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Zhang W, Li R, You D, Su Y, Dong W, Ma Z. Dosimetry and Feasibility Studies of Volumetric Modulated Arc Therapy With Deep Inspiration Breath-Hold Using Optical Surface Management System for Left-Sided Breast Cancer Patients. Front Oncol 2020; 10:1711. [PMID: 33014848 PMCID: PMC7494967 DOI: 10.3389/fonc.2020.01711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/31/2020] [Indexed: 01/29/2023] Open
Abstract
Background During radiotherapy (RT) procedure of breast cancer, portions of the heart and lung will receive some radiation dose, which may result in acute and late toxicities. In the current study, we report the experience of our single institution with organs at risk (OARs)–sparing RT with deep inspiration breath hold (DIBH) using an Optical Surface Management System (OSMS) and compare the dosimetric parameters with that of free breathing (FB). Patients and Methods Forty-eight cases diagnosed as early stage left-sided breast cancer scheduled for postoperative RT were enrolled. The OSMS was used to monitor the breathing magnitude and track the real-time respiratory status, which can control a stable lung and heart volume during RT delivery under DIBH. We did the dosimetric analysis of the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast under FB and DIBH plans. Results Compared with FB–volumetric-modulated arc therapy (FB-VMAT), DIBH-VMAT resulted in significantly changed volumes to the heart and lungs receiving irradiation dose. The average mean heart dose and average D2%, V5, and V10 showed significant differences between the DIBH and FB techniques. For the LAD coronary artery, we found significantly reduced average mean dose, D2%, and V10 with DIBH. Similar results were also found in the lungs and contralateral breast. The use of flattening-filter–free decreased treatment time compared with the flat beam mode in our VMAT (p < 0.05). For the 48 patients, there were no significant differences in the lateral, longitudinal, and vertical directions between OSMS and cone beam CT. Conclusions DIBH-VMAT with OSMS is very feasible in daily practice with excellent patient compliance in our single-center experience. Note that OSMS is an effective tool that may allow easier-to-achieve precise positioning and better and shorter position-verify time. Meanwhile, compared with FB, DIBH was characterized by lower doses to OARs, which may reduce the probability of cardiac and pulmonary complications in the future.
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Affiliation(s)
- Wei Zhang
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ruisheng Li
- Department of Medical Imaging, Yantai Yuhuangding Hospital, Yantai, China
| | - Dong You
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yi Su
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Wei Dong
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Zhao Ma
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
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Jacob J, Reyns N, Valéry CA, Feuvret L, Simon JM, Mazeron JJ, Jenny C, Cuttat M, Maingon P, Pasquier D. Radiotherapy of non-tumoral refractory neurological pathologies. Cancer Radiother 2020; 24:523-533. [PMID: 32859467 DOI: 10.1016/j.canrad.2020.06.012] [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: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
Intracranial radiotherapy has been improved, primarily because of the development of stereotactic approaches. While intracranial stereotactic body radiotherapy is mainly indicated for treatment of benign or malignant tumors, this procedure is also effective in the management of other neurological pathologies; it is delivered using GammaKnife® and linear accelerators. Thus, brain arteriovenous malformations in patients who are likely to experience permanent neurological sequelae can be managed by single session intracranial stereotactic body radiotherapy, or radiosurgery, in specific situations, with an advantageous benefit/risk ratio. Radiosurgery can be recommended for patients with disabling symptoms, which are poorly controlled by medication, such as trigeminal neuralgia, and tremors, whether they are essential or secondary to Parkinson's disease. This literature review aims at defining the place of intracranial stereotactic body radiotherapy in the management of patients suffering from non-tumoral refractory neurological pathologies. It is clear that the multidisciplinary collaboration of experienced teams from Neurosurgery, Neurology, Neuroradiology, Radiation Oncology and Medical Physics is needed for the procedures using high precision radiotherapy techniques, which deliver high doses to locations near functional brain areas.
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Affiliation(s)
- J Jacob
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - N Reyns
- Centre Hospitalier Régional Universitaire de Lille, Department of Neurosurgery and Neuro-Oncology, Neurosurgery service, 2, avenue Oscar-Lambret, 59000 Lille, France; Lille University, Inserm, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, 1, avenue Oscar-Lambret, 59000 Lille, France
| | - C-A Valéry
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Neurosurgery, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-M Simon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Jenny
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Medical Physics, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Cuttat
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Medical Physics, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Maingon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Pasquier
- Centre Oscar-Lambret, Academic Department of Radiation Oncology, 3, rue Frédéric-Combemale, 59000 Lille, France; Lille University, Centre de Recherche en Informatique, Signal et Automatique de Lille, CRIStAL UMR 9189, Scientific Campus, bâtiment Esprit, avenue Henri-Poincaré, 59655 Villeneuve-d'Ascq, France
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3
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Dose Hypofractionated Stereotactic Radiotherapy for Intracranial Arteriovenous Malformations: A Case Series and Review of the Literature. World Neurosurg 2019; 126:e1456-e1467. [DOI: 10.1016/j.wneu.2019.03.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/17/2022]
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Standardization of volumetric modulated arc therapy‐based frameless stereotactic technique using a multidimensional ensemble‐aided knowledge‐based planning. Med Phys 2019; 46:1953-1962. [DOI: 10.1002/mp.13470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/31/2022] Open
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De Saint-Hubert M, Majer M, Hršak H, Heinrich Z, Kneževic Ž, Miljanic S, Porwol P, Stolarczyk L, Vanhavere F, Harrison RM. OUT-OF-FIELD DOSES IN CHILDREN TREATED FOR LARGE ARTERIOVENOUS MALFORMATIONS USING HYPOFRACTIONATED GAMMA KNIFE RADIOSURGERY AND INTENSITY-MODULATED RADIATION THERAPY. RADIATION PROTECTION DOSIMETRY 2018; 181:100-110. [PMID: 29351691 DOI: 10.1093/rpd/ncx301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/20/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to measure out-of-field organ doses in two anthropomorphic child phantoms for the treatment of large brain arteriovenous malformations (AVMs) using hypofractionated gamma knife (GK) radiosurgery and to compare these with an alternative treatment using intensity-modulated radiation therapy (IMRT). Target volume was identical in size and shape in all cases. Radiophotoluminescent (RPL), thermoluminescent (TL) and optically stimulated luminescent (OSL) dosimeters were used for out-of-field dosimetry during GK treatment and a good agreement within 1-2% between results was shown. In addition, the use of multiple dosimetry systems strengthens the reliability of the findings. The number of GK isocentres was confirmed to be important for the magnitude of out-of-field doses. Measured GK doses for the same distance from the target, when expressed per target dose and isocentre, were comparable in both phantoms. GK out-of-field doses averaged for both phantoms were evaluated to be 120 mGy/Gy for eyes then sharply reduced to 20 mGy/Gy for mandible and slowly reduced up to 0.8 mGy/Gy for testes. Taking into account the fractionation regimen used to treat AVM patients, the total treatment organ doses to the out-of-field organs were calculated and compared with IMRT. The eyes were better spared with GK whilst for more distant organs doses were up to a factor of 2.8 and 4 times larger for GK compared to IMRT in 5-year and 10-year old phantoms, respectively. Presented out-of-field dose values are specific for the investigated AVM case, phantoms and treatment plans used for GK and IMRT, but provide useful information about out-of-field dose levels and emphasise their importance.
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Affiliation(s)
| | - Marija Majer
- Ruder Boškovic Institute, Bijenicka c. 54, Zagreb, Croatia
| | - Hrvoje Hršak
- University Hospital Centre Zagreb, Kišpaticeva, Zagreb, Croatia
| | | | | | | | - Paulina Porwol
- Radiology Therapeutic Centre Poland SP. Z O.O., os. Zlotej Jesieni 1, Kraków, Poland
| | - Liliana Stolarczyk
- Institute of Nuclear Physics PAS, Krakow, Radzikowskiego 152, Krakow, Poland
| | - Filip Vanhavere
- Belgium Nuclear Research Centre (SCK-CEN), Boeretang 200, Mol, Belgium
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Ilyas A, Chen CJ, Ding D, Taylor DG, Moosa S, Lee CC, Cohen-Inbar O, Sheehan JP. Volume-staged versus dose-staged stereotactic radiosurgery outcomes for large brain arteriovenous malformations: a systematic review. J Neurosurg 2018; 128:154-164. [PMID: 28128692 DOI: 10.3171/2016.9.jns161571] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several recent studies have improved our understanding of the outcomes of volume-staged (VS) and dose-staged (DS) stereotactic radiosurgery (SRS) for the treatment of large (volume > 10 cm3) brain arteriovenous malformations (AVMs). In light of these recent additions to the literature, the aim of this systematic review is to provide an updated comparison of VS-SRS and DS-SRS for large AVMs. METHODS A systematic review of the literature was performed using PubMed to identify cohorts of 5 or more patients with large AVMs who had been treated with VS-SRS or DS-SRS. Baseline data and post-SRS outcomes were extracted for analysis. RESULTS A total of 11 VS-SRS and 10 DS-SRS studies comprising 299 and 219 eligible patients, respectively, were included for analysis. The mean obliteration rates for VS-SRS and DS-SRS were 41.2% (95% CI 31.4%-50.9%) and 32.3% (95% CI 15.9%-48.8%), respectively. Based on pooled individual patient data, the outcomes for patients treated with VS-SRS were obliteration in 40.3% (110/273), symptomatic radiation-induced changes (RICs) in 13.7% (44/322), post-SRS hemorrhage in 19.5% (50/256), and death in 7.4% (24/323); whereas the outcomes for patients treated with DS-SRS were obliteration in 32.7% (72/220), symptomatic RICs in 12.2% (31/254), post-SRS hemorrhage in 10.6% (30/282), and death in 4.6% (13/281). CONCLUSIONS Volume-staged SRS appears to afford higher obliteration rates than those achieved with DS-SRS, although with a less favorable complication profile. Therefore, VS-SRS or DS-SRS may be a reasonable treatment approach for large AVMs, either as stand-alone therapy or as a component of a multimodality management strategy.
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Affiliation(s)
- Adeel Ilyas
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Dale Ding
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Davis G Taylor
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Shayan Moosa
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Or Cohen-Inbar
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
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Sangaiah A, Ganesh KM, Ramalingam K, Karthikeyan K, Jagadheeskumar N. Dosimetric Validation of Volumetric Modulated Arc Therapy (VMAT) Using AAPM TG-119 Benchmark Plans in an Upgraded CLINAC 2100CD for Flattening Filter Free (FFF) Photon Beams. Asian Pac J Cancer Prev 2017; 18:2965-2970. [PMID: 29172266 PMCID: PMC5773778 DOI: 10.22034/apjcp.2017.18.11.2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Recently we have upgraded our Varian Clinac 2100CD with a 6MV FFF beam, this upgrade being the first of its kind in our country. Even though the dosimetric characteristics of FFF beams have been reported both in experimental and Monte Carlo studies, application in planning and delivery is complex. The aim of this study was to validate the commissioning of upgraded FFF beams dosimetrically using AAPM TG-119 bench mark plans for VMAT and to make a comparison with IMRT plans for both flattened filtered and FFF beams. Materials and Methods: AAPM TG-119 proposes a set of test clinical cases for testing the accuracy of IMRT planning and delivery systems. For these clinical cases we generated four treatment plans using IMRT FF, IMRT FFF, VMAT FF and VMAT FFF on a Varian Clinac 2100CD machine equipped with a millennium 120 MLC in Eclipse treatment planning system. Dose prescription and planning objectives were set according to the TG-119 goals and plans were scored based on planning objectives. Plans were compared using dose coverage, the conformity index and the homogeneity index. Point doses were measured at points recommended by TG-119 using a CC13 ion chamber. Planar dosimetry was accomplished using Imatrix and gamma evaluation was conducted using Omnipro IMRT software. Results: Dose distributions of FFF beam based plans were comparable to FF plans for both IMRT and VMAT. Our planning results matched TG-119 planning results. Measured point doses were within ±2% of planned doses and planar dosimetry gamma values were <1 for >95% of data points for all plans. Conclusion: We found a reduction of 40% treatment time for FFF against FF beams for sliding window IMRT. Upgraded FFF beams were in good agreement with TG-119 benchmark plans and goals.
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Affiliation(s)
- Ashokkumar Sangaiah
- Research and Development Center, Bharathiar University, Coimbatore-641046, India.,Department of Radiation Oncology, Yashoda Hospitals,Secunderabad-500003, India.
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8
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Swamy ST, Radha CA, Arun G, Kathirvel M, Subramanian S. Planning and Dosimetric Study of Volumetric Modulated Arc Based Hypofractionated Stereotactic Radiotherapy for Acoustic Schwannoma--6MV Flattening Filter Free Photon Beam. Asian Pac J Cancer Prev 2016; 16:5019-24. [PMID: 26163634 DOI: 10.7314/apjcp.2015.16.12.5019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the dosimetric and clinical feasibility of volumetric modulated arc based hypofractionated stereotactic radiotherapy (RapidArc) treatment for large acoustic schwannoma (AS>10 cc). MATERIALS AND METHODS Ten AS patients were immobilized using BrainLab mask. They were subject to multimodality imaging (magnetic resonance and computed tomography) to contour target and organs at risk (brainstem and cochlea). Volumetric modulated arc therapy (VMAT) based stereotactic plans were optimized in Eclipse (V11) treatment planning system (TPS) using progressive resolution optimizer-III and final dose calculations were performed using analytical anisotropic algorithm with 1.5 mm grid resolution. All AS presented in this study were treated with VMAT based HSRT to a total dose of 25 Gy in 5 fractions (5 fractions/ week). VMAT plan contains 2-4 non-coplanar arcs. Treatment planning was performed to achieve at least 99% of PTV volume (D99) receives 100% of prescription dose (25 Gy), while dose to OAR's were kept below the tolerance limits. Dose-volume histograms (DVH) were analyzed to assess plan quality. Treatments were delivered using upgraded 6 MV un-flattened photon beam (FFF) from Clinac-iX machine. Extensive pretreatment quality assurance measurements were carried out to report on quality of delivery. Point dosimetry was performed using three different detectors, which includes CC13 ion-chamber, Exradin A14 ion-chamber and Exradin W1 plastic scintillator detector (PSD) which have measuring volume of 0.13 cm3, 0.009 cm3 and 0.002 cm3 respectively. RESULTS Average PTV volume of AS was 11.3 cc (±4.8), and located in eloquent areas. VMAT plans provided complete PTV coverage with average conformity index of 1.06 (±0.05). OAR's dose were kept below tolerance limit recommend by American Association of Physicist in Medicine task group-101(brainstem V0.5 cc<23 Gy, cochlea maximum<25 Gy and Optic pathway<25 Gy). PSD resulted in superior dosimetric accuracy compared with other two detectors (p=0.021 for PSD.
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Moosa S, Chen CJ, Ding D, Lee CC, Chivukula S, Starke RM, Yen CP, Xu Z, Sheehan JP. Volume-staged versus dose-staged radiosurgery outcomes for large intracranial arteriovenous malformations. Neurosurg Focus 2015; 37:E18. [PMID: 25175437 DOI: 10.3171/2014.5.focus14205] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim in this paper was to compare the outcomes of dose-staged and volume-staged stereotactic radio-surgery (SRS) in the treatment of large (> 10 cm(3)) arteriovenous malformations (AVMs). METHODS A systematic literature review was performed using PubMed. Studies written in the English language with at least 5 patients harboring large (> 10 cm(3)) AVMs treated with dose- or volume-staged SRS that reported post-treatment outcomes data were selected for review. Demographic information, radiosurgical treatment parameters, and post-SRS outcomes and complications were analyzed for each of these studies. RESULTS The mean complete obliteration rates for the dose- and volume-staged groups were 22.8% and 47.5%, respectively. Complete obliteration was demonstrated in 30 of 161 (18.6%) and 59 of 120 (49.2%) patients in the dose- and volume-staged groups, respectively. The mean rates of symptomatic radiation-induced changes were 13.5% and 13.6% in dose- and volume-staged groups, respectively. The mean rates of cumulative post-SRS latency period hemorrhage were 12.3% and 17.8% in the dose- and volume-staged groups, respectively. The mean rates of post-SRS mortality were 3.2% and 4.6% in dose- and volume-staged groups, respectively. CONCLUSIONS Volume-staged SRS affords higher obliteration rates and similar complication rates compared with dose-staged SRS. Thus, volume-staged SRS may be a superior approach for large AVMs that are not amenable to single-session SRS. Staged radiosurgery should be considered as an efficacious component of multimodality AVM management.
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Affiliation(s)
- Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Swamy ST, Radha CA, Kathirvel M, Arun G, Subramanian S. Feasibility Study of Deep Inspiration Breath-Hold Based Volumetric Modulated Arc Therapy for Locally Advanced Left Sided Breast Cancer Patients. Asian Pac J Cancer Prev 2014; 15:9033-8. [DOI: 10.7314/apjcp.2014.15.20.9033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Thirumalai Swamy S, Anuradha C, Kathirvel M, Arun G, Subramanian S. Pretreatment quality assurance of volumetric modulated arc therapy on patient CT scan using indirect 3D dosimetry system. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0204.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Stereotactic radiosurgery (SRS) with volumetric modulated arc therapy (VMAT): interim results of a multi-arm phase I trial (DESTROY-2). Clin Oncol (R Coll Radiol) 2014; 26:748-56. [PMID: 25175042 DOI: 10.1016/j.clon.2014.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/22/2014] [Accepted: 08/07/2014] [Indexed: 01/07/2023]
Abstract
AIMS To present the interim results of a phase I trial on stereotactic radiosurgery (SRS) delivered using volumetric modulated arc therapy (VMAT) in patients with primary or metastatic tumours in different extracranial sites. MATERIALS AND METHODS Patients were enrolled in different arms according to tumour site and clinical stage, and sequentially assigned to a given dose level. Acute toxicity, tumour response and early local control were investigated and reported. RESULTS One hundred lesions in 65 consecutive patients (male/female: 30/35, median age: 66 years; range: 40-89) were treated. Of these 100 lesions, 21 were primary or metastatic lung tumours, 24 were liver metastases, 30 were bone metastases, 24 were nodal metastases and one was a primary vulvar melanoma. The prescribed dose ranged from 12 (BED(2Gy,α/β:10) = 26.4 Gy) to 28 Gy (BED(2Gy,α/β:10) = 106.4 Gy) to the planning target volume. Twenty-one patients (32.3%) experienced grade 1-2 acute toxicity, which was grade 2 in only two cases. The overall response rate based on computed tomography/magnetic resonance imaging was 52% (95% confidence interval 40.1-63.2%) and based on positron emission tomography scan was 90% (95% confidence interval 76.2-96.4%). As of November 2013, the median duration of follow-up was 11 months (range = 1-38). Recurrence/progression within the SRS-VMAT treated field was observed in nine patients (total lesions = 18): the inside SRS-VMAT field local control expressed on a per lesion basis was 87.8% at 12 months and 71.9% at 24 months. CONCLUSIONS The maximum tolerable dose has not yet been reached in any study arm. SRS-VMAT resulted in positive early clinical results in terms of tumour response, local control rate and acute toxicity.
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Abacioglu U, Ozen Z, Yilmaz M, Arifoglu A, Gunhan B, Kayalilar N, Peker S, Sengoz M, Gurdalli S, Cozzi L. Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study. Radiat Oncol 2014; 9:119. [PMID: 24884967 PMCID: PMC4038714 DOI: 10.1186/1748-717x-9-119] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the role of RapidArc (RA) for stereotactic radiosurgery (SRS) of benign brain lesions in comparison to GammaKnife (GK) based technique. METHODS Twelve patients with vestibular schwannoma (VS, n = 6) or cavernous sinus meningioma (CSM, n = 6) were planned for both SRS using volumetric modulated arc therapy (VMAT) by RA. 104 MV flattening filter free photon beams with a maximum dose rate of 2400 MU/min were selected. Data were compared against plans optimised for GK. A single dose of 12.5 Gy was prescribed. The primary objective was to assess treatment plan quality. Secondary aim was to appraise treatment efficiency. RESULTS For VS, comparing best GK vs. RA plans, homogeneity was 51.7 ± 3.5 vs. 6.4 ± 1.5%; Paddick conformity Index (PCI) resulted 0.81 ± 0.03 vs. 0.84 ± 0.04. Gradient index (PGI) was 2.7 ± 0.2 vs. 3.8 ± 0.6. Mean target dose was 17.1 ± 0.9 vs. 12.9 ± 0.1 Gy. For the brain stem, D(1cm3) was 5.1 ± 2.0 Gy vs 4.8 ± 1.6 Gy. For the ipsilateral cochlea, D(0.1cm3) was 1.7 ± 1.0 Gy vs. 1.8 ± 0.5 Gy. For CSM, homogeneity was 52.3 ± 2.4 vs. 12.4 ± 0.6; PCI: 0.86 ± 0.05 vs. 0.88 ± 0.05; PGI: 2.6 ± 0.1 vs. 3.8 ± 0.5; D(1cm3) to brain stem was 5.4 ± 2.8 Gy vs. 5.2 ± 2.8 Gy; D(0.1cm3) to ipsi-lateral optic nerve was 4.2 ± 2.1 vs. 2.1 ± 1.5 Gy; D(0.1cm3) to optic chiasm was 5.9 ± 3.1 vs. 4.5 ± 2.1 Gy. Treatment time was 53.7 ± 5.8 (64.9 ± 24.3) minutes for GK and 4.8 ± 1.3 (5.0 ± 0.7) minutes for RA for schwannomas (meningiomas). CONCLUSIONS SRS with RA and FFF beams revealed to be adequate and comparable to GK in terms of target coverage, homogeneity, organs at risk sparing with some gain in terms of treatment efficiency.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luca Cozzi
- Medical Physics Unit, Oncology Institute of Southern Switzerland, 6504 Bellinzona, Switzerland.
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DEODATO FRANCESCO, CILLA SAVINO, MACCHIA GABRIELLA, CARAVATTA LUCIANA, MIGNOGNA SAMANTHA, MASSACCESI MARIANGELA, PICARDI VINCENZO, DIGESU CINZIA, SALLUSTIO GIUSEPPINA, BONOMO PIERLUIGI, PIERMATTEI ANGELO, FERRANDINA GABRIELLA, SCAMBIA GIOVANNI, VALENTINI VINCENZO, CELLINI NUMA, MORGANTI ALESSIOG. Extracranial radiosurgery with volumetric modulated arc therapy: Feasibility evaluation of a phase I trial. Oncol Lett 2013; 5:1889-1896. [PMID: 23833662 PMCID: PMC3700848 DOI: 10.3892/ol.2013.1276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 12/03/2012] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to report early clinical experience in stereotactic body radiosurgery (SBRS) delivered using volumetric intensity modulated arc therapy (VMAT) in patients with primary or metastatic tumors in various extra-cranial body sites. Each enrolled subject was included in a different phase I study arm, depending on the tumor site and the disease stage (lung, liver, bone, metastatic), and sequentially assigned to a particular dose level. Technical feasibility and dosimetric results were investigated. The acute toxicity, tumor response and early local control were also studied. In total, 25 lesions in 20 consecutive patients (male/female, 11/9; median age, 67 years; age range, 47-86 years) were treated. Of these 25 lesions, 4 were primary or metastatic lung tumors, 6 were liver metastases, 8 were bone metastases and 7 were nodal metastases. The dose-volume constraints for organs at risk (OARs) were observed in 19 patients using a single-arc technique. Only in one patient were two arcs required. The treatment was performed without interruption or any other technical issues. The prescribed dose ranged from 12-26 Gy to the planning target volume (PTV). Delivery time ranged from 4 min to 9 min and 13 sec (median, 6 min and 6 sec). No incidence of grade 2-4 acute toxicity was recorded. The overall response rate was 48% (95% confidence interval (CI), 24.2-70.2) based on computed tomography (CT)/magnetic resonance imaging (MRI) and 89% (95% CI, 58.6-98.7) based on the positron emission tomography (PET) scan. SBRS delivered by means of VMAT allowed the required target coverage to be achieved while remaining within the normal tissue dose-volume constraints in the 20 consecutive patients. VMAT-SBRS resulted in adequate technical feasibility; the maximum tolerable dose has not yet been reached in any study arm.
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Affiliation(s)
- FRANCESCO DEODATO
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - SAVINO CILLA
- Medical Physics, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - GABRIELLA MACCHIA
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - LUCIANA CARAVATTA
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - SAMANTHA MIGNOGNA
- Palliative Therapies, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - MARIANGELA MASSACCESI
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - VINCENZO PICARDI
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - CINZIA DIGESU
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - GIUSEPPINA SALLUSTIO
- Radiology, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - PIERLUIGI BONOMO
- Palliative Therapies, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - ANGELO PIERMATTEI
- Departments of Medical Physics, Università Cattolica del S. Cuore, I-86100 Campobasso,
Italy
| | - GABRIELLA FERRANDINA
- Gynaecologic Oncology, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
| | - GIOVANNI SCAMBIA
- Gynaecologic Oncology, Università Cattolica del S. Cuore, I-86100 Campobasso,
Italy
| | - VINCENZO VALENTINI
- Radiotherapy, Università Cattolica del S. Cuore, I-86100 Campobasso,
Italy
| | - NUMA CELLINI
- Radiotherapy, Università Cattolica del S. Cuore, I-86100 Campobasso,
Italy
| | - ALESSIO G MORGANTI
- Units of Radiotherapy, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
- Palliative Therapies, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del S. Cuore
- Radiotherapy, Università Cattolica del S. Cuore, I-86100 Campobasso,
Italy
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Hypofractionated stereotactic radiotherapy for large or involving critical organs cerebral arteriovenous malformations. Radiol Oncol 2013; 47:50-6. [PMID: 23450258 PMCID: PMC3573834 DOI: 10.2478/v10019-012-0046-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/19/2012] [Indexed: 11/29/2022] Open
Abstract
Background The treatment of large arteriovenous malformations (AVMs) or AVMs involving eloquent regions of the brain remains a challenge. For inoperable lesions, observation, volume-staged radiosurgery or hypofractionated stereotactic radiotherapy (HFSRT) are proposed. The aim of our study was to assess the safety and efficiency of HFSRT for large AVMs located in eloquent areas of the brain. Materials and methods An analysis of records of 49 patients irradiated for cerebral AVMs with a mean dose of 19.9 Gy (12–28 Gy) delivered in 2–4 fractions with planned gap (at least one week) between fractions. Actuarial obliteration rates and annual bleeding hazard were calculated using Kaplan-Meier survival analysis and life tables. Results Annual bleeding hazard rates were 4.5% and 1.6% after one and two years of the follow-up, respectively. Actuarial total obliteration rates were 7%, 11%, and 21% and total response rate (total and partial obliterations) 22%, 41%, and 55% after one, two and three years of the follow-up, respectively. There was a trend towards larger total obliteration rate in patients irradiated with fraction dose ≥ 8 Gy and total dose > 21 Gy for lesions of volume ≤ 8.18 cm3 which was not observed in case of partial obliterations. Conclusions HFSRT results with relatively low obliteration rate but is not associated with a significant risk of permanent neurological deficits if both total and fraction doses are adjusted to size and location of the lesion. Predictive factors for total and partial obliterations can be different; this observation, however, is not firmly supported and requires further studies.
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Wang HC, Chang RJ, Xiao F. Hypofractionated stereotactic radiotherapy for large arteriovenous malformations. Surg Neurol Int 2012; 3:S105-10. [PMID: 22826813 PMCID: PMC3400490 DOI: 10.4103/2152-7806.95421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/22/2012] [Indexed: 11/22/2022] Open
Abstract
Cerebral arteriovenous malformations (AVMs) are abnormal connections between the arteries and veins, with possible serious consequences of intracranial hemorrhage. The curative treatment for AVMs includes microsurgery and radiosurgery, sometimes with embolization as an adjunct. However, controversies exist with the treatment options available for large to giant AVMs. Hypofractionated stereotactic radiotherapy (HSRT) is one treatment option for such difficult lesions. We aim to review recent literature, looking at the treatment outcome of HSRT in terms of AVM obliteration rate and complications. The rate of AVM obliteration utilizing HSRT as a primary treatment was comparable with that of stereotactic radiosurgery (SRS). For those not totally obliterated, HSRT makes them smaller and turns some lesions manageable by single-dose SRS or microsurgery. Higher doses per fraction seemed to exhibit better response. However, patients receiving higher total dose may be at risk for higher rates of complications. Fractionated regimens of 7 Gy × 4 and 6–6.5 Gy × 5 may be accepted compromises between obliteration and complication. Embolization may not be beneficial prior to HSRT in terms of obliteration rate or the volume reduction. Future work should aim on a prospectively designed study for larger patient groups and long-term follow-up results.
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Affiliation(s)
- Huan-Chih Wang
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
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