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Tremi I, Nowsheen S, Aziz K, Siva S, Ventura J, Hatzi VI, Martin OA, Georgakilas AG. Inflammation and oxidatively induced DNA damage: A synergy leading to cancer development. Cancer 2021. [DOI: 10.1016/b978-0-12-819547-5.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rijken J, Kairn T, Crowe S, Trapp J. Effect of arc length on skin dose from hypofractionated volumetric modulated arc radiotherapy treatments of the lung and spine. Med Dosim 2019; 44:309-314. [DOI: 10.1016/j.meddos.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
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Colodro JFM, Berná AS, Puchades VP, Amores DR, Baños MA. Volumetric-modulated Arc Therapy Lung Stereotactic Body Radiation Therapy Dosimetric Quality Assurance: A Comparison between Radiochromic Film and Chamber Array. J Med Phys 2017; 42:133-139. [PMID: 28974858 PMCID: PMC5618459 DOI: 10.4103/jmp.jmp_130_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: The aim of this work is to verify the use of radiochromic film in the quality assurance (QA) of volumetric-modulated arc therapy (VMAT) lung stereotactic body radiation therapy (SBRT) plans and compare the results with those obtained using an ion chamber array. Materials and Methods: QA was performed for 14 plans using a two-dimensional-array seven29 and EBT3 film. Dose values per session ranged between 7.5 Gy and 18 Gy. The multichannel method was used to obtain a dose map for film. Results: The results obtained were compared with treatment planning system calculated profiles through gamma analysis. Passing criteria were 3%/3 mm, 2%/2 mm and 3%/1.5 mm with maximum and local dose (LD) normalization. Mean gamma passing rate (GPR) (percentage of points presenting a gamma function value of <1) was obtained and compared. Calibration curves were obtained for each color channel within the dose range 0–16 Gy. Mean GPR values for film were >98.9% for all criteria when normalizing per maximum dose. When using LD, normalization was >92.7%. GPR values for the array were lower for all criteria; this difference being statistically significant when normalizing at LD, reaching 12% for the 3%/1.5 mm criterion. Conclusion: Both detectors provide satisfactory results for the QA of plans for VMAT lung SBRT. The film provided greater mean GPR values, afforded greater spatial resolution and was more efficient overall.
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Affiliation(s)
- Juan Fernando Mata Colodro
- Department of Medical Physics and Radiation Protection, Santa Lucia University Hospital, Cartagena, Murcia, Spain
| | - Alfredo Serna Berná
- Department of Medical Physics and Radiation Protection, Santa Lucia University Hospital, Cartagena, Murcia, Spain
| | - Vicente Puchades Puchades
- Department of Medical Physics and Radiation Protection, Santa Lucia University Hospital, Cartagena, Murcia, Spain
| | - David Ramos Amores
- Department of Medical Physics and Radiation Protection, Santa Lucia University Hospital, Cartagena, Murcia, Spain
| | - Miguel Alcaraz Baños
- Department of Medical Physic Radiology and Physical Medicine, Faculty of Medicine/Dentistry, University of Murcia, Murcia, Spain
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Hardcastle N, Oborn BM, Haworth A. On the use of a convolution-superposition algorithm for plan checking in lung stereotactic body radiation therapy. J Appl Clin Med Phys 2016; 17:99-110. [PMID: 27685114 PMCID: PMC5874108 DOI: 10.1120/jacmp.v17i5.6186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 05/09/2016] [Accepted: 04/18/2016] [Indexed: 12/31/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) aims to deliver a highly conformal ablative dose to a small target. Dosimetric verification of SBRT for lung tumors presents a challenge due to heterogeneities, moving targets, and small fields. Recent software (M3D) designed for dosimetric verification of lung SBRT treatment plans using an advanced convolution–superposition algorithm was evaluated. Ten lung SBRT patients covering a range of tumor volumes were selected. 3D CRT plans were created using the XiO treatment planning system (TPS) with the superposition algorithm. Dose was recalculated in the Eclipse TPS using the AAA algorithm, M3D verification software using the collapsed‐cone‐convolution algorithm, and in‐house Monte Carlo (MC). Target point doses were calculated with RadCalc software. Near‐maximum, median, and near‐minimum target doses, conformity indices, and lung doses were compared with MC as the reference calculation. M3D 3D gamma passing rates were compared with the XiO and Eclipse. Wilcoxon signed‐rank test was used to compare each calculation method with XiO with a threshold of significance of p<0.05. M3D and RadCalc point dose calculations were greater than MC by up to 7.7% and 13.1%, respectively, with M3D being statistically significant (s.s.). AAA and XiO calculated point doses were less than MC by 11.3% and 5.2%, respectively (AAA s.s.). Median and near‐minimum and near‐maximum target doses were less than MC when calculated with AAA and XiO (all s.s.). Near‐maximum and median target doses were higher with M3D compared with MC (s.s.), but there was no difference in near‐minimum M3D doses compared with MC. M3D‐calculated ipsilateral lung V20 Gy and V5 Gy were greater than that calculated with MC (s.s.); AAA‐ and XiO‐calculated V20 Gy was lower than that calculated with MC, but not statistically different to MC for V5 Gy. Nine of the 10 plans achieved M3D gamma passing rates greater than 95% and 80%for 5%/1 mm and 3%/1 mm criteria, respectively. M3D typically calculated a higher target and lung dose than MC for lung SBRT plans. The results show a range of calculated doses with different algorithms and suggest that M3D is in closer agreement with Monte Carlo, thus discrepancies between the TPS and M3D software will be observed for lung SBRT plans. M3D provides a useful supplement to verification of lung SBRT plans by direct measurement, which typically excludes patient specific heterogeneities. PACS number(s): 87.55.D‐, 87.55.Qr, 87.55.K‐
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Siva S, Kron T, Bressel M, Haas M, Mai T, Vinod S, Sasso G, Wong W, Le H, Eade T, Hardcastle N, Chesson B, Pham D, Høyer M, Montgomery R, Ball D. A randomised phase II trial of Stereotactic Ablative Fractionated radiotherapy versus Radiosurgery for Oligometastatic Neoplasia to the lung (TROG 13.01 SAFRON II). BMC Cancer 2016; 16:183. [PMID: 26944262 PMCID: PMC4778366 DOI: 10.1186/s12885-016-2227-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Stereotactic ablative body radiotherapy (SABR) is emerging as a non-invasive method for precision irradiation of lung tumours. However, the ideal dose/fractionation schedule is not yet known. The primary purpose of this study is to assess safety and efficacy profile of single and multi-fraction SABR in the context of pulmonary oligometastases. Methods/Design The TROG 13.01/ALTG 13.001 clinical trial is a multicentre unblinded randomised phase II study. Eligible patients have up to three metastases to the lung from any non-haematological malignancy, each < 5 cm in size, non-central targets, and have all primary and extrathoracic disease controlled with local therapies. Patients are randomised 1:1 to a single fraction of 28Gy versus 48Gy in four fractions of SABR. The primary objective is to assess the safety of each treatment arm, with secondary objectives including assessment of quality of life, local efficacy, resource use and costs, overall and disease free survival and time to distant failure. Outcomes will be stratified by number of metastases and origin of the primary disease (colorectal versus non-colorectal primary). Planned substudies include an assessment of the impact of online e-Learning platforms for lung SABR and assessment of the effect of SABR fractionation on the immune responses. A total of 84 patients are required to complete the study. Discussion Fractionation schedules have not yet been investigated in a randomised fashion in the setting of oligometastatic disease. Assuming the likelihood of similar clinical efficacy in both arms, the present study design allows for exploration of the hypothesis that cost implications of managing potentially increased toxicities from single fraction SABR will be outweighed by costs associated with delivering multiple-fraction SABR. Trials registration ACTRN12613001157763, registered 17th October 2013
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Affiliation(s)
- Shankar Siva
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, 3002, Australia. .,University of Melbourne, Royal Parade, Parkville, 8006, Australia.
| | - Tomas Kron
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, 3002, Australia. .,University of Melbourne, Royal Parade, Parkville, 8006, Australia.
| | - Mathias Bressel
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, 3002, Australia.
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway Sydney, 2007, Australia.
| | - Tao Mai
- Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Qld, 4102, Australia.
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
| | - Giuseppe Sasso
- Radiation Oncology Department, Auckland City Hospital, Auckland, New Zealand.
| | - Wenchang Wong
- Department of Radiation Oncology, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia.
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.
| | - Thomas Eade
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.
| | - Nicholas Hardcastle
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.
| | - Brent Chesson
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, 3002, Australia.
| | - Daniel Pham
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, 3002, Australia.
| | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, 8000, Denmark.
| | - Rebecca Montgomery
- Trans Tasman Radiation Oncology Group (TROG), PO Box 88, Waratah, 2298, Australia.
| | - David Ball
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, 3002, Australia. .,University of Melbourne, Royal Parade, Parkville, 8006, Australia.
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Dosimetric Consequences of 3D Versus 4D PET/CT for Target Delineation of Lung Stereotactic Radiotherapy. J Thorac Oncol 2015; 10:1112-5. [DOI: 10.1097/jto.0000000000000555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Siva S, Callahan JW, Kron T, Chesson B, Barnett SA, Macmanus MP, Hicks RJ, Ball DL. Respiratory-gated (4D) FDG-PET detects tumour and normal lung response after stereotactic radiotherapy for pulmonary metastases. Acta Oncol 2015; 54:1105-12. [PMID: 25833329 DOI: 10.3109/0284186x.2015.1027409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Response assessment after stereotactic ablative body radiotherapy (SABR) in lung can be confounded by radiation-induced inflammation, fibrosis and subsequent alteration of tumour motion. The purpose of this prospective pilot study was to evaluate the utility of four-dimensional (4D) FDG-PET/CT for post-SABR tumour and normal lung response assessment in pulmonary oligometastases. MATERIAL AND METHODS Patients enrolled from February 2010 to December 2011 in this prospective ethics approved study had 1-2 pulmonary metastases on staging FDG-PET. Serial contemporaneous 3D and 4D FDG-PET/CT scans were performed at baseline, 14 days and 70 days after a single fraction of 26 Gy SABR. Tumour response was evaluated in 3D and 4D using SUVmax, RECIST and PERCIST criteria. Normal lung radiotoxicity was evaluated using SUVmean within 0-2 Gy, 2-5 Gy, 5-10 Gy, 10-20 Gy and 20 + Gy isodose volumes. RESULTS In total, 17 patients were enrolled of which seven were ineligible due to interval progression from staging PET to baseline 4D-PET. The mean time between scans was 62 days. At a median follow-up of 16 months, 10 patients with 13 metastases received SABR, with no patient having local progression. The vector of tumour motion was larger in patients with discordant 3D and 4D PET PERCIST response (p < 0.01), with a mean (± SEM) motion of 10.5 mm (± 0.96 mm) versus 6.14 mm (± 0.81 mm) in those patients with concordant 3D and 4D response. Surrounding normal lung FDG uptake at 70 days was strongly correlated to delivered radiation dose (r(2) = 0.99, p < 0.01), with significant elevations across all dose levels (p ≤ 0.05), except the < 2 Gy volume (p = 0.30). CONCLUSIONS We demonstrate high rates of interval progression between staging PET scans in patients with oligometastases. We found that tumour response on conventional 3D PET is not concordant with 4D PET for tumours with large motion. Normal lung metabolic uptake is strongly dose dependent after SABR, a novel finding that should be further validated.
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Affiliation(s)
- Shankar Siva
- a Sir Peter MacCallum Department of Oncology , The University of Melbourne , Parkville, Victoria , Australia
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Herschtal A, Te Marvelde L, Mengersen K, Hosseinifard Z, Foroudi F, Devereux T, Pham D, Ball D, Greer PB, Pichler P, Eade T, Kneebone A, Bell L, Caine H, Hindson B, Kron T. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors. Phys Med Biol 2015; 60:1793-805. [PMID: 25658193 DOI: 10.1088/0031-9155/60/5/1793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement ('random error') than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts -19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements.
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Affiliation(s)
- A Herschtal
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia. Faculty of Health Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Hubbard P, Callahan J, Cramb J, Budd R, Kron T. Audit of radiation dose delivered in time-resolved four-dimensional computed tomography in a radiotherapy department. J Med Imaging Radiat Oncol 2015; 59:346-52. [PMID: 25728211 DOI: 10.1111/1754-9485.12284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 01/01/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To review the dose delivered to patients in time-resolved computed tomography (4D CT) used for radiotherapy treatment planning. METHODS 4D CT is used at Peter MacCallum Cancer Centre since July 2007 for radiotherapy treatment planning using a Philips Brilliance Wide Bore CT scanner (16 slice, helical 4D CT acquisition). All scans are performed at 140 kVp and reconstructed in 10 datasets for different phases of the breathing cycle. Dose records were analysed retrospectively for 387 patients who underwent 4D CT procedures between 2007 and 2013. RESULTS A total of 444 4D CT scans were acquired with the majority of them (342) being for lung cancer radiotherapy. Volume CT dose index (CTDIvol) as recorded over this period was fairly constant at approximately 20 mGy for adults. The CTDI for 4D CT for lung cancers of 19.6 ± 9.3 mGy (n = 168, mean ± 1SD) was found to be 63% higher than CTDIs for conventional CT scans for lung patients that were acquired in the same period (CTDIvol 12 ± 4 mGy, sample of n = 25). CTDI and dose length product (DLP) increased with increasing field of view; however, no significant difference between DLPs for different indications (breast, kidney, liver and lung) could be found. Breathing parameters such as breathing rate or pattern did not affect dose. CONCLUSION 4D CT scans can be acquired for radiotherapy treatment planning with a dose less than twice the one required for conventional CT scanning.
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Affiliation(s)
- Patricia Hubbard
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jason Callahan
- Department of Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Imaging and Radiation Science, Monash University, Melbourne, Victoria, Australia
| | - Jim Cramb
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ray Budd
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tomas Kron
- Department of Medical Imaging and Radiation Science, Monash University, Melbourne, Victoria, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Sawyer B, Pun E, Samuel M, Tay H, Kron T, Bressel M, Ball D, Siva S. CT perfusion imaging in response assessment of pulmonary metastases undergoing stereotactic ablative radiotherapy. J Med Imaging Radiat Oncol 2015; 59:207-15. [PMID: 25601133 DOI: 10.1111/1754-9485.12272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/19/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stereotactic ablative body radiotherapy (SABR) is an emerging treatment technique for pulmonary metastases in which conventional Response Evaluation Criteria in Solid Tumours (RECIST) may be inadequate. This study aims to assess the utility of CT perfusion imaging in response assessment of pulmonary metastases after SABR. METHODS In this ethics board-approved prospective study, 11 patients underwent a 26-Gy single fraction of SABR to pulmonary metastases. CT perfusion imaging occurred prior to and at 14 and 70 days post-SABR. Blood flow (mL/100 mL/min), blood volume (mL/100 mL), time to peak (seconds) and surface permeability (mL/100 mL/min), perfusion parameters of pulmonary metastases undergoing SABR, were independently assessed by two radiologists. Inter-observer variability was analysed. CT perfusion results were analysed for early response assessment comparing day 14 with baseline scans and for late response by comparing day 70 with baseline scans. The largest diameter of the pulmonary metastases undergoing SABR was recorded. RESULTS Ten patients completed all three scans and one patient had baseline and early response assessment CT perfusion scans only. There was strong level of inter-observer agreement of CT perfusion interpretation with a median intraclass coefficient of 0.87 (range 0.20-0.98). Changes in all four perfusion parameters and tumour sizes were not statistically significant. CONCLUSION CT perfusion imaging of pulmonary metastases is a highly reproducible imaging technique that may provide additional response assessment information above that of conventional RECIST, and it warrants further study in a larger cohort of patients undergoing SABR.
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Affiliation(s)
- Brooke Sawyer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Bronchoscopic Delivery of Lipiodol as a Fiducial Marker in Lung Tumors Before Radiotherapy. J Thorac Oncol 2014; 9:1579-83. [DOI: 10.1097/jto.0000000000000268] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Results of patient specific quality assurance for patients undergoing stereotactic ablative radiotherapy for lung lesions. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2014; 37:45-52. [DOI: 10.1007/s13246-013-0239-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 12/28/2013] [Indexed: 12/31/2022]
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Siva S, Pham D, Gill S, Bressel M, Dang K, Devereux T, Kron T, Foroudi F. An analysis of respiratory induced kidney motion on four-dimensional computed tomography and its implications for stereotactic kidney radiotherapy. Radiat Oncol 2013; 8:248. [PMID: 24160868 PMCID: PMC3829388 DOI: 10.1186/1748-717x-8-248] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Stereotactic ablative body radiotherapy (SABR) is an emerging treatment modality for primary renal cell carcinoma. To account for respiratory-induced target motion, an internal target volume (ITV) concept is often used in treatment planning of SABR. The purpose of this study is to assess patterns of kidney motion and investigate potential surrogates of kidney displacement with the view of ITV verification during treatment. MATERIAL AND METHODS Datasets from 71 consecutive patients with free breathing four-dimensional computed tomography (4DCT) planning scans were included in this study. The displacement of the left and right hemi-diaphragm, liver dome and abdominal wall were measured and tested for correlation with the displacement of the both kidneys and patient breathing frequency. RESULTS Nine patients were excluded due to severe banding artifact. Of 62 evaluable patients, the median age was 68 years, with 41 male patients and 21 female patients. The mean (range) of the maximum, minimum and average breathing frequency throughout the 4DCTs were 20.1 (11-38), 15.1 (9-24) and 17.3 (9-27.5) breaths per minute, respectively. The mean (interquartile range) displacement of the left and right kidneys was 0.74 cm (0.45-0.98 cm) and 0.75 cm (0.49-0.97) respectively. The amplitude of liver-dome motion was correlated with right kidney displacement (r=0.52, p<0.001), but not with left kidney displacement (p=0.796). There was a statistically significant correlation between the magnitude of right kidney displacement and that of abdominal displacement (r=0.36, p=0.004), but not the left kidney (r=0.24, p=0.056). Hemi-diaphragm displacements were correlated with kidney displacements respectively, with a weaker correlation for the left kidney/left diaphragm (r=0.45, [95% CI 0.22 to 0.63], p=<0.001) than for the right kidney/right diaphragm (r=0.57, [95% CI 0.37 to 0.72], p=<0.001). CONCLUSIONS For the majority of patients, maximal left and right kidney displacement is subcentimeter in magnitude. The magnitude of kidney motion cannot be reliably estimated from the diaphragmatic, liver dome or abdominal wall surrogates. One explanation may be that the kidneys are not uniformly in contact with the surrogates investigated in this study. Further investigation is required before surrogates of kidney displacement are used for clinical SABR delivery.
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Affiliation(s)
- Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, Victoria 8006, Australia
| | - Daniel Pham
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Suki Gill
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kim Dang
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Thomas Devereux
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Siva S, Devereux T, Kron T, Gill S, MacManus M, Bressel M, Chesson B, Callahan J, Pham D, Hicks R, Foroudi F, Ball D. Vacuum immobilisation reduces tumour excursion and minimises intrafraction error in a cohort study of stereotactic ablative body radiotherapy for pulmonary metastases. J Med Imaging Radiat Oncol 2013; 58:244-52. [DOI: 10.1111/1754-9485.12112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 08/13/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Shankar Siva
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Victoria Australia
| | - Tomas Devereux
- Department of Radiation Therapy Services; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Tomas Kron
- Deparment of Physical Sciences; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Suki Gill
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Michael MacManus
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Victoria Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Brent Chesson
- Department of Radiation Therapy Services; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Jason Callahan
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Daniel Pham
- Department of Radiation Therapy Services; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Rodney Hicks
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
| | - Farshad Foroudi
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Victoria Australia
| | - David Ball
- Division of Cancer Imaging and Radiation Oncology; Peter MacCallum Cancer Centre; East Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Victoria Australia
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Rana T, Schultz MA, Freeman ML, Biswas S. Loss of Nrf2 accelerates ionizing radiation-induced bone loss by upregulating RANKL. Free Radic Biol Med 2012; 53:2298-307. [PMID: 23085426 PMCID: PMC3762920 DOI: 10.1016/j.freeradbiomed.2012.10.536] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/23/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022]
Abstract
Radiation therapy is an integral part of treatment for cancer patients; however, major side effects of this modality include aberrant bone remodeling and bone loss. Ionizing radiation (IR) is a major external factor that contributes to a significant increase in oxidative stress such as reactive oxygen species (ROS), has been implicated in osteoporotic phenotypes, and has been implicated in osteoporotic phenotypes, bone loss, and fracture risk. One of the major cellular defenses against heightened oxidative stress is mediated by nuclear factor (erythroid-derived 2)-like 2 (Nrf2), a master transcription factor that regulates induction of antioxidant gene expression and phase II antioxidant enzymes. Our objective was to test the hypothesis that loss of functional Nrf2 increases radiation-induced bone loss. We irradiated (single dose, 20Gy) the hindlegs of age- and sex-matched Nrf2(+/+) and Nrf2(-/-) mice. After 1 month, microCT analysis and histology revealed a drastic overall decrease in the bone volume after irradiation of mice lacking Nrf2. Although radiation exposure led to bone loss in mice with intact Nrf2, it was dramatically enhanced by loss of Nrf2. Furthermore, in the absence of Nrf2, a decrease in osteoblast mineralization was noted in calvarial osteoblasts compared with wild-type controls, and treatment with a common antioxidant, N-acetyl-l-cysteine (NAC), was able to rescue the mineralization. As expected, we observed a higher number of osteoclasts in Nrf2(-/-) mice compared to Nrf2(+/+) mice, and after irradiation, the trend remained the same. RT-PCR analysis of calvarial osteoblasts revealed that in the absence of Nrf2, the expression of RANKL was increased after irradiation. Interestingly, RANKL expression was suppressed when the calvarial osteoblasts were treated with NAC before IR exposure. Taken together, our data suggest that loss of Nrf2 leads to heightened oxidative stress and increased susceptibility to radiation-induced bone loss.
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Affiliation(s)
- Tapasi Rana
- Department of Radiation Oncology 1161 21st Avenue S MCN DD1218 Nashville, TN 37232 United States
| | - Michelle A Schultz
- Department of Radiation Oncology 1161 21st Avenue S MCN DD1218 Nashville, TN 37232 United States
| | - Michael L Freeman
- Department of Radiation Oncology 1161 21st Avenue S MCN DD1218 Nashville, TN 37232 United States; Cancer Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Swati Biswas
- Department of Radiation Oncology 1161 21st Avenue S MCN DD1218 Nashville, TN 37232 United States; Cancer Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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