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Makita K, Hamamoto Y, Kanzaki H, Nagasaki K. The potential overdose of heart and left anterior descending coronary artery region during intensity-modulated radiation therapy in patients with esophageal cancer. JOURNAL OF RADIATION RESEARCH 2024; 65:238-243. [PMID: 38151920 PMCID: PMC10959431 DOI: 10.1093/jrr/rrad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/14/2023] [Indexed: 12/29/2023]
Abstract
This study aimed to investigate the changes in dose distribution in the heart and left anterior descending coronary artery region (LADR) during intensity-modulated radiation therapy (IMRT) in patients with esophageal cancer (EC) treated at our institution. The heart and LADR were delineated on the initial and off-cord boost planning computed tomography (CT) images. Cardiac volume reduction (CVR) was defined as the reduction in cardiac volume between the initial CT and off-cord boost CT at the dose of 36 Gy irradiated. The involved field IMRT plan was created based on each initial and off-cord boost CT image and was analyzed based on the relationship between CVR and heart and LADR dose-volume parameters (Heart-Dmax, Heart-Dmean, Heart-V20, Heart-V30, Heart-V40, LADR-Dmax, LADR-Dmean, LADR-V15 and LADR-V30). Forty patients with EC were investigated between January 2016 and January 2022. The median CVR ratio during radiation therapy (RT) was 5.57% (range, -7.79 to 18.26%). Simple linear regression analysis revealed significant correlations between CVR during RT and changes in the heart and LADR dose-volume parameters. Some patients (>10%) experienced severe changes in the heart and LADR dose distribution. In three cases with reduced heart volume and primary tumor mass, the changes in LADR-V15 and LADR-V30 showed outliers. In conclusion, CVR during RT correlated with an increase in the heart and LADR dose. When both CVR and tumor volume reduction are large, a potential overdose of LADR during RT should be noted in the IMRT era.
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Affiliation(s)
- Kenji Makita
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime 791-0280, Japan
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime 791-0280, Japan
| | - Hiromitsu Kanzaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime 791-0280, Japan
| | - Kei Nagasaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime 791-0280, Japan
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Makita K, Hamamoto Y, Kanzaki H, Makita A, Nagasaki K. Cardiac volume reduction during radiotherapy in patients with esophageal carcinoma. Mol Clin Oncol 2024; 20:19. [PMID: 38332993 PMCID: PMC10851180 DOI: 10.3892/mco.2024.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
The present study investigated the factors contributing to cardiac volume reduction (CVR) during radiotherapy (RT) in patients with esophageal carcinoma (EC). This retrospective study included patients with EC treated at National Hospital Organization Shikoku Cancer Center (Matsuyama, Japan). Cardiac delineation was based on initial and off-cord boost (spinal cord-sparing approach) planning computed tomography images. The relationship between CVR and other relevant parameters was analyzed. A total of 58 patients with EC were investigated between January 2016 and January 2022. Univariate and multiple regression analyses revealed a statistically significant association between CVR during RT and the change ratio of the inferior vena cava (IVC) volume and body mass index (BMI) loss. In multivariate analysis of CVR of >10%, only the change in IVC volume exhibited a significant association. Conversely, CVR during RT displayed no association with heart dose-volume parameters, laboratory data, or changes in blood pressure and pulse rate. Among the 12 cases with CVR of >10%, the median movement of the left anterior descending coronary artery region (LADR) was 1.35 cm (range, 0.0-2.7 cm). In conclusion, CVR during RT was most strongly associated with changes in IVC volume, suggesting dehydration as the primary cause, rather than radiation-induced heart damage. LADR movement due to a CVR of >10% may lead to LADR radiation overdose.
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Affiliation(s)
- Kenji Makita
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
- Department of Radiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime 790-0024, Japan
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Hiromitsu Kanzaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Ayu Makita
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Kei Nagasaki
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
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Protecting the Heart: A Practical Approach to Account for the Full Extent of Heart Motion in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2020; 108:1082-1090. [PMID: 32629080 DOI: 10.1016/j.ijrobp.2020.06.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/04/2020] [Accepted: 06/26/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Emerging evidence suggests that the heart is more radiosensitive than previously assumed; therefore, accounting for heart motion in radiation therapy planning is becoming more critical. In this study, we determined how much heart delineations based on 3-dimensional (3D) computed tomography (CT), 4-dimensional (4D) average projection (AVG), and maximum intensity projection (MIP) images should be extended to represent the full extent of heart motion during 4D imaging acquisition. METHODS AND MATERIALS The 3D and 4D CT scans of 10 lung cancer patients treated with stereotactic ablative radiation therapy were used. Median surfaces were derived from heart delineations of 3 observers on the 3D CT, AVG, MIP, and 25% exhale scans. Per patient, the 25% exhale contour was propagated on every phase of the 4D scan. The union of all 4D phase delineations (U4D) represented the full extent of heart motion during imaging acquisition. Surface distances from U4D to 3D, AVG, and MIP volumes were calculated. Distances in the most extreme surface points (1.5 cm most superoinferior, 10% most right/left/anteroposterior) were used to derive margins accounting only for systematic (delineation) errors. RESULTS Heart delineations on the MIP were the closest to the full extent of motion, requiring only ≤2.5-mm margins. Delineations on the AVG and 3D scans required margins up to 3.4 and 7.1 mm, respectively. The largest margins were for the inferior, right, and anterior aspects for the delineations on the 3D, AVG, and MIP scans, respectively. CONCLUSION Delineations on 3D, AVG, or MIP scans required extensions for representing the heart's full extent of motion, with the MIP requiring the smallest margins. Research including daily imaging to determine the random components for the margins and dosimetric measurements to determine the relevance of creating a planning organ at risk volume of the heart is required.
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Ren J, Gong G, Yao X, Yin Y. Dosimetric comparison of dose accumulation between rigid registration and deformation registration in intensity-modulated radiation therapy for large volume non-small cell lung cancer. Transl Cancer Res 2019; 8:2878-2885. [PMID: 35117045 PMCID: PMC8798251 DOI: 10.21037/tcr.2019.11.15] [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: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022]
Abstract
Background To evaluate the cumulative dose to the target volumes and organs at risk (OARs) after replanning during intensity-modulated radiation therapy (IMRT) for large volume non-small cell lung cancer (NSCLC) based on rigid registration and deformation registration technologies. Methods Thirty patients with large volume NSCLC who were treated with IMRT were selected, and two four-dimensional computed tomography (4DCT) scans were acquired before radiotherapy and after 20 fractions of radiotherapy. The initial treatment plan (Plan1) based on the average density projection CT (CT1-avg) of the first 4DCT images and the second treatment plan (Plan2) based on CT2-avg of the second 4DCT images were calculated. Then, the dose distributions of Plan2 and Plan1 were accumulated based on rigid and deformation registration technologies to obtain Planrig and Plandef, respectively. Finally, the volume changes of the gross tumor volume (GTV) and OARs between the two CT scans, and the dose-volume parameters among Plan1, Plan2, Planrig and Plandef were compared. Results Compared with those on the first CT, the mean GTV and heart volume on the second CT decreased by 44.2% and 5.5%, respectively, while the mean volumes of the ipsilateral lung, contralateral lung and total lung increased by 5.2%, 6.2% and 5.8%, respectively. The differences in the above volume parameters between the two CT scans were statistically significant (P<0.05). Compared with those in Plan1, the D95, D98 and V100% values of the IGTV (GTV fusion of 10 CT phases) and planning target volume (PTV) in Plan2 did not change significantly (P>0.05), and those of Planrig and Plandef decreased slightly (P<0.05). The dose-volume parameters of the spinal cord, heart, ipsilateral lung and total lung in Plan2, Planrig and Plandef were significantly lower than those in Plan1 (P<0.05). Among these parameters, V30 and the mean dose to the heart in Plan2, Planrig and Plandef decreased by 27.3%, 16.5%, and 15.3% and 15.2%, 6.6%, and 5.6% compared to those in Plan1, respectively; V20 and the mean dose to the total lung in Plan2, Planrig and Plandef decreased by 15.6%, 4.5%, and 3.7% and 15.7%, 6.2%, and 5.1% compared to those in Plan1, respectively. Some dose-volume parameters (including D95 and D98 to the target volume, V40 of the heart, V20 and the mean dose to the ipsilateral lung and the total lung) of Plandef were slightly higher than those in Planrig (P<0.05). The Dice similarity coefficients (DSCs) of the OARs after deformation registration were significantly higher than those after rigid registration (P<0.05). Conclusions The dose-volume parameters of OARs in Plan2 were noticeably different from those in Plan1, so all of these parameters have large deviations in evaluating the actual dose to the OARs. And, the dose-volume parameters obtained by deformation registration can better predict the actual dose than those obtained by rigid registration.
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Affiliation(s)
- Jianxin Ren
- School of Physics and Technology, Wuhan University, Wuhan 430072, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Guanzhong Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Xinsen Yao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
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Wang X, Wang JZ, Li JB, Zhang YJ, Li FX, Wang W, Guo YL, Shao Q, Xu M, Liu XJ, Wang Y. Changes in cardiac volume determined with repeated enhanced 4DCT during chemoradiotherapy for esophageal cancer. Radiat Oncol 2018; 13:181. [PMID: 30227865 PMCID: PMC6145198 DOI: 10.1186/s13014-018-1121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
Background Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. Radiation-induced heart damage receives much attention. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes. Methods Forty-six patients with esophageal cancer underwent enhanced 4DCT and three-dimensional (3D) CT scans before radiotherapy and every 10 fractions during treatment. The heart was contoured on 3DCT images, 4DCT end expiratory (EE) images and 4DCT maximum intensity projection (MIP) images by the same radiation oncologist. Heart volumes and other relative parameters were compared by the SPSS software package, version 19.0. Results Compared with its initial value, heart volume was smaller at the 10th fraction (reduction = 3.27%, 4.45% and 4.52% on 3DCT, EE and MIP images, respectively, p < 0.05) and the 20th fraction (reduction = 6.05%, 5.64% and 4.51% on 3DCT, EE and MIP images, respectively, p < 0.05), but not at the 30th fraction. Systolic and diastolic blood pressures were reduced (by 16.95 ± 16.69 mmHg and 7.14 ± 11.64 mmHg, respectively, both p < 0.05) and the heart rate was elevated by 5.27 ± 6.25 beats/min (p < 0.05) after radiotherapy. None of the potential explanatory variables correlated with heart volume changes. Conclusions Cardiac volume reduced significantly from an early treatment stage and maintained the reduction until the middle stage. The heart volume changes observed on 3DCT and 4DCT were consistent during radiotherapy. The changes in heart volume, blood pressure and heart rate may be valuable indicators of cardiac impairment and target dose changes.
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Affiliation(s)
- Xue Wang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.,Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Jin-Zhi Wang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Jian-Bin Li
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Ying-Jie Zhang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Feng-Xiang Li
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Wei Wang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Yan-Luan Guo
- Department of PET-CT Room, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Qian Shao
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Min Xu
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Xi-Jun Liu
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Yue Wang
- Medical imaging department, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
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Heart volume reduction during radiotherapy involving the thoracic region in children: An unexplained phenomenon. Radiother Oncol 2018; 128:214-220. [PMID: 29703501 DOI: 10.1016/j.radonc.2018.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 03/06/2018] [Accepted: 04/06/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy involving the thoracic region is associated with cardiotoxicity in long-term childhood cancer survivors. We quantified heart volume changes during radiotherapy in children (<18 years) and investigated correlations with patient and treatment related characteristics. MATERIAL AND METHODS Between 2010 and 2016, 34 children received radiotherapy involving the thoracic region. We delineated heart contours and measured heart volumes on 114 CBCTs. Relative volume changes were quantified with respect to the volume on the first CBCT (i.e., 100%). Cardiac radiation dose parameters expressed as 2 Gy/fraction equivalent doses were calculated from DVHs. Chemotherapy was categorized as treatment with anthracyclines, alkylating agents, vinca-alkaloids, and other. RESULTS The overall median heart volume reduction from the first to the last CBCT was 5.5% (interquartile range1.6-9.7%; p < 0.001). Heart volumes decreased significantly between the baseline measurement and the first week (Bonferroni's adjusted p = 0.002); volume changes were not significant during the following weeks. Univariate analysis showed a significant correlation between heart volume reduction and alkylating agents; however, no multivariate analyses could be done to further confirm this. CONCLUSIONS We found a significant heart volume reduction in children during radiotherapy. Elucidation of underlying mechanisms, clinical relevance, and possible long-term consequences of early heart volume reduction require a prospective follow-up study.
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van Nunen A, van der Sangen MJC, van Boxtel M, van Haaren PMA. Cone-Beam CT-based position verification for oesophageal cancer: Evaluation of registration methods and anatomical changes during radiotherapy. Tech Innov Patient Support Radiat Oncol 2017; 3-4:30-36. [PMID: 32095564 PMCID: PMC7033772 DOI: 10.1016/j.tipsro.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 07/28/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate different registration methods, setup margins and number of corrections for CBCT-based position verification for oesophageal cancer and to evaluate anatomical changes during the course of radiotherapy treatment. Methods From 50 patients, 440 CBCT-scans were registered automatically using a soft tissue or bone registration algorithm and compared to the clinical match. Moreover, relevant anatomical changes were monitored. A sub-analysis was performed to evaluate if tumour location influenced setup variations. Margin calculation was performed and the number of setup corrections was estimated. Results were compared to a patient group previously treated with MV-EPID based position verification. Results CBCT-based setup variations were smaller than EPID-based setup variations, resulting in smaller setup margins of 5.9 mm (RL), 7.5 mm (CC) and 4.7 mm (AP) versus 6.0 mm, 7.8 mm and 5.5 mm, respectively. A reduction in average number of setup corrections per patient was found from 0.75 to 0.36. From all automatically registered CBCT-scans, a clipbox around PTV and vertebras combined with soft tissue registration resulted in the smallest setup margins of 5.9 mm (RL), 7.7 mm (CC), 4.8 mm (AP) and smallest average number of corrections of 0.38. For distally located tumours, a setup margin of 7.7 mm (CC) was required compared to 5.6 mm for proximal tumours. Reduction of GTV volume, heart volume and change in diaphragm position were observed in 16, 10 and 15 patients, respectively. Conclusions CBCT-based set-up variations are smaller than EPID-based variations and vary according to tumour location. When using kV-CBCT a large variety of anatomical changes is revealed, which cannot be observed with MV-EPID.
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Key Words
- AC, Adenocarcinoma
- Anatomical changes
- CBCT, Cone Beam Computed Tomography
- CTV, Clinical Target Volume
- Cone-Beam CT
- EPID, Electronic Portal Imaging Device
- EUS, Endoscopic UltraSound
- GTV, Gross Tumor Volume
- IGRT, Image Guided RadioTherapy
- IMRT, Intensity Modulated Radiotherapy
- OAR, Organs at Risk
- Oesophageal cancer
- PET/CT, Positron Emission Tomography/Computed Tomography
- PTV, Planning Target Volume
- SAL, Shrinking Action Level
- SCC, Squamous Cell Carcinoma
- Setup margins
- Setup variations
- TPS, Treatment Planning System
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Affiliation(s)
- A van Nunen
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | | | - M van Boxtel
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | - P M A van Haaren
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
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van Haaren P, Claassen-Janssen F, van de Sande I, Boersma L, van der Sangen M, Hurkmans C. Heart position variability during voluntary moderate deep inspiration breath-hold radiotherapy for breast cancer determined by repeat CBCT scans. Phys Med 2017; 40:88-94. [DOI: 10.1016/j.ejmp.2017.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/21/2017] [Accepted: 07/13/2017] [Indexed: 12/25/2022] Open
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Huijskens SC, van Dijk IW, de Jong R, Visser J, Fajardo RD, Ronckers CM, Janssens GO, Maduro JH, Rasch CR, Alderliesten T, Bel A. Quantification of renal and diaphragmatic interfractional motion in pediatric image-guided radiation therapy: A multicenter study. Radiother Oncol 2015; 117:425-31. [DOI: 10.1016/j.radonc.2015.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/31/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
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Brada M, Pope A, Baumann M. SABR in NSCLC – The beginning of the end or the end of the beginning? Radiother Oncol 2015; 114:135-7. [DOI: 10.1016/j.radonc.2015.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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Haj Mohammad N, Kamphuis M, Hulshof MCCM, Lutkenhaus LJ, Gisbertz SS, Bergman JJGHM, de Bruin-Bon HACMR, Geijsen ED, Bel A, Boekholdt SM, van Laarhoven HWM. Reduction of heart volume during neoadjuvant chemoradiation in patients with resectable esophageal cancer. Radiother Oncol 2015; 114:91-5. [PMID: 25630429 DOI: 10.1016/j.radonc.2014.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/27/2014] [Accepted: 12/21/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Neoadjuvant chemoradiation (nCRT) followed by surgery is considered curative intent treatment for patients with resectable esophageal cancer. The aim was to establish hemodynamic aspects of changes in heart volume and to explore whether changes in heart volume resulted in clinically relevant changes in the dose distribution of radiotherapy. METHODS A prospective study was conducted in patients who were treated with nCRT consisting of carboplatin and paclitaxel concomitant with radiotherapy (41.4 Gy/1.8 Gy per fraction). Physical parameters, cardiac volume on CT and Cone beam CT, cardiac blood markers and cardiac ultrasound were obtained. RESULTS In 23 patients a significant decrease of 55.3 ml in heart volume was detected (95% CI 36.7-73.8 ml, p<0.001). There was a decrease in both systolic (mean decrease 18 mmHg, 95% CI 11-26 mmHg, p<0.001) and diastolic blood pressure (mean decrease 8 mmHg, 95% CI 2-14 mmHg, p=0.008) and an increase in heart rate with 6 beats/min (95% CI 1-11 beats/min, p=0.021). Except for Troponin T, no change in other cardiac markers and echocardiography parameters were observed. The change in heart volume did not result in a clinically relevant change in radiation dose distribution. CONCLUSION Heart volume was significantly reduced, but was not accompanied by overt cardiac dysfunction. All observed changes in hemodynamic parameters are consistent with volume depletion. Adaptation of the treatment plan during the course of radiotherapy is not advocated.
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Affiliation(s)
- Nadia Haj Mohammad
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Martijn Kamphuis
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte J Lutkenhaus
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Elisabeth D Geijsen
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Mathijs Boekholdt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Regarding Edmunds et al. Cardiac volume effects during chemoradiotherapy for esophageal cancer. Radiother Oncol 2015; 114:130. [DOI: 10.1016/j.radonc.2014.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/21/2014] [Indexed: 11/18/2022]
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Cardiac volume effects during chemoradiotherapy for esophageal cancer (Regarding Lutkenhaus et al. Reduction in cardiac volume during chemoradiotherapy for patients with esophageal cancer). Radiother Oncol 2014; 114:128-9. [PMID: 25497875 DOI: 10.1016/j.radonc.2014.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/23/2014] [Indexed: 12/25/2022]
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