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Sheikh K, Daniel BL, Roumeliotis M, Lee J, Hrinivich WT, Benkert T, Bhat H, Seethamraju RT, Viswanathan AN, Schmidt EJ. Inversion-recovery ultrashort-echo-time (IR-UTE) MRI-based detection of radiation dose heterogeneity in gynecologic cancer patients treated with HDR brachytherapy. Radiat Oncol 2024; 19:105. [PMID: 39107776 PMCID: PMC11305063 DOI: 10.1186/s13014-024-02499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To evaluate the relationship between delivered radiation (RT) and post-RT inversion-recovery ultrashort-echo-time (IR-UTE) MRI signal-intensity (SI) in gynecologic cancer patients treated with high-dose-rate (HDR) brachytherapy (BT). METHODS Seven patients underwent whole-pelvis RT (WPRT) followed by BT to the high-risk clinical target volume (HR-CTV). MR images were acquired at three time-points; pre-RT, post-WPRT/pre-BT, and 3-6 months post-BT. Diffuse-fibrosis (FDiffuse) was imaged with a non-contrast dual-echo IR (inversion time [TI] = 60 ms) UTE research application, with image-subtraction of the later echo, only retaining the ultrashort-echo SI. Dense-fibrosis (FDense) imaging utilized single-echo Late-Gadolinium-Enhanced IR-UTE, acquired ∼ 15 min post-Gadavist injection. Resulting FDiffuse and FDense SI were normalized to the corresponding gluteal-muscle SI. Images were deformably registered between time-points based on normal tissue anatomy. The remnant tumor at both time-points was segmented using multi-parametric MRI. Contours corresponding to the 50%, 100%, 150%, and 200% isodose lines (IDLs) of the prescription BT-dose were created. Mean FDiffuse and FDense SI within (i) each IDL contour and (ii) the remnant tumor were calculated. Post-BT FDiffuse and FDense SI were correlated with prescribed BT-dose. To determine the relationship between BT-dose and IR-UTE SI, the differences in the post-BT FDense across IDLs was determined using paired t-tests with Bonferroni correction. RESULTS FDense was higher in regions of higher dose for 6/7 patients, with mean ± SD values of 357 ± 103% and 331 ± 97% (p = .03) in the 100% and 50% IDL, respectively. FDense was higher in regions of higher dose in the responsive regions with mean ± SD values of 380 ± 122% and 356 ± 135% (p = .03) in the 150% and 50% IDL, respectively. Within the segmented remnant tumor, an increase in prescribed dose correlated with an increase in FDense post-BT (n = 5, r = .89, p = .04). Post-BT FDiffuse inversely correlated (n = 7, r = -.83, p = .02) with prescribed BT-dose within the 100% IDL. CONCLUSIONS Results suggest that FDense SI 3-6 months post-BT is a sensitive measure of tissue response to heterogeneous BT radiation-dose. Future studies will validate whether FDiffuse and FDense are accurate biomarkers of fibrotic radiation response.
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Affiliation(s)
- Khadija Sheikh
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 5255 Loughboro Road NW, Washington, DC, USA.
| | - Bruce L Daniel
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Michael Roumeliotis
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 5255 Loughboro Road NW, Washington, DC, USA
| | - Junghoon Lee
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 5255 Loughboro Road NW, Washington, DC, USA
| | - William T Hrinivich
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 5255 Loughboro Road NW, Washington, DC, USA
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthineers AG, Erlangen, Germany
| | | | | | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 5255 Loughboro Road NW, Washington, DC, USA
| | - Ehud J Schmidt
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 5255 Loughboro Road NW, Washington, DC, USA
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Johnson AL, Elder SS, McKendrick JG, Hegarty LM, Mercer E, Emmerson E. A single dose of radiation elicits comparable acute salivary gland injury to fractionated radiation. Dis Model Mech 2024; 17:dmm050733. [PMID: 39086326 PMCID: PMC11361643 DOI: 10.1242/dmm.050733] [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: 01/29/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
The salivary glands are often damaged during head and neck cancer radiotherapy. This results in chronic dry mouth, which adversely affects quality of life and for which there is no long-term cure. Mouse models of salivary gland injury are routinely used in regenerative research. However, there is no clear consensus on the radiation regime required to cause injury. Here, we analysed three regimes of γ-irradiation of the submandibular salivary gland. Transcriptional analysis, immunofluorescence and flow cytometry was used to profile DNA damage, gland architecture and immune cell changes 3 days after single doses of 10 or 15 Gy or three doses of 5 Gy. Irrespective of the regime, radiation induced comparable levels of DNA damage, cell cycle arrest, loss of glandular architecture, increased pro-inflammatory cytokines and a reduction in tissue-resident macrophages, relative to those observed in non-irradiated submandibular glands. Given these data, coupled with the fact that repeated anaesthetic can negatively affect animal welfare and interfere with saliva secretion, we conclude that a single dose of 10 Gy irradiation is the most refined method of inducing acute salivary gland injury in a mouse model.
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Affiliation(s)
- Amanda L. Johnson
- The Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Sonia S. Elder
- The Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - John G. McKendrick
- The Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
- The Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Lizi M. Hegarty
- The Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
- The Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Ella Mercer
- The Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Elaine Emmerson
- The Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, 4-5 Little France Drive, Edinburgh, EH16 4UU, UK
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Varlotto JM, Sun Z, Ky B, Upshaw J, Fitzgerald TJ, Diehn M, Lovly C, Belani C, Oettel K, Masters G, Harkenrider M, Ross H, Ramalingam S, Pennell NA. A Review of Concurrent Chemo/Radiation, Immunotherapy, Radiation Planning, and Biomarkers for Locally Advanced Non-small Cell Lung Cancer and Their Role in the Development of ECOG-ACRIN EA5181. Clin Lung Cancer 2022; 23:547-560. [PMID: 35882620 DOI: 10.1016/j.cllc.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
ECOG-ACRIN EA5181 is a current prospective, randomized trial that is investigating whether the addition of concomitant durvalumab to standard chemo/radiation followed by 1 year of consolidative durvalumab results in an overall survival benefit over standard chemo/radiation alone followed by 1 year of consolidative durvalumab in patients with locally advanced, unresectable non-small cell lung cancer (NSCLC). Because multiple phase I/II trials have shown the relative safety of adding immunotherapy to chemo/radiation and due to the known synergism between chemotherapy and immunotherapy, it is hoped that concomitant durvalumab can reduce the relatively high incidence of local failure (38%-46%) as seen in recent prospective, randomized trials of standard chemo/radiation in this patient population. We will review the history of radiation for LA-NSCLC and discuss the role of induction, concurrent and consolidative chemotherapy as well as the concerns for late cardiac and pulmonary toxicities associated with treatment. Furthermore, we will review the potential role of next generation sequencing, PD-L1, ctDNA and tumor mutation burden and their possible impact on this trial.
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Affiliation(s)
- John Michael Varlotto
- Department of Oncology, Edwards Comprehensive Cancer Center/Marshall University, Huntington, WV.
| | - Zhuoxin Sun
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Bonnie Ky
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jenica Upshaw
- Department of Medicine, Tufts University, Boston, MA
| | | | - Max Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Christine Lovly
- Division of Hematology Oncology, Vanderbilt University, Nashville, TN
| | - Chandra Belani
- Department of Medical Oncology, Penn State Cancer Institute, Hershey, PA
| | - Kurt Oettel
- Department of Medical Oncology, Gundersen Lutheran Medical Center, La Crosse, WI
| | | | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine Loyola University Chicago, Maywood, IL
| | - Helen Ross
- Department of Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | - Nathan A Pennell
- Department of Hematology Oncology, Cleveland Clinic, Cleveland, OH
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4
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Kelly-Reif K, Bertke S, Daniels RD, Richardson DB, Schubauer-Berigan MK. Nonmalignant respiratory disease mortality in male Colorado Plateau uranium miners, 1960-2016. Am J Ind Med 2022; 65:773-782. [PMID: 35941829 PMCID: PMC10031748 DOI: 10.1002/ajim.23419] [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: 04/08/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate trends of nonmalignant respiratory disease (NMRD) mortality among US underground uranium miners on the Colorado Plateau, and to estimate the exposure-response association between cumulative radon progeny exposure and NMRD subtype mortality. METHODS Standardized mortality ratios (SMRs) and excess relative rates per 100 working level months (excess relative rate [ERR]/100 WLM) were estimated in a cohort of 4021 male underground uranium miners who were followed from 1960 through 2016. RESULTS We observed elevated SMRs for all NMRD subtypes. Silicosis had the largest SMR (n = 52, SMR = 41.4; 95% confidence interval [CI]: 30.9, 54.3), followed by other pneumoconiosis (n = 49, SMR = 39.6; 95% CI: 29.6, 52.3) and idiopathic pulmonary fibrosis (IPF) (n = 64, SMR = 4.77; 95% CI 3.67, 6.09). SMRs for silicosis increased with duration of employment; SMRs for IPF increased with duration of employment and calendar period. There was a positive association between cumulative radon exposure and silicosis with evidence of modification by smoking (ERR/100 WLM≥10 pack-years = 0.78; 95% CI: 0.05, 24.6 and ERR/100 WLM<10 pack-years = 0.01; 95% CI: -0.03, 0.52), as well as a small positive association between radon and IPF (ERR/100 WLM = 0.06, 95% CI: 0.00, 0.24); these associations were driven by workers with prior employment in hard rock mining. CONCLUSIONS Uranium mining workers had excess NMRD mortality compared with the general population; this excess persisted throughout follow-up. Exposure-response analyses indicated a positive association between radon exposure and IPF and silicosis, but these analyses have limitations due to outcome misclassification and missing information on occupational co-exposures such as silica dust.
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Affiliation(s)
- Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Robert D Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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Leon SM, Paucar O, Correa N, Glassell M, Gonzales Ccoscco AEE, Olguin EA, Shankar A, Moskvin V, Schwarz BC, Alva-Sanchez MS, Moyses H, Hamrick B, Sarria G, Li B, Tajima T, Necas A, Guzman C, Challco R, Montoya Zavaleta ME, Meza Z, Zapata Requena MR, Gonzales Gálvez A, Marquina J, Quispe K, Chavez T, Castilla L, Moscoso Carrasco JM, Ramirez J, Marquez Pachas JF, Neira E, Vilca W, Mendez J, Hernandez J, Roa D. Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject. Biomed Phys Eng Express 2022; 8. [PMID: 35961284 DOI: 10.1088/2057-1976/ac8939] [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: 05/09/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs. APPROACH A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses. MAIN RESULTS Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 0.7%. SIGNIFICANCE An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.
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Affiliation(s)
- Stephanie M Leon
- Radiology, University of Florida, P.O. Box 100374, Gainesville, Gainesville, Florida, 32610, UNITED STATES
| | - Oliver Paucar
- Universidad Nacional de Ingeniería, Av. Túpac Amaru 210, Rimac, 15333, PERU
| | - Nathalie Correa
- Radiology, University of Florida, P.O. Box 100374, Gainesville, Gainesville, Florida, 32610, UNITED STATES
| | - Megan Glassell
- Radiology, University of Florida, P.O. Box 100374, Gainesville, Gainesville, Florida, 32610, UNITED STATES
| | | | - Edmond Alonso Olguin
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Massachusetts, 02215, UNITED STATES
| | - Alok Shankar
- Radiology, University of Florida, P.O. Box 100374, Gainesville, Gainesville, Florida, 32610, UNITED STATES
| | - Vadim Moskvin
- Department of Radiation Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 210, Memphis, Tennessee, 38105, UNITED STATES
| | - Bryan C Schwarz
- Radiology, University of Florida, PO Box 100374, Gainesville, Florida, 32610-0374, UNITED STATES
| | - Mirko Salomon Alva-Sanchez
- Ciências Exatas e Sócias aplicadas, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Porto Alegre, RS, 90050-170, BRAZIL
| | - Harry Moyses
- Department of Radiation Oncology, University of California Irvine, 101 The City Drive South, Orange, California, 92868, UNITED STATES
| | - Barbara Hamrick
- Environmental Health and Safety, University of California Irvine, 101 The City Drive South, Orange, California, 92868, UNITED STATES
| | - Gustavo Sarria
- University Hospital Bonn, Venusberg-Campus 1, Bonn, Nordrhein-Westfalen, 53127, GERMANY
| | - Benjamin Li
- University of California San Francisco, 1600 Divisadero Street, San Francisco, California, 94115, UNITED STATES
| | - Toshiki Tajima
- University of California, 4129 Frederick Reines Hall, Irvine, California, 92697, UNITED STATES
| | - Ales Necas
- TAE Technologies, 1961 Pauling, Foothill Ranch, California, 92610, UNITED STATES
| | - Carmen Guzman
- Universidad Ricardo Palma Facultad de Medicina Humana, Av. Benavides 5440, Santiago de Surco, Lima, 33, PERU
| | - Roger Challco
- Universidad Nacional de Ingeniería, Av. Túpac Amaru 210, Rimac, 15333, PERU
| | | | - Zintia Meza
- Universidad Nacional de Ingeniería, Av. Túpac Amaru 210, Rimac, 15333, PERU
| | | | | | - Juan Marquina
- Aliada Centro Oncologico, Av. José Gálvez Barrenechea N° 1044, San Isidro, Lima, 27, PERU
| | - Karina Quispe
- Aliada Centro Oncologico, Av. José Gálvez Barrenechea N° 1044, San Isidro, Lima, 27, PERU
| | - Toribia Chavez
- Aliada Centro Oncologico, Av. José Gálvez Barrenechea N° 1044, San Isidro, Lima, 27, PERU
| | - Luisa Castilla
- Aliada Centro Oncologico, Av. José Gálvez Barrenechea N° 1044, San Isidro, Lima, 27, PERU
| | | | - Jose Ramirez
- Aliada Centro Oncologico, Av. José Gálvez Barrenechea N° 1044, San Isidro, Lima, Callao, 27, PERU
| | - Jose Fernando Marquez Pachas
- FACULTAD DE CIENCIAS FÍSICAS, Universidad Nacional Mayor de San Marcos, AV. CARLOS AMEZAGA 375, LIMA 1, Lima, LIMA, 506, PERU
| | - Edith Neira
- Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos 2520, Surquillo, Lima, 15038, PERU
| | - Walter Vilca
- Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos 2520, Surquillo, Lima, 15038, PERU
| | - Juan Mendez
- Universidad Nacional del Callao, Av. Juan Pablo Ⅱ 306, Bellavista, Callao, 07011, PERU
| | - Jimmy Hernandez
- HRS Oncology International, 2657 Windmill Parkway, PO Box 375, Henderson, Nevada, 89074, UNITED STATES
| | - Dante Roa
- Department of Radiation Oncology, University of California Irvine, 101 The City Drive South, Orange, California, 92868, UNITED STATES
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Roa D, Leon S, Paucar O, Gonzales A, Schwarz B, Olguin E, Moskvin V, Alva-Sanchez M, Glassell M, Correa N, Moyses H, Shankar A, Hamrick B, Sarria GR, Li B, Tajima T, Necas A, Guzman C, Challco R, Montoya M, Meza Z, Zapata M, Gonzales A, Marquez F, Neira R, Vilca W, Mendez J, Hernandez J. Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope. Phys Med 2021; 94:24-34. [PMID: 34979431 DOI: 10.1016/j.ejmp.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs. MATERIALS AND METHODS PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. RESULTS Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover ∼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment. CONCLUSION A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.
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Affiliation(s)
- D Roa
- Department of Radiation Oncology, University of California, Irvine Health, Orange, CA 92868, USA.
| | - S Leon
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - O Paucar
- Facultad de Ingenieria Electrica y Electronica, Universidad Nacional de Ingenieria, Lima, Peru
| | - A Gonzales
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - B Schwarz
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - E Olguin
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - V Moskvin
- Department of Radiation Oncology, St. Judes Children's Research Hospital, Memphis, TN 38105, USA
| | - M Alva-Sanchez
- Department of Exact and Applied Sciences, University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - M Glassell
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - N Correa
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - H Moyses
- Department of Radiation Oncology, University of California, Irvine Health, Orange, CA 92868, USA
| | - A Shankar
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - B Hamrick
- Environmental Health and Safety, University of California, Irvine Health, Orange, CA 92868, USA
| | - G R Sarria
- University Hospital Bonn, Department of Radiation Oncology, University of Bonn, Bonn, Germany
| | - B Li
- Department of Radiation Oncology, University of California, San Francisco, CA 94115, USA
| | - T Tajima
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - A Necas
- TAE Technologies, 1961 Pauling, Foothill Ranch, CA 92610, USA
| | - C Guzman
- Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, Peru
| | - R Challco
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - M Montoya
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - Z Meza
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - M Zapata
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - A Gonzales
- Clinica Aliada contra el Cancer, Lima, Peru
| | - F Marquez
- Facultad de Ciencias Físicas, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - R Neira
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - W Vilca
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - J Mendez
- Facultad de Ciencias Naturales y Matemática, Universidad Nacional del Callao, Callao, Peru
| | - J Hernandez
- HRS Oncology International, Las Vegas, NV 89119, USA
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7
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Stavropoulou A, Szmul A, Chandy E, Veiga C, Landau D, McClelland JR. A multichannel feature-based approach for longitudinal lung CT registration in the presence of radiation induced lung damage. Phys Med Biol 2021; 66:175020. [PMID: 34352743 PMCID: PMC8395598 DOI: 10.1088/1361-6560/ac1b1d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022]
Abstract
Quantifying parenchymal tissue changes in the lungs is imperative in furthering the study of radiation induced lung damage (RILD). Registering lung images from different time-points is a key step of this process. Traditional intensity-based registration approaches fail this task due to the considerable anatomical changes that occur between timepoints. This work proposes a novel method to successfully register longitudinal pre- and post-radiotherapy (RT) lung computed tomography (CT) scans that exhibit large changes due to RILD, by extracting consistent anatomical features from CT (lung boundaries, main airways, vessels) and using these features to optimise the registrations. Pre-RT and 12 month post-RT CT pairs from fifteen lung cancer patients were used for this study, all with varying degrees of RILD, ranging from mild parenchymal change to extensive consolidation and collapse. For each CT, signed distance transforms from segmentations of the lungs and main airways were generated, and the Frangi vesselness map was calculated. These were concatenated into multi-channel images and diffeomorphic multichannel registration was performed for each image pair using NiftyReg. Traditional intensity-based registrations were also performed for comparison purposes. For the evaluation, the pre- and post-registration landmark distance was calculated for all patients, using an average of 44 manually identified landmark pairs per patient. The mean (standard deviation) distance for all datasets decreased from 15.95 (8.09) mm pre-registration to 4.56 (5.70) mm post-registration, compared to 7.90 (8.97) mm for the intensity-based registrations. Qualitative improvements in image alignment were observed for all patient datasets. For four representative subjects, registrations were performed for three additional follow-up timepoints up to 48 months post-RT and similar accuracy was achieved. We have demonstrated that our novel multichannel registration method can successfully align longitudinal scans from RILD patients in the presence of large anatomical changes such as consolidation and atelectasis, outperforming the traditional registration approach both quantitatively and through thorough visual inspection.
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Affiliation(s)
- A Stavropoulou
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - A Szmul
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - E Chandy
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
- University College Hospital London, United Kingdom
| | - C Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - D Landau
- University College Hospital London, United Kingdom
| | - J R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
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8
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Roa D, Moyses H, Leon S, Hamrick B, Sarria GR, Li B, Tajima T, Necas A, Guzman C, Paucar O, Gonzales A, Challco R, Montoya M, Arqque Z, Gonzales A, Hernandez J, Drake J, Villane R, Lea J. Dose simulations of an early 20th century kilovoltage pneumonia radiotherapy technique performed with a modern fluoroscope. Med Dosim 2020; 46:74-79. [PMID: 32958360 PMCID: PMC7500403 DOI: 10.1016/j.meddos.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Abstract
To simulate an early 20th century viral pneumonia radiotherapy treatment using modern fluoroscopy and evaluated it according to current dose guidelines. Monte Carlo was used to assess the dose distribution on an anthropomorphic phantom. Critical organs were: skin, breasts, esophagus, ribs, vertebrae, heart, thymus, and spinal cord. A 100 kVp beam with 3 mm Al HVL, 25 × 25 cm2 posterior-anterior (PA) field and 50 cm source-to-surface distance were simulated. Simulations had a resolution of 0.4 × 0.4 × 0.06 cm3 and a 6% uncertainty. Hundred percent dose was normalized to the skin surface and results were displayed in axial, coronal, and sagittal planes. Dose volume histograms were generated in MATLAB for further analysis. Prescription doses of 0.3, 0.5, and 1.0 Gy were applied to the 15% isodose for organ-dose comparison to current tolerances and potential risk of detriment. Ninety-five and ninety-seven percent of the right and left lung volumes, respectively, were well-covered by the 15% isodose line. For the 0.3, 0.5, and 1.0 Gy prescriptions, the maximum skin doses were 2.9, 4.8, and 9.6 Gy compared to a 2.0 Gy transient erythema dose threshold; left/right lung maximum doses were 1.44/1.46, 2.4/2.4, and 4.8/4.9 Gy compared to a 6.5 Gy pneumonitis and 30 Gy fibrosis thresholds; maximum heart doses were 0.5, 0.9, and 1.8 Gy compared to the 0.5 Gy ICRP-recommendation; maximum spinal cord doses were 1.4, 2.3, and 4.6 Gy compared to 7.0 Gy single fraction dose threshold. Maximum doses to other critical organs were below modern dose thresholds. A 100 kVp PA field could deliver a 0.3 Gy or 0.5 Gy dose without risk of complications. However, a 1.0 Gy dose treatment could be problematic. Critical organ doses could be further reduced if more than one treatment field is used.
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Affiliation(s)
- Dante Roa
- Department of Radiation Oncology, University of California, Irvine Health, Orange, CA 92868, USA.
| | - Harry Moyses
- Department of Radiation Oncology, University of California, Irvine Health, Orange, CA 92868, USA
| | - Stephanie Leon
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - Barbara Hamrick
- Environmental Health and Safety, University of California, Irvine Health, Orange, CA 92868, USA
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Benjamin Li
- Department of Radiation Oncology, University of California, San Francisco, CA 94115, USA
| | - Toshiki Tajima
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - Ales Necas
- TAE Technologies, Foothill Ranch, CA 92610, USA
| | - Carmen Guzman
- Facultad de Ciencias Naturales y Matematica, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Oliver Paucar
- Facultad de Ingenieria Electrica y Electronica, Universidad Nacional de Ingenieria, Lima, Peru
| | - Alberto Gonzales
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - Roger Challco
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - Modesto Montoya
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - Zintia Arqque
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | | | | | | | | | - Jon Lea
- GE Healthcare, Salt Lake Ciry, UT 84116, USA
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9
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Schröder C, Engenhart-Cabillic R, Kirschner S, Blank E, Buchali A. Changes of lung parenchyma density following high dose radiation therapy for thoracic carcinomas - an automated analysis of follow up CT scans. Radiat Oncol 2019; 14:72. [PMID: 31036015 PMCID: PMC6489276 DOI: 10.1186/s13014-019-1276-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background An objective way to qualify the effect of radiotherapy (RT) on lung tissue is the analysis of CT scans after RT. In this analysis we focused on the changes in Hounsfield units (ΔHU) and the correlation with the corresponding radiation dose after RT. Methods Pre- and post-RT CT scans were matched and ΔHU was calculated using customized research software. ΔHU was calculated in 5-Gy-intervals and the correlation between ΔHU and the corresponding dose was calculated as well as the regression coefficients. Additionally the mean ΔHU and ΔHU in 5-Gy-intervals were calculated for each tumor entity. Results The mean density changes at 12 weeks and 6 months post RT were 28,16 HU and 32,83 HU. The correlation coefficient between radiation dose and ΔHU at 12 weeks and 6 months were 0,166 (p = 0,000) and 0,158 (p = 0,000). The resulting regression coefficient were 1439 HU/Gy (p = 0,000) and 1612 HU/Gy (p = 0,000). The individual regression coefficients for each patient range from − 2,23 HU/Gy to 7,46 HU/Gy at 12 weeks and − 0,45 HU/Gy to 10,51 HU/Gy at 6 months. When looking at the three tumor entities individually the highest ΔHU at 12 weeks was seen in patients with SCLC (38,13 HU) and at 6 month in those with esophageal carcinomas (40,98 HU). Conclusion For most dose intervals there was an increase of ΔHU with an increased radiation dose. This is reflected by a statistically significant, although low correlation coefficient. The regression coefficients of all patients show large interindividual differences.
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Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany. .,Clinic for Radiation Oncology, Universitätsspital Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland.
| | - Rita Engenhart-Cabillic
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
| | - Sven Kirschner
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
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10
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Zhou J, Yi Z, Fu Q. Dynamic decreased expression and hypermethylation of secreted frizzled-related protein 1 and 4 over the course of pulmonary fibrosis in mice. Life Sci 2019; 218:241-252. [PMID: 30586565 DOI: 10.1016/j.lfs.2018.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 01/08/2023]
Abstract
Aberrantly activated Wnt signaling pathway and dysregulation of extracellular antagonists of Wnt signaling have been revealed in pulmonary fibrosis. In this study we evaluated the expression of secreted frizzled-related proteins (SFRPs) and their aberrant promoter methylation to investigate the involvement of epigenetic regulation in pulmonary fibrosis. The pulmonary fibrosis induced by intratracheal injection of bleomycin (BLM) into mice was adopted. The transcription and relative protein expression of SFRPs were detected at Day 7 (D7), D14, and D21. DNA methylation analysis was performed by methylation-specific polymerase chain reaction (MSP). A DNA methyltransferase (DNMT) inhibitor (5-aza-2'-deoxycytidine; 5-aza) was used for demethylation and the relative β-catenin expression levels were measured to assess overactivity of the canonical Wnt signaling pathway. The transcription and protein expression of SFRP1 significantly decreased at D14 and D21, whereas the transcription and protein expression of SFRP4 significantly decreased at D7 and stayed downregulated until D21. The significantly hypermethylated promoters of SFRP1 and SFRP4 resulted in impaired transcription and decreased expression during pulmonary fibrosis in mice. Besides, reactivation of SFRP1 and SFRP4 by 5-aza reduced β-catenin mRNA and protein expression in vivo and in vitro. Animal experiments confirmed that 5-aza could significantly alleviate bleomycin-induced pulmonary fibrosis in mice. Thus, changes of promoter hypermethylation might downregulate SFRP1 and SFRP4 at different stages of pulmonary fibrosis, and the finding supports the usefulness of DNMT inhibitors, which might effectively reverse activation of β-catenin and reduce pulmonary fibrosis in mice. These data provide a possible new direction in the research on pulmonary fibrosis treatments.
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Affiliation(s)
- Junfei Zhou
- Department of Rheumatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Zheng Yi
- Department of Rheumatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China.
| | - Qiang Fu
- Department of Rheumatology, The First Affiliated Hospital of University of South China, HengYang 421001, PR China
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11
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Kim SJ, Lee JW, Kang MK, Kim JC, Lee JE, Park SH, Kim MY, Lee SJ, Moon SH, Ko BS. Evaluation of the hybrid-dynamic conformal arc therapy technique for radiotherapy of lung cancer. Radiat Oncol J 2018; 36:241-247. [PMID: 30309216 PMCID: PMC6226139 DOI: 10.3857/roj.2018.00171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose A hybrid-dynamic conformal arc therapy (HDCAT) technique consisting of a single half-rotated dynamic conformal arc beam and static field-in-field beams in two directions was designed and evaluated in terms of dosimetric benefits for radiotherapy of lung cancer. Materials and Methods This planning study was performed in 20 lung cancer cases treated with the VERO system (BrainLAB AG, Feldkirchen, Germany). Dosimetric parameters of HDCAT plans were compared with those of three-dimensional conformal radiotherapy (3D-CRT) plans in terms of target volume coverage, dose conformity, and sparing of organs at risk. Results HDCAT showed better dose conformity compared with 3D-CRT (conformity index: 0.74 ± 0.06 vs. 0.62 ± 0.06, p < 0.001). HDCAT significantly reduced the lung volume receiving more than 20 Gy (V20: 21.4% ± 8.2% vs. 24.5% ± 8.8%, p < 0.001; V30: 14.2% ± 6.1% vs. 15.1% ± 6.4%, p = 0.02; V40: 8.8% ± 3.9% vs. 10.3% ± 4.5%, p < 0.001; and V50: 5.7% ± 2.7% vs. 7.1% ± 3.2%, p < 0.001), V40 and V50 of the heart (V40: 5.2 ± 3.9 Gy vs. 7.6 ± 5.5 Gy, p < 0.001; V50: 1.8 ± 1.6 Gy vs. 3.1 ± 2.8 Gy, p = 0.001), and the maximum spinal cord dose (34.8 ± 9.4 Gy vs. 42.5 ± 7.8 Gy, p < 0.001) compared with 3D-CRT. conclusions HDCAT could achieve highly conformal target coverage and reduce the doses to critical organs such as the lung, heart, and spinal cord compared to 3D-CRT for the treatment of lung cancer patients.
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Affiliation(s)
- Sung Joon Kim
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jeong Won Lee
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Chul Kim
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Eun Lee
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin-Hyung Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mi Young Kim
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Korea
| | - Seoung-Jun Lee
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Korea
| | - Soo-Ho Moon
- Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Korea
| | - Byoung-Soo Ko
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea
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12
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Veiga C, Landau D, McClelland JR, Ledermann JA, Hawkes D, Janes SM, Devaraj A. Long term radiological features of radiation-induced lung damage. Radiother Oncol 2018; 126:300-306. [PMID: 29191458 DOI: 10.1016/j.radonc.2017.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To describe the radiological findings of radiation-induced lung damage (RILD) present on CT imaging of lung cancer patients 12 months after radical chemoradiation. MATERIAL AND METHODS Baseline and 12-month CT scans of 33 patients were reviewed from a phase I/II clinical trial of isotoxic chemoradiation (IDEAL CRT). CT findings were scored in three categories derived from eleven sub-categories: (1) parenchymal change, defined as the presence of consolidation, ground-glass opacities (GGOs), traction bronchiectasis and/or reticulation; (2) lung volume reduction, identified through reduction in lung height and/or distortions in fissures, diaphragm, anterior junction line and major airways anatomy, and (3) pleural changes, either thickening and/or effusion. RESULTS Six patients were excluded from the analysis due to anatomical changes caused by partial lung collapse and abscess. All remaining 27 patients had radiological evidence of lung damage. The three categories, parenchymal change, shrinkage and pleural change were present in 100%, 96% and 82% respectively. All patients had at least two categories of change present and 72% all three. GGOs, reticulation and traction bronchiectasis were present in 44%, 52% and 37% of patients. CONCLUSIONS Parenchymal change, lung shrinkage and pleural change are present in a high proportion of patients and are frequently identified in RILD. GGOs, reticulation and traction bronchiectasis are common at 12 months but not diagnostic.
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Affiliation(s)
- Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK.
| | - David Landau
- Department of Oncology, Guy's & St. Thomas' NHS Trust, London, UK; Department of Oncology, University College London Hospital, London, UK
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Jonathan A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - David Hawkes
- Centre for Medical Image Computing, Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
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13
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Fu Q, Zheng Y, Dong X, Wang L, Jiang CG. Activation of cannabinoid receptor type 2 by JWH133 alleviates bleomycin-induced pulmonary fibrosis in mice. Oncotarget 2017; 8:103486-103498. [PMID: 29262578 PMCID: PMC5732744 DOI: 10.18632/oncotarget.21975] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022] Open
Abstract
Activation of cannabinoid receptor type 2 has been shown to have anti-fibrosis function in skin and heart. However, whether activating cannabinoid receptor type 2 inhibits pulmonary fibrosis remains elusive. Lung fibroblasts and TGF-β1 are key players in the pathogenesis of pulmonary fibrosis. In this research, we aimed to investigate the role of cannabinoid receptor type 2 in pulmonary fibrosis in vitro and in vivo. In lung fibroblasts stimulated by TGF-β1, preincubated by cannabinoid receptor type 2 agonist JWH133 not only reduced the elevated levels of collagen I and α-SMA, but also inhibited fibroblasts’ proliferation and migration. The dosage of JWH133 had no clear cytotoxic activity, and all these JWH133 effects were partially abrogated by cannabinoid receptor type 2 antagonist SR144528. In bleomycin-induced mice pulmonary fibrosis model, CT images of the lung tissue revealed an extensive ground-glass opacity, reticular pattern and fibrosis stranding. Notably, JWH133 treatment controlled the ongoing fibrotic process (showed by decreased lung density and fibrosis score). Meanwhile, lung histological results revealed that JWH133 treatment suppressed both the inflammatory response and extracellular collagen deposition. SR144528 may increase the pulmonary fibrosis, but no statistically significant difference was proved. Importantly, JWH133 reduced serum profibrotic cytokines levels of TGF-β1 and inhibited TGF-β1/Smad2 pathway in vitro and in vivo. Our research indicated that activating cannabinoid receptor type 2 by a pharmacological method might be a potential strategy for pulmonary fibrosis.
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Affiliation(s)
- Qiang Fu
- Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi Zheng
- Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin Dong
- Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chun Guo Jiang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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14
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Avanzo M, Barbiero S, Trovo M, Bissonnette JP, Jena R, Stancanello J, Pirrone G, Matrone F, Minatel E, Cappelletto C, Furlan C, Jaffray DA, Sartor G. Voxel-by-voxel correlation between radiologically radiation induced lung injury and dose after image-guided, intensity modulated radiotherapy for lung tumors. Phys Med 2017; 42:150-156. [PMID: 29173909 DOI: 10.1016/j.ejmp.2017.09.127] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/24/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To correlate radiation dose to the risk of severe radiologically-evident radiation-induced lung injury (RRLI) using voxel-by-voxel analysis of the follow-up computed tomography (CT) of patients treated for lung cancer with hypofractionated helical Tomotherapy. METHODS AND MATERIALS The follow-up CT scans from 32 lung cancer patients treated with various regimens (5, 8, and 25 fractions) were registered to pre-treatment CT using deformable image registration (DIR). The change in density was calculated for each voxel within the combined lungs minus the planning target volume (PTV). Parameters of a Probit formula were derived by fitting the occurrences of changes of density in voxels greater than 0.361gcm-3 to the radiation dose. The model's predictive capability was assessed using the area under receiver operating characteristic curve (AUC), the Kolmogorov-Smirnov test for goodness-of-fit, and the permutation test (Ptest). RESULTS The best-fit parameters for prediction of RRLI 6months post RT were D50 of 73.0 (95% CI 59.2.4-85.3.7)Gy, and m of 0.41 (0.39-0.46) for hypofractionated (5 and 8 fractions) and D50 of 96.8 (76.9-123.9)Gy, and m of 0.36 (0.34-0.39) for 25 fractions RT. According to the goodness-of-fit test the null hypothesis of modeled and observed occurrence of RRLI coming from the same distribution could not be rejected. The AUC was 0.581 (0.575-0.583) for fractionated and 0.579 (0.577-0.581) for hypofractionated patients. The predictive models had AUC>upper 95% band of the Ptest. CONCLUSIONS The correlation of voxel-by-voxel density increase with dose can be used as a support tool for differential diagnosis of tumor from benign changes in the follow-up of lung IMRT patients.
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Affiliation(s)
- Michele Avanzo
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy.
| | - Sara Barbiero
- Radiotherapy Department, Casa di Cura S. Rossore, Pisa, Italy
| | - Marco Trovo
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy; Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Jean-Pierre Bissonnette
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, UK
| | | | - Giovanni Pirrone
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Fabio Matrone
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Emilio Minatel
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Cristina Cappelletto
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Carlo Furlan
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - David A Jaffray
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Giovanna Sartor
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
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15
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A survey of changing trends in modelling radiation lung injury in mice: bringing out the good, the bad, and the uncertain. J Transl Med 2016; 96:936-49. [PMID: 27479087 DOI: 10.1038/labinvest.2016.76] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/10/2016] [Accepted: 06/04/2016] [Indexed: 12/22/2022] Open
Abstract
Within this millennium there has been resurgence in funding and research dealing with animal models of radiation-induced lung injury to identify and establish predictive biomarkers and effective mitigating agents that are applicable to humans. Most have been performed on mice but there needs to be assurance that the emphasis on such models is not misplaced. We therefore considered it timely to perform a comprehensive appraisal of the literature dealing with radiation lung injury of mice and to critically evaluate the validity and clinical relevance of the research. A total of 357 research papers covering the period of 1970-2015 were extensively reviewed. Whole thorax irradiation (WTI) has become the most common treatment for studying lung injury in mice and distinct trends were seen with regard to the murine strain, radiation dose, intended pathology investigated, length of study, and assays. Recently, the C57BL/6 strain has been increasingly used in the majority of these studies with the notion that they are susceptible to pulmonary fibrosis. Nonetheless, many of these investigations depend on animal survival as the primary end point and neglect the importance of radiation pneumonitis and the anomaly of lethal pleural effusions. A relatively large variation in survival times of C5BL/6 mice is also seen among different institutions pointing to the need for standardization of radiation treatments and environmental conditions. An analysis of mitigating drug treatments is complicated by the fact that the majority of studies are limited to the C57BL/6 strain with a premature termination of the experiments and do not establish whether the treatment actually prevents or simply delays the progression of radiation injury. This survey of the literature has pointed to several improvements that need to be considered in establishing a reliable preclinical murine model of radiation lung injury. The lethality end point should also be used cautiously and with greater emphasis on other assays such as non-invasive lung functional and imaging monitoring in order to quantify specific pulmonary injury that can be better extrapolated to radiation toxicity encountered in our own species.
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16
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Gasinska A. The contribution of women to radiobiology: Marie Curie and beyond. Rep Pract Oncol Radiother 2016; 21:250-8. [PMID: 27601958 PMCID: PMC5002019 DOI: 10.1016/j.rpor.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/26/2015] [Accepted: 11/30/2015] [Indexed: 01/09/2023] Open
Abstract
Marie Sklodowska-Curie, an extraordinary woman, a Polish scientist who lived and worked in France, led to the development of nuclear energy and the treatment of cancer. She was the laureate of two Nobel Prizes, the first woman in Europe who obtained the degree of Doctor of Science and opened the way for women to enter fields which had been previously reserved for men only. As a result of her determination and her love of freedom, she has become an icon for many female scientists active in radiation sciences. They are successors of Maria Curie and without the results of their work, improvement in radiation oncology will not be possible. Many of them shared some elements of Maria Curie's biography, like high ethical and moral standards, passionate dedication to work, strong family values, and scientific collaboration with their husbands. The significance of Tikvah Alper, Alma Howard, Shirley Hornsey, Juliana Denekamp, Helen Evans, Eleanor Blakely, Elizabeth L. Travis, Fiona Stewart, Andree Dutreix, Catharine West, Peggy Olive, Ingela Turesson, Penny Jeggo, Irena Szumiel, Eleonor Blakely, Sara Rockwell and Carmel Mothersill contribution to radiation oncology is presented. All the above mentioned ladies made significant contribution to the development of radiotherapy (RT) and more efficient cancer treatment. Due to their studies, new schedules of RT and new types of ionizing radiation have been applied, lowering the incidence of normal tissue toxicity. Their achievements herald a future of personalized medicine.
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Affiliation(s)
- Anna Gasinska
- Department of Applied Radiobiology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Poland
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17
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Defraene G, van Elmpt W, Crijns W, Slagmolen P, De Ruysscher D. CT characteristics allow identification of patient-specific susceptibility for radiation-induced lung damage. Radiother Oncol 2015; 117:29-35. [DOI: 10.1016/j.radonc.2015.07.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/18/2015] [Accepted: 07/25/2015] [Indexed: 12/25/2022]
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18
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Orth M, Lauber K, Niyazi M, Friedl AA, Li M, Maihöfer C, Schüttrumpf L, Ernst A, Niemöller OM, Belka C. Current concepts in clinical radiation oncology. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:1-29. [PMID: 24141602 PMCID: PMC3935099 DOI: 10.1007/s00411-013-0497-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/05/2013] [Indexed: 05/04/2023]
Abstract
Based on its potent capacity to induce tumor cell death and to abrogate clonogenic survival, radiotherapy is a key part of multimodal cancer treatment approaches. Numerous clinical trials have documented the clear correlation between improved local control and increased overall survival. However, despite all progress, the efficacy of radiation-based treatment approaches is still limited by different technological, biological, and clinical constraints. In principle, the following major issues can be distinguished: (1) The intrinsic radiation resistance of several tumors is higher than that of the surrounding normal tissue, (2) the true patho-anatomical borders of tumors or areas at risk are not perfectly identifiable, (3) the treatment volume cannot be adjusted properly during a given treatment series, and (4) the individual heterogeneity in terms of tumor and normal tissue responses toward irradiation is immense. At present, research efforts in radiation oncology follow three major tracks, in order to address these limitations: (1) implementation of molecularly targeted agents and 'omics'-based screening and stratification procedures, (2) improvement of treatment planning, imaging, and accuracy of dose application, and (3) clinical implementation of other types of radiation, including protons and heavy ions. Several of these strategies have already revealed promising improvements with regard to clinical outcome. Nevertheless, many open questions remain with individualization of treatment approaches being a key problem. In the present review, the current status of radiation-based cancer treatment with particular focus on novel aspects and developments that will influence the field of radiation oncology in the near future is summarized and discussed.
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Affiliation(s)
- Michael Orth
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Kirsten Lauber
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anna A. Friedl
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Minglun Li
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Cornelius Maihöfer
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lars Schüttrumpf
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anne Ernst
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Olivier M. Niemöller
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
- Present Address: Clinic for Radiation Oncology, St. Elisabeth Hospital Ravensburg, Ravensburg, Germany
| | - Claus Belka
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Lee S, Stroian G, Kopek N, AlBahhar M, Seuntjens J, Naqa IE. Analytical modelling of regional radiotherapy dose response of lung. Phys Med Biol 2012; 57:3309-21. [DOI: 10.1088/0031-9155/57/11/3309] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Robbins ME, Brunso-Bechtold JK, Peiffer AM, Tsien CI, Bailey JE, Marks LB. Imaging radiation-induced normal tissue injury. Radiat Res 2012; 177:449-66. [PMID: 22348250 DOI: 10.1667/rr2530.1] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Technological developments in radiation therapy and other cancer therapies have led to a progressive increase in five-year survival rates over the last few decades. Although acute effects have been largely minimized by both technical advances and medical interventions, late effects remain a concern. Indeed, the need to identify those individuals who will develop radiation-induced late effects, and to develop interventions to prevent or ameliorate these late effects is a critical area of radiobiology research. In the last two decades, preclinical studies have clearly established that late radiation injury can be prevented/ameliorated by pharmacological therapies aimed at modulating the cascade of events leading to the clinical expression of radiation-induced late effects. These insights have been accompanied by significant technological advances in imaging that are moving radiation oncology and normal tissue radiobiology from disciplines driven by anatomy and macrostructure to ones in which important quantitative functional, microstructural, and metabolic data can be noninvasively and serially determined. In the current article, we review use of positron emission tomography (PET), single photon emission tomography (SPECT), magnetic resonance (MR) imaging and MR spectroscopy to generate pathophysiological and functional data in the central nervous system, lung, and heart that offer the promise of, (1) identifying individuals who are at risk of developing radiation-induced late effects, and (2) monitoring the efficacy of interventions to prevent/ameliorate them.
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Affiliation(s)
- Mike E Robbins
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Oh YT, Noh OK, Jang H, Chun M, Park KJ, Park KJ, Kim MH, Park HJ. The features of radiation induced lung fibrosis related with dosimetric parameters. Radiother Oncol 2012; 102:343-6. [PMID: 22342420 DOI: 10.1016/j.radonc.2012.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 02/08/2012] [Accepted: 02/08/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Radiation induced lung fibrosis (RILF) is a major complication after lung irradiation and is very important for long term quality of life and could result in fatal respiratory insufficiency. However, there has been little information on dosimetric parameters for radiotherapy planning in the aspect of RILF. The features of RILF related with dosimetric parameters were evaluated. METHODS AND MATERIALS Forty-eight patients with non-small cell lung carcinoma who underwent post-operative radiation therapy (PORT) without adjuvant chemotherapy were analyzed. The degree of lung fibrosis was estimated by fibrosis volume and the dosimetric parameters were calculated from the plan of 3-dimensional conformal radiotherapy. RESULTS The fibrosis volume and V-dose as dosimetric parameters showed significant correlation and the correlation coefficient ranged from 0.602 to 0.683 (P<0.01). The degree of the correlation line was steeper as the dose increase and threshold dose was not found. Mean lung dose (MLD) showed strong correlation with fibrosis volume (correlation coefficient = 0.726, P<0.01). CONCLUSIONS The fibrosis volume is continuously increased with V-dose as the reference dose increases. MLD is useful as a single parameter for comparing rival plans in the aspect of RILF.
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Affiliation(s)
- Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
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Hof H, Zgoda J, Nill S, Hoess A, Kopp-Schneider A, Herfarth K, Debus J, Plathow C. Time- and Dose-Dependency of Radiographic Normal Tissue Changes of the Lung After Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2010; 77:1369-74. [PMID: 19932943 DOI: 10.1016/j.ijrobp.2009.06.082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 06/18/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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CT Density in Lung Cancer Patients After Radiotherapy Sensitized by Metoclopramide. Strahlenther Onkol 2010; 186:163-8. [PMID: 20165821 DOI: 10.1007/s00066-010-2040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 12/12/2009] [Indexed: 10/19/2022]
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Jackson IL, Vujaskovic Z, Down JD. Revisiting strain-related differences in radiation sensitivity of the mouse lung: recognizing and avoiding the confounding effects of pleural effusions. Radiat Res 2010; 173:10-20. [PMID: 20041755 DOI: 10.1667/rr1911.1] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The mouse has been used extensively to model radiation injury to the lung, a major dose-limiting organ for radiotherapy. Substantial differences in the timing and sensitivity of this tissue between mouse strains have been reported, with some strains, including C57BL/6, being designated as "fibrosis-prone". Pleural effusions have also been reported to be a prominent problem in many mouse strains, but it remains unclear how this affects the lung function and survival of the standard C57BL/6 mouse. The purpose of this investigation was to re-evaluate this strain in comparison with C57L and CBA mice after whole-thorax irradiation at doses ranging from 10 to 15 Gy. Breathing rate measurements, micro-computerized tomography, lung tissue weight, pleural fluid weight and histopathology showed that the most prominent features were an early phase of pneumonitis (C57L and CBA) followed by a late incidence of massive pleural effusions (CBA and C57BL/6). A remarkable difference was seen between the C57 strains: The C57L mice were exquisitely sensitive to early pneumonitis at 3 to 4 months while C57BL/6 mice showed a delayed response, with most mice presenting with large accumulations of pleural fluid at 6 to 9 months. These results therefore caution against the routine use of C57BL/6 mice in radiation lung experiments because pleural effusions are rarely observed in patients as a consequence of radiotherapy. Future experiments designed to investigate genetic determinants of radiation lung damage should focus on the high sensitivity of the C57L strain (in comparison with CBA or C3H mice) and the possibility that they are more susceptible to pulmonary fibrosis as well as pneumonitis.
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Affiliation(s)
- Isabel L Jackson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
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Miyazaki K, Satoh H, Kurishima K, Nakamura R, Ishikawa H, Kagohashi K, Hizawa N. Interstitial lung disease in patients with small cell lung cancer. Med Oncol 2009; 27:763-7. [PMID: 19657749 DOI: 10.1007/s12032-009-9283-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 07/28/2009] [Indexed: 12/31/2022]
Affiliation(s)
- Kunihiko Miyazaki
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Jin JY, Kong FM, Chetty IJ, Ajlouni M, Ryu S, Ten Haken R, Movsas B. Impact of fraction size on lung radiation toxicity: hypofractionation may be beneficial in dose escalation of radiotherapy for lung cancers. Int J Radiat Oncol Biol Phys 2009; 76:782-8. [PMID: 19577855 DOI: 10.1016/j.ijrobp.2009.02.079] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 02/24/2009] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess how fraction size impacts lung radiation toxicity and therapeutic ratio in treatment of lung cancers. METHODS AND MATERIALS The relative damaged volume (RDV) of lung was used as the endpoint in the comparison of various fractionation schemes with the same normalized total dose (NTD) to the tumor. The RDV was computed from the biologically corrected lung dose-volume histogram (DVH), with an alpha/beta ratio of 3 and 10 for lung and tumor, respectively. Two different (linear and S-shaped) local dose-effect models that incorporated the concept of a threshold dose effect with a single parameter D(L50) (dose at 50% local dose effect) were used to convert the DVH into the RDV. The comparison was conducted using four representative DVHs at different NTD and D(L50) values. RESULTS The RDV decreased with increasing dose/fraction when the NTD was larger than a critical dose (D(CR)) and increased when the NTD was less than D(CR). The D(CR) was 32-50 Gy and 58-87 Gy for a small tumor (11 cm(3)) for the linear and S-shaped local dose-effect models, respectively, when D(L50) was 20-30 Gy. The D(CR) was 66-97 Gy and 66-99 Gy, respectively, for a large tumor (266 cm(3)). Hypofractionation was preferred for small tumors and higher NTDs, and conventional fractionation was better for large tumors and lower NTDs. Hypofractionation might be beneficial for intermediate-sized tumors when NTD = 80-90 Gy, especially if the D(L50) is small (20 Gy). CONCLUSION This computational study demonstrated that hypofractionated stereotactic body radiotherapy is a better regimen than conventional fractionation in lung cancer patients with small tumors and high doses, because it generates lower RDV when the tumor NTD is kept unchanged.
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Affiliation(s)
- Jin-Yue Jin
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA.
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Faria S, Aslani M, Tafazoli F, Souhami L, Freeman C. The Challenge of Scoring Radiation-induced Lung Toxicity. Clin Oncol (R Coll Radiol) 2009; 21:371-5. [DOI: 10.1016/j.clon.2009.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 12/22/2008] [Accepted: 01/28/2009] [Indexed: 11/24/2022]
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Fenwick J, Nahum A, Malik Z, Eswar C, Hatton M, Laurence V, Lester J, Landau D. Escalation and Intensification of Radiotherapy for Stage III Non-small Cell Lung Cancer: Opportunities for Treatment Improvement. Clin Oncol (R Coll Radiol) 2009; 21:343-60. [DOI: 10.1016/j.clon.2008.12.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/29/2008] [Accepted: 12/30/2008] [Indexed: 12/18/2022]
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Schubauer-Berigan MK, Daniels RD, Pinkerton LE. Radon exposure and mortality among white and American Indian uranium miners: an update of the Colorado Plateau cohort. Am J Epidemiol 2009; 169:718-30. [PMID: 19208723 DOI: 10.1093/aje/kwn406] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Studies of uranium miners on the US Colorado Plateau have identified associations between exposure to radon progeny and risk of lung cancer. This study added 15 years of mortality follow-up for the 4,137 miners (primarily white or American Indian) in the Colorado Plateau cohort. The cohort experienced 209 new lung cancer deaths. For white miners, the standardized mortality ratio for lung cancer compared with the regional population was 3.99 (95% confidence interval: 3.43, 4.62) for the period 1991-2005. For American Indian miners, the lung cancer standardized mortality ratio was 3.27 (95% confidence interval: 2.19, 4.73). These standardized mortality ratios have not declined substantially since the 1980s. Internally standardized rate ratios by radon exposure category over the entire follow-up period are similar to those based on earlier follow-up, although estimates within smoking categories demonstrated improved precision. The apparent interaction between radon and smoking in causing lung cancer remains submultiplicative but greater than additive. Mortality rates from silicosis remain highly elevated in the cohort. Elevated mortality rates were observed from interstitial pulmonary fibrosis, multiple myeloma, and non-Hodgkin lymphoma. Significant trends were observed with increased radon exposure in silicosis and pulmonary fibrosis mortality and in the incidence of diabetes-related end-stage renal disease among white miners.
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Vågane R, Danielsen T, Fosså SD, Løkkevik E, Olsen DR. Late regional density changes of the lung after radiotherapy for breast cancer. Radiother Oncol 2009; 90:148-52. [DOI: 10.1016/j.radonc.2007.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 12/28/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
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Ma J, Zhang J, Zhou S, Hubbs JL, Foltz RJ, Hollis DR, Light KL, Wong TZ, Kelsey CR, Marks LB. Association between RT-induced changes in lung tissue density and global lung function. Int J Radiat Oncol Biol Phys 2008; 74:781-9. [PMID: 19084355 DOI: 10.1016/j.ijrobp.2008.08.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/12/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the association between radiotherapy (RT)-induced changes in computed tomography (CT)-defined lung tissue density and pulmonary function tests (PFTs). METHODS AND MATERIALS Patients undergoing incidental partial lung RT were prospectively assessed for global (PFTs) and regional (CT and single photon emission CT [SPECT]) lung function before and, serially, after RT. The percent reductions in the PFT and the average changes in lung density were compared (Pearson correlations) in the overall group and subgroups stratified according to various clinical factors. Comparisons were also made between the CT- and SPECT-based computations using the Mann-Whitney U test. RESULTS Between 1991 and 2004, 343 patients were enrolled in this study. Of these, 111 patients had a total of 203 concurrent post-RT evaluations of changes in lung density and PFTs available for the analyses, and 81 patients had a total of 141 concurrent post-RT SPECT images. The average increases in lung density were related to the percent reductions in the PFTs, albeit with modest correlation coefficients (range, 0.20-0.43). The analyses also indicated that the association between lung density and PFT changes is essentially equivalent to the corresponding association with SPECT-defined lung perfusion. CONCLUSION We found a weak quantitative association between the degree of increase in lung density as defined by CT and the percent reduction in the PFTs.
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Affiliation(s)
- Jinli Ma
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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Day RM, Barshishat-Kupper M, Mog SR, McCart EA, Prasanna PGS, Davis TA, Landauer MR. Genistein protects against biomarkers of delayed lung sequelae in mice surviving high-dose total body irradiation. JOURNAL OF RADIATION RESEARCH 2008; 49:361-72. [PMID: 18434686 PMCID: PMC2575019 DOI: 10.1269/jrr.07121] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The effects of genistein on 30-day survival and delayed lung injury were examined in C57BL/6J female mice. A single subcutaneous injection of vehicle (PEG-400) or genistein (200 mg/kg) was administered 24 h before total body irradiation (7.75 Gy (60)Co, 0.6 Gy/min). Experimental groups were: No treatment + Sham (NC), Vehicle + Sham (VC), Genistein + Sham (GC), Radiation only (NR), Vehicle + Radiation (VR), Genistein + Radiation (GR). Thirty-day survivals after 7.75 Gy were: NR 23%, VR 53%, and GR 92%, indicating significant protection from acute radiation injury by genistein. Genistein also mitigated radiation-induced weight loss on days 13-28 postirradiation. First generation lung fibroblasts were analyzed for micronuclei 24 h postirradiation. Fibroblasts from the lungs of GR-treated mice had significantly reduced micronuclei compared with NR mice. Collagen deposition was examined by histochemical staining. At 90 days postirradiation one half of the untreated and vehicle irradiated mice had focal distributions of small collagen-rich plaques in the lungs, whereas all of the genistein-treated animals had morphologically normal lungs. Radiation reduced the expression of COX-2, transforming growth factor-beta receptor (TGFbetaR) I and II at 90 days after irradiation. Genistein prevented the reduction in TGFbetaRI. However, by 180 days postirradiation, these proteins normalized in all groups. These results demonstrate that genistein protects against acute radiation-induced mortality in female mice and that GR-treated mice have reduced lung damage compared to NR or VR. These data suggest that genistein is protective against a range of radiation injuries.
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Affiliation(s)
- Regina M Day
- Department of Pharmacology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Vågane R, Bruland ØS, Fosså SD, Olsen DR. Radiological and functional assessment of radiation-induced pulmonary damage following breast irradiation. Acta Oncol 2008; 47:248-54. [PMID: 18210300 DOI: 10.1080/02841860701630267] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to compare late radiation-induced radiological abnormalities of the lung with spirometric observations. Radiological abnormalities were also related to theoretical calculations, in order to predict late effects based on dose-volume histograms. PATIENTS AND METHODS Sixty-one breast cancer patients who had received postoperative radiotherapy were included. During a follow-up examination 3 years or more after start of radiotherapy, computed tomography (CT) scans and pulmonary function tests were performed. Grading of radiological abnormalities (fibrosis) was performed based on CT images. Based on the dose volume histograms of the lung, effective dose was calculated. RESULTS There was a positive correlation between the effective radiation dose and the fraction of patients that developed radiation induced fibrosis. No significant association was found between the normalized forced vital capacity (FVC) and the radiological abnormality score or the effective radiation dose. CONCLUSION In this study we found no correlation between local radiation-induced changes in the lung tissue and overall lung function. The effective dose was a better predictive factor for radiation induced fibrosis than for overall lung function.
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Stroian G, Martens C, Souhami L, Collins DL, Seuntjens J. Local Correlation Between Monte-Carlo Dose and Radiation-Induced Fibrosis in Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2008; 70:921-30. [DOI: 10.1016/j.ijrobp.2007.10.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 09/13/2007] [Accepted: 10/06/2007] [Indexed: 11/29/2022]
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Matsuo Y, Nagata Y, Mizowaki T, Takayama K, Sakamoto T, Sakamoto M, Norihisa Y, Hiraoka M. Evaluation of mass-like consolidation after stereotactic body radiation therapy for lung tumors. Int J Clin Oncol 2007; 12:356-62. [DOI: 10.1007/s10147-007-0691-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 05/17/2007] [Indexed: 11/30/2022]
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Misirlioglu CH, Demirkasimoglu T, Kucukplakci B, Sanri E, Altundag K. Pentoxifylline and alpha-tocopherol in prevention of radiation-induced lung toxicity in patients with lung cancer. Med Oncol 2007; 24:308-11. [PMID: 17873306 DOI: 10.1007/s12032-007-0006-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 11/30/1999] [Accepted: 02/22/2007] [Indexed: 12/01/2022]
Abstract
Combined use of pentoxifylline and vitamin E is reported to reduce radiation-induced toxicity in normal tissues at molecular level. We plan to evaluate the role of combined use of pentoxifylline (PTX) and alpha-tocopherol (vitamin E; Vit E) for minimizing radiation-induced lung toxicity. A total of 91 lung cancer patients were randomized. Among them, 44 received PTX (400 mg three times a day orally and Vit E 300 mg twice a day orally during the entire period of radiotherapy. PTX and Vit E were further administered at doses of 400 mg once a day and 300 mg once a day, respectively for 3 months after radiotherapy. A total of 47 patients were assigned as a control group. Radiation related acute and late toxicities are evaluated by radiation RTOG/EORTC toxicity scale. Median age was 59 (range, 41-75). Median follow-up was 13 months (range, 3-28 months). Radiation-induced lung toxicity was more frequent in control group for all phases than in pentoxifylline and alpha-tocopherol group (acute phase, P = 0.042, subacute phase P = 0.0001, late phase P = 0.256). PTX and Vit E combination might be considered especially in patients with lung cancer who receive concurrent chemo-radiotherapy, or have a poor respiratory function tests.
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Affiliation(s)
- Cem H Misirlioglu
- Department of Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey
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Kong FM, Hayman JA, Griffith KA, Kalemkerian GP, Arenberg D, Lyons S, Turrisi A, Lichter A, Fraass B, Eisbruch A, Lawrence TS, Ten Haken RK. Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): predictors for radiation pneumonitis and fibrosis. Int J Radiat Oncol Biol Phys 2006; 65:1075-86. [PMID: 16647222 DOI: 10.1016/j.ijrobp.2006.01.051] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Revised: 01/28/2006] [Accepted: 01/30/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE We aimed to report the final toxicity results on a radiation-dose escalation trial designed to test a hypothesis that very high doses of radiation could be safely administered to patients with non-small-cell lung cancer (NSCLC) by quantifying the dose-volume toxicity relationship of the lung. METHODS AND MATERIALS A total of 109 patients with unresectable or medically inoperable NSCLC were enrolled and treated with radiation-dose escalation (on the basis of predicted normal-lung toxicity) either alone or with neoadjuvant chemotherapy by use of 3D conformal techniques. Eighty-four patients (77%) received more than 69 Gy, the trial was stopped after the dose reached 103 Gy. Estimated median follow-up was 110 months. RESULTS There were 17 (14.6%) Grade 2 to 3 pneumonitis and 15 (13.8%) Grade 2 to 3 fibrosis and no Grade 4 to 5 lung toxicity. Multivariate analyses showed them to be (1) not associated with the dose prescribed to the tumor, and (2) significantly (p<0.001) associated with lung-dosimetric parameters such as the mean lung dose (MLD), volume of lung that received at least 20 Gy (V20), and the normal-tissue complication probability (NTCP) of the lung. If cutoffs are 30% for V20, 20 Gy for MLD, and 10% for NTCP, these factors have positive predictive values of 50% to 71% and negative predictive value of 85% to 89%. CONCLUSIONS With long-term follow-up for toxicity, we have demonstrated that much higher doses of radiation than are traditionally administered can be safely delivered to a majority of patients with NSCLC. Quantitative lung dose-volume toxicity-based dose escalation can form the basis for individualized high-dose radiation treatment to maximize the therapeutic ratio in these patients.
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Affiliation(s)
- Feng-Ming Kong
- Department of Radiation Oncology, University of Michigan, and Radiation Oncology, Veterans Administration Medical Center, Ann Arbor, MI 48109, USA.
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Plathow C, Hof H, Kuhn S, Puderbach M, Ley S, Biederer J, Claussen CD, Huber PE, Schaefer J, Tuengerthal S, Kauczor HU. Therapy monitoring using dynamic MRI: Analysis of lung motion and intrathoracic tumor mobility before and after radiotherapy. Eur Radiol 2006; 16:1942-50. [PMID: 16628438 DOI: 10.1007/s00330-006-0237-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 02/19/2006] [Accepted: 03/03/2006] [Indexed: 11/30/2022]
Abstract
A frequent side effect after radiotherapy of lung tumors is a decrease of pulmonary function accompanied by dyspnea due to developing lung fibrosis. The aim of this study was to monitor lung motion as a correlate of pulmonary function and intrathoracic tumor mobility before and after radiotherapy (RT) using dynamic MRI (dMRI). Thirty-five patients with stage I non-small-cell lung carcinoma were examined using dMRI (trueFISP; three images/s). Tumors were divided into T1 and T2 tumors of the upper, middle and lower lung region (LR). Maximum craniocaudal (CC) lung dimensions and tumor mobility in three dimensions were monitored. Vital capacity (VC) was measured and correlated using spirometry. Before RT, the maximum CC motion of the tumor-bearing hemithorax was 5.2 +/- 0.9 cm if the tumor was located in the lower LR (middle LR: 5.5 +/- 0.8 cm; upper LR: 6.0 +/- 0.6 cm). After RT, lung motion was significantly reduced in the lower LR (P < 0.05). Before RT, the maximum CC tumor mobility was significantly higher in tumors of the lower LR 2.5 +/- 0.6 vs. 2.0 +/- 0.3 cm (middle LR; P < 0.05) vs. 0.7 +/- 0.2 cm (upper LR; P < 0.01). After RT, tumor mobility was significantly reduced in the lower LR (P < 0.01) and in T2 tumor patients (P < 0.05). VC showed no significant changes. dMRI is capable of monitoring changes in lung motion that were not suspected from spirometry. This might make the treatment of side effects possible at a very early stage. Changes of lung motion and tumor mobility are highly dependent on the tumor localization and tumor diameter.
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Affiliation(s)
- Christian Plathow
- Department of Diagnostic Radiology, Eberhard-Karls University Tuebingen, Hoppe-Seyler 3, 72060, Tuebingen, Germany.
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Kong FM, Ten Haken R, Eisbruch A, Lawrence TS. Non-small cell lung cancer therapy-related pulmonary toxicity: an update on radiation pneumonitis and fibrosis. Semin Oncol 2005; 32:S42-54. [PMID: 16015535 DOI: 10.1053/j.seminoncol.2005.03.009] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Successful treatment of non-small cell lung cancer requires adequate local and systemic disease control. Although it has been shown to have superior results, high-dose radiation therapy is not a current practice largely because of concerns of normal tissue toxicity. This article reviews and updates the possible mechanism of radiation-induced pneumonitis and fibrosis, their associations with dose intensity, and the role they may play in making treatment decisions. The commonly used clinical terminology and grading systems are summarized. Pneumonitis and fibrosis after 3-dimensional conformal high-dose radiation are reviewed, including recent updates from radiation dose escalation trials. Chemotherapy- and chemoradiation-related lung toxicities are also discussed. Individual susceptibility and potential predictive models are examined; dose and 3-dimensional dosimetric parameters are reviewed along with estimation of normal tissue complication probability and biologic predictive assays. Based on the risk levels of toxicity for each patient, future clinical trials may be designed to maximize individual therapeutic gain.
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Affiliation(s)
- Feng-Ming Kong
- Department of Radiation Oncology, University of Michigan, UH-B2C490, Box 0010, 1300 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
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Plathow C, Li M, Gong P, Zieher H, Kiessling F, Peschke P, Kauczor HU, Abdollahi A, Huber PE. Computed tomography monitoring of radiation-induced lung fibrosis in mice. Invest Radiol 2005; 39:600-9. [PMID: 15377939 DOI: 10.1097/01.rli.0000138134.89050.a5] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To identify characteristics of lung fibrosis in a mouse model after radiotherapy (RT) using thin-section computed tomography (CT), histology and clinical parameters. MATERIALS AND METHOD Using a multislice CT-scanner, follow-up chest CT scans of 10 out of 72 included mice (C57BL/6J, 36 control mice, 36 mice (20Gy)) were performed every 2 weeks until week 26 after RT. Hounsfield units (HU) and cardiothoracic ratio (CTR) were measured, and a multireader analysis on characteristic lung changes was performed and correlated with histology and clinical parameters. RESULTS From weeks 4 to 8 after RT changes in histology (leukocyte count, extraalveolar edema, P < 0.01) and from week 12 changes in CT were detected (increase in HU, intralobular opacity and fibrotic strandings, P < 0.05). From week 14 clinical manifestations occurred (loss of weight, mobility, breathing, increased mortality, P < 0.01). CTR showed no significant changes. Three readers showed excellent interobserver agreement (kappa >0.84). CONCLUSION Thin-section CT in a mouse model is capable of detecting the development of lung fibrosis after RT prior to the onset of clinical deterioration.
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Affiliation(s)
- Christian Plathow
- Department of Radiology, Deutsches Krebsforschungszentrum Heidelberg, Germany.
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Werner-Wasik M, Yu X, Marks LB, Schultheiss TE. Normal-tissue toxicities of thoracic radiation therapy: esophagus, lung, and spinal cord as organs at risk. Hematol Oncol Clin North Am 2004; 18:131-60, x-xi. [PMID: 15005286 DOI: 10.1016/s0889-8588(03)00150-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The evolution of therapeutic approaches for lung cancer illustrates the trend for treatment intensification, with hopes that dose-intense chemotherapy regimens, higher radiation therapy (RT) doses, or novel fractionation schemes will result in prolongation of survival. Current chemotherapy- and RT-intense regimens may not be intensified further without addressing dose-limiting toxicities such as esophagitis. It is important to understand factors pre-disposing to esophagitis so that strategies to minimize its severity can be investigated. Pulmonary complications such as pneumonitis and fibrosis from RT (with or without chemotherapy) are dose and volume dependent. Methods to better identify the target tissues and improved RT-delivery systems may facilitate increasing target doses or reducing doses to adjacent normal tissues. Biologic predictors may allow clinicians in the future to individualize RT treatment based on a patient's toxicity risk profile. Radiation myelopathy is still the most feared radiation complication of lung cancer treatment. The authors address the known parameters that influence the incidence of thoracic radiation myelopathy and the putative factors that could be considered when a clinician may be required to push the spinal cord dose in favor of tumor control.
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Affiliation(s)
- Maria Werner-Wasik
- Department of Radiation Oncology, Kimmel Cancer Center of Jefferson Medical College, 111 South 11th Street, Philadelphia, PA 19107, USA.
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Roof KS, Fidias P, Lynch TJ, Choi NC. Radiation dose intensification in limited-stage small-cell lung cancer. Clin Lung Cancer 2003; 4:339-46. [PMID: 14599300 DOI: 10.3816/clc.2003.n.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple studies have confirmed the value of radiation therapy in limited-stage small-cell lung cancer. The appropriate dose of radiation and the optimal fractionation scheme, however, remain controversial. This article will examine the history of radiation therapy in the management of small-cell lung cancer. It will review the rationale for the various approaches to radiation dose intensification, and review the results of important trials investigating the issue of radiation dose in the management of this disease. Survival outcomes and toxicity of various approaches to radiation dose intensification, including dose escalation and hyperfractionation, will be assessed. The implications of advancements in technology will be examined, and the optimal design of future trials will be discussed.
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Affiliation(s)
- Kevin S Roof
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02116, USA.
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Pietrzak WS, Gamboa M, Patel K, Sharma D, Kumar M, Eppley BL. The effect of therapeutic irradiation on LactoSorb absorbable copolymer. J Craniofac Surg 2002; 13:547-53. [PMID: 12140421 DOI: 10.1097/00001665-200207000-00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Bioabsorbable implants continue to gain popularity in providing temporary internal fixation due to their many advantages over metallic internal fixation. Coincident with the presence of internal fixation devices, it may be necessary to use radiotherapy to treat tumors. While metal implants can alter the distribution of the radiotherapy beam, bioabsorbable polymer implants are, essentially, tissue equivalent. This ionizing irradiation, in sufficiently high dose, can affect polymers through chain scission and cross-linking and accelerate the hydrolysis of absorbable polymers. However, little is known about the effects of therapeutic doses on such materials. This study exposed LactoSorb (Biomet, Inc., Warsaw, IN) absorbable copolymer to doses of x-ray irradiation in a clinically relevant manner, in vitro, with individual doses of 2 Gy administered five days per week for up to eight weeks, yielding a total cumulative dose of up to 80 Gy. Specimens were tested both mechanically and for inherent viscosity. Overall, the LactoSorb specimens withstood exposure to the irradiation exceedingly well, providing empirical evidence of the suitability of this material for temporary internal fixation when subsequent radiotherapy in the region is probable.
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