1
|
Hsu CX, Lin KH, Wang SY, Tsai WT, Chang CH, Tien HJ, Shueng PW, Wu TH, Mok GSP. Planning evaluation of a novel volume-based algorithm for personalized optimization of lung dose in VMAT for esophageal cancer. Sci Rep 2022; 12:2513. [PMID: 35169144 PMCID: PMC8847643 DOI: 10.1038/s41598-021-04571-3] [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: 09/23/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Radiotherapy treatment planning (RTP) is time-consuming and labor-intensive since medical physicists must devise treatment plans carefully to reduce damage to tissues and organs for patients. Previously, we proposed the volume-based algorithm (VBA) method, providing optimal partial arcs (OPA) angle to achieve the low-dose volume of lungs in dynamic arc radiotherapy. This study aimed to implement the VBA for esophageal cancer (EC) patients and compare the lung dose and delivery time between full arcs (FA) without using VBA and OPA angle using VBA in volumetric modulated arc therapy (VMAT) plans. We retrospectively included 30 patients diagnosed with EC. RTP of each patient was replanned to 4 VMAT plans, including FA plans without (FA-C) and with (FA + C) dose constraints of OARs and OPA plans without (OPA-C) and with (OPA + C) dose constraints of OARs. The prescribed dose was 45 Gy. The OARs included the lungs, heart, and spinal cord. The dose distribution, dose-volume histogram, monitor units (MUs), delivery time, and gamma passing rates were analyzed. The results showed that the lung V5 and V10 in OPA + C plans were significantly lower than in FA + C plans (p < 0.05). No significant differences were noted in planning target volume (PTV) coverage, lung V15, lung V20, mean lung dose, heart V30, heart V40, mean heart dose, and maximal spinal cord dose between FA + C and OPA + C plans. The delivery time was significantly longer in FA + C plans than in OPA + C plans (237 vs. 192 s, p < 0.05). There were no significant differences between FA + C and OPA + C plans in gamma passing rates. We successfully applied the OPA angle based on the VBA to clinical EC patients and simplified the arc angle selection in RTP. The VBA could provide a personalized OPA angle for each patient and effectively reduce lung V5, V10, and delivery time in VMAT.
Collapse
Affiliation(s)
- Chen-Xiong Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Industrial Ph.D. Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Ta Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiu-Han Chang
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hui-Ju Tien
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, SAR, China
| |
Collapse
|
2
|
Mishra S, Ahmad F, Singh S, Singh RK, Das KJM, Kumar S. Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus. Cancer Rep (Hoboken) 2021; 4:e1332. [PMID: 33369258 PMCID: PMC8222558 DOI: 10.1002/cnr2.1332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patterns of failure following definitive CRT (dCRT) are different as compared to neoadjuvant chemoradiotherapy (NACRT) with increased locoregional failures documented with dCRT. AIM To document failure patterns in patients with esophageal carcinoma treated with neoadjuvant and definitive intent radiation strategies. METHODS Subjects were 123 patients treated with two chemoradiotherapy strategies. Group 1 (n = 99) underwent dose escalated definitive chemoradiotherapy (dCRT), Group 2 (n = 24) received neoadjuvant chemoradiotherapy (NACRT) followed by surgery. Cumulative incidence of locoregional failure (LRF), local failure (LF), regional lymph node failure (RLNF), and distant metastasis (DM) were computed; differences between the groups was evaluated using log rank test. Univariable and multivariable predictors of failure were identified using Cox regression analysis. RESULTS Cumulative LRF: 64% in Group 1 vs 35% in Group 2 (P = .050). Cumulative LF: 59% in Group 1 vs 12% in Group 2 (P = .000). Cumulative RLNF: 30% in Group 1 vs 24% in Group 2 (P = .592). Most common RLNF: mediastinum for both groups (6% vs 12.5%, respectively). Distant metastasis: 40.4% Group 1 vs 17% Group 2 (P = .129), predominantly lung (Group 1, 5%), and nonregional nodes (Group 2, 8.3%). Univariate analysis identified age ≤50, absence of concurrent chemotherapy, dose ≤50 Gy, and incomplete radiotherapy to predict higher odds of LRF and DM for Group 1; absence of comorbidities predicted for lower odds of LRF for Group 2. Age ≤50 predicted for higher odds of RNLR for Group 1, while absence of comorbidities predicted for lower odds of RNLR in Group 2. Multivariate analysis identified age ≤50, incomplete radiotherapy, and absence of concurrent chemotherapy to predict higher odds of LRF for Group 1. Age ≤50, absence of concurrent chemotherapy predicted higher odds of DM for Group 1. Absence of comorbidity predicted lower odds of LRF in Group 2. CONCLUSION LRF is common in both groups, with LF being predominant in dCRT as opposed to RNLF in NACRT. Age ≤50, absence of concurrent chemotherapy is a predictor of LRF and DM in dCRT.
Collapse
Affiliation(s)
- Shagun Mishra
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Farhan Ahmad
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Shalini Singh
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Rajneesh K. Singh
- Department of GastrosurgerySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Koilpillai J. Maria Das
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| | - Shaleen Kumar
- Department of RadiotherapySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowUttar PradeshIndia
| |
Collapse
|