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Xu D, Descovich M, Liu H, Sheng K. Robust localization of poorly visible tumor in fiducial free stereotactic body radiation therapy. Radiother Oncol 2024; 200:110514. [PMID: 39214256 DOI: 10.1016/j.radonc.2024.110514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/27/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND PURPOSE Effective respiratory motion management reduces healthy tissue toxicity and ensures sufficient dose delivery to lung cancer cells in pulmonary stereotactic body radiation therapy (SBRT) with high fractional doses. An articulated robotic arm paired with an X-ray imaging system is designed for real-time motion-tracking (RTMT) dose delivery. However, small tumors (<15 mm) or tumors at challenging locations may not be visible in the X-ray images, disqualifying patients with such tumors from RTMT dose delivery unless fiducials are implanted via an invasive procedure. To track these practically invisible lung tumors in SBRT, we hereby develop a deep learning-enabled template-free tracking framework, SAFE Track. METHODS SAFE Track is a fully supervised framework that trains a generalizable prior for template-free target localization. Two sub-stages are incorporated in SAFE Track, including the initial pretraining on two large-scale medical image datasets (DeepLesion and Node21) followed by fine-tuning on our in-house dataset. A two-stage detector, Faster R-CNN, with a backbone of ResNet50, was selected as our detection network. 94 patients (415 fractions; 40,348 total frames) with low tumor visibility who thus had implanted fiducials were included. The cohort is categorized by the longest dimension of the tumor (<10 mm, 10-15 mm and > 15 mm). The patients were split into training (n = 66) and testing (n = 28) sets. We simulated fiducial-free tumors by removing the fiducials from the X-ray images. We classified the patients into two groups - fiducial implanted inside tumors and implanted outside tumors. To ensure the rigor of our experiment design, we only conducted fiducial removal simulation in training patients and utilized patients with fiducial implanted outside of the tumors for testing. Commercial Xsight Lung Tracking (XLT) and a Deep Match were included for comparison. RESULTS SAFE Track achieves promising outcomes to as accurate as 1.23±1.32 mm 3D distance in testing patients with tumor size > 15 mm where Deep Match is at 4.75±1.67 mm and XLT is at 12.23±4.58 mm 3D distance. Even for the most challenging tumor size (<10 mm), SAFE Track maintains its robustness at 1.82 plus or minus 1.67 mm 3D distance, where Deep Match is at 5.32 plus or minus 2.32 mm, and XLT is at 24.83±12.95 mm 3D distance. Moreover, SAFE Track can detect some considerably challenging cases where the tumor is almost invisible or overlapped with dense anatomies. CONCLUSION SAFE Track is a robust, clinically compatible, fiducial-free, and template-free tracking framework that is applicable to patients with small tumors or tumors obscured by overlapped anatomies in SBRT.
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Affiliation(s)
- Di Xu
- Radiation Oncology, University of California, San Francisco, USA
| | | | - Hengjie Liu
- Radiation Oncology, University of California, Los Angeles, USA
| | - Ke Sheng
- Radiation Oncology, University of California, San Francisco, USA.
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Qiao K, Wei Y, Tao C, Zhu J, Yuan S. Proton therapy for breast cancer: Reducing toxicity. Thorac Cancer 2024. [PMID: 39275876 DOI: 10.1111/1759-7714.15451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/25/2024] [Accepted: 09/03/2024] [Indexed: 09/16/2024] Open
Abstract
Radiotherapy is a crucial component in the holistic management of breast cancer, with approximately 60% of individuals diagnosed with breast cancer requiring this treatment. As the survival rate of individuals with breast cancer has significantly increased, there is a growing focus on the long-term well-being of patients. Proton therapy (PT) is a new and rapidly developing radiotherapy method. In comparison with conventional photon therapy, PT offers the benefits of decreased radiation toxicity and increased dosage in the designated region. This can extend patients' lifespan and enhance their overall well-being. The present analysis examines the function of PT in diminishing the harmful effects of radiation in cases of breast cancer, while also providing a brief overview of the future potential and obstacles associated with PT for breast cancer.
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Affiliation(s)
- Kailin Qiao
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yuchun Wei
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Cheng Tao
- Department of Radiation Oncology Physics & Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhu
- Department of Radiation Oncology Physics & Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuanghu Yuan
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Han D, Dong J, Wang Q, Li B, Liu J, Liu H, Qiu B, Zhang W, Yang H, Shen W, Zhang Y, Zhu X, Wang Y, Wu L, Sun H, Huang W. Neoadjuvant radiation target volume definition in esophageal squamous cell cancer: a multicenter recommendations from Chinese experts. BMC Cancer 2024; 24:1086. [PMID: 39223503 PMCID: PMC11367793 DOI: 10.1186/s12885-024-12825-2] [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: 03/27/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study aimed to establish a consensus on the delineation of target volumes for neoadjuvant radiation therapy (nRT) in esophageal squamous cell carcinoma (ESCC) within China. METHODS From February 2020 to June 2021, nine ESCC patients who received nRT were retrospectively selected from Sun Yat-sen University Cancer Center and Shandong Cancer Hospital. A panel from eight cancer radiotherapy centers performed two rounds of nRT target volume delineation for these patients: the first round for cases 1-6 and the second for cases 7-9. Online meetings were held after each delineation round to discuss findings. The consistency of delineations across centers was compared using mean undirected Hausdorff distances (Hmean), dice similarity coefficients (DSC), and total volumes, analyzed with the Mann-Whitney U test. RESULTS The second round of delineations showed improved consistency across centers (total clinical target volume (CTVtotal): mean DSC = 0.76-0.81; mean Hmean = 2.11-3.14 cm) compared to the first round (CTVtotal: mean DSC = 0.63-0.64; mean Hmean = 5.66-7.34 cm; DSC and Hmean: P < 0.050 between rounds), leading to the formation of a consensus and an atlas for ESCC nRT target volume delineation. A proposal was reached through evaluating target volume delineations, analyzing questionnaire survey outcomes, and reviewing pertinent literature. CONCLUSIONS We have developed guidelines and an atlas for target volume delineation in nRT therapy for ESCC in China. These resources are designed to facilitate more consistent delineation of target volumes in both clinical practice and clinical trials.
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Affiliation(s)
- Dan Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Jinling Dong
- Department of Oncology, Yankuang New Journey General Hospital, Zoucheng, 273500, China
| | - Qifeng Wang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Jun Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200050, China
| | - Hui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Bo Qiu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Wencheng Zhang
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Hong Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Wenbin Shen
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050017, China
| | - Yaowen Zhang
- Department sixth of Radiotherapy, Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, 455001, China
| | - Xiangzhi Zhu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Yi Wang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Lei Wu
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Huaiyin distract, Jinan, 250117, Shandong Province, China.
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Boothe PF, Kumar VP, Kong Y, Wang K, Levinson H, Mu D, Brown ML. Radiation Induced Skin Fibrosis (RISF): Opportunity for Angiotensin II-Dependent Intervention. Int J Mol Sci 2024; 25:8261. [PMID: 39125831 PMCID: PMC11312688 DOI: 10.3390/ijms25158261] [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: 07/04/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Medical procedures, such as radiation therapy, are a vital element in treating many cancers, significantly contributing to improved survival rates. However, a common long-term complication of such exposure is radiation-induced skin fibrosis (RISF), a complex condition that poses substantial physical and psychological challenges. Notably, about 50% of patients undergoing radiation therapy may achieve long-term remission, resulting in a significant number of survivors managing the aftereffects of their treatment. This article delves into the intricate relationship between RISF, reactive oxygen species (ROS), and angiotensin II (Ang II) signaling. It proposes the underlying mechanisms and examines potential treatments for mitigating skin fibrosis. The primary goal is to offer essential insights in order to better care for and improve the quality of life of cancer survivors who face the risk of developing RISF.
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Affiliation(s)
- Patricia F. Boothe
- Department of Internal Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA
| | - Vidya P. Kumar
- Armed Forces Radiobiology Research Institute, The Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Yali Kong
- Department of Biomedical and Translational Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA; (Y.K.); (D.M.)
| | - Kan Wang
- Department of Biomedical and Translational Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA; (Y.K.); (D.M.)
| | - Howard Levinson
- The Center for Plastic Surgery at Sentara, 301 Riverview Ave. #400, Norfolk, VA 23510, USA;
| | - David Mu
- Department of Biomedical and Translational Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA; (Y.K.); (D.M.)
- Leroy T. Canoles Jr. Cancer Research Center, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA
| | - Milton L. Brown
- Department of Internal Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA
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Caroprese M, Cella L, Barillaro A, Oliviero C, Clemente S, Mainenti P, Pacelli R, Conson M. Bronchiolitis Obliterans Organizing Pneumonia After Breast Radiation Therapy. Pract Radiat Oncol 2024:S1879-8500(24)00151-6. [PMID: 39032596 DOI: 10.1016/j.prro.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/15/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
Presented here is a case report of a 77-year-old woman affected by rheumatoid arthritis who underwent breast-conserving surgery followed by radiation therapy (RT) for left-breast cancer and developed bronchiolitis obliterans organizing pneumonia (BOOP) after RT and during a COVID-19 vaccination campaign. BOOP incidence is an uncommon morbidity after breast RT (1.2%-2.9%); however, specific predisposing factors can play a role. In this patient, both rheumatoid arthritis and the vaccine may have predisposed her to an increased risk of organizing pneumonia, probably by triggering a proinflammatory cascade. Our report highlights the importance of factors that influence the occurrence of uncommon radiation-induced morbidities, such as BOOP, in specific subsets of patients. Further studies are necessary to evaluate factors increasing radiation sensitivity.
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Affiliation(s)
- Mara Caroprese
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy.
| | - Laura Cella
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy
| | - Angela Barillaro
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Caterina Oliviero
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Napoli, Italy
| | - Stefania Clemente
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Napoli, Italy
| | - Pierpaolo Mainenti
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, University Federico II, Napoli, Italy
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Wei H, Han W, Zhang X, Zhang M. Gastroscopic observation and dose-volume histogram parameter study on gastrointestinal mucous injury for pancreatic cancer treated with TOMO. Medicine (Baltimore) 2024; 103:e38469. [PMID: 38905414 PMCID: PMC11191859 DOI: 10.1097/md.0000000000038469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/15/2024] [Indexed: 06/23/2024] Open
Abstract
To explore the relationships between gastrointestinal radiation injuries of pancreatic cancer patients treated with TOMO and dose-volume histogram parameters prospectively. Seventy patients with pancreatic cancer who underwent TOMO were enrolled in this prospective study from February 2015 to May 2020. The clinical and dose-volume histogram parameters of the patients were collected. The optimal dose parameters for gastrointestinal radiation ulcers were confirmed based on the receiver operating characteristic curve (ROC) and the area below the ROC curve. Acute gastrointestinal tract toxic and side effect and injury grading correlation analyzed by Kruskal-Wallis rank sum test. Gastrointestinal injury often occurs during radiotherapy for pancreatic cancer, as observed using gastroscopy. The main adverse reactions were radioactive gastrointestinal inflammation (58.5%), radioactive gastrointestinal ulcers (41.4%), active bleeding (10%), newly-developed gastric retention (8.6%), and gastric varices (5.7%). As for the stomach, Dmean and V10 were related to radiation ulcer injury. ROC curve indicated that for stomach a Dmean of 13.39 Gy (area under ROC curves = 0.74, P = .048) and a V10 of 72.21% (area = 0.74, P = .048) was the tolerated dose for the injury of stomach radiation ulcer. As for duodenum, aV20 and aV25 are related to radiation ulcer injury. ROC curve indicated that aV20 of 22.82 cm3 (area = 0.68, P = .025) and aV25 of 32.04 cm3 (area = 0.66, P < .047) was the tolerated dose for the injury of duodenum radiation ulcer. The acute gastrointestinal tract toxic and side effects have no significant correlation with injury grading under gastroscope. Dmean > 13.39 Gy and V10 > 72.21% were the key dosimetric indices for predicting radiation-induced gastric ulcer, and aV20 > 22.82 cm3 and aV25 > 32.04 cm3 were for duodenal. Gastrointestinal reactions cannot be used as an overall basis for the diagnosis of gastrointestinal injury, and gastroscopy is recommended as a review item after radiotherapy.
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Affiliation(s)
- Hualin Wei
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei, PR China
| | - Wei Han
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei, PR China
| | - Xianbo Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei, PR China
| | - Ming Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei, PR China
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Chirilă ME, Kraja F, Marta GN, Neves Junior WFP, de Arruda GV, Gouveia AG, Franco P, Poortmans P, Ratosa I. Organ-sparing techniques and dose-volume constrains used in breast cancer radiation therapy - Results from European and Latin American surveys. Clin Transl Radiat Oncol 2024; 46:100752. [PMID: 38425691 PMCID: PMC10900109 DOI: 10.1016/j.ctro.2024.100752] [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: 12/31/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Advances in local and systemic therapies have improved the outcomes of patients with breast cancer (BC), leading to a possible increased risk for postoperative radiation therapy (RT) late adverse events. The most adequate technologies and dose constraints for organs at risk (OAR) in BC RT have yet to be defined. Methods An online survey was distributed to radiation oncologists (ROs) practicing in Europe and Latin America including the Caribbean (LAC) through personal contacts, RO and BC professional groups' networks. Demographic data and clinical practice information were collected. Results The study included 585 responses from ROs practicing in 57 different countries. The most frequently contoured OAR by European and LAC participants were the whole heart (96.6 % and 97.7 %), the ipsilateral (84.3 % and 90.8 %), and contralateral lung (71.3 % and 77.4 %), whole lung (69.8 % and 72.9 %), and the contralateral breast (66.4 % and. 83.2 %). ESTRO guidelines were preferred in Europe (33.3 %) and the RTOG contouring guideline was the most popular in LAC (62.2 %), while some participants used both recommendations (13.2 % and 19.2 %). IMRT (68.6 % and 59.1 %) and VMAT (65.6 % and 60.2 %) were the preferred modalities used in heart sparing strategies, followed by deep inspiration breath-hold (DIBH) (54.8 % and 37.4 %) and partial breast irradiation (PBI) (41.6 % and 24.6 %). Only a small percentage of all ROs reported the dose-volume constraints for OAR used in routine clinical practice. A mean heart dose (Heart-Dmean) between 4 and 5 Gy was the most frequently reported parameter (17.2 % and 39.3 %). Conclusion The delineation approaches and sparing techniques for OAR in BC RT vary between ROs worldwide. The low response rate to the dose constraints subset of queries reflects the uncertainty surrounding this topic and supports the need for detailed consensus recommendations in the clinical practice.
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Affiliation(s)
- Monica-Emila Chirilă
- Radiation Oncology Department, Amethyst Radiotherapy Centre, Cluj-Napoca, Romania
- Department of Clinical Development, MVision AI, Helsinki, Finland
| | - Fatjona Kraja
- Surgery Department, Faculty of Medicine, University of Medicine Tirana, Albania
- Department of Oncology, University Hospital Centre Mother Teresa, Tirana, Albania
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Radiology and Oncology Department, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Wellington Furtado Pimenta Neves Junior
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Radiology and Oncology Department, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gustavo Viani de Arruda
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - André Guimarães Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Pierfrancesco Franco
- Department of Translational Sciences (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Faculty of Medicine and Health Sciences, University of Antwerp, Iridium Netwerk, Wilrijk-Antwerp, Belgium
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
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Kong Y, Su M, Zhu Y, Li X, Zhang J, Gu W, Yang F, Zhou J, Ni J, Yang X, Zhu Z, Huang J. Enhancing the prediction of symptomatic radiation pneumonitis for locally advanced non-small-cell lung cancer by combining 3D deep learning-derived imaging features with dose-volume metrics: a two-center study. Strahlenther Onkol 2024:10.1007/s00066-024-02221-x. [PMID: 38498173 DOI: 10.1007/s00066-024-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE This study aims to examine the ability of deep learning (DL)-derived imaging features for the prediction of radiation pneumonitis (RP) in locally advanced non-small-cell lung cancer (LA-NSCLC) patients. MATERIALS AND METHODS The study cohort consisted of 90 patients from the Fudan University Shanghai Cancer Center and 59 patients from the Affiliated Hospital of Jiangnan University. Occurrences of RP were used as the endpoint event. A total of 512 3D DL-derived features were extracted from two regions of interest (lung-PTV and PTV-GTV) delineated on the pre-radiotherapy planning CT. Feature selection was done using LASSO regression, and the classification models were built using the multilayered perceptron method. Performances of the developed models were evaluated by receiver operating characteristic curve analysis. In addition, the developed models were supplemented with clinical variables and dose-volume metrics of relevance to search for increased predictive value. RESULTS The predictive model using DL features derived from lung-PTV outperformed the one based on features extracted from PTV-GTV, with AUCs of 0.921 and 0.892, respectively, in the internal test dataset. Furthermore, incorporating the dose-volume metric V30Gy into the predictive model using features from lung-PTV resulted in an improvement of AUCs from 0.835 to 0.881 for the training data and from 0.690 to 0.746 for the validation data, respectively (DeLong p < 0.05). CONCLUSION Imaging features extracted from pre-radiotherapy planning CT using 3D DL networks could predict radiation pneumonitis and may be of clinical value for risk stratification and toxicity management in LA-NSCLC patients. CLINICAL RELEVANCE STATEMENT Integrating DL-derived features with dose-volume metrics provides a promising noninvasive method to predict radiation pneumonitis in LA-NSCLC lung cancer radiotherapy, thus improving individualized treatment and patient outcomes.
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Affiliation(s)
- Yan Kong
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
| | - Mingming Su
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
- Department of Medical Oncology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People's Hospital, 214187, Wuxi, Jiangsu, China
| | - Yan Zhu
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
| | - Xuan Li
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
- Department of Medical Oncology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People's Hospital, 214187, Wuxi, Jiangsu, China
| | - Jinmeng Zhang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Wenchao Gu
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, 305-8577, Ibaraki, Japan
| | - Fei Yang
- Department of Radiation Oncology, University of Miami, 33136, Miami, FL, USA
| | - Jialiang Zhou
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui, 200032, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China.
| | - Jianfeng Huang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 1000 Hefeng Road, 214122, Wuxi, Jiangsu, China.
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Masuo M, Shinohara E, Kitano M, Maruta R, Chonabayashi S, Endo S, Matumoto S, Nishiyama N, Machitori Y, Kobayashi M. A comparison of the incidence of ≥ grade 2 radiation pneumonitis between intensity-modulated radiotherapy and three-dimensional conformal radiotherapy in patients with unresectable non-small cell lung cancer treated with durvalumab after concurrent chemoradiotherapy. Jpn J Clin Oncol 2024; 54:312-318. [PMID: 38010609 DOI: 10.1093/jjco/hyad158] [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: 08/01/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) has been increasingly used as a new radiation modality for unresectable non-small cell lung cancer (NSCLC). The risk factors for radiation pneumonitis (RP) during consolidation durvalumab following concurrent chemoradiotherapy (CCRT) using IMRT have not been thoroughly investigated. METHODS This retrospective study analyzed medical record data from consecutive patients diagnosed with NSCLC who underwent CCRT and consolidation durvalumab at our institution between April 2018 and September 2022. Since we adopted IMRT for the treatment of NSCLC in April 2020, these patients were categorized into two groups: those treated with IMRT after April 2020 and those treated with three-dimensional conformal radiotherapy (3D-CRT) before April 2020. RESULTS A total of 31 patients underwent IMRT (the IMRT group), while 25 patients underwent 3D-CRT (the 3D-CRT group). In both groups, the total dose was 60 Gy in 30 fractions. The cumulative incidence of ≥ grade 2 RP at 12 months was significantly lower in the IMRT group than in the 3D-CRT group (27.0% vs. 64.0%, hazard ratio [HR]: 0.338, 95% confidence interval [CI]: 0.144-0.793, p = 0.013). In the multivariable analysis, V20 (≥ 25.6%, HR: 2.706, 95% CI: 1.168-6.269, p = 0.020) and radiotherapy technique (IMRT, HR: 0.414, 95% CI: 0.172-0.994, p = 0.048) were identified as significant risk factors for ≥ grade 2 RP. CONCLUSIONS IMRT is associated with a lower rate of ≥ grade 2 RP in patients with NSCLC who received CCRT followed by durvalumab.
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Affiliation(s)
- Masahiro Masuo
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Eiko Shinohara
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Masataka Kitano
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Ryusuke Maruta
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Satoshi Chonabayashi
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
- Department of Respiratory Medicine, Kashiwa City Hospital, Chiba 277-0825, Japan
| | - Shun Endo
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Suhei Matumoto
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Naoki Nishiyama
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Yumiko Machitori
- Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
| | - Masayoshi Kobayashi
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-1022, Japan
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10
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Li XJ, Li CR, Ye YC, Zhang YS, Zong XQ, Feng CL. A Dosimetric Comparative Study of Carbon-Ion Radiotherapy Versus X-ray Volumetric Modulated Arc Therapy for Stage III Non-Small-Cell Lung Cancer. Niger J Clin Pract 2024; 27:236-243. [PMID: 38409153 DOI: 10.4103/njcp.njcp_734_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Compared to photon beam, carbon-ion radiotherapy (CIRT) has both physical and biological advantages. AIM To examine whether two-dimensional (2D) CIRT is dosimetrically superior to photon beam volume-modulated arc therapy (VMAT) in protecting the normal tissues for stage III non-small-cell lung cancer (NSCLC). SUBJECTS AND METHODS A retrospective study was conducted. Thirteen patients with stage III NSCLC treated in our center with curative CIRT and a sham photon beam VMAT treatment planning with the same normal tissue dose constraints were included for analysis. Target dose distributions and the homogeneity index (HI) within the planning target volumes were compared. RESULTS Both CIRT and VMAT plans have good tumor coverage with no significant differences in D98, D95, and D50 of Planning target volume 1 (PTV1) between the two plans. The HIs between the two plans are similar. The HI of PTV2 is superior in the CIRT plan (CIRT vs. VMAT: 0.08 vs. 0.16, P < 0.05). In general, CIRT results in a lower dose of the organ-at-risk (OAR) than the photon plans. The V5, V10, V20, V30, V40, and Dmean of the contralateral lung in the CIRT plan are significantly lower than that of the photon VMAT. For the ipsilateral lung, the V5 of CIRT is significantly lower. The CIRT also had significantly lower spinal cord Dmax, esophageal Dmean and V50, V10 and V30 of bone, and V50 of the trachea and bronchial tree. CONCLUSIONS Compared with photon VMAT, 2D-CIRT using the passive beam scanning technique significantly reduces the radiation dose to the OARs in curative radiotherapy of stage III NSCLC, suggesting a better protection of the normal tissues.
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Affiliation(s)
- X-J Li
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - C-R Li
- Radiotherapy Center, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Y-C Ye
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - Y-S Zhang
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - X-Q Zong
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
| | - C L Feng
- Heavy Ion Radiotherapy Department, Wuwei Cancer Hospital and Institute, Wuwei Academy of Medical Sciences, Wuwei, Gansu, China
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11
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Aoyama T, Shimizu H, Koide Y, Kamezawa H, Fukunaga JI, Kitagawa T, Tachibana H, Suzuki K, Kodaira T. Deep Learning-based Lung dose Prediction Using Chest X-ray Images in Non-small Cell Lung Cancer Radiotherapy. J Med Phys 2024; 49:33-40. [PMID: 38828071 PMCID: PMC11141742 DOI: 10.4103/jmp.jmp_122_23] [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: 09/15/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This study aimed to develop a deep learning model for the prediction of V20 (the volume of the lung parenchyma that received ≥20 Gy) during intensity-modulated radiation therapy using chest X-ray images. Methods The study utilized 91 chest X-ray images of patients with lung cancer acquired routinely during the admission workup. The prescription dose for the planning target volume was 60 Gy in 30 fractions. A convolutional neural network-based regression model was developed to predict V20. To evaluate model performance, the coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE) were calculated with conducting a four-fold cross-validation method. The patient characteristics of the eligible data were treatment period (2018-2022) and V20 (19.3%; 4.9%-30.7%). Results The predictive results of the developed model for V20 were 0.16, 5.4%, and 4.5% for the R2, RMSE, and MAE, respectively. The median error was -1.8% (range, -13.0% to 9.2%). The Pearson correlation coefficient between the calculated and predicted V20 values was 0.40. As a binary classifier with V20 <20%, the model showed a sensitivity of 75.0%, specificity of 82.6%, diagnostic accuracy of 80.6%, and area under the receiver operator characteristic curve of 0.79. Conclusions The proposed deep learning chest X-ray model can predict V20 and play an important role in the early determination of patient treatment strategies.
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Affiliation(s)
- Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hidemi Kamezawa
- Division of Radiological Sciences, Graduate School of Health Sciences, Teikyo University, Fukuoka, Japan
| | - Jun-Ichi Fukunaga
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | | | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
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12
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Bai H, Song H, Li Q, Bai J, Wang R, Liu X, Chen F, Pan X. Application of dose-gradient function in reducing radiation induced lung injury in breast cancer radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:415-426. [PMID: 38189733 PMCID: PMC11091614 DOI: 10.3233/xst-230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Try to create a dose gradient function (DGF) and test its effectiveness in reducing radiation induced lung injury in breast cancer radiotherapy. MATERIALS AND METHODS Radiotherapy plans of 30 patients after breast-conserving surgery were included in the study. The dose gradient function was defined as DGH=VDVp3, then the area under the DGF curve of each plan was calculated in rectangular coordinate system, and the minimum area was used as the trigger factor, and other plans were triggered to optimize for area reduction. The dosimetric parameters of target area and organs at risk in 30 cases before and after re-optimization were compared. RESULTS On the premise of ensuring that the target dose met the clinical requirements, the trigger factor obtained based on DGF could further reduce the V5, V10, V20, V30 and mean lung dose (MLD) of the ipsilateral lung in breast cancer radiotherapy, P < 0.01. And the D2cc and mean heart dose (MHD) of the heart were also reduced, P < 0.01. Besides, the NTCPs of the ipsilateral lung and the heart were also reduced, P < 0.01. CONCLUSION The trigger factor obtained based on DGF is efficient in reducing radiation induced lung injury in breast cancer radiotherapy.
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Affiliation(s)
- Han Bai
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
- Department of Physics and Astronomy, Yunnan University, Kunming, Yunnan
| | - Hui Song
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
| | - Qianyan Li
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
| | - Jie Bai
- Department of Radiation Oncology, Daqin Tumor Hospital, Guiyang, Guizhou, China
| | - Ru Wang
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
| | - Xuhong Liu
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
| | - Feihu Chen
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
| | - Xiang Pan
- Department of Radiation Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Xishan District, Kunming, Yunnan, People’s Republic of China
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13
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Li Q, Deng F, Pan X, Bai H, Bai J, Liu X, Chen F, Ge R. Application research on reducing radiation-induced lung injury with a trigger operator based on overlap volume histogram (OVH) in breast cancer postoperative radiotherapy. Sci Rep 2023; 13:22042. [PMID: 38086847 PMCID: PMC10716111 DOI: 10.1038/s41598-023-49282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
This study aims to develop a trigger operator based on the Overlap Volume Histogram (OVH) and examined its effectiveness in enhancing plan quality to minimize radiation-induced lung injury in postoperative radiotherapy for breast cancer. This trigger operator was applied for plan re-optimization to the previous Volumetric Modulated Arc Therapy (VMAT) plans of 16 left breast conserving surgery cases. These cases were categorized into a Contiguous Group (CG) and a Separated Group (SG) based on the relative position between the target and the Left-Lung (L-Lung). We investigated the changes in Vx, mean dose, and Normal Tissue Complication Probability (NTCP) values of organs-at-risk (OARs) before and after using the trigger operator. The Pairwise Sample T test was employed to evaluate the differences in indices between the two groups before and after optimizations. The trigger operator effectively initiated plan re-optimization. The values of V5, V10, V20, V30, and V40 of the L-Lung, as well as the mean dose of the heart, all decreased after re-optimization. The Pairwise Sample T test results showed statistically significant differences in the V20, V30, and V40 of the L-Lung in the CG (P < 0.01), and in the V5, V10, V20, V30, and V40 of the L-Lung in the SG (P < 0.01). Our findings suggest that the proposed trigger operator can improve plan quality, thereby reducing radiation-induced lung injury in postoperative radiotherapy for breast cancer.
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Affiliation(s)
- Qianyan Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Feifei Deng
- Department of Oncology, 920Th Hospital of Joint Logistics Support Force, PLA, Kunming, Yunnan, China
| | - Xiang Pan
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Han Bai
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China.
- Department of Physics and Astronomy, Yunnan University, Kunming, Yunnan, China.
| | - Jie Bai
- Department of Radiation Oncology, Daqin Tumor Hospital, Guiyang, Guizhou, China
| | - Xuhong Liu
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Feihu Chen
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Ren Ge
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hongkong, China
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14
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Lee SH, Geng H, Arnold J, Caruana R, Fan Y, Rosen MA, Apte AP, Deasy JO, Bradley JD, Xiao Y. Interpretable Machine Learning for Choosing Radiation Dose-volume Constraints on Cardio-pulmonary Substructures Associated with Overall Survival in NRG Oncology RTOG 0617. Int J Radiat Oncol Biol Phys 2023; 117:1270-1286. [PMID: 37343707 PMCID: PMC10728350 DOI: 10.1016/j.ijrobp.2023.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/08/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Our objective was to use interpretable machine learning for choosing dose-volume constraints on cardiopulmonary substructures (CPSs) associated with overall survival (OS) in radiation therapy for locally advanced non-small cell lung cancer. METHODS AND MATERIALS A total of 428 patients with non-small cell lung cancer were randomly divided into training/validation/test subsets (n = 230/149/49) in Radiation Therapy Oncology Group 0617. Manual or automated contouring was performed to segment CPSs, including heart, atria, ventricles, aorta, left/right ventricle/atrium (LV+RV+LA+RA), inferior/superior vena cava, pulmonary artery, and pericardium. Peri (pericardium-heart), rest (heart-[LV+RV+LA+RA]), clinical target volume (CTV), and lungs-CTV contours were also obtained. Dose-volume histogram features were extracted, including minimum/mean dose to the hottest x% volume (Dx%[Gy]/MOHx%[Gy]), minimum/mean/maximum dose, percent volume receiving at least xGy (VxGy[%]), and overlapping volume of each CPS with planning target volume (PTV_Voverlap[%]). Clinical parameters were collected from the National Clinical Trials Network/Community oncology research program data archive. Feature selection was performed using a series of multiblock sparse partial least squares regression, stability selection supervised principal component analysis, and Boruta. Explainable boosting machine (EBM) was trained using a conditional survival distribution-based approach for imputing censored data, treating survival analysis as a regression problem. Harrell's C-index was used to evaluate OS discrimination performance of EBM, Cox proportional hazards (CPH), random survival forest, extreme gradient boosting survival embeddings, and CPH deep neural network (DeepSurv) models in the test set. Dose-volume constraints were selected using the binary change point detection algorithm in Shapley additive explanations-based partial dependence functions. RESULTS Selected features included LA_V60Gy(%), pericardium_D30%(Gy), lungs-CTV_PTV_Voverlap(%), RA_V55Gy(%), and received_cons_chemo. All models ranked LA_V60Gy(%) as the most important feature. EBM achieved the best performance for predicting OS, followed by extreme gradient boosting survival embeddings, random survival forest, DeepSurv, and CPH (C-index = 0.653, 0.646, 0.642, 0.638, and 0.632). EBM global explanations suggested that LA_V60Gy(%) < 25.6, lungs-CTV_PTV_Voverlap(%) < 1.1, pericardium_D30%(Gy) < 18.9, RA_V55Gy(%) < 19.5, and received_cons_chemo = 'Yes' for improved OS. CONCLUSIONS EBM can be used to discriminate OS while also guiding dose-volume constraint selection for optimal management of cardiac toxicity in lung cancer radiation therapy.
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Affiliation(s)
- Sang Ho Lee
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Huaizhi Geng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacinta Arnold
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Yong Fan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark A Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditya P Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey D Bradley
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Batra U, Prabhash K, Agarwal JP, Darlong L, Munshi A, Penumadu P, Thangakunam B, Bansal A. Clinical management of stage III non-small cell lung cancer in India: An expert consensus statement. Asia Pac J Clin Oncol 2023; 19:606-617. [PMID: 36815621 DOI: 10.1111/ajco.13938] [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: 06/08/2022] [Revised: 11/17/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
Non-small cell lung cancer (NSCLC) is considered the most common type of lung cancer (>80% of all lung cancers); patients are often diagnosed at advanced stages of the disease. The management of NSCLC is considered challenging owing to variations in size, an extension of the tumors, involvement patterns, and classification. Although adequate literature and guidelines are available on the management of NSCLC in several countries, an Indian perspective on stage III NSCLC management is lacking. We used the modified Delphi approach to form consensus statements. A thorough literature search was done. The authors then convened and deliberated over published literature, available guidelines, and clinical judgment. Recommendation statements were formed for different clinical scenarios. These statements were sent as a form of survey to other oncologists, and their responses were recorded and mentioned. Evidence-based statements were formed for diagnosing and managing stage III NSCLC. These recommendation statements cover various aspects-surgical, radiation, and medical treatment in various clinical scenarios including adjuvant, neoadjuvant, and consolidation therapies.
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Affiliation(s)
- Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India
| | - Kumar Prabhash
- Department of Medical Oncology, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Laleng Darlong
- Department of Oncosurgery, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India
| | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, Delhi, India
| | | | | | - Abhishek Bansal
- Department of Radiology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, Delhi, India
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SHIRATO H. Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2023; 99:389-426. [PMID: 37821390 PMCID: PMC10749389 DOI: 10.2183/pjab.99.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Biomedical advances of external-beam radiotherapy (EBRT) with improvements in physical accuracy are reviewed. High-precision (±1 mm) three-dimensional radiotherapy (3DRT) can utilize respective therapeutic open doors in the tumor control probability curve and in the normal tissue complication probability curve instead of the one single therapeutic window in two-dimensional EBRT. High-precision 3DRT achieved higher tumor control and probable survival rates for patients with small peripheral lung and liver cancers. Four-dimensional radiotherapy (4DRT), which can reduce uncertainties in 3DRT due to organ motion by real-time (every 0.1-1 s) tumor-tracking and immediate (0.1-1 s) irradiation, have achieved reduced adverse effects for prostate and pancreatic tumors near the digestive tract and with similar or better tumor control. Particle beam therapy improved tumor control and probable survival for patients with large liver tumors. The clinical outcomes of locally advanced or multiple tumors located near serial-type organs can theoretically be improved further by integrating the 4DRT concept with particle beams.
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Affiliation(s)
- Hiroki SHIRATO
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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17
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Cui J, Xiao J, Hou Y, Wu X, Zhou J, Peng X, Wang Y. Unsupervised Domain Adaptive Dose Prediction via Cross-Attention Transformer and Target-Specific Knowledge Preservation. Int J Neural Syst 2023; 33:2350057. [PMID: 37771298 DOI: 10.1142/s0129065723500570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Radiotherapy is one of the leading treatments for cancer. To accelerate the implementation of radiotherapy in clinic, various deep learning-based methods have been developed for automatic dose prediction. However, the effectiveness of these methods heavily relies on the availability of a substantial amount of data with labels, i.e. the dose distribution maps, which cost dosimetrists considerable time and effort to acquire. For cancers of low-incidence, such as cervical cancer, it is often a luxury to collect an adequate amount of labeled data to train a well-performing deep learning (DL) model. To mitigate this problem, in this paper, we resort to the unsupervised domain adaptation (UDA) strategy to achieve accurate dose prediction for cervical cancer (target domain) by leveraging the well-labeled high-incidence rectal cancer (source domain). Specifically, we introduce the cross-attention mechanism to learn the domain-invariant features and develop a cross-attention transformer-based encoder to align the two different cancer domains. Meanwhile, to preserve the target-specific knowledge, we employ multiple domain classifiers to enforce the network to extract more discriminative target features. In addition, we employ two independent convolutional neural network (CNN) decoders to compensate for the lack of spatial inductive bias in the pure transformer and generate accurate dose maps for both domains. Furthermore, to enhance the performance, two additional losses, i.e. a knowledge distillation loss (KDL) and a domain classification loss (DCL), are incorporated to transfer the domain-invariant features while preserving domain-specific information. Experimental results on a rectal cancer dataset and a cervical cancer dataset have demonstrated that our method achieves the best quantitative results with [Formula: see text], [Formula: see text], and HI of 1.446, 1.231, and 0.082, respectively, and outperforms other methods in terms of qualitative assessment.
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Affiliation(s)
- Jiaqi Cui
- School of Computer Science, Sichuan University, Chengdu, P. R. China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yun Hou
- Agile and Intelligent Computing Key Laboratory, Southwest China Institute of Electronic Technology, Chengdu, P. R. China
| | - Xi Wu
- School of Computer Science, Chengdu University of Information Technology, P. R. China
| | - Jiliu Zhou
- School of Computer Science, Sichuan University, Chengdu, P. R. China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yan Wang
- School of Computer Science, Sichuan University, Chengdu, P. R. China
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18
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Ghassemi N, Castillo R, Castillo E, Jones BL, Miften M, Kavanagh B, Werner-Wasik M, Miller R, Barta JA, Grills I, Leiby BE, Guerrero T, Rusthoven CG, Vinogradskiy Y. Evaluation of variables predicting PFT changes for lung cancer patients treated on a prospective 4DCT-ventilation functional avoidance clinical trial. Radiother Oncol 2023; 187:109821. [PMID: 37516361 PMCID: PMC10529225 DOI: 10.1016/j.radonc.2023.109821] [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: 01/24/2023] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Functional avoidance radiotherapy uses functional imaging to reduce pulmonary toxicity by designing radiotherapy plans that reduce doses to functional regions of the lung. A phase-II, multi-center, prospective study of 4DCT-ventilation functional avoidance was completed. Pre and post-treatment pulmonary function tests (PFTs) were acquired and assessed pulmonary function change. This study aims to evaluate which clinical, dose and dose-function factors predict PFT changes for patients treated with 4DCT-ventilation functional avoidance radiotherapy. MATERIALS AND METHODS 56 patients with locally advanced lung cancer receiving radiotherapy were accrued. PFTs were obtained at baseline and three months following radiotherapy and included forced expiratory volume in 1-second (FEV1), forced vital capacity (FVC), and FEV1/FVC. The ability of patient, clinical, dose (lung and heart), and dose-function metrics (metrics that combine dose and 4DCT-ventilation-based function) to predict PFT changes were evaluated using univariate and multivariate linear regression. RESULTS Univariate analysis showed that only dose-function metrics and the presence of chronic obstructive pulmonary disease (COPD) were significant (p<0.05) in predicting FEV1 decline. Multivariate analysis identified a combination of clinical (immunotherapy status, presence of thoracic comorbidities, smoking status, and age), along with lung dose, heart dose, and dose-function metrics in predicting FEV1 and FEV1/FVC changes. CONCLUSION The current work evaluated factors predicting PFT changes for patients treated in a prospective functional avoidance radiotherapy study. The data revealed that lung dose- function metrics could predict PFT changes, validating the significance of reducing the dose to the functional lung to mitigate the decline in pulmonary function and providing guidance for future clinical trials.
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Affiliation(s)
- Nader Ghassemi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Miller
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julie A Barta
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Benjamin E Leiby
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
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19
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Niezink AGH, van der Schaaf A, Wijsman R, Chouvalova O, van der Wekken AJ, Rutgers SR, Pieterman RM, van Putten JWG, de Hosson SM, van der Leest AHD, Ubbels JF, Woltman-van Iersel M, Widder J, Langendijk JA, Muijs CT. External validation of NTCP-models for radiation pneumonitis in lung cancer patients treated with chemoradiotherapy. Radiother Oncol 2023; 186:109735. [PMID: 37327975 DOI: 10.1016/j.radonc.2023.109735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Normal tissue complication probability (NTCP) models can be used to estimate the risk of radiation pneumonitis (RP). The aim of this study was to externally validate the most frequently used prediction models for RP, i.e., the QUANTEC and APPELT models, in a large cohort of lung cancer patients treated with IMRT or VMAT. [1-2] METHODS AND MATERIALS: This prospective cohort study, included lung cancer patients treated between 2013 and 2018. A closed testing procedure was performed to test the need for model updating. To improve model performance, modification or removal of variables was considered. Performance measures included tests for goodness of fit, discrimination, and calibration. RESULTS In this cohort of 612 patients, the incidence of RP ≥ grade 2 was 14.5%. For the QUANTEC-model, recalibration was recommended which resulted in a revised intercept and adjusted regression coefficient (from 0.126 to 0.224) of the mean lung dose (MLD),. The APPELT-model needed revision including model updating with modification and elimination of variables. After revision, the New RP-model included the following predictors (and regression coefficients): MLD (B = 0.250), age (B = 0.049, and smoking status (B = 0.902). The discrimination of the updated APPELT-model was higher compared to the recalibrated QUANTEC-model (AUC: 0.79 vs. 0.73). CONCLUSIONS This study demonstrated that both the QUANTEC- and APPELT-model needed revision. Next to changes of the intercept and regression coefficients, the APPELT model improved further by model updating and performed better than the recalibrated QUANTEC model. This New RP-model is widely applicable containing non-tumour site specific variables, which can easily be collected.
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Affiliation(s)
- Anne G H Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Olga Chouvalova
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anthonie J van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Steven R Rutgers
- Department of Pulmonology, Treant Hospital Group, Scheper Hospital, Emmen, the Netherlands
| | - Remge M Pieterman
- Department of Pulmonary Diseases, Ommelander Hospital Groningen, Scheemda, the Netherlands
| | - John W G van Putten
- Department of Pulmonary Diseases, Martini Hospital Groningen, Groningen, the Netherlands
| | - Sander M de Hosson
- Department of Pulmonary Diseases, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Annija H D van der Leest
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan F Ubbels
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marleen Woltman-van Iersel
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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20
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Chen Y, Wu M. Exploration of molecular mechanism underlying protective effect of astragaloside IV against radiation-induced lung injury by suppressing ferroptosis. Arch Biochem Biophys 2023; 745:109717. [PMID: 37573925 DOI: 10.1016/j.abb.2023.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
In this study, we aimed to investigate the pharmacological effects and underlying mechanisms of astragaloside IV (AS IV) against radiation-induced lung injury. We established experimental models of radiation-induced lung injury and observed the effect of AS IV on cell viability, cell death, inflammatory responses and ferroptosis. Accordingly, we found that AS IV restored the suppressed cell viability and promoted cell death induced by X-ray irradiation. Moreover, radiation-induced up-regulation of lactate dehydrogenase (LDH) release, ferroptosis, reactive oxygen species (ROS) and inflammatory responses were also restored by AS IV in a dose-dependent manner. Besides, in radiation-induced lung injury C57BL/6 mice, AS IV evidently alleviated lung injury and promoted the survival rate of lung-injured mice. And the ferroptosis level in mice lung tissues were also alleviated by the administration of AS IV in a dose-dependent manner. As a conclusion, by comparing the changes of ferroptosis, ROS and inflammatory responses in the experimental models, we validated that AS IV could inhibit inflammatory responses and cell injury in the treatment of radiation-induced lung injury by suppressing ferroptosis. This finding not only find potentially effective treatments to mitigate radiation-induced lung injury, but also provides supporting evidence for clinical application of AS IV to improve the management of radiation-treated patients and minimize the associated lung complications or other adverse effects. Moreover, as inflammation and ROS are key contributors to tissue damage in various diseases, our study suggested the potential application of AS IV in the treatments for other diseases.
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Affiliation(s)
- Yunlong Chen
- Department of Oncology, Rudong County Hospital of Traditional Chinese Medicine, Rudong, Jiangsu, 226400, China
| | - Mianhua Wu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210046, China.
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21
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Kirakli EK, Erdem S, Susam S, Erim E. Ipsilateral lung dose as a correlative measure for radiation pneumonitis in patients treated with definitive concurrent radiochemotherapy. J Cancer Res Ther 2023; 19:1153-1159. [PMID: 37787278 DOI: 10.4103/jcrt.jcrt_618_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Objective Mean lung dose (MLD) and percent of total lung (TL) volume that receive a dose greater than 20 Gy (V20) have been the most validated parameters in the prediction of radiation pneumonitis (RP). However, these parameters present mean values of TL parenchyma and predict the right and the left lung as a unique functional organ unit, not take into account the difference in function and dose density between the lungs. Furthermore, there have been very limited data evaluating ipsilateral lung dosimetric constraints in addition to TL parameters to predict RP in non-small cell lung cancer (NSCLC) patients treated with radiochemotherapy (RCT). Methods Between 2010 and 2017, clinical-radiological findings of NSCLC patients treated with RCT were evaluated in terms of RP, retrospectively. MLD, V20, and V30 values of ipsilateral lung were assessed from dose-volume histogram and registered. The primary endpoint was to assess the relation between ipsilateral lung dose constraints and RP risk. Results There were 75 patients. There was ≥Grade 2 RP in 33 cases (%44). In univariate analysis, ipsilateral MLD, ipsilateral V20, ipsilateral V30, and TL V30 were found to be significant. Ipsilateral MLD and PTV were found to be the independent risk factors for RP. Cutoff values for RP risk were determined as 18Gy, 35%, and 28% for ipsilateral MLD, ipsilateral V20, and ipsilateral V30, respectively. Predictive values for ipsilateral MLD and ipsilateral V20 were higher than TL. Conclusions In NSCLC patients treated with RCT, MLD, V20, and V30 values of ipsilateral lung parameters might increase the predictability of RP risk in addition to TL parameters. Advances in Knowledge Cutoff values for RP risk were determined as 18Gy, 35%, and 28% for ipsilateral MLD, ipsilateral V20, and ipsilateral V30, respectively. Predictive values for ipsilateral MLD and ipsilateral V20 were higher than TL.
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Affiliation(s)
- Esra Korkmaz Kirakli
- Department of Radiation, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
| | - Sevilay Erdem
- Department of Radiation, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
| | - Eser Erim
- Department of Radiation, Dr. Suat Seren Chest Diseases and Surgery Research and Training Hospital, Konak, Izmir, Turkey
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22
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Alaswad M. Locally advanced non-small cell lung cancer: current issues and recent trends. Rep Pract Oncol Radiother 2023; 28:286-303. [PMID: 37456701 PMCID: PMC10348324 DOI: 10.5603/rpor.a2023.0019] [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: 08/16/2022] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
The focus of this paper was to review and summarise the current issues and recent trends within the framework of locally advanced (LA) non-small cell lung cancer (NSCLC). The recently proposed 8th tumour-node-metastases (TNM) staging system exhibited significant amendments in the distribution of the T and M descriptors. Every revision to the TNM classification should contribute to clinical improvement. This is particularly necessary regarding LA NSCLC stratification, therapy and outcomes. While several studies reported the superiority of the 8th TNM edition in comparison to the previous 7th TNM edition, in terms of both the discrimination ability among the various T subgroups and clinical outcomes, others argued against this interpretation. Synergistic cytotoxic chemotherapy with radiotherapy is most prevalent in treating LA NSCLC. Clinical trial experience from multiple references has reported that the risk of locoregional relapse and distant metastasis was less evident for patients treated with concomitant radiochemotherapy than radiotherapy alone. Nevertheless, concern persists as to whether major incidences of toxicity may occur due to the addition of chemotherapy. Cutting-edge technologies such as four-dimensional computed tomography (4D-CT) and volumetric modulated arc therapy (VMAT) should yield therapeutic gains due to their capability to conform radiation doses to tumours. On the basis of the preceding notion, the optimum radiotherapy technique for LA NSCLC has been a controversial and much-disputed subject within the field of radiation oncology. Notably, no single-perspective research has been undertaken to determine the optimum radiotherapy modality for LA NSCLC. The landscape of immunotherapy in lung cancer is rapidly expanding. Currently, the standard of care for patients with inoperable LA NSCLC is concurrent chemoradiotherapy followed by maintenance durvalumab according to clinical outcomes from the PACIFIC trial. An estimated 42.9% of patients randomly assigned to durvalumab remained alive at five years, and free of disease progression, thereby establishing a new benchmark for the standard of care in this setting.
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Affiliation(s)
- Mohammed Alaswad
- Comprehensive Cancer Centre, Radiation Oncology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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23
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Chen F, Niu J, Wang M, Zhu H, Guo Z. Re-evaluating the risk factors for radiation pneumonitis in the era of immunotherapy. J Transl Med 2023; 21:368. [PMID: 37287014 DOI: 10.1186/s12967-023-04212-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
As one of the common complications of radiotherapy, radiation pneumonia (RP) limits the prognosis of patients. Therefore, better identifying the high-risk factors that lead to RP is essential to effectively prevent its occurrence. However, as lung cancer treatment modalities are being replaced and the era of immunotherapy has arrived, literature that reviews the parameters and mode of radiotherapy, chemotherapy drugs, targeted drugs and current hot immune checkpoint inhibitors related to RP is lacking. This paper summarizes the risk factors for radiation pneumonia by retrieving and analysing previously published literature and the results of large clinical trials. The literature primarily included retrospective analyses, including clinical trials in different periods and a part of the literature review. A systematic literature search of Embase, PubMed, Web of Science, and Clinicaltrials.gov was performed for relevant publications up to 6 Dec. 2022. Search keywords include, but are not limited to, "radiation pneumonia", "pneumonia", "risk factors", "immunotherapy", etc. The factors related to RP in this paper include physical parameters of radiotherapy, including V5, V20, and MLD; chemoradiotherapy mode and chemotherapy drugs, including paclitaxel and gemcitabine; EGFR-TKI; ALK inhibitors; antiangiogenic drugs; immune drugs and the underlying disease of the patient. We also introduce the possible mechanism of RP. In the future, we hope that this article not only sounds the alarm for clinicians but also helps to identify a method that can effectively intervene and reduce the occurrence of RP, significantly improve the quality of life and prognosis of patients, and more effectively improve the therapeutic effect of radiation therapy.
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Affiliation(s)
- Feihu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Jiling Niu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Min Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
| | - Zhijun Guo
- Department of Intensive Care Unit, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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24
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Saroj DK, Yadav S, Paliwal N, Haldar S, Jagtap A, Kumar A. Assessment of Treatment Plan Quality between Flattening Filter and Flattening Filter Free Photon Beam for Carcinoma of the Esophagus with IMRT Technique. J Biomed Phys Eng 2023; 13:227-238. [PMID: 37312893 PMCID: PMC10258210 DOI: 10.31661/jbpe.v0i0.2108-1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
Background As compared to the flattened photon beam, removing the flattening filter (FF) from the head of a gantry decreases the average energy of the photon beam and increases the dose rate, leading to an impact on the quality of treatment plans. Objective This study aimed to compare the quality of intensity-modulated radiation therapy (IMRT) treatment plans for esophageal cancer with and without a flattened filter photon beam. Material and Methods In this analytical study, 12 patients, who had already been treated with a 6X FF photon beam, were treated based on new IMRT methods using a 6X the flattening filter-free (FFF) photon beam. Both 6X FF IMRT and 6X FFF IMRT plans used identical beam parameters and planning objectives. All plans were evaluated with planning indices and doses for organs at risk (OARs). Results Insignificant dose variation was for HI, CI, D98%, and V95% between FF and FFF photon beam IMRT plans. FF-based IMRT plan delivered a 15.51 % and 11.27% higher mean dose to both lungs and heart than the FFF plan, respectively. The integral dose (ID) for the heart and lungs was 11.21% and 15.51%, respectively, less in the IMRT plan with an FFF photon beam. Conclusion In contrast to the FF photon beam, a filtered photon beam-oriented IMRT plan provides significant OAR sparing without losing the quality of the treatment plan. High monitor units (MUs), low ID, and Beam on Time (BOT) are major highlights of the IMRT plan with FFF beam.
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Affiliation(s)
- Dinesh Kumar Saroj
- Department of Radiotherapy, Alexis Multispecialty Hospital Nagpur-440030 (Maharashtra), India
- Department of Science, Rabindranath Tagore University, Bhopal, Madhya Pradesh, India
| | - Suresh Yadav
- Department of Radiotherapy, Gandhi Medical College, Bhopal-462001 (M.P.), India
| | - Neetu Paliwal
- Department of Science, Rabindranath Tagore University, Bhopal, Madhya Pradesh, India
| | - Subhas Haldar
- Department of Radiotherapy, Saroj Gupta Cancer Center and Research Institute, Kolkata-700063 (West Bengal), India
| | - Amol Jagtap
- Department of Radiotherapy, Alexis Multispecialty Hospital Nagpur-440030 (Maharashtra), India
| | - Arvind Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences (AIIMS), Rishikesh-249203 (U.K.), India
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25
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Sakagami M, Inokuchi H, Mukumoto N, Itoyama H, Hamaura N, Yamagishi M, Mukumoto N, Matsuda S, Kabata D, Shibuya K. Clinical features and risk factors for interstitial lung disease spreading in low-dose irradiated areas after definitive radiotherapy with or without durvalumab consolidation therapy for patients with non-small cell lung cancer. Radiat Oncol 2023; 18:87. [PMID: 37217919 DOI: 10.1186/s13014-023-02276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The current standard of care for patients with unresectable locally advanced non-small cell lung cancer (NSCLC) is chemoradiotherapy (CRT) combined with durvalumab consolidation therapy. However, radiotherapy (RT) always carries the risk of radiation pneumonitis (RP), which can preclude durvalumab continuation. In particular, the spread of interstitial lung disease (ILD) in low-dose areas or extending beyond the RT field often makes it difficult to determine the safety of continuation or rechallenging of durvalumab. Thus, we retrospectively analyzed ILD/RP after definitive RT with and without durvalumab, with assessment of radiologic features and dose distribution in RT. METHODS We retrospectively evaluated the clinical records, CT imaging, and radiotherapy planning data of 74 patients with NSCLC who underwent definitive RT at our institution between July 2016 and July 2020. We assessed the risk factors for recurrence within one year and occurrence of ILD/RP. RESULTS Kaplan-Meier method showed that ≥ 7 cycles of durvalumab significantly improved 1-year progression free survival (PFS) (p < 0.001). Nineteen patients (26%) were diagnosed with ≥ Grade 2 and 7 (9.5%) with ≥ Grade 3 ILD/RP after completing RT. There was no significant correlation between durvalumab administration and ≥ Grade 2 ILD/RP. Twelve patients (16%) developed ILD/RP that spread outside the high-dose (> 40 Gy) area, of whom 8 (67%) had ≥ Grade 2 and 3 (25%) had Grade 3 symptoms. In unadjusted and multivariate Cox proportional-hazards models adjusted for V20 (proportion of the lung volume receiving ≥ 20 Gy), high HbA1c level was significantly correlated with ILD/RP pattern spreading outside the high-dose area (hazard ratio, 1.842; 95% confidence interval, 1.35-2.51). CONCLUSIONS Durvalumab improved 1-year PFS without increasing the risk of ILD/RP. Diabetic factors were associated with ILD/RP distribution pattern spreading in the lower dose area or outside RT fields, with a high rate of symptoms. Further study of the clinical background of patients including diabetes is needed to safely increase the number of durvalumab doses after CRT.
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Affiliation(s)
- Mai Sakagami
- Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Haruo Inokuchi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroshige Itoyama
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Nobunari Hamaura
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mutsumi Yamagishi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Naoki Mukumoto
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shogo Matsuda
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Keiko Shibuya
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Laughlin BS, Stoker J, Vern-Gross T. Proton Beam Therapy for Unresectable Mediastinal and Pericardial Spindle Cell Sarcoma: A Case Report. Int J Part Ther 2023; 10:43-50. [PMID: 37823013 PMCID: PMC10563663 DOI: 10.14338/ijpt-23-00001.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/29/2023] [Indexed: 10/13/2023] Open
Abstract
Unresectable mediastinal soft tissue sarcomas are often aggressive and associated with a poor prognosis. A 17-year-old male presented with progressive fatigue, shortness of breath, and heart palpitations secondary to an extensive mass involving the mediastinum and pericardium. He was treated with chemotherapy per protocol Children's Oncology Group Protocol ARST0332 and proton beam therapy to the involved mediastinum, pericardium, and heart. At the 5-year follow-up evaluation, he remained disease-free on surveillance imaging. An echocardiogram revealed a 55% to 60% left ventricular ejection fraction. Given the patient's extended survival, we present the oncologic rationale for treatment and considerations of late toxicity.
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Affiliation(s)
| | - Joshua Stoker
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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27
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McWilliam A, Abravan A, Banfill K, Faivre-Finn C, van Herk M. Demystifying the Results of RTOG 0617: Identification of Dose Sensitive Cardiac Subregions Associated With Overall Survival. J Thorac Oncol 2023; 18:599-607. [PMID: 36738929 DOI: 10.1016/j.jtho.2023.01.085] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The RTOG 0617 trial presented a worse survival for patients with lung cancer treated in the high-dose (74 Gy) arm. In multivariable models, radiation level and whole-heart volumetric dose parameters were associated with survival. In this work, we consider heart subregions to explain the observed survival difference between radiation levels. METHODS Voxel-based analysis identified anatomical regions where the dose was associated with survival. Bootstrapping clinical and dosimetric variables into an elastic net model selected variables associated with survival. Multivariable Cox regression survival models assessed the significance of dose to the heart subregion, compared with whole heart v5 and v30. Finally, the trial outcome was assessed after propensity score matching of patients on lung dose, heart subregion dose, and tumor volume. RESULTS A total of 458 patients were eligible for voxel-based analysis. A region of significance (p < 0.001) was identified in the base of the heart. Bootstrapping selected mean lung dose, radiation level, log tumor volume, and heart region dose. The multivariable Cox model exhibited dose to the heart region (p = 0.02), and tumor volume (p = 0.03) were significantly associated with survival, and radiation level was not significant (p = 0.07). The models exhibited that whole heart v5 and v30 were not associated with survival, with radiation level being significant (p < 0.05). In the matched cohort, no significant survival difference was seen between radiation levels. CONCLUSIONS Dose to the base of the heart is associated with overall survival, partly removing the radiation level effect, and explaining that worse survival in the high-dose arm is owing, in part, to the heart subregion dose. By defining a heart avoidance region, future dose escalation trials may be feasible.
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Affiliation(s)
- Alan McWilliam
- The Division of Cancer Science, The University of Manchester, Manchester, United Kingdom; The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom.
| | - Azadeh Abravan
- The Division of Cancer Science, The University of Manchester, Manchester, United Kingdom; The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Kathryn Banfill
- The Division of Cancer Science, The University of Manchester, Manchester, United Kingdom; The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- The Division of Cancer Science, The University of Manchester, Manchester, United Kingdom; The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marcel van Herk
- The Division of Cancer Science, The University of Manchester, Manchester, United Kingdom; The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
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Azumi R, Soyama M, Saito M. Early Detection of Radiation Pneumonitis on Cone-Beam CT Images During a Course of Radiotherapy: A Case Series Report. Cureus 2023; 15:e38275. [PMID: 37261180 PMCID: PMC10227775 DOI: 10.7759/cureus.38275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Background and aim Radiation pneumonitis (RP) is a critical pulmonary toxicity following dose delivery to the lung, and it is usually diagnosed after radiotherapy courses are completed. Because RP may result in a lethal complication, a practical method for detecting early-phase RP is awaited. In this article, we describe our experience through a variety of clinical cases and discuss treatment decisions and lessons we have made and learned. Materials and methods A daily cone-beam computed tomography (CBCT) scan was employed with a lung window setting to detect the early-phase RP during treatment courses. For the past five years, thirty patients were diagnosed with RP, and eight patients were detected during radiotherapy courses on the CBCT images. Our best efforts were made in detecting early ground-glass opacity and early RP on CBCT images prior to symptoms. The eight cases were described in more detail with CBCT or CT images. Results and discussion Initially, RP was detected at 50 Gy or greater. However, more careful CBCT observation resulted in earlier detection at around 40 Gy. Then, a new problem arose whether the treatment should be terminated. It was reported that early RP development was associated with higher-grade complications, and therefore it is preferable to terminate radiotherapy once we detect even early-phase RP. However, termination in the middle of the treatment course may significantly reduce the therapeutic effect. In our experience, patients with favorable clinical status may continue to receive radiotherapy with careful observation of lung parenchyma on CBCT images and clinical data, such as Krebs Von den Lungen-6 (KL-6) and C-reactive protein (CRP). Conclusion We have shown that early detection of RP may be feasible during radiotherapy courses by daily monitoring of CBCT lung images. Further studies are awaited to proceed.
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Affiliation(s)
- Rieko Azumi
- Radiology, National Hospital Organization (NHO) Nishiniigata Chuo Hospital, Niigata, JPN
| | - Maki Soyama
- Radiology, National Hospital Organization (NHO) Nishiniigata Chuo Hospital, Niigata, JPN
| | - Mari Saito
- Radiology, Niigata Diagnostic Imaging Center, Niigata, JPN
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Katsuta Y, Kadoya N, Kajikawa T, Mouri S, Kimura T, Takeda K, Yamamoto T, Imano N, Tanaka S, Ito K, Kanai T, Nakajima Y, Jingu K. Radiation pneumonitis prediction model with integrating multiple dose-function features on 4DCT ventilation images. Phys Med 2023; 105:102505. [PMID: 36535238 DOI: 10.1016/j.ejmp.2022.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Radiation pneumonitis (RP) is dose-limiting toxicity for non-small-cell cancer (NSCLC). This study developed an RP prediction model by integrating dose-function features from computed four-dimensional computed tomography (4DCT) ventilation using the least absolute shrinkage and selection operator (LASSO). METHODS Between 2013 and 2020, 126 NSCLC patients were included in this study who underwent a 4DCT scan to calculate ventilation images. We computed two sets of candidate dose-function features from (1) the percentage volume receiving > 20 Gy or the mean dose on the functioning zones determined with the lower cutoff percentile ventilation value, (2) the functioning zones determined with lower and upper cutoff percentile ventilation value using 4DCT ventilation images. An RP prediction model was developed by LASSO while simultaneously determining the regression coefficient and feature selection through fivefold cross-validation. RESULTS We found 39.3 % of our patients had a ≥ grade 2 RP. The mean area under the curve (AUC) values for the developed models using clinical, dose-volume, and dose-function features with a lower cutoff were 0.791, and the mean AUC values with lower and upper cutoffs were 0.814. The relative regression coefficient (RRC) on dose-function features with upper and lower cutoffs revealed a relative impact of dose to each functioning zone to RP. RRCs were 0.52 for the mean dose on the functioning zone, with top 20 % of all functioning zone was two times greater than that of 0.19 for these with 60 %-80 % and 0.17 with 40 %-60 % (P < 0.01). CONCLUSIONS The introduction of dose-function features computed from functioning zones with lower and upper cutoffs in a machine learning framework can improve RP prediction. The RRC given by LASSO using dose-function features allows for the quantification of the RP impact of dose on each functioning zones and having the potential to support treatment planning on functional image-guided radiotherapy.
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Affiliation(s)
- Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Kajikawa
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shina Mouri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Kochi Medical School, Kochi University, Nangoku, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takayuki Kanai
- Department of Radiation Oncology, Yamagata University, Yamagata, Japan
| | - Yujiro Nakajima
- Department of Radiological Sciences, Komazawa University, Tokyo, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Miao T, Zhang R, Jermyn M, Bruza P, Zhu T, Pogue BW, Gladstone DJ, Williams BB. Computational dose visualization & comparison in total skin electron treatment suggests superior coverage by the rotational versus the Stanford technique. J Med Imaging Radiat Sci 2022; 53:612-622. [PMID: 36045017 PMCID: PMC10152509 DOI: 10.1016/j.jmir.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/16/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION/BACKGROUND The goal of Total Skin Electron Therapy (TSET) is to achieve a uniform surface dose, although assessment of this is never really done and typically limited points are sampled. A computational treatment simulation approach was developed to estimate dose distributions over the body surface, to compare uniformity of (i) the 6 pose Stanford technique and (ii) the rotational technique. METHODS The relative angular dose distributions from electron beam irradiation was calculated by Monte Carlo simulation for cylinders with a range of diameters, approximating body part curvatures. These were used to project dose onto a 3D body model of the TSET patient's skin surfaces. Computer animation methods were used to accumulate the dose values, for display and analysis of the homogeneity of coverage. RESULTS The rotational technique provided more uniform coverage than the Stanford technique. Anomalies of under dose were observed in lateral abdominal regions, above the shoulders and in the perineum. The Stanford technique had larger areas of low dose laterally. In the rotational technique, 90% of the patient's skin was within ±10% of the prescribed dose, while this percentage decreased to 60% or 85% for the Stanford technique, varying with patient body mass. Interestingly, the highest discrepancy was most apparent in high body mass patients, which can be attributed to the loss of tangent dose at low angles of curvature. DISCUSSION/CONCLUSION This simulation and visualization approach is a practical means to analyze TSET dose, requiring only optical surface body topography scans. Under- and over-exposed body regions can be found, and irradiation could be customized to each patient. Dose Area Histogram (DAH) distribution analysis showed the rotational technique to have better uniformity, with most areas within 10% of the umbilicus value. Future use of this approach to analyze dose coverage is possible as a routine planning tool.
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Affiliation(s)
- Tianshun Miao
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA; Department of Medicine, Radiation Oncology, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Michael Jermyn
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA; DoseOptics, LLC, Lebanon NH 03755 USA
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA; DoseOptics, LLC, Lebanon NH 03755 USA
| | - Timothy Zhu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, 19104 USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA; DoseOptics, LLC, Lebanon NH 03755 USA; Department of Medical Physics, University of Wisconsin-Madison, Wisconsin WI 53705 USA.
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA; Department of Medicine, Radiation Oncology, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Benjamin B Williams
- Thayer School of Engineering, Dartmouth College, Hanover NH, 03755, USA; Department of Medicine, Radiation Oncology, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
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Doshita K, Tabuchi Y, Kenmotsu H, Omori S, Kawabata T, Kodama H, Nishioka N, Miyawaki E, Iida Y, Mamesaya N, Kobayashi H, Ko R, Wakuda K, Ono A, Naito T, Murakami H, Mori K, Harada H, Kaneko T, Takahashi T. Incidence and Treatment Outcome of Radiation Pneumonitis in Patients With Limited-stage Small Cell Lung Cancer Treated With Concurrent Accelerated Hyperfractionated Radiation Therapy and Chemotherapy. Adv Radiat Oncol 2022; 8:101129. [PMID: 36845617 PMCID: PMC9943774 DOI: 10.1016/j.adro.2022.101129] [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: 03/15/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed to clarify the characteristics of and evaluate the risk factors for radiation pneumonitis (RP) induced by chemoradiation therapy (CRT) using accelerated hyperfractionated (AHF) radiation therapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC). Methods and Materials Between September 2002 and February 2018, 125 patients with LS-SCLC were treated with early concurrent CRT using AHF-RT. Chemotherapy was comprised of carboplatin/cisplatin with etoposide. RT was administered twice daily (45 Gy/30 fractions). We collected data regarding onset and treatment outcomes for RP, and analyzed the relationship between RP and total lung dose-volume histogram findings. Uni- and multivariate analyses were performed to assess patient- and treatment-related factors for grade ≥2 RP. Results The median age of patients was 65 years, and 73.6% of participants were men. In addition, 20% and 80.0% of participants presented with disease stage II and III, respectively. The median follow-up time was 73.1 months. Grades 1, 2, and 3 RP were observed in 69, 17, and 12 patients, respectively. Grades 4 to 5 RP were not observed. RP was treated with corticosteroids in patients with grade ≥2 RP, without recurrence. The median time from initiation of RT to onset of RP was 147 days. Three patients developed RP within 59 days, 6 within 60 to 89 days, 16 within 90 to 119 days, 29 within 120 to 149 days, 24 within 150 to 179 days, and 20 within ≥180 days. Among the dose-volume histogram parameters, the percentage of lung volume receiving >30 Gy (V30) was most strongly related to the incidence of grade ≥2 RP, and the optimal threshold to predict RP incidence was V30 ≥20%. On multivariate analysis, V30 ≥20% was an independent risk factor for grade ≥2 RP. Conclusions The incidence of grade ≥2 RP correlated strongly with a V30 of ≥20%. Contrarily, the onset of RP induced by concurrent CRT using AHF-RT may occur later. RP is manageable in patients with LS-SCLC.
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Affiliation(s)
- Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan,Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yuya Tabuchi
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi-cho Suntou-gun, Shizuoka, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan,Corresponding author: Hirotsugu Kenmotsu, PhD
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi-cho Suntou-gun, Shizuoka, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Shizuoka, Japan
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Hsu C, Lin K, Shueng P, Wu Y, Tsai W, Chang C, Tien H, Wang S, Wu T, Mok GSP. Integrating 18 F-FDG PET/CT with lung dose-volume for assessing lung inflammatory changes after arc-based radiotherapy for esophageal cancer: A pilot study. Thorac Cancer 2022; 13:3114-3123. [PMID: 36163634 PMCID: PMC9663684 DOI: 10.1111/1759-7714.14661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The incidence of radiation pneumonitis (RP) has a highly linear relationship with low-dose lung volume. We previously established a volume-based algorithm (VBA) method to improve low-dose lung volume in radiotherapy (RT). This study assessed lung inflammatory changes by integrating fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) with VBA for esophageal cancer patients undergoing arc-based RT. METHODS Thirty esophageal cancer patients received 18 F-FDG PET/CT imaging pre-RT and post-RT were included in a retrospective pilot study. We fused lung doses and parameters of PET/CT in RT planning. Based on VBA, we used the 5Gy isodose curve to define high-dose (HD) and low-dose (LD) regions in the lung volume. We divided patients into non-RP (nRP) and RP groups. The maximum, mean standardized uptake value (SUVmax, SUVmean), global lung glycolysis (GLG), mean lung dose (MLD) and V5-30 in lungs were analyzed. Area under the curve values were utilized to identify optimal cut-off values for RP. RESULTS Eleven patients in the nRP group and 19 patients in the RP group were identified. In 30 RP lungs, post-RT SUVmax, SUVmean and GLG of HD regions showed significant increases compared to values for pre-RT lungs. There were no significant differences in values of 22 nRP lungs. Post-RT SUVmax and SUVmean of HD regions, MLD, and lung V5 and V10 in RP lungs were significantly higher than in nRP lungs. For detecting RP, the optimal cut-off values were post-RT SUVmax > 2.28 and lung V5 > 47.14%. CONCLUSION This study successfully integrated 18 F-FDG PET/CT with VBA to assess RP in esophageal cancer patients undergoing RT. Post-RT SUVmax > 2.28 and lung V5 > 47.14% might be potential indicators of RP.
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Affiliation(s)
- Chen‐Xiong Hsu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan
| | - Kuan‐Heng Lin
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan,Industrial Ph.D. Program of Biomedical Science and EngineeringNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Pei‐Wei Shueng
- Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan,Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Yen‐Wen Wu
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Department of Nuclear Medicine, Division of CardiologyCardiovascular Medical Center, Far Eastern Memorial HospitalTaipei CityTaiwan
| | - Wei‐Ta Tsai
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Chiu‐Han Chang
- Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan
| | - Hui‐Ju Tien
- Division of Radiation OncologyFar Eastern Memorial HospitalTaipei CityTaiwan
| | - Shan‐Ying Wang
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan,Department of Nuclear Medicine, Division of CardiologyCardiovascular Medical Center, Far Eastern Memorial HospitalTaipei CityTaiwan
| | - Tung‐Hsin Wu
- National Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Greta S. P. Mok
- Department of Electrical and Computer Engineering, Faculty of Science and TechnologyUniversity of MacauZhuhaiChina
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Chen Z, Kuriyama K, Nakatani E, Sato Y, Saito R, Marino K, Komiyama T, Onishi H. Anatomy-based prediction method for determining ipsilateral lung doses in postoperative breast radiation therapy assisted by diagnostic computed tomography images. Rep Pract Oncol Radiother 2022; 27:699-706. [PMID: 36196413 PMCID: PMC9521692 DOI: 10.5603/rpor.a2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to investigate whether ipsilateral lung doses (ILDs) could be predicted by anatomical indexes measured using diagnostic computed tomography (CT) prior to the planning stage of breast radiation therapy (RT). Materials and methods The thoracic diameters and the length of lines drawn manually were measured on diagnostic CT images. The parameters of interest were the skin maximum lung distance (sMLD), central lung distance (CLD), Haller index (HI), and body mass index (BMI). Lung dose-volume histograms were created with conformal planning, and the lung volumes receiving 5-40 Gy (V5-V40) were calculated. Linear regression models were used to investigate the correlations between the anatomical indexes and dose differences and to estimate the slope and 95% confidence intervals (CIs). Results A total of 160 patients who had undergone three-dimensional conformal RT after breast-conserving surgery were included. Univariable analysis revealed that the sMLD (p < 0.001), CLD (p < 0.001), HI (p = 0.002), and BMI (p < 0.001) were significantly correlated with the V20. However, multivariable analysis revealed that only the sMLD (slope: 0.147, p = 0.001, 95% CI: 0.162-0.306) and CLD (0.157, p = 0.005, 0.048-0.266) were strongly correlated with the V20. The p-value for the sMLD was the lowest among the p-values for all indexes, thereby indicating that the sMLD had the best predictive power for ILD. Conclusions sMLD and CLD are anatomical markers that can be used to predict ILD in whole breast RT. An sMLD > 20.5 mm or a CLD > 24.3 mm positively correlated with a high ILD.
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Affiliation(s)
- Zhe Chen
- Department of Radiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kengo Kuriyama
- Department of Radiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Graduate School of Public Health (Medical Statistics), Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Yoko Sato
- Graduate School of Public Health (Medical Statistics), Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Ryo Saito
- Department of Radiology, Shimada General Medical Center, Shimada, Shizuoka, Japan
| | - Kan Marino
- Department of Radiology, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takafumi Komiyama
- Department of Radiology, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
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Barik BK, Jena JP, Sahoo DK, Muraleedharan A, Parida SK, Majumdar SKD, Barik SK, Das DK, Parida DK. Divided target optimization with volumetric modulated arc therapy planning to improve target coverage and homogeneity in lung radiation therapy. J Med Imaging Radiat Sci 2022; 53:471-477. [DOI: 10.1016/j.jmir.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
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Ding L, Bradford C, Kuo IL, Fan Y, Ulin K, Khalifeh A, Yu S, Liu F, Saleeby J, Bushe H, Smith K, Bianciu C, LaRosa S, Prior F, Saltz J, Sharma A, Smyczynski M, Bishop-Jodoin M, Laurie F, Iandoli M, Moni J, Cicchetti MG, FitzGerald TJ. Radiation Oncology: Future Vision for Quality Assurance and Data Management in Clinical Trials and Translational Science. Front Oncol 2022; 12:931294. [PMID: 36033446 PMCID: PMC9399423 DOI: 10.3389/fonc.2022.931294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The future of radiation oncology is exceptionally strong as we are increasingly involved in nearly all oncology disease sites due to extraordinary advances in radiation oncology treatment management platforms and improvements in treatment execution. Due to our technology and consistent accuracy, compressed radiation oncology treatment strategies are becoming more commonplace secondary to our ability to successfully treat tumor targets with increased normal tissue avoidance. In many disease sites including the central nervous system, pulmonary parenchyma, liver, and other areas, our service is redefining the standards of care. Targeting of disease has improved due to advances in tumor imaging and application of integrated imaging datasets into sophisticated planning systems which can optimize volume driven plans created by talented personnel. Treatment times have significantly decreased due to volume driven arc therapy and positioning is secured by real time imaging and optical tracking. Normal tissue exclusion has permitted compressed treatment schedules making treatment more convenient for the patient. These changes require additional study to further optimize care. Because data exchange worldwide have evolved through digital platforms and prisms, images and radiation datasets worldwide can be shared/reviewed on a same day basis using established de-identification and anonymization methods. Data storage post-trial completion can co-exist with digital pathomic and radiomic information in a single database coupled with patient specific outcome information and serve to move our translational science forward with nimble query elements and artificial intelligence to ask better questions of the data we collect and collate. This will be important moving forward to validate our process improvements at an enterprise level and support our science. We have to be thorough and complete in our data acquisition processes, however if we remain disciplined in our data management plan, our field can grow further and become more successful generating new standards of care from validated datasets.
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Affiliation(s)
- Linda Ding
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Carla Bradford
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - I-Lin Kuo
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Yankhua Fan
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Kenneth Ulin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Abdulnasser Khalifeh
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Suhong Yu
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Fenghong Liu
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Jonathan Saleeby
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Harry Bushe
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Koren Smith
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Camelia Bianciu
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Salvatore LaRosa
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas, Little Rock, AR, United States
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Mark Smyczynski
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Maryann Bishop-Jodoin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Fran Laurie
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Matthew Iandoli
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Janaki Moni
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - M. Giulia Cicchetti
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Thomas J. FitzGerald
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
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VMAT-Based Planning Allows Sparing of a Spatial Dose Pattern Associated with Radiation Pneumonitis in Patients Treated with Radiotherapy for a Locally Advanced Lung Cancer. Cancers (Basel) 2022; 14:cancers14153702. [PMID: 35954366 PMCID: PMC9367460 DOI: 10.3390/cancers14153702] [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: 06/22/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 12/07/2022] Open
Abstract
Introduction: In patients treated with radiotherapy for locally advanced lung cancer, respect for dose constraints to organs at risk (OAR) insufficiently protects patients from acute pulmonary toxicity (APT), such toxicities being associated with a potential impact on the treatment’s completion and the patient’s quality of life. Dosimetric planning does not take into account regional lung functionality. An APT prediction model combining usual dosimetry features with the mean dose (DMeanPmap) received by a voxel-based volume (Pmap) localized in the posterior right lung has been previously developed. A DMeanPmap of ≥30.3 Gy or a predicted APT probability (ProbAPT) of ≥8% were associated with a higher risk of APT. In the present study, the authors aim to demonstrate the possibility of decreasing the DMeanPmap via a volumetric arctherapy (VMAT)-based adapted planning and evaluate the impact on the risk of APT. Methods: Among the 207 patients included in the initial study, only patients who presented with APT of ≥grade 2 and with a probability of APT ≥ 8% based on the prediction model were included. Dosimetry planning was optimized with a new constraint (DMeanPmap < 30.3 Gy) added to the usual constraints. The initial and optimized treatment plans were compared using the t-test for the independent variables and the non-parametric Mann−Whitney U test otherwise, regarding both doses to the OARs and PTV (Planning Target Volume) coverage. Conformity and heterogeneity indexes were also compared. The risk of APT was recalculated using the new dosimetric features and the APT prediction model. Results: Dosimetric optimization was considered successful for 27 out of the 44 included patients (61.4%), meaning the dosimetric constraint on the Pmap region was achieved without compromising the PTV coverage (p = 0.61). The optimization significantly decreased the median DMeanPmap from 28.8 Gy (CI95% 24.2−33.4) to 22.1 Gy (CI95% 18.3−26.0). When recomputing the risk of APT using the new dosimetric features, the optimization significantly reduced the risk of APT (p < 0.0001) by reclassifying 43.2% (19/44) of the patients. Conclusion: Our approach appears to be both easily implementable on a daily basis and efficient at reducing the risk of APT. Regional radiosensitivity should be considered in usual lung dose constraints, opening the possibility of new treatment strategies, such as dose escalation or innovative treatment associations.
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YANG X, MEI T, YU M, GONG Y. Symptomatic Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKIs and Concurrent Once-daily Thoracic Radiotherapy: Predicting the Value of Clinical and Dose-volume Histogram Parameters. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:409-419. [PMID: 35747920 PMCID: PMC9244499 DOI: 10.3779/j.issn.1009-3419.2022.102.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of symptomatic radiation pneumonitis (RP) and its relationship with dose-volume histogram (DVH) parameters in non-small cell lung cancer (NSCLC) patients receiving epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and concurrent once-daily thoracic radiotherapy (TRT) remain unclear. We aim to analyze the values of clinical factors and dose-volume histogram (DVH) parameters to predict the risk for symptomatic RP in these patients. METHODS Between 2011 and 2019, we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and once-daily TRT simultaneously (EGFR-TKIs group) and 129 patients who had received concurrent chemoradiotherapy (CCRT group). The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event (CTCAE) criteria (grade 2 or above). Statistical analyses were performed using SPSS 26.0. RESULTS In total, the incidences of symptomatic (grade≥2) and severe RP (grade≥3) were 43.5% (37/85) and 16.5% (14/85) in EGFR-TKIs group vs 27.1% (35/129) and 10.1% (13/129) in CCRT group respectively. After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching, chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group (χ2=4.469, P=0.035). In EGFR-TKIs group, univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving ≥30 Gy (ilV30) [odds ratio (OR): 1.163, 95%CI: 1.036-1.306, P=0.011] and the percentage of total lung volume receiving ≥20 Gy (tlV20) (OR: 1.171, 95%CI: 1.031-1.330, P=0.015), with chronic obstructive pulmonary disease (COPD) or not (OR: 0.158, 95%CI: 0.041-0.600, P=0.007), were independent predictors of symptomatic RP. Compared to patients with lower ilV30/tlV20 values (ilV30 and tlV20<cut-off point values) and without COPD, patients with higher ilV30/tlV20 values (ilV30 and tlV20>cut-off point values) and COPD had a significantly higher risk for developing symptomatic RP, with a hazard ratio (HR) of 1.350 (95%CI: 1.190-1.531, P<0.001). CONCLUSIONS Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy. The ilV30, tlV20, and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.
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Affiliation(s)
- Xuexi YANG
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ting MEI
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Min YU
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Youling GONG
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,Youling GONG, E-mail:
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Pneumonitis after Stereotactic Thoracic Radioimmunotherapy with Checkpoint Inhibitors: Exploration of the Dose-Volume-Effect Correlation. Cancers (Basel) 2022; 14:cancers14122948. [PMID: 35740613 PMCID: PMC9221463 DOI: 10.3390/cancers14122948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Stereotactic body radiation therapy (SBRT) is widely applied for treatment of early stage lung cancer and pulmonary metastases. Modern immune checkpoint blockade (ICB) is progressively used in cancer treatment. Pneumonitis is a relevant side effect of both thoracic SBRT and ICB. Currently, it remains unclear whether we can presume the same radiation dose–volume–effect correlations and dose constraints for safe application of SBRT + ICB. We present a dose–volume–effect correlation analysis method using pneumonitis contours and dose–volume histograms (DVH). We showed dosimetric differences for pneumonitis volumes between SBRT + ICB and SBRT alone. We found a large extent of pneumonitis, even bilateral and apart from the radiation field for combined SBRT + ICB. We noticed a shift in pneumonitis DVHs towards lower doses and a trend towards decreased areas under the curve (AUC) for SBRT + ICB. This provides a direction for re-evaluation and potential adaptation of lung dose constraints for combined SBRT and ICB. Abstract Thoracic stereotactic body radiation therapy (SBRT) is extensively used in combination with immune checkpoint blockade (ICB). While current evidence suggests that the occurrence of pneumonitis as a side effect of both treatments is not enhanced for the combination, the dose–volume correlation remains unclear. We investigate dose–volume–effect correlations for pneumonitis after combined SBRT + ICB. We analyzed patient clinical characteristics and dosimetric data for 42 data sets for thoracic SBRT with ICB treatment (13) and without (29). Dose volumes were converted into 2 Gy equivalent doses (EQD2), allowing for dosimetric comparison of different fractionation regimes. Pneumonitis volumes were delineated and corresponding DVHs were analyzed. We noticed a shift towards lower doses for combined SBRT + ICB treatment, supported by a trend of smaller areas under the curve (AUC) for SBRT+ ICB (median AUC 1337.37 vs. 5799.10, p = 0.317). We present a DVH-based dose–volume–effect correlation method and observed large pneumonitis volumes, even with bilateral extent in the SBRT + ICB group. We conclude that further studies using this method with enhanced statistical power are needed to clarify whether adjustments of the radiation dose constraints are required to better estimate risks of pneumonitis after the combination of SBRT and ICB.
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Dosimetric predictors of pneumonitis in locally advanced non-small cell lung cancer patients treated with chemoradiation followed by durvalumab. Lung Cancer 2022; 170:58-64. [PMID: 35716632 DOI: 10.1016/j.lungcan.2022.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The incidence and predictors of pneumonitis for patients with unresectable, locally advanced non-small cell lung cancer (NSCLC) in the era of consolidation durvalumab have yet to be fully elucidated. In this large single institution analysis, we report the incidence of and factors associated with grade 2 + pneumonitis in NSCLC patients treated with the PACIFIC regimen. MATERIALS AND METHODS We identified all patients treated at our institution with definitive CRT followed by durvalumab from 2018 to 2021. Clinical documentation and imaging studies were reviewed to determine grade 2 + pneumonitis events, which required the following: 1) pulmonary symptoms warranting prolonged steroid taper, oxygen dependence, and/or hospital admission and 2) radiographic findings consistent with pneumonitis. RESULTS One-hundred ninety patients were included. The majority received 60 Gray (Gy) in 30 fractions with concurrent carboplatin and paclitaxel. Median number of durvalumab cycles received was 12 (IQR: 4-22). At a median follow-up of 14.8 months, 50 (26.3%) patients experienced grade 2 + pneumonitis with a 1-year cumulative incidence of 27.8% (95% CI: 21.9-35.4). Seventeen (8.9%) patients experienced grade 3 + pneumonitis and 4 grade 5 (2.1%). Dosimetric predictors of pneumonitis included ipsilateral and total lung volume receiving 5 Gy or greater (V5Gy), V10Gy, V20Gy, V40Gy, and mean dose and contralateral V40Gy. Heart V5Gy, V10Gy, and mean dose were also significant variables. Overall survival estimates at 1 and 3 years were 87.4% (95% CI: 82.4-92.8) and 60.3% (95% CI: 47.9-74.4), respectively. CONCLUSION We report a risk of pneumonitis higher than that seen on RTOG 0617 and comparable to the PACIFIC study. Multiple lung and heart dosimetric factors were predictive of pneumonitis.
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Katsuta Y, Kadoya N, Sugai Y, Katagiri Y, Yamamoto T, Takeda K, Tanaka S, Jingu K. Feasibility of Differential Dose-Volume Histogram Features in Multivariate Prediction Model for Radiation Pneumonitis Occurrence. Diagnostics (Basel) 2022; 12:diagnostics12061354. [PMID: 35741164 PMCID: PMC9221601 DOI: 10.3390/diagnostics12061354] [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: 04/01/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study is to introduce differential dose−volume histogram (dDVH) features into machine learning for radiation pneumonitis (RP) prediction and to demonstrate the predictive performance of the developed model based on integrated cumulative dose−volume histogram (cDVH) and dDVH features. Materials and methods: cDVH and dDVH features were calculated for 153 patients treated for non-small-cell lung cancer with 60−66 Gy and dose bins ranging from 2 to 8 Gy in 2 Gy increments. RP prediction models were developed with the least absolute shrinkage and selection operator (LASSO) through fivefold cross-validation. Results: Among the 152 patients in the patient cohort, 41 presented ≥grade 2 RP. The interdependencies between cDVH features evaluated by Spearman’s correlation were significantly resolved by the inclusion of dDVH features. The average area under curve for the RP prediction model using cDVH and dDVH model was 0.73, which was higher than the average area under curve using cDVH model for 0.62 with statistically significance (p < 0.01). An analysis using the entire set of regression coefficients determined by LASSO demonstrated that dDVH features represented four of the top five frequently selected features in the model fitting, regardless of dose bin. Conclusions: We successfully developed an RP prediction model that integrated cDVH and dDVH features. The best RP prediction model was achieved using dDVH (dose bin = 4 Gy) features in the machine learning process.
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Affiliation(s)
- Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
- Correspondence: ; Tel.: +81-22-717-7312; Fax: +81-22-717-7316
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
| | - Yuto Sugai
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
| | - Yu Katagiri
- Department of Radiation Oncology, Japan Red Cross Ishinomaki Hospital, Ishinomaki 986-8522, Japan;
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
| | - Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (N.K.); (Y.S.); (T.Y.); (K.T.); (S.T.); (K.J.)
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Li F, Luo Y, Chen J, He L, Liang Y, Lai J, Guo F. Association between tumor morphology and dosimetric parameters of organs at risk after intensity-modulated radiotherapy in esophagus cancer. J Appl Clin Med Phys 2022; 23:e13612. [PMID: 35635800 PMCID: PMC9278670 DOI: 10.1002/acm2.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We explored the effects of geometrical topological properties of tumors such as tumor length and "axial cross-sectional area (ACSA)" of tumors (planning target volume [PTV] volume /PTV length) on the dosimetric parameters of organs at risk (lung and heart) in patients with esophagus cancer (EPC) treated by way of intensity-modulated radiation therapy (IMRT), so as to provide a guideline for the dosimetric limitation for organs at risk in IMRT treatment. METHODS A retrospective analysis was done on 103 cases of patients with EPC who were treated by IMRT from November 2010 to August 2019, in which PTV-G stood for the externally expanded planning target volume (PTV) of the gross tumor volume (GTV) and PTV-C for the externally expanded volume of the clinical target volume (CTV). A linear regression model was employed to analyze the several pairs of correlation: the 1st one between the relative length of tumors (PTV length/lung length) and pulmonary dose-volume parameters, the 2nd one between ACSA of tumors and pulmonary dose-volume parameters, the 3rd one between PTV length and the dosimetric parameters of the heart, and the last one between ACSA of tumors and the dosimetric parameters of the heart. RESULTS (i) There was a strong positive correlation between the relative length of tumors (PTV length/lung length) and V5 (p < 0.001, r = 0.73), and V10 (p < 0.001, r = 0.66) of the lung. There was a moderate positive correlation between the relative length of tumors and V30 (p < 0.001, r = 0.44) of the lung, and a weak positive correlation between the relative length of tumors and V20 (p < 0.001, r = 0.39) of the lung. (ii) There was a strong positive correlation between ACSA of tumors (PTV volume/PTV length) and V30 (p < 0.001, r = 0.67) of the lung, a moderate positive correlation between ACSA of tumors and V20 (p <0.001, r = 0.51) of the lung, and a weak positive correlation between ACSA of tumors and V10 (p = 0.019, r = 0.23) of the lung, yet there was not an obvious correlation between ACSA of tumors and V5 p > 0.05) of the lung. (iii) There was a moderate positive correlation between PTV length and V40 (p < 0.001, r = 0.58), and Dmean (p < 0.001, r = 0.52) of the heart, yet there was no obvious correlation between ACSA of tumors and Dmean and V40 of the heart (p > 0.05). CONCLUSIONS (i) Compared with the high-dose region of the lung, the relative length of tumors (PTV length/lung length) has a greater impact on the low-dose region of the lung. The linear regression equation of scatter plot showed that when the relative length of tumors increased by 0.1, the lung dose-volume parameters of V5 , V10 , V20 , and V30 increased by approximately 5.37%, 3.59%, 1.05%, and 1.08%, respectively. When PTV length increased by 1 cm, Dmean and V40 of the heart increased by approximately 153.6 cGy and 2.03%, respectively. (ii) Compared with the low-dose region of the lung, the value of ACSA of tumors (PTV volume/PTV length) has a greater impact on the high-dose region of the lung. However, the value of ACSA of tumors has no significant effect on the dosimetric parameters of the heart (Dmean and V40 ). The linear regression equation of scatter plot showed that when ACSA of tumors increased by 10 cm2 , the lung dose-volume parameters of V10 , V20, and V30 increased by approximately 3.11%, 3.37%, and 4.01%, respectively.
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Affiliation(s)
- Fahui Li
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuxuan Luo
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Jing Chen
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Liping He
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Yiying Liang
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Junjie Lai
- The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
| | - Feibao Guo
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,The Medical Technology and Engineering Academy of Fujian Medical University, Fuzhou, China
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Borghetti P, Guerini AE, Sangalli C, Piperno G, Franceschini D, La Mattina S, Arcangeli S, Filippi AR. Unmet needs in the management of unresectable stage III non-small cell lung cancer: a review after the 'Radio Talk' webinars. Expert Rev Anticancer Ther 2022; 22:549-559. [PMID: 35450510 DOI: 10.1080/14737140.2022.2069098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stage III non-small cell lung cancer (NSCLC) is a variable entity, encompassing bulky primary tumors, nodal involvement or both. Multidisciplinary evaluation is essential to discuss multiple treatment options, to outline optimal management and to examine the main debated topics and critical issues not addressed by current trials and guidelines that influence daily clinical practice. AREAS COVERED From March to May 2021, 5 meetings were scheduled in a webinar format titled 'Radio Talk' due to the COVID-19 pandemic; the faculty was composed of 6 radiation oncologists from 6 different Institutions of Italy, all of them were the referring radiation oncologist for lung cancer treatment at their respective departments and were or had been members of AIRO (Italian Association of Radiation Oncology) Thoracic Oncology Study Group. The topics covered included: pulmonary toxicity, cardiac toxicity, radiotherapy dose, fractionation and volumes, unfit/elderly patients, multidisciplinary management. EXPERT OPINION The debate was focused on the unmet needs triggered by case reports, personal experiences and questions; the answers were often not univocal, however, the exchange of opinion and the contribution of different centers confirmed the role of multidisciplinary management and the necessity that the most critical issues should be investigated in clinical trials.
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Affiliation(s)
- Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Claudia Sangalli
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Salvatore La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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Carbon Monoxide Diffusing Capacity (DL CO) Correlates with CT Morphology after Chemo-Radio-Immunotherapy for Non-Small Cell Lung Cancer Stage III. Diagnostics (Basel) 2022; 12:diagnostics12051027. [PMID: 35626183 PMCID: PMC9139430 DOI: 10.3390/diagnostics12051027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction: Curatively intended chemo-radio-immunotherapy for non-small cell lung cancer (NSCLC) stage III may lead to post-therapeutic pulmonary function (PF) impairment. We hypothesized that the decrease in global PF corresponds to the increase in tissue density in follow-up CTs. Hence, the study aim was to correlate the dynamics in radiographic alterations to carbon monoxide diffusing capacity (DLCO) and FEV1, which may contribute to a better understanding of radiation-induced lung disease. Methods: Eighty-five patients with NSCLC III were included. All of them received two cycles of platinum-based induction chemotherapy followed by high dose radiation. Thereafter, durvalumab was administered for one year in 63/85 patients (74%). Pulmonary function tests (PFTs) were performed three months and six months after completion of radiotherapy (RT) and compared to baseline. At the same time points, patients underwent diagnostic CT (dCT). These dCTs were matched to the planning CT (pCT) using RayStation® Model Based Segmentation and deformable image registration. Differential volumes defined by specific isodoses were generated to correlate them with the PFTs. Results: In general, significant correlations between PFTs and differential volumes were found in the mid-dose range, especially for the volume of the lungs receiving between 65% and 45% of the dose prescribed (V65−45%) and DLCO (p<0.01). This volume range predicted DLCO after RT (p-value 0.03) as well. In multivariate analysis, DLCO (p-value 0.040) and FEV1 (p-value 0.014) predicted pneumonitis. Conclusions: The current analysis revealed a strong relation between the dynamics of DLCO and CT morphology changes in the mid-dose range, which convincingly indicates the importance of routinely used PFTs in the context of a curative treatment approach.
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Tamilarasu S, Saminathan M. Dosimetric comparison of normal breathing and deep inspiration breath hold technique for synchronous bilateral breast cancer using 6MV flattened beam and flattening filter free beam. Rep Pract Oncol Radiother 2022; 27:63-75. [PMID: 35402027 PMCID: PMC8989442 DOI: 10.5603/rpor.a2021.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background The present study was to investigate the usefulness of deep inspiration breath hold (DIBH) in bilateral breast patients using 6MV flattened beam (FB) and flattening filter free beam (FFFB). Materials and methods Twenty bilateral breast cancer patients were simulated, using left breast patients treated with DIBH technique. CT scans were performed in the normal breathing (NB) and DIBH method. Three-dimensional conformal radiotherapy (3DCRT) and volumetric arc therapy (VMAT) plans were generated. Results In our study the best organ at risk (OAR) sparing is achieved in the 3DCRT DIBH plan with adequate PTV coverage (V95 ≥ 47.5 Gy) as compared to 6MV FB and FFFB VMAT DIBH plans. The DIBH scan plan reduces the heart mean dose significantly at the rate of 49% in 3DCRT (p = 0.00) and 22% in VMAT (p = 0.010). Similarly, the DIBH scan plan produces lesser common lung mean dose of 18% in 3DCRT (p = 0.011) and 8% in VMAT (0.007) as compared to the NB scan. The conformity index is much better in VMAT FB (1.04 ± 0.04 vs. 1.04 ± 0.05), p =1.00 and VMAT FFFB (1.04 ± 0.05 vs. 1 ± 0.24, p = 0.345) plans as compared to 3DCRT (1.63 ± 0.2 vs. 1.47 ± 0.28, p = 0.002). The homogeneity index of all the plans is less than 0.15. The global dmax is more in VMAT FFFB DIBH plan (113.7%). The maximum MU noted in the NB scan plan (478 vs. 477MU, 1366 vs. 1299 MU and 1853 vs. 1788 MU for 3DCRT, VMAT FB and VMAT FFFB technique as compared to DIBH scan. Conclusion We recommend that the use of DIBH techniques for bilateral breast cancer patients significantly reduces the radiation doses to OARs in both 3DCRT and VMAT plans.
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Affiliation(s)
- Suresh Tamilarasu
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Yamamoto T, Tsukita Y, Katagiri Y, Matsushita H, Umezawa R, Ishikawa Y, Takahashi N, Suzuki Y, Takeda K, Miyauchi E, Saito R, Katsuta Y, Kadoya N, Jingu K. Durvalumab after chemoradiotherapy for locally advanced non-small cell lung cancer prolonged distant metastasis-free survival, progression-free survival and overall survival in clinical practice. BMC Cancer 2022; 22:364. [PMID: 35379201 PMCID: PMC8981776 DOI: 10.1186/s12885-022-09354-1] [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: 01/07/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background In clinical practice, the effect of durvalumab and radiation pneumonitis (RP) on survival after intensity-modulated radiotherapy (IMRT) is not fully understood. The purpose of this retrospective study was to investigate factors related to distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) after IMRT for locally advanced non-small cell lung cancer (LA-NSCLC). Methods All patients who were treated with conventional fractionated IMRT for LA-NSCLC between April 2016 and March 2021 were eligible. Time-to-event data were assessed by using the Kaplan–Meier estimator, and the Cox proportional hazards model was used for prognostic factor analyses. Factors that emerged after the start of IMRT, such as durvalumab administration or the development of RP, were analysed as time-dependent covariates. Results A total of 68 consecutive patients treated with conventional fractionated IMRT for LA-NSCLC were analysed. Sixty-six patients completed radiotherapy, 50 patients received concurrent chemotherapy, and 36 patients received adjuvant durvalumab. During the median follow-up period of 14.3 months, 23 patients died, and tumour progression occurred in 37 patients, including 28 patients with distant metastases. The 1-year DMFS rate, PFS rate and OS rate were 59.9%, 48.7% and 84.2%, respectively. Grade 2 RP occurred in 16 patients, grade 3 in 6 patients and grade 5 in 1 patient. The 1-year cumulative incidences of grade 2 or higher RP and grade 3 or higher RP were 33.8% and 10.3%, respectively. The results of multivariate analyses showed that durvalumab had a significantly lower hazard ratio (HR) for DMFS, PFS and OS (HR 0.31, p < 0.01; HR 0.33, p < 0.01 and HR 0.32, p = 0.02), respectively. Grade 2 or higher RP showed significance for DMFS and a nonsignificant trend for OS (HR 2.28, p = 0.04 and HR 2.12, p = 0.13), respectively, whereas a higher percentage of lung volume receiving 20 Gy or higher was significant for PFS (HR 2.25, p = 0.01). Conclusions In clinical practice, durvalumab administration following IMRT with concomitant chemotherapy showed a significant survival benefit. Reducing the risk of grade 2 or higher RP would also be beneficial.
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Affiliation(s)
- Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Das Majumdar SK, Amritt A, Dhar SS, Barik S, Beura SS, Mishra T, Muduly DK, Dash A, Parida DK. A Dosimetric Study Comparing 3D-CRT vs. IMRT vs. VMAT in Left-Sided Breast Cancer Patients After Mastectomy at a Tertiary Care Centre in Eastern India. Cureus 2022; 14:e23568. [PMID: 35494897 PMCID: PMC9045011 DOI: 10.7759/cureus.23568] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Post-mastectomy radiation in left-sided breast cancer in women continues to pose a significant risk to the underlying lungs and heart. This study analyzed the difference in planning target volume (PTV) coverage and dose to the organs at risk (OAR) by using three different planning methods for the same patient - three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT). Material and methods Thirty-five left-sided breast cancer patients' post-mastectomy were included in this study, and three different plans for adjuvant radiation were created using 3D-CRT, IMRT, and VMAT. The prescribed dose was 50Gy in 25 fractions. Kruskal-Wallis analysis of variance (ANOVA) was done, followed by a pairwise t-test to establish a hierarchy of plan quality and dosimetric benefits. The plans were compared with PTV95, homogeneity index (HI), conformity index (CI), hotspot (V107%), left lung V20Gy, mean lung dose, heart V25Gy, mean heart dose, and integral dose (ID) to the body. Results Both VMAT and IMRT led to improved PTV95% coverage (95.63±1.82%, p=0.000 in VMAT; 93.70±2.16 %, p=0.000; 81.40±6.27% in 3D-CRT arm) and improved CI (0.91±0.06 in IMRT [p<0.05] and 0.96±0.02 for VMAT plans [p<0.05]) as compared to 3D-CRT (0.66±0.11), which was statistically significant on pairwise analysis. In contrast, the difference in HI and reduction in hotspots were not significantly different. Left lung V20 was statistically very different between the three arms with the highest values in IMRT (36.64±4.45) followed by 3D-CRT (34.80±2.24) and the most negligible value in VMAT (33.03±4.20). Mean lung dose was also statistically different between the three arms. There was a statistically significant difference in mean heart dose between the three arms on pairwise analysis. Both the inverse planning methods led to a statistically significant increase in low dose volume (V5 and V10) of the ipsilateral lung, opposite lung, and heart, and increased ID to the body excluding the PTV. Conclusion While both the inverse planning modalities led to increased coverage, better CI, and better HI and decreased high dose volumes in OARs, there was increased low volume irradiation of heart, lungs, and body with VMAT faring marginally better than IMRT in coverage and decreasing lung irradiation with comparable heart irradiation.
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Affiliation(s)
| | - Adhar Amritt
- Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Sovan Sarang Dhar
- Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Sandip Barik
- Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Sasanka S Beura
- Medical Physics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Tushar Mishra
- Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Dillip K Muduly
- Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Ashish Dash
- Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Dillip Kumar Parida
- Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Harris W, Yorke E, Li H, Czmielewski C, Chawla M, Lee RP, Hotca-Cho A, McKnight D, Rimner A, Lovelock DM. Can bronchoscopically implanted anchored electromagnetic transponders be used to monitor tumor position and lung inflation during deep inspiration breath-hold lung radiotherapy? Med Phys 2022; 49:2621-2630. [PMID: 35192211 PMCID: PMC9007909 DOI: 10.1002/mp.15565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/22/2022] [Accepted: 02/05/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficacy of using bronchoscopically implanted anchored electromagnetic transponders (EMTs) as surrogates for 1) tumor position and 2) repeatability of lung inflation during deep-inspiration breath-hold (DIBH) lung radiotherapy. METHODS 41 patients treated with either hypofractionated (HF) or conventional (CF) lung radiotherapy on an IRB approved prospective protocol using coached DIBH were evaluated for this study. Three anchored EMTs were bronchoscopically implanted into small airways near or within the tumor. DIBH treatment was gated by tracking the EMT positions. Breath-hold cone-beam-CTs (CBCTs) were acquired prior to every HF treatment or weekly for CF patients. Retrospectively, rigid registrations between each CBCT and the breath-hold planning CT were performed to match to 1) spine 2) EMTs and 3) tumor. Absolute differences in registration between EMTs and spine were analyzed to determine surrogacy of EMTs for lung inflation. Differences in registration between EMTs and tumor were analyzed to determine surrogacy of EMTs for tumor position. The stability of the EMTs was evaluated by analyzing the difference between inter-EMT displacements recorded at treatment from that of the plan for the CF patients, as well as the geometric residual (GR) recorded at the time of treatment. RESULTS 219 CBCTs were analyzed. The average differences between EMT centroid and spine registration among all CBCTs were 0.45±0.42cm, 0.29±0.28cm, and 0.18±0.15cm in superior-inferior (SI), anterior-posterior (AP) and lateral directions, respectively. Only 59% of CBCTs had differences in registration <0.5cm for EMT centroid compared to spine, indicating that lung inflation is not reproducible from simulation to treatment. The average differences between EMT centroid and tumor registration among all CBCTs were 0.13±0.13cm, 0.14±0.13cm and 0.12±0.12cm in SI, AP and lateral directions, respectively. 95% of CBCTs resulted in <0.5cm change between EMT centroid and tumor registration, indicating that EMT positions correspond well with tumor position during treatments. Six out of the 7 recorded CF patients had average differences in inter-EMT displacements to be ≤0.26cm and average GR ≤0.22cm, indicating that the EMTs are stable throughout treatment. CONCLUSIONS Bronchoscopically implanted anchored EMTs are good surrogates for tumor position and are reliable for maintaining tumor position when tracked during DIBH treatment, as long as the tumor size and shape are stable. Large differences in registration between EMTs and spine for many treatments suggest that lung inflation achieved at simulation is often not reproduced. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wendy Harris
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Henry Li
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Christian Czmielewski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Mohit Chawla
- Department of Medicine, Pulmonary Service, Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Robert P Lee
- Department of Medicine, Pulmonary Service, Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Alexandra Hotca-Cho
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Dominique McKnight
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - D Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
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Matsumoto Y. A pictorial essay on radiological changes after stereotactic body radiation therapy for lung tumors. Jpn J Radiol 2022; 40:647-663. [PMID: 35184250 PMCID: PMC9252968 DOI: 10.1007/s11604-022-01252-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/04/2022] [Indexed: 12/19/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is a frequently used modality for the treatment of early stage non-small cell lung cancer and oligometastatic disease of the lung. The radiological changes observed in the lung after SBRT are likely to differ from those observed after conventional thoracic radiation therapy, primarily due to the small size of the target volume and highly conformal dose distributions with steep dose gradients from the target to surrounding normal lung tissues used in SBRT. Knowledge of the radiological changes that can occur after SBRT is required to correctly diagnose local failure. Herein, I report several radiological changes specific to SBRT that have been observed.
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49
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Katsuta Y, Kadoya N, Mouri S, Tanaka S, Kanai T, Takeda K, Yamamoto T, Ito K, Kajikawa T, Nakajima Y, Jingu K. Prediction of radiation pneumonitis with machine learning using 4D-CT based dose-function features. JOURNAL OF RADIATION RESEARCH 2022; 63:71-79. [PMID: 34718683 PMCID: PMC8776701 DOI: 10.1093/jrr/rrab097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/20/2021] [Indexed: 06/13/2023]
Abstract
In this article, we highlight the fundamental importance of the simultaneous use of dose-volume histogram (DVH) and dose-function histogram (DFH) features based on functional images calculated from 4-dimensional computed tomography (4D-CT) and deformable image registration (DIR) in developing a multivariate radiation pneumonitis (RP) prediction model. The patient characteristics, DVH features and DFH features were calculated from functional images by Hounsfield unit (HU) and Jacobian metrics, for an RP grade ≥ 2 multivariate prediction models were computed from 85 non-small cell lung cancer patients. The prediction model is developed using machine learning via a kernel-based support vector machine (SVM) machine. In the patient cohort, 21 of the 85 patients (24.7%) presented with RP grade ≥ 2. The median area under curve (AUC) was 0.58 for the generated 50 prediction models with patient clinical features and DVH features. When HU metric and Jacobian metric DFH features were added, the AUC improved to 0.73 and 0.68, respectively. We conclude that predictive RP models that incorporate DFH features were successfully developed via kernel-based SVM. These results demonstrate that effectiveness of the simultaneous use of DVH features and DFH features calculated from 4D-CT and DIR on functional image-guided radiotherapy.
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Affiliation(s)
- Yoshiyuki Katsuta
- Corresponding author. Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan, Tel: +81-22-717-7312, Fax: +81-22-717-7316, E-mail:
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50
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Mayahara H, Uehara K, Harada A, Kitatani K, Yabuuchi T, Miyazaki S, Ishihara T, Kawaguchi H, Kubota H, Okada H, Ninomaru T, Shindo C, Hata A. Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer. Radiat Oncol 2022; 17:7. [PMID: 35033139 PMCID: PMC8760798 DOI: 10.1186/s13014-021-01979-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) may increase or not. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with focus on predicting factors for symptomatic RP. Methods Patients who were pathologically diagnosed as NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 to December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predicting factors for symptomatic RP. Results Of the 67 patients who planned CCRT, 63 patients completed the entire CCRT course. Of these, 56 patients proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportion of the patients who exhibited symptomatic RP was 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38–18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09–9.19, respectively). Conclusions Pulmonary fibrosis sore and lung V40 were significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients having subclinical pulmonary fibrosis. To our best knowledge, this is one of the first report showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who received CCRT followed by durvalumab. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01979-z.
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Affiliation(s)
- Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan.
| | - Kazuyuki Uehara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Aya Harada
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Keiji Kitatani
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Tomonori Yabuuchi
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Shuichirou Miyazaki
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hikaru Kubota
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hideaki Okada
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Taira Ninomaru
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Chihiro Shindo
- Department of Diagnostic Radiology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Akito Hata
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
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