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Shueng P, Huang C, Liu Y, Wu Y, Huang P, Yen S, Lin K, Hsu C. Combined modality therapy for patients with esophageal squamous cell carcinoma: Radiation dose and survival analyses. Thorac Cancer 2022; 14:143-148. [PMID: 36351568 PMCID: PMC9834687 DOI: 10.1111/1759-7714.14724] [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: 10/03/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We aimed to analyze the radiation dose and compare survival among combined modality therapy using modern radiation techniques for patients with esophageal squamous cell carcinoma (ESCC). METHODS This retrospective study included patients with clinically staged T1-4N0-3M0 ESCC from 2014 to 2018. Patients who received combined modality therapies with curative intent were enrolled. The overall survival (OS) rates among combined modality therapy were compared. The clinical variables and impacts of radiation dose on survival were analyzed by the Kaplan-Meier method and Cox regression model. RESULTS Of the 259 patients, 141 (54.4%) received definitive concurrent chemoradiotherapy (DCCRT); 67 (25.9%) underwent neoadjuvant chemoradiotherapy followed by surgery (NCRT+S); 51 (19.7%) obtained surgery followed by adjuvant chemoradiotherapy (S+ACRT). Two-year OS rates of the DCCRT, NCRT+S and S+ACRT group were 48.9, 61.5 and 51.2%. In the subgroup analysis of DCCRT group, the 2-year OS of patients receiving radiation dose 55-60 Gy was 57.1%. Multivariate analyses showed that clinical stage (p = 0.004), DCCRT with 55-60 Gy (p = 0.043) and NCRT+S with pathological complete response (pCR) (p = 0.014) were significant prognostic factors for better OS. The radiation dose-survival curve demonstrated a highly positive correlation between higher radiation dose and better survival. CONCLUSION Our results suggest that NCRT+S can provide a favorable survival for patients with ESCC, especially in patients who achieved pCR. The optimal radiation dose might be 55-60 Gy for patients receiving DCCRT via modern radiation techniques. Further randomized clinical studies are required to confirm the survival benefits between NCRT+S and DCCRT with escalated dose.
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Affiliation(s)
- Pei‐Wei Shueng
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan,School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chun‐Chieh Huang
- Division of Medical Imaging, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Yu‐Ming Liu
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Yuan‐Hong Wu
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan,Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Pin‐I Huang
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Sang‐Hue Yen
- Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan,Department of Radiation Oncology, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Kuan‐Heng Lin
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan,Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chen‐Xiong Hsu
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan,Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan,Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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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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Hsu CX, Lin KH, Wang SY, Tsai WT, Chang CH, Tien HJ, Shueng PW, Wu TH, Mok GSP. Planning evaluation of a novel volume-based algorithm for personalized optimization of lung dose in VMAT for esophageal cancer. Sci Rep 2022; 12:2513. [PMID: 35169144 PMCID: PMC8847643 DOI: 10.1038/s41598-021-04571-3] [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: 09/23/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Radiotherapy treatment planning (RTP) is time-consuming and labor-intensive since medical physicists must devise treatment plans carefully to reduce damage to tissues and organs for patients. Previously, we proposed the volume-based algorithm (VBA) method, providing optimal partial arcs (OPA) angle to achieve the low-dose volume of lungs in dynamic arc radiotherapy. This study aimed to implement the VBA for esophageal cancer (EC) patients and compare the lung dose and delivery time between full arcs (FA) without using VBA and OPA angle using VBA in volumetric modulated arc therapy (VMAT) plans. We retrospectively included 30 patients diagnosed with EC. RTP of each patient was replanned to 4 VMAT plans, including FA plans without (FA-C) and with (FA + C) dose constraints of OARs and OPA plans without (OPA-C) and with (OPA + C) dose constraints of OARs. The prescribed dose was 45 Gy. The OARs included the lungs, heart, and spinal cord. The dose distribution, dose-volume histogram, monitor units (MUs), delivery time, and gamma passing rates were analyzed. The results showed that the lung V5 and V10 in OPA + C plans were significantly lower than in FA + C plans (p < 0.05). No significant differences were noted in planning target volume (PTV) coverage, lung V15, lung V20, mean lung dose, heart V30, heart V40, mean heart dose, and maximal spinal cord dose between FA + C and OPA + C plans. The delivery time was significantly longer in FA + C plans than in OPA + C plans (237 vs. 192 s, p < 0.05). There were no significant differences between FA + C and OPA + C plans in gamma passing rates. We successfully applied the OPA angle based on the VBA to clinical EC patients and simplified the arc angle selection in RTP. The VBA could provide a personalized OPA angle for each patient and effectively reduce lung V5, V10, and delivery time in VMAT.
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Affiliation(s)
- Chen-Xiong Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Industrial Ph.D. Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Ta Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiu-Han Chang
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hui-Ju Tien
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, SAR, China
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