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Importance of training in external beam treatment planning for locally advanced cervix cancer: Report from the EMBRACE II dummy run. Radiother Oncol 2019; 133:149-155. [DOI: 10.1016/j.radonc.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022]
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Abrunhosa-Branquinho AN, Bar-Deroma R, Collette S, Clementel E, Liu Y, Hurkmans CW, Feuvret L, Van Beek K, van den Bent M, Baumert BG, Weber DC. Radiotherapy quality assurance for the RTOG 0834/EORTC 26053-22054/NCIC CTG CEC.1/CATNON intergroup trial "concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic glioma": Individual case review analysis. Radiother Oncol 2018; 127:292-298. [PMID: 29606522 PMCID: PMC6258055 DOI: 10.1016/j.radonc.2018.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The EORTC phase III 26053-22054/ RTOG 0834/NCIC CTG CEC.1/CATNON intergroup trial was designed to evaluate the impact on concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic gliomas. The primary endpoint was overall survival. We report the results of retrospective individual case reviews (ICRs) for the first patient randomized per institution to detect the compliance with the study protocol. MATERIAL AND METHODS Sixty-nine institutions were required to submit the radiotherapy plan of their first randomized patient. Full digital datasets uploaded to the EORTC server were assessed by three independent and blinded reviewers through the EORTC radiotherapy quality assurance platform. RESULTS Sixty-two (90%) of sixty-nine ICRs were received and assessable. Of the 62 cases, 22 were evaluated as per protocol (35.5%), 11 as acceptable variation (17.7%) and 29 were classified as unacceptable variations (46.8%). Most common unacceptable variations were related to the PTV dose (n = 19, 31%) and delineation (n = 17, 27%) processes. CONCLUSIONS The ICR analysis showed a significant number of unacceptable variations with potential impact on tumor control and/or toxicity profile. Prospective ICRs are encouraged for future studies to prevent and correct protocol violations before start of treatment.
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Affiliation(s)
- André N Abrunhosa-Branquinho
- EORTC HQ, Brussels, Belgium; Radiotherapy Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, EPE, Portugal.
| | | | | | | | | | - Coen W Hurkmans
- ROG RTQA Strategic Committee, EORTC, Brussels, Belgium; Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Loïc Feuvret
- Service de Radiothérapie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Karen Van Beek
- Department of Radiation Oncology, University Hospital Leuven, Belgium
| | | | - Brigitta G Baumert
- Maastricht University Medical Centre and GROW (School for Oncology and Developmental Biology), Maastricht, Netherlands; Dept. of Radiation Oncology, Paracelsus Clinic, Osnabrück & Dept. of Radiation Oncology, University of Müenster, Germany
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; University Hospital of Zürich, Switzerland
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Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 2016; 17:1521-1532. [PMID: 27686946 PMCID: PMC5124485 DOI: 10.1016/s1470-2045(16)30313-8] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Outcome of low-grade glioma (WHO grade II) is highly variable, reflecting molecular heterogeneity of the disease. We compared two different, single-modality treatment strategies of standard radiotherapy versus primary temozolomide chemotherapy in patients with low-grade glioma, and assessed progression-free survival outcomes and identified predictive molecular factors. METHODS For this randomised, open-label, phase 3 intergroup study (EORTC 22033-26033), undertaken in 78 clinical centres in 19 countries, we included patients aged 18 years or older who had a low-grade (WHO grade II) glioma (astrocytoma, oligoastrocytoma, or oligodendroglioma) with at least one high-risk feature (aged >40 years, progressive disease, tumour size >5 cm, tumour crossing the midline, or neurological symptoms), and without known HIV infection, chronic hepatitis B or C virus infection, or any condition that could interfere with oral drug administration. Eligible patients were randomly assigned (1:1) to receive either conformal radiotherapy (up to 50·4 Gy; 28 doses of 1·8 Gy once daily, 5 days per week for up to 6·5 weeks) or dose-dense oral temozolomide (75 mg/m2 once daily for 21 days, repeated every 28 days [one cycle], for a maximum of 12 cycles). Random treatment allocation was done online by a minimisation technique with prospective stratification by institution, 1p deletion (absent vs present vs undetermined), contrast enhancement (yes vs no), age (<40 vs ≥40 years), and WHO performance status (0 vs ≥1). Patients, treating physicians, and researchers were aware of the assigned intervention. A planned analysis was done after 216 progression events occurred. Our primary clinical endpoint was progression-free survival, analysed by intention-to-treat; secondary outcomes were overall survival, adverse events, neurocognitive function (will be reported separately), health-related quality of life and neurological function (reported separately), and correlative analyses of progression-free survival by molecular markers (1p/19q co-deletion, MGMT promoter methylation status, and IDH1/IDH2 mutations). This trial is closed to accrual but continuing for follow-up, and is registered at the European Trials Registry, EudraCT 2004-002714-11, and at ClinicalTrials.gov, NCT00182819. FINDINGS Between Sept 23, 2005, and March 26, 2010, 707 patients were registered for the study. Between Dec 6, 2005, and Dec 21, 2012, we randomly assigned 477 patients to receive either radiotherapy (n=240) or temozolomide chemotherapy (n=237). At a median follow-up of 48 months (IQR 31-56), median progression-free survival was 39 months (95% CI 35-44) in the temozolomide group and 46 months (40-56) in the radiotherapy group (unadjusted hazard ratio [HR] 1·16, 95% CI 0·9-1·5, p=0·22). Median overall survival has not been reached. Exploratory analyses in 318 molecularly-defined patients confirmed the significantly different prognosis for progression-free survival in the three recently defined molecular low-grade glioma subgroups (IDHmt, with or without 1p/19q co-deletion [IDHmt/codel], or IDH wild type [IDHwt]; p=0·013). Patients with IDHmt/non-codel tumours treated with radiotherapy had a longer progression-free survival than those treated with temozolomide (HR 1·86 [95% CI 1·21-2·87], log-rank p=0·0043), whereas there were no significant treatment-dependent differences in progression-free survival for patients with IDHmt/codel and IDHwt tumours. Grade 3-4 haematological adverse events occurred in 32 (14%) of 236 patients treated with temozolomide and in one (<1%) of 228 patients treated with radiotherapy, and grade 3-4 infections occurred in eight (3%) of 236 patients treated with temozolomide and in two (1%) of 228 patients treated with radiotherapy. Moderate to severe fatigue was recorded in eight (3%) patients in the radiotherapy group (grade 2) and 16 (7%) in the temozolomide group. 119 (25%) of all 477 patients had died at database lock. Four patients died due to treatment-related causes: two in the temozolomide group and two in the radiotherapy group. INTERPRETATION Overall, there was no significant difference in progression-free survival in patients with low-grade glioma when treated with either radiotherapy alone or temozolomide chemotherapy alone. Further data maturation is needed for overall survival analyses and evaluation of the full predictive effects of different molecular subtypes for future individualised treatment choices. FUNDING Merck Sharpe & Dohme-Merck & Co, Canadian Cancer Society, Swiss Cancer League, UK National Institutes of Health, Australian National Health and Medical Research Council, US National Cancer Institute, European Organisation for Research and Treatment of Cancer Cancer Research Fund.
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Yang Z, Zhang Z, Wang X, Hu Y, Lyu Z, Huo L, Wei R, Fu J, Hong J. Intensity-modulated radiotherapy for gliomas:dosimetric effects of changes in gross tumor volume on organs at risk and healthy brain tissue. Onco Targets Ther 2016; 9:3545-54. [PMID: 27366091 PMCID: PMC4914054 DOI: 10.2147/ott.s100455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim The aim of this study was to explore the effects of changes in the gross tumor volume (GTV) on dose distribution in organs at risk (OARs) and healthy brain tissue in patients with gliomas. Methods Eleven patients suffering from gliomas with intensity-modulated radiotherapy (IMRT) plans treated with a simultaneous integrated boost technique planned before therapy (initial plans) were prospectively enrolled. At the end of radiotherapy, patients underwent repeat computed tomography and magnetic resonance imaging, and IMRT was replanned. The GTV and dosimetric parameters between the initial and replanned IMRT were compared using the Wilcoxon two-related-sample test, and correlations between the initial GTV and the replanned target volumes were assessed using the bivariate correlation test. Results The volume of the residual tumor did not change significantly (P>0.05), the volume of the surgical cavity decreased significantly (P<0.05), and the GTV and target volumes decreased significantly at the end of IMRT (all P<0.05). The near-maximum dose to OARs and volumes of healthy brain tissue receiving total doses of 10–50 Gy were lower in the replanned IMRT than in the initial IMRT (all P<0.05). The GTV in the initial plan was significantly positively correlated with the changes in the GTV and planning target volume 1 that occurred during IMRT (all P<0.05). Conclusion The reduction in the GTV in patients with gliomas resulted from shrinkage of the surgical cavity during IMRT, leading to decreased doses to the OARs and healthy brain tissue. Such changes appeared to be most meaningful in patients with large initial GTV values.
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Affiliation(s)
- Zhen Yang
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Zijian Zhang
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Xia Wang
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Yongmei Hu
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Zhiping Lyu
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Lei Huo
- Department of Neurosurgery, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Rui Wei
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Jun Fu
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
| | - Jidong Hong
- Department of Oncology, The Institute of Skull Base Surgery and Neurooncology at Hunan, Central South University, Xiangya Hospital, Changsha, Hunan, People's Republic of China
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Hansen CR, Johansen J, Kristensen CA, Smulders B, Andersen LJ, Samsøe E, Andersen E, Petersen JBB, Overgaard J, Grau C. Quality assurance of radiation therapy for head and neck cancer patients treated in DAHANCA 10 randomized trial. Acta Oncol 2015. [PMID: 26206516 DOI: 10.3109/0284186x.2015.1063780] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Jørgen Johansen
- b Department of Oncology , Odense University Hospital , Denmark
| | - Claus A Kristensen
- c Department of Oncology , Finsen Centre, Copenhagen University Hospital , Denmark
| | - Bob Smulders
- c Department of Oncology , Finsen Centre, Copenhagen University Hospital , Denmark
| | | | - Eva Samsøe
- e Department of Oncology , Division of Radiophysics, University Hospital Herlev , Denmark
| | - Elo Andersen
- f Department of Oncology , University Hospital Herlev , Denmark
| | | | - Jens Overgaard
- h Department of Experimental Clinical Oncology , Aarhus University Hospital , Denmark
| | - Cai Grau
- i Department of Oncology , Aarhus University Hospital , Denmark
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Tran AN, Lai A, Li S, Pope WB, Teixeira S, Harris RJ, Woodworth DC, Nghiemphu PL, Cloughesy TF, Ellingson BM. Increased sensitivity to radiochemotherapy in IDH1 mutant glioblastoma as demonstrated by serial quantitative MR volumetry. Neuro Oncol 2013; 16:414-20. [PMID: 24305712 DOI: 10.1093/neuonc/not198] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Isocitrate dehydrogenase 1 (IDH1) mutations have been linked to favorable outcomes in patients with glioblastoma multiforme (GBM). Recent in vitro experiments suggest that IDH1 mutation sensitizes tumors to radiation damage. We hypothesized that radiographic treatment response would be significantly different between IDH1 mutant versus wild-type GBMs after radiotherapy (RT) and concurrent temozolomide (TMZ). METHODS A total of 39 newly diagnosed GBM patients with known IDH1 mutational status (10 IDH1 mutants), who followed standard therapy and had regular post-contrast T1W (T1+C) and T2W/ fluid-attenuated inversion recovery (FLAIR) images in the 6-month period after starting RT, were enrolled. The volume of contrast-enhancing and FLAIR hyperintensity were calculated from each scan. Linear and polynomial regression techniques were used to estimate the rate of change and temporal patterns in tumor volumes. RESULTS IDH1 mutant GBMs demonstrated a favorable response to RT/TMZ in the study period, as demonstrated by 10 of 10 mutants showing radiographic response (decreasing V(T1+C)), compared with 13 of 29 wild-types (P < .001). During the study period, V(T1+C) and V(FLAIR) changed at -3.6% per week and +0.6% per week in IDH1 mutant tumors, respectively, as compared with +0.8% per week and +5.2% per week in IDH1 wild-type tumors (P = .0076 and P = .0118, respectively). Amongst the radiographic responders, IDH1 mutant GBMs still demonstrated significant progression-free and overall survival benefit. Aggregated tumor kinetics by group showed significant lower rate in IDH1 mutant GBMs in specific periods: >105 days for V(FLAIR) and 95-120 and >150 days for V(T1+C) from starting RT/TMZ. CONCLUSIONS The current study supports the hypothesis that IDH1 mutant GBMs are more sensitive to radiochemotherapy than IDH1 wild-type GBMs.
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Affiliation(s)
- Anh N Tran
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore (A.N.T.); Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (A.T., W.B.P., S.T., R.J.H., D.C.W., P.L.N., B.M.E.); Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (A.N.T., A.L., S.L., P.L.N., T.F.C.); Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (R.J.H., D.C.W., B.M.E.); Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
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Forde E, Kneebone A, Bromley R, Guo L, Hunt P, Eade T. Volumetric-modulated arc therapy in postprostatectomy radiotherapy patients: A planning comparison study. Med Dosim 2013; 38:262-7. [DOI: 10.1016/j.meddos.2013.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 01/09/2013] [Accepted: 02/19/2013] [Indexed: 11/27/2022]
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Gwynne S, Spezi E, Sebag-Montefiore D, Mukherjee S, Miles E, Conibear J, Staffurth J. Improving radiotherapy quality assurance in clinical trials: assessment of target volume delineation of the pre-accrual benchmark case. Br J Radiol 2013; 86:20120398. [PMID: 23392188 PMCID: PMC3635785 DOI: 10.1259/bjr.20120398] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/31/2012] [Accepted: 01/07/2013] [Indexed: 11/05/2022] Open
Abstract
As the complexity of radiotherapy (RT) trials increases, issues surrounding target volume delineation will become more important. Some form of outlining assessment prior to trial entry is increasingly being mandated in UK RT trials. This document produced by the Outlining and Imaging Subgroup (OISG) of the National Cancer Research Institute will address methods to reduce interobserver variation in clinical trials and how to conduct an assessment of outlining through a pre-accrual benchmark case. We review currently available methods of describing the variation and identify areas where further work is needed. The OISG would encourage ongoing discussion with chief investigators in order to provide advice on individual aspects of benchmark case assessment for current and future trials.
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Affiliation(s)
- S Gwynne
- Department of Clinical Oncology, Singleton Hospital, Swansea, UK.
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Coskun M, Straube W, Hurkmans CW, Melidis C, de Haan PF, Villà S, Collette S, Weber DC. Quality assurance of radiotherapy in the ongoing EORTC 22042-26042 trial for atypical and malignant meningioma: results from the dummy runs and prospective individual case Reviews. Radiat Oncol 2013; 8:23. [PMID: 23363568 PMCID: PMC3564920 DOI: 10.1186/1748-717x-8-23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ongoing EORTC 22042-26042 trial evaluates the efficacy of high-dose radiotherapy (RT) in atypical/malignant meningioma. The results of the Dummy Run (DR) and prospective Individual Case Review (ICR) were analyzed in this Quality Assurance (QA) study. MATERIAL/METHODS Institutions were requested to submit a protocol compliant treatment plan for the DR and ICR, respectively. DR-plans (n=12) and ICR-plans (n=50) were uploaded to the Image-Guided Therapy QA Center of Advanced Technology Consortium server (http://atc.wustl.edu/) and were assessed prospectively. RESULTS Major deviations were observed in 25% (n=3) of DR-plans while no minor deviations were observed. Major and minor deviations were observed in 22% (n=11) and 10% (n=5) of the ICR-plans, respectively. Eighteen% of ICRs could not be analyzed prospectively, as a result of corrupted or late data submission. CTV to PTV margins were respected in all cases. Deviations were negatively associated with the number of submitted cases per institution (p=0.0013), with a cutoff of 5 patients per institutions. No association (p=0.12) was observed between DR and ICR results, suggesting that DR's results did not predict for an improved QA process in accrued brain tumor patients. CONCLUSIONS A substantial number of protocol deviations were observed in this prospective QA study. The number of cases accrued per institution was a significant determinant for protocol deviation. These data suggest that successful DR is not a guarantee for protocol compliance for accrued patients. Prospective ICRs should be performed to prevent protocol deviations.
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Affiliation(s)
- Mehtap Coskun
- Department of Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey
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Fairchild A, Collette L, Hurkmans C, Baumert B, Weber D, Gulyban A, Poortmans P. Do results of the EORTC dummy run predict quality of radiotherapy delivered within multicentre clinical trials? Eur J Cancer 2012; 48:3232-9. [DOI: 10.1016/j.ejca.2012.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 04/26/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
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Li S, Chou AP, Chen W, Chen R, Deng Y, Phillips HS, Selfridge J, Zurayk M, Lou JJ, Everson RG, Wu KC, Faull KF, Cloughesy T, Liau LM, Lai A. Overexpression of isocitrate dehydrogenase mutant proteins renders glioma cells more sensitive to radiation. Neuro Oncol 2012; 15:57-68. [PMID: 23115158 DOI: 10.1093/neuonc/nos261] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mutations in isocitrate dehydrogenase 1 (IDH1) or 2 (IDH2) are found in a subset of gliomas. Among the many phenotypic differences between mutant and wild-type IDH1/2 gliomas, the most salient is that IDH1/2 mutant glioma patients demonstrate markedly improved survival compared with IDH1/2 wild-type glioma patients. To address the mechanism underlying the superior clinical outcome of IDH1/2 mutant glioma patients, we investigated whether overexpression of the IDH1(R132H) protein could affect response to therapy in the context of an isogenic glioma cell background. Stable clonal U87MG and U373MG cell lines overexpressing IDH1(WT) and IDH1(R132H) were generated, as well as U87MG cell lines overexpressing IDH2(WT) and IDH2(R172K). In vitro experiments were conducted to characterize baseline growth and migration and response to radiation and temozolomide. In addition, reactive oxygen species (ROS) levels were measured under various conditions. U87MG-IDH1(R132H) cells, U373MG-IDH1(R132H) cells, and U87MG-IDH2(R172K) cells demonstrated increased sensitivity to radiation but not to temozolomide. Radiosensitization of U87MG-IDH1(R132H) cells was accompanied by increased apoptosis and accentuated ROS generation, and this effect was abrogated by the presence of the ROS scavenger N-acetyl-cysteine. Interestingly, U87MG-IDH1(R132H) cells also displayed decreased growth at higher cell density and in soft agar, as well as decreased migration. Overexpression of IDH1(R132H) and IDH2(R172K) mutant protein in glioblastoma cells resulted in increased radiation sensitivity and altered ROS metabolism and suppression of growth and migration in vitro. These findings provide insight into possible mechanisms contributing to the improved outcomes observed in patients with IDH1/2 mutant gliomas.
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Affiliation(s)
- Sichen Li
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California 90095, USA
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Batumalai V, Jameson MG, Forstner DF, Vial P, Holloway LC. How important is dosimetrist experience for intensity modulated radiation therapy? A comparative analysis of a head and neck case. Pract Radiat Oncol 2012; 3:e99-e106. [PMID: 24674377 DOI: 10.1016/j.prro.2012.06.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/04/2012] [Accepted: 06/22/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Treatment planning for IMRT is a complex process that requires additional training and expertise. The aim of this study was to compare and analyze IMRT plans generated by dosimetrists with varying levels of IMRT planning experience. METHODS AND MATERIALS The computed tomography (CT) data of a patient previously treated with IMRT for left tonsillar carcinoma were used. The patient's preexisting planning target volumes (PTVs) and all organs at risk were provided with the CT data set. Six dosimetrists with variable IMRT planning experience generated IMRT plans according to the department's protocol. Plan analysis included visual inspection and comparison of dose-volume histogram, conformity indices, treatment delivery efficiency, and dose delivery accuracy. RESULTS Visual review of the dose distribution showed that the 6 plans were comparable. However, only the 2 most experienced dosimetrists were able to meet the strict PTV aims and critical structure constraints. The least experienced dosimetrist had the worst planning outcome. Comparison of delivery efficiency showed that the number of segments, total monitor units, and treatment time increased as the IMRT planning experience decreased. CONCLUSIONS Dosimetrists with higher levels of IMRT planning experience produced a better quality head and neck IMRT plan. Different planning experience may need to be considered when organizing appropriate departmental resources.
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Affiliation(s)
- Vikneswary Batumalai
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; University of New South Wales, NSW, Australia.
| | - Michael G Jameson
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Dion F Forstner
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Collaboration of Cancer Outcome Research and Evaluation (CCORE), Liverpool Hospital, Sydney, Australia
| | - Philip Vial
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Institute of Medical Physics, School of Medical Physics, University of Sydney, Sydney, Australia
| | - Lois C Holloway
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; University of New South Wales, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia; Institute of Medical Physics, School of Medical Physics, University of Sydney, Sydney, Australia
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Quality assurance in the EORTC 22033–26033/CE5 phase III randomized trial for low grade glioma: The digital individual case review. Radiother Oncol 2012; 103:287-92. [DOI: 10.1016/j.radonc.2012.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/20/2012] [Accepted: 04/03/2012] [Indexed: 11/17/2022]
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EORTC Radiation Oncology Group quality assurance platform: establishment of a digital central review facility. Radiother Oncol 2012; 103:279-86. [PMID: 22633815 DOI: 10.1016/j.radonc.2012.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 04/10/2012] [Accepted: 04/24/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Quality assurance (QA) in clinical trials is essential to ensure treatment is safely and effectively delivered. As QA requirements have increased in complexity in parallel with evolution of radiation therapy (RT) delivery, a need to facilitate digital data exchange emerged. Our objective is to present the platform developed for the integration and standardization of QART activities across all EORTC trials involving RT. METHODS The following essential requirements were identified: secure and easy access without on-site software installation; integration within the existing EORTC clinical remote data capture system; and the ability to both customize the platform to specific studies and adapt to future needs. After retrospective testing within several clinical trials, the platform was introduced in phases to participating sites and QART study reviewers. RESULTS The resulting QA platform, integrating RT analysis software installed at EORTC Headquarters, permits timely, secure, and fully digital central DICOM-RT based data review. Participating sites submit data through a standard secure upload webpage. Supplemental information is submitted in parallel through web-based forms. An internal quality check by the QART office verifies data consistency, formatting, and anonymization. QART reviewers have remote access through a terminal server. Reviewers evaluate submissions for protocol compliance through an online evaluation matrix. Comments are collected by the coordinating centre and institutions are informed of the results. CONCLUSIONS This web-based central review platform facilitates rapid, extensive, and prospective QART review. This reduces the risk that trial outcomes are compromised through inadequate radiotherapy and facilitates correlation of results with clinical outcomes.
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Thwaites DI, Malicki J. Physics and technology in ESTRO and in Radiotherapy and Oncology: past, present and into the 4th dimension. Radiother Oncol 2011; 100:327-32. [PMID: 21962819 DOI: 10.1016/j.radonc.2011.09.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 12/11/2022]
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Ohtakara K, Hayashi S, Hoshi H. The relation between various conformity indices and the influence of the target coverage difference in prescription isodose surface on these values in intracranial stereotactic radiosurgery. Br J Radiol 2011; 85:e223-8. [PMID: 21937612 DOI: 10.1259/bjr/36606138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe the relation between various frequently used conformity indices (CIs) and to examine the influence of the target coverage (TC) difference in prescription isodose surface (IDS) on these CI values in dynamic conformal arc (DCA) plans. METHOD 73 plans for simple-shaped brain metastases that were previously characterised for dose distribution with regard to the effect of the target volume (TV) and the depth from the skin surface were reviewed. Three different-definition CI values for each TV were calculated at the 80% IDS, and at D99, D95, D90 and D85, considering the interplanner variability in the TC values for the prescription IDS. RESULTS The CI used as the Radiation Therapy Oncology Group criterion showed nearly perfect values at D90. The CI defined in the BrainSCAN (BrainLAB AG, Feldkirchen, Germany) treatment planning system (CI(BS)) denoted lower (superior) values as the TC of the reference IDS decreased. Nakamura's CI (NCI) had lower variability but demonstrated lower (superior) values at D95. NCI showed the most stringent (higher) values at an 80% IDS, but the differences between the plans were less distinct with NCI. CONCLUSION The TC difference in IDS chosen for dose prescription or evaluation significantly led to CI value variability in a definition-dependent manner, even when NCI was applied. Definition of the reference IDS at a specific TC value according to clinical situation would reduce the CI value variability to a minimum and would make the CI(BS) sufficient for the objective metric with a perfect value of 1.
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Affiliation(s)
- K Ohtakara
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
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