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Oki Y, Akasaka H, Uehara K, Mizonobe K, Sawada M, Nagata J, Harada A, Mayahara H. Evaluation of robustness of optimization methods in breast intensity-modulated radiation therapy using TomoTherapy. Phys Eng Sci Med 2024; 47:465-475. [PMID: 38265521 DOI: 10.1007/s13246-023-01377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Intensity-modulated radiation therapy (IMRT) has become a popular choice for breast cancer treatment. We aimed to evaluate and compare the robustness of each optimization method used for breast IMRT using TomoTherapy. A retrospective analysis was performed on 10 patients with left breast cancer. For each optimization method (clipping, virtual bolus, and skin flash), a corresponding 50 Gy/25 fr plan was created in the helical and direct TomoTherapy modes. The dose-volume histogram parameters were compared after shifting the patients anteriorly and posteriorly. In the helical mode, when the patient was not shifted, the median D1cc (minimum dose delivered to 1 cc of the organ volume) of the breast skin for the clipping and virtual bolus plans was 52.2 (interquartile range: 51.9-52.6) and 50.4 (50.1-50.8) Gy, respectively. After an anterior shift, D1cc of the breast skin for the clipping and virtual bolus plans was 56.0 (55.6-56.8) and 50.9 (50.5-51.3) Gy, respectively. When the direct mode was used without shifting the patient, D1cc of the breast skin for the clipping, virtual bolus, and skin flash plans was 52.6 (51.9-53.1), 53.4 (52.6-53.9), and 52.3 (51.7-53.0) Gy, respectively. After shifting anteriorly, D1cc of the breast skin for the clipping, virtual bolus, and skin flash plans was 55.6 (54.1-56.4), 52.4 (52.0-53.0), and 53.6 (52.6-54.6) Gy, respectively. The clipping method is not sufficient for breast IMRT. The virtual bolus and skin flash methods were more robust optimization methods according to our analyses.
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Affiliation(s)
- Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan.
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, Australia
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Masanobu Sawada
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
- Division of Radiological Technology, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo, 669-1321, Japan
| | - Junya Nagata
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
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Lan W, Lihong L, Chun H, Shutang L, Qi W, Liang X, Xiaoning L, Likun L. Comparison of efficacy and safety between simultaneous integrated boost intensity-modulated radiotherapy and standard-dose intensity-modulated radiotherapy in locally advanced esophageal squamous cell carcinoma: a retrospective study. Strahlenther Onkol 2022; 198:802-811. [PMID: 35029718 PMCID: PMC9402727 DOI: 10.1007/s00066-021-01894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
Objective This study aimed to evaluate the efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) versus standard-dose intensity-modulated radiotherapy (SD-IMRT) in the treatment of locally advanced esophageal squamous cell carcinoma. Methods From July 2003 to March 2014, 1748 patients in a single center who received definitive chemoradiotherapy were included in the analysis. A total of 109 patients who underwent SIB-IMRT and fulfilled all inclusion and exclusion criteria were identified as the study group. A total of 266 patients who underwent SD-IMRT (60 Gy/30 fractions, 2 Gy/fraction, 1 time/day, 5 times/week) during the same period were selected as the control group. Propensity score matching (PSM) was used to balance the baseline characteristics. Survival status, treatment failure mode, and the occurrence of adverse events were compared between the two groups. Results There were more women and more cervical and upper thoracic cancers (P = 0.038, < 0.001, respectively) in the SIB-IMRT group before case matching. The median progression-free survival (PFS) in the SD-IMRT and SIB-IMRT groups was 22 and 19 months, respectively, and the median overall survival duration was 24 and 22 months, respectively, with χ2 = 0.244 and P = 0.621. After PSM of 1:1, 138 patients entered the final analysis (69 cases from each group). The median PFS of the SD-IMRT group and the SIB-IMRT group was 13 and 18 months, respectively, with χ2 = 8.776 and P = 0.003. The 1‑, 3‑, and 5‑year overall survival rates were 66.7, 21.7, and 8.7% and 65.2, 36.2, and 27.3%, respectively, and the median overall survival duration was 16 and 22 months, respectively, with χ2 = 5.362 and P = 0.021. Treatment failure mode: 5‑year local regional recurrence rates of SD-IMRT and SIB-IMRT were 50.7 and 36.2%, respectively, with χ2 = 2.949 and P = 0.086. The 5‑year distant metastasis rates of the two groups were 36.2 and 24.6%, respectively, with χ2 = 2.190 and P = 0.139. Adverse events: 3 patients experienced grade 4–5 toxicity (2.2%), including one case of grade 4 radiation esophagitis and two cases of grade 5 radiation pneumonitis, all in the SD-IMRT group; 14 patients experienced grade 3 adverse events (10.1%), primarily including radiation esophagitis, radiation pneumonitis, and hematological toxicity. Conclusion The technique of SIB-IMRT was safe and reliable compared with SD-IMRT. In addition, SIB-IMRT had locoregional control advantages and potential survival benefits. Supplementary Information The online version of this article (10.1007/s00066-021-01894-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wang Lan
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
| | - Liu Lihong
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
| | - Han Chun
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China.
| | - Liu Shutang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
| | - Wang Qi
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
| | - Xu Liang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
| | - Li Xiaoning
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
| | - Liu Likun
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, 050011, Shijiazhuang, China
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Mathew JM, Mukherji A, Saxena SK, Vijayaraghavan N, Menon A, Sriharsha K, Rafi M. Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies - a prospective observational study. Rep Pract Oncol Radiother 2021; 26:655-663. [PMID: 34760301 DOI: 10.5603/rpor.a2021.0078] [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: 08/30/2020] [Accepted: 02/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Intensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies. The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied. Materials and methods 40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m2. Results Proportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = -0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5-41 Hz) with significant increase in roughness of voice post treatment (p = 0.01). Conclusion There was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.
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Affiliation(s)
- John M Mathew
- Department of Radiation Oncology, JIPMER, Pondicherry, India
| | | | | | | | - Abhilash Menon
- Department of Radiation Oncology, JIPMER, Pondicherry, India
| | | | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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Medenwald D, Fietkau R, Klautke G, Langer S, Würschmidt F, Vordermark D. Trends in radiotherapy inpatient admissions in Germany: a population-based study over a 10-year period. Strahlenther Onkol 2021; 197:865-875. [PMID: 34477888 PMCID: PMC8458212 DOI: 10.1007/s00066-021-01829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
Objective With the increasing complexity of oncological therapy, the number of inpatient admissions to radiotherapy and non-radiotherapy departments might have changed. In this study, we aim to quantify the number of inpatient cases and the number of radiotherapy fractions delivered under inpatient conditions in radiotherapy and non-radiotherapy departments. Methods The analysis is founded on data of all hospitalized cases in Germany based on Diagnosis-Related Group Statistics (G-DRG Statistics, delivered by the Research Data Centers of the Federal Statistical Office). The dataset includes information on the main diagnosis of cases (rather than patients) and the performed procedures during hospitalization based on claims of reimbursement. We used linear regression models to analyze temporal trends. The considered data encompass the period from 2008 to 2017. Results Overall, the number of patients treated with radiotherapy as inpatients remained constant between 2008 (N = 90,952) and 2017 (N = 88,998). Starting in January 2008, 48.9% of 4000 monthly cases received their treatment solely in a radiation oncology department. This figure decreased to 43.7% of 2971 monthly cases in October 2017. We found a stepwise decrease between December 2011 and January 2012 amounting to 4.3%. Fractions received in radiotherapy departments decreased slightly by 29.3 (95% CI: 14.0–44.5) fractions per month. The number of days hospitalized in radiotherapy departments decreased by 83.4 (95% CI: 59.7, 107.0) days per month, starting from a total of 64,842 days in January 2008 to 41,254 days in 2017. Days per case decreased from 16.2 in January 2008 to 13.9 days in October 2017. Conclusion Our data give evidence to the notion that radiotherapy remains a discipline with an important inpatient component. Respecting reimbursement measures and despite older patients with more comorbidities, radiotherapy institutions could sustain a constant number of cases with limited temporal shifts. Supplementary Information The online version of this article (10.1007/s00066-021-01829-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Rainer Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Chemnitz Hospital, Chemnitz, Germany
| | - Susan Langer
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | | | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Iatì G, Parisi S, Santacaterina A, Pontoriero A, Cacciola A, Brogna A, Platania A, Palazzolo C, Cambareri D, Davì V, Napoli I, Lillo S, Severo C, Tamburella C, Vadalà R, Delia P, Pergolizzi S. Simultaneous Integrated Boost Radiotherapy in Unresectable Stage IV (M0) Head and Neck Squamous Cell Cancer Patients: Daily Clinical Practice. Rep Pract Oncol Radiother 2020; 25:399-404. [PMID: 32368191 PMCID: PMC7190747 DOI: 10.1016/j.rpor.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 03/07/2020] [Accepted: 04/02/2020] [Indexed: 12/21/2022] Open
Abstract
AIM To evaluate clinical outcome in locally-advanced stage IV (M0) head and neck cancer patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in daily clinical practice. BACKGROUND Despite SIB-IMRT has been reported as a feasible and effective advanced head and neck cancer treatment, there are few data about its concurrent use with systemic therapies. MATERIAL AND METHODS We reviewed 41 staged IV (M0) head and neck cancer patients treated in two radiotherapy units in the city of Messina (Italy) during the last six years, using intensity modulated techniques-SIB. 22/41 patients had concomitant chemotherapy or cetuximab. Acute and late toxicities, objective response (OR) rate, local control (LC) and overall survival (OS) have been evaluated. RESULTS 37/41 patients received the planned doses of radiotherapy, 2 patients died during the therapy. The major acute regional toxicities were skin reaction and mucositis. A case of mandibular osteoradionecrosis was recorded. At completion of treatment, OR was evaluated in 38 patients: 32/38 patients (84.2%) had complete (55.3%) and partial (28.9%) response. The 1- and 5-year LC rates were 73.4% and 69.73%, respectively. The 1-, 3-, and 5-year OS rates were 85.93%, 51.49% and 44.14%, respectively. No statistically significant differences in outcomes have been observed in patients treated with radiotherapy alone vs. irradiation concomitant to chemo/biotherapy. The median OS was 45 months. CONCLUSION SIB-IMRT is safeand can be used with concomitant chemotherapy/biotherapy in real-life daily clinical practice. SIB-IMRT alone is a valid alternative in patients unfit for systemic therapies.
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Affiliation(s)
- Giuseppe Iatì
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
| | - Silvana Parisi
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | | | - Antonio Pontoriero
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
| | - Alberto Cacciola
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Anna Brogna
- Unit of Medical Physics, University Hospital “G. Martino”, Messina, Italy
| | - Angelo Platania
- Unit of Radiation Oncology - Papardo Hospital, Messina, Italy
| | | | - Domenico Cambareri
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Valerio Davì
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Ilenia Napoli
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Sara Lillo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Cesare Severo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Consuelo Tamburella
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Roberta Vadalà
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Pietro Delia
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
| | - Stefano Pergolizzi
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
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Lin SY, Chuang CC, Tsan DL, Hung YS, Fu CJ, Shen YL, Chiang YY, Huang YC, Lu YJ, Yang CC. Maintenance of multi-domain neurocognitive functions in patients with newly-diagnosed primary CNS lymphoma after primary cranial radiotherapy combined with methotrexate-based chemotherapy: A preliminary case-series study. APPLIED NEUROPSYCHOLOGY. ADULT 2020; 29:432-441. [PMID: 32301346 DOI: 10.1080/23279095.2020.1749630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Conventional treatment for treating primary central nervous system lymphoma (PCNSL) has consisted of either whole-brain radiotherapy (WBRT) or methotrexate (MTX)-based combined modality therapy. However, delayed cognitive sequelae have emerged as a significant debilitating complication in PCNSL patients. A prospective observational case-series study with prospective assessments of neurocognitive functions (NCFs), neuroimaging, and activities of daily living in newly-diagnosed PCNSL patients was undertaken. A battery of neuropsychological measures, used to evaluate NCFs, is composed of ten standardized NCF tests, representing four domains sensitive to disease and treatment effects (executive function, attention, verbal memory, psychomotor speed), and activities of daily living. A total of 15 patients with newly-diagnosed PCNSL were consecutively enrolled in this study. Comparing the NCF scores between the baseline (before WBRT) and post-treatment (after combined chemoradiation therapy) intervals (Mean = 122.33 days, SD = 34.49, range = 77-196), neurobehavioral outcomes consistently remained improving or stable in almost each domain of NCF. Specifically, the scores on Paced Auditory Serial Addition Test-Revised (PASAT-R) were significantly improved between the baseline and post-chemoradiation assessment. Under the multidisciplinary treatment guidelines for treating patients with newly-diagnosed PCNSL, multi-domain NCF become stabilized and even improved after the course of conformal WBRT combined with or without MTX-based chemotherapy.
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Affiliation(s)
- Shinn-Yn Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Din-Li Tsan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chen-Ju Fu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yi-Liang Shen
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yin-Yin Chiang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Lu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan.,Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
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Jiang L, Zhang Y, Yang Z, Liang F, Wu J, Wang R. A comparison of clinical outcomes between simultaneous integrated boost (SIB) versus sequential boost (SEQ) intensity modulated radiation therapy (IMRT) for head and neck cancer: A meta-analysis. Medicine (Baltimore) 2019; 98:e16942. [PMID: 31441887 PMCID: PMC6716705 DOI: 10.1097/md.0000000000016942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal intensity modulated radiation therapy (IMRT) technique for head and neck cancer (HNC) has not been determined yet. The present study aimed to compare the clinical outcomes of the simultaneous integrated boost (SIB)-IMRT versus the sequential boost (SEQ)-IMRT in HNC. METHODS A meta-analysis of 7 studies involving a total of 1049 patients was carried out to compare the treatment outcomes together with severe acute adverse effects of the SIB-IMRT versus the SEQ-IMRT in HNC patients. RESULTS Comparison of the SIB-IMRT and SEQ-IMRT showed no significant difference in the measurement of overall survival (OS) (hazard ratio [HR] 0.94; 95% confidence inerval [CI], 0.70-1.27; P = .71), progression free survival (PFS) (HR 1.03; 95% CI, 0.82-1.30; P = .79), locoregional recurrence free survival (LRFS) (HR 0.98; 95% CI, 0.65-1.47; P = .91), and distance metastasis free survival (DMFS) (HR 0.87; 95% CI, 0.50-1.53; P = .63). Moreover, there were no significant differences in adverse effect occurrence between the SIB-IMRT and SEQ-IMRT groups. CONCLUSION SIB-IMRT and SEQ-IMRT can provide comparable outcomes in the treatment of patients afflicted by HNC. Both IMRT techniques were found to carry a similar risk of severe acute adverse effect. SIB-IMRT may have advantages due to its convenience and short-course of treatment; however, the optimum fractionation and prescribed dose remained unclear. Furthermore, both IMRT techniques can be advocated as the technique of choice for HNC. Treatment plan should be individualized for patients.
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Dong Y, Zhang Y, Zhang T, Fan M, Zhu J, Li B, Huang W. Feasibility and Efficacy of Simultaneous Integrated Boost Intensity-modulated Radiation Therapy based on MRI-CT fusion in Patients with Brain Metastases of Non-small Cell Lung Cancer. J Cancer 2018; 9:4477-4483. [PMID: 30519353 PMCID: PMC6277651 DOI: 10.7150/jca.26547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/09/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose: To assess the feasibility and therapeutic effects of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) based on the fusion imaging of magnetic resonance imaging (MRI) and computed tomography (CT) as a dose-intensive technique in patients with brain metastases (BM) of non-small cell lung cancer (NSCLC). Methods and materials: Forty-six NSCLC patients with 1 to 7 brain metastases were enrolled in this retrospective study between November, 2011 and February, 2017. Thirty-one patients (67.4%) had 1-3 metastases (oligometastases), otherwise, more than 3 metastases were seen in only 15 patients (32.6%). GTV (Gross tumor volume) contouring was based on the fusion imaging of MRI-CT, WBRT was prescribed in 37.5 Gy/15 fractions with a simultaneous boost in the metastatic lesions of 52.5 Gy/15 fractions. Results: The median overall survival (OS) and intracranial progression free survival (PFS) for all the patients were 20.0 months and 11.0 months, respectively. The 6-month and 1-year OS were 87.0% and 69.6% respectively, while the 6-month and 1-year PFS were 78.3% and 43.5% respectively. Until the end of the follow-up, 16 patients (34.8%) were alive. No evidence of intracranial progress or recurrence was found in 6 patients (13.0%) during the follow-up. Conclusion: SIB-IMRT with the dose/fractionation based on the fusion imaging of MRI-CT is feasible and safe. It is beneficial to the NSCLC patients with BM and can reduce the overall costs of treatment.
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Affiliation(s)
- Yinping Dong
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yanke Zhang
- Department of Radiation Oncology, the General Hospital of Yan-zhou Mining Group, Jining, China
| | - Tianyi Zhang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | - Min Fan
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
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Atiq M, Atiq A, Iqbal K, Shamsi QA, Andleeb F, Buzdar SA. Interpretation of Gamma Index for Quality Assurance of Simultaneously Integrated Boost (SIB) IMRT Plans for Head and Neck Carcinoma. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2017. [DOI: 10.1515/pjmpe-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective: The Gamma Index is prerequisite to estimate point-by-point difference between measured and calculated dose distribution in terms of both Distance to Agreement (DTA) and Dose Difference (DD). This study aims to inquire what percentage of pixels passing a certain criteria assure a good quality plan and suggest gamma index as efficient mechanism for dose verification of Simultaneous Integrated Boost Intensity Modulated Radiotherapy plans.
Method: In this study, dose was calculated for 14 head and neck patients and IMRT Quality Assurance was performed with portal dosimetry using the Eclipse treatment planning system. Eclipse software has a Gamma analysis function to compare measured and calculated dose distribution. Plans of this study were deemed acceptable when passing rate was 95% using tolerance for Distance to agreement (DTA) as 3mm and Dose Difference (DD) as 5%.
Result and Conclusion: Thirteen cases pass tolerance criteria of 95% set by our institution. Confidence Limit for DD is 9.3% and for gamma criteria our local CL came out to be 2.0% (i.e., 98.0% passing). Lack of correlation was found between DD and γ passing rate with R2 of 0.0509. Our findings underline the importance of gamma analysis method to predict the quality of dose calculation. Passing rate of 95% is achieved in 93% of cases which is adequate level of accuracy for analyzed plans thus assuring the robustness of SIB IMRT treatment technique. This study can be extended to investigate gamma criteria of 5%/3mm for different tumor localities and to explore confidence limit on target volumes of small extent and simple geometry.
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Affiliation(s)
- Maria Atiq
- Department of Physics , The Islamia University of Bahawalpur
| | - Atia Atiq
- Department of Physics , The Islamia University of Bahawalpur
| | - Khalid Iqbal
- Shaukat Khanum Memorial cancer hospital & research center Lahore Pakistan
| | | | - Farah Andleeb
- Department of Physics , The Islamia University of Bahawalpur
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Garibaldi C, Jereczek-Fossa BA, Marvaso G, Dicuonzo S, Rojas DP, Cattani F, Starzyńska A, Ciardo D, Surgo A, Leonardi MC, Ricotti R. Recent advances in radiation oncology. Ecancermedicalscience 2017; 11:785. [PMID: 29225692 PMCID: PMC5718253 DOI: 10.3332/ecancer.2017.785] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy (RT) is very much a technology-driven treatment modality in the management of cancer. RT techniques have changed significantly over the past few decades, thanks to improvements in engineering and computing. We aim to highlight the recent developments in radiation oncology, focusing on the technological and biological advances. We will present state-of-the-art treatment techniques, employing photon beams, such as intensity-modulated RT, volumetric-modulated arc therapy, stereotactic body RT and adaptive RT, which make possible a highly tailored dose distribution with maximum normal tissue sparing. We will analyse all the steps involved in the treatment: imaging, delineation of the tumour and organs at risk, treatment planning and finally image-guidance for accurate tumour localisation before and during treatment delivery. Particular attention will be given to the crucial role that imaging plays throughout the entire process. In the case of adaptive RT, the precise identification of target volumes as well as the monitoring of tumour response/modification during the course of treatment is mainly based on multimodality imaging that integrates morphological, functional and metabolic information. Moreover, real-time imaging of the tumour is essential in breathing adaptive techniques to compensate for tumour motion due to respiration. Brief reference will be made to the recent spread of particle beam therapy, in particular to the use of protons, but also to the yet limited experience of using heavy particles such as carbon ions. Finally, we will analyse the latest biological advances in tumour targeting. Indeed, the effectiveness of RT has been improved not only by technological developments but also through the integration of radiobiological knowledge to produce more efficient and personalised treatment strategies.
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Affiliation(s)
- Cristina Garibaldi
- Unit of Medical Physics, European Institute of Oncology, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giulia Marvaso
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Damaris Patricia Rojas
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, 20141 Milan, Italy
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 80–211 Gdańsk, Poland
| | - Delia Ciardo
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
| | | | - Rosalinda Ricotti
- Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy
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11
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Dobler B, Obermeier T, Hautmann MG, Khemissi A, Koelbl O. Simultaneous integrated boost therapy of carcinoma of the hypopharynx/larynx with and without flattening filter - a treatment planning and dosimetry study. Radiat Oncol 2017; 12:114. [PMID: 28679448 PMCID: PMC5499025 DOI: 10.1186/s13014-017-0850-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/28/2017] [Indexed: 01/26/2023] Open
Abstract
Background The aim of this study was to investigate if the flattening filter free (FFF) irradiation mode of a linear accelerator (linac) is advantageous as compared to the flat beam (FF) irradiation mode in intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for carcinoma of the hypopharynx / larynx. Methods Four treatment plans were created for each of 10 patients for an Elekta Synergy linac with Agility collimating device, a dual arc VMAT and a nine field step and shoot IMRT each with and without flattening filter. Plan quality was compared considering target coverage and dose to the organs at risk. All plans were verified by a 2D–ionization-chamber-array and delivery times were compared. Peripheral point doses were determined as a measure of second cancer risk. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. Results Plan quality was similar for all four treatment plans without statistically significant differences of clinical relevance. The clinical goals were met in all plans for the PTV-SIB (V95% > 95%), the spinal cord (D1ccm < 45 Gy) and the brain stem (D1ccm < 48 Gy). For the parotids, the goal of D50% < 30 Gy was met in 70% and 60% of the plans for the left and right parotid respectively, and the V95% of the SIB reached an average of 94%. Delivery times were similar for FF and FFF and significantly decreased by around 70% for VMAT as compared to IMRT. Peripheral doses were significantly reduced by 18% in FFF mode as compared to FF and by 26% for VMAT as compared to IMRT. Lowest peripheral doses were found for VMAT FFF, followed by VMAT FF. Conclusions The FFF mode of a linear accelerator is advantageous for the treatment of hypopharynx/larynx carcinoma only with respect to reduction of second cancer induction in peripheral organs for the combination of Elekta Synergy linacs and Oncentra® External Beam v4.5 treatment planning system. This might be of interest in a therapy with curative intent.
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Affiliation(s)
- Barbara Dobler
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany.
| | - Tina Obermeier
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Amine Khemissi
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
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12
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Meattini I, Marrazzo L, Zani M, Paiar F, Pallotta S, Simontacchi G, Bucciolini M, Livi L. Four-dimensional computed tomography in accelerated partial breast irradiation planning: single series from a phase III trial. Radiol Med 2015; 120:1078-82. [PMID: 25907992 DOI: 10.1007/s11547-015-0541-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of our study was to evaluate the usefulness of the four-dimensional computed tomography (4DCT) in accelerated partial breast irradiation (aPBI) planning. MATERIALS AND METHODS At our Institute, we have been treating the index quadrant with external intensity-modulated radiation therapy in a phase III trial. For this study, we selected a sample of 10 patients with right- or left-sided breast cancer and surgical clips at the excision site. Contouring of the target was performed both using three-dimensional computed tomography (3DCT) and 4DCT imaging. On both 3DCT and 4DCT, we recorded the clinical target volume (CTV) and the planning target volume (PTV) and the coordinates of the PTV centroid. We calculated the treatment plans, according to our protocol, using the contours drawn on the 3DCT and 4DCT and evaluated target coverage and sparing of organs at risk (OAR). RESULTS Median age of the patients was 63.5 years (range 52-75). The comparison between the 3DCT and 4DCT PTV volumes was not statistically significant (p = 0.79). Concerning centroid coordinates, the average absolute differences were 0.1 mm in the latero-lateral, 0.7 mm in the antero-posterior and 0.3 mm in the supero-inferior direction. No statistically significant differences were observed both in PTV coverage and OAR sparing; the 4D PTV contour is adequately covered when the plan based on the 3D contours is used. Target coverage was reduced on average by 1 % and no statistically significant difference was observed (p = 0.93). CONCLUSIONS In our experience, no significant differences between PTV volumes, PTV coverage, OAR sparing and centroid position are evidenced when comparing 3DCT and 4DCT plans. Conventional 3DCT-based planning is adequate for aPBI.
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Affiliation(s)
- Icro Meattini
- Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Livia Marrazzo
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Fabiola Paiar
- Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Stefania Pallotta
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Marta Bucciolini
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
- University of Florence, Florence, Italy
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Han D, Qin Q, Hao S, Huang W, Wei Y, Zhang Z, Wang Z, Li B. Feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy in patients with limited-disease small cell lung cancer. Radiat Oncol 2014; 9:280. [PMID: 25498196 PMCID: PMC4269843 DOI: 10.1186/s13014-014-0280-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the feasibility and efficacy of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) in patients with limited-disease small-cell lung cancer (LD-SCLC). METHODS Patients with LD-SCLC were treated with SIB-IMRT within 1 week after completion of 2 cycles of induction chemotherapy. Then 2-4 cycles of adjuvant chemotherapy were administered within 1 week after SIB-IMRT. Irradiation was given accelerated hyper-fractionated with the prescribed dose 57Gy at 1.9Gy twice daily to the gross tumor volume (GTV) , 51Gy at 1.7Gy twice daily to the clinical tumor volume (CTV) and 45Gy at 1.5Gy twice daily to the planning target volume (PTV). The chemotherapy regimen consisted of platinum plus etoposide. Prophylactic cranial radiation (25Gy in 10 fractions) was administered to patients who got complete response (CR) or near complete response (nCR). The primary endpoint of this study was the frequency of grade 3 or higher acute non-hematologic treatment-related toxicities. Secondary end points included objective response, overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS). RESULTS A cohort of 35 patients were enrolled in the study, the biological equivalent dose (BED) of the GTV in the SIB-IMRT was 59.16Gy. Grade 1, 2, and 3 esophagitis were observed in 11 (31%), 12 (34%), and 6 (17%) patients, respectively; Grade 1 and 2 pneumonitis were observed in 8 (23%) and 4 (11%) patients, respectively. The median OS and PFS of the whole group were 37.7 months and 29.3 months, respectively. The 1- and 2-year OS was 94.1% and 68.5%, respectively. The 1- and 2-year PFS was 76.8% and 40.7%, respectively. The 1- and 2-year LRFS was 87.7% and 73.8%, respectively. CONCLUSIONS SIB-IMRT was feasible and well-tolerated in patients with LD-SCLC, and worth further evaluating in a large prospective clinical trial.
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Affiliation(s)
- Dan Han
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China. .,School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong, 250062, China.
| | - Qin Qin
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
| | - Shaoyu Hao
- Department of Thoraic Surgery, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
| | - Wei Huang
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
| | - Yumei Wei
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
| | - Zicheng Zhang
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
| | - Zhongtang Wang
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
| | - Baosheng Li
- Department of 6th Radiation Oncology, Cancer Prevention and Treatment Institute of Shandong Province, Shandong, 250117, China.
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Lee HC, Kim SH, Suh YJ, Chung MJ, Kang DG, Choi HJ, Lee JH. A prospective cohort study on postoperative radiotherapy with TomoDirect using simultaneous integrated boost technique in early breast cancer. Radiat Oncol 2014; 9:244. [PMID: 25410791 PMCID: PMC4244044 DOI: 10.1186/s13014-014-0244-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/30/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the technical feasibility and toxicity of TomoDirect in breast cancer patients who received radiotherapy after breast-conserving surgery. METHODS 155 consecutive patients with breast carcinoma in situ or T1-2 breast cancer with negative lymph node received breast irradiation with TomoDirect using simultaneous integrated boost technique in the prospective cohort study. A radiation dose of 50.4 Gy and 57.4 Gy in 28 fractions was prescribed to the ipsilateral breast and tumor bed, respectively. Dosimetric parameters of target and organ at risk and acute complication were assessed prospectively. RESULTS The mean dose for the tumor bed is 58.90 Gy. The mean values of V54.53Gy (95% of the prescribed dose), V63.14Gy (110% of the prescribed dose), and V66.01Gy (115% of the prescribed dose) were 99.97%, 1.26%, and 0%, respectively. The mean value of radiation conformality index was 1.01. The mean value of radical dose homogeneity index was 0.89. The average dose irradiated to the ipsilateral lung, heart, and contralateral breast was 4.72 Gy, 1.09 Gy, and 0.19 Gy, respectively. The most common toxicity was dermatitis. During breast irradiation, grade 2 and 3 dermatitis occurred in 41 (26.5%) and 6 (3.9%) of the 155 patients, respectively. Two patients had arm lymphedema during breast irradiation. Two patients had grade 2 pneumonitis 1 month after breast irradiation. CONCLUSIONS Radiotherapy using TomoDirect in early breast cancer patients showed acceptable toxicities and optimal results in terms of target coverage and organ at risk sparing.
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Affiliation(s)
- Hyo Chun Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Young Jin Suh
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Mi Joo Chung
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Dae Gyu Kang
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
| | - Hyun Joo Choi
- Department of Hospital Pathology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
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15
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Comparison of 3D confromal radiotherapy and intensity modulated radiotherapy with or without simultaneous integrated boost during concurrent chemoradiation for locally advanced head and neck cancers. PLoS One 2014; 9:e94456. [PMID: 24714187 PMCID: PMC3979891 DOI: 10.1371/journal.pone.0094456] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Radiotherapy techniques have evolved from 3D conformal radiotherapy (3D-CRT) to intensity modulated radiotherapy (IMRT) where boost fields are delivered either sequentially (IMRTseq) or with a simultaneous integrated boost (IMRT+SIB). Our goal was to compare the outcomes of patients treated with IMRT+SIB to traditional standards. METHODS We analyzed the efficacy and toxicity of patients treated with concurrent chemoradiation using 3D-CRT, IMRTseq or IMRT+SIB. Between 1993 and 2012, 379 patients with non-metastatic Stage III-IV head and neck squamous cell cancer were treated with concurrent chemoradiation using 3D-CRT (n = 125), IMRTseq (n = 120) and IMRT+SIB (n = 134). RESULTS Patients treated with any technique had similar rates of 2y local control, 2y regional control, 2y progression free survival and 2y overall survival. Patients treated with IMRT+SIB had lower rates acute toxicity according to Grade 3 or greater mucositis (3D-CRT: 44.0% vs. IMRTseq: 36.7% vs. IMRT+SIB: 22.4%; P<.0001), dermatitis (3D-CRT: 44.0% vs. IMRTseq: 20.0% vs. IMRT+SIB: 7.5%; P<.0001) and feeding tube placement during radiotherapy (3D-CRT: 80.0% vs. IMRTseq: 50.8% vs. IMRT+SIB: 44.0%; P<.0001) as well as late toxicity as measured by feeding tube use (P<.0001) and tracheostomy use (P<.0001). On multivariate analysis, IMRT+SIB predicted for less mucositis, dermatitis and feeding tube use compared to 3D-CRT and for less dermatitis compared to IMRTseq. CONCLUSIONS Compared to 3D-CRT and IMRTseq, IMRT+SIB provided similar outcomes and potentially less toxicity indicating it is a feasible technique for chemoradiation in locally advanced head and neck cancer.
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