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Saroj DK, Yadav S, Paliwal N, Haldar S, Jagtap A, Kumar A. Assessment of Treatment Plan Quality between Flattening Filter and Flattening Filter Free Photon Beam for Carcinoma of the Esophagus with IMRT Technique. J Biomed Phys Eng 2023; 13:227-238. [PMID: 37312893 PMCID: PMC10258210 DOI: 10.31661/jbpe.v0i0.2108-1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
Background As compared to the flattened photon beam, removing the flattening filter (FF) from the head of a gantry decreases the average energy of the photon beam and increases the dose rate, leading to an impact on the quality of treatment plans. Objective This study aimed to compare the quality of intensity-modulated radiation therapy (IMRT) treatment plans for esophageal cancer with and without a flattened filter photon beam. Material and Methods In this analytical study, 12 patients, who had already been treated with a 6X FF photon beam, were treated based on new IMRT methods using a 6X the flattening filter-free (FFF) photon beam. Both 6X FF IMRT and 6X FFF IMRT plans used identical beam parameters and planning objectives. All plans were evaluated with planning indices and doses for organs at risk (OARs). Results Insignificant dose variation was for HI, CI, D98%, and V95% between FF and FFF photon beam IMRT plans. FF-based IMRT plan delivered a 15.51 % and 11.27% higher mean dose to both lungs and heart than the FFF plan, respectively. The integral dose (ID) for the heart and lungs was 11.21% and 15.51%, respectively, less in the IMRT plan with an FFF photon beam. Conclusion In contrast to the FF photon beam, a filtered photon beam-oriented IMRT plan provides significant OAR sparing without losing the quality of the treatment plan. High monitor units (MUs), low ID, and Beam on Time (BOT) are major highlights of the IMRT plan with FFF beam.
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Affiliation(s)
- Dinesh Kumar Saroj
- Department of Radiotherapy, Alexis Multispecialty Hospital Nagpur-440030 (Maharashtra), India
- Department of Science, Rabindranath Tagore University, Bhopal, Madhya Pradesh, India
| | - Suresh Yadav
- Department of Radiotherapy, Gandhi Medical College, Bhopal-462001 (M.P.), India
| | - Neetu Paliwal
- Department of Science, Rabindranath Tagore University, Bhopal, Madhya Pradesh, India
| | - Subhas Haldar
- Department of Radiotherapy, Saroj Gupta Cancer Center and Research Institute, Kolkata-700063 (West Bengal), India
| | - Amol Jagtap
- Department of Radiotherapy, Alexis Multispecialty Hospital Nagpur-440030 (Maharashtra), India
| | - Arvind Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences (AIIMS), Rishikesh-249203 (U.K.), India
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Marks LB, Reinsberg SA, Yorke E, Moiseenko V. Why Do Both Mean Dose and V≥x Often Predict for Normal Tissue Outcomes? Adv Radiat Oncol 2022; 7:101039. [PMID: 36092989 PMCID: PMC9450075 DOI: 10.1016/j.adro.2022.101039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
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Ippolito E, Floreno B, Rinaldi CG, Trodella L, Meroni FL, Iurato A, D'Angelillo RM, Ramella S, Fiore M. Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer. Chemotherapy 2018; 63:76-82. [PMID: 29554652 DOI: 10.1159/000487897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/21/2018] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the efficacy of a propolis-based syrup, FARINGEL®, in preventing radiation-induced esophagitis in locally advanced lung cancer patients. METHODS Patients were treated with concurrent chemoradiotherapy (CRT) using involved-field radiotherapy (RT). Every patient received FARINGEL at the beginning of CRT until the first follow-up. The data of the study group were compared with the data of a control group treated without the administration of the syrup. RESULTS Forty-five patients were enrolled. Forty-one (91.1%) completed the protocol and were evaluable for esophagitis. Grade ≥2 toxicity occurred in 9/41 patients (22%). No differences in overall toxicity were detected between the study group and the control group (n = 55, 60.9 vs. 54.5%; p = ns). Grade 2-3 esophagitis was lower in the study group in comparison with the control group (22 and 38%, respectively), but statistical significance was not reached (p = 0.09). However, the onset of grade ≥2 esophagitis was delayed in the study group compared to the control group, occurring at higher doses of RT (41.8 vs. 25.4 Gy; p < 0.001). Furthermore, the mean number of interruption days for esophagitis was lower in the study group than in the control group (0.6 ± 2.0 vs. 2.1 ± 3.6; p = 0.025). CONCLUSION FARINGEL was well-tolerated and delayed esophagitis that was induced by CRT for locally advanced lung cancer.
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Bagdare P, Gurjar OP, Shrivastav G. Dosimetric analysis of intensity modulated radiotherapy (IMRT) and three dimensional conformal radiotherapy (3DCRT) for treatment of non-small cell lung cancer: A comparative study. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.33.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Shrimali RK, Mahata A, Reddy GD, Franks KN, Chatterjee S. Pitfalls and Challenges to Consider before Setting up a Lung Cancer Intensity-modulated Radiotherapy Service: A Review of the Reported Clinical Experience. Clin Oncol (R Coll Radiol) 2015; 28:185-97. [PMID: 26329504 DOI: 10.1016/j.clon.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 05/27/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of non-small cell lung cancer (NSCLC), despite the absence of published randomised controlled trials. Planning studies and retrospective series have shown a decrease in known predictors of lung toxicity (V20 and mean lung dose) and the maximum spinal cord dose. Potential dosimetric advantages, accessibility of technology, a desire to escalate dose or a need to meet normal organ dose constraints are some of the factors recognised as supporting the use of IMRT. However, IMRT may not be appropriate for all patients being treated with radical radiotherapy. Unique problems with using IMRT for NSCLC include organ and tumour motion because of breathing and the potential toxicity from low doses of radiotherapy to larger amounts of lung tissue. Caution should be exercised as there is a paucity of prospective data regarding the efficacy and safety of IMRT in lung cancer when compared with three-dimensional conformal radiotherapy and IMRT data from other cancer sites should not be extrapolated. This review looks at the use of IMRT in NSCLC, addresses the challenges and highlights the potential benefits of using this complex radiotherapy technique.
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Affiliation(s)
- R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - A Mahata
- Medical Physics, Tata Medical Center, Kolkata, India
| | - G D Reddy
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - K N Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Ling DC, Hess CB, Chen AM, Daly ME. Comparison of Toxicity Between Intensity-Modulated Radiotherapy and 3-Dimensional Conformal Radiotherapy for Locally Advanced Non-small-cell Lung Cancer. Clin Lung Cancer 2015; 17:18-23. [PMID: 26303127 DOI: 10.1016/j.cllc.2015.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/05/2015] [Accepted: 07/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role of intensity-modulated radiotherapy (IMRT) in reducing treatment-related toxicity for locally advanced non-small-cell lung cancer (NSCLC) remains incompletely defined. We compared acute toxicity and oncologic outcomes in a large cohort of patients treated with IMRT or 3-dimensional conformal radiotherapy (3-DCRT), with or without elective nodal irradiation (ENI). METHODS A single-institution retrospective review was performed evaluating 145 consecutive patients with histologically confirmed stage III NSCLC treated with definitive chemoradiotherapy. Sixty-five (44.8%) were treated with 3-DCRT using ENI, 43 (30.0%) with 3-DCRT using involved-field radiotherapy (IFRT), and 37 (25.5%) with IMRT using IFRT. All patients received concurrent chemotherapy. Comparison of acute toxicities by treatment technique (IMRT vs. 3-DCRT) and extent of nodal irradiation (3-DCRT-IFRT vs. 3-DCRT-ENI) was performed for grade 2 or higher esophagitis or pneumonitis, number of acute hospitalizations, incidence of opioid requirement, percutaneous endoscopic gastrostomy utilization, and percentage weight loss during treatment. Local control and overall survival were analyzed by the Kaplan-Meier method. RESULTS We identified no significant differences in any measures of acute toxicity by treatment technique or extent of nodal irradiation. There was a trend toward lower rates of grade 2 or higher pneumonitis among IMRT patients compared to 3-DCRT patients (5.4% vs. 23.0%; P = .065). Local control and overall survival were similar between cohorts. CONCLUSION Acute and subacute toxicities were similar for patients treated with IMRT and with 3-DCRT with or without ENI, with a nonsignificant trend toward a reduction in pneumonitis with IMRT. Larger studies are needed to better define which patients will benefit from IMRT.
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Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Clayton B Hess
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Allen M Chen
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
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Tsutsumi S, Tada T, Maekado T, Tokunaga M, Tanaka N, Kobayashi A, Okazaki E, Matsuda S, Hosono MN, Miki Y. Lung cancer: a 6-field technique using lateral beams in conformal radiotherapy for bilateral supraclavicular lymph node metastases. SPRINGERPLUS 2014; 3:733. [PMID: 25674465 PMCID: PMC4320133 DOI: 10.1186/2193-1801-3-733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/24/2014] [Indexed: 11/29/2022]
Abstract
A 6-field technique using lateral beams in conformal radiotherapy was developed for patients with bilateral supraclavicular lymph node metastasis of lung cancer. The possibility of using this technique in practice was evaluated. Six fields with the same isocenter point (IP) were arranged. Two fields using anterior-posterior opposed beams involved all of the planning target volume (PTV). The next 2 fields using off-cord oblique beams involved the PTV inferior to the IP. The remaining 2 fields using lateral opposed beams, that shielded the spinal cord, involved the PTV superior to the IP. The oblique 2 fields and lateral 2 fields were connected using a half-beam technique. In 6 patients with non-small-cell lung cancer (NSCLC, n = 4) or small-cell lung cancer (SCLC, n = 2), treatment re-planning based on this technique was performed. This technique was applicable in 4 patients with NSCLC, in whom the general criteria of radiotherapy for lung cancer were met. In 2 patients with SCLC, the cumulative volume of lung that received more than 20 Gy exceeded 37% of the total lung volume. This technique was usable in 67% of the patients and was not necessarily contraindicated in the other 33%.
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Affiliation(s)
- Shinichi Tsutsumi
- />Department of Radiation Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 5458585 Japan
| | - Takuhito Tada
- />Department of Radiology, Izumi Municipal Hospital, 4-10-10, Fuchucho, Izumi, 5940071 Japan
| | - Tomoko Maekado
- />Department of Radiology, JCHO Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka, 5530003 Japan
| | - Masahiro Tokunaga
- />Department of Radiology, Izumi Municipal Hospital, 4-10-10, Fuchucho, Izumi, 5940071 Japan
| | - Noriko Tanaka
- />Department of Radiology, Izumi Municipal Hospital, 4-10-10, Fuchucho, Izumi, 5940071 Japan
| | - Ai Kobayashi
- />Department of Radiology, Izumi Municipal Hospital, 4-10-10, Fuchucho, Izumi, 5940071 Japan
| | - Eiichiro Okazaki
- />Department of Radiation Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 5458585 Japan
| | - Shougo Matsuda
- />Department of Radiation Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 5458585 Japan
| | - Masako N Hosono
- />Department of Radiation Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 5458585 Japan
| | - Yukio Miki
- />Department of Radiation Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 5458585 Japan
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Wu Z, Xie C, Hu M, Han C, Yi J, Zhou Y, Yuan H, Jin X. Dosimetric benefits of IMRT and VMAT in the treatment of middle thoracic esophageal cancer: is the conformal radiotherapy still an alternative option? J Appl Clin Med Phys 2014; 15:93–101. [PMID: 24892336 PMCID: PMC5711052 DOI: 10.1120/jacmp.v15i3.4641] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/25/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study is to investigate the dosimetric differences among conformal radiotherapy (CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated radiotherapy (VMAT) in the treatment of middle thoracic esophageal cancer, and determine the most appropriate treatment modality. IMRT and one-arc VMAT plans were generated for eight middle thoracic esophageal cancer patients treated previous with CRT. The planning target volume (PTV) coverage and protections on organs at risk of three planning schemes were compared. All plans have sufficient PTV coverage and no significant differences were observed, except for the conformity and homogeneity. The lung V5, V10, and V13 in CRT were 47.9% ± 6.1%, 36.5% ± 4.6%, and 33.2% ± 4.2%, respectively, which were greatly increased to 78.2% ± 13.7% (p < 0.01), 80.8% ± 14.9% (p < 0.01), 48.4% ± 8.2% (p = 0.05) in IMRT and 58.6% ± 10.5% (p = 0.03), 67.7% ± 14.0% (p < 0.01), and 53.0% ± 10.1% (p < 0.01) in VMAT, respectively. The lung V20 (p = 0.03) in VMAT and the V30 (p = 0.04) in IMRT were lower than those in CRT. Both IMRT and VMAT achieved a better protection on heart. However, the volumes of the healthy tissue outside of PTV irradiated by a low dose were higher for IMRT and VMAT. IMRT and VMAT also had a higher MU, optimization time, and delivery time compared to CRT. In conclusion, all CRT, IMRT, and VMAT plans are able to meet the prescription and there is no clear distinction on PTV coverage. IMRT and VMAT can only decrease the volume of lung and heart receiving a high dose, but at a cost of delivering low dose to more volume of lung and normal tissues. CRT is still a feasible option for middle thoracic esophageal cancer radiotherapy, especially for the cost-effective consideration.
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Affiliation(s)
- Zhiqin Wu
- the 1st Affiliated Hospital of Wenzhou Medical College.
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Harris JP, Murphy JD, Hanlon AL, Le QT, Loo BW, Diehn M. A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2014; 88:872-84. [DOI: 10.1016/j.ijrobp.2013.12.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 10/21/2013] [Accepted: 12/10/2013] [Indexed: 12/25/2022]
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10
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Belderbos J, Sonke JJ. State-of-the-art lung cancer radiation therapy. Expert Rev Anticancer Ther 2014; 9:1353-63. [DOI: 10.1586/era.09.118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Jin X, Yi J, Zhou Y, Yan H, Han C, Xie C. CRT combined with a sequential VMAT boost in the treatment of upper thoracic esophageal cancer. J Appl Clin Med Phys 2013; 14:153-61. [PMID: 24036867 PMCID: PMC5714557 DOI: 10.1120/jacmp.v14i5.4325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 05/02/2013] [Accepted: 05/27/2013] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study is to investigate the potential benefits of conformal radiotherapy (CRT) combined with a sequential volumetric‐modulated arc therapy (VMAT) boost in the treatment of upper thoracic esophageal cancer. Ten patients with upper thoracic esophageal cancer previously treated with CRT plus a sequential VMAT boost plan were replanned with CRT plus an off‐cord CRT boost plan and a full course of VMAT plan. Dosimetric parameters were compared. Results indicated that CRT plus off‐cord CRT boost was inferior in planning target volume (PTV) coverage, as indicated by the volume covered by 93% (p = 0.05) and 95% (p = 0.02) of the prescription dose. The full course VMAT plan was superior in conformal index (CI) and conformation number (CN), and produced the highest protection for the spinal cord. CRT plus a VMAT boost demonstrated significant advantages in decreasing the volume of the lung irradiated by a dose of 10 Gy (V10, p = 0.007),13 Gy (V13, p = 0.003), and 20 Gy (V20, p = 0.001). The full course VMAT plan demonstrated the lowest volume of lung receiving a dose of 30 Gy. CRT plus a VMAT boost for upper thoracic esophageal cancer can improve the target coverage and reduce the volume of lung irradiated by an intermediate dose. This combination may be a promising treatment technique for patients with upper thoracic esophageal cancer. PACS number: 87.53.Kn, 87.55.x, 87.55.D, 87.55.dk
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Affiliation(s)
- Xiance Jin
- The 1st Affiliated Hospital of Wenzhou Medical College.
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Topkan E, Parlak C, Topuk S, Pehlivan B. Influence of oral glutamine supplementation on survival outcomes of patients treated with concurrent chemoradiotherapy for locally advanced non-small cell lung cancer. BMC Cancer 2012; 12:502. [PMID: 23113946 PMCID: PMC3529187 DOI: 10.1186/1471-2407-12-502] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 10/18/2012] [Indexed: 12/25/2022] Open
Abstract
Background Glutamine (Gln) supplementation during concurrent chemoradiotherapy (C-CRT) effectively reduces the incidence and severity of acute radiation-induced esophagitis (RIE). However, there are concerns that Gln might stimulate tumor growth, and therefore negatively impact the outcomes of anticancer treatment. We retrospectively investigated the effect of co-administration of oral Gln during C-CRT on survival outcomes of patients with stage IIIB non-small cell lung carcinoma (NSCLC). We additionally evaluated role of oral Gln in preventing C-CRT-induced weight change, acute and late toxicities. Methods The study included 104 patients: 56 (53.8%) received prophylactic powdered Gln (Gln+) orally at a dose of 10 g/8 h and 48 (46.2%) did not receive Gln (Gln-) and served as controls. The prescribed radiation dose to the planning target volume was 66 Gy in 2-Gy fractions. Primary endpoints of progression-free survival (PFS), local/regional progression-free survival (LRPFS), and overall survival (OS) were correlated with status of Gln supplementation. Results Oral Gln was well tolerated except for mild nausea/vomiting in 14 (25.0%) patients. There was no C-CRT-related acute or late grade 4–5 toxicity. Administration of Gln was associated with a decrease in the incidence of grade 3 acute radiation-induced esophagitis (RIE) (7.2% vs. 16.7% for Gln+ vs. Gln-; p=0.02) and late-RIE (0% vs. 6.3%; p=0.06), a reduced need for unplanned treatment breaks (7.1% vs. 20.8%; p=0.04), and reduced incidence of weight loss (44.6% vs. 72.9%; p=0.002). At a median follow-up of 24.2 months (range 9.2-34.4) the median OS, LRPFS, and PFS for Gln+ vs. Gln- cohorts were 21.4 vs. 20.4 (p=0.35), 14.2 vs.11.3 (p=0.16), and 10.2 vs. 9.0 months (p=0.11), respectively. Conclusion In our study, supplementation with Gln during C-CRT had no detectable negative impact on tumor control and survival outcomes in patients with Stage IIIB NSCLC. Furthermore, Gln appeared to have a beneficial effect with respect to prevention of weight loss and unplanned treatment delays, and reduced the severity and incidence of acute- and late-RIE.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey.
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Kwint M, Uyterlinde W, Nijkamp J, Chen C, de Bois J, Sonke JJ, van den Heuvel M, Knegjens J, van Herk M, Belderbos J. Acute Esophagus Toxicity in Lung Cancer Patients After Intensity Modulated Radiation Therapy and Concurrent Chemotherapy. Int J Radiat Oncol Biol Phys 2012; 84:e223-8. [DOI: 10.1016/j.ijrobp.2012.03.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 12/25/2022]
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Comparison of anisotropic aperture based intensity modulated radiotherapy with 3D-conformal radiotherapy for the treatment of large lung tumors. Radiother Oncol 2012; 102:268-73. [DOI: 10.1016/j.radonc.2011.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 09/19/2011] [Accepted: 10/07/2011] [Indexed: 12/25/2022]
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Intensity modulated radiation therapy (IMRT) for the treatment of unicentric Castlemans disease: a case report and review of the use of radiotherapy in the literature. Radiol Oncol 2012; 46:265-70. [PMID: 23077466 PMCID: PMC3472945 DOI: 10.2478/v10019-012-0008-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 10/17/2011] [Indexed: 12/03/2022] Open
Abstract
Background Surgical resection is considered standard therapy for cases of resectable unicentric Castleman’s disease (UCD). Unresectable cases of UCD do not have a consensus regarding the optimal treatment approach, but have utilized steroids, observation, chemotherapy, and radiotherapy. Here we discuss a patient presentation of UCD treated with an advanced radiotherapy technique, IMRT. Case report A 47 year old female was found to have an intra-thoracic posterior UCD and was determined not to be a good surgical candidate. She was referred for radiotherapy and was treated using IMRT to a total dose of 4320 cGy in 180 cGy fractions including a scheduled 10 day break. Following the break, the patient’s treatment was replanned at which the initial treatment volume was reduced by 50.9% for the duration of the treatment course. Radiation Therapy Oncology Group (RTOG) grade III pneumonitis developed which was managed medically. Neither disease progression nor late effects have occurred. Conclusions The use of IMRT and planned treatment break was successful in the treatment of a case of UCD, and should be considered for other unresectable cases.
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Du XL, Sheng XG, Jiang T, Yu H, Yan YF, Gao R, Lu CH, Li QS. Intensity-modulated radiation therapy versus para-aortic field radiotherapy to treat para-aortic lymph node metastasis in cervical cancer: prospective study. Croat Med J 2010; 51:229-36. [PMID: 20564766 DOI: 10.3325/cmj.2010.51.229] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To compare dosimetry, efficacy, and toxicity of intensity-modulated radiation therapy (IMRT) with para-aortic field radiotherapy in patients with para-aortic lymph node (PALN) metastasis of cervical cancer. METHODS This prospective study examined 60 patients with cervical cancer with PALN metastasis who underwent whole-pelvis radiotherapy followed by brachytherapy between November 1, 2004 and May 31, 2008. After 3 cycles of chemotherapy, patients were serially allocated into two groups and treated with IMRT or para-aortic field RT at doses of 58-68 Gy and 45-50 Gy, respectively. Treatment response was evaluated and toxicities were assessed. Patients in the IMRT group were treated with both para-aortic field RT and IMRT in order to compare the exposure dose of organs at risk. RESULTS In the IMRT group, the mean dose delivered to the planning target volume was 67.5 Gy. At least 99% of the gross tumor volume received effective coverage and radical dose (median, 63.5 Gy; range, 54.5-66) during treatment. IMRT plans yielded better dose conformity to the target and better sparing of the spinal cord and small intestine than para-aortic field RT. The IMRT patients experienced less acute and chronic toxicities. The IMRT group also had higher 2- and 3-year survival rates than the para-aortic RT group (2-year, 58.8% vs 25.0%, P = 0.019; 3-year, 36.4% vs 15.6%, P = 0.016). However, no significant difference was found in 1-year survival (67.7% vs 51.3%, P =0.201). The median survival in the IMRT group was 25 months (range, 3 to 37 months). The actuarial overall survival, disease-free survival, and locoregional control rates at 2 years were 67%, 77%, and 88%, respectively, in the IMRT group. CONCLUSIONS IMRT provides better clinical outcomes than para-aortic field radiotherapy in patients with PALN metastasis. However, cervical local and distal recurrence remain a problem. Long-term follow-up and studies involving more patients are needed to confirm our results.
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Affiliation(s)
- Xue-lian Du
- Xiu-gui Sheng, Department of Gynecologic Oncology, Shandong Tumor Hospital and Institute, Jinan 250117, People's Republic of China
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Lievens Y, Nulens A, Gaber MA, Defraene G, De Wever W, Stroobants S, Van den Heuvel F. Intensity-modulated radiotherapy for locally advanced non-small-cell lung cancer: a dose-escalation planning study. Int J Radiat Oncol Biol Phys 2010; 80:306-13. [PMID: 20888706 DOI: 10.1016/j.ijrobp.2010.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 06/15/2010] [Accepted: 06/18/2010] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the potential for dose escalation with intensity-modulated radiotherapy (IMRT) in positron emission tomography-based radiotherapy planning for locally advanced non-small-cell lung cancer (LA-NSCLC). METHODS AND MATERIALS For 35 LA-NSCLC patients, three-dimensional conformal radiotherapy and IMRT plans were made to a prescription dose (PD) of 66 Gy in 2-Gy fractions. Dose escalation was performed toward the maximal PD using secondary endpoint constraints for the lung, spinal cord, and heart, with de-escalation according to defined esophageal tolerance. Dose calculation was performed using the Eclipse pencil beam algorithm, and all plans were recalculated using a collapsed cone algorithm. The normal tissue complication probabilities were calculated for the lung (Grade 2 pneumonitis) and esophagus (acute toxicity, grade 2 or greater, and late toxicity). RESULTS IMRT resulted in statistically significant decreases in the mean lung (p <.0001) and maximal spinal cord (p = .002 and 0005) doses, allowing an average increase in the PD of 8.6-14.2 Gy (p ≤.0001). This advantage was lost after de-escalation within the defined esophageal dose limits. The lung normal tissue complication probabilities were significantly lower for IMRT (p <.0001), even after dose escalation. For esophageal toxicity, IMRT significantly decreased the acute NTCP values at the low dose levels (p = .0009 and p <.0001). After maximal dose escalation, late esophageal tolerance became critical (p <.0001), especially when using IMRT, owing to the parallel increases in the esophageal dose and PD. CONCLUSION In LA-NSCLC, IMRT offers the potential to significantly escalate the PD, dependent on the lung and spinal cord tolerance. However, parallel increases in the esophageal dose abolished the advantage, even when using collapsed cone algorithms. This is important to consider in the context of concomitant chemoradiotherapy schedules using IMRT.
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Affiliation(s)
- Yolande Lievens
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
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Ding K, Bayouth JE, Buatti JM, Christensen GE, Reinhardt JM. 4DCT-based measurement of changes in pulmonary function following a course of radiation therapy. Med Phys 2010; 37:1261-72. [PMID: 20384264 DOI: 10.1118/1.3312210] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Radiation therapy (RT) for lung cancer is commonly limited to subtherapeutic doses due to unintended toxicity to normal lung tissue. Reducing the frequency of occurrence and magnitude of normal lung function loss may benefit from treatment plans that incorporate the regional lung and radiation dose information. In this article, the authors propose a method that quantitatively measures the regional changes in lung tissue function following a course of radiation therapy by using 4DCT and image registration techniques. METHODS 4DCT data sets before and after RT from two subjects are used in this study. Nonlinear 3D image registration is applied to register an image acquired near end inspiration to an image acquired near end expiration to estimate the pulmonary function. The Jacobian of the image registration transformation, indicating local lung expansion or contraction, serves as an index of regional pulmonary function. Approximately 120 annotated vascular bifurcation points are used as landmarks to evaluate registration accuracy. The authors compare regional pulmonary function before and after RT to the planned radiation dose at different locations of the lung. RESULTS In all registration pairs, the average landmark distances after registration are on the order of 1 mm. The pulmonary function change as indicated by the Jacobian change ranges from -0.15 to 0.1 in the contralateral lung and -0.22 to 0.23 in the ipsilateral lung for subject A, and ranges from -0.4 to 0.39 in the contralateral lung and -0.25 to 0.5 in the ipsilateral lung for subject B. Both of the subjects show larger range of the increase in the pulmonary function in the ipsilateral lung than the contralateral lung. For lung tissue regions receiving a radiation dose larger than 24 Gy, a decrease in pulmonary function was observed. For regions receiving a radiation dose smaller than 24 Gy, either an increase or a decrease in pulmonary function was observed. The relationship between the pulmonary function change and the radiation dose varies at different locations. CONCLUSIONS With the use of 4DCT and image registration techniques, the pulmonary function prior to and following a course of radiation therapy can be measured. In the preliminary application of this approach for two subjects, changes in pulmonary function were observed with a weak correlation between the dose and pulmonary function change. In certain sections of the lung, detected locally compromised pulmonary function may have resulted from radiation injury.
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Affiliation(s)
- Kai Ding
- Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa 52242, USA
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Lyatskaya Y, James S, Killoran JH, Soto R, Mamon HJ, Chin L, Allen AM. Infrared-Guided Patient Setup for Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2008; 71:1124-33. [DOI: 10.1016/j.ijrobp.2007.11.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 10/17/2007] [Accepted: 11/14/2007] [Indexed: 10/22/2022]
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Mayo CS, Urie MM, Fitzgerald TJ, Ding L, Lo YC, Bogdanov M. Hybrid IMRT for treatment of cancers of the lung and esophagus. Int J Radiat Oncol Biol Phys 2008; 71:1408-18. [PMID: 18262730 DOI: 10.1016/j.ijrobp.2007.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 01/08/2023]
Abstract
PURPOSE To report on a hybrid intensity-modulated radiation therapy (IMRT; static plus IMRT beams treated concurrently) technique for lung and esophageal patients to reduce the volume of lung treated to low doses while delivering a conformal dose distribution. METHODS Treatment plans were analyzed for 18 patients (12 lung and 6 esophageal). Patients were treated with a hybrid technique that concurrently combines static (approximately two-thirds dose) and IMRT (approximately one-third dose) beams. These plans were compared with conventional three-dimensional (3D; non-IMRT) plans and all IMRT plans using custom four- and five-field arrangements and nine equally spaced coplanar beams. Plans were optimized to reduce V13 and V5 values. Dose-volume histograms were calculated for the planning target volume, heart, and the ipsilateral, contralateral, and total lung. Lung volumes V5, V13, V20, V30; mean lung dose (MLD); and the generalized equivalent uniform dose (gEUD) were calculated for each plan. RESULTS Hybrid plans treated significantly smaller total and contralateral lung volumes with low doses than nine-field IMRT plans. Largest reductions were for contralateral lung V5, V13, and V20 values for lung (-11%, -15%, -7%) and esophageal (-16%, -20%, -7%) patients. Smaller reductions were found also for 3D and four- and five-field IMRT plans. MLD and gEUDs were similar for all plan types. The 3D plans treated much larger extra planning target volumes to prescribed dose levels. CONCLUSIONS Hybrid IMRT demonstrated advantages for reduction of low-dose lung volumes in the thorax for reducing low dose to lung while also reducing the potential magnitude of dose deviations due to intrafraction motion and small field calculation accuracy.
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Affiliation(s)
- Charles S Mayo
- University of Massachusetts Medical School, Department of Radiation Oncology, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Marks LB, Ma J. Challenges in the clinical application of advanced technologies to reduce radiation-associated normal tissue injury. Int J Radiat Oncol Biol Phys 2007; 69:4-12. [PMID: 17707263 DOI: 10.1016/j.ijrobp.2007.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 05/07/2007] [Accepted: 05/07/2007] [Indexed: 11/21/2022]
Affiliation(s)
- Lawrence B Marks
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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Maingon P, Truc G, Peignaux K, Créhange G, Lagneau E. Radiothérapie par modulation d’intensité. ONCOLOGIE 2007. [DOI: 10.1007/s10269-007-0653-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Algara M, Rodríguez N, Viñals P, Lacruz M, Foro P, Reig A, Quera J, Lozano J, Fernández-Velilla E, Membrive I, Dengra J, Sanz X. Prevention of radiochemotherapy-induced esophagitis with glutamine: results of a pilot study. Int J Radiat Oncol Biol Phys 2007; 69:342-9. [PMID: 17531398 DOI: 10.1016/j.ijrobp.2007.03.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 03/08/2007] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the usefulness of oral glutamine to prevent radiochemotherapy-induced esophagitis in patients with lung cancer, and to determine the dosimetric parameter predictive of esophagitis. METHODS AND MATERIALS Seventy-five patients were enrolled; 34.7% received sequential radiochemotherapy, and 65.3% received concomitant radiochemotherapy. Every patient received prophylactic glutamine powder in doses of 10 g/8 h. Prescribed radiation doses were 45-50 Gy to planning target volume (PTV)1 (gross tumor volume plus wide margins) and 65-70 Gy to PTV2 (reduced margins). The primary endpoint was the incidence of Grade 2 or greater acute esophagitis. RESULTS No patient experienced glutamine intolerance or glutamine-related toxicity. Seventy-three percent of patients who received sequential chemotherapy and 49% of those who received concomitant chemotherapy did not present any form of esophagitis. V50 was the dosimetric parameter with better correlation between esophagitis and its duration. A V50 of <or=30% had a 22% risk of esophagitis Grade >or=2, which increased to 71% with a V50 of >30% (p = 0.0009). CONCLUSIONS The use of oral glutamine may have an important role in the prevention of esophageal complications of concomitant radiochemotherapy in lung cancer patients. However, randomized trials are needed to corroborate that effect. V50 is the dosimetric parameter with better correlation with esophagitis grade and duration.
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Affiliation(s)
- Manuel Algara
- Department of Radiation Oncology, Hospital de l'Esperança, Institut Municipal d'Assistència Sanitaria (IMAS), Barcelona, Spain.
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