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Abuduxiku M, Chen X, Zhang S, Yang J, Liao W, Xiao J. Optimization of collimator angle combined island blocking with parked gap achieves superior normal tissue sparing in SBRT planning of multiple liver lesions. J Appl Clin Med Phys 2024; 25:e14267. [PMID: 38259201 PMCID: PMC11163495 DOI: 10.1002/acm2.14267] [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: 08/18/2023] [Revised: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE To propose an efficient collimator angle optimization method by combining island blocking (IB) and parked gap (PG) problem to reduce the radiotherapy dose for normal tissue. The reduction will be done with single-isocenter multi-lesion volumetric modulated arc therapy (VMAT) for the stereotactic body radiation therapy (SBRT) of liver cancer. METHODS A novel collimator angle optimization algorithm was developed based on the two-dimensional projection of targets on a beam's eye view (BEV) plane as a function of gantry and collimator angle. This optimization algorithm minimized the sum of the combined IB and PG (IB & PG) areas from all gantry angles for each arc. For comparison, two SBRT plans were respectively generated for each of the 20 retrospective liver cancer cases with multiple lesions. One plan was optimized using the IB & PG algorithm, and the other plan was optimized with a previously reported optimization algorithm that only considered the IB area. Plans were then evaluated and compared using typical dosimetric metrics. RESULTS With the comparable target coverage, IB & PG plans had significantly lower D500cc, D700cc, mean dose (Dmean), and V15 of normal liver tissues when compared to IB plans. The median percent reductions were 3.32% to 5.36%. The D1cc, D5cc, and Dmean for duodenum and small intestine in IB & PG plans were significantly reduced in a range from 7.60% up to 16.03%. Similarly, the median integral dose was reduced by 3.73%. Furthermore, the percentage of normal liver Dmean sparing when IB & PG plans compared to IB plans, was found to be positively correlated (ρ = 0.669, P = 0.001) with the inter-target distance. CONCLUSION The proposed IB & PG algorithm has been demonstrated to outperform the IB algorithm in almost all normal tissue sparing, and the magnitude of liver sparing was positively correlated with inter-target distance.
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Affiliation(s)
- Maidina Abuduxiku
- Radiotherapy Physics & Technology CenterCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Xiaoqiang Chen
- Radiotherapy Physics & Technology CenterCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Shu Zhang
- Head and Neck Oncology DepartmentCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
- Department of Radiation OncologyCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Jiangping Yang
- Head and Neck Oncology DepartmentCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Wenjun Liao
- Department of Radiation OncologyAffiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Jianghong Xiao
- Radiotherapy Physics & Technology CenterCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
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2
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Ogawa A, Yoshimura M, Nakamura M, Adachi T, Iwai T, Ashida R, Mizowaki T. Impact of planning organ at risk volume margins and matching method on late gastrointestinal toxicity in moderately hypofractionated IMRT for locally advanced pancreatic ductal adenocarcinoma. Radiat Oncol 2023; 18:103. [PMID: 37337247 PMCID: PMC10280835 DOI: 10.1186/s13014-023-02288-3] [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: 01/12/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND This study examined the differences in late gastrointestinal (GI) toxicities in moderately hypofractionated intensity-modulated radiation therapy (IMRT) for locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) by changing the planning organs at risk volume (PRV) margin and the target matching method and assessed the causes of adverse events. METHODS We examined 37 patients with LA-PDAC who underwent moderately hypofractionated IMRT between 2016 and 2020 at our institution; 23 patients were treated with wide PRV margins and soft tissue matching (Protocol A) and 14 with narrow PRV margins and fiducial marker matching (Protocol B). The GI toxicities, local control (LC) rate, and overall survival (OS) were assessed for each protocol. The initially planned and daily doses to the gross tumor volume (GTV), stomach, and duodenum, reproduced from cone-beam computed tomography, were evaluated. RESULTS The late GI toxicity rate of grades 3-4 was higher in Protocol B (42.9%) than in Protocol A (4.3%). Although the 2-year LC rates were significantly higher in Protocol B (90.0%) than in Protocol A (33.3%), no significant difference was observed in OS rates. In the initial plan, no deviations were found for the stomach and duodenum from the dose constraints in either protocol. In contrast, daily dose evaluation for the stomach to duodenal bulb revealed that the frequency of deviation of V3 Gy per session was 44.8% in Protocol B, which was significantly higher than the 24.3% in Protocol A. CONCLUSIONS Reducing PRV margins with fiducial marker matching increased GI toxicities in exchange for improved LC. Daily dose analysis indicated the trade-off between the GTV dose coverage and the irradiated doses to the GI. This study showed that even with strict matching methods, the PRV margin could not be reduced safely because of GI inter-fractional error, which is expected to be resolved with online adaptive radiotherapy.
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Affiliation(s)
- Ayaka Ogawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takanori Adachi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takahiro Iwai
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ryo Ashida
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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3
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Song JY, Chie EK, Kang SH, Jeon YJ, Ko YA, Kim DY, Kang HC. Dosimetric evaluation of magnetic resonance imaging-guided adaptive radiation therapy in pancreatic cancer by extent of re-contouring of organs-at-risk. Radiat Oncol J 2022; 40:242-250. [PMID: 36606301 PMCID: PMC9830039 DOI: 10.3857/roj.2022.00332] [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: 06/13/2022] [Accepted: 11/14/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The safety of online contouring and planning for adaptive radiotherapy is unknown. This study aimed to evaluate the dosimetric difference of the organ-at-risk (OAR) according to the extent of contouring in stereotactic magnetic resonance image-guided adaptive RT (SMART) for pancreatic cancer. MATERIALS AND METHODS We reviewed the treatment plan data used for SMART in patients with pancreatic cancer. For the online contouring and planning, OARs within 2 cm from the planning target volume (PTV) in the craniocaudal direction were re-controlled daily at the attending physician's discretion. The entire OARs were re-contoured retrospectively for data analysis. We termed the two contouring methods the Rough OAR and the Full OAR, respectively. The proportion of dose constraint violation and other dosimetric parameters was analyzed. RESULTS Nineteen patients with 94 fractions of SMART were included in the analysis. The dose constraint was violated in 10.6% and 43.6% of the fractions in Rough OAR and Full OAR methods, respectively (p = 0.075). Patients with a large tumor, a short distance from gross tumor volume (GTV) to OAR, and a tumor in the body or tail were associated with more occult dose constraint violations-large tumor (p = 0.027), short distance from GTV to OAR (p = 0.061), tumor in body or tail (p = 0.054). No dose constraint violation occurred outside 2 cm from the PTV. CONCLUSION More occult dose constraint violations can be found by the Full OAR method in patients with pancreatic cancer with some clinical factors in the online re-planning for SMART. Re-contouring all the OARs would be helpful to detect occult dose constraint violations in SMART planning. Since the dosimetric profile of SMART cannot be represented by a single fraction, patient selection for the Full OAR method should be weighted between the clinical usefulness and the time and workforce required.
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Affiliation(s)
- Jun Yeong Song
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Hee Kang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Yeon-Jun Jeon
- Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Ah Ko
- Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Yun Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea,Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyun-Cheol Kang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea,Correspondence: Hyun-Cheol Kang Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-2526 E-mail:
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4
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Borghesi S, Aristei C, Marampon F. Doses, fractionations, constraints for stereotactic radiotherapy. Rep Pract Oncol Radiother 2022; 27:10-14. [PMID: 35402033 PMCID: PMC8989440 DOI: 10.5603/rpor.a2021.0139] [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: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
This paper describes how to select the most appropriate stereotactic radiotherapy (SRT ) dose and fractionation scheme according to lesion size and site, organs at risk (OARs) proximity and the biological effective dose. In single-dose SRT, 15-34 Gy are generally used while in fractionated SRT 30 and 75 Gy in 2-5 fractions are administered. The ICRU Report No. 91, which is specifically dedicated to SRT treatments, provided indications for dose prescription (with its definition and essential steps), dose delivery and optimal coverage which was defined as the best planning target volume coverage that can be obtained in the irradiated district. Calculation algorithms and OAR s dose constraints are provided as well as treatment planning system characteristics, suggested beam energy and multileaf collimator leaf size. Finally, parameters for irradiation geometry and plan quality are also reported.
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Affiliation(s)
- Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Francesco Marampon
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Italy
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5
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Sweeney RA, Kahl KH, Ciernik FI, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic Body Radiotherapy of adrenal metastases - A dose-finding study. Int J Cancer 2022; 151:412-421. [PMID: 35383919 DOI: 10.1002/ijc.34017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Optimal doses for the treatment of adrenal metastases with stereotactic radiotherapy (SBRT) are unknown. We aimed to identify dose-volume cut-points associated with decreased local recurrence rates (LRR). A multicenter database of patients with adrenal metastases of any histology treated with SBRT (biologically effective dose, BED10 ≥ 50Gy, ≤ 12 fractions) was analyzed. Details on dose-volume parameters were required (planning target volume: PTV-D98%, PTV-D50%, PTV-D2%; gross tumor volume: GTV-D50%, GTV-mean). Cut-points for LRR were optimized using the R maxstat package. 196 patients with 218 lesions were included, the largest histopathological subgroup was adenocarcinoma (n = 101). Cut-point optimization resulted in significant cut-points for PTV-D50% (BED10: 73.2Gy; p = 0.003), GTV-D50% (BED10: 74.2Gy; p = 0.006), GTV-mean (BED10: 73.0Gy; p = 0.007), and PTV-D2% (BED10: 78.0Gy; p = 0.02) but not for the PTV-D98% (p = 0.06). Differences in LRR were clinically relevant (LRR ≥ doubled for cut-points that were not achieved). Further dose-escalation was not associated with further improved LRR. PTV-D50%, GTV-D50%, and GTV-mean cut-points were also associated with significantly improved LRR in the adenocarcinoma subgroup. Separate dose optimizations indicated a lower cut-point for the PTV-D50% (BED10: 69.1Gy) in adenocarcinoma lesions, other values were similar (< 2% difference). Associations of cut-points with overall survival (OS) and progression-free survival were not significant but durable freedom from local recurrence was associated with OS in a landmark model (p < 0.001). To achieve a significant improvement of LRR for adrenal SBRT, a moderate escalation of PTV-D50% BED10 > 73.2Gy (adenocarcinoma: 69.1Gy) should be considered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Deutschland
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Österreich
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Deutschland
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Deutschland
| | - Barbara Röper
- DIE RADIOLOGIE, MVZ Strahlentherapie Bogenhausen - Harlaching - Neuperlach, München, Deutschland
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Deutschland
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Deutschland
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Deutschland
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Deutschland
| | - Reinhart A Sweeney
- Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Deutschland
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Deutschland
| | - F Ilja Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Deutschland
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Deutschland
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Michael Hoffmann
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich.,Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, Neuherberg, Deutschland.,Deutsches Zentrum für Translationale Krebsforschung (DKTK) Partner Site Munich
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
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6
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Simoni N, Rossi G, Cellini F, Vitolo V, Orlandi E, Valentini V, Mazzarotto R, Sverzellati N, D'Abbiero N. Ablative Radiotherapy (ART) for Locally Advanced Pancreatic Cancer (LAPC): Toward a New Paradigm? Life (Basel) 2022; 12:life12040465. [PMID: 35454956 PMCID: PMC9025325 DOI: 10.3390/life12040465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Locally advanced pancreatic cancer (LAPC) represents a major urgency in oncology. Due to the massive involvement of the peripancreatic vessels, a curative-intent surgery is generally precluded. Historically, LAPC has been an indication for palliative systemic therapy. In recent years, with the introduction of intensive multi-agent chemotherapy regimens and aggressive surgical approaches, the survival of LAPC patients has significantly improved. In this complex and rapidly evolving scenario, the role of radiotherapy is still debated. The use of standard-dose conventional fractionated radiotherapy in LAPC has led to unsatisfactory oncological outcomes. However, technological advances in radiation therapy over recent years have definitively changed this paradigm. The use of ablative doses of radiotherapy, in association with image-guidance, respiratory organ-motion management, and adaptive protocols, has led to unprecedented results in terms of local control and survival. In this overview, principles, clinical applications, and current pitfalls of ablative radiotherapy (ART) as an emerging treatment option for LAPC are discussed.
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Affiliation(s)
- Nicola Simoni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126 Parma, Italy
| | - Gabriella Rossi
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Integrata, 37126 Verona, Italy
| | - Francesco Cellini
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Vincenzo Valentini
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Renzo Mazzarotto
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Integrata, 37126 Verona, Italy
| | - Nicola Sverzellati
- Division of Radiology, Azienda Ospedaliera Universitaria, 43126 Parma, Italy
| | - Nunziata D'Abbiero
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126 Parma, Italy
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7
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Abstract
Dose constraints are essential for performing dosimetry, especially for intensity modulation and for radiotherapy under stereotaxic conditions. We present the update of the recommendations of the French society of oncological radiotherapy for the use of these doses in classical current practice but also for reirradiation.
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Affiliation(s)
- G Noël
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - D Antoni
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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8
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Cha MJ, Cuculich PS, Robinson CG, Chang JH. Tailored stereotactic radiotherapy technique using deep inspiration breath-hold to reduce stomach dose for cardiac radioablation. Radiat Oncol J 2021; 39:167-173. [PMID: 34610655 PMCID: PMC8497870 DOI: 10.3857/roj.2021.00276] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To provide a new insight on a novel safe cardiac radioablation using deep inspiration breath-hold (DIBH) to reduce gastrointestinal dose. Materials and Methods For treating incessant ventricular tachycardia (VT) originated from left ventricle inferior scar abutting the stomach, a target delineation and treatment planning for cardiac radioablation was performed. With four different computed tomography (CT) scan protocols—DIBH, full expiration breath-hold, four-dimensional (4D) CT without and with abdominal compression, the distances between the target and the stomach were compared. Results Among the protocols, the CT scan with DIBH showed largest distance between the target and the stomach and selected for the treatment planning. The prescribed dose was 25 Gy in a single fraction, and satisfactory dosimetric parameters were achieved with the DIBH. The patient was successfully treated with the DIBH, and experienced no acute toxicity. Conclusion To gain the best benefit from cardiac radioablation, understanding the possible toxicity in the adjacent organs is crucial. By moving the heart with thoraco-diaphragmatic movement by DIBH, the target could be physically separated from the stomach.
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Affiliation(s)
- Myung-Jin Cha
- Cardiovascular Division, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Phillip S Cuculich
- Cardiovascular Division, Department of Internal Medicine, Washington University, St Louis, MO, USA
| | | | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
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9
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Camprodon G, Huguet F. Unrecognized digestive toxicities of radiation therapy. Cancer Radiother 2021; 25:723-728. [PMID: 34391649 DOI: 10.1016/j.canrad.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022]
Abstract
The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important.
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Affiliation(s)
- G Camprodon
- Service d'Oncologie Médicale, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif, France.
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
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10
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Kapitanova I, Biswas S, Divekar S, Kemmerer EJ, Rostock RA, Forster KM, Grimm RJ, Scofield CJ, Grimm J, Emami B, Mahadevan A. Estimating the tolerance of brachial plexus to hypofractionated stereotactic body radiotherapy: a modelling-based approach from clinical experience. Radiat Oncol 2021; 16:98. [PMID: 34098991 PMCID: PMC8186142 DOI: 10.1186/s13014-021-01822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Brachial plexopathy is a potentially serious complication from stereotactic body radiation therapy (SBRT) that has not been widely studied. Therefore, we compared datasets from two different institutions and generated a brachial plexus dose–response model, to quantify what dose constraints would be needed to minimize the effect on normal tissue while still enabling potent therapy for the tumor.
Methods Two published SBRT datasets were pooled and modeled from patients at Indiana University and the Richard L. Roudebush Veterans Administration Medical Center from 1998 to 2007, as well as the Karolinska Institute from 2008 to 2013. All patients in both studies were treated with SBRT for apically located lung tumors localized superior to the aortic arch. Toxicities were graded according to Common Terminology Criteria for Adverse Events, and a probit dose response model was created with maximum likelihood parameter fitting. Results This analysis includes a total of 89 brachial plexus maximum point dose (Dmax) values from both institutions. Among the 14 patients who developed brachial plexopathy, the most common complications were grade 2, comprising 7 patients. The median follow-up was 30 months (range 6.1–72.2) in the Karolinska dataset, and the Indiana dataset had a median of 13 months (range 1–71). Both studies had a median range of 3 fractions, but in the Indiana dataset, 9 patients were treated in 4 fractions, and the paper did not differentiate between the two, so our analysis is considered to be in 3–4 fractions, one of the main limitations. The probit model showed that the risk of brachial plexopathy with Dmax of 26 Gy in 3–4 fractions is 10%, and 50% with Dmax of 70 Gy in 3–4 fractions. Conclusions This analysis is only a preliminary result because more details are needed as well as additional comprehensive datasets from a much broader cross-section of clinical practices. When more institutions join the QUANTEC and HyTEC methodology of reporting sufficient details to enable data pooling, our field will finally reach an improved understanding of human dose tolerance.
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Affiliation(s)
- Irina Kapitanova
- Department of Psychiatry, Mount Sinai St. Luke's Hospital, New York, NY, USA
| | - Sharmi Biswas
- Department of Pediatric Nephrology, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina Divekar
- Sackler School of Medicine, Tel Aviv University, New York, NY, USA
| | - Eric J Kemmerer
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Robert A Rostock
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Kenneth M Forster
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Rachel J Grimm
- Department of Radiation Oncology, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | - Carla J Scofield
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA. .,Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Bahman Emami
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
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11
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Mahadevan A, Emami B, Grimm J, Kleinberg LR, Redmond KJ, Welsh JS, Rostock R, Kemmerer E, Forster KM, Stanford J, Shah S, Asbell SO, LaCouture TA, Scofield C, Butterwick I, Xue J, Muacevic A, Adler JR. Potential Clinical Significance of Overall Targeting Accuracy and Motion Management in the Treatment of Tumors That Move With Respiration: Lessons Learnt From a Quarter Century of Stereotactic Body Radiotherapy From Dose Response Models. Front Oncol 2021; 10:591430. [PMID: 33634020 PMCID: PMC7900559 DOI: 10.3389/fonc.2020.591430] [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: 08/04/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine the long-term normal tissue complication probability with stereotactic body radiation therapy (SBRT) treatments for targets that move with respiration and its relation with the type of respiratory motion management (tracking vs. compression or gating). METHODS A PubMed search was performed for identifying literature regarding dose, volume, fractionation, and toxicity (grade 3 or higher) for SBRT treatments for tumors which move with respiration. From the identified papers logistic or probit dose-response models were fitted to the data using the maximum-likelihood technique and confidence intervals were based on the profile-likelihood method in the dose-volume histogram (DVH) Evaluator. RESULTS Pooled logistic and probit models for grade 3 or higher toxicity for aorta, chest wall, duodenum, and small bowel suggest a significant difference when live motion tracking was used for targeting tumors with move with respiration which was on the average 10 times lower, in the high dose range. CONCLUSION Live respiratory motion management appears to have a better toxicity outcome when treating targets which move with respiration with very steep peripheral dose gradients. This analysis is however limited by sparsity of rigorous data due to poor reporting in the literature.
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Affiliation(s)
- Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Bahman Emami
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, United States
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Lawrence R. Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - James S. Welsh
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, United States
| | - Robert Rostock
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Eric Kemmerer
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Kenneth M. Forster
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Jason Stanford
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Sunjay Shah
- Department of Radiation Oncology, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE, United States
| | - Sucha O. Asbell
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tamara A. LaCouture
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Carla Scofield
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Ian Butterwick
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, United States
| | - Jinyu Xue
- Department of Radiation Oncology, New York University, New York City, NY, United States
| | | | - John R. Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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12
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Tonneau M, Lacornerie T, Mirabel X, Pasquier D. [Stereotactic body radiotherapy for locally advanced pancreatic cancer: A systemic review]. Cancer Radiother 2021; 25:283-295. [PMID: 33423968 DOI: 10.1016/j.canrad.2020.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 01/11/2023]
Abstract
Stereotactic body radiation therapy (SBRT) for locally advanced pancreatic cancer (LAPC) is an emerging treatment option. Most studies showed local control of approximately 75% with no evidence of improved overall survival. Gastrointestinal toxicities could be significant, ranging up to 22% for acute toxicities≥grade 3+ and 44% for late toxicities≥grade 3+. Currently, no standardized guidelines for treatment and management scheme. We conducted a systemic review of published prospective and retrospective trials to evaluate the efficacy, safety, technical data, and discuss future directions.
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Affiliation(s)
- M Tonneau
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France.
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille, UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France
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13
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Placidi L, Romano A, Chiloiro G, Cusumano D, Boldrini L, Cellini F, Mattiucci GC, Valentini V. On-line adaptive MR guided radiotherapy for locally advanced pancreatic cancer: Clinical and dosimetric considerations. Tech Innov Patient Support Radiat Oncol 2020; 15:15-21. [PMID: 32642565 PMCID: PMC7334416 DOI: 10.1016/j.tipsro.2020.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Magnetic Resonance-guided Radiation Therapy (MRgRT) allows online adaptations (OA) of the treatment plan to optimize daily dose distribution based on patient's anatomy, just before fraction delivery. The aim of this study is to evaluate feasibility and the dosimetric improvement of the OA workflow implemented in our institution for locally advanced pancreatic cancer (LAPC) patients, in terms of target coverage and organs at risk (OARs) sparing. Methods We retrospectively analysed 8 LAPC patients treated with MRgRT in combination with the OA approach, using video-assisted inspiratory breath-hold for a total of 38 fractions with a dose ranging from 30 Gy to 40 Gy in 5 fractions.Dose distribution of the baseline plan was first calculated based on daily anatomy, obtaining a "predicted" plan to assess the dosimetric improvement. If the dose distribution did not meet the constraints set in the planning phase, PTV, GTV and OARs were re-contoured within a distance of 3 cm from the PTV external edge and a new online "adaptive" plan was generated. Other clinical and planning parameters were also evaluated to assess the feasibility and the dosimetic benefit of the online adaptive workflow. Results Out of 38 total fractions, 26 (68.4%) were adapted online and 12 (31.6%) were delivered using the baseline plan. The use of the adaptive workflow resulted to be feasible in our clinical practice and advantageous in all the patients: mean PTV V95% increased by 10.8% (5.7-20.8) while mean CTV V98% of 12.6% (7.3-17.7). Also OARs V33 and V25 showed a positive trend avoiding unnecessary irradiation. Conclusion OA workflow improves the dosimetric benefit of MRgRT, preventing the occurrence of high-doses to OARs and increasing the safety of stereotactic treatment for LAPC, without any drawback for our daily clinical practice routine.
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Affiliation(s)
- Lorenzo Placidi
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Boldrini
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gian Carlo Mattiucci
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
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14
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Park J, Park JW, Kang MK. Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma. Yeungnam Univ J Med 2019; 36:192-200. [PMID: 31620633 PMCID: PMC6784649 DOI: 10.12701/yujm.2019.00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an advanced form of radiotherapy (RT) with a growing interest on its application in the treatment of hepatocellular carcinoma (HCC). It can deliver ablative radiation doses to tumors in a few fractions without excessive doses to normal tissues, with the help of advanced modern RT and imaging technologies. Currently, SBRT is recommended as an alternative to curative treatments, such as surgery and radiofrequency ablation. This review discusses the current status of SBRT to aid in the decision making on how it is incorporated into the HCC management.
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Affiliation(s)
- Jongmoo Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
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15
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Ding Y, Campbell WG, Miften M, Vinogradskiy Y, Goodman KA, Schefter T, Jones BL. Quantifying Allowable Motion to Achieve Safe Dose Escalation in Pancreatic SBRT. Pract Radiat Oncol 2019; 9:e432-e442. [PMID: 30951868 PMCID: PMC6592725 DOI: 10.1016/j.prro.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Tumor motion plays a key role in the safe delivery of stereotactic body radiation therapy (SBRT) for pancreatic cancer. The purpose of this study was to use tumor motion measured in patients to establish limits on motion magnitude for safe delivery of pancreatic SBRT and to help guide motion-management decisions in potential dose-escalation scenarios. METHODS AND MATERIALS Using 91 sets of pancreatic tumor motion data, we calculated the motion-convolved dose of the gross tumor volume, duodenum, and stomach for 25 patients with pancreatic cancer. We derived simple linear or quadratic models relating motion to changes in dose and used these models to establish the maximum amount of motion allowable while satisfying error thresholds on key dose metrics. In the same way, we studied the effects of dose escalation and tumor volume on allowable motion. RESULTS In our patient cohort, the mean (range) allowable motion for 33, 40, and 50 Gy to the planning target volume was 11.9 (6.3-22.4), 10.4 (5.2-19.1), and 9.0 (4.2-16.0) mm, respectively. The maximum allowable motion decreased as the dose was escalated and was smaller in patients with larger tumors. We found significant differences in allowable motion between the different plans, suggesting a patient-specific approach to motion management is possible. CONCLUSIONS The effects of motion on pancreatic SBRT are highly variable among patients, and there is potential to allow more motion in certain patients, even in dose-escalated scenarios. In our dataset, a conservative limit of 6.3 mm would ensure safe treatment of all patients treated to 33 Gy in 5 fractions.
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Affiliation(s)
- Yijun Ding
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Warren G Campbell
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | | | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Tracey Schefter
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado, Denver, Colorado.
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16
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Loi M, Magallon-Baro A, Suker M, van Eijck C, Sharma A, Hoogeman M, Nuyttens J. Pancreatic cancer treated with SBRT: Effect of anatomical interfraction variations on dose to organs at risk. Radiother Oncol 2019; 134:67-73. [PMID: 31005226 DOI: 10.1016/j.radonc.2019.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Interfraction shape and position variations of organs at risk (OARs) may increase uncertainty in dose delivery during stereotactic body radiotherapy (SBRT), potentially leading to overirradiation or concessions in planned tumor dose and/or coverage to prevent clinical constraints violation. The aim of our study was to quantitatively analyze the impact of anatomical interfraction variations on dose to OARs in pancreatic cancer (PC) treated by SBRT using a CyberKnife with integrated CT-on-rails. MATERIALS AND METHODS Thirty-five PC patients treated with SBRT (40 Gy/5 fractions) underwent a CT-scan in treatment position before each of the first three fractions using the CT-on-rails system. OARs (stomach, duodenum, bowel) were manually delineated and concatenated to one structure (Gastro-Intestinal Organ, GIO). To overlay the planned dose distribution, fiducial-based alignment of the fraction CT with the planning CT was performed. Planned DVH parameters of the OAR were compared to the parameters calculated in the fractions CTs. RESULTS Compared to the treatment plan, the median V35, D2, D5, D10 and Dmax of the fraction CTs in the GIO was increased by 1.0 (IQR: 0.2-2.6), 4.4% (0.4-10.8), 2.3% (0.2-7.5), 3.3% (-0.4 to 7.1), and 12.0% (5.0-18.9) respectively. Median increase was statistically significant for all parameters in GIO and for V35 in all critical structures at Wilcoxon test. CONCLUSIONS Anatomical interfraction variations increase OAR dose during SBRT for pancreatic cancer daily imaging using integrated CT/CyberKnife may allow to implement strategies to reduce the risk of OAR overirradiation during pancreatic SBRT.
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Affiliation(s)
- Mauro Loi
- Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - Alba Magallon-Baro
- Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Mustafa Suker
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Casper van Eijck
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Aman Sharma
- Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Mischa Hoogeman
- Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Joost Nuyttens
- Department of Radiotherapy, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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17
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Nakamura A, Prichard HA, Wo JY, Wolfgang JA, Hong TS. Elective nodal irradiation with simultaneous integrated boost stereotactic body radiotherapy for pancreatic cancer: Analyses of planning feasibility and geometrically driven DVH prediction model. J Appl Clin Med Phys 2019; 20:71-83. [PMID: 30636367 PMCID: PMC6370996 DOI: 10.1002/acm2.12528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 12/05/2018] [Accepted: 12/14/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We evaluate the feasibility of the elective nodal irradiation strategy in stereotactic body radiotherapy (SBRT) for pancreatic cancer. METHODS Three simultaneous integrated boost (SIB)-SBRT plans (Boost1, Boost2, and Boost3) were retrospectively generated for each of 20 different patients. Boost1 delivered 33 and 25 Gy to PTV1 and PTV2, respectively. Boost2 delivered 40, 33, and 25 Gy to boostCTV, PTV1, and PTV2, respectively. Boost3 delivered 33 and 25 Gy to PTV1 and PTV3, respectively. PTV1 covered the initial standard SBRT plan (InitPlan) gross tumor volume (GTV). PTV2 covered CTVgeom which was created by a 10-mm expansion (15 mm posterior) of GTV. PTV3 covered CTVprop which included elective nodal regions. The boostCTV included GTV as well as involved vasculature. The planning feasibility in each scenario and dose-volume histograms (DVHs) were analyzed and compared with the InitPlan (delivered 33 Gy only to PTV1) by paired t-test. Next, a novel DVH prediction model was developed and its performance was evaluated according to the prediction accuracy (AC) of planning violations. Then, the model was used to simulate the impacts of GTV-to-organs at risk (OAR) distance and gastrointestinal (GI) OAR volume variations on planning feasibility. RESULTS Significant dose increases were observed in GI-OARs in SIB-SBRT plans when compared with InitPlan. All dose constraints were met in 63% of cases in InitPlan, Boost1, and Boost2, whereas Boost3 developed DVH violations in all cases. Utilizing previous patient anatomy, the novel DVH prediction model achieved a high AC in the prediction of violations for GI-OARs; the positive predictive value, negative predictive value, and AC were 66%, 90%, and 84%, respectively. Experiments with the model demonstrated that the larger proximity volume of GI-OAR at the shorter distance substantially impacted on planning violations. CONCLUSIONS SIB-SBRT plan with geometrically defined prophylactic areas can be dosimetrically feasible, but including all nodal areas with 25 Gy in five fractions appears to be unrealistic.
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Affiliation(s)
- Akira Nakamura
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugh A Prichard
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John A Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Sun Y, Zhu Q, Zhou M, Yang W, Shi H, Shan Y, Zhang Q, Yu F. Restoration of miRNA-148a in pancreatic cancer reduces invasion and metastasis by inhibiting the Wnt/β-catenin signaling pathway via downregulating maternally expressed gene-3. Exp Ther Med 2018; 17:639-648. [PMID: 30651845 PMCID: PMC6307449 DOI: 10.3892/etm.2018.7026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/16/2018] [Indexed: 12/21/2022] Open
Abstract
Various microRNAs (miRNA) have been recognized potential novel tumor markers and have a critical role in cancer development and progression. Recently, methylation of miRNA-148a was identified as a crucial biochemical process in the progression of cancer. However, its potential role and in pancreatic cancer as well as the underlying mechanisms have remained largely elusive. The present study investigated the potential antitumor effect of miR-148a as well as its impact on invasion and metastasis in pancreatic cancer. It was found that the expression of miRNA-148a and the potential predictive biomarker maternally expressed gene-3 (MEG-3) were obviously decreased in human pancreatic cancer tissues compared with those in adjacent non-tumorous tissues. Furthermore, miR-148a was found to be downregulated in pancreatic cancer cell lines compared with normal pancreatic cells through promoter methylation. An MTT assay and a clonogenic assay demonstrated that restoration of miRNA-148a inhibited the proliferation and colony formation of pancreatic cancer cells. In addition, miR-148a transduction led to the upregulation of MEG-3 expression and promoted apoptosis of pancreatic cancer cells. Western blot analysis revealed that transduction of miR-148a markedly decreased the expression levels of C-myc, cyclin D1 and β-catenin in pancreatic cancer cells. Methylation of miR-148a not only decreased the endogenous β-catenin levels but also inhibited the nuclear translocation of β-catenin to delay cell cycle progression. Furthermore, ectopic miR-148a methylation inhibited pancreatic cancer cell migration and invasion via causing an upregulation of MEG-3 expression. Most importantly, ectopic overexpression of miR-148a in pancreatic cancer cells inhibited tumor formation in an animal experiment. Taken together, miR-148a methylation is a crucial regulatory process to inhibit the proliferation and invasion of pancreatic cancer cells, and transduction of miR-148a suppressed the proliferation of pancreatic cancer cells through negative regulation of the Wnt/β-catenin signaling pathway. The findings of the present study suggested that miRNA-148a acts as a tumor suppressor in pancreatic cancer and may contribute to the development of novel treatments for pancreatic cancer.
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Affiliation(s)
- Yunpeng Sun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Qiandong Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Mengtao Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Wenjun Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Hongqi Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Yunfeng Shan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Qiyu Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
| | - Fuxiang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, P.R. China
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19
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Retrospective evaluation of decision-making for pancreatic stereotactic MR-guided adaptive radiotherapy. Radiother Oncol 2018; 129:319-325. [DOI: 10.1016/j.radonc.2018.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/11/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
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20
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Goldsmith C, Plowman PN, Green MM, Dale RG, Price PM. Stereotactic ablative radiotherapy (SABR) as primary, adjuvant, consolidation and re-treatment option in pancreatic cancer: scope for dose escalation and lessons for toxicity. Radiat Oncol 2018; 13:204. [PMID: 30340643 PMCID: PMC6194644 DOI: 10.1186/s13014-018-1138-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/24/2018] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Stereotactic ablative radiotherapy (SABR) offers an alternative treatment for pancreatic cancer, with the potential for improved tumour control and reduced toxicity compared with conventional therapies. However, optimal dose planning and delivery strategies are unelucidated and gastro-intestinal (GI) toxicity remains a key concern. METHODS Patients with inoperable non-metastatic pancreatic cancer who received CyberKnife® SABR (18-36 Gy) in three fractions as primary, adjuvant, consolidation or re-treatment options were studied. Patient individualised planning and delivery variables were collected and their impact on patient outcome examined. Linear-quadratic (LQ) radiobiology modelling methods were applied to assess SABR parameters against a conventional fractionated radiotherapy schedule. RESULTS In total 42 patients were included, 37 (88%) of whom had stage T4 disease. SABR was used > 6 months post-primary therapy to re-treat residual disease in 11 (26.2%) patients and relapsed disease in nine (21.4%) patients. SABR was an adjuvant to other primary therapy for 14 (33.3%) patients and was the sole primary therapy for eight (19.0%) patients. The mean (95% CI) planning target volume (PTV), prescription isodose, percentage cover, minimum dose to PTV and biological effective dose (BED) were 76.3(63.8-88.7) cc, 67.3(65.2-69.5)%, 96.6(95.5-97.7)%, 22.3(21.0-23.6) Gy and 50.3(47.7-53.0) Gy, respectively. Only 3/37 (8.1%) patients experienced Grade 3 acute toxicities. Two (4.8%) patients converted to resectable status and median freedom-from-local-progression (FFLP) and overall survival (OS) were 9.8 and 8.4 months, respectively. No late toxicity was experienced in 27/32 (84.4%) patients; however, four (12.5%) patients - of whom two had particularly large PTV, two had sub-optimal number of fiducials and three breached organ-at-risk (OAR) constraints-showed Grade 4 duodenal toxicities. Longer delivery time, extended treatment course and reduced percentage coverage additionally associated with late toxicity, likely reflecting parameters typically applied to riskier patients. Larger PTV size and longer treatment course associated with OS. Comparator regimen LQ modelling analysis indicated 50% of patients received minimum PTV doses less potent than a conventional radiotherapy regimen, indicating scope for dose escalation. CONCLUSION The results demonstrate the value of SABR for a range of indications in pancreatic cancer. Dose escalation to increase BED may improve FFLP and OS in inoperable, non-metastatic disease: however concomitant enhanced stringency for duodenal protection is critical, particularly for patients where SABR is more challenging.
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Affiliation(s)
| | - P Nicholas Plowman
- The London CyberKnife Centre, The Harley Street Clinic, 81 Harley Street, London, W1G 8PP, UK.,St. Bartholomew's Hospital, London, UK
| | - Melanie M Green
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Roger G Dale
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Patricia M Price
- The London CyberKnife Centre, The Harley Street Clinic, 81 Harley Street, London, W1G 8PP, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Di Maso LD, Huang J, Bassetti MF, DeWerd LA, Miller JR. Investigating a novel split-filter dual-energy CT technique for improving pancreas tumor visibility for radiation therapy. J Appl Clin Med Phys 2018; 19:676-683. [PMID: 30117641 PMCID: PMC6123148 DOI: 10.1002/acm2.12435] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose Tumor delineation using conventional CT images can be a challenge for pancreatic adenocarcinoma where contrast between the tumor and surrounding healthy tissue is low. This work investigates the ability of a split‐filter dual‐energy CT (DECT) system to improve pancreatic tumor contrast and contrast‐to‐noise ratio (CNR) for radiation therapy treatment planning. Materials and methods Multiphasic scans of 20 pancreatic tumors were acquired using a split‐filter DECT technique with iodinated contrast medium, OMNIPAQUETM. Analysis was performed on the pancreatic and portal venous phases for several types of DECT images. Pancreatic gross target volume (GTV) contrast and CNR were calculated and analyzed from mixed 120 kVp‐equivalent images and virtual monoenergetic images (VMI) at 57 and 40 keV. The role of iterative reconstruction on DECT images was also investigated. Paired t‐tests were used to assess the difference in GTV contrast and CNR among the different images. Results The VMIs at 40 keV had a 110% greater image noise compared to the mixed 120 kVp‐equivalent images (P < 0.0001). VMIs at 40 keV increased GTV contrast from 15.9 ± 19.9 HU to 93.7 ± 49.6 HU and CNR from 1.37 ± 2.05 to 3.86 ± 2.78 in comparison to the mixed 120 kVp‐equivalent images. The iterative reconstruction algorithm investigated decreased noise in the VMIs by about 20% and improved CNR by about 30%. Conclusions Pancreatic tumor contrast and CNR were significantly improved using VMIs reconstructed from the split‐filter DECT technique, and the use of iterative reconstruction further improved CNR. This gain in tumor contrast may lead to more accurate tumor delineation for radiation therapy treatment planning.
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Affiliation(s)
- Lianna D Di Maso
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53716, USA
| | - Jessie Huang
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, 53716, USA
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, 53716, USA
| | - Larry A DeWerd
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53716, USA
| | - Jessica R Miller
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, 53716, USA
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Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT. Strahlenther Onkol 2018; 194:414-424. [PMID: 29404626 DOI: 10.1007/s00066-018-1271-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE For assessing healthy liver reactions after robotic SBRT (stereotactic body radiotherapy), we investigated early morphologic alterations on MRI (magnetic resonance imaging) with respect to patient and treatment plan parameters. PATIENTS AND METHODS MRI data at 6-17 weeks post-treatment from 22 patients with 42 liver metastases were analyzed retrospectively. Median prescription dose was 40 Gy delivered in 3-5 fractions. T2- and T1-weighted MRI were registered to the treatment plan. Absolute doses were converted to EQD2 (Equivalent dose in 2Gy fractions) with α/β-ratios of 2 and 3 Gy for healthy, and 8 Gy for modelling pre-damaged liver tissue. RESULTS Sharply defined, centroid-shaped morphologic alterations were observed outside the high-dose volume surrounding the GTV. On T2-w MRI, hyperintensity at EQD2 isodoses of 113.3 ± 66.1 Gy2, 97.5 ± 54.7 Gy3, and 66.5 ± 32.0 Gy8 significantly depended on PTV dimension (p = 0.02) and healthy liver EQD2 (p = 0.05). On T1-w non-contrast MRI, hypointensity at EQD2 isodoses of 113.3 ± 49.3 Gy2, 97.4 ± 41.0 Gy3, and 65.7 ± 24.2 Gy8 significantly depended on prior chemotherapy (p = 0.01) and total liver volume (p = 0.05). On T1-w gadolinium-contrast delayed MRI, hypointensity at EQD2 isodoses of 90.6 ± 42.5 Gy2, 79.3 ± 35.3 Gy3, and 56.6 ± 20.9 Gy8 significantly depended on total (p = 0.04) and healthy (p = 0.01) liver EQD2. CONCLUSIONS Early post-treatment changes in healthy liver tissue after robotic SBRT could spatially be correlated to respective isodoses. Median nominal doses of 10.1-11.3 Gy per fraction (EQD2 79-97 Gy3) induce characteristic morphologic alterations surrounding the lesions, potentially allowing for dosimetric in-vivo accuracy assessments. Comparison to other techniques and investigations of the short- and long-term clinical impact require further research.
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Contraintes de doses aux organes à risque en radiothérapie conformationnelle et stéréotaxique : intestin grêle et duodénum. Cancer Radiother 2017; 21:613-618. [DOI: 10.1016/j.canrad.2017.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/02/2017] [Indexed: 12/25/2022]
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Lacornerie T, Rio E, Mahé MA. [Stereotactic body radiation therapy for hepatic malignancies: Organs at risk, uncertainties margins, doses]. Cancer Radiother 2017; 21:574-579. [PMID: 28844506 DOI: 10.1016/j.canrad.2017.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 11/30/2022]
Abstract
Stereotactic body radiation therapy for primary and metastatic hepatic malignancies can be performed in association and/or as an alternative to surgery and radiofrequency. The consequences of the great number of techniques available are heterogeneity in contouring, dose prescription and in determination of dose constraints for organs at risk. The objective of this paper is to improve the quality and safety and to help the diffusion of this technique for a majority of patients. In 2016, the French Society of Radiation Oncology (SFRO) published guidelines for external radiotherapy and brachytherapy ("Recorad"). This paper is an update of these recommendations considering recent publications.
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Affiliation(s)
- T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille, France.
| | - E Rio
- Service de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France
| | - M-A Mahé
- Service de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France
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Rao AD, Feng Z, Shin EJ, He J, Waters KM, Coquia S, DeJong R, Rosati LM, Su L, Li D, Jackson J, Clark S, Schultz J, Hutchings D, Kim SH, Hruban RH, DeWeese TL, Wong J, Narang A, Herman JM, Ding K. A Novel Absorbable Radiopaque Hydrogel Spacer to Separate the Head of the Pancreas and Duodenum in Radiation Therapy for Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2017; 99:1111-1120. [PMID: 28943075 DOI: 10.1016/j.ijrobp.2017.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. METHODS AND MATERIALS Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement. The duodenal dose reduction and planning target volume (PTV) coverage were characterized using pre- and postspacer injection stereotactic body radiation therapy (SBRT) plans for the 2 cadavers with EUS-guided placement, the delivery method that appeared the most clinically desirable. Modeling studies were performed using 60 SBRT plans consisting of 10 previously treated patients with unresectable pancreatic cancer, each with 6 different HOP-duodenum separation distances. The duodenal volume receiving 15 Gy (V15), 20 Gy (V20), and 33 Gy (V33) was assessed for each iteration. RESULTS In the 3 cadaveric studies, an average of 0.9 cm, 1.1 cm, and 0.9 cm HOP-duodenum separation was achieved. In the 2 EUS cases, the V20 decreased from 3.86 cm3 to 0.36 cm3 and 3.75 cm3 to 1.08 cm3 (treatment constraint <3 cm3), and the V15 decreased from 7.07 cm3 to 2.02 cm3 and 9.12 cm3 to 3.91 cm3 (treatment constraint <9 cm3). The PTV coverage improved or was comparable between the pre- and postinjection studies. Modeling studies demonstrated that a separation of 8 mm was sufficient to consistently reduce the V15, V20, and V33 to acceptable clinical constraints. CONCLUSIONS Currently, dose escalation has been limited owing to radiosensitive structures adjacent to the pancreas. We demonstrated the feasibility of hydrogel separation of the HOP and duodenum. Future studies will evaluate the safety and efficacy of this technique with the potential for more effective dose escalation using SBRT or intensity-modulated radiation therapy to improve the outcomes in patients with unresectable pancreatic cancer.
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Affiliation(s)
- Avani D Rao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ziwei Feng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eun Ji Shin
- Department of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jin He
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kevin M Waters
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephanie Coquia
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert DeJong
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lauren M Rosati
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lin Su
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dengwang Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Juan Jackson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephen Clark
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeffrey Schultz
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Danielle Hutchings
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Seong-Hun Kim
- Department of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Theodore L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph M Herman
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer. Radiother Oncol 2017; 125:439-444. [PMID: 28811038 DOI: 10.1016/j.radonc.2017.07.028] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/23/2017] [Accepted: 07/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE To implement a robust and fast stereotactic MR-guided adaptive radiation therapy (SMART) online strategy in locally advanced pancreatic cancer (LAPC). MATERIAL AND METHODS SMART strategy for plan adaptation was implemented with the MRIdian system (ViewRay Inc.). At each fraction, OAR (re-)contouring is done within a distance of 3cm from the PTV surface. Online plan re-optimization is based on robust prediction of OAR dose and optimization objectives, obtained by building an artificial neural network (ANN). Proposed limited re-contouring strategy for plan adaptation (SMART3CM) is evaluated by comparing 50 previously delivered fractions against a standard (re-)planning method using full-scale OAR (re-)contouring (FULLOAR). Plan quality was assessed using PTV coverage (V95%, Dmean, D1cc) and institutional OAR constraints (e.g. V33Gy). RESULTS SMART3CM required a significant lower number of optimizations than FULLOAR (4 vs 18 on average) to generate a plan meeting all objectives and institutional OAR constraints. PTV coverage with both strategies was identical (mean V95%=89%). Adaptive plans with SMART3CM exhibited significant lower intermediate and high doses to all OARs than FULLOAR, which also failed in 36% of the cases to adhere to the V33Gy dose constraint. CONCLUSIONS SMART3CM approach for LAPC allows good OAR sparing and adequate target coverage while requiring only limited online (re-)contouring from clinicians.
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Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal Tissue Constraints for Abdominal and Thoracic Stereotactic Body Radiotherapy. Semin Radiat Oncol 2017; 27:197-208. [PMID: 28577827 DOI: 10.1016/j.semradonc.2017.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy has become an established standard of care for the treatment of a variety of malignancies, our understanding of normal tissue dose tolerance with extreme hypofractionation remains immature. Since Timmerman initially proposed normal tissue dose constraints for SBRT in the 2008 issue of Seminars of Radiation Oncology, experience with SBRT has grown, and more long-term clinical outcome data have been reported. This article reviews the modern toxicity literature and provides updated clinically practical and useful recommendations of SBRT dose constraints for extracranial sites. We focus on the major organs of the thoracic and upper abdomen, specifically the liver and the lung.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA.
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LaCouture TA, Xue J, Subedi G, Xu Q, Lee JT, Kubicek G, Asbell SO. Small Bowel Dose Tolerance for Stereotactic Body Radiation Therapy. Semin Radiat Oncol 2016; 26:157-64. [DOI: 10.1016/j.semradonc.2015.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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