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Yarovoy AA, Golanov AV, Yarovaya VA, Kostjuchenko VV, Volodin DP. Stereotactic Gamma Knife® Radiosurgery of Intraocular Retinoblastoma: Six-Year Experience. Cureus 2022; 14:e28751. [PMID: 36211113 PMCID: PMC9529235 DOI: 10.7759/cureus.28751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background External beam radiotherapy for resistant retinoblastoma is now seen as a last resort to saving the eye because of the risk of severe side effects: secondary cancers and cosmetic problems of orbital bone growth retardation. To reduce such complications, treatment modalities have shifted towards new radiation therapy techniques. No information on single fraction Gamma Knife® radiosurgery (GKRS) for intraocular retinoblastoma exists. Materials and methods Eighteen children (19 eyes) with retinoblastoma were treated with GKRS. The mean age at the time of treatment was 35 months (from 12 to 114 months). Before GKRS, all routes of chemotherapy delivery were held in all cases. The eligibility criteria for GKRS were retinoblastomas not amenable either to systemic or local chemotherapy and local ophthalmological treatment, retinoblastomas too large for conventional local methods, and inability to perform intraarterial chemotherapy. Conventional external beam radiotherapy was excluded in the presented cases, given the possible complications mentioned above. In every case, eye removal was suggested to the child's parents, but they flatly refused. GKRS was proposed as the last chance to save the eye (in four cases, it was performed on the only eye). The median prescribed dose was 22 Gy (interquartile range [IQR]: 18-35 Gy), and the median prescribed isodose was 50% (IQR: 36-90%). Results Local control was achieved in 79% of cases (complete tumor regression in 69%, incomplete regression in 10%). Two eyes (10.5%) could not be preserved and had to be enucleated due to the tumor recurrence. Two eyes (10.5%) developed secondary complications (total vitreous hemorrhage, retinal detachment, and iris neovascularization), making adequate tumor control nearly impossible. Overall, 15 eyes (79%) were preserved, and four eyes (21%) were enucleated after GKRS with no signs of tumor recurrence and metastasis in the mean follow-up of 41 months. No acute radiation side effects occurred in any patient after GKRS. Ten children (10 eyes, 53%) were diagnosed with vitreous hemorrhage from mild to severe. Three eyes presented with optic neuropathy one year after GKRS, and four eyes developed retinopathy. Radiation-induced cataract occurred in two eyes. There were no cases of secondary glaucoma or keratopathy in our study. All patients and eyes treated by GKRS were stable within 41 months (from seven to 74 months). Conclusions Single fraction Gamma Knife® radiosurgery may be a reasonable salvage treatment for resistant and recurrent retinoblastoma as an alternative approach to enucleation in selected cases. GKRS should be considered in retinoblastoma management.
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Absorbed dose distribution in human eye simulated by FOTELP-VOX code and verified by volumetric modulated arc therapy treatment plan. NUCLEAR TECHNOLOGY AND RADIATION PROTECTION 2022. [DOI: 10.2298/ntrp2201078z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This paper illustrates the potential of the FOTELP-VOX code, a modification
of the general-purpose FOTELP code, combining Monte Carlo techniques to
simulate particle transportation from an external source through the
internal organs, resulting in a 3-D absorbed dose distribution. The study
shows the comparison of results obtained by FOTELP software and the
volumetric modulated arc therapy technique. This planning technique with two
full arcs was applied, and the plan was created to destroy the diseased
tissue in the eye tumor bed and avoid damage to surrounding healthy tissue,
for one patient. The dose coverage, homogeneity index, conformity index of
the target, and the dose volumes of critical structures were calculated.
Good agreement of the results for absorbed dose in the human eye was
obtained using these two techniques.
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Dosimetric comparison of different radiotherapy techniques for the treatment of Retinoblastoma. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
This study aims to compare the dosimetric parameters among four different external beam radiotherapy techniques used for the treatment of retinoblastoma.
Materials and methods:
Computed tomography (CT) sets of five retinoblastoma patients who required radiotherapy to one globe were included. Four different plans were generated for each patient using three dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and VMAT using flattening filter free (VMAT-FFF) beam techniques. Plans were compared for target coverage and organs at risk (OARs) sparing.
Results:
The target coverage of planning target volume (PTV) for all the four modalities were clinically acceptable with a V95 of 95 ± 0%, 97·6 ± 1·87%, 99·3 ± 0·5% and 99·17 ± 0·45% for 3DCRT, IMRT, VMAT and VMAT-FFF respectively. The VMAT and IMRT plans had better target coverage than the 3DCRT plans (p = 0·001 and p = 0·07 respectively). IMRT and VMAT plans were also found superior to 3DCRT plans in terms of OAR sparing like brainstem, optic chiasm, brain (p < 0·05). VMAT delivered significantly lower dose to the brainstem and contralateral optic nerve in comparison to IMRT. Use of VMAT-FFF beams did not show any benefit over VMAT in target coverage and OAR sparing.
Conclusion:
VMAT should be preferred over 3DCRT and IMRT for treatment of retinoblastoma owing to better target coverage and less dose to most of the OARs. However, IMRT and VMAT should be used with caution because of the increased low dose volumes to the OARs like contralateral lens and eyeball.
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Zheng X, Han C, Yi J, Zhou Y, Ai Y, Xie C, Jin X. Comparative study of automatic and manual planning methods for volumetric modulated arc therapy in patients with intraocular cancer. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xiaomin Zheng
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Ce Han
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Jinling Yi
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Yongqiang Zhou
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Yao Ai
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Congying Xie
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
| | - Xiance Jin
- Radiation and Medical Oncology Department Wenzhou Medical University First Affiliated Hospital Wenzhou China
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Sardaro A, Carbonara R, Petruzzelli MF, Turi B, Moschetta M, Scardapane A, Stabile Ianora AA. Proton therapy in the most common pediatric non-central nervous system malignancies: an overview of clinical and dosimetric outcomes. Ital J Pediatr 2019; 45:170. [PMID: 31881905 PMCID: PMC6935184 DOI: 10.1186/s13052-019-0763-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/17/2019] [Indexed: 11/20/2022] Open
Abstract
Radiation therapy represents an important approach in the therapeutic management of children and adolescents with malignant tumors and its application with modern techniques – including Proton Beam Therapy (PBT) – is of great interest. In particular, potential radiation-induced injuries and secondary malignancies – also associated to the prolonged life expectancy of patients – are still questions of concern that increase the debate on the usefulness of PBT in pediatric treatments. This paper presents a literary review of current applications of PBT in non-Central Nervous System pediatric tumors (such as retinoblastoma, Hodgkin Lymphoma, Wilms tumor, bone and soft tissues sarcomas). We specifically reported clinical results achieved with PBT and dosimetric comparisons between PBT and the most common photon-therapy techniques. The analysis emphasizes that PBT minimizes radiation doses to healthy growing organs, suggesting for reduced risks of late side-effects and radiation-induced secondary malignancies. Extended follow up and confirms by prospective clinical trials should support the effectiveness and long-term tolerance of PBT in the considered setting.
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Affiliation(s)
- Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Roberta Carbonara
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy.
| | - Maria Fonte Petruzzelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Barbara Turi
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Marco Moschetta
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
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Li J, Zhang X, Li J, Jiang R, Sui J, Chan MF, Yang R. Impact of delivery characteristics on dose delivery accuracy of volumetric modulated arc therapy for different treatment sites. JOURNAL OF RADIATION RESEARCH 2019; 60:603-611. [PMID: 31147684 PMCID: PMC6805974 DOI: 10.1093/jrr/rrz033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/31/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to investigate the impact of delivery characteristics on the dose delivery accuracy of volumetric modulated arc therapy (VMAT) for different treatment sites. The pretreatment quality assurance (QA) results of 344 VMAT patients diagnosed with gynecological (GYN), head and neck (H&N), rectal or prostate cancer were randomly chosen in this study. Ten metrics reflecting VMAT delivery characteristics were extracted from the QA plans. Compared with GYN and rectal plans, H&N and prostate plans had higher aperture complexity and monitor units (MU), and smaller aperture area. Prostate plans had the smallest aperture area and lowest leaf speed compared with other plans (P < 0.001). No differences in gantry speed were found among the four sites. The gamma passing rates (GPRs) of GYN, rectal and H&N plans were inversely associated with union aperture area (UAA) and leaf speed (Pearson's r: -0.39 to -0.68). GPRs of prostate plans were inversely correlated with aperture complexity, MU and small aperture score (SAS) (absolute Pearson's r: 0.34 to 0.49). Significant differences in GPR between high SAS and low SAS subgroups were found only when leaf speed was <0.42 cm s-1 (P < 0.001). No association of GPR with gantry speed was found in four sites. Leaf speed was more strongly associated with UAA. Aperture complexity and MU were more strongly associated with SAS. VMAT plans from different sites have distinct delivery characteristics. Affecting dose delivery accuracy, leaf speed is the key factor for GYN, rectal and H&N plans, while aperture complexity, MU and small apertures have a higher influence on prostate plans.
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Affiliation(s)
- Jiaqi Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xile Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jun Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Rongtao Jiang
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jing Sui
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Maria F Chan
- Medical Physics Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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Nguyen SM, Sison J, Jones M, Berry JL, Kim JW, Murphree AL, Salinas V, Olch AJ, Chang EL, Wong KK. Lens Dose-Response Prediction Modeling and Cataract Incidence in Patients With Retinoblastoma After Lens-Sparing or Whole-Eye Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 103:1143-1150. [PMID: 30537543 DOI: 10.1016/j.ijrobp.2018.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/29/2018] [Accepted: 12/01/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE We retrospectively assessed the incidence of cataracts in patients with retinoblastoma (Rb) treated with either lens-sparing radiation therapy (LSRT) or whole-eye radiation therapy (WERT). A secondary aim of this study was to model the dose-response risk of cataract. METHODS AND MATERIALS We reviewed 65 patients with Rb treated with radiation therapy (RT) at Children's Hospital, Los Angeles from 1997 to 2015. Eyes that were enucleated before RT or lacked follow-up eye examinations were excluded. All patients underwent computed tomography simulation, and mean lens dose data were collected. Follow-up ophthalmologic examinations and intraocular lens implant history were reviewed for cataracts. The primary event-free survival (EFS) outcome was cataract development. Eyes without cataracts were censored on the last date of eye examination or post-RT enucleation, if applicable. Kaplan-Meier estimates were used to compare EFS outcomes, and dose response was projected with Cox regression and logistic regression models. RESULTS Sixty-one patients (94 eyes) were analyzed with a median follow-up of 51.8 months. For eyes treated with WERT, cataracts developed in 71.7% versus 35.3% for LSRT. Median EFS for WERT and LSRT were 20.8 and 67.9 months, respectively. Compared with WERT, a significant EFS benefit was demonstrated for LSRT (P < .001). Mean lens dose had a significant effect on cataracts in both Cox regression and logistic regression models (P < .01). The mean lens dose of 7 Gy was projected to have a 5-year cataract incidence of 20% and 25% with the logistic and Cox regression models, respectively. CONCLUSIONS We report the first clinical data demonstrating significantly improved EFS in patients with Rb treated with LSRT. Through lens dose-response modeling, we validate a mean lens dose threshold of 7 Gy to keep cataract risk below 25%. Although RT is used less often for Rb owing to advances in chemotherapy delivery options, these findings are relevant for refining lens dose constraints, particularly in children who have received radiation dose near the orbit.
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Affiliation(s)
- Steven M Nguyen
- University of Central Florida College of Medicine, Orlando, Florida
| | - Julian Sison
- Robert Wood Johnson Medical School, Piscataway, New Jersey
| | | | - Jesse L Berry
- Department of Ophthalmology, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan W Kim
- Department of Ophthalmology, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
| | - A Linn Murphree
- Department of Ophthalmology, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
| | - Vanessa Salinas
- Division of Hematology/Oncology, City of Hope, Duarte, California
| | - Arthur J Olch
- Department of Radiation Oncology, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth K Wong
- Department of Radiation Oncology, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California.
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Challenges and differences in external radiation therapy for retinoblastoma: from standard techniques to new developments. TUMORI JOURNAL 2017; 103:438-442. [PMID: 26350182 DOI: 10.5301/tj.5000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/20/2022]
Abstract
AIMS The purpose of this study is to calculate the treatment plans and to compare the dose distributions and dose-volume histograms (DVH) for 6 external radiotherapy techniques for the treatment of retinoblastoma as well as intensity-modulated radiotherapy (IMRT) and fractionated stereotactic radiotherapy (Cyberknife). METHODS Treatment plans were developed using 6 techniques, including an en face electron technique (ET), an anterior and lateral wedge photon technique (LFT), a 3D conformal (6 fields) technique (CRT), an inverse plan IMRT, tomotherapy, and conventional focal stereotactic external beam radiotherapy with Cyberknife (SBRT). Dose volume analyses were carried out for each technique. RESULTS All techniques except electron provided similar target coverage. When comparing conformal plan with IMRT and SBRT, there was no significant difference in planning target volume dose distribution. The mean volume of ipsilateral bony orbit received more than 20 Gy, a suggested threshold for bone growth inhibition. The V20 Gy was 73% for the ET, 57% for the LFT, 87% for the CRT, 65% for the IMRT, 66% for the tomotherapy, and 2.7% for the SBRT. CONCLUSIONS This work supports the potential use of IMRT and SBRT to spare normal tissues in these patients.
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Chawla B, Singh R. Recent advances and challenges in the management of retinoblastoma. Indian J Ophthalmol 2017; 65:133-139. [PMID: 28345569 PMCID: PMC5381292 DOI: 10.4103/ijo.ijo_883_16] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The treatment of retinoblastoma (Rb) has improved significantly in recent times. Worldwide, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum morbidity. Recently, the use of targeted delivery of chemotherapy to the eye in the form of selective intra-arterial and intravitreal chemotherapy has shown promising results. Radiotherapy is beneficial in selected cases, either in the form of plaque brachytherapy or as external beam radiotherapy. Orbital disease carries a poor prognosis for survival. However, a multimodal treatment protocol has improved survival in children with extraocular disease. Nevertheless, challenges remain, especially for the developing world. This review aims to highlight recent advances in the management of Rb that have contributed towards improving treatment outcomes and also discuss the challenges ahead, with special reference to the Indian scenario.
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Affiliation(s)
- Bhavna Chawla
- Dr. R.P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rashmi Singh
- Dr. R.P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Deng Z, Shen L, Zheng X, Zhou Y, Yi J, Han C, Xie C, Jin X. Dosimetric advantage of volumetric modulated arc therapy in the treatment of intraocular cancer. Radiat Oncol 2017; 12:83. [PMID: 28490344 PMCID: PMC5424493 DOI: 10.1186/s13014-017-0819-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this study is to investigate the dosimetric advantages of volumetric modulated arc therapy (VMAT) in the treatment of intraocular cancer by comparing it directly with three-dimensional conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT). Methods CRT plan, 7f-IMRT plan, and one-arc VMAT plan were generated for 14 intraocular cancer patients. Dosimetric and biological quality indices for target volume and organs at risks (OARs) were evaluated and compared. Results The target coverage presented by V95 for CRT, IMRT and VMAT were 95.02% ± 0.67%, 95.51% ± 2.25%, and 95.92% ± 3.05%, respectively. The homogeneity index (HI) for CRT, IMRT and VMAT were 0.15 ± 0.05, 0.23 ± 0.05, and 0.23 ± 0.06, respectively. IMRT and VMAT greatly decreased the dose to ipsilateral lens compared with CRT with a D1 of 2972.66 ± 1407.12 cGy, 3317.82 ± 915.28 cGy and 4809.54 ± 524.60 cGy for IMRT, VMAT and CRT, respectively. Similar results were observed for ipsilateral eyeballs. IMRT and VMAT also spared better on brainstem, optical nerves and optical chiasm compared CRT. However, CRT achieved lower dose to the eyeballs compared with IMRT and VMAT. VMAT and IMRT showed mixed results on target coverage and OAR sparing. The average MUs and delivery time of IMRT and VMAT were 531.25 ± 81.21 vs. 400.99 ± 61.49 and 5.05 ± 0.53 vs.1.71 ± 0.69 min, respectively. Conclusions Although no clear distinction on PTV coverage among CRT, IMRT and VMAT plans was observed in the treatment of intraocular cancer, VMAT and IMRT achieved better homogeneity and conformity for target volume, and delivered fewer doses to ipsilateral lens and eyeballs compared with CRT. However, VMAT and IMRT increased the low dose volume to the contralateral OARs. Although VMAT and IMRT showed mixed results on target coverage and OAR sparing, VMAT decreased MU and delivery time significantly compared with IMRT. VMAT is a promising and feasible external beam radiotherapy technique in the treatment of intraocular cancer patients.
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Affiliation(s)
- Zhenxiang Deng
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Lanxiao Shen
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Xiaomin Zheng
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Yongqiang Zhou
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Jinling Yi
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Ce Han
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Congying Xie
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China
| | - Xiance Jin
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenhzou Medical University, No.2 Fuxue Lane, Wenzhou, 325000, China.
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Abstract
PURPOSE Proton radiotherapy (PRT) is used in the treatment of retinoblastoma (RB) and has the potential to minimize exposure of normal tissue to radiation and thus decrease risk of toxicity and second malignancies. However, comprehensive analyses of long-term patient outcomes are not available. METHODS RB patients treated with PRT at our institution between 1986 and 2012 were invited to return for participation in a study designed to assess long-term outcomes. Enrolled patients underwent comprehensive analysis including oncologic, ophthalmic, endocrine, cephalometric, and quality of life (QOL) assessments. RESULTS A total of 12 patients were enrolled in this study, and the average length of follow-up among enrolled patients was 12.9 years (range 4.8-22.2 years). All enrolled patients had bilateral disease, and the disease and visual outcomes for enrolled patients were similar to outcomes for all RB patients treated with PRT over the same time period at our institution. Endocrine evaluation revealed no growth abnormalities or hormonal deficiencies across the cohort. Based on MRI and external cephalometry, PRT was associated with less facial hypoplasia than enucleation. Patient and parent-proxy QOL assessments revealed that RB treatment did not appear to severely impact long-term QOL. CONCLUSIONS In addition to providing an opportunity for long-term disease control and functional eye preservation, PRT does not appear to be associated with unexpected late visual, endocrine, or QOL effects in this cohort.
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San-Miguel I, Carmona R, Luque L, Cabrera R, Lloret M, Rutllan F, Lara PC. Volumetric Modulated Arc Therapy (VMAT) make a difference in retro-orbital irradiation treatment of patients with bilateral Graves' ophthalmopathy. Comparative analysis of dosimetric parameters from different radiation techniques. Rep Pract Oncol Radiother 2016; 21:435-40. [PMID: 27489513 DOI: 10.1016/j.rpor.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 01/24/2016] [Accepted: 03/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Graves' ophthalmopathy is the commonest extrathyroidal manifestation of Graves' disease. Treatment options include steroid therapy, corrective/decompressive surgery, radiation therapy or combination of these approaches. AIM Our purpose was to investigate if retro-orbital irradiation with Volumetric Modulated Arc Therapy (VMAT) yielded better target coverage and dose sparing to adjacent normal structures compared to 3-Dimensional Conformal Radiotherapy (3DCRT) and Lateral Opposing Conformed Fields (LOCF). METHODS Fourteen consecutive patients diagnosed with bilateral Graves' ophthalmopathy were prospectively recruited into this study from August 2012 until August 2014. An individual VMAT, 3DCRT and LOF plan was created for each patient. Conformity Index (CI), Homogeneity Index (HI) and other dosimetric parameters of the targets and organs-at-risk (OAR) were analyzed in all 28 orbits compared between the different techniques. RESULTS CI generated by VMAT was superior to that produced by 3DCRT(p < .001) and LOF (p < .001). As expected, 3DCRT was also superior to LOF (p = .007). Regarding the OARs sparing dose (lens, globes, retina and lacrimal glands), VMAT showed a significant benefit when compared with 3DCRT and LOCF, with no differences between the two latter techniques. CONCLUSIONS VMAT should be preferred over 3DCRT and LOF for bilateral Graves' ophthalmopathy treatment.
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Affiliation(s)
- Iñigo San-Miguel
- Radiation Oncology Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Ruth Carmona
- Radiation Oncology Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Luis Luque
- Medical Physics Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Raquel Cabrera
- Radiation Oncology Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Marta Lloret
- Radiation Oncology Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Francisco Rutllan
- Ofthalmology Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Pedro Carlos Lara
- Radiation Oncology Department, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
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Kim JY, Park Y. Treatment of Retinoblastoma: The Role of External Beam Radiotherapy. Yonsei Med J 2015; 56:1478-91. [PMID: 26446627 PMCID: PMC4630033 DOI: 10.3349/ymj.2015.56.6.1478] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/18/2015] [Accepted: 05/27/2015] [Indexed: 12/26/2022] Open
Abstract
The risk of radiotherapy-related secondary cancers in children with constitutional retinoblastoma 1 (RB1) mutations has led to reduced use of external beam radiotherapy (EBRT) for RB. Presently, tumor reduction with chemotherapy with or without focal surgery (chemosurgery) is most commonly undertaken; EBRT is avoided as much as possible and is considered only as the last treatment option prior to enucleation. Nevertheless, approximately 80% of patients are diagnosed at a locally advanced stage, and only 20-25% of early stage RB patients can be cured with a chemosurgery strategy. As a whole, chemotherapy fails in more than two-thirds of eyes with advanced stage disease, requiring EBRT or enucleation. Radiotherapy is still considered necessary for patients with large tumor(s) who are not candidates for chemosurgery but who have visual potential. When radiation therapy is indicated, the lowest possible radiation dose combined with systemic or local chemotherapy and focal surgery may yield the best clinical outcomes in terms of local control and treatment-related toxicity. Proton beam therapy is one EBRT method that can be used for treatment of RB and reduces the radiation dose delivered to the adjacent orbital bone while maintaining an adequate dose to the tumor. To maximize the therapeutic success of treatment of advanced RB, the possibility of integrating radiotherapy at early stages of treatment may need to be discussed by a multidisciplinary team, rather than considering EBRT as only a last treatment option.
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Affiliation(s)
- Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea.
| | - Younghee Park
- Proton Therapy Center, National Cancer Center, Goyang, Korea
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Li J, Di C, Jing J, Di Q, Nakhla J, Adamson DC. OTX2 is a therapeutic target for retinoblastoma and may function as a common factor between C-MYC, CRX, and phosphorylated RB pathways. Int J Oncol 2015; 47:1703-10. [PMID: 26397460 DOI: 10.3892/ijo.2015.3179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/19/2014] [Indexed: 11/06/2022] Open
Abstract
The homeobox transcription factor orthodenticle homeobox 2 (OTX2) plays a critical role in very early neurogenesis, but can become oncogenic when aberrantly expressed later in life. We previously discovered its novel oncogenic role in the malignant childhood brain tumor medulloblastoma and hypothesize an oncogenic role in retinoblastoma. Primary retinoblastoma tumors and cell lines were analyzed by quantitative-PCR, immunoblotting and immunohistochemistry for OTX2. The effect of modulating OTX2 expression on tumorigenesis was tested pharmacologically and by siRNA. A lentiviral shRNA-engineered vector was used for conditional knockdown studies on tumor growth in vivo. A luciferase reporter assay was used to analyze ATRA's effect on OTX2's promoter. In this study on retinoblastoma, OTX2 was frequently amplified and/or overexpressed in primary tumors and cell lines. Knockdown of OTX2 expression by siRNA or pharmacologic inhibition by all-trans retinoic acid (ATRA) repressed OTX2 expression and cell proliferation and significantly decreased tumor growth in vivo. Loss of OTX2 expression also resulted in decreased expression of C-MYC and CRX, genes previously implicated in retinoblastoma tumorigenesis. Loss of OTX2 expression increased the phosphorylation of RB, a potential mechanism of modulating cell proliferation. Aberrant expression of OTX2 may contribute to the development of retinoblastoma. OTX2 may serve as a common transcription factor that interlinks multiple tumor-driving pathways. These results also show that OTX2 can be genetically and pharmacologically targeted, providing an exciting new therapeutic option that may be less toxic and more efficacious than current treatments.
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Affiliation(s)
- Jing Li
- Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, USA
| | - Chunhui Di
- Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, USA
| | - Jenny Jing
- Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, USA
| | - Qun Di
- Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, USA
| | - Jonathan Nakhla
- Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, USA
| | - David Cory Adamson
- Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, USA
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Chawla B, Lokdarshi G, Pathy S. Recent advances in management of retinoblastoma: A review. World J Ophthalmol 2015; 5:31-35. [DOI: 10.5318/wjo.v5.i1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023] Open
Abstract
The management of retinoblastoma has evolved significantly over recent years. Current treatment options aim to preserve the globe as well as vision with minimum morbidity. High resolution imaging has improved tumor detection and is useful for prognosticating cases and monitoring response to treatment. Targeted chemotherapy such as intra-arterial and intra-vitreal chemotherapy has shown promising results and these routes are being increasingly employed world-wide for globe preservation. The advent of new radiotherapy techniques has led to improved radiation delivery to the target and more conformal treatment plans with better normal tissue sparing. This review aims to highlight newer advancements in the field of diagnosis and management of retinoblastoma that have been introduced in recent times, with a special emphasis on globe-preserving therapy.
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Dionisi F, Avery S, Lukens JN, Ding X, Kralik J, Kirk M, Roses RE, Amichetti M, Metz JM, Plastaras JP. Proton therapy in adjuvant treatment of gastric cancer: planning comparison with advanced x-ray therapy and feasibility report. Acta Oncol 2014; 53:1312-20. [PMID: 24797885 DOI: 10.3109/0284186x.2014.912351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adjuvant chemoradiotherapy improves both overall- and relapse-free survival in patients with resected gastric cancer. However, this comes at the cost of increased treatment-related toxicity. Proton therapy (PT) has distinct dosimetric characteristics that may reduce dose to normal tissues, improving the therapeutic ratio. The purpose of this treatment planning study is to compare PT and intensity-modulated x-ray therapy (IMXT) in gastric cancer with regards to normal tissue sparing. MATERIAL AND METHODS The patient population consisted of resected gastric cancer patients treated at a single institution between 2008 and 2013. Patients who had undergone 4D CT simulation were replanned to the originally delivered doses (45-54 Gy in 25-30 daily fractions) using six-field photon IMXT and 2-3-field PT (double scattering-uniform scanning techniques). RESULTS Thirteen patients were eligible for the planning comparison. IMXT provided slightly higher homogeneity indices (median values 0.04 ± 0.01 vs. 0.07 ± 0.01, p = 0.03). PT resulted in significantly (p < 0.05) lower intermediate-low doses for all the normal tissues examined (small bowel V15 82 ml vs. 133 ml, liver mean doses Gy 11.9 vs. 14.4 Gy, left/right kidney mean doses 5/0.9 Gy vs. 7.8/3.1 Gy, heart mean doses 7.4 Gy vs. 9.5 Gy). The total energy deposited outside the target volume was significantly lower with PT (median integral dose 90.1 J vs. 129 J). Four patients were treated with PT: treatment was feasible and verifications scans showed that target coverage was robust. CONCLUSION PT can contribute to normal tissue sparing in the adjuvant treatment of gastric cancer, with a potential benefit in terms of compliance to treatment, acute and late toxicities.
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Affiliation(s)
- Francesco Dionisi
- Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari (APSS) , Trento , Italy
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