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Oral contrast agents lead to underestimation of dose calculation in volumetric-modulated arc therapy planning for pelvic irradiation. Chin Med J (Engl) 2020; 133:2061-2070. [PMID: 32810050 PMCID: PMC7478501 DOI: 10.1097/cm9.0000000000001025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text Background The effects of oral contrast agents (OCAs) on dosimetry have not been studied in detail. Therefore, this study aimed to examine the influence of OCAs on dose calculation in volumetric-modulated arc therapy plans for rectal cancer. Methods From 2008 to 2016, computed tomography (CT) images were obtained from 33 rectal cancer patients administered OCA with or without intravenous contrast agent (ICA) and 14 patients who received no contrast agent. CT numbers of organs at risk were recorded and converted to electronic densities. Volumetric-modulated arc therapy plans were designed before and after the original densities were replaced with non-enhanced densities. Doses to the planned target volume (PTV) and organs at risk were compared between the plans. Results OCA significantly increased the mean and maximum densities of the bowels, while the effects of ICA on these parameters depended on the blood supply of the organs. With OCA, the actual doses for PTV were significantly higher than planned and doses to the bowel increased significantly although moderately. However, the increase in the volume receiving a high-range doses was substantial (the absolute change of intestine volume receiving ≥52 Gy: 1.46 [0.05−3.99, cubic centimeter range: −6.74 to 128.12], the absolute change of colon volume receiving ≥50 Gy: 0.34 [0.01−1.53 cc, range: −0.08 to 3.80 cc]. Dose changes due to ICA were insignificant. Pearson correlation showed that dose changes were significantly correlated with a high intestinal volume within or near the PTV (ρ > 0.5, P < 0.05) and with the density of enhanced intestine (ρ > 0.3, P < 0.05). Conclusions Contrast agents applied in simulation cause underestimation of doses in actual treatment. The overdose due to ICA was slight, while that due to OCA was moderate. The bowel volume receiving ≥50Gy was dramatically increased when OCA within the bowel was absent. Physicians should be aware of these issues if the original plan is barely within clinical tolerance or if a considerable volume of enhanced intestine is within or near the PTV.
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Prediction of mucositis risk secondary to cancer therapy: a systematic review of current evidence and call to action. Support Care Cancer 2020; 28:5059-5073. [PMID: 32592033 DOI: 10.1007/s00520-020-05579-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/12/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Despite advances in personalizing the efficacy of cancer therapy, our ability to identify patients at risk of severe treatment side effects and provide individualized supportive care is limited. This is particularly the case for mucositis (oral and gastrointestinal), with no comprehensive risk evaluation strategies to identify high-risk patients. We, the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) Mucositis Study Group, therefore aimed to systematically review current evidence on that factors that influence mucositis risk to provide a foundation upon which future risk prediction studies can be based. METHODS We identified 11,018 papers from PubMed and Web of Science, with 197 records extracted for full review and 113 meeting final eligibility criteria. Data were then synthesized into tables to highlight the level of evidence for each risk predictor. RESULTS The strongest level of evidence supported dosimetric parameters as key predictors of mucositis risk. Genetic variants in drug-metabolizing pathways, immune signaling, and cell injury/repair mechanisms were also identified to impact mucositis risk. Factors relating to the individual were variably linked to mucositis outcomes, although female sex and smoking status showed some association with mucositis risk. CONCLUSION Mucositis risk reflects the complex interplay between the host, tumor microenvironment, and treatment specifications, yet the large majority of studies rely on hypothesis-driven, single-candidate approaches. For significant advances in the provision of personalized supportive care, coordinated research efforts with robust multiplexed approaches are strongly advised.
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Reijtenbagh DMW, Godart J, Mens JWM, Heijkoop ST, Heemsbergen WD, Hoogeman MS. Patient-reported acute GI symptoms in locally advanced cervical cancer patients correlate with rectal dose. Radiother Oncol 2020; 148:38-43. [PMID: 32311599 DOI: 10.1016/j.radonc.2020.03.035] [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] [Received: 12/19/2019] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE To investigate relationships between patient-reported acute gastro-intestinal symptoms in a locally advanced cervical cancer (LACC) prospective cohort and clinical and dosimetric parameters, while also taking spatial dose into account. MATERIAL AND METHODS A total of 103 patients was included, receiving radiotherapy based on a plan-library-based plan-of-the-day protocol, combined either with concurrent chemotherapy or with neo-adjuvant chemotherapy and concomitant hyperthermia. Toxicity endpoints were extracted from questionnaires sent out weekly during treatment and regularly in the acute phase after treatment. Endpoints were defined for symptoms concerning obstipation, diarrhea, fecal leakage, bowel cramps and rectal bleeding. Dose surface maps were constructed for the rectum. Clinical parameters and dosimetric parameters of the bowel bag and rectum were collected for all patients. RESULTS The use of concomitant chemotherapy and an increase in Planning Target Volume (PTV) resulted in a significant increase in reported diarrhea. The dose-volume parameters V5Gy-V25Gy of the rectum were found to be significant, unlike dose-volume parameters of the bowel bag. Additionally, a significantly higher dose to the inferior part of the rectum was found for patients reporting diarrhea. No significance was reached for fecal leakage and bowel cramps. CONCLUSION The significance of results for patients reporting diarrhea symptoms found for PTV volume indicates a potential benefit for a plan-of-the-day protocol. Additionally, the results suggest that a reduction of inferior rectum dose could decrease patient-reported diarrhea symptoms, while the administration of concomitant chemotherapy appears to lead to radiosensitizing effects that increase these symptoms.
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Affiliation(s)
| | - Jeremy Godart
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Jan-Willem M Mens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Sabrina T Heijkoop
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Wilma D Heemsbergen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Mischa S Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands.
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Appelt AL, Kerkhof EM, Nyvang L, Harderwijk EC, Abbott NL, Teo M, Peters FP, Kronborg CJ, Spindler KLG, Sebag-Montefiore D, Marijnen CA. Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer - A multicentre dose planning study. Tech Innov Patient Support Radiat Oncol 2019; 11:14-21. [PMID: 32095545 PMCID: PMC7033757 DOI: 10.1016/j.tipsro.2019.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/16/2019] [Accepted: 09/16/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND PURPOSE Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). MATERIALS AND METHODS The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 × 5 Gy) and long course (LCRT, 25 × 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for ≥90% of plans. RESULTS Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V 10Gy < 180 cm3, V 18Gy < 110 cm3, V 23Gy < 85 cm3 for bowel cavity; V 21Gy < 15% and V 25Gy < 5% for bladder; and V 12.5Gy < 11% for femoral heads. Corresponding objectives for LCRT: V 20Gy < 180 cm3, V 30Gy < 130 cm3, V 45Gy < 90 cm3 for bowel cavity; V 35Gy < 22% and V 50Gy < 7% for bladder; and V 25Gy < 15% for femoral heads. Constraints were validated across all three institutions. CONCLUSION We utilized a multicentre planning study approach to develop robust planning objectives for mesorectal radiotherapy for early rectal cancer.
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Affiliation(s)
- Ane L. Appelt
- Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Ellen M. Kerkhof
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Lars Nyvang
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ernst C. Harderwijk
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Natalie L. Abbott
- Radiotherapy Trials Quality Assurance Group, Velindre Cancer Centre, Cardiff, UK
| | - Mark Teo
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Femke P. Peters
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - David Sebag-Montefiore
- Leeds Institute of Medical Research at St James’s, University of Leeds and Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Corrie A.M. Marijnen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
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Sini C, Noris Chiorda B, Gabriele P, Sanguineti G, Morlino S, Badenchini F, Cante D, Carillo V, Gaetano M, Giandini T, Landoni V, Maggio A, Perna L, Petrucci E, Sacco V, Valdagni R, Rancati T, Fiorino C, Cozzarini C. Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects. Radiother Oncol 2017; 124:296-301. [PMID: 28739383 DOI: 10.1016/j.radonc.2017.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose-volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. MATERIALS AND METHODS Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8Gy (range 50.4-54.4, 1.7-2Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose-volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. RESULTS Analyses were focused on the four questions showing a median ΔIBDQ-B>0. No dose volume/surface parameters were predictive, other than ΔIBDQ5≥3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R2=0.92) and was found to be robust after bootstrap-based internal validation. CONCLUSIONS Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients.
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Affiliation(s)
- Carla Sini
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Pietro Gabriele
- Radiotherapy Department, Candiolo Cancer Institute - FPO, IRCCS, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Morlino
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Fabio Badenchini
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Viviana Carillo
- Radiotherapy, Centro AKTIS Diagnostica e terapia, Napoli, Italy
| | | | - Tommaso Giandini
- Medical Physics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Valeria Landoni
- Department of Physics, Regina Elena National Cancer Institute, Rome, Italy
| | - Angelo Maggio
- Medical Physics Department, Candiolo Cancer Institute - FPO, IRCCS, Italy
| | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Vincenzo Sacco
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Valdagni
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; UNIV Hematology and Hemato-Oncology, Università degli Studi di Milano, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
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Perna L, Sini C, Cozzarini C, Agnello G, Cattaneo G, Hysing L, Muren L, Fiorino C, Calandrino R. Deformable registration-based segmentation of the bowel on Megavoltage CT during pelvic radiotherapy. Phys Med 2016; 32:898-904. [DOI: 10.1016/j.ejmp.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 05/24/2016] [Accepted: 06/17/2016] [Indexed: 11/15/2022] Open
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Colliaux J, Kharchi L, Vincendeau S, Simon A, Perdrieux M, Le Prisé É, Bellisant É, Castelli J, de Crevoisier R. [Expected benefit of lymph node and seminal vesical dissection to decrease high-risk prostate cancer radiotherapy]. Cancer Radiother 2016; 20:347-56. [PMID: 27344535 DOI: 10.1016/j.canrad.2016.04.006] [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: 11/30/2015] [Revised: 04/07/2016] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE In case of pelvic lymph node and seminal vesicle dissection followed by prostate cancer intensity-modulated radiotherapy, the objective of the study was to evaluate the dosimetric benefit of reducing the target volume. PATIENTS AND METHODS A total of 25 patients with high-risk prostate cancer had surgery first followed by intensity-modulated radiotherapy and androgen deprivation. Four treatment planning were simulated for each patient, based on two CT scans performed before and after surgery. The target volumes were: prostate-seminal vesicles-lymph nodes, prostate-lymph nodes, prostate-seminal vesicles and prostate only. The total dose was 46Gy in the seminal vesicles and lymph nodes, and 80Gy in the prostate. RESULTS Compared to prostate target volume only, the addition of seminal vesicles and lymph nodes multiplied by a factor of 1.6 and 6.5 the target volume, respectively. Decreasing the target volume from prostate-seminal vesicles-lymph nodes to prostate-seminal vesicles, to prostate only decreased the rectal wall mean dose from 49Gy to 42Gy, to 36Gy, and the risk of late rectal bleeding from 4.4% to 3.2%, to 2.4% (P<0.05), respectively. The bladder wall mean dose decreased from 51Gy to 40Gy, to 35Gy (P<0,05), respectively. Not irradiating the lymph nodes decreased the absolute risk of diarrhea by 11%. CONCLUSION Lymph node and seminal vesicle dissection before prostate cancer intensity-modulated radiotherapy allows decreasing moderately the risk of digestive toxicity.
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Affiliation(s)
- J Colliaux
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - L Kharchi
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Inserm, U1099, laboratoire de traitement du signal et de l'image, 263, avenue du Général-Leclerc, 35042 Rennes, France
| | - S Vincendeau
- Service d'urologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - A Simon
- Inserm, U1099, laboratoire de traitement du signal et de l'image, 263, avenue du Général-Leclerc, 35042 Rennes, France
| | - M Perdrieux
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - É Le Prisé
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - É Bellisant
- Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - J Castelli
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - R de Crevoisier
- Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Inserm, U1099, laboratoire de traitement du signal et de l'image, 263, avenue du Général-Leclerc, 35042 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France.
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Landoni V, Fiorino C, Cozzarini C, Sanguineti G, Valdagni R, Rancati T. Predicting toxicity in radiotherapy for prostate cancer. Phys Med 2016; 32:521-32. [PMID: 27068274 DOI: 10.1016/j.ejmp.2016.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/15/2016] [Accepted: 03/02/2016] [Indexed: 02/08/2023] Open
Abstract
This comprehensive review addresses most organs at risk involved in planning optimization for prostate cancer. It can be considered an update of a previous educational review that was published in 2009 (Fiorino et al., 2009). The literature was reviewed based on PubMed and MEDLINE database searches (from January 2009 up to September 2015), including papers in press; for each section/subsection, key title words were used and possibly combined with other more general key-words (such as radiotherapy, dose-volume effects, NTCP, DVH, and predictive model). Publications generally dealing with toxicity without any association with dose-volume effects or correlations with clinical risk factors were disregarded, being outside the aim of the review. A focus was on external beam radiotherapy, including post-prostatectomy, with conventional fractionation or moderate hypofractionation (<4Gy/fraction); extreme hypofractionation is the topic of another paper in this special issue. Gastrointestinal and urinary toxicity are the most investigated endpoints, with quantitative data published in the last 5years suggesting both a dose-response relationship and the existence of a number of clinical/patient related risk factors acting as dose-response modifiers. Some results on erectile dysfunction, bowel toxicity and hematological toxicity are also presented.
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Affiliation(s)
- Valeria Landoni
- Medical Physics, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Claudio Fiorino
- Medical Physics, Raffaele Scientific Institute IRCCS, Milan, Italy
| | | | | | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Efficacy of Synbiotics to Reduce Acute Radiation Proctitis Symptoms and Improve Quality of Life: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial. Int J Radiat Oncol Biol Phys 2014; 90:289-95. [DOI: 10.1016/j.ijrobp.2014.05.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 01/01/2023]
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Scher ED, Ahmed I, Yue NJ, Jabbour SK. Technical aspects of radiation therapy for anal cancer. J Gastrointest Oncol 2014; 5:198-211. [PMID: 24982768 DOI: 10.3978/j.issn.2078-6891.2014.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/22/2014] [Indexed: 01/26/2023] Open
Abstract
Historically treated with surgery, current practice recommends anal carcinoma to be treated with a combination of chemotherapy and radiation. This review will examine the anatomy, modes of disease spread and recurrence, and evaluate the existing evidence for treatment options for these tumors. An in-depth examination of specific radiation therapy (RT) techniques-such as conventional 3D-conformal RT and intensity-modulated RT-will be discussed along with modern dose constraints. RT field arrangement, patient setup, and recommended gross and clinical target volume (CTV) contours will be considered. Areas in need of further investigation, such as the role in treatment for positron emission tomography (PET) will be explored.
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Affiliation(s)
- Eli D Scher
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Inaya Ahmed
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Ning J Yue
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
| | - Salma K Jabbour
- 1 Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA ; 2 Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08903, USA
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Radiochemotherapy and brachytherapy could be the standard treatment for anal canal cancer in elderly patients? A retrospective single-centre analysis. Med Oncol 2013; 30:402. [DOI: 10.1007/s12032-012-0402-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
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DeFoe SG, Kabolizadeh P, Heron DE, Beriwal S. Dosimetric Parameters Predictive of Acute Gastrointestinal Toxicity in Patients with Anal Carcinoma Treated with Concurrent Chemotherapy and Intensity-Modulated Radiation Therapy. Oncology 2013; 85:1-7. [DOI: 10.1159/000348387] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022]
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Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer. Strahlenther Onkol 2012; 188:990-6. [DOI: 10.1007/s00066-012-0171-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/13/2012] [Indexed: 12/20/2022]
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14
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Cambria R, Jereczek-Fossa BA, Zerini D, Cattani F, Serafini F, Luraschi R, Pedroli G, Orecchia R. Physical and clinical implications of radiotherapy treatment of prostate cancer using a full bladder protocol. Strahlenther Onkol 2011; 187:799-805. [PMID: 22127358 DOI: 10.1007/s00066-011-2259-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 06/16/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the dosimetric and clinical implication when applying the full bladder protocol for the treatment of the localized prostate cancer (PCA). PATIENTS AND METHODS A total of 26 consecutive patients were selected for the present study. Patients underwent two series of CT scans: the day of the simulation and after 40 Gy. Each series consisted of two consecutive scans: (1) full bladder (FB) and (2) empty bladder (EB). The contouring of clinical target volumes (CTVs) and organs at risk (OAR) were compared to evaluate organ motion. Treatment plans were compared by dose distribution and dose-volume histograms (DVH). RESULTS CTV shifts were negligible in the laterolateral and superior-inferior directions (the maximum shift was 1.85 mm). Larger shifts were recorded in the anterior-posterior direction (95% CI, 0.83-4.41 mm). From the dosimetric point of view, shifts are negligible: the minimum dose to the CTV was 98.5% (median; 95%CI, 95-99%). The potential advantage for GU toxicity in applying the FB treatment protocol was measured: the ratio between full and empty bladder dose-volume points (selected from our protocol) is below 0.61, excluding the higher dose region where DVHs converge. CONCLUSION Having a FB during radiotherapy does not affect treatment effectiveness, on the contrary it helps achieve a more favorable DVH and lower GU toxicities.
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Affiliation(s)
- Raffaella Cambria
- Department of Medical Physics, Istituto Europeo di Oncologia, Milan, Italy.
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Paumier A, Bonvalot S, Beaudré A, Terrier P, Rimareix F, Domont J, Le Cesne A, Roberti E, Lefkopoulos D, Le Péchoux C. [Intensity modulated radiotherapy as adjuvant post-operative treatment for retroperitoneal sarcoma: acute toxicity]. Cancer Radiother 2011; 15:413-20. [PMID: 21737334 DOI: 10.1016/j.canrad.2011.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/12/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the acute toxicity of intensity modulated radiotherapy as post-operative adjuvant treatment for retroperitoneal sarcoma. PATIENTS AND METHODS Patients who received adjuvant intensity modulated radiotherapy from January 2009 to September 2010 were retrospectively reviewed. RESULTS Fourteen patients entered the study (seven primary tumours and seven relapses). All tumours were liposarcoma and had macroscopically complete resection, epiploplasty was systematically realized. Median tumour size was 21 cm (range: 15-45), median planning target volume was 580 cm(3) (range: 329-1172) and median prescribed dose was 50.4 Gy (range: 45-54). Median follow-up was 11.5 months (range: 2-21.4). Acute toxicity was mild: acute digestive toxicity grade 1-2 occurred in 12/14 patients (86%). However, there was no weight loss of more than 5% during radiotherapy and no treatment interruption was required. Two months after completion of radiotherapy, digestive toxicity grade 1 remained present in 1/14 patients (7%). One case of grade 3 toxicity occurred during follow-up (transient abdominal pain). Three relapses occurred: two were outside treaded volume and one was both in and outside treated volume. CONCLUSIONS Intensity modulated radiotherapy in the postoperative setting of retroperitoneal sarcoma provides low acute toxicity. Longer follow-up is needed to assess late toxicity, especially for bowel, kidney and radio-induced malignancies.
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Affiliation(s)
- A Paumier
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114 rue Édouard-Vaillant, Villejuif, France
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À propos de l’article « Dose de tolérance à l’irradiation des tissus sains : intestin grêle » par Martin et al. (Cancer Radiother 14:350–3). Cancer Radiother 2011; 15:258-9. [DOI: 10.1016/j.canrad.2011.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 01/20/2011] [Accepted: 01/28/2011] [Indexed: 11/20/2022]
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Martin E, Pointreau Y, Roche-Forestier S, Barillot I. [Normal tissue tolerance to external beam radiation therapy: small bowel]. Cancer Radiother 2010; 14:350-3. [PMID: 20598616 DOI: 10.1016/j.canrad.2010.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 02/22/2010] [Accepted: 03/03/2010] [Indexed: 01/12/2023]
Abstract
The small bowel is a hollow organ involved in the transit and absorption of food. In relation to its anatomical location, a significant amount of this organ is exposed in whole or in part to ionizing radiation in external radiotherapy during abdominal or pelvic irradiation either for primary cancers or metastasis. The acute functional changes during external beam radiation are mainly leading to diarrhea, abdominal pain and bloating. The main late side effects of irradiation of the small intestine are chronic diarrhea, malabsorption with steatorrhea, abdominal spasms, intestinal obstruction, bleeding and fistulas. The architecture of the small intestine may be considered as parallel with a significant correlation between the irradiated volume of small bowel and the likelihood of acute toxicity, whatever the dose. The literature analysis recommends to consider the volume of small bowel receiving 15 Gy (threshold of 100 to 200 cm(3)) but also 30 and 50 Gy (thresholds of 35 to 300 cm(3), depending on the level of dose considered). Modern techniques of conformal radiotherapy with modulated intensity will probably have beneficial impact on small bowel toxicity.
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Affiliation(s)
- E Martin
- Département de Radiothérapie, Centre Georges-Francois-Leclerc, 1 Rue du Professeur-Marion, 21079 Dijon cedex, France
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Perna L, Alongi F, Fiorino C, Broggi S, Cattaneo Giovanni M, Cozzarini C, Di Muzio N, Calandrino R. Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy. Radiother Oncol 2010; 97:71-5. [PMID: 20307910 DOI: 10.1016/j.radonc.2010.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 02/22/2010] [Accepted: 02/23/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE/OBJECTIVE Whole pelvis irradiation with IMRT (WPRT-IMRT) after prostatectomy is efficient in reducing acute toxicity: however, a number of patients still experience moderate acute bowel toxicity. MATERIALS AND METHODS Ninety-six patients treated with WPRT-IMRT after prostatectomy with adjuvant or salvage intent were analysed. A number of parameters were individually recovered, including the DVHs of the intestinal cavity outside PTV and of the loops referred to both the WPRT phase and the whole treatment. Correlation between clinical-dosimetric parameters and acute bowel toxicity was investigated by logistic analyses. Best predictive cut-off values for continuous variables were assessed by ROC curves. RESULTS 15/96 (15.6%) Patients experienced grade 2 toxicity (no grade 3). Best dose-volume predictors were the fraction of loops receiving more than 45, 50 and 55 Gy (respectively, V45TL ≥ 50cc, V50TL ≥ 13cc, V55TL ≥ 3cc; p-values ranging from 0.005 to 0.027). Age, GU acute toxicity, rectal acute toxicity and time between prostatectomy and IMRT were also predictors of acute bowel toxicity. Multivariate analysis showed that the most predictive independent parameters were age (OR: 1.13; 95%CI: 1.02-1.25; p=0.021) and V50TL (≥ 13cc, OR: 8.2; 95%CI: 1.7-40; p=0.009). CONCLUSIONS The risk of moderate acute uGI toxicity during WPRT-IMRT for post-operatively treated patients increases with age; the risk is substantially reduced in patients with small overlap between PTV and loops.
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Affiliation(s)
- Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
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Fiorino C, Valdagni R, Rancati T, Sanguineti G. Dose–volume effects for normal tissues in external radiotherapy: Pelvis. Radiother Oncol 2009; 93:153-67. [DOI: 10.1016/j.radonc.2009.08.004] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 08/11/2009] [Accepted: 08/11/2009] [Indexed: 02/07/2023]
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