance delivered with helical tomotherapy after induction chemotherapy for non-sinonasal neuroendocrine carcinoma of the upper airways. Radiat Oncol 2012; 7:21. [PMID: 22336394 PMCID: PMC3306202 DOI: 10.1186/1748-717x-7-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background Non-sinonasal neuroendocrine carcinomas (NSNECs) of the head and neck are considered an unfrequent clinico-pathological entity. Combined modality treatment represents an established therapeutic option for undifferentiated forms where distant metastasis is a common pattern of failure. Methods We report on a case of NSNEC treated with sequential chemo-radiation consisting of 6 cycles of cisplatin and etoposide followed by loco-regional radiation to the head and neck and simultaneous prophylactic cranial irradiation to prevent from intracranial spread, delivered with helical tomotherapy with the 'hippocampal avoidance' technique in order to reduce neuro-cognitive late effects. Results One year after the end of the whole combined modality approach, the patient achieved complete remission, with no treatment-related sub-acute and late effects. Conclusions The present report highlights the importance of multidisciplinary management for NSNECs of the head and neck, as the possibility to achieve substantial cure rates with mild side effects with modern radiotherapy techniques.
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Affiliation(s)
- Pierfrancesco Franco
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale U,Parini, AUSL Valle d'Aosta, Viale Ginevra n° 3, 11100 Aosta, Italy.
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156
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Milhe de Saint Victor S, Bonnard D, Darrouzet V, Bellec O, Franco-Vidal V. Stage II vestibular schwannoma: predictive factors for postoperative hearing loss and facial palsy. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:87-92. [PMID: 22226671 DOI: 10.1016/j.anorl.2011.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/16/2011] [Accepted: 09/06/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess predictive factors for deafness and facial palsy after vestibular schwannoma surgery on a translabyrinthine or retrolabyrinthine approach, and to compare sequela results to those for gamma knife radiosurgery. PATIENTS AND METHODS A retrospective study included 70 patients operated on for stage II vestibular schwannoma (Koos classification). Postoperative hearing was assessed on pure-tone average and speech discrimination score, and facial palsy on the House and Brackmann classification, preoperatively and at 1 year postoperatively. Various predictive factors were assessed for both. Statistical analysis used the Fischer exact test, with a significance threshold of P<0.05. RESULTS Hearing was conserved in 18.9% of patients operated on with a retrolabyrinthine approach, with 8.1% conserving useful hearing. Facial function was conserved in 91.4%. Predictive factors for hearing conservation did not achieve statistical significance, but showed trends for: preoperative pure-tone average threshold≤30dB and speech discrimination score≥ 70%, age less than 55 years, tinnitus, nearly normal auditory brainstem response (ABR) latency, and homogeneous tumor on MRI. Predictive factors for conserved facial function likewise did not achieve statistical significance, but showed trends for: age less than 55 years, deafness of progressive onset, absence of cardiovascular risk factors, nearly normal ABR latency and tumor size<13.5mm on MRI. CONCLUSION Facial nerve risk is largely the same with surgery or gamma knife radiosurgery. Concerning hearing, gamma knife radiosurgery seems to provide better hearing conservation, but only over the short term.
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Affiliation(s)
- S Milhe de Saint Victor
- Service d'otorhinolaryngologie et de chirurgie de la base du crâne, CHU Pellegrin, université Victor-Segalen Bordeaux-2, place Amélie-Raba-Léon, Bordeaux cedex, France
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157
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Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T. Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. J Neurosurg 2011; 115:1078-86. [DOI: 10.3171/2011.7.jns11749] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Gamma Knife surgery (GKS) has been a safe and effective treatment for small- to medium-sized vestibular schwannomas (VSs) over relatively long-term outcomes. However, even with recent radiosurgical techniques, hearing results following GKS remain unsatisfactory. The purpose of this study was to evaluate the hearing preservation rate as well as factors related to hearing preservation in patients with VSs and serviceable hearing who were treated with GKS.
Methods
Among patients with Gardner-Robertson (GR) Class I or II serviceable hearing and VSs treated with GKS between 1991 and 2009, 117 were evaluable via periodic MR imaging and audiometry.
Results
The median age at the time of GKS was 52 years. Four patients (3%) had undergone prior surgery. Fifty-six patients (48%) had GR Class I hearing and 61 (52%) had GR Class II hearing at the time of GKS. The median tumor volume was 1.9 cm3. The median maximum and tumor margin radiation doses were 24 and 12 Gy, respectively. The median follow-up periods for MR imaging and audiometry were 74 and 38 months, respectively. The overall tumor control rate was 97.5%. Actuarial 3-, 5-, and 8-year hearing preservation rates were 55%, 43%, and 34%, respectively. On multivariate analysis, GR hearing class at the time of GKS and the mean cochlear dose affected hearing preservation significantly. In a limited number of patients who were treated using the most recent dose planning techniques and who had GR Class I hearing before treatment, the 3- and 5-year hearing preservation rates increased to 80% and 70%, respectively.
Conclusions
For the majority of patients with small- to medium-sized VSs, GKS was an effective and reasonable alternative to resection with satisfactory long-term tumor control. Factors related to hearing preservation included a GR Class I hearing pre-GKS and a lower mean cochlear radiation dose. To retain serviceable hearing, it is important to apply GKS treatment while patients retain GR Class I hearing.
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158
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Milano MT, Usuki KY, Walter KA, Clark D, Schell MC. Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy: Normal tissue dose constraints of the central nervous system. Cancer Treat Rev 2011; 37:567-78. [PMID: 21571440 DOI: 10.1016/j.ctrv.2011.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/31/2011] [Accepted: 04/16/2011] [Indexed: 12/31/2022]
Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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159
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160
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Prospective study on the dose distribution to the acoustic structures during postoperative 3D conformal radiotherapy for parotid tumors: dosimetric and audiometric aspects. Strahlenther Onkol 2011; 187:350-6. [PMID: 21603994 DOI: 10.1007/s00066-011-2170-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE To analyze dose distribution in the hearing organ and to evaluate the dose effect on the hearing thresholds in patients treated with post-parotidectomy 3-dimensional conformal radiotherapy (3D-CRT). METHODS AND MATERIALS A total of 17 patients received post-parotidectomy 3D-CRT (median dose: 63 Gy). The audiometric evaluation comprised pure tone audiometry and tympanometry performed before radiotherapy (RT) and 3, 6, and 24 months after RT. The ear structures were delineated on planning computer tomography scans. Mean and maximum doses were calculated and dose-volume histograms were plotted. RESULTS Before RT, the median baseline audiometric thresholds were normal. At 3 months post-RT, 3 patients were diagnosed as having middle ear underpressure and/or effusion that resolved completely by 6 months. During 2-year follow-up, none of the ears showed perceptive hearing loss at speech frequencies. The mean doses at ipsilateral external auditory canal, mastoids cells, tympanic case, Eustachian tube, semicircular canals, and cochlea were 44.8 Gy, 39.0 Gy, 30.9 Gy, 33.0 Gy, 19.6 Gy, and 19.2 Gy, respectively. The doses to the contralateral ear were negligible, except for the Eustachian tube (up to 28.2 Gy). CONCLUSION Post-parotidectomy 3D-CRT is associated with relatively low doses to the ear and the surrounding structures. Post-RT audiometry did not show any permanent (neither conductive nor perceptive) hearing impairment. Only in 3 patients were there signs of transient unilateral dysfunction of the Eustachian tube observed during the first few months after RT. Longer follow-up and larger patient series are warranted to confirm these preliminary findings.
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161
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Raney RB, Walterhouse DO, Meza JL, Andrassy RJ, Breneman JC, Crist WM, Maurer HM, Meyer WH, Parham DM, Anderson JR. Results of the Intergroup Rhabdomyosarcoma Study Group D9602 protocol, using vincristine and dactinomycin with or without cyclophosphamide and radiation therapy, for newly diagnosed patients with low-risk embryonal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. J Clin Oncol 2011; 29:1312-8. [PMID: 21357783 DOI: 10.1200/jco.2010.30.4469] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Patients with localized, grossly resected, or gross residual (orbital only) embryonal rhabdomyosarcoma (ERMS) had 5-year failure-free survival (FFS) rates of 83% and overall survival rates of 95% on Intergroup Rhabdomyosarcoma Study Group (IRSG) protocols III/IV. IRSG D9602 protocol (1997 to 2004) objectives were to decrease toxicity in similar patients by reducing radiotherapy (RT) doses and eliminating cyclophosphamide for the lowest-risk patients. PATIENTS AND METHODS Subgroup A patients (lowest risk, with ERMS, stage 1 group I/IIA, stage 1 group III orbit, stage 2 group I) received vincristine plus dactinomycin (VA). Subgroup B patients (ERMS, stage 1 group IIB/C, stage I group III nonorbit, stage 2 group II, stage 3 group I/II) received VA plus cyclophosphamide. Patients in group II/III received RT. Compared with IRS-IV, doses were reduced from 41.4 to 36 Gy for stage 1 group IIA patients and from 50 or 59 to 45 Gy for group III orbit patients. RESULTS Estimated 5-year FFS rates were 89% (95% CI, 84% to 92%) for subgroup A patients (n = 264) and 85% (95% CI, 74%, 91%) for subgroup B patients (n = 78); median follow-up: 5.1 years. Estimated 5-year FFS rates were 81% (95% CI, 68% to 90%) for patients with stage 1 group IIA tumors (n = 62) and 86% (95% CI, 76% to 92%) for patients with group III orbit tumors (n = 77). CONCLUSION Five-year FFS and OS rates were similar to those observed in comparable IRS-III patients, including patients receiving reduced RT doses, but were lower than in comparable IRS-IV patients receiving VA plus cyclophosphamide. Five-year FFS rates were similar among subgroups A and B patients.
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Affiliation(s)
- R Beverly Raney
- Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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162
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Petsuksiri J, Sermsree A, Thephamongkhol K, Keskool P, Thongyai K, Chansilpa Y, Pattaranutaporn P. Sensorineural hearing loss after concurrent chemoradiotherapy in nasopharyngeal cancer patients. Radiat Oncol 2011; 6:19. [PMID: 21333025 PMCID: PMC3048471 DOI: 10.1186/1748-717x-6-19] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sensorineural hearing loss (SNHL) is one of the major long term side effects from radiation therapy (RT) in nasopharyngeal cancer (NPC) patients. This study aims to review the incidences of SNHL when treating with different radiation techniques. The additional objective is to determine the relationship of the SNHL with the radiation doses delivered to the inner ear. METHODS A retrospective cohort study of 134 individual ears from 68 NPC patients, treated with conventional RT and IMRT in combination with chemotherapy from 2004-2008 was performed. Dosimetric data of the cochlea were analyzed. Significant SNHL was defined as >15 dB increase in bone conduction threshold at 4 kHz and PTA (pure tone average of 0.5, 1, 2 kHz). Relative risk (RR) was used to determine the associated factors with the hearing threshold changes at 4 kHz and PTA. RESULTS Median audiological follow up time was 14 months. The incidence of high frequency (4 kHz) SNHL was 44% for the whole group (48.75% in the conventional RT, 37% with IMRT). Internal auditory canal mean dose of >50 Gy had shown a trend to increase the risk of high frequency SNHL (RR 2.02 with 95% CI 1.01-4.03, p=0.047). CONCLUSION IMRT and radiation dose limitation to the inner ear appeared to decrease SNHL.
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Affiliation(s)
- Janjira Petsuksiri
- Division of Radiation Oncology, Faculty of Medicine Siriraj Hospital, 2 Prannok Rd, Bangkoknoi, Bangkok, Thailand.
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163
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Kirkpatrick JP, Marks LB, Mayo CS, Lawrence YR, Bhandare N, Ryu S. Estimating normal tissue toxicity in radiosurgery of the CNS: application and limitations of QUANTEC. JOURNAL OF RADIOSURGERY AND SBRT 2011; 1:95-107. [PMID: 29296303 PMCID: PMC5675466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/23/2011] [Indexed: 06/07/2023]
Abstract
Minimizing radiation-induced normal tissue damage in the central nervous system (CNS) is a key objective and primary impetus for stereotactic radiosurgery and radiotherapy. The recently published Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) study provides updated dose/volume/ outcome data on normal tissue tolerance for sixteen anatomic sites, including the CNS. Most of the data used to develop the relationship between dose, volume and normal tissue toxicity derived from large field, conventionally fractionated regimens, and quantitative dose/volume/outcome data at high doses per fraction to limited volumes is much sparser. Nonetheless, QUANTEC provides some limited recommendations for dose constraints in stereotactic radiosurgery/ radiotherapy of the CNS. This paper critically reviews the findings, recommendations and limitations of QUANTEC as they apply to radiosurgery of the CNS, as well as presenting suggestions to establish and validate clinically meaningful dose/volume/toxicity relationships in this setting.
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Affiliation(s)
- John P. Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Lawrence B. Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Charles S. Mayo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yaacov R. Lawrence
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Niranjan Bhandare
- Departments of Radiation Oncology and Otolaryngology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
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