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Kokuryo D, Aoki I, Yuba E, Kono K, Aoshima S, Kershaw J, Saga T. Evaluation of a combination tumor treatment using thermo-triggered liposomal drug delivery and carbon ion irradiation. Transl Res 2017; 185:24-33. [PMID: 28482173 DOI: 10.1016/j.trsl.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 02/03/2023]
Abstract
The combination of radiotherapy with chemotherapy is one of the most promising strategies for cancer treatment. Here, a novel combination strategy utilizing carbon ion irradiation as a high-linear energy transfer (LET) radiotherapy and a thermo-triggered nanodevice is proposed, and drug accumulation in the tumor and treatment effects are evaluated using magnetic resonance imaging relaxometry and immunohistology (Ki-67, n = 15). The thermo-triggered liposomal anticancer nanodevice was administered into colon-26 tumor-grafted mice, and drug accumulation and efficacy was compared for 6 groups (n = 32) that received or did not receive the radiotherapy and thermo trigger. In vivo quantitative R1 maps visually demonstrated that the multimodal thermosensitive polymer-modified liposomes (MTPLs) can accumulate in the tumor tissue regardless of whether the region was irradiated by carbon ions or not. The tumor volume after combination treatment with carbon ion irradiation and MTPLs with thermo-triggering was significantly smaller than all the control groups at 8 days after treatment. The proposed strategy of combining high-LET irradiation and the nanodevice provides an effective approach for minimally invasive cancer treatment.
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Affiliation(s)
- Daisuke Kokuryo
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan; Graduate School of System Informatics, Kobe University, Kobe, Hyogo, Japan
| | - Ichio Aoki
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan.
| | - Eiji Yuba
- Graduate School of Engineering, Osaka Prefecture University, Sakai, Osaka, Japan
| | - Kenji Kono
- Graduate School of Engineering, Osaka Prefecture University, Sakai, Osaka, Japan
| | | | - Jeff Kershaw
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - Tsuneo Saga
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan
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Impact of different beam directions on intensity-modulated radiation therapy dose delivered to functioning lung tissue identified using single-photon emission computed tomography. Contemp Oncol (Pozn) 2014; 18:436-41. [PMID: 25784844 PMCID: PMC4355654 DOI: 10.5114/wo.2014.46237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 11/17/2022] Open
Abstract
Aim of the study To use different beam arrangements and numbers to plan intensity-modulated radiation therapy (IMRT) and investigate their effects on low and high radiation doses delivered to the functional lung, in order to reduce radiation-induced lung damage. Material and methods Ten patients with stage I–III non-small cell lung carcinoma (NSCLC) underwent IMRT. Beam arrangements were selected on the basis of orientation and dose-volume histograms to create SPECT-guided IMRT plans that spared the functional lung and maintained target coverage. Four different plans, including CT-7, SPECT-7, SPECT-4, SPECT-5 with different beam arrangements, were used. The differences of conformity index (CI), heterogeneity index (HI) between the plans were analyzed, by using a paired t-test. Results The seven-beam SPECT (SPECT-7) plan reduced the volume of the functional lung irradiated with at least 20 Gy (FV20) and 30 Gy (FV30) by 26.02% ±15.45% and 14.41% ±16.66%, respectively, as compared to the seven-beam computed tomography (CT-7) plan. The CI significantly differed between the SPECT-7 and SPECT-4 plans and between the SPECT-5 and SPECT-4 plans, but not between the SPECT-5 and SPECT-7 plans. The CIs in the SPECT-5 and SPECT-7 plans were better than that in the SPECT-4 plan. The heterogeneity index significantly differed among the three SPECT plans and was best in the SPECT-7 plan. Conclusions The incorporation of SPECT images into IMRT planning for NSCLC greatly affected beam angles and number of beams. Fewer beams and modified beam angles achieved similar or better IMRT quality. The low-dose volumes were lower in SPECT-4.
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McGuire SM, Marks LB, Yin FF, Das SK. A methodology for selecting the beam arrangement to reduce the intensity-modulated radiation therapy (IMRT) dose to the SPECT-defined functioning lung. Phys Med Biol 2009; 55:403-16. [PMID: 20019404 DOI: 10.1088/0031-9155/55/2/005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Macroaggregated albumin single-photon emission computed tomography (MAA-SPECT) provides a map of the spatial distribution of lung perfusion. Our previous work developed a methodology to use SPECT guidance to reduce the dose to the functional lung in IMRT planning. This study aims to investigate the role of beam arrangement on both low and high doses in the functional lung. In our previous work, nine-beam IMRT plans were generated with and without SPECT guidance and compared for five patients. For the current study, the dose-function histogram (DFH) contribution for each of the nine beams for each patient was calculated. Four beams were chosen based on orientation and DFH contributions to create a SPECT-guided plan that spared the functional lung and maintained target coverage. Four-beam SPECT-guided IMRT plans reduced the F(20) and F(30) values by (16.5 +/- 6.8)% and (6.1 +/- 9.2)%, respectively, when compared to nine-beam conventional IMRT plans. Moreover, the SPECT-4F Plan reduces F(5) and F(13) for all patients by (11.0 +/- 8.2)% and (6.1 +/- 3.6)%, respectively, compared to the SPECT Plan. Using fewer beams in IMRT planning may reduce the amount of functional lung that receives 5 and 13 Gy, a factor that has recently been associated with radiation pneumonitis.
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Affiliation(s)
- S M McGuire
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Park SH, Park HC, Park SW, Oh DH, Choi Y, Kim JK, Ahn YC, Park W, Suh HS, Lee R, Bae H. Multi-institutional comparison of intensity modulated radiation therapy (IMRT) planning strategies and planning results for nasopharyngeal cancer. J Korean Med Sci 2009; 24:248-55. [PMID: 19399266 PMCID: PMC2672124 DOI: 10.3346/jkms.2009.24.2.248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 06/26/2008] [Indexed: 11/20/2022] Open
Abstract
The intensity-modulated radiation therapy (IMRT) planning strategies for nasopharyngeal cancer among Korean radiation oncology facilities were investigated. Five institutions with IMRT planning capacity using the same planning system were invited to participate in this study. The institutions were requested to produce the best plan possible for 2 cases that would deliver 70 Gy to the planning target volume of gross tumor (PTV1), 59.4 Gy to the PTV2, and 51.5 Gy to the PTV3 in which elective irradiation was required. The advised fractionation number was 33. The planning parameters, resultant dose distributions, and biological indices were compared. We found 2-3-fold variations in the volume of treatment targets. Similar degree of variation was found in the delineation of normal tissue. The physician-related factors in IMRT planning had more influence on the plan quality. The inhomogeneity index of PTV dose ranged from 4 to 49% in Case 1, and from 5 to 46% in Case 2. Variation in tumor control probabilities for the primary lesion and involved LNs was less marked. Normal tissue complication probabilities for parotid glands and skin showed marked variation. Results from this study suggest that greater efforts in providing training and continuing education in terms of IMRT planning parameters usually set by physician are necessary for the successful implementation of IMRT.
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Affiliation(s)
- Sung Ho Park
- Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Won Park
- Department of Radiation Oncology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Youngmin Choi
- Department of Radiation Oncology, Dong-A University Medical Center, Busan, Korea
| | - Jeung Kee Kim
- Department of Radiation Oncology, Dong-A University Medical Center, Busan, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Sook Suh
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Rena Lee
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hoonsik Bae
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
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Shioyama Y, Jang SY, Liu HH, Guerrero T, Wang X, Gayed IW, Erwin WD, Liao Z, Chang JY, Jeter M, Yaremko BP, Borghero YO, Cox JD, Komaki R, Mohan R. Preserving Functional Lung Using Perfusion Imaging and Intensity-Modulated Radiation Therapy for Advanced-Stage Non–Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2007; 68:1349-58. [PMID: 17446001 DOI: 10.1016/j.ijrobp.2007.02.015] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 02/06/2007] [Accepted: 02/07/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess quantitatively the impact of incorporating functional lung imaging into intensity-modulated radiation therapy planning for locally advanced non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Sixteen patients with advanced-stage NSCLC who underwent radiotherapy were included in this study. Before radiotherapy, each patient underwent lung perfusion imaging with single-photon-emission computed tomography and X-ray computed tomography (SPECT-CT). The SPECT-CT was registered with simulation CT and was used to segment the 50- and 90-percentile hyperperfusion lung (F50 lung and F90 lung). Two IMRT plans were designed and compared in each patient: an anatomic plan using simulation CT alone and a functional plan using SPECT-CT in addition to the simulation CT. Dosimetric parameters of the two types of plans were compared in terms of tumor coverage and avoidance of normal tissues. RESULTS In incorporating perfusion information in IMRT planning, the median reductions in the mean doses to the F50 and F90 lung in the functional plan were 2.2 and 4.2 Gy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with >5 Gy, >10 Gy, and >20 Gy in the functional plans were 7.1%, 6.0%, and 5.1%, respectively, for F50 lung, and 11.7%, 12.0%, and 6.8%, respectively, for F90 lung. A greater degree of sparing of the functional lung was achieved for patients with large perfusion defects compared with those with relatively uniform perfusion distribution. CONCLUSION Function-guided IMRT planning appears to be effective in preserving functional lung in locally advanced-stage NSCLC patients.
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Affiliation(s)
- Yoshiyuki Shioyama
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Yom SS, Liao Z, Liu HH, Tucker SL, Hu CS, Wei X, Wang X, Wang S, Mohan R, Cox JD, Komaki R. Initial evaluation of treatment-related pneumonitis in advanced-stage non-small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2007; 68:94-102. [PMID: 17321067 DOI: 10.1016/j.ijrobp.2006.12.031] [Citation(s) in RCA: 233] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 12/01/2006] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the rate of high-grade treatment-related pneumonitis (TRP) in patients with advanced non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS From August 2002 to August 2005, 151 NSCLC patients were treated with IMRT. We excluded patients who did not receive concurrent chemotherapy or who had early-stage cancers, a history of major lung surgery, prior chest RT, a dose <50 Gy, or IMRT combined with three-dimensional conformal RT (3D-CRT). Toxicities were graded by Common Terminology Criteria for Adverse Events version 3.0. Grade > or = 3 TRP for 68 eligible IMRT patients was compared with TRP among 222 similar patients treated with 3D-CRT. RESULTS The median follow-up durations for the IMRT and 3D-CRT patients were 8 months (range, 0-27 months) and 9 months (range, 0-56 months), respectively. The median IMRT and 3D-CRT doses were 63 Gy. The median gross tumor volume was 194 mL (range, 21-911 mL) for IMRT, compared with 142 mL (range, 1.5-1,186 mL) for 3D-CRT (p = 0.002). Despite the IMRT group's larger gross tumor volume, the rate of Grade > or = 3 TRP at 12 months was 8% (95% confidence interval 4%-19%), compared with 32% (95% confidence interval 26%-40%) for 3D-CRT (p = 0.002). CONCLUSIONS In advanced NSCLC patients treated with chemoradiation, IMRT resulted in significantly lower levels of Grade > or = 3 TRP compared with 3D-CRT. Clinical, dosimetric, and patient selection factors that may have influenced rates of TRP require continuing investigation. A randomized trial comparing IMRT with 3D-CRT has been initiated.
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Affiliation(s)
- Sue S Yom
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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