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Yu J, Li N, Tang Y, Wang X, Tang Y, Wang SL, Song YW, Liu YP, Li YX, Jin J. Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases. J Surg Oncol 2019; 119:532-538. [PMID: 30609038 DOI: 10.1002/jso.25361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES To assess the efficacy and the effect of biologic effective dose (BED) on outcomes treated by hypofractionated stereotactic radiotherapy for colorectal cancer (CRC) oligometastases. METHODS Patients with CRC oligometastases treated at our hospital between 2009 and 2016 were included. The relationship between BED and risk of local recurrence was assessed. Recursive partitioning analysis (RPA) was used to evaluate the effect of BED on outcomes. RESULTS A total of 48 patients were included in this study. Median follow-up time of surviving patient was 15 months (range, 3-82 months). The 1-year local control rate was 85%. The risk of local recurrence decreased sharply when BED was >90 Gy10 . RPA showed BED of 100 Gy 10 was the appropriate dose for recurrence risk stratification. BED ≥ 100 Gy 10 was significantly better than BED < 100 Gy 10 for achieving 1-year local control (94.4% vs 63.2%; P = 0.022) and 1-year OS (100% vs 73.4%; P = 0.028). One patient who received long-term antiangiogenic treatment died of massive intestinal hemorrhage; no other grade 3 or above early or late events were observed. CONCLUSIONS Hypofractionated stereotactic radiotherapy provides favorable outcomes with acceptable toxicities in CRC oligometastases. BED ≥ 100 Gy is associated with better outcomes.
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Affiliation(s)
- Jing Yu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Mast M, Kouwenhoven E, Roos J, van Geen S, van Egmond J, van Santvoort J, de Boer L, Florijn M, Kalidien Y, Nobel N, Rovers L, van der Togt W, de Vet S, van der Voort van Zyp N, Wenmakers F, van Wingerden J, Ceha H. Two years' experience with inspiration breath-hold in liver SBRT. Tech Innov Patient Support Radiat Oncol 2018; 7:1-5. [PMID: 32095574 PMCID: PMC7033777 DOI: 10.1016/j.tipsro.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/24/2018] [Accepted: 04/26/2018] [Indexed: 12/22/2022] Open
Abstract
The workflow of inspiration breath-hold SBRT for liver metastases is described. Inspiration breath-hold in liver SBRT is feasible for 95% of the patients. An individual margin recipe for inspiration breath-hold liver SBRT is explained. Margin reduction of 10 mm using inspiration breath-hold compared to free breathing.
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Affiliation(s)
- M Mast
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - E Kouwenhoven
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - J Roos
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - S van Geen
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - J van Egmond
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - J van Santvoort
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - L de Boer
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - M Florijn
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Y Kalidien
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - N Nobel
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - L Rovers
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - W van der Togt
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - S de Vet
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - N van der Voort van Zyp
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - F Wenmakers
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - J van Wingerden
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - H Ceha
- Radiation Therapy Department, Haaglanden Medical Center, Burg Banninglaan 1, 2262 BA Leidschendam, The Netherlands
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Exploration of Superior Modality: Safety and Efficacy of Hypofractioned Image-Guided Intensity Modulated Radiation Therapy in Patients with Unresectable but Confined Intrahepatic Hepatocellular Carcinoma. Can J Gastroenterol Hepatol 2017; 2017:6267981. [PMID: 29098144 PMCID: PMC5643031 DOI: 10.1155/2017/6267981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/10/2017] [Accepted: 09/17/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of hypofractioned image-guided intensity modulated radiation therapy (IG-IMRT) for unresectable but confined intrahepatic hepatocellular carcinoma in comparison with conventional 3-dimensional conformal radiotherapy (3D-CRT). METHODS Ninety patients with unresectable but confined intrahepatic hepatocellular carcinoma without distant metastasis and tumor thrombosis received external beam radiation therapy. Of these patients, 45 received IG-IMRT and 45 received 3D-CRT. The IG-IMRT design delivered a median total hypofractionated dose of 54 Gy (2.2-5.5 Gy/fx), and 3D-CRT delivered a median total dose of 54 Gy with a conventional fraction (2.0 Gy/fx). The clinical response, overall survival, and side effects were analyzed. RESULTS The IG-IMRT group showed significantly higher 1-year survival (93.3 versus 77.8%) and 2-year survival (73.3 versus 51.1%) and longer median survival (44.7 versus 24.0 months) than the 3D-CRT group. Multivariate analysis indicated that the patients with intrahepatic tumors smaller than 8 cm, prior TACE before RT, and IG-IMRT would have a survival benefit. There were no significant differences in the rates of side effects between the two groups. CONCLUSION Hypofractioned IG-IMRT could improve the therapeutic response and confer a potential survival of patients with unresectable but confined intrahepatic hepatocellular carcinoma compared to 3D-CRT with acceptable toxicity.
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Postoperative carcinoembryonic antigen level has a prognostic value for distant metastasis and survival in rectal cancer patients who receive preoperative chemoradiotherapy and curative surgery: a retrospective multi-institutional analysis. Clin Exp Metastasis 2016; 33:809-816. [DOI: 10.1007/s10585-016-9818-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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Bae SH, Moon SK, Kim YH, Cho KH, Shin EJ, Lee MS, Ryu CB, Ko BM, Yun J. Feasibility and response of helical tomotherapy in patients with metastatic colorectal cancer. Radiat Oncol J 2015; 33:320-7. [PMID: 26756032 PMCID: PMC4707215 DOI: 10.3857/roj.2015.33.4.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 11/26/2015] [Accepted: 12/10/2015] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate the treatment outcome and the toxicity of helical tomotherapy (HT) in patients with metastatic colorectal cancer (mCRC). Materials and Methods We retrospectively reviewed 18 patients with 31 lesions from mCRC treated with HT between 2009 and 2013. The liver (9 lesions) and lymph nodes (9 lesions) were the most frequent sites. The planning target volume (PTV) ranged from 12 to 1,110 mL (median, 114 mL). The total doses ranged from 30 to 70 Gy in 10-30 fractions. When the α/β value for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the total doses ranged from 39 to 119 Gy10 (median, 55 Gy10). Nineteen lesions were treated with concurrent chemotherapy (CCRT). Results With a median follow-up time of 16 months, the median overall survival for 18 patients was 33 months. Eight lesions (26%) achieved complete response. The 1- and 3-year local progression free survival (LPFS) rates for 31 lesions were 45% and 34%, respectively. On univariate analysis, significant parameters influencing LPFS rates were chemotherapy response before HT, aim of HT, CCRT, PTV, BED, and adjuvant chemotherapy. On multivariate analysis, PTV ≤113 mL and BED >48 Gy10 were associated with a statistically significant improvement in LFPS. During HT, four patients experienced grade 3 hematologic toxicities, each of whom had also received CCRT. Conclusion The current study demonstrates the efficacy and tolerability of HT for mCRC. To define optimal RT dose according to tumor size of mCRC, further study should be needed.
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Affiliation(s)
- Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seong Kwon Moon
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yong Ho Kim
- Department of Radiation Oncology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Kwang Hwan Cho
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Eung Jin Shin
- Department of General Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Moon Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chang Beom Ryu
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bong Min Ko
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jina Yun
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Impact of inadequate respiratory motion management in SBRT for oligometastatic colorectal cancer. Radiother Oncol 2014; 113:235-9. [DOI: 10.1016/j.radonc.2014.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/22/2022]
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Yu M, Lee JH, Jang HS, Jeon DM, Cheon JS, Lee HC, Lee JH. A comparison of dosimetric parameters between tomotherapy and three-dimensional conformal radiotherapy in rectal cancer. Radiat Oncol 2013; 8:181. [PMID: 23866263 PMCID: PMC3721992 DOI: 10.1186/1748-717x-8-181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/08/2013] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Tomotherapy for intensity-modulated radiation has been demonstrated to reduce unnecessary irradiations to adjacent organs at risk (OARs). The purpose of this study was to compare the dosimetric parameters between Tomotherapy and three-dimensional conformal radiotherapy (3D-CRT) in rectal cancer patients. MATERIALS AND METHODS We redesigned three-dimensional conformal plans for 20 rectal cancer patients who had received short-course preoperative radiotherapy with Tomotherapy. The target coverage for 3D-CRT and Tomotherapy was evaluated with the following including the mean dose, V(nGy), D(min), D(max), radiation conformality index (RCI), and radical dose homogeneity index (rDHI). RESULTS The mean PTV dose for Tomotherapy is significantly higher than that observed for the 3D-CRT (p = 0.043). However, there is no significant difference in the V(23.25Gy), V(26.25Gy), V(27.5Gy), and RCI values between Tomotherapy and 3D-CRT. However, the average rDHI (p < 0.001) value for Tomotherapy was significantly lower than that reported for the 3D-CRT. Tomotherapy significantly lowered the mean level of irradiation doses to the bladder, small bowel, and femur heads as compared to 3D-CRT. CONCLUSIONS Tomotherapy could produce a favorable target coverage and significant dose reduction for the OARs at the expense of acceptable dose inhomogeneity of the PTV compared with 3D-CRT in rectal cancer patients.
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Affiliation(s)
- Mina Yu
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea
| | - Joo Hwan Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Min Jeon
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Suk Cheon
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Chun Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea
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