1
|
Mills M, Miller J, Liveringhouse C, Bryant JM, Kawahara Y, Feygelman V, Latifi K, Yang G, Johnstone PA, Naghavi AO. Novel Postoperative Hypofractionated Accelerated Radiation Dose-Painting Approach for Soft Tissue Sarcoma. Adv Radiat Oncol 2024; 9:101391. [PMID: 38495036 PMCID: PMC10943519 DOI: 10.1016/j.adro.2023.101391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 03/19/2024] Open
Abstract
Purpose Hypofractionated radiation therapy (RT) offers benefits in the treatment of soft tissue sarcomas (STS), including exploitation of the lower α/β, patient convenience, and cost. This study evaluates the acute toxicity of a hypofractionated accelerated RT dose-painting (HARD) approach for postoperative treatment of STS. Methods and Materials This is a retrospective review of 53 consecutive patients with STS who underwent resection followed by postoperative RT. Standard postoperative RT dosing for R0/R1/gross disease with sequential boost (50 Gy + 14/16/20 Gy in 32-35 fractions) were replaced with dose-painting, which adapts dose based on risk of disease burden, to 50.4 and 63, 64.4, 70 Gy in 28 fractions, respectively. The first 10 patients were replanned with a sequential boost RT approach and dosimetric indices were compared. Time-to-event outcomes, including local control, regional control, distant control, and overall survival, were estimated with Kaplan-Meier analysis. Results Median follow-up was 25.2 months. Most patients had high-grade (59%) STS of the extremity (63%) who underwent resection with either R1 (40%) or close (36%) margins. Four patients experienced grade 3 acute dermatitis which resolved by the 3-month follow-up visit. The 2-year local control, regional control, distant control, and overall survival were 100%, 92%, 68%, and 86%, respectively. Compared with the sequential boost plan, HARD had a significantly lower field size (total V50 Gy; P = .002), bone V50 (P = .031), and maximum skin dose (P = .008). Overall treatment time was decreased by 4 to 7 fractions, which translated to a decrease in estimated average treatment cost of $3056 (range, $2651-$4335; P < .001). Conclusions In addition to benefits in cost, convenience, and improved biologic effect in STS, HARD regimen offers a safe treatment approach with dosimetric advantages compared with conventional sequential boost, which may translate to improved long-term toxicity.
Collapse
Affiliation(s)
- Matthew Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Justin Miller
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Casey Liveringhouse
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - John M. Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yuki Kawahara
- University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Vladimir Feygelman
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - George Yang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Arash O. Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| |
Collapse
|
2
|
Ortiz González I, Morera Cano D, Roncero Sánchez R, Mateos Salvador P, Valencia Blanco L, Vidal Borrás M, Aymar Salís N, Gadea Quinteiro J, Jiménez Jiménez E, Gelabert JF, Pardo Masferrer J. Dosimetric comparison of volumetric-arc therapy versus sliding window intensity-modulated radiotherapy in postoperative treatment for primary soft tissue sarcoma of the thigh. Asia Pac J Clin Oncol 2019; 15:371-376. [PMID: 31321885 DOI: 10.1111/ajco.13220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/07/2019] [Indexed: 12/01/2022]
Abstract
AIM Intensity-modulated radiotherapy (IMRT) has demonstrated improved local control in extremity soft tissue sarcoma (STS) after limb-sparing surgery compared with three-dimensional conformal radiation therapy. Our purpose was to evaluate sliding-window IMRT (SW-IMRT) and volumetric arc therapy (VMAT) in planning target volume (PTV) coverage and dose to organs-at-risk (OAR). METHODS Sixteen patients undergoing postoperative RT for lower extremity STS were included. For each patient, one VMAT plan and one SW-IMRT plan were proposed. Both were evaluated using cumulative dose-volume histogram data for OAR and PTVs. Prescribed dose was 66 Gy (2 Gy/fraction) to PTV1 and 56 Gy (1.69 Gy/fraction) to PTV2. OARs contoured were femur, neurovascular bundle, minimum tissue corridor, normal tissue outside PTV2, joint and genitalia. T-Student test was performed. RESULTS Eleven male (69%) and five female patients (31%) were analyzed. Mean age was 60 years. Both techniques showed optimal target coverage, conformity index (CI) and homogeneity index (HI). VMAT PTV2 CI was 1.13 (mean) ± 0.08 (standard deviation) versus 1.19 ± 0.10 SW-IMRT PTV2 CI (P < 0.05). VMAT PTV1 HI was 0.09 ± 0.01 versus 0.08 ± 0.01 SW-IMRT PTV1 HI (P < 0.05). Regarding OARs, VMAT delivered lower dose to femur, genitalia, normal tissue outside PTV2 and joints. SW-IMRT spared tissue corridor mean dose (10.4 Gy ± 6.8 Gy) versus (14.7 ± 6.5 Gy) VMAT (P < 0.05). CONCLUSIONS Both techniques achieved great conformity, homogeneity and coverage of PTV. VMAT produced lower dose to OARS and SW-IMRT was superior in sparing dose to normal-tissue-corridor, which could reduce risk of lymphedema.
Collapse
Affiliation(s)
- Irene Ortiz González
- Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Morera Cano
- Medical Physics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Raquel Roncero Sánchez
- Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Meritxell Vidal Borrás
- Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Neus Aymar Salís
- Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jon Gadea Quinteiro
- Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Esther Jiménez Jiménez
- Radiation Oncology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Joan Font Gelabert
- Medical Physics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - José Pardo Masferrer
- Radiation Oncology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria de Illes Balears, Palma de Mallorca, Spain.,Hospital General de Catalunya Quironsalud, Sant Cugat del Vallès, Spain
| |
Collapse
|
3
|
Bleloch JS, Ballim RD, Kimani S, Parkes J, Panieri E, Willmer T, Prince S. Managing sarcoma: where have we come from and where are we going? Ther Adv Med Oncol 2017; 9:637-659. [PMID: 28974986 PMCID: PMC5613860 DOI: 10.1177/1758834017728927] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023] Open
Abstract
Sarcomas are a heterogeneous group of neoplasms of mesenchymal origin. Approximately 80% arise from soft tissue and 20% originate from bone. To date more than 100 sarcoma subtypes have been identified and they vary in molecular characteristics, pathology, clinical presentation and response to treatment. While sarcomas represent <1% of adult cancers, they account for approximately 21% of paediatric malignancies and thus pose some of the greatest risks of mortality and morbidity in children and young adults. Metastases occur in one-third of all patients and approximately 10-20% of sarcomas recur locally. Surgery in combination with preoperative and postoperative therapies is the primary treatment for localized sarcoma tumours and is the most promising curative possibility. Metastasized sarcomas, on the other hand, are treated primarily with single-agent or combination chemotherapy, but this rarely leads to a complete and robust response and often becomes a palliative form of treatment. The heterogeneity of sarcomas results in variable responses to current generalized treatment strategies. In light of this and the lack of curative strategies for metastatic and unresectable sarcomas, there is a need for novel subtype-specific treatment strategies. With the more recent understanding of the molecular mechanisms underlying the pathogenesis of some of these tumours, the treatment of sarcoma subtypes with targeted therapies is a rapidly evolving field. This review discusses the current management of sarcomas as well as promising new therapies that are currently underway in clinical trials.
Collapse
Affiliation(s)
- Jenna S Bleloch
- Department of Human Biology, University of Cape Town, South Africa
| | - Reyna D Ballim
- Department of Human Biology, University of Cape Town, South Africa
| | - Serah Kimani
- Department of Human Biology, University of Cape Town, South Africa
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, South Africa
| | - Eugenio Panieri
- Department of Surgery, University of Cape Town, South Africa
| | - Tarryn Willmer
- Department of Human Biology, University of Cape Town, South Africa
| | - Sharon Prince
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| |
Collapse
|
4
|
Castilho MS, Ferrigno R, Baraldi H, Novaes PERDS. Treatment of bone and soft tissue tumors of the limbs with conformal radiotherapy and intensity-modulated radiotherapy (IMRT). Rev Assoc Med Bras (1992) 2017; 63:477-480. [PMID: 28876420 DOI: 10.1590/1806-9282.63.06.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
5
|
|
6
|
Cai A, Boos AM, Arkudas A, Horch RE. Management of extremely hard-to-heal extremity wounds with severe life-threatening complications. Int Wound J 2016; 14:708-715. [PMID: 27778451 DOI: 10.1111/iwj.12681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 12/11/2022] Open
Abstract
The introduction of neoadjuvant radiotherapy has allowed limb-preserving surgical treatment in patients with extremity soft tissue sarcoma, and the overall prognosis of this approach is similar to that of limb amputation. The benefits of this treatment, however, are often accompanied with a higher risk of major complications and blood vessel damage because of radiation-induced inflammation and necrosis of the vessel wall. In particular, it is associated with the rupture of large vessels like the femoral artery and more severe complications of wounds located in the proximal lower extremity. We present a series of four patients with soft tissue sarcoma of the thigh undergoing tumour removal and reconstruction of the defect after neoadjuvant radiotherapy. The post-operative outcome depended on the total dose of radiation used as well as the closing technique of the resulting wound. Major wound complications occurred when the irradiated skin was closed directly over the resection cavity or when local skin flaps were used. In one case, severe radiation-induced life-threatening multiple bleeding events occurred, which led to multiple flap failures. Even if the skin cover is not a problem, we propose a combined interdisciplinary approach involving immediate plastic surgical transfer of healthy, well-vascularised tissue into a defect resulting from oncological resection of sarcoma of the lower extremity following neoadjuvant radiotherapy in order to avoid secondary wound breakdown and severe bleeding complications.
Collapse
Affiliation(s)
- Aijia Cai
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Anja M Boos
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuernberg (FAU), Erlangen, Germany
| |
Collapse
|
7
|
Wang CW, Zhou Y, Bai JP, Liu H, Liu Y, Shi GL, Ding JJ, Ma DH, Li WT, Xie PM, Yan Y. Application of Volumetric Modulated Arc Therapy and Simultaneous Integrated Boost Techniques to Prepare "Safe Margin" in the Rabbit VX2 Limb Tumor Model. Med Sci Monit 2015; 21:2397-405. [PMID: 26280694 PMCID: PMC4544349 DOI: 10.12659/msm.894909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In this study, we aimed to establish the rabbit VX2 limb tumor model, and then prepare a “necrotic zone” as a safe margin by volumetric modulated arc therapy and simultaneous integrated boost (VMAT-SIB) technique applied in the areas where the tumor is located adjacent to the bone (GTVboost area). Material/Methods Rabbits in the control group (n=10) were not treated, while those in the test group (n=10) were treated with the SIB schedule delivering a dose of 40Gy, 35Gy, 30Gy, and 25Gy to the GTVboost, GTV (gross tumor volume), CTV (clinical target volume), and PTV (planning target volume) in 10 fractions. Magnetic resonance diffusion-weighted imaging (MRDWI), 3-dimensional power Doppler angiography (3D-PDA), and histological changes were observed after radiotherapy. Results After radiotherapy, the two groups showed a significant difference in the GTVboost area. In the test group, the tumor necrosis showed a significantly low signal in DWI and high signal in apparent diffusion coefficient (ADC) maps. The 3D-PDA observation showed that tumor vascular structures decreased significantly. Histological analysis demonstrated that a necrotic zone could be generated in the GTVboost area, and microscopic examination observed cell necrosis and fibroplasia. Conclusions This studies demonstrated the feasibility of using VMAT-SIB technique in the rabbit VX2 limb tumor model. The formation of a necrotic zone can be effectively defined as safe margin in the GTVboost area. showing potential clinical applicability.
Collapse
Affiliation(s)
- Chong-Wen Wang
- Department of Bone and Soft Tissue, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yang Zhou
- Department of Bone and Soft Tissue, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jing-Ping Bai
- Department of Bone and Soft Tissue, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Hao Liu
- Department of Radiotherapy, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yan Liu
- Department of Magnetic Resonance Imaging, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Guang-Li Shi
- Department of Bone and Soft Tissue, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jiao-Jiao Ding
- Department of Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Dong-Hui Ma
- Department of Radiotherapy, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Wen-Ting Li
- Department of Pathology, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Peng-Ming Xie
- Department of Bone and Soft Tissue, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yue Yan
- Department of Bone and Soft Tissue, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| |
Collapse
|
8
|
Meyer P, Bouhours H, Dehaynin N, Jarnet D, Gantier M, Karamanoukian D, Niederst C. The optimal tomotherapy treatment planning parameters for extremity soft tissue sarcomas. Phys Med 2015; 31:542-52. [PMID: 26032005 DOI: 10.1016/j.ejmp.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE To determine the optimum combination of treatment parameters between pitch, field width (FW) and modulation factor (MF) for extremity sarcomas in tomotherapy. MATERIALS AND METHODS Six patients previously treated for extremity sarcomas (3 arms and 3 legs) with tomotherapy were included in this study. 288 treatment plans were recalculated, corresponding to all combinations between 2 FW (2.5 and 5 cm), 4 MF (1.5, 2, 2.5 and 3) and 6 pitches (0.215, 0.287, 0.43 and 3 off-axis pitches). The treatment parameters (MF, FW or pitch) are modified between each plan, and the calculation is relaunched for 400 iterations, without modifying the optimisation constraints of the plan under which the patient has been treated. RESULTS We suggest eliminating the 0.43 pitch and never combining a 0.215 pitch with an MF ≤ 2. We also do not recommend using an MF = 1.5 unless treatment time is an absolute priority over plan quality. We did not see any advantage in using Chen off-axis pitches, except for targets far from the axis (>15 cm) treated with a high pitch. A combination of MF = 2/FW = 5 cm/pitch = 0.287 gives plans of acceptable quality, combined with reduced treatment times. These conclusions are true only for extremity sarcomas treated in 2 Gy/fraction. CONCLUSIONS We have shown that the choice of pitch/MF/FW combination is crucial for the treatment of extremity sarcomas in tomotherapy: some produce good dosimetric quality with a reduced irradiation time, while others may increase the time without improving the quality.
Collapse
Affiliation(s)
- Philippe Meyer
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France.
| | - Hugo Bouhours
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Nicolas Dehaynin
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Delphine Jarnet
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Matthieu Gantier
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Diran Karamanoukian
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Claudine Niederst
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| |
Collapse
|
9
|
Navarro A, Cacicedo J. The next generation of radiation oncologists: Challenges and perspectives. Rep Pract Oncol Radiother 2012; 17:243-5. [PMID: 24669301 DOI: 10.1016/j.rpor.2012.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Arturo Navarro
- Department of Radiation Oncology, Institut Català d'Oncologia, Gran vía s/n, Km 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Cacicedo
- Cruces University Hospital, Radiation Oncology Department, Barakaldo, Vizcaya, Spain
| |
Collapse
|
10
|
Malicki J. The importance of accurate treatment planning, delivery, and dose verification. Rep Pract Oncol Radiother 2012; 17:63-5. [PMID: 24377001 DOI: 10.1016/j.rpor.2012.02.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Julian Malicki
- Medical Physics Department, Greater Poland Cancer Centre, Poznan, Poland ; Electroradiology Department, University of Medical Sciences, Poznan, Poland
| |
Collapse
|
11
|
Slosarek K, Grządziel A, Osewski W, Dolla L, Bekman B, Petrovic B. Beam rate influence on dose distribution and fluence map in IMRT dynamic technique. Rep Pract Oncol Radiother 2012; 17:97-103. [PMID: 24377007 DOI: 10.1016/j.rpor.2012.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 11/08/2011] [Accepted: 01/13/2012] [Indexed: 11/15/2022] Open
Abstract
AIM To examine the impact of beam rate on dose distribution in IMRT plans and then to evaluate agreement of calculated and measured dose distributions for various beam rate values. BACKGROUND Accelerators used in radiotherapy utilize some beam rate modes which can shorten irradiation time and thus reduce ability of patient movement during a treatment session. This aspect should be considered in high conformal dynamic techniques. MATERIALS AND METHODS Dose calculation was done for two different beam rates (100 MU/min and 600 MU/min) in an IMRT plan. For both, a comparison of Radiation Planning Index (RPI) and MU was conducted. Secondly, the comparison of optimal fluence maps and corresponding actual fluence maps was done. Next, actual fluence maps were measured and compared with the calculated ones. Gamma index was used for that assessment. Additionally, positions of each leaf of the MLC were controlled by home made software. RESULTS Dose distribution obtained for lower beam rates was slightly better than for higher beam rates in terms of target coverage and risk structure protection. Lower numbers of MUs were achieved in 100 MU/min plans than in 600 MU/min plans. Actual fluence maps converted from optimal ones demonstrated more similarity in 100 MU/min plans. Better conformity of the measured maps to the calculated ones was obtained when a lower beam rate was applied. However, these differences were small. No correlation was found between quality of fluence map conversion and leaf motion accuracy. CONCLUSION Execution of dynamic techniques is dependent on beam rate. However, these differences are minor. Analysis shows a slight superiority of a lower beam rate. It does not significantly affect treatment accuracy.
Collapse
Affiliation(s)
- Krzysztof Slosarek
- Radiotherapy and Brachytherapy Planning Department, Center of Oncology - MSC Memorial Institute, Gliwice Branch, Poland
| | - Aleksandra Grządziel
- Radiotherapy and Brachytherapy Planning Department, Center of Oncology - MSC Memorial Institute, Gliwice Branch, Poland
| | - Wojciech Osewski
- Radiotherapy and Brachytherapy Planning Department, Center of Oncology - MSC Memorial Institute, Gliwice Branch, Poland
| | - Lukasz Dolla
- Radiotherapy and Brachytherapy Planning Department, Center of Oncology - MSC Memorial Institute, Gliwice Branch, Poland
| | - Barbara Bekman
- Radiotherapy and Brachytherapy Planning Department, Center of Oncology - MSC Memorial Institute, Gliwice Branch, Poland
| | - Borislava Petrovic
- Radiotherapy Department, Institute of Oncology Vojvodine, Sremska Kamienica, Serbia
| |
Collapse
|
12
|
Intensity modulated radiation therapy (IMRT) for the treatment of unicentric Castlemans disease: a case report and review of the use of radiotherapy in the literature. Radiol Oncol 2012; 46:265-70. [PMID: 23077466 PMCID: PMC3472945 DOI: 10.2478/v10019-012-0008-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 10/17/2011] [Indexed: 12/03/2022] Open
Abstract
Background Surgical resection is considered standard therapy for cases of resectable unicentric Castleman’s disease (UCD). Unresectable cases of UCD do not have a consensus regarding the optimal treatment approach, but have utilized steroids, observation, chemotherapy, and radiotherapy. Here we discuss a patient presentation of UCD treated with an advanced radiotherapy technique, IMRT. Case report A 47 year old female was found to have an intra-thoracic posterior UCD and was determined not to be a good surgical candidate. She was referred for radiotherapy and was treated using IMRT to a total dose of 4320 cGy in 180 cGy fractions including a scheduled 10 day break. Following the break, the patient’s treatment was replanned at which the initial treatment volume was reduced by 50.9% for the duration of the treatment course. Radiation Therapy Oncology Group (RTOG) grade III pneumonitis developed which was managed medically. Neither disease progression nor late effects have occurred. Conclusions The use of IMRT and planned treatment break was successful in the treatment of a case of UCD, and should be considered for other unresectable cases.
Collapse
|