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Mishra A, Pathak R, Mittal KK, Srivastava AK, Dayashankar MS, Mishra SP, Singh SK. Efficacy of the collapsed cone algorithm calculated radiotherapy plans in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT): A comparative dosimetric study in tumors of thorax. J Cancer Res Ther 2024; 20:383-388. [PMID: 38554350 DOI: 10.4103/jcrt.jcrt_2171_22] [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: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 04/01/2024]
Abstract
AIM In this study, efficacy of collapsed cone algorithm-generated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) were evaluated for treatment of thoracic esophageal cancer. MATERIALS AND METHODS Ten previously treated patients with VMAT were considered for evaluation. The planning parameters were evaluated in terms of max dose, mean dose, Homogeneity Index, Conformity Index for planning target volume, and organ at risk doses. Total monitor unit, treatment time, and gamma passing index were also reported. RESULTS The target dose coverage of the VMAT and IMRT plans achieved the clinical dosimetric criteria for all ten patients in the evaluation. Under the condition of equivalent target dose distribution, the VMAT plan's Conformity Index, monitor unit, treatment time, and gamma passing index rate were superior than in the IMRT plan, and the result was statistically significant. CONCLUSION Collapsed cone algorithm-based VMAT can have a more effective and better approach for esophageal cancer than IMRT.
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Affiliation(s)
- Atul Mishra
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
- Department of Radiation Oncology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Ramji Pathak
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
- Department of Physics, D.A.V. Degree College, Lucknow, Uttar Pradesh, India
| | - Kailash Kumar Mittal
- Department of Radiation Oncology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Anoop Kumar Srivastava
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Maurya Surendrakumar Dayashankar
- Department of Applied Physics, Amity University Gwalior, Madhya Pradesh, India
- Department of Radiation Oncology, Shalby Hospitals Indore, Madhya Pradesh, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudesh Kumar Singh
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
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Wang Y, Zhu Y, Xu X. Advances in the management of radiation-induced cystitis in patients with pelvic malignancies. Int J Radiat Biol 2023; 99:1307-1319. [PMID: 36940182 DOI: 10.1080/09553002.2023.2181996] [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: 03/17/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Radiotherapy plays a vital role as a treatment for malignant pelvic tumors, in which the bladder represents a significant organ at risk involved during tumor radiotherapy. Exposing the bladder wall to high doses of ionizing radiation is unavoidable and will lead to radiation cystitis (RC) because of its central position in the pelvic cavity. Radiation cystitis will result in several complications (e.g. frequent micturition, urgent urination, and nocturia) that can significantly reduce the patient's quality of life and in very severe cases become life-threatening. METHODS Existing studies on the pathophysiology, prevention, and management of radiation-induced cystitis from January 1990 to December 2021 were reviewed. PubMed was used as the main search engine. Besides the reviewed studies, citations to those studies were also included. RESULTS AND DISCUSSIONS In this review, the symptoms of radiation cystitis and the mainstream grading scales employed in clinical situations are presented. Next, preclinical and clinical research on preventing and treating radiation cystitis are summarized, and an overview of currently available prevention and treatment strategies as guidelines for clinicians is provided. Treatment options involve symptomatic treatment, vascular interventional therapy, surgery, hyperbaric oxygen therapy (HBOT), bladder irrigation, and electrocoagulation. Prevention includes filling up the bladder to remove it from the radiation field and delivering radiation based on helical tomotherapy and CT-guided 3D intracavitary brachytherapy techniques.
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Affiliation(s)
- Yimin Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoting Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Guo XQ, Mao RH, Liu B, Ge H. Study on esophageal cancer radiotherapy dosimetry and position verification for volumetric modulated arc therapy. Asian J Surg 2023; 46:120-125. [PMID: 35221195 DOI: 10.1016/j.asjsur.2022.02.001] [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: 07/22/2021] [Revised: 10/07/2021] [Accepted: 02/11/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study analyzed the respective advantages and disadvantages by comparing volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) on the dose distribution and position verification distribution characteristics in esophageal cancer radiotherapy, in order to provide the reference for the clinical radiotherapy technology optimization of esophageal cancer. METHODS A total of 56 cases of patients with esophageal cancer were selected and applied to the Pinnacle three-dimensional radiation treatment planning system (TPS), in order to design a VMAT plan and IMRT plan under the guidance of image-guided radiotherapy (IGRT). The dosimetry and position verification difference were compared between the two groups. RESULTS Revealed that the target dose distribution of the VMAT plan and IMRT plan meets the requirements in clinical dosimetry for all 56 patients in this study. Under the premise of similar target coverage, the conformal index (CI) of the VMAT plan, homogeneity index (HI), target volume, BODY-PTV radiated volume and spinal cord Dmax, bilateral lung V5, V20 and mean lung dose (MLD), monitor unit (MU) and treatment time (TT), as well as position verification and others, were obviously superior to those in the IMRT plan; and the difference was statistically significant. CONCLUSION CBCT guided VMAT is a potential effective treatment for esophageal cancer and may be more effective and safer than IMRT.
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Affiliation(s)
- Xiao-Qi Guo
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China
| | - Rong-Hu Mao
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China
| | - Bing Liu
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China
| | - Hong Ge
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China.
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Bakkal BH, Elmas O. Dosimetric comparison of organs at risk in 5 different radiotherapy plans in patients with preoperatively irradiated rectal cancer. Medicine (Baltimore) 2021; 100:e24266. [PMID: 33429836 PMCID: PMC7793361 DOI: 10.1097/md.0000000000024266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/12/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) is a widely used irradiation technique in rectal cancer patients. We aimed to compare 4 different IMRT plans with 3-dimensional conformal radiotherapy (3D-CRT) considering organs at risk (OARs) in patients with rectal carcinoma. METHODS This retrospective study included 27 rectal cancer patients who were irradiated preoperatively between January 2016 and December 2018. Five different plans (4-field 3D-CRT in 2 phases, 7-field IMRT in 2 phases, 9-field IMRT in 2 phases, 7-field simultaneous integrated boost [SIB] IMRT, and 9-field SIB IMRT) were generated for each patient. Comparison of 5 different plans according to bladder and bilateral femoral head mean doses, bladder V40, bilateral femoral head V40, and small bowel V35 values were evaluated. RESULTS Most of the OAR parameters significantly favored IMRT plans compared to the 3D-CRT plan. The largest difference was observed in bladder V40 values (reduction of V40 value up to 51.2% reduction) in favor of IMRT. In addition, SIB plans showed significantly better reduction in OARs than phase plans except for small bowel V35 values. CONCLUSIONS IMRT plans reduced almost all the OARs doses compared with the 3D-CRT plan in rectal cancer patients. Furthermore, SIB plans demonstrated lower OAR doses than the phase plans. IMRT techniques, especially SIB plans, reduce OAR doses and provide safer doses for the treatment of rectal carcinoma.
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A treatment planning study of prone vs. supine positions for locally advanced rectal carcinoma. Strahlenther Onkol 2018; 194:975-984. [DOI: 10.1007/s00066-018-1324-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
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Ito H. Effect of body thickness on helical and direct treatment delivery modes: a phantom study. J Rural Med 2018; 13:110-115. [PMID: 30546799 PMCID: PMC6288721 DOI: 10.2185/jrm.2965] [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: 02/28/2018] [Accepted: 05/30/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: Chemoradiation therapy is among the standard treatments for
cancer, which often causes a decrease in appetite and subsequent weight loss. When weight
loss occurs during treatment, the external body contour changes from that indicated during
initial planning, causing changes in dose distribution to the target tumor regions and
organs at risk (OARs). This study aimed to examine the dose changes to both the target
regions and OARs, based on the dose-volume histogram (DVH). Methods: We established a 60 mm-diameter planning target volume (PTV) and a
30 mm-diameter rectum region of interest (OAR), using a phantom; this was followed by a 50
Gy/25 fraction irradiation to the target region that was measured using a
two-dimensional-array ion chamber device. The measurement was conducted by varying the
bolus thickness from 0 to −25 mm, in 5 mm decrements. In addition, the maximum dose for
both PTV and OAR were evaluated based on the DVH, created using the Adaptive software. Results: The gamma analysis showed that the pass rate was less than 95% when
the bolus thickness was altered by −25 mm for the helical delivery mode and by −10 mm for
the direct delivery mode, resulting in a dose error greater than 3%. Results of the DVH
evaluation revealed that the maximum dose of PTV increased by 5.18% when the bolus
thickness was −25 mm for helical delivery, whereas a 9.95% increase was noted for the
direct delivery mode compared with the dose at the reference level of 0 mm bolus
thickness. Discussion: Our results suggest that it is necessary to formulate a new
treatment plan owing to increased dose error, if the body thickness decreases by more than
20 mm and 10 mm for the helical and direct delivery modes, respectively. The results also
demonstrate that helical delivery is less affected by changes in body thickness than
direct delivery.
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Affiliation(s)
- Hiroya Ito
- Department of Radiation Therapy, Suzuka General Hospital, Japan
- Graduate School of Health Science, Suzuka University of Medical Science, Japan
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Taggar AS, Graham D, Kurien E, Gräfe JL. Volumetric-modulated arc therapy versus intensity-modulated radiotherapy for large volume retroperitoneal sarcomas: A comparative analysis of dosimetric and treatment delivery parameters. J Appl Clin Med Phys 2017; 19:276-281. [PMID: 29178585 PMCID: PMC5768010 DOI: 10.1002/acm2.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 01/03/2023] Open
Abstract
Purpose To compare dosimetric and treatment delivery parameter differences between volumetric‐modulated arc radiotherapy (VMAT) and intensity‐modulated radiotherapy (IMRT) for large volume retroperitoneal sarcomas (RPS). Materials and Methods Both VMAT and IMRT planning were performed on CT datasets of 10 patients with RPS who had been previously treated with preoperative radiotherapy. Plans were optimized to deliver ≥95% dose to the PTV and were evaluated for conformity and homogeneity. Dose to the organs at risk (OARs) (kidney, liver, spinal cord, and bowel space), unspecified tissue, and dose evaluation volumes (DEVs) at 1, 2, and 5 cm from PTV were calculated and compared. Monitor units (MUs) and treatment delivery times were recorded and compared between the two techniques. The deliverability of the large volume RPS VMAT plans was verified by portal dosimetry on a Truebeam™ linac. Results VMAT and IMRT plans were equivalent for PTV coverage and homogeneity (P > 0.05); however, VMAT plans had slightly better conformity index, CI (P < 0.001). Doses to the OARs were not significantly different between VMAT and IMRT plans (P > 0.05). Mean doses to the unspecified tissue as well as at 1, 2, and 5 cm DEVs were lower with VMAT compared with IMRT, P = 0.04 and P < 0.01, respectively. MUs and average beam‐on times were both significantly lower in the VMAT vs IMRT plans, P < 0.001 and P = 0.001, respectively. All VMAT plans passed portal dosimetry delivery verification with an average gamma passing rate of 99.6 ± 0.4%. Conclusions VMAT planning for large volume RPS improved CI, and achieved comparable OAR sparing, as compared with IMRT. As treatment delivery time was lower, the use of VMAT for RPS may translate into improved treatment delivery efficiency.
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Affiliation(s)
- Amandeep S Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Darren Graham
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Elizabeth Kurien
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Cumming School of Medicine, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - James L Gräfe
- Department of Physics, Ryerson University, Toronto, ON, Canada
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Lupattelli M, Matrone F, Gambacorta MA, Osti M, Macchia G, Palazzari E, Nicosia L, Navarria F, Chiloiro G, Valentini V, Aristei C, De Paoli A. Preoperative intensity-modulated radiotherapy with a simultaneous integrated boost combined with Capecitabine in locally advanced rectal cancer: short-term results of a multicentric study. Radiat Oncol 2017; 12:139. [PMID: 28830475 PMCID: PMC5568311 DOI: 10.1186/s13014-017-0870-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Preoperative radiotherapy (RT) in combination with fluoropyrimidine-based chemotherapy (CT) is the standard of care in patients with locally advanced, T3-T4 N0-2, rectal cancer (LARC). Given the correlation between RT dose-tumor response and the prognostic role of the tumor regression grade (TRG), treatment intensification represents an area of active investigation. The aim of the study was to analyze the role of RT dose-intensification in the preoperative treatment of LARC in terms of feasibility, efficacy and toxicity. METHODS We retrospectively analyzed patients with LARC treated with intensity-modulated radiotherapy (IMRT) and simultaneous integrated boost (SIB) at five Italian radiation oncology centers. Concurrent Capecitabine was administered. Treatment response was evaluated in terms of disease down-staging and TRG. Acute toxicity was evaluated according to the CTC-AE 4.0 scale. RESULTS A total of 76 patients were identified for this analysis. A dose of 45 Gy was prescribed to the entire mesorectum and pelvic lymph nodes with a median SIB dose of 54 Gy (range 52.5-57.5) to the tumor and corresponding mesorectum. Overall, 74/76 (97.4%) patients completed the planned RT, whereas 64/76 (84.2%) patients completed the prescribed CT. Eight (10.5%) patients developed grade 3-4 acute toxicity. Overall, 72/76 patients underwent surgery. The tumor and nodal down-staging was documented in 51 (70.8%) and 43 (67%) patients, respectively. Twenty (27.8%) patients obtained a pathologic complete response. Surgical morbidity was reported in 13/72 patients (18.1%). CONCLUSIONS Although retrospective in design, this study indicates that IMRT-SIB with a dose range of 52.5-57.5 Gy (median 54 Gy) and concomitant Capecitabine appears feasible, well tolerated and effective in terms of disease down-staging and pathological complete response. Long-term toxicity and the impact on disease control and patient survival will be evaluated with a longer follow-up time. TRIAL REGISTRATION NA.
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Affiliation(s)
- Marco Lupattelli
- Radiation Oncology Dept., Santa Maria della Misericordia Hospital, Piazzale Menghini, 1 - 06129 Perugia, Italy
| | - Fabio Matrone
- Radiation Oncology Dept., CRO - National Cancer Institute, Aviano, Italy
| | | | - Mattia Osti
- Radiation Oncology Dept., Sant’ Andrea Hospital - Sapienza University, Rome, Italy
| | - Gabriella Macchia
- Radiation Oncology Dept., Catholic University of Sacred Heart, Campobasso, Italy
| | - Elisa Palazzari
- Radiation Oncology Dept., Santa Maria della Misericordia Hospital - University, Perugia, Italy
| | - Luca Nicosia
- Radiation Oncology Dept., Sant’ Andrea Hospital - Sapienza University, Rome, Italy
| | - Federico Navarria
- Radiation Oncology Dept., CRO - National Cancer Institute, Aviano, Italy
| | - Giuditta Chiloiro
- Radiation Oncology Dept., Catholic University of Sacred Heart, Rome, Italy
| | - Vincenzo Valentini
- Radiation Oncology Dept., Catholic University of Sacred Heart, Rome, Italy
| | - Cynthia Aristei
- Radiation Oncology Dept., Santa Maria della Misericordia Hospital - University, Perugia, Italy
| | - Antonino De Paoli
- Radiation Oncology Dept., CRO - National Cancer Institute, Aviano, Italy
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Small bowel protection in IMRT for rectal cancer. Strahlenther Onkol 2017; 193:578-588. [DOI: 10.1007/s00066-017-1107-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/27/2017] [Indexed: 12/25/2022]
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