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Yang X, Dai Z, Song H, Gong H, Li X. A novel predictor for dosimetry data of lung and the radiation pneumonitis incidence prior to SBRT in lung cancer patients. Sci Rep 2024; 14:18628. [PMID: 39128912 PMCID: PMC11317486 DOI: 10.1038/s41598-024-69293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024] Open
Abstract
Normal tissue complication probability (NTCP) models for radiation pneumonitis (RP) in lung cancer patients with stereotactic body radiation therapy (SBRT), which based on dosimetric data from treatment planning, are limited to patients who have already received radiation therapy (RT). This study aims to identify a novel predictive factor for lung dose distribution and RP probability before devising actionable SBRT plans for lung cancer patients. A comprehensive correlation analysis was performed on the clinical and dose parameters of lung cancer patients who underwent SBRT. Linear regression models were utilized to analyze the dosimetric data of lungs. The performance of the regression models was evaluated using mean squared error (MSE) and the coefficient of determination (R2). Correlational analysis revealed that most clinical data exhibited weak correlations with dosimetric data. However, nearly all dosimetric variables showed "strong" or "very strong" correlations with each other, particularly concerning the mean dose of the ipsilateral lung (MI) and the other dosimetric parameters. Further study verified that the lung tumor ratio (LTR) was a significant predictor for MI, which could predict the incidence of RP. As a result, LTR can predict the probability of RP without the need to design an elaborate treatment plan. This study, as the first to offer a comprehensive correlation analysis of dose parameters, explored the specific relationships among them. Significantly, it identified LTR as a novel predictor for both dose parameters and the incidence of RP, without the need to design an elaborate treatment plan.
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Affiliation(s)
- Xiong Yang
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Zeyi Dai
- The Institute for Advanced Studies, Wuhan University, Wuhan, 430072, Hubei, China
| | - Hongbing Song
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Hongyun Gong
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China.
| | - Xiangpan Li
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China.
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Chiou C, Wu Y, Huang P, Lan K, Chen Y, Kang Y, Chou L, Hu Y. The potential of integrating stereotactic ablative radiotherapy techniques with hyperfractionation for lung cancer. Thorac Cancer 2024; 15:1679-1687. [PMID: 38881388 PMCID: PMC11293925 DOI: 10.1111/1759-7714.15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Limited literature exists on the feasibility and effectiveness of integrating stereotactic ablative radiotherapy (SABR) techniques with hyperfractionated regimens for patients with lung cancer. This study aims to assess whether the SABR technique with hyperfractionation can potentially reduce lung toxicity. METHODS We utilized the linear-quadratic model to find the optimal fraction to maximize the tumor biological equivalent dose (BED) to normal-tissue BED ratio. Validation was performed by comparing the SABR plans with 50 Gy/5 fractions and hyperfractionationed plans with 88.8 Gy/74 fractions with the same tumor BED and planning criteria for 10 patients with early-stage lung cancer. Mean lung BED, Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP), critical volume (CV) criteria (volume below BED of 22.92 and 25.65 Gy, and mean BED for lowest 1000 and 1500 cc) and the percentage of the lung receiving 20Gy or more (V20) were compared using the Wilcoxon signed-rank test. RESULTS The transition point occurs when the tumor-to-normal tissue ratio (TNR) of the physical dose equals the TNR of α/β in the BED dose-volume histogram of the lung. Compared with the hypofractionated regimen, the hyperfractionated regimen is superior in the dose range above but inferior below the transition point. The hyperfractionated regimen showed a lower mean lung BED (6.40 Gy vs. 7.73 Gy) and NTCP (3.50% vs. 4.21%), with inferior results concerning CV criteria and higher V20 (7.37% vs. 7.03%) in comparison with the hypofractionated regimen (p < 0.01 for all). CONCLUSIONS The hyperfractionated regimen has an advantage in the high-dose region of the lung but a disadvantage in the low-dose region. Further research is needed to determine the superiority between hypo- and hyperfractionation.
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Affiliation(s)
- Chi‐Chuan Chiou
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
| | - Yuan‐Hung Wu
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
- Therapeutic and Research Center of Pancreatic CancerTaipei Veterans General HospitalTaipeiTaiwan, ROC
| | - Pin‐I Huang
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
| | - Keng‐Li Lan
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
- Institute of Traditional Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
| | - Yi‐Wei Chen
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
| | - Yu‐Mei Kang
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
| | - Lin‐Shan Chou
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
| | - Yu‐Wen Hu
- Department of Heavy Particles and Radiation OncologyTaipei Veterans General HospitalTaipeiTaiwan, ROC
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
- Institute of Public Health, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan, ROC
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Geng-Cahuayme AAA, Peregrín-Pastor B, Ramos-Albiac M, Recalde-Vizcay E, Parada-Zuluaga JS, Giralt-López de Sagredo J, Maldonado-Pijoan X, Giraldo-Marín A. Stereotactic ablative radiotherapy (SABR) for patients with lung tumor and severe pulmonary function impairment. Clin Transl Oncol 2024:10.1007/s12094-024-03557-7. [PMID: 38869740 DOI: 10.1007/s12094-024-03557-7] [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: 04/15/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To evaluate clinical outcomes after SABR in a cohort of early-stage non-small cell lung cancer (NSCLC) or pulmonary metastases in chronic obstructive pulmonary disease (COPD) patients with forced expiratory volume in the first second predicted (FEV1) ≤ 50%. METHODS Retrospective single-center study was performed to analyze clinical outcomes and toxicities in COPD patients with severe lung dysfunction treated with SABR from 1st June 2015 to 31st October 2022. RESULTS Thirty four patients (forty locations) were enrolled for analysis. Median follow-up was 2.9 years. Median age was 73.5 years (range, 65.6-80.1). FEV1 was 38% (range, 28.2-50.0) prior to radiotherapy. Median overall survival (OS) was 41.1 months (95% CI 38.9-not reached). OS rates at 2-, 3-, and 5- years were 79%, 71%, and 36%, respectively. Cancer-specific survival rates at 2-, 3-, and 5- years were 96%, 96%, and 68%, respectively. Local control rates at 2-, 3-, and 5- years were 88%, 83%, and 83%, respectively. No grade 4 or 5 toxicity was observed. The most common acute toxicity was pneumonitis (38.2%), of which only 1 patient (2.9%) reported grade 3 acute toxicity. CONCLUSIONS Lung SABR in patients with poor pulmonary function may be effective with acceptable toxicity.
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Affiliation(s)
| | - Blanca Peregrín-Pastor
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Mónica Ramos-Albiac
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Enar Recalde-Vizcay
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Juan Sebastián Parada-Zuluaga
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Jordi Giralt-López de Sagredo
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Xavier Maldonado-Pijoan
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Alexandra Giraldo-Marín
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
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Manabe Y, Shiinoki T, Fujimoto K, Ueda K, Karita M, Ono T, Kajima M, Tanaka H. Intra- and inter-fractional variations of tumors with fiducial markers measured using respiratory-correlated computed tomography images for respiratory gated lung stereotactic body radiation therapy. J Appl Clin Med Phys 2024; 25:e14280. [PMID: 38252745 PMCID: PMC11163493 DOI: 10.1002/acm2.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 10/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE This study evaluated the intra- and inter-fractional variation of tumors with fiducial markers (FMs), relative to the tumor-FM distance, to establish how close an FM should be inserted for respiratory-gated stereotactic body radiation therapy (RG-SBRT). METHODS Forty-five lung tumors treated with RG-SBRT were enrolled. End-expiratory computed tomography (CT) (CTplan) and four-dimensional-CT (4D-CT) scans were obtained for planning. End-expiratory CT (CTfr) scanning was performed before each fraction. The FMs were divided into two groups based on the median tumor-FM distance in the CTplan (Dp). For the intra-fractional variation, the correlations between the corresponding tumor and FM intra-fractional motions, defined as the centroid coordinates of those in each 0-90% phase, with the 50% phase of 4D-CT as the origin, were calculated in the left-right, anterior-posterior, and superior-inferior directions. Furthermore, the maximum difference in the tumor-FM distance in each phase of 4D-CT scan, based on those in the 50% phase of 4D-CT scan (Dmax), was obtained. Inter-fractional variation was defined as the maximum distance between the tumors in CTplan and CTfr, when the CT scans were fused based on each FM or vertebra. RESULTS The median Dp was 26.1 mm. While FM intra-fractional motions were significantly and strongly correlated with the tumor intra-fractional motions in only anterior-posterior and superior-inferior directions for the Dp > 26 mm group, they were significantly and strongly correlated in all directions for the Dp ≤ 26 mm group. In all directions, Dmax values of the Dp ≤ 26 mm group were lower than those of the Dp > 26 mm group. The inter-fractional variations based on the Dp ≤ 26 mm were smaller than those on the Dp > 26 mm and on the vertebra in all directions. CONCLUSIONS Regarding intra- and inter-fractional variation, FMs for Dp ≤ 26 mm can increase the accuracy for RG-SBRT.
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Affiliation(s)
- Yuki Manabe
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Takehiro Shiinoki
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Koya Fujimoto
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Kazushi Ueda
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Masako Karita
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Taiki Ono
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Miki Kajima
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Hidekazu Tanaka
- Department of Radiation OncologyYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
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Feng A, Huang Y, Zeng Y, Shao Y, Wang H, Chen H, Gu H, Duan Y, Shen Z, Xu Z. Improvement of Prediction Performance for Radiation Pneumonitis by Using 3-Dimensional Dosiomic Features. Clin Lung Cancer 2024; 25:e173-e180.e2. [PMID: 38402120 DOI: 10.1016/j.cllc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Patients with early non-small-cell lung cancer (NSCLC) have a relatively long survival time after stereotactic body radiation therapy (SBRT). Predicting radiation-induced pneumonia (RP) has important clinical and social implications for improving the quality of life of such patients. This study developed an RP prediction model by using 3-dimensional (3D) dosiomic features. The model can be used to guide radiation therapy to reduce toxicity. METHODS Radiomic features were extracted from pre-treatment CT, dose-volume histogram (DVH) parameters and dosiomic features were extracted from the 3D dose distribution of 140 lung cancer patients. Four predictive models: (1) CT; (2) CT + DVH; (3) CT + Rtdose; and (4) Hybrid, CT + DVH + Rtdose, were trained to predict symptomatic RP by extremely randomized trees. Accuracy, sensitivity, specificity, and area under the receiver operator characteristic curve were evaluated. RESULT Results showed that the fraction regimen was correlated with symptomatic RP (P < .001). The proposed model achieved promising prediction results. The performance metrics for CT, CT + DVH, CT + Rtdose, and Hybrid were as follows: accuracy: 0.786, 0.821, 0.821, and 0.857; sensitivity: 0.625, 1, 0.875, and 1; specificity: 0.8, 0.565, 0.5, and 0.875; and area under the receiver operator characteristic curve: 0.791, 0.809, 0.907, and 0.920, respectively. CONCLUSION Dosiomic features can improve the performance of the predictive model for symptomatic RP compared with that obtained with the CT + DVH model. The model proposed in this study can help radiation oncologists individually predict the incidence rate of RP.
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Affiliation(s)
- AiHui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Modern Physics, Fudan University, Shanghai, China; Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Modern Physics, Fudan University, Shanghai, China; Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, China
| | - Ya Zeng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - HengLe Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YanHua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Modern Physics, Fudan University, Shanghai, China; Key Laboratory of Nuclear Physics and Ion-beam Application (MOE), Fudan University, Shanghai, China
| | - ZhenJiong Shen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ZhiYong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Lucia F, Bourhis D, Pinot F, Hamya M, Goasduff G, Blanc-Béguin F, Hennebicq S, Mauguen M, Kerleguer K, Schick U, Consigny M, Pradier O, Le Gal G, Salaun PY, Bourbonne V, Le Roux PY. Prediction of Acute Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy Using Dose-Volume Parameters From Functional Mapping on Gallium 68 Perfusion Positron Emission Tomography/Computed Tomography. Int J Radiat Oncol Biol Phys 2024; 118:952-962. [PMID: 37875246 DOI: 10.1016/j.ijrobp.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The aim of this work was to compare anatomic and functional dose-volume parameters as predictors of acute radiation-induced lung toxicity (RILT) in patients with lung tumors treated with stereotactic body radiation therapy. METHODS AND MATERIALS Fifty-nine patients treated with stereotactic body radiation therapy were prospectively included. All patients underwent gallium 68 lung perfusion positron emission tomography (PET)/computed tomography (CT) imaging before treatment. Mean lung dose (MLD) and volumes receiving x Gy (VxGy, 5-30 Gy) were calculated in 5 lung volumes: the conventional anatomic volume (AV) delineated on CT images, 3 lung functional volumes (FVs) defined on lung perfusion PET imaging (FV50%, FV70%, and FV90%; ie, the minimal volume containing 50%, 70%, and 90% of the total activity within the AV), and a low FV (LFV; LFV = AV - FV90%). The primary endpoint of this analysis was grade ≥2 acute RILT at 3 months as assessed with National Cancer Institute Common Terminology Criteria for Adverse Events version 5. Dose-volume parameters in patients with and without acute RILT were compared. Receiver operating characteristic curves assessing the ability of dose-volume parameters to discriminate between patients with and without acute RILT were generated, and area under the curve (AUC) values were calculated. RESULTS Of the 59 patients, 10 (17%) had grade ≥2 acute RILT. The MLD and the VxGy in the AV and LFV were not statistically different between patients with and without acute RILT (P > .05). All functional parameters were significantly higher in acute RILT patients (P < .05). AUC values (95% CI) for MLD AV, LFV, FV50%, FV70%, and FV90% were 0.66 (0.46-0.85), 0.60 (0.39-0.80), 0.77 (0.63-0.91), 0.77 (0.64-0.91), and 0.75 (0.58-0.91), respectively. AUC values for V20Gy AV, LFV, FV50%, FV70%, and FV90% were 0.65 (0.44-0.87), 0.64 (0.46-0.83), 0.82 (0.69-0.95), 0.81 (0.67-0.96), and 0.75 (0.57-0.94), respectively. CONCLUSIONS The predictive value of PET perfusion-based functional parameters outperforms the standard CT-based dose-volume parameters for the risk of grade ≥2 acute RILT. Functional parameters could be useful for guiding radiation therapy planning and reducing the risk of acute RILT.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, INSERM, UMR 1101, University of Brest, Brest, France.
| | - David Bourhis
- Service de Médecine Nucléaire, CHRU de Brest, Brest, France
| | - Fanny Pinot
- Service de Médecine Nucléaire, CHRU de Brest, Brest, France
| | - Mohamed Hamya
- LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | | | | | | | - Maëlle Mauguen
- Radiation Oncology Department, University Hospital, Brest, France
| | | | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Maëlys Consigny
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU Brest, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada; Centre d'Investigation Clinique CIC 1412, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, CHRU de Brest, Brest, France; GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, Brest, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Pierre-Yves Le Roux
- Service de Médecine Nucléaire, CHRU de Brest, Brest, France; GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, Brest, France.
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Sasse A, Oh P, Saeed N, Yang DX, Hayman TJ, Knowlton CA, Peters GW, Campbell A, Laird J, Housri N, Park HS. Dose-Volume Predictors of Radiation Pneumonitis After Thoracic Hypofractionated Radiation Therapy. Pract Radiat Oncol 2024; 14:e97-e104. [PMID: 37984711 DOI: 10.1016/j.prro.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Hypofractionated radiation therapy (HFRT) is a common treatment for thoracic tumors, typically delivered as 60 Gy in 15 fractions. We aimed to identify dosimetric risk factors associated with radiation pneumonitis in patients receiving HFRT at 4 Gy per fraction, focusing on lung V20, mean lung dose (MLD), and lung V5 as potential predictors of grade ≥2 pneumonitis. METHODS AND MATERIALS All patients were treated with thoracic HFRT to 60 Gy in 15 fractions or 72 Gy in 18 fractions at a single health care system from 2013 to 2020. Tumors near critical structures (trachea, proximal tracheobronchial tree, esophagus, spinal cord, or heart) were considered central (within 2 cm), and those closer were classified as ultracentral (within 1 cm). The primary endpoint was grade ≥2 pneumonitis. Logistic regression analyses, adjusting for target size and dosimetric variables, were used to establish a dose threshold associated with <20% risk of grade ≥2 pneumonitis. RESULTS During a median 24.3-month follow-up, 18 patients (16.8%) developed grade ≥2 radiation pneumonitis, with no significant difference between the 2 dose regimens (17.3% vs 16.3%, P = .88). Four patients (3.7%) experienced grade ≥3 pneumonitis, including 2 grade 5 cases. Patients with grade ≥2 pneumonitis had significantly higher lung V20 (mean 23.4% vs 14.5%, P < .001), MLD (mean 13.0 Gy vs 9.5 Gy, P < .001), and lung V5 (mean 49.6% vs 40.6%, P = .01). Dose thresholds for a 20% risk of grade ≥2 pneumonitis were lung V20 <17.7%, MLD <10.6 Gy, and V5 <41.3%. Multivariable analysis revealed a significant association between lung V20 and grade ≥2 pneumonitis (adjusted odds ratio, 1.48, P = .03). CONCLUSIONS To minimize the risk of grade ≥2 radiation pneumonitis when delivering 4 Gy per fraction at either 60 Gy or 72 Gy, it is advisable to maintain lung V20<17.7%. MLD <10.6 Gy and V5<41.3% can also be considered as lower-priority constraints. However, additional validation is necessary before incorporating these constraints into clinical practice or trial planning guidelines.
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Affiliation(s)
- Alexander Sasse
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Patrick Oh
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Nadia Saeed
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel X Yang
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas
| | - Thomas J Hayman
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christin A Knowlton
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Allison Campbell
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - James Laird
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Nadine Housri
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
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Zaher A, Duchman B, Ivanovic M, Spitz DR, Furqan M, Allen BG, Petronek MS. Exploratory Analysis of Image-Guided Ionizing Radiation Delivery to Induce Long-Term Iron Accumulation and Ferritin Expression in a Lung Injury Model: Preliminary Results. Bioengineering (Basel) 2024; 11:182. [PMID: 38391668 PMCID: PMC10886280 DOI: 10.3390/bioengineering11020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Radiation therapy (RT) is an integral and commonly used therapeutic modality for primary lung cancer. However, radiation-induced lung injury (RILI) limits the irradiation dose used in the lung and is a significant source of morbidity. Disruptions in iron metabolism have been linked to radiation injury, but the underlying mechanisms remain unclear. PURPOSE To utilize a targeted radiation delivery approach to induce RILI for the development of a model system to study the role of radiation-induced iron accumulation in RILI. METHODS This study utilizes a Small Animal Radiation Research Platform (SARRP) to target the right lung with a 20 Gy dose while minimizing the dose delivered to the left lung and adjacent heart. Long-term pulmonary function was performed using RespiRate-x64image analysis. Normal-appearing lung volumes were calculated using a cone beam CT (CBCT) image thresholding approach in 3D Slicer software. Quantification of iron accumulation was performed spectrophotometrically using a ferrozine-based assay as well as histologically using Prussian blue and via Western blotting for ferritin heavy chain expression. RESULTS Mild fibrosis was seen histologically in the irradiated lung using hematoxylin and eosin-stained fixed tissue at 9 months, as well as using a scoring system from CBCT images, the Szapiel scoring system, and the highest fibrotic area metric. In contrast, no changes in breathing rate were observed, and median survival was not achieved up to 36 weeks following irradiation, consistent with mild lung fibrosis when only one lung was targeted. Our study provided preliminary evidence on increased iron content and ferritin heavy chain expression in the irradiated lung, thus warranting further investigation. CONCLUSIONS A targeted lung irradiation model may be a useful approach for studying the long-term pathological effects associated with iron accumulation and RILI following ionizing radiation.
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Affiliation(s)
- Amira Zaher
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Bryce Duchman
- Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, UC San Diego Health, San Diego, CA 92093, USA
| | - Marina Ivanovic
- Department of Pathology and Laboratory Medicine, Loyola University Health System, Loyola University, Chicago, IL 60660, USA
| | - Douglas R Spitz
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Muhammad Furqan
- Department of Internal Medicine Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242, USA
| | - Bryan G Allen
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA 52242, USA
| | - Michael S Petronek
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA 52242, USA
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9
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Huang BT, Lin PX, Wang Y, Luo LM. Developing a Prediction Model for Radiation Pneumonitis in Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy Combined With Clinical, Dosimetric Factors, and Laboratory Biomarkers. Clin Lung Cancer 2023; 24:e323-e331.e2. [PMID: 37648569 DOI: 10.1016/j.cllc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The study aims to identify the risk factors and develop a model for predicting grade ≥2 radiation pneumonitis (RP) for lung cancer patients treated with stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS Clinical data, dosimetric data, and laboratory biomarkers from 186 patients treated with lung SBRT were collected. Univariate and multivariate logistic regression were performed to determine the predictive factors for grade ≥2 RP. Three models were developed by using the clinical, dosimetric, and combined factors, respectively. RESULTS With a median follow-up of 36 months, grade ≥2 RP was recorded in 13.4% of patients. On univariate logistic regression analysis, clinical factors of age and lung volume, dosimetric factors of treatment durations, fractional dose and V10, and laboratory biomarkers of neutrophil, PLT, PLR, and Hb levels were significantly associated with grade ≥2 RP. However, on multivariate analysis, only age, lung volume, fractional dose, V10, and Hb levels were independent factors. AUC values for the clinical, dosimetric, and combined models were 0.730 (95% CI, 0.660-0.793), 0.711 (95% CI, 0.641-0.775) and 0.830 (95% CI, 0.768-0.881), respectively. The combined model provided superior discriminative ability than the clinical and dosimetric models (P < .05). CONCLUSION Age, lung volume, fractional dose, V10, and Hb levels were demonstrated to be significant factors associated with grade ≥2 RP for lung cancer patients after SBRT. A novel model combining clinical, dosimetric factors, and laboratory biomarkers improved predictive performance compared with the clinical and dosimetric model alone.
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Affiliation(s)
- Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
| | - Pei-Xian Lin
- Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ying Wang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Li-Mei Luo
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
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10
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Kita N, Tomita N, Takaoka T, Okazaki D, Niwa M, Torii A, Takano S, Mekata Y, Niimi A, Hiwatashi A. Clinical and dosimetric factors for symptomatic radiation pneumonitis after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Clin Transl Radiat Oncol 2023; 41:100648. [PMID: 37346273 PMCID: PMC10279771 DOI: 10.1016/j.ctro.2023.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
Background and purpose The present study attempted to identify risk factors for symptomatic radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) in patients with early-stage non-small cell lung cancer (NSCLC). Materials and methods We reviewed 244 patients with early-stage NSCLC treated with SBRT. The primary endpoint was the incidence of grade ≥2 RP. Gray's test was performed to examine the relationship between clinical risk factors and grade ≥2 RP, and the Fine-Gray model was used for a multivariate analysis. The effects of each dose parameter on grade ≥2 RP were evaluated with the Fine-Gray model and optimal thresholds were tested using receiver operating characteristic (ROC) curves. Results With a median follow-up period of 48 months, the 4-year cumulative incidence of grade ≥2 RP was 15.3%. Gray's test revealed that tumor size, a central tumor, interstitial pneumonia, and the biologically effective dose correlated with RP. In the multivariate analysis, a central tumor and interstitial pneumonia remained significant factors (p < 0.001, p = 0.002). Among dose parameters, the total lung volume (%) receiving at least 8 Gy (V8), V10, V20, and the mean lung dose correlated with RP (p = 0.012, 0.011, 0.022, and 0.014, respectively). The results of the Fine-Gray model and ROC curve analyses showed that V10 >16.7% was the best indicator of symptomatic RP among dose parameters. Conclusion The present results suggest that a central tumor and interstitial pneumonia are independent risk factors for symptomatic RP and lung V10 ≤16.7% is recommended as the threshold in SBRT.
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Affiliation(s)
- Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Yuji Mekata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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11
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Guberina N, Wirsdörfer F, Stuschke M, Jendrossek V. Combined radiation- and immune checkpoint-inhibitor-induced pneumonitis – The challenge to predict and detect overlapping immune-related adverse effects from evolving laboratory biomarkers and clinical imaging. Neoplasia 2023; 39:100892. [PMID: 37011458 PMCID: PMC10124136 DOI: 10.1016/j.neo.2023.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 04/04/2023]
Abstract
The risk of overlapping pulmonary toxicity induced by thoracic radio(chemo)therapy and immune checkpoint inhibitor therapy in the treatment of patients suffering from non-small cell lung cancer (NSCLC) is one important challenge in successful radioimmunotherapy. In the present opinion we highlight factors that we find important to be considered before treatment initiation, during the treatment sequence, and after treatment completion combined or sequential application of radio(chemo)therapy and immune checkpoint inhibitor therapy. A major aim is to optimize the therapeutic index and to avoid immune related adverse effects. The goals in the future will be focused not only on identifying patients already in the pretreatment phase who could benefit from this complex treatment, but also in identifying patients, who are most likely to have higher grade toxicity. In this respect, proper assessment of clinical performance status, monitoring for the presence of certain comorbidities, evaluation of laboratory parameters such as TGF-α and IL-6 levels, human leukocyte antigens (HLA), and consideration of other potential biomarkers which will evolve in near future are essential. Likewise, the critical parameters must be monitored during the treatment phase and follow-up care to detect potential side effects in time. With the help of high-end imaging which is already used on a daily basis in image guided radiotherapy (IGRT) for intensity modulated radiotherapy (IMRT), its advanced form volumetric modulated arc therapy (VMAT), and adaptive radiation therapy (ART), clinically relevant changes in lung tissue can be detected at an early stage of disease. Concurrent radiotherapy and immunotherapy requires a special focus on adverse events, particularly of the lung, but, when properly approached and applied, it may offer new perspectives for patients with locally advanced NSCLC to be seriously considered as a curative option.
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12
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Mark F, Alnsour A, Penfold SN, Esterman A, Keys R, Le H. Volumetric modulated arc therapy (VMAT) comparison to 3D-conformal technique in lung stereotactic ablative radiotherapy (SABR). J Med Radiat Sci 2023; 70:72-80. [PMID: 36424510 PMCID: PMC9977664 DOI: 10.1002/jmrs.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) can be a curative option for non-small cell lung cancer (NSCLC) and oligometastatic lung disease. Volumetric modulated arc therapy (VMAT) has offered further advancements in terms of radiation dose shaping without compromising treatment times however there is potential for greater low-dose exposure to the lung. This study was to assess whether VMAT lung SABR would result in any increase to the dosimetry parameters compared with three-dimensional conformal radiotherapy (3D-CRT) that could confer increased risk of radiation pneumonitis. METHODS A total of 53 and 30 3D-CRT treatment plans of patients treated with 48 Gy in 4 fractions were compared. RESULTS No statistically significant difference in planning target volumes between the VMAT 29.9 cc (range 12.4-58.5 cc) and 3D-CRT 31.2 cc (range 12.3-58.3 cc) P = 0.79. The mean of total lung V5, ipsilateral lung V5 and contralateral lung V5 all showed a trend of being smaller in the VMAT treatment group- 14% versus 15.8%, 25.6% versus 30.4% and 1.6% versus 2.2%, respectively, but all were not statistically significant differences. Mean of the mean lung dose MLD, again showed a trend of being lower in the VMAT treatments but was also non-significant, 2.6 Gy versus 3.0 Gy, P = 1.0. Mean V20 was the same in both cohorts, 3.3%. CONCLUSIONS The dosimetry for 3D-CRT and VMAT plans were not significantly different including V5, and therefore we conclude that VMAT treatment is unlikely to be associated with an increased risk of radiation pneumonitis.
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Affiliation(s)
- Frances Mark
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Oncology DepartmentPlymouth Hospitals TrustPlymouthUK
| | | | - Scott N. Penfold
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia,Department of PhysicsUniversity of AdelaideAdelaideSouth AustraliaAustralia,SAHMRIAdelaideSouth AustraliaAustralia
| | - Adrian Esterman
- Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Robert Keys
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Hien Le
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia,Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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13
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Lucia F, Hamya M, Pinot F, Bourhis D, Le Roux PY. Lung Stereotactic Body Radiation Therapy in a Patient with Severe Lung Function Impairment Allowed by Gallium-68 Perfusion PET/CT Imaging: A Case Report. Diagnostics (Basel) 2023; 13:diagnostics13040718. [PMID: 36832204 PMCID: PMC9955343 DOI: 10.3390/diagnostics13040718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Lung stereotactic body radiotherapy (SBRT) is increasingly proposed, especially for patients with poor lung function who are not eligible for surgery. However, radiation-induced lung injury remains a significant treatment-related adverse event in these patients. Moreover, for patients with very severe COPD, we have very few data about the safety of SBRT for lung cancer. We present the case of a female with very severe chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in one second (FEV1) of 0.23 L (11%), for whom a localized lung tumor was found. Lung SBRT was the only possible treatment. It was allowed and safely performed, based on a pre-therapeutic evaluation of regional lung function with Gallium-68 perfusion lung positron emission tomography combined with computed tomography (PET/CT). This is the first case report to highlight the potential use of a Gallium-68 perfusion PET/CT in order to safely select patients with very severe COPD who can benefit from SBRT.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- LaTIM, INSERM, UMR 1101, University of Brest, 29200 Brest, France
- Correspondence:
| | - Mohamed Hamya
- Radiation Oncology Department, University Hospital, 29200 Brest, France
| | - Fanny Pinot
- Inserm, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, University of Brest, 29238 Brest, France
| | - David Bourhis
- Inserm, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, University of Brest, 29238 Brest, France
| | - Pierre-Yves Le Roux
- Inserm, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, University of Brest, 29238 Brest, France
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14
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Kang HJ, Kwak YK, Kim M, Lee SJ. Application of real-time MRI-guided linear accelerator in stereotactic ablative body radiotherapy for non-small cell lung cancer: one step forward to precise targeting. J Cancer Res Clin Oncol 2022; 148:3215-3223. [PMID: 36040666 DOI: 10.1007/s00432-022-04264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor motion is a major challenge in stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer (NSCLC), causing excessive irradiation to compensate for this motion. Real-time tumor tracking with a magnetic resonance imaging-guided linear accelerator (MR-Linac) could address this problem. This study aimed to assess the effects and advantages of MR-Linac in SABR for the treatment of lung tumors. METHODS Overall, 41 patients with NSCLC treated with SABR using MR-Linac between March 2019 and December 2021 were included. For comparison, 40 patients treated with SABR using computed tomography-based modalities were also enrolled. The SABR dose ranged from 48 to 60 Gy in 3-5 fractions. The primary endpoint was a lower radiation volume compared to CT-based SABR. The secondary endpoint was the local control rate of SABR using the MR-Linac. RESULTS The median follow-up time was 19 months (range: 3-105 months). There was no significant difference in the gross tumor volume between the MR and CT groups (7.1 ± 9.3 cm3 vs 8.0 ± 6.8 cm3, p = 0.643), but the planning target volume was significantly smaller in the MR group (20.8 ± 18.8 cm3 vs 34.1 ± 22.9 cm3, p = 0.005). The 1-year local control rates for the MR and CT groups were 92.1 and 75.4%, respectively (p = 0.07), and the 1-year overall survival rates were 87.4 and 87.0%, respectively (p = 0.30). CONCLUSION Lung SABR with MR-Linac can reduce the radiation field without compromising the local control rate. Further follow-up is needed to assess the long-term effects.
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Affiliation(s)
- Hye Jin Kang
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea.
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - So Jung Lee
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
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15
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Qin X, Wang S, Liu X, Duan J, Cheng K, Mu Z, Jia J, Wei Y, Yuan S. Diagnostic Value of 18F-NOTA-FAPI PET/CT in a Rat Model of Radiation-Induced Lung Damage. Front Oncol 2022; 12:879281. [PMID: 35719937 PMCID: PMC9201039 DOI: 10.3389/fonc.2022.879281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, we explore the diagnostic value of a novel PET/CT imaging tracer that specifically targets fibroblast activation protein (FAP), 18F-NOTA-FAPI, in a radiation induced lung damage (RILD) rat model. High focal radiation (40, 60, or 90 Gy) was administered to a 5-mm diameter area of the right lung in Wistar rats for evaluation of RILD induction. Lung tissues exposed to 90 Gy radiation were scanned with 18F-NOTA-FAPI PET/CT and with 18F-FDG. Dynamic 18F-NOTA-FAPI PET/CT scanning was performed on day 42 post-irradiation. After in vivo scanning, lung cryosections were prepared for autoradiography, hematoxylin and eosin (HE) and immunohistochemical (IHC) staining. An animal model of RILD was established and validated by histopathological analysis. On 18F-NOTA-FAPI PET/CT, RILD was first observed on days 42, 35 and 7 in the 40, 60 and 90 Gy groups, respectively. After treatment with 90 Gy, 18F-NOTA-FAPI uptake in an area of RILD emerged on day 7 (0.65 ± 0.05%ID/ml) and reappeared on day 28 (0.81 ± 0.09%ID/ml), remaining stable for 4–6 weeks. Autoradiography and HE staining IHC staining revealed that 18F-NOTA-FAPI accumulated mainly in the center of the irradiated area. IHC staining confirmed the presence of FAP+ macrophages in the RILD area, while FAP+ fibroblasts were observed in the peripheral area of irradiated lung tissue. 18F-NOTA-FAPI represents a promising radiotracer for in vivo imaging of RILD in a dose- and time-dependent manner. Noninvasive imaging of FAP may potentially aiding in the clinical management of radiotherapy patients.
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Affiliation(s)
- Xueting Qin
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shijie Wang
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaoli Liu
- Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jinghao Duan
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Kai Cheng
- Department of PET/CT Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhengshuai Mu
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jing Jia
- Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuchun Wei
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuanghu Yuan
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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16
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Akasaka H, Mizonobe K, Oki Y, Uehara K, Nakayama M, Tamura S, Munetomo Y, Kawaguchi H, Ishida J, Harada A, Ishihara T, Kubota H, Kawaguchi H, Sasaki R, Mayahara H. Fiducial marker position affects target volume in stereotactic lung irradiation. J Appl Clin Med Phys 2022; 23:e13596. [PMID: 35377962 PMCID: PMC9195037 DOI: 10.1002/acm2.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Real‐time tracking systems of moving respiratory targets such as CyberKnife, Radixact, or Vero4DRT are an advanced robotic radiotherapy device used to deliver stereotactic body radiotherapy (SBRT). The internal target volume (ITV) of lung tumors is assessed through a fiducial marker fusion using four‐dimensional computed tomography (CT). It is important to minimize the ITV to protect normal lung tissue from exposure to radiation and the associated side effects post SBRT. However, the ITV may alter if there is a change in the position of the fiducial marker with respect to the tumor. This study investigated the relationship between fiducial marker position and the ITV in order to prevent radiation exposure of normal lung tissue, and correct target coverage. Materials and methods This study retrospectively reviewed 230 lung cancer patients who received a fiducial marker for SBRT between April 2015 and September 2021. The distance of the fiducial marker to the gross tumor volume (GTV) in the expiratory (dex) and inspiratory (din) CT, and the ratio of the ITV/V(GTVex), were investigated. Results Upon comparing each lobe, although there was no significant difference in the ddiff and the ITV/V(GTVex) between all lobes for dex < 10 mm, there was significant difference in the ddiff and the ITV/V(GTVex) between the lower and upper lobes for dex ≥ 10 mm (p < 0.05). Moreover, there was significant difference in the ddiff and the ITV/V(GTVex) between dex ≥10 mm and dex < 10 mm in all lung regions (p < 0.05). Conclusion The ITV that had no margin from GTVs increased when dex was ≥10 mm for all lung regions (p < 0.05). Furthermore, the increase in ITV tended to be greater in the lower lung lobe. These findings can help decrease the possibility of adverse events post SBRT, and correct target coverage.
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Affiliation(s)
- Hiroaki Akasaka
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan.,Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuo-ku Kobe, Hyogo, Japan
| | - Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuo-ku Kobe, Hyogo, Japan.,Division of Radiation Therapy, Kita-Harima Medical Center, Hyogo, Japan
| | - Shuhei Tamura
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Yoshiki Munetomo
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Haruna Kawaguchi
- Department of Radiology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Jun Ishida
- Department of Radiology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Hospital, Chuo-ku Kobe, Hyogo, Japan
| | - Hikaru Kubota
- Division of Radiation Oncology, Kobe University Hospital, Chuo-ku Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe University Hospital, Chuo-ku Kobe, Hyogo, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Hospital, Chuo-ku Kobe, Hyogo, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku Kobe, Hyogo, Japan
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17
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Kishi N, Matsuo Y, Yoneyama M, Ueki K, Mizowaki T. Symptomatic radiation pneumonitis after stereotactic body radiotherapy for multiple pulmonary oligometastases or synchronous primary lung cancer. Adv Radiat Oncol 2022; 7:100911. [PMID: 35647407 PMCID: PMC9133396 DOI: 10.1016/j.adro.2022.100911] [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: 10/14/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022] Open
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18
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Hellbach K. Moderne Tumortherapien und ihre pulmonalen Nebenwirkungen. BEST PRACTICE ONKOLOGIE 2022. [PMCID: PMC8743752 DOI: 10.1007/s11654-021-00360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Die Strahlentherapie und in jüngerer Zeit insbesondere die medikamentöse molekulare Therapie sind zentrale Bestandteile der modernen Onkologie. Beide Therapieformen eignen sich dazu, Tumoren bei vergleichsweise geringen systemischen Nebenwirkungen effektiv zu behandeln. Dennoch haben auch diese Behandlungsansätze Nebenwirkungen, die zum einen durch die Toxizität der Strahlung, zum anderen durch immunmodulatorische Effekte der verabreichten Medikamente ausgelöst werden. Das pneumotoxische Potenzial dieser Therapieformen spiegelt sich unter anderem in der Entstehung von interstitiellen Pneumonitiden wider, die in fibrotische Lungengerüstveränderungen übergehen können. Erschwert wird die klinische Diagnose der Erkrankung durch die unspezifischen Symptome. Die Computertomographie (CT) stellt ein ausgezeichnetes Mittel dar, um korrespondierende Verdichtungen zu diagnostizieren und im zeitlichen Verlauf zu monitoren. Damit wird dem Radiologen im interdisziplinären Kontext eine wichtige Rolle bei der Diagnostik dieses Krankheitsbildes zuteil.
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Affiliation(s)
- Katharina Hellbach
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Deutschland
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19
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Dosiomic feature comparison between dose-calculation algorithms used for lung stereotactic body radiation therapy. Radiol Phys Technol 2022; 15:63-71. [DOI: 10.1007/s12194-022-00651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Machitori Y, Ito K, Kito S, Nakajima Y, Saito M, Karasawa K. Local control of stereotactic body radiotherapy with dynamic tumor tracking for lung tumors: a propensity score-matched analysis. Jpn J Clin Oncol 2022; 52:609-615. [DOI: 10.1093/jjco/hyac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/05/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Dynamic tumor tracking (DTT) is a method of respiratory motion management in radiotherapy. It reduces the radiation field but risks delivering an insufficient radiation dose to the tumor. We investigated the local control of DTT-stereotactic body radiotherapy (SBRT) for lung tumors.
Methods
Patients treated with SBRT for early-stage, non-small-cell lung cancer and lung metastases (2013–18) were retrospectively reviewed. Patients with tumor motion >1 cm were treated with DTT-SBRT (DTT group); those with tumor motion ≤1 cm were treated with static-SBRT (static group). A static planning target volume for the static-SBRT plan was also created for patients in the DTT group, and planning target volume reduction relative to the planning target volume for the DTT-SBRT plan was assessed. Patients were matched in a 1:1 ratio using a propensity score predictive of the SBRT technique.
Results
Of the 245 lesions in 218 patients (median follow-up, 25.4 months), 69 were treated with DTT-SBRT and 176 with static-SBRT. The median planning target volume reduction in the DTT group was 30.3%. After propensity score matching, 124 lesions were included (62 per group). Two-year local control rates for the DTT and static groups were 94.2 and 95.9%, respectively, for all lesions (P = 0.19) and 96.3 and 94.5%, respectively, for matched lesions (P = 0.79). In univariate analysis, DTT-SBRT was not associated with local control for all lesions (hazard ratio, 2.06; P = 0.20) or matched lesions (hazard ratio, 1.22; P = 0.79). No grade 4/5 toxicities were observed.
Conclusions
DTT-SBRT for lung tumors reduced the planning target volume, but not local control rates. DTT was useful for respiratory motion management.
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Xing D, Chen L, Wang L, Jin J, Liu D, Liu H, Dong S. An analysis of the treatment effect of two modes of oxygenation on patients with radiation pneumonia complicated by respiratory failure. Technol Health Care 2022; 30:869-880. [PMID: 35001901 DOI: 10.3233/thc-213597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stereotactic radiotherapy (SBRT) is widely used in the treatment of thoracic cancer. OBJECTIVE To evaluate the efficacy of a non-rebreather mask (NRBM) and high-flow nasal cannula (HFNC) in patients with radiation pneumonia complicated with respiratory failure. METHODS This was a single-center randomized controlled study. Patients admitted to the EICU of the Fourth Hospital of Hebei Medical University were selected and divided into NRBM and HFNC group. Arterial blood gas analysis, tidal volume, respiratory rates and the cases of patients receiving invasive assisted ventilation were collected at 0, 4, 8, 12, 24, 48, and 72 h after admission. RESULTS (1) The PaO2/FiO2, respiratory rates, and tidal volume between the two groups at 0, 4, 8, 12, 24, 48, and 72 h were different, with F values of 258.177, 294.121, and 134.372, all P< 0.01. These indicators were different under two modes of oxygenation, with F values of 40.671, 168.742, and 55.353, all P< 0.01, also varied with time, with an F value of 7.480, 9.115, and 12.165, all P< 0.01. (2) The incidence of trachea intubation within 72 h between HFNC and NRBM groups (23 [37.1%] vs. 34 [54.0%], P< 0.05). The transition time to mechanical ventilation in the HFNC and NRBM groups (55.3 ± 3.2 h vs. 45.9 ± 3.6 h, P< 0.05). (3) The risk of intubation in patients with an APACHE-II score > 23 was 2.557 times than score ⩽ 23, and the risk of intubation in the NRBM group was 1.948 times more than the HFNC group (P< 0.05). CONCLUSION Compared with the NRBM, HFNC can improve the oxygenation state of patients with radiation pneumonia complicated with respiratory failure in a short time, and reduce the incidence of trachea intubation within 72 h.
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Affiliation(s)
- Dong Xing
- Department of Emergency, The Fourth Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Chen
- Department of General practice, The Fourth Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lantao Wang
- Department of Emergency, The Fourth Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jing Jin
- Department of Tumor Research Institute, The Fourth Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dong Liu
- Department of Anesthesiology, Baoding No. 1 Hospital, Baoding, Hebei, China
| | - Huan Liu
- Department of Emergency, The Fourth Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shimin Dong
- Department of Emergency, The Third Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
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22
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Nakamura M. [3. Important Notice on Radiation Treatment Planning Based on 4D Imaging Information]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:652-657. [PMID: 35718455 DOI: 10.6009/jjrt.2022-2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University
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Bayasgalan U, Moon SH, Kim TH, Kim TY, Lee SH, Suh YG. Dosimetric Comparisons between Proton Beam Therapy and Modern Photon Radiation Techniques for Stage I Non-Small Cell Lung Cancer According to Tumor Location. Cancers (Basel) 2021; 13:cancers13246356. [PMID: 34944976 PMCID: PMC8699272 DOI: 10.3390/cancers13246356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Stereotactic ablative radiotherapy (SABR) is a well-established technique used to treat stage I non-small cell lung cancer (NSCLC). Proton beam therapy (PBT) offers dosimetric advantages over photon SABR techniques by reducing doses to normal organs. Hence, it is believed that PBT is helpful for patients with tumors located centrally in stage I NSCLC. However, the benefits of PBT for other locations, such as peripherally located tumors, have not been well-described. We investigated dosimetric benefits for PBT over modern photon radiation techniques for stage I NSCLC according to tumor locations. A total of 42 patients’ (including tumors that were central (11), peripheral (nine), and close to the chest wall (22)) PBT plans were compared with those of modern photon radiation techniques. In all locations, PBT significantly reduced radiation exposure to the lung and heart. To reduce potential lung and heart toxicities, PBT is ideal, even in the peripherally located stage I NSCLC. Abstract Herein, we investigated the dosimetric benefits for proton beam therapy (PBT) over modern photon radiation techniques according to tumor location (central, peripheral, and close to the chest wall) for stage I non-small cell lung cancer (NSCLC) patients. A total of 42 patients with stage I NSCLC were treated with PBT with a total dose of 50–70 Gy in four or 10 fractions considering the risk of treatment-related toxicities. Simulation plans for three-dimensional conformal radiation therapy (3D-CRT), static-field intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT) were retrospectively generated using the same treatment volumes as implemented in the PBT plans for these patients. Dosimetric improvements were observed with PBT as compared with all the photon-based radiation techniques with regards to the mean lung dose, lung V5 and V10, mean heart dose, and heart V5 and V10 in all locations. Moreover, lower radiation exposure to the chest wall was observed within PBT for peripherally located and close to the chest wall tumors. All radiotherapy modalities achieved clinically satisfactory treatment plans in the current study. Notably, the usage of PBT resulted in significant dosimetric improvements in the lung and heart over photon-based techniques at all tumor locations, including the periphery, for stage I NSCLC.
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Affiliation(s)
- Unurjargal Bayasgalan
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea; (U.B.); (S.H.M.); (T.H.K.); (T.Y.K.); (S.H.L.)
- Department of Radiation Oncology, National Cancer Center, Ulaanbaatar 13370, Mongolia
| | - Sung Ho Moon
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea; (U.B.); (S.H.M.); (T.H.K.); (T.Y.K.); (S.H.L.)
| | - Tae Hyun Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea; (U.B.); (S.H.M.); (T.H.K.); (T.Y.K.); (S.H.L.)
| | - Tae Yoon Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea; (U.B.); (S.H.M.); (T.H.K.); (T.Y.K.); (S.H.L.)
| | - Seung Hyun Lee
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea; (U.B.); (S.H.M.); (T.H.K.); (T.Y.K.); (S.H.L.)
| | - Yang-Gun Suh
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea; (U.B.); (S.H.M.); (T.H.K.); (T.Y.K.); (S.H.L.)
- Correspondence: ; Tel.: +82-31-920-1722
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Itonaga T, Sugahara S, Mikami R, Saito T, Yamada T, Kurooka M, Shiraishi S, Okubo M, Saito K. Evaluation of the relationship between the range of radiation-induced lung injury on CT images after IMRT for stage I lung cancer and dosimetric parameters. Ann Med 2021; 53:267-273. [PMID: 33430616 PMCID: PMC7877951 DOI: 10.1080/07853890.2020.1869297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study evaluated the correlation between radiation-induced lung injury (RILI) and dosimetric parameters on computed tomography (CT) images of stage I non-small cell lung cancer (NSCLC) patients undergoing intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS Sixty-three stage I NSLC patients who underwent IMRT were enrolled in the study. The patients underwent CT within 6 months (acute phase) and 1.5 years (late phase) after radiotherapy. These were fused with the planned irradiation CT. The range of RILI was measured from 10% to 100%, with an IC in 10% increments. RESULTS The median interval from completion of radiotherapy to acute and late phase CT was 92 and 440 days, respectively. The median RILI ranges of the acute and late phases were in the 80% (20-100%) and 70% dose regions (20-100%), respectively. The significantly narrower range of RILI when lung V20 in the acute phase was less than 19.2% and that of V5 in the late phase was less than 27.6% at the time of treatment planning. CONCLUSIONS This study showed that RILI occurred in a localized range in stage I NSCLC patients who underwent IMRT. The range of RILI was correlated with V20 in the acute phase and V5 in the late phase. KEY MESSAGES RILI correlated with V20 in acute and V5 in late phase. The shadow of RILI occurred in 80% dose region in acute and 70% in late phase. No relationship exists between radiographic changes in RILI and PTV volume.
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Affiliation(s)
- Tomohiro Itonaga
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Shinji Sugahara
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Ryuji Mikami
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Tatsuhiko Saito
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Masahiko Kurooka
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Sachika Shiraishi
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
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Jasper K, Liu B, Olson R, Matthews Q. Evidence-Based Planning Target Volume Margin Reduction for Modern Lung Stereotactic Ablative Radiation Therapy Using Deformable Registration. Adv Radiat Oncol 2021; 6:100750. [PMID: 34401609 PMCID: PMC8349747 DOI: 10.1016/j.adro.2021.100750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Standard planning target volume (PTV) margins for lung stereotactic ablative radiation therapy (SABR) are 5 mm. High-dose-rate volumetric modulated arc therapy delivered using flattening filter-free (FFF) beams with modern immobilization systems may allow for PTV margin reduction. This study assesses whether PTV margins can be reduced from 5 to 3 mm. METHODS Target intrafractional motions derived from pretreatment and posttreatment cone beam computed tomography (CBCT) scans for 33 patients receiving lung SABR treated with 10XFFF energy and 5-mm PTV margins from 2016 to 2019 were used to calculate the required PTV margin. Deformable registration of the planning CT scan and internal gross tumor volume (IGTV) contour to posttreatment CBCT scans for 36 consecutive patients with 4 fraction schedules was completed to capture volume changes and intrafractional movement. Plans were replanned with 3-mm margins and recalculated on each deformed CT scan to assess deformed IGTV (d-IGTV) coverage and organ-at-risk doses. RESULTS Margin analysis showed PTV margins may be reduced to 3 mm. The mean d-IGTV coverage (percentage of the d-IGTV receiving ≥100% of the prescription dose [V100%] and the minimum dose covering 99.9% of the d-IGTV volume [D99.9%]) over 4 fractions for each patient was >95% with both margins. With 5-mm PTV margins, all 144 fractions had a d-IGTV V100% of >95% and a D99.9% >95%. With 3-mm PTV margins, the d-IGTV V100% was >95% in 99.3% of fractions (143 of 144) and the D99.9% was >95% in 98.6% of fractions (142 of 144). With 3-mm PTV margins, significant reductions in body V50%, body V80%, the volume of the lung receiving ≥20 Gy, and the mean lung dose and chest wall dose to 0.035 cm3 and 30 cm3 were observed (all P < .001). Using theoretical models, the normal tissue complication probability for radiation pneumonitis decreased by a mean of 0.8% (range, 0.1%-2.7%), and the mean 2-year tumor control probability was 96.1% and 95.2% with 5-mm and 3-mm PTV margins, respectively. CONCLUSION With modern treatment and immobilization techniques in lung SABR, 3-mm PTV margins maintain acceptable IGTV coverage, modestly reduce toxicity to organs at risk, and maintain a calculated 2-year local control rate of >95%.
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Affiliation(s)
- Katie Jasper
- BC Cancer–Vancouver, Vancouver, British Columbia, Canada
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baochang Liu
- BC Cancer–Prince George, Prince George, British Columbia, Canada
- Radiation Medicine Program, Walker Family Cancer Centre, St. Catharines, Ontario, Canada
| | - Robert Olson
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer–Prince George, Prince George, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer–Prince George, Prince George, British Columbia, Canada
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26
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Jang SS, Shin Y, Park SY, Huh GJ, Yang YJ. Impact of tumor size and location on lung dose difference between stereotactic body radiation therapy techniques for non-small cell lung cancer. Thorac Cancer 2021; 12:3310-3318. [PMID: 34689429 PMCID: PMC8671891 DOI: 10.1111/1759-7714.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate the lung dose differences between three‐dimensional conformal radiotherapy (3D‐CRT) and intensity‐modulated radiation therapy (IMRT) techniques for lung stereotactic body radiation therapy (SBRT) and the correlations with tumor characteristics, such as size and location. Methods Dosimetric comparisons between the two SBRT techniques in high‐ and low‐ to intermediate‐dose regions were retrospectively performed using four planning indices and lung‐dose parameters in 31 lung tumors. The magnitude of differences in these parameters was analyzed with relation to the planning target volume (PTV) and location‐related parameters. Results The absolute differences between the two techniques in lung‐dose parameters were small in both ipsilateral and bilateral lungs. The dosimetric differences were mainly correlated with the PTV rather than location‐related parameters, with positive and negative correlations with the high‐dose and intermediate‐dose parameters, respectively. The distances from the ipsilateral lung centroid to the PTV center were not correlated with the differences in any of the lung‐dose parameters. Additionally, the negative correlations with the MLD and V20 differences disappeared after applying a more rapid dose fall‐off in the IMRT plans for tumors with small PTVs of ≤15 cc. Conclusions Lung dose differences between the 3D‐CRT and IMRT techniques for lung SBRT were mainly correlated with the PTV rather than location‐related parameters. Together with the dosimetric benefit in high‐dose lung regions of IMRT for larger tumors, the relative increases in the MLD and V20 for small‐sized tumors could be reduced by applying a more rapid dose fall‐off outside the PTV.
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Affiliation(s)
- Seong Soon Jang
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yohan Shin
- Department of Radiation Oncology, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Suk Young Park
- Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Gil Ja Huh
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Jun Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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27
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Gui LG, Shi M, Li J. Cone beam computed tomography and image registration based on target area for stereotactic body radiation therapy of lung cancer. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1981754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Long-Gang Gui
- Radiotherapy Center, Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Miao Shi
- Radiotherapy Center, Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Jun Li
- Radiotherapy Center, Northern Jiangsu People’s Hospital, Yangzhou, China
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28
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Hellbach K. [Modern tumor therapy and its pulmonary side effects]. Radiologe 2021; 61:955-967. [PMID: 34550423 PMCID: PMC8456401 DOI: 10.1007/s00117-021-00912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Die Strahlentherapie und in jüngerer Zeit insbesondere die medikamentöse molekulare Therapie sind zentrale Bestandteile der modernen Onkologie. Beide Therapieformen eignen sich dazu, Tumoren bei vergleichsweise geringen systemischen Nebenwirkungen effektiv zu behandeln. Dennoch haben auch diese Behandlungsansätze Nebenwirkungen, die zum einen durch die Toxizität der Strahlung, zum anderen durch immunmodulatorische Effekte der verabreichten Medikamente ausgelöst werden. Das pneumotoxische Potenzial dieser Therapieformen spiegelt sich unter anderem in der Entstehung von interstitiellen Pneumonitiden wider, die in fibrotische Lungengerüstveränderungen übergehen können. Erschwert wird die klinische Diagnose der Erkrankung durch die unspezifischen Symptome. Die Computertomographie (CT) stellt ein ausgezeichnetes Mittel dar, um korrespondierende Verdichtungen zu diagnostizieren und im zeitlichen Verlauf zu monitoren. Damit wird dem Radiologen im interdisziplinären Kontext eine wichtige Rolle bei der Diagnostik dieses Krankheitsbildes zuteil.
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Affiliation(s)
- Katharina Hellbach
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
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29
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Kinkopf P, Modiri A, Yu KC, Yan Y, Mohindra P, Timmerman R, Sawant A, Vicente E. Virtual bronchoscopy-guided lung SAbR: dosimetric implications of using AAA versus Acuros XB to calculate dose in airways. Biomed Phys Eng Express 2021; 7. [PMID: 34488197 DOI: 10.1088/2057-1976/ac240c] [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: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022]
Abstract
In previous works, we showed that incorporating individual airways as organs-at-risk (OARs) in the treatment of lung stereotactic ablative radiotherapy (SAbR) patients potentially mitigates post-SAbR radiation injury. However, the performance of common clinical dose calculation algorithms in airways has not been thoroughly studied. Airways are of particular concern because their small size and the density differences they create have the potential to hinder dose calculation accuracy. To address this gap in knowledge, here we investigate dosimetric accuracy in airways of two commonly used dose calculation algorithms, the anisotropic analytical algorithm (AAA) and Acuros-XB (AXB), recreating clinical treatment plans on a cohort of four SAbR patients. A virtual bronchoscopy software was used to delineate 856 airways on a high-resolution breath-hold CT (BHCT) image acquired for each patient. The planning target volumes (PTVs) and standard thoracic OARs were contoured on an average CT (AVG) image over the breathing cycle. Conformal and intensity-modulated radiation therapy plans were recreated on the BHCT image and on the AVG image, for a total of four plan types per patient. Dose calculations were performed using AAA and AXB, and the differences in maximum and mean dose in each structure were calculated. The median differences in maximum dose among all airways were ≤0.3Gy in magnitude for all four plan types. With airways grouped by dose-to-structure or diameter, median dose differences were still ≤0.5Gy in magnitude, with no clear dependence on airway size. These results, along with our previous airway radiosensitivity works, suggest that dose differences between AAA and AXB correspond to an airway collapse variation ≤0.7% in magnitude. This variation in airway injury risk can be considered as not clinically relevant, and the use of either AAA or AXB is therefore appropriate when including patient airways as individual OARs so as to reduce risk of radiation-induced lung toxicity.
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Affiliation(s)
- P Kinkopf
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - A Modiri
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Kun-Chang Yu
- Broncus Medical, Inc., San Jose, CA, United States of America
| | - Y Yan
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - P Mohindra
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - R Timmerman
- UT Southwestern Medical Center, Dallas, TX, United States of America
| | - A Sawant
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - E Vicente
- University of Maryland School of Medicine, Baltimore, MD, United States of America
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30
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Ono T, Yamamoto N, Nomoto A, Nakajima M, Iwai Y, Isozaki Y, Kasuya G, Ishikawa H, Nemoto K, Tsuji H. The Risk Factors for Radiation Pneumonitis After Single-Fraction Carbon-Ion Radiotherapy for Lung Cancer or Metastasis. Cancers (Basel) 2021; 13:3229. [PMID: 34203485 PMCID: PMC8267739 DOI: 10.3390/cancers13133229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/21/2021] [Accepted: 06/25/2021] [Indexed: 12/09/2022] Open
Abstract
There are no studies on the risk factors of radiation pneumonitis (RP) after carbon-ion radiotherapy at a dose of 50 Gy (relative biological effectiveness (RBE)) in a single fraction. The objective of this study was to identify factors associated with RP after radiotherapy, including dose-volume parameters. Ninety-eight patients without a history of thoracic radiotherapy who underwent treatment for solitary lung tumors between July 2013 and April 2016 were retrospectively analyzed. Treatment was planned using Xio-N. The median follow-up duration was 53 months, and the median clinical target volume was 32.3 mL. Three patients developed grade 2 RP, and one patient developed grade 3 interstitial pneumonitis. None of the patients developed grade 4 or 5 RP. The dose-volume parameters of the normal lung irradiated at least with 5-30 Gy (RBE), and the mean lung dose was significantly lower in patients with grade 0-1 RP than in those with grade 2-3 RP. Pretreatment with higher SP-D and interstitial pneumonitis were significant factors for the occurrence of symptomatic RP. The present study showed a certain standard for single-fraction carbon-ion radiotherapy that does not increase the risk of RP; however, further validation studies are needed.
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Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, 2-2-2, Iida-Nishi, Yamagata 990-9585, Japan;
| | - Naoyoshi Yamamoto
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Akihiro Nomoto
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Mio Nakajima
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Yuma Iwai
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Yuka Isozaki
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Goro Kasuya
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, 2-2-2, Iida-Nishi, Yamagata 990-9585, Japan;
| | - Hiroshi Tsuji
- Department of Radiation Oncology, QST Hospital, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (Y.I.); (G.K.); (H.I.); (H.T.)
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A treatment planning study comparison between supine and prone position for different lung tumour locations using CyberKnife TPS. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920001193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim:
CyberKnife is the most advanced form of stereotactic body radiotherapy (SBRT) system that uses a robotic arm to deliver highly focused beams of radiation; however, a limitation is that it only irradiates from ceiling to floor direction. In patients with posterior lungs tumour who are positioned supine, normal lung tissue may suffer undesirable radiation injuries. This study compares the treatment planning between the prone set-up and the supine set-up for lung cancer in CyberKnife SBRT to decrease normal lung dose to avoid radiation side effects.
Materials and methods:
A human phantom was used to generate 108 plans (54 for prone and 54 for supine) using the CyberKnife planning platform. The supine and prone plans were compared in terms of the dosimetric characteristics, delivery efficiency and plan efficiency.
Results:
For posterior targets, the area of low-dose exposure to normal lungs was smaller in the prone set-up than in the supine set-up. V10 of the lungs was 7·53% and 10·47% (p < 0·001) in the anterior region, and 10·78% and 8·03% (p < 0·001) in the posterior region in the supine and prone set-up plans, respectively.
Conclusions:
The comparison between the prone set-up and the supine set-up was investigated with regard to target coverage and dose to organs at risk. Our results may be deployed in CyberKnife treatment planning to monitor normal tissue dose by considering patient positioning. This may assist in the design of better treatment plans and prevention of symptomatic radiation pneumonitis in lung cancer patients.
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Takemoto S, Shibamoto Y, Hashizume C, Miyakawa A, Murai T, Yanagi T, Sugie C, Nagai A. Changes in pulmonary function and their correlation with dose-volume parameters in patients undergoing stereotactic body radiotherapy for lung cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:338-345. [PMID: 33480428 PMCID: PMC7948829 DOI: 10.1093/jrr/rraa131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/13/2020] [Indexed: 06/12/2023]
Abstract
It is desirable to estimate the degree of the decrease in pulmonary function before lung stereotactic body radiation therapy (SBRT) especially for patients with poor pulmonary function. The purpose of this study was to investigate whether decreases in pulmonary function after SBRT may be predicted from radiation dose-volume parameters. A total of 70 patients undergoing SBRT were evaluated for changes in pulmonary function. Of these, 67 had primary lung cancer and 3 had lung metastasis. Twenty-six (37%) patients had chronic obstructive pulmonary disease. Pulmonary function tests (PFTs) were performed shortly before and at 18-24 months after SBRT. Radiation pneumonitis was Grade 2 in 10 patients and Grade 3 in 1. Mean forced vital capacity (FVC) decreased from 2.67 to 2.51 L (P < 0.01) and mean forced expiratory volume in 1 s (FEV1) decreased from 1.80 to 1.72 L (P < 0.01). Planning target volume (PTV) was correlated with changes in FVC. Changes in percent predicted FVC were correlated with %V5Gy (% of lung volume receiving > 5 Gy) and %V40Gy. Although the correlation was not significant, the %V20Gy value was the closest to the percent reduction in predicted FVC; %V20Gy of 10% tended to be associated with ~10% reduction in predicted FVC. Patients with poor pulmonary function did not necessarily show greater decreases in each PFT parameter. Decreases in FVC and FEV1 were within previously reported ranges. PTV was associated with decreases in FVC. The %V20Gy value was closest to the percentage decrease in predicted FVC.
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Affiliation(s)
- Shinya Takemoto
- Corresponding author. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan. Tel: +81-52-853-8274; Fax: +81-52-852-5244; E-mail:
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, 1-172, Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Takeshi Yanagi
- Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi, Aichi, 441-8021, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Aiko Nagai
- Department of Radiation Oncology, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, 477-8522, Japan
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Adachi T, Nakamura M, Shintani T, Mitsuyoshi T, Kakino R, Ogata T, Ono T, Tanabe H, Kokubo M, Sakamoto T, Matsuo Y, Mizowaki T. Multi-institutional dose-segmented dosiomic analysis for predicting radiation pneumonitis after lung stereotactic body radiation therapy. Med Phys 2021; 48:1781-1791. [PMID: 33576510 DOI: 10.1002/mp.14769] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To predict radiation pneumonitis (RP) grade 2 or worse after lung stereotactic body radiation therapy (SBRT) using dose-based radiomic (dosiomic) features. METHODS This multi-institutional study included 247 early-stage nonsmall cell lung cancer patients who underwent SBRT with a prescribed dose of 48-70 Gy at an isocenter between June 2009 and March 2016. Ten dose-volume indices (DVIs) were used, including the mean lung dose, internal target volume size, and percentage of entire lung excluding the internal target volume receiving greater than x Gy (x = 5, 10, 15, 20, 25, 30, 35, and 40). A total of 6,808 dose-segmented dosiomic features, such as shape, first order, and texture features, were extracted from the dose distribution. Patients were randomly partitioned into two groups: model training (70%) and test datasets (30%) over 100 times. Dosiomic features were converted to z-scores (standardized values) with a mean of zero and a standard deviation (SD) of one to put different variables on the same scale. The feature dimension was reduced using the following methods: interfeature correlation based on Spearman's correlation coefficients and feature importance based on a light gradient boosting machine (LightGBM) feature selection function. Three different models were developed using LightGBM as follows: (a) a model with ten DVIs (DVI model), (b) a model with the selected dosiomic features (dosiomic model), and (c) a model with ten DVIs and selected dosiomic features (hybrid model). Suitable hyperparameters were determined by searching the largest average area under the curve (AUC) value in the receiver operating characteristic curve (ROC-AUC) via stratified fivefold cross-validation. Each of the final three models with the closest the ROC-AUC value to the average ROC-AUC value was applied to the test datasets. The classification performance was evaluated by calculating the ROC-AUC, AUC in the precision-recall curve (PR-AUC), accuracy, precision, recall, and f1-score. The entire process was repeated 100 times with randomization, and 100 individual models were developed for each of the three models. Then the mean value and SD for the 100 random iterations were calculated for each performance metric. RESULTS Thirty-seven (15.0%) patients developed RP after SBRT. The ROC-AUC and PR-AUC values in the DVI, dosiomic, and hybrid models were 0.660 ± 0.054 and 0.272 ± 0.052, 0.837 ± 0.054 and 0.510 ± 0.115, and 0.846 ± 0.049 and 0.531 ± 0.116, respectively. For each performance metric, the dosiomic and hybrid models outperformed the DVI models (P < 0.05). Texture-based dosiomic feature was confirmed as an effective indicator for predicting RP. CONCLUSIONS Our dose-segmented dosiomic approach improved the prediction of the incidence of RP after SBRT.
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Affiliation(s)
- Takanori Adachi
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Shintani
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamasa Mitsuyoshi
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryo Kakino
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ogata
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomohiro Ono
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Tanabe
- Department of Radiological Technology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takashi Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Saha A, Beasley M, Hatton N, Dickinson P, Franks K, Clarke K, Jain P, Teo M, Murray P, Lilley J. Clinical and dosimetric predictors of radiation pneumonitis in early-stage lung cancer treated with Stereotactic Ablative radiotherapy (SABR) - An analysis of UK's largest cohort of lung SABR patients. Radiother Oncol 2021; 156:153-159. [PMID: 33333139 DOI: 10.1016/j.radonc.2020.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stereotactic Ablative Radiotherapy (SABR) is the standard treatment for early-stage medically inoperable lung cancer. Predictors of radiation pneumonitis (RP) in patients treated with SABR are poorly defined. In this study, we investigate clinical and dosimetric parameters, which can predict symptomatic RP in early-stage lung cancer patients treated with SABR. MATERIALS AND METHODS Patients treated with lung SABR between May 2009 and August 2018, in a single United Kingdom (UK) radiotherapy center were included. The patient's baseline characteristics, treatment details, and toxicity were retrieved from the electronic medical record. Dosimetric data was extracted from Xio and Monaco treatment planning systems. Patients were treated according to the UK SABR consortium guidelines. RP was graded retrospectively using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, based on available clinical and imaging information. Univariate and multivariate binary logistic regression was performed to determine predictive factors for grade ≥ 2 radiation pneumonitis, using Statistical Package for the Social Sciences (SPSS) statistics version 21 software. The goodness of fit was assessed using the Hosmer and Lemeshow test. The optimal diagnostic threshold was tested using the Receiver operating characteristics (ROC) curve. The chi-square test was carried out to test the different risk factors against the likelihood of developing grade ≥ 2 pneumonitis. RESULTS A total of 1266 patients included in the analysis. The median age of patients was 75 years. Six hundred sixty-six patients (52.6%) were female. Median follow up was 56 months. Sixty-five percent of patients received 55 Gy in 5 fractions. Forty-three percent of patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 and 16.2% had PS of 3. The Median Charlson comorbidity index was 6 (range 2-11). Median Standardized Uptake Value (SUV) max of the tumor was 6.5. Four hundred two patients (31.8%) had confirmed histological diagnosis; other patients were treated based on a radiological diagnosis. The median tumor size was 20 mm (range 4 mm-63 mm). Median Planning Target Volume (PTV) was 30.3 cc. Median values of R100, R50, and D2cm were 1.1, 5.6, 32.8 Gy. The median value of mean lung dose, V20, and V12.5 were 3.9 Gy, 5 %and 9.3% respectively. Eighty-five (6.7%) patients developed symptomatic RP (grade ≥ 2) with only 5(0.4%) developing grade 3 RP. Five percent of patients developed rib fractures but only 28% of these were symptomatic. On univariate analysis lower lobe tumor location, larger tumor size, PTV, mean lung dose, lung V20Gy, and V12.5 Gy were significantly associated with grade ≥ 2 RP. On multivariate analysis, only mean lung dose was associated with grade ≥ 2 pneumonitis. ROC curve analysis showed optimal diagnostic threshold for tumour size, PTV, mean lung dose, V20 and V12.5; are 22.5 mm ((Area Under Curve (AUC)-0.565)), 27.15 cc (AUC-0.58), 3.7 Gy (AUC-0.633), 4.6% (AUC-0.597), 9.5% (AUC-0.616). The incidence of ≥grade 2 RP was significantly high for values higher than the ROC threshold. CONCLUSION SABR treatment resulted in a very low rate of grade 3 pneumonitis. Lower lobe tumor location, larger tumor size, PTV, mean lung dose, V20, and V12.5 were found to be significant predictors of symptomatic radiation pneumonitis.
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Affiliation(s)
- Animesh Saha
- Department of Oncology, Apollo Gleneagles Cancer Hospital, Kolkata, India.
| | - Matthew Beasley
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Nathaniel Hatton
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Peter Dickinson
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Kevin Franks
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Katy Clarke
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Pooja Jain
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Mark Teo
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Patrick Murray
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - John Lilley
- Department of Medical Physics, St James's University Hospital, Leeds, UK
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Ma M, Ren W, Li M, Niu C, Dai J. Dosimetric comparison of coplanar and noncoplanar beam arrangements for radiotherapy of patients with lung cancer: A meta-analysis. J Appl Clin Med Phys 2021; 22:34-43. [PMID: 33634946 PMCID: PMC8035566 DOI: 10.1002/acm2.13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Radiotherapy plays an important role in the treatment of lung cancer, and both coplanar beam arrangements (CBA) and noncoplanar beam arrangements (NCBA) are adopted in clinic practice. The aim of this study is to answer the question whether NCBA are dosimetrically superior to CBA. Methods Search of publications were performed in PubMed, Web of Science, and the Cochran Library till March 2020. The searching terms were as following: ((noncoplanar) or ("non coplanar") or ("4pi") or ("4π")) AND (("lung cancer") or ("lung tumor") or ("lung carcinoma")) AND ((radiotherapy) or ("radiation therapy")). The included studies and extracted data were manually screened. All forest and funnel plots were carried out with RevMan software, and the Egger’s regression asymmetry tests were conducted with STATA software. Results Nine studies were included and evaluated in the meta‐analysis and treatment plans were designed with both CBA and NCBA. For the planning target volumes (PTV), D98%, D2%, the conformity index (CI), and the gradient index (GI) had no statistically significant difference. For organs‐at‐risk (OAR), V20 of the whole lung and the maximum dose of the spinal cord were significantly reduced in NCBA plans compared with CBA ones. But V10, V5, and mean dose of the whole lung, the maximum dose of the heart, and the maximum dose of the esophagus exhibited no significant difference when the two types of beam arrangements were compared. Conclusion After combining multicenter results, NCBA plans have significant advantages in reducing V20 of the whole lung and max dose of spinal cord.
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Affiliation(s)
- Min Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenting Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghui Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chuanmeng Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC Pulm Med 2021; 21:9. [PMID: 33407290 PMCID: PMC7788688 DOI: 10.1186/s12890-020-01376-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Chemo-radiotherapy and systemic therapies have proven satisfactory outcomes as standard treatments for various thoracic malignancies; however, adverse pulmonary effects, like pneumonitis, can be life-threatening. Pneumonitis is caused by direct cytotoxic effect, oxidative stress, and immune-mediated injury. Radiotherapy Induced Lung Injury (RILI) encompasses two phases: an early phase known as Radiation Pneumonitis (RP), characterized by acute lung tissue inflammation as a result of exposure to radiation; and a late phase called Radiation Fibrosis (RF), a clinical syndrome that results from chronic pulmonary tissue damage. Currently, diagnoses are made by exclusion using clinical assessment and radiological findings. Pulmonary function tests have constituted a significant step in evaluating lung function status during radiotherapy and useful predictive tools to avoid complications or limit toxicity. Systemic corticosteroids are widely used to treat pneumonitis complications, but its use must be standardized, and consider in the prophylaxis setting given the fatal outcome of this adverse event. This review aims to discuss the clinicopathological features of pneumonitis and provide practical clinical recommendations for prevention, diagnosis, and management.
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Affiliation(s)
- Marisol Arroyo-Hernández
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Federico Maldonado
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Francisco Lozano-Ruiz
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Wendy Muñoz-Montaño
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México
| | - Mónica Nuñez-Baez
- Departamento de Radioncología, Hospital Universitario HM Sanchinarro, Caracas, Venezuela
| | - Oscar Arrieta
- Head of Thoracic Oncology Unit, Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Sección XVI, Tlalpan, 14080, México City, CDMX, México.
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Shao W, Chen Z, Bai Y, Xu B, Xu L, Zhao Q, Wang Y, Tang X. Stereotactic body radiation therapy for non-small cell lung cancer using the non-coplanar radiation of Cyberknife and Varian linac. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:635-643. [PMID: 33935131 DOI: 10.3233/xst-210867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE This study aims to evaluate the planned dose of stereotactic body radiation therapy (SBRT) for treating early peripheral non-small cell lung cancer (NSCLC) using the non-coplanar radiation from Cyberknife and Varian linac. Moreover, this study investigates whether Cyberknife and Varian linac are qualified for non-coplanar radiation SBRT for treating early peripheral NSCLC, and which one is better for protecting organs at risk (OARs). METHODS Retrospective analysis was performed based on the Cyberknife radiation treatment plans (RTPs) and Varian Eclipse RTPs of 10 patients diagnosed with early peripheral NSCLC. The dose distributions in the target and OARs were compared between the RTPs of Cyberknife and Varian Eclipse using Mim medical imaging software. RESULTS For PTV, no significant difference in D98 and D95 between the Cyberknife and Eclipse was observed (t = -0.35, -1.67, P > 0.05). The homogeneity indexes (HIs) of Cyberknife plans are higher (t = 71.86, P < 0.05) than those of Eclipse plans. The V10, V15, V20, V25, V30 and Dmean of the lung with NSCLC and the V20 of the whole lung for Cyberknife were less than those for Eclipse (t = -4.73, -5.62, -7.75, -6.38, -6.89, -3.14, -7.09, respectively, P < 0.05). Cyberknife plans have smaller spinal cord Dmax, trachea Dmax, heart Dmax, chest wall Dmax (t = -2.49, -2.57, -3.71, -3.56, respectively, P < 0.05) and esophagus Dmax (t = -1.95, P > 0.05) than Varian Eclipse plans. CONCLUSION To fulfill SBRT by non-coplanar radiation, Cyberknife is recommended for the institutions equipped with Cyberknife, while Varian linac can be applied for the institutions that have not adopted Cyberknife in clinical radiotherapy yet.
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Affiliation(s)
- Wencheng Shao
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, P. R. China
| | - Ziyin Chen
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Yanchun Bai
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Bingchen Xu
- Department of Radiation Therapy, Jilin Central Hospital, Jilin, P. R. China
| | - Lili Xu
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Qiushuang Zhao
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Yang Wang
- Accelerator Treatment Site, Harbin Chest Hospital, Harbin, P. R. China
| | - Xiaobin Tang
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
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Zou X, Lan L, Zheng L, Chen J, Guo F, Cai C, Hong J, Zhang W. Effect of tumor and normal lung volumes on the lung volume-dose parameters of IMRT in non-small-cell lung cancer. Clinics (Sao Paulo) 2021; 76:e2769. [PMID: 34231708 PMCID: PMC8240768 DOI: 10.6061/clinics/2021/e2769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the effect of tumor and normal lung volumes on lung volume-dose parameters in patients with non-small-cell lung cancer (NSCLC) who had undergone intensity-modulated radiation therapy (IMRT). METHODS The clinical data of 208 patients with NSCLC who underwent radical IMRT between June 2014 and June 2018 were retrospectively analyzed. A regression model curve was used to evaluate the effect of tumor and normal lung volumes on normal lung relative volumes receiving greater than 5 and 20 Gy (V5, V20), on mean lung dose (MLD), and on absolute volumes spared from greater than 5 and 20 Gy (AVS5, AVS20). RESULTS The V5, V20, and MLD of the bilateral lung were fitted to a quadratic equation curve with the change in tumor volume, which increased initially and then decreased when the tumor volume increased. The V5, V20, and MLD of the lung reached their apex when the tumor volumes were 288.07, 341.69, and 326.83 cm3, respectively. AVS5 and AVS20 decreased in a logarithmic curve with an increase in tumor volume. The V5, V20, and MLD of the small normal lung volume group were all significantly higher than those of the large normal lung volume group (p<0.001, p=0.004, p=0.002). However, the AVS5 and AVS20 of the small normal lung volume group were all significantly lower than those of the large normal lung volume group (p<0.001). CONCLUSION The effects of tumor volume and normal lung volume on dose-volume parameters should be considered. AVS5 is an important supplementary dose limitation parameter for patients whose tumor volume exceeds a certain boundary value (approximately 300 cm3).
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Affiliation(s)
- Xi Zou
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
| | - Linzhen Lan
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
| | - Lijing Zheng
- Department of Oncology, Fujian Provincial Hospital, Gulou District, Fuzhou City, Fujian Province, 350005, China
| | - Jinmei Chen
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
| | - Feibao Guo
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
| | - Chuanshu Cai
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Corresponding authors. E-mails: /
| | - Weijian Zhang
- Department of Radiotherapy, Cancer Center, First Affiliated Hospital of Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Taijiang District, Fuzhou City, Fujian Province, 350005, China
- Corresponding authors. E-mails: /
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Liu Y, Zhu Y, Wu R, Hu M, Zhang L, Lin Q, Weng D, Sun X, Liu Y, Xu Y. Stereotactic body radiotherapy for early stage non-small cell lung cancer in patients with subclinical interstitial lung disease. Transl Lung Cancer Res 2020; 9:2328-2336. [PMID: 33489796 PMCID: PMC7815350 DOI: 10.21037/tlcr-20-1050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background For lung cancer patients with subclinical (untreated and asymptomatic) interstitial lung disease (ILD), there is a lack of relatively safe and effective treatment. Stereotactic body radiation therapy (SBRT) can achieve a high level of tumor control with low toxicity in early-stage non-small cell lung cancer (NSCLC). This study aimed to evaluate the efficacy and toxicity of early stage NSCLC patients with subclinical ILD receiving SBRT. Methods A total of 109 early stage NSCLC patients receiving SBRT treatment between December 2011 and August 2016 were reviewed in our institutions; patients with clinical ILD were excluded. The median dose of SBRT was 50 Gy in 5 fractions. The median biologically effective dose (BED; α/β=10) was 100 Gy (range, 72–119 Gy). An experienced radiation oncologist and an experienced radiologist reviewed the presence of subclinical ILD in the CT findings before SBRT. The relationships among the efficacy, radiation-induced lung injury (RILI) and subclinical ILD were explored. Results In all, 38 (34.9%) of 109 patients were recognized with subclinical ILD before SBRT, 48 (44.0%) of 109 patients were recognized with grade 2–5 RILI after SBRT, and 18 (47.4%) of 38 patients with subclinical ILD were observed with grade 2–5 RILI. Subclinical ILD was not a significant factor of grade 2–5 RILI (P=0.608); however, 3 patients had extensive RILI, and they all suffered from subclinical ILD. Dosimetric factor of the lungs, such as mean lung dose (MLD) was significantly related with Grade 2–5 RILI in patients with subclinical ILD (P=0.042). The progression-free survival (PFS) rates at 3 years in the subclinical ILD patients and those without ILD were 61.6% and 66.8%, respectively (P=0.266). Conclusions Subclinical ILD was not a significant factor for RILI or PFS in early stage NSCLC patients receiving SBRT; however, patients with subclinical ILD receiving SBRT may experience uncommon extensive RILI.
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Affiliation(s)
- Yuanjun Liu
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China.,Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yaoyao Zhu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ran Wu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Hu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lingnan Zhang
- Department of Radiology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Qingren Lin
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Denghu Weng
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaojiang Sun
- Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yu Liu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yaping Xu
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China.,Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
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Risk factors for symptomatic radiation pneumonitis after stereotactic body radiation therapy (SBRT) in patients with non-small cell lung cancer. Radiother Oncol 2020; 156:231-238. [PMID: 33096168 DOI: 10.1016/j.radonc.2020.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Radiation pneumonitis (RP) can be a potential fatal toxicity of stereotactic body radiation therapy (SBRT) for medically inoperable non-small cell lung cancer (NSCLC). This study aimed to examine the risk factors that predict RP and explore dosimetric tolerance for safe practice in a large institutional series of NSCLC patients. MATERIALS AND METHODS Patients with early-stage and locally recurrent NSCLC who received lung SBRT between 2002 and 2015 formed the study population. The primary endpoint was grade 2 or above radiation pneumonitis (RP2). Lungs were re-contoured consistently by one radiation oncologist according to the RTOG atlas for organs at risk. Dosimetric factors were computed consistently with exclusion of gross tumor volume of either ipsilateral, contralateral, or total lungs. RESULTS A total of 339 patients were eligible. With a median follow-up of 47 months, RP2 was recorded in 10% patients. History of respiratory comorbidity, previous thoracic radiation, right lung location, mean lung doses of total or ipsilateral lung, and total lung volume receiving 20 Gy were all significantly associated with the risk of RP2. The dosimetric parameters of contralateral lung, including mean dose and volume receiving more than 5, 10, and 20 Gy, were not significantly associated with RP2 (ps > 0.05). A model of combining significant clinical and dosimetric factors had a predictive accuracy AUC of 0.76. According to this model, RP2 can be limited to <10% should the patient have no previous lung radiation and the mean dose of total and ipsilateral lungs be kept less than 6 Gy and 20 Gy, respectively. CONCLUSION Dosimetric factors of total or ipsilateral lung together with important clinical factors were significant risk factors for symptomatic radiation pneumonitis after SBRT. Constraining mean lung dose can limit clinically significant lung toxicity.
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Moiseenko V, Grimm J, Yorke E, Jackson A, Yip A, Huynh-Le MP, Mahadevan A, Forster K, Milano MT, Hattangadi-Gluth JA. Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design. Cureus 2020; 12:e10808. [PMID: 33163312 PMCID: PMC7641492 DOI: 10.7759/cureus.10808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and purpose Recently published HyTEC report summarized lung toxicity data and proposed guidelines of mean lung dose (MLD) <8 Gy and normal lung receiving at least 20 Gy, V20Gy<10-15% to avoid lung toxicity. Support for preferred use of a particular dosimetric parameter has been limited. We performed a detailed dose-volume analysis of data on radiation pneumonitis (RP) following lung stereotactic body radiation therapy (SBRT) to search for parameters showing the strongest correlation with RP. Materials and methods Two patient cohorts (primary and metastatic lung tumor patients) from previously reported studies were analyzed. Total number of patients was 96, and incidence of grade ≥2 RP was 13.5% (13/96). Fitting to the logistic function was performed to investigate correlation between incidence of RP and reported dosimetric and volumetric parameters. Another independent cohort was used to explore correlation between dosimetric parameters. Results Among normal lung parameters (MLD and reported Vx), only MLD consistently showed significant correlation with incidence of RP. Gross tumor volume (GTV), internal target volume, planning target volume (PTV), and minimum dose covering 95% of GTV or PTV did not show statistical significance. A significant correlation between reported Vx and MLD was observed in all cohorts. Conclusions In considering tumor- and target-specific (e.g., GTV, PTV) and normal lung-specific (e.g., MLD, Vx) metrics, MLD was the only parameter that consistently correlated with incidence of RP across both cohorts. Because SBRT planning constraints allow small normal lung volumes to receive high doses, utility of MLD is not obvious. The parallel structure of lung is one possible explanation, but correlation between dosimetric parameters obscures elucidation of the preferred or mechanistically based parameter to guide radiotherapy planning.
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Affiliation(s)
- Vitali Moiseenko
- Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, USA
| | - Jimm Grimm
- Radiation Oncology, Geisinger Health System, Danville, USA
| | - Ellen Yorke
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrew Jackson
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Anthony Yip
- Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, USA
| | - Minh-Phuong Huynh-Le
- Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, USA
| | - Anand Mahadevan
- Radiation Oncology, Geisinger Cancer Institute, Danville, USA
| | - Kenneth Forster
- Radiation Oncology, Geisinger Cancer Institute, Danville, USA
| | - Michael T Milano
- Radiology Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, USA
| | - Jona A Hattangadi-Gluth
- Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, USA
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Gao Y, Wu X, Li Y, Li Y, Zhou Q, Wang Q, Wei C, Shi D, Xie C, Pan H. The Predictive Value of MLR for Radiation Pneumonia During Radiotherapy of Thoracic Tumor Patients. Cancer Manag Res 2020; 12:8695-8701. [PMID: 33061568 PMCID: PMC7518777 DOI: 10.2147/cmar.s268964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the predictive value of blood lymphocyte, monocyte to lymphocyte ratio (MLR), and neutrophil to lymphocyte ratio (NLR) for radiation pneumonia (RP) in patients with thoracic tumors receiving radiotherapy. Patients and Methods The clinical data of 65 patients with thoracic tumor (esophageal cancer, lung cancer) treated by radiotherapy in our hospital were retrospectively analyzed. Patients were divided into the RP group and the non-RP group according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). Data on blood cell counts, including lymphocytes, monocytes, and neutrophils, were collected before (0 weeks) and after 1, 2, and 4 weeks of radiotherapy. Results Of the 65 patients enrolled, 27 developed radiation pneumonia and 38 did not. Patients’ clinical factors, including age, TNM stage, tumor type, underlying lung disease, and history of smoking, had no correlation with RP. ANOVA of repeated measurement data showed that the changes of MLR in the group with RP during radiotherapy were significantly different from those in the non-RP group (P<0.05). The RP prediction model based on the identified risk factors was established using receiver operator characteristic curves. The results showed that the area under the curve for the monocyte to lymphocyte ratio was 0.755 (95% CI, 0.63–0.87, P=0.000), and the best cutoff point for MLR was 0.426. Conclusion MLR could predict radiation pneumonia in patients with thoracic tumor radiotherapy and achieve early monitoring, early prevention, and treatment.
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Affiliation(s)
- Ya Gao
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xinyi Wu
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yunhao Li
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yifei Li
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qingyu Zhou
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qiongqiong Wang
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chaoyi Wei
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Deli Shi
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Congying Xie
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Huanle Pan
- Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Dynamic tumor-tracking stereotactic body radiation therapy for a solitary tumor in a transplanted organ: two case reports. Int Cancer Conf J 2020; 9:221-226. [PMID: 32904140 DOI: 10.1007/s13691-020-00429-z] [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: 04/01/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022] Open
Abstract
Solid-organ transplant recipients require long-term immunosuppressants to prevent graft rejection. However, immunosuppressant use increases the risk of malignancy. Radiotherapy can be a treatment option for patients who are medically inoperable or refuse surgery; however, whether the irradiation of transplanted organs is safe remains unclear. We present two patients with malignancies that developed in transplanted organs and were treated with dynamic tumor-tracking (DTT) stereotactic body radiation therapy (SBRT). The first patient underwent transplantation owing to liver cirrhosis caused by hepatitis C virus and subsequently developed hepatocellular carcinoma in the donated liver. There was no evidence of recurrence 12 months post-treatment, and liver function enzyme levels did not deviate from their pre-SBRT baselines. The second patient had a solitary tongue cancer metastasis in a transplanted lung; she also had a history of interstitial pneumonia caused by scleroderma. Six weeks after DTT-SBRT, she developed grade 3 radiation pneumonitis but recovered with oral steroids; she experienced no tumor recurrence after 14 months, although her respiratory function was worse than it was pre-SBRT owing to post-transplant rejection. DTT-SBRT is thus feasible for treating tumors that arise in transplanted lungs and livers.
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Jiao Y, Ren Y, Ge W, Zhang L, Zheng X. Adoption of Biologically Effective Dose of the Non-Target Lung Volume to Predict Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy With Variable Fractionations for Lung Cancer. Front Oncol 2020; 10:1153. [PMID: 32850328 PMCID: PMC7411255 DOI: 10.3389/fonc.2020.01153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background: This study aims to establish lung biologically effective dose (BED)–based uniform dosimetric constraints for minimizing the risk of symptomatic radiation pneumonitis (SRP) from stereotactic body radiation therapy (SBRT) using variable fractionations in patients with lung tumors. Materials and Methods: A total of 102 patients with primary or oligometastatic lung tumors treated with SBRT in our institution were enrolled into this study. The associations between the clinical and dosimetric parameters and the incidences of SRP were analyzed using univariate and multivariate Cox regression hazard models. The receiver operating characteristic (ROC) curve was generated to evaluate the predictive performance of lung BED on the SRP risk compared with the physical dose. Results: SRP occurred in 11 patients (10.8%). In univariate analysis, the mean lung dose (p = 0.002), V5 (p = 0.005), V20 (p < 0.001), and the percentage of non-target normal lung volume receiving more than a BED of 5–170 Gy (VBED5−170, p < 0.05) were associated with SRP. Multivariate logistic regression analysis showed that there existed a significant statistical correlation between SRP and VBED70 (p < 0.001), which performed better than V5 or V20 on the ROC curves, resulting in an optimal cut-off value of lung VBED70 of 2.22%. Conclusions: This retrospective study indicated that non-target lung BED may better predict SRP from patients with SBRT-treated lung cancer. Limiting the lung VBED70 below 2.22% may be favorable to reduce the incidence of SRP, which warranted further prospective validation.
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Affiliation(s)
- Yuxin Jiao
- Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yanping Ren
- Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China
| | - Weiqiang Ge
- Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China
| | - Libo Zhang
- Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China
| | - Xiangpeng Zheng
- Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai, China
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Dupic G, Biau J, Molnar I, Chassin V, Dedieu V, Lapeyre M, Bellière-Calandry A. Significant Correlation Between Overall Survival and Mean Lung Dose in Lung Stereotactic Body Radiation Therapy (SBRT). Front Oncol 2020; 10:1577. [PMID: 32850462 PMCID: PMC7433697 DOI: 10.3389/fonc.2020.01577] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background After stereotactic body radiation therapy (SBRT) for medically inoperable stage I non-small-cell lung cancer (NSCLC), more patients die of comorbidities, particularly severe pulmonary insufficiency, than of tumor progression. The aim of this study was to evaluate correlation between lung biologically effective dose (BED) with an α/β ratio of 3 Gy (BED3) and overall survival (OS) for these patients. Methods From 2012 to 2017, we have developed a prospectively updated institutional database for all first 100 consecutively treated patients with inoperable Stage 1 (T1T2N0M0) NSCLC. All SBRT were conducted on a Novalis Tx® LINAC with two coplanar dynamic conformal arcs (84%) or with coplanar volumetric modulated arc therapy (VMAT) (16%). Mean GTV and PTV were 8.6 cc and 50.8 cc, respectively. The marginal dose prescribed to the PTV was the 80% isodose line (IDL), i.e., 54 Gy in 3 fractions for 76 patients (BED10 = 126 Gy) and 50 Gy in 5 fractions for 24 patients (BED10 = 83.3 Gy). Pulmonary heterogeneity has been taken into account by using Monte Carlo or AAA algorithms. Median follow-up was 25 months. Results At 1, 2, 3 and 5 years, local control (LC) was respectively 100, 98.2, 98.2, and 77.7%, and OS was respectively 83, 71.2, 58.1, and 33.2% (median OS was 49 months). Significant OS prognostic factors in univariate and multivariate analysis were mean lung BED3 (HR = 1.14, p = 0.01) and PTV volume (HR = 1.01, p = 0.004). A mean lung BED3 ≤ 5 Gy was significantly associated with a doubling of median OS from 29 months to more than 60 months (not achieved, p = 0.0068). For patients with a forced expiratory volume in 1 second (FEV1) ≤ 40%, a mean lung BED3 ≤ 4 Gy was significantly associated with a doubling of median OS from 23 to 46 months (p = 0.019). Conclusion Mean lung BED3 is strongly and significantly associated with OS in SBRT for inoperable Stage I NSCLC. For all treated patients, a mean lung BED3 ≤ 5 Gy lead to a doubling of median OS. This threshold value should be reduced to 4 Gy for patients with FEV1 ≤ 40%.
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Affiliation(s)
- Guillaume Dupic
- Department of Radiation Oncology, University of Clermont Auvergne, Jean Perrin Center, Clermont-Ferrand, France
| | - Julian Biau
- Department of Radiation Oncology, University of Clermont Auvergne, Jean Perrin Center, Clermont-Ferrand, France
| | - Ioana Molnar
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France.,Department of Clinical Research UMR 501, Jean Perrin Center, Clermont-Ferrand, France
| | - Vincent Chassin
- Department of Medical Physics, University of Clermont Auvergne, Jean Perrin Center, Clermont-Ferrand, France
| | - Véronique Dedieu
- Department of Medical Physics, University of Clermont Auvergne, Jean Perrin Center, Clermont-Ferrand, France
| | - Michel Lapeyre
- Department of Radiation Oncology, University of Clermont Auvergne, Jean Perrin Center, Clermont-Ferrand, France
| | - Aurélie Bellière-Calandry
- Department of Radiation Oncology, University of Clermont Auvergne, Jean Perrin Center, Clermont-Ferrand, France
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Frerker B, Hildebrandt G. <p>Distinguishing Radiation Pneumonitis from Local Tumour Recurrence Following SBRT for Lung Cancer</p>. REPORTS IN MEDICAL IMAGING 2020. [DOI: 10.2147/rmi.s176901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bertho A, Dos Santos M, Buard V, Paget V, Guipaud O, Tarlet G, Milliat F, François A. Preclinical Model of Stereotactic Ablative Lung Irradiation Using Arc Delivery in the Mouse: Effect of Beam Size Changes and Dose Effect at Constant Collimation. Int J Radiat Oncol Biol Phys 2020; 107:548-562. [PMID: 32278852 DOI: 10.1016/j.ijrobp.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy is a therapeutic option offered to high surgical risk patients with lung cancer. Focal lung irradiation in mice is a new preclinical model to help understand the development of lung damage in this context. Here we developed a mouse model of lung stereotactic therapy using arc delivery and monitored the development of lung damage while varying the beam size and dose delivered. METHODS AND MATERIALS C57BL/6JRj mice were exposed to 90 Gy focal irradiation on the left lung using 1-mm diameter, 3 × 3 mm2, 7 × 7 mm2, or 10 × 10 mm2 beam collimation for beam size effect and using 3 × 3 mm2 beam collimation delivering 20 to 120 Gy for dose effect. Long-term lung damage was monitored with micro-computed tomography imaging with anatomopathologic and gene expression measurements in the injured patch and the ipsilateral and contralateral lungs. RESULTS Both 1-mm diameter and 3 × 3 mm2 beam collimation allow long-term studies, but only 3-mm beam collimation generates lung fibrosis when delivering 90 Gy. Dose-effect studies with constant 3-mm beam collimation revealed a dose of 60 Gy as the minimum to obtain lung fibrosis 6 months postexposure. Lung fibrosis development was associated with club cell depletion and increased type II pneumocyte numbers. Lung injury developed with ipsilateral and contralateral consequences such as parenchymal thickening and gene expression modifications. CONCLUSIONS Arc therapy allows long-term studies and dose escalation without lethality. In our dose-delivery conditions, dose-effect studies revealed that 3 × 3 mm2 beam collimation to a minimum single dose of 60 Gy enables preclinical models for the assessment of lung injury within a 6-month period. This model of lung tissue fibrosis in a time length compatible with mouse life span may offer good prospects for future mechanistic studies.
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Affiliation(s)
- Annaïg Bertho
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Morgane Dos Santos
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Accidentelles, Fontenay-aux-Roses, France
| | - Valérie Buard
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Vincent Paget
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Olivier Guipaud
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Georges Tarlet
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Fabien Milliat
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France
| | - Agnès François
- Institut de Radioprotection et de Sûreté Nucléaire, Service de Recherche en Radiobiologie et en Médecine régénérative, Laboratoire de Radiobiologie des expositions Médicales, Fontenay-aux-Roses, France.
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Shintani T, Nakamura M, Matsuo Y, Miyabe Y, Mukumoto N, Mitsuyoshi T, Iizuka Y, Mizowaki T. Investigation of 4D dose in volumetric modulated arc therapy-based stereotactic body radiation therapy: does fractional dose or number of arcs matter? JOURNAL OF RADIATION RESEARCH 2020; 61:325-334. [PMID: 32030408 PMCID: PMC7246072 DOI: 10.1093/jrr/rrz103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/05/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
The aim of this study was to assess the impact of fractional dose and the number of arcs on interplay effects when volumetric modulated arc therapy (VMAT) is used to treat lung tumors with large respiratory motions. A three (fractional dose of 4, 7.5 or 12.5 Gy) by two (number of arcs, one or two) VMAT plan was created for 10 lung cancer cases. The median 3D tumor motion was 17.9 mm (range: 8.2-27.2 mm). Ten phase-specific subplans were generated by calculating the dose on each respiratory phase computed tomography (CT) scan using temporally assigned VMAT arcs. We performed temporal assignment of VMAT arcs using respiratory information obtained from infrared markers placed on the abdomens of the patients during CT simulations. Each phase-specific dose distribution was deformed onto exhale phase CT scans using contour-based deformable image registration, and a 4D plan was created by dose accumulation. The gross tumor volume dose of each 4D plan (4D GTV dose) was compared with the internal target volume dose of the original plan (3D ITV dose). The near-minimum 4D GTV dose (D99%) was higher than the near-minimum 3D internal target volume (ITV) dose, whereas the near-maximum 4D GTV dose (D1%) was lower than the near-maximum 3D ITV dose. However, the difference was negligible, and thus the 4D GTV dose corresponded well with the 3D ITV dose, regardless of the fractional dose and number of arcs. Therefore, interplay effects were negligible in VMAT-based stereotactic body radiation therapy for lung tumors with large respiratory motions.
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Affiliation(s)
- Takashi Shintani
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuki Miyabe
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takamasa Mitsuyoshi
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Iizuka
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Radiation-induced lung toxicity predictors: Retrospective analysis of 90 patients treated with stereotactic body radiation therapy for stage I non-small-cell lung carcinoma. Cancer Radiother 2020; 24:120-127. [PMID: 32173269 DOI: 10.1016/j.canrad.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The main complication after hypofractionated radiotherapy for lung carcinoma is radiation-induced lung toxicity, which can be divided into radiation pneumonitis (acute toxicity, occurring within 6 months) and lung fibrosis (late toxicity, occurring after 6 months). The literature describes several predictive factors related to the patient, to the tumor (volume, central location), to the dosimetry and to biological factors. MATERIALS AND METHODS This study is a retrospective analysis of 90 patients treated with stereotactic body irradiation for stage I non-small-cell lung carcinoma between December 2010 and May 2015. RESULTS Radiation pneumonitis was observed in 61.5% of the patients who were mainly asymptomatic (34%). Chronic obstructive pulmonary disease was not predictive of radiation pneumonitis, whereas active smoking was protective. Centrally located tumors were not more likely to result in this complication if the radiation schedule utilized adapted fractionation. In our study, no predictive factor was identified. Whereas the mean lung dose was a predictive factor in 3D radiotherapy, the lung volume irradiated at high doses seemed to be involved in the pathogenesis after hypofractionated radiotherapy. CONCLUSION The discovery of predictive factors for radiation pneumonitis is difficult due to the rarity of this complication, especially with an 8×7.5Gy schedule. Radiation pneumonitis seems to be correlated with the volume irradiated at high doses, which is in contrast to the known knowledge about the organs in parallel. This finding leads us to raise the hypothesis that vessel damage, organs in series, occurring during hypofractionated radiotherapy could be responsible for this toxicity.
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Ryckman JM, Baine M, Carmicheal J, Osayande F, Sleightholm R, Samson K, Zheng D, Zhen W, Lin C, Zhang C. Correlation of dosimetric factors with the development of symptomatic radiation pneumonitis in stereotactic body radiotherapy. Radiat Oncol 2020; 15:33. [PMID: 32054487 PMCID: PMC7020355 DOI: 10.1186/s13014-020-1479-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/27/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The development of radiation pneumonitis (RP) after Stereotactic Body Radiotherapy (SBRT) is known to be associated with many different factors, although historical analyses of RP have commonly utilized heterogeneous fractionation schemes and methods of reporting. This study aims to correlate dosimetric values and their association with the development of Symptomatic RP according to recent reporting standards as recommended by the American Association of Physicists in Medicine. METHODS We performed a single-institution retrospective review for patients who received SBRT to the lung from 2010 to 2017. Inclusion criteria required near-homogeneous tumoricidal (α/β = 10 Gy) biological effective dose (BED10) of 100-105 Gy (e.g., 50/5, 48/4, 60/8), one or two synchronously treated lesions, and at least 6 months of follow up or documented evidence of pneumonitis. Symptomatic RP was determined clinically by treating radiation oncologists, requiring radiographic evidence and the administration of steroids. Dosimetric parameters and patient factors were recorded. Lung volumes subtracted gross tumor volume(s). Wilcoxon Rank Sums tests were used for nonparametric comparison of dosimetric data between patients with and without RP; p-values were Bonferroni adjusted when applicable. Logistic regressions were conducted to predict probabilities of symptomatic RP using univariable models for each radiation dosimetric parameter. RESULTS The final cohort included 103 treated lesions in 93 patients, eight of whom developed symptomatic RP (n = 8; 8.6%). The use of total mean lung dose (MLD) > 6 Gy alone captured five of the eight patients who developed symptomatic RP, while V20 > 10% captured two patients, both of whom demonstrated a MLD > 6 Gy. The remaining three patients who developed symptomatic RP without exceeding either metric were noted to have imaging evidence of moderate interstitial lung disease, inflammation of the lungs from recent concurrent chemoradiation therapy to the contralateral lung, or unique peri-tumoral inflammatory appearance at baseline before treatment. CONCLUSIONS This study is the largest dosimetric analysis of symptomatic RP in the literature, of which we are aware, that utilizes near-homogenous tumoricidal BED fractionation schemes. Mean lung dose and V20 are the most consistently reported of the various dosimetric parameters associated with symptomatic RP. MLD should be considered alongside V20 in the treatment planning process. TRIAL REGISTRATION Retrospectively registered on IRB 398-17-EP.
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Affiliation(s)
- Jeffrey M Ryckman
- Department of Radiation Oncology, University of Nebraska Medical Center, 505 S 45th Street, Omaha, NE, 68106, USA.
| | - Michael Baine
- Department of Radiation Oncology, University of Nebraska Medical Center, 505 S 45th Street, Omaha, NE, 68106, USA
| | - Joseph Carmicheal
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ferdinand Osayande
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, 505 S 45th Street, Omaha, NE, 68106, USA
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, 505 S 45th Street, Omaha, NE, 68106, USA
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, 505 S 45th Street, Omaha, NE, 68106, USA
| | - Chi Zhang
- Department of Radiation Oncology, University of Nebraska Medical Center, 505 S 45th Street, Omaha, NE, 68106, USA
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