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Yegya-Raman N, Zou W, Nie K, Malhotra J, Jabbour SK. Advanced radiation techniques for locally advanced non-small cell lung cancer: intensity-modulated radiation therapy and proton therapy. J Thorac Dis 2018; 10:S2474-S2491. [PMID: 30206493 DOI: 10.21037/jtd.2018.07.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radiation therapy (RT) represents an integral part of a multimodality treatment plan in the definitive, preoperative and postoperative management of non-small cell lung cancer (NSCLC). Technological advances in RT have enabled a shift from two-dimensional radiotherapy to more conformal techniques. Three-dimensional conformal radiotherapy (3DCRT), the current minimum technological standard for treating NSCLC, allows for more accurate delineation of tumor burden by using computed tomography-based treatment planning instead of two-dimensional radiographs. Intensity-modulated RT (IMRT) and proton therapy represent advancements over 3DCRT that aim to improve the conformity of RT and provide the possibility for dose escalation to the tumor by minimizing radiation dose to organs at risk. Both techniques likely confer benefits to certain anatomic subgroups of NSCLC requiring RT. This article reviews pertinent studies evaluating the use of IMRT and proton therapy in locally advanced NSCLC, and outlines challenges, indications for use, and areas for future research.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ke Nie
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Jyoti Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Wang R, Zeidan A, Yu JB, Soulos PR, Davidoff AJ, Gore SD, Huntington S, Gross CP, Ma X. Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study. Prostate 2017; 77:437-445. [PMID: 27868212 PMCID: PMC5785924 DOI: 10.1002/pros.23281] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/04/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients. METHODS We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery. RESULTS Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47%) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95% confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR = 1.66, 95% CI: 1.09-2.54). CONCLUSIONS Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions. Prostate 77:437-445, 2017. © 2016 Wiley Periodicals, Inc.
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MESH Headings
- Aged
- Aged, 80 and over
- Cohort Studies
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Radiation-Induced/diagnosis
- Leukemia, Radiation-Induced/epidemiology
- Leukemia, Radiation-Induced/etiology
- Male
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/etiology
- Population Surveillance/methods
- Prostatic Neoplasms/diagnosis
- Prostatic Neoplasms/epidemiology
- Prostatic Neoplasms/radiotherapy
- Radiotherapy, Intensity-Modulated/adverse effects
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
| | - Amer Zeidan
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - James B. Yu
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Therapeutic Radiology, Yale School of Medicine
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - Amy J. Davidoff
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Health Policy and Management, Yale School of Public Health
| | - Steven D. Gore
- Department of Internal Medicine, Yale School of Medicine
| | - Scott Huntington
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
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Yadav P, Yan Y, Ignatowski T, Olson A. Dosimetric aspects of breast radiotherapy with three-dimensional and intensity-modulated radiotherapy helical tomotherapy planning modules. Med Dosim 2017; 42:42-46. [PMID: 28129971 DOI: 10.1016/j.meddos.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 09/08/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022]
Abstract
In this work, we investigated the dosimetric differences between the intensity-modulated radiotherapy (IMRT) plans and the three-dimensional (3D) helical plans based on the TomoTherapy system. A total of 15 patients with supine setup were randomly selected from the data base. For patients with lumpectomy planning target volume (PTV), regional lymph nodes were also included as part of the target. For dose sparing, the significant differences between the helical IMRT and helical 3D were only found in the heart and contralateral breast. For the dose to the heart, helical IMRT reduced the maximum point dose by 6.98Gy compared to the helical 3D plan (p = 0.01). For contralateral breast, the helical IMRT plans significantly reduced the maximum point dose by 5.6Gy compared to the helical 3D plan. However, compared to the helical 3D plan, the helical IMRT plan increased the volume for lower dose (13.08% increase in V5Gy, p = 0.01). In general, there are no significant differences in dose sparing between helical IMRT and helical 3D plans.
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Affiliation(s)
- Poonam Yadav
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI; Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
| | - Yue Yan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Tasha Ignatowski
- Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
| | - Anna Olson
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI; Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
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Zhu Z, Fu X. The radiation techniques of tomotherapy & intensity-modulated radiation therapy applied to lung cancer. Transl Lung Cancer Res 2015. [PMID: 26207214 DOI: 10.3978/j.issn.2218-6751.2015.01.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Radiotherapy (RT) plays an important role in the management of lung cancer. Development of radiation techniques is a possible way to improve the effect of RT by reducing toxicities through better sparing the surrounding normal tissues. This article will review the application of two forms of intensity-modulated radiation therapy (IMRT), fixed-field IMRT and helical tomotherapy (HT) in lung cancer, including dosimetric and clinical studies. The advantages and potential disadvantages of these two techniques are also discussed.
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Affiliation(s)
- Zhengfei Zhu
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China ; 3 Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiaolong Fu
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China ; 3 Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Price A. Intensity-Modulated Radiotherapy, Not 3 Dimensional Conformal, Is the Preferred Technique for Treating Locally Advanced Disease With High-Dose Radiotherapy: The Argument Against. Semin Radiat Oncol 2015; 25:117-21. [DOI: 10.1016/j.semradonc.2014.11.004] [Citation(s) in RCA: 8] [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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Dai X, Zhao Y, Liang Z, Dassarath M, Wang L, Jin L, Chen L, Dong J, Price RA, Ma CM. Volumetric-modulated arc therapy for oropharyngeal carcinoma: a dosimetric and delivery efficiency comparison with static-field IMRT. Phys Med 2014; 31:54-9. [PMID: 25284321 DOI: 10.1016/j.ejmp.2014.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
The purpose of this study is to evaluate the treatment plan adequacy and delivery efficiency among volumetric-modulated arc therapy (VMAT) with one or two arcs and the conventional static-field dynamic multileaf collimator (dMLC) intensity-modulated radiation therapy (IMRT) in patients undergoing oropharyngeal carcinoma. Fifteen patient cases were included in this investigation. Each of the cases was planned using step-and-shoot IMRT, VMAT with a single arc (Arc1) and VMAT with double arcs (Arc2). A two-dose level prescription for planning target volumes (PTVs) was delivered with 70 Gy/56 Gy in 30 fractions. Comparisons were performed of the dose-volume histograms (DVH) for PTVs, the DVH for organs at risk (OARs), the monitor units per fraction (MU/fx), and delivery time. IMRT and Arc2 achieved similar target coverage, but superior to Arc1. Apart from the oral cavity, Arc1 showed no advantage in sparing of OARs compared with IMRT, while Arc2 obtained equivalent or better sparing of OARs among the three techniques. VMAT reduced MU/fx and shortened delivery time remarkably compared with IMRT. Our results demonstrated that for oropharyngeal cases, Arc2 can achieve superior target coverage and normal tissue sparing, as well as a significant reduction in treatment time.
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Affiliation(s)
- Xiaofang Dai
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Yingchao Zhao
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Zhiwen Liang
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Meera Dassarath
- Cancer Center, Union Hospital, Huazhong University of Sciences and Technology, Wuhan, China
| | - Lu Wang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Lihui Jin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Lili Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - James Dong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - C-M Ma
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Joosten A, Bochud F, Moeckli R. A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer. Phys Med Biol 2014; 59:4697-722. [DOI: 10.1088/0031-9155/59/16/4697] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Murray L, Henry A, Hoskin P, Siebert FA, Venselaar J. Second primary cancers after radiation for prostate cancer: a systematic review of the clinical data and impact of treatment technique. Radiother Oncol 2014; 110:213-28. [PMID: 24485765 PMCID: PMC3988985 DOI: 10.1016/j.radonc.2013.12.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 12/18/2013] [Accepted: 12/25/2013] [Indexed: 02/07/2023]
Abstract
The development of a radiation induced second primary cancer (SPC) is one the most serious long term consequences of successful cancer treatment. This review aims to evaluate SPC in prostate cancer (PCa) patients treated with radiotherapy, and assess whether radiation technique influences SPC. A systematic review of the literature was performed to identify studies examining SPC in irradiated PCa patients. This identified 19 registry publications, 21 institutional series and 7 other studies. There is marked heterogeneity in published studies. An increased risk of radiation-induced SPC has been identified in several studies, particularly those with longer durations of follow-up. The risk of radiation-induced SPC appears small, in the range of 1 in 220 to 1 in 290 over all durations of follow-up, and may increase to 1 in 70 for patients followed up for more than 10 years, based on studies which include patients treated with older radiation techniques (i.e. non-conformal, large field). To date there are insufficient clinical data to draw firm conclusions about the impact of more modern techniques such as IMRT and brachytherapy on SPC risk, although limited evidence is encouraging. In conclusion, despite heterogeneity between studies, an increased risk of SPC following radiation for PCa has been identified in several studies, and this risk appears to increase over time. This must be borne in mind when considering which patients to irradiate and which techniques to employ.
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Affiliation(s)
| | - Ann Henry
- St. James's Institute of Oncology, Leeds, UK.
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Murray L, Henry A, Hoskin P, Siebert FA, Venselaar J. Second primary cancers after radiation for prostate cancer: a review of data from planning studies. Radiat Oncol 2013; 8:172. [PMID: 23835163 PMCID: PMC3724744 DOI: 10.1186/1748-717x-8-172] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 06/23/2013] [Indexed: 11/29/2022] Open
Abstract
A review of planning studies was undertaken to evaluate estimated risks of radiation induced second primary cancers (RISPC) associated with different prostate radiotherapy techniques for localised prostate cancer. A total of 83 publications were identified which employed a variety of methods to estimate RISPC risk. Of these, the 16 planning studies which specifically addressed absolute or relative second cancer risk using dose-response models were selected for inclusion within this review. There are uncertainties and limitations related to all the different methods for estimating RISPC risk. Whether or not dose models include the effects of the primary radiation beam, as well as out-of-field regions, influences estimated risks. Regarding the impact of IMRT compared to 3D-CRT, at equivalent energies, several studies suggest an increase in risk related to increased leakage contributing to out-of-field RISPC risk, although in absolute terms this increase in risk may be very small. IMRT also results in increased low dose normal tissue irradiation, but the extent to which this has been estimated to contribute to RISPC risk is variable, and may also be very small. IMRT is often delivered using 6MV photons while conventional radiotherapy often requires higher energies to achieve adequate tissue penetration, and so comparisons between IMRT and older techniques should not be restricted to equivalent energies. Proton and brachytherapy planning studies suggest very low RISPC risks associated with these techniques. Until there is sufficient clinical evidence regarding RISPC risks associated with modern irradiation techniques, the data produced from planning studies is relevant when considering which patients to irradiate, and which technique to employ.
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Affiliation(s)
- Louise Murray
- St James’s Institute of Oncology, Beckett St, Leeds LS9 7TF, UK
- University of Leeds, Leeds, UK
| | - Ann Henry
- St James’s Institute of Oncology, Beckett St, Leeds LS9 7TF, UK
- University of Leeds, Leeds, UK
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, London, UK
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A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, tangential-IMRT, multi-beam IMRT and VMAT. Radiat Oncol 2013; 8:89. [PMID: 23587298 PMCID: PMC3648459 DOI: 10.1186/1748-717x-8-89] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 04/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSES To compare the dosimetry for the left-sided breast cancer treatment using five different radiotherapy techniques. MATERIALS AND METHODS Twenty patients with left sided breast cancer were treated with conservative surgery followed by radiotherapy. They were planned using five different radiotherapy techniques, including: 1) conventional tangential wedge-based fields (TW); 2) field-in-field (FIF) technique; 3) tangential inverse planning intensity-modulated radiation therapy (T-IMRT); 4) multi-field IMRT (M-IMRT); and 5) volumetric modulated arc therapy (VMAT). The CTV, PTV and OARs including the heart, the regions of coronary artery (CA), the contralateral breast, the left and right lung were delineated. The PTV dose was prescribed 50Gy and V47.5≥95%. Same dose constraint was used for all five plans. The planned volumetric dose of PTV and PRV-OARs were compared and analyzed. RESULTS Except VMAT (Average V47.5 was 94.72%±1.2%), all the other four plans were able to meet the V95% (V47.5) requirement. T-IMRT plan improved the PTV dose homogeneity index (HI) by 0.02 and 0.03 when compared to TW plan and VMAT plan, and decreased the V5, V10 and V20 of all PRV-OARs. However, the high dose volume (≥ 30Gy) of the PRV-OARs in T-IMRT plan had no statistically significant difference compared with the other two inverse plans. In all five plans, the dose volume of coronary artery area showed a strong correlation to the dose volume of the heart (the correlation coefficients were 0.993, 0.996, 1.000, 0.995 and 0.986 respectively). CONCLUSION Compared to other techniques, the T-IMRT technology reduced radiation dose exposure to normal tissues and maintained reasonable target homogeneity, VMAT is not recommended for left-sided breast cancer treatment. In five techniques, the dose-volume histogram (DVH) of the heart can be used to predict the dose-volume histogram (DVH) of the coronary artery.
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D'Souza D, Rumble R, Fyles A, Yaremko B, Warde P. Intensity-modulated Radiotherapy in the Treatment of Gynaecological Cancers. Clin Oncol (R Coll Radiol) 2012; 24:499-507. [DOI: 10.1016/j.clon.2012.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 04/13/2012] [Accepted: 05/16/2012] [Indexed: 01/17/2023]
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Blais AR, Lederer E, Oliver M, Leszczynski K. Static and rotational step-and-shoot IMRT treatment plans for the prostate: A risk comparison study. Med Phys 2012; 39:1069-78. [DOI: 10.1118/1.3679338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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