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El Ouardy K, Zerfaoui M, Oulhouq Y, Bahhous K, Rrhioua A, Bakari D. A comparative study of boost dose delivery techniques in breast cancer radiotherapy optimising efficacy and minimising toxicity. RADIATION PROTECTION DOSIMETRY 2024; 200:459-466. [PMID: 38273648 DOI: 10.1093/rpd/ncad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
The present study aims to compare three techniques for delivering a boost absorbed dose: conventional reduced tangential (3D), volumetric modulated arc therapy (VMAT) and fields forward-planned technique boost (3DF). The study included 15 postoperative breast cancer patients who received a boost absorbed dose following breast-conserving surgery. The conformity index and homogeneity index were used to evaluate treatment outcomes, along with the average absorbed dose received by organs at risk (OAR). All the calculated dosimetric plans are carried out using Monaco Treatment Planning System (TPS). VMAT offers superior conformity, dose homogeneity and target coverage, it is associated with higher absorbed doses to OAR such as the heart and lung. In contrast, the 3D and 3DF techniques exhibit advantages in reducing absorbed doses to critical structures, potentially minimising the risk of cardiac and pulmonary complications. Each technique has its advantages and disadvantages. The choice of technique should be individualised, taking into account patient-specific factors and treatment goals and involves a multidisciplinary approach.
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Affiliation(s)
- Khalid El Ouardy
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Mustapha Zerfaoui
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Yassine Oulhouq
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Karim Bahhous
- Faculty of Science, University Mohammed V in Rabat, Rabat B.P. 1014, Morocco
| | - Abdeslem Rrhioua
- Laboratory of Physics of Matter and Radiation, Faculty of Sciences, Mohammed First University, Oujda, 60000, Morocco
| | - Dikra Bakari
- National School of Applied Sciences, Mohammed First University, Oujda 60000, Morocco
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Mohanty S, Patil D, Joshi K, Gamre P, Mishra A, Khairnar S, Kakoti S, Nayak L, Punatar S, Jain J, Phurailatpam R, Goda JS. Dosimetric Impact of Voluntary Deep Inspiration Breath Hold (DIBH) in Mediastinal Hodgkin Lymphomas: A Comparative Evaluation of Three Different Intensity Modulated Radiation Therapy (IMRT) Delivery Methods Using Voluntary DIBH and Free Breathing Techniques. Cancers (Basel) 2024; 16:690. [PMID: 38398081 PMCID: PMC10886974 DOI: 10.3390/cancers16040690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024] Open
Abstract
Hodgkin lymphomas are radiosensitive and curable tumors that often involve the mediastinum. However, the application of radiation therapy to the mediastinum is associated with late effects including cardiac and pulmonary toxicities and secondary cancers. The adoption of conformal IMRT and deep inspiration breath- hold (DIBH) can reduce the dose to healthy normal tissues (lungs, heart and breast). We compared the dosimetry of organs at risk (OARs) using different IMRT techniques for two breathing conditions, i.e., deep inspiration breath hold (DIBH) and free breathing. Twenty-three patients with early-stage mediastinal Hodgkin lymphomas were accrued in the prospective study. The patients were given treatment plans which utilized full arc volumetric modulated arc therapy (F-VMAT), Butterfly VMAT (B-VMAT), and fixed field IMRT (FF-IMRT) techniques for both DIBH and free breathing methods, respectively. All the plans were optimized to deliver 95% of the prescription dose which was 25.2 Gy to 95% of the PTV volume. The mean dose and standard error of the mean for each OAR, conformity index (CI), and homogeneity index (HI) for the target using the three planning techniques were calculated and compared using Student's t-test for parametric data and Wilcoxon signed-rank test for non-parametric data. The HI and CI of the target was not compromised using the DIBH technique for mediastinal lymphomas. The mean values of CI and HI for both DIBH and FB were comparable. The mean heart doses were reduced by 2.1 Gy, 2.54 Gy, and 2.38 Gy in DIBH compared to FB for the F-VMAT, B-VMAT, and IMRT techniques, respectively. There was a significant reduction in V5Gy, V10Gy, and V15Gy to the heart (p < 0.005) with DIBH. DIBH reduced the mean dose to the total lung by 1.19 Gy, 1.47 Gy, and 1.3 Gy, respectively. Among the 14 female patients, there was a reduction in the mean right breast dose with DIBH compared to FB (4.47 Gy vs. 3.63 Gy, p = 0.004). DIBH results in lower heart, lung, and breast doses than free breathing in mediastinal Hodgkin Lymphoma. Among the different IMRT techniques, FF-IMRT, B-VMAT, and F-VMAT showed similar PTV coverage, with similar conformity and homogeneity indices. However, the time taken for FF-IMRT was much longer than for the F-VMAT and B-VMAT techniques for both breathing methods. B-VMAT and F-VMAT emerged as the optimal planning techniques able to achieve the best target coverage and lower doses to the OARs, with less time required to deliver the prescribed dose.
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Affiliation(s)
- Samarpita Mohanty
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Divya Patil
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Kishore Joshi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Poonam Gamre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Ajay Mishra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Sunil Khairnar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Sangeeta Kakoti
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Lingaraj Nayak
- Department of Hemato Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (L.N.); (S.P.)
| | - Sachin Punatar
- Department of Hemato Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (L.N.); (S.P.)
| | - Jeevanshu Jain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Reena Phurailatpam
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
| | - Jayant S. Goda
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India; (S.M.); (D.P.); (K.J.); (P.G.); (A.M.); (S.K.); (S.K.); (J.J.); (R.P.)
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Gallio E, Sardo A, Badellino S, Mantovani C, Levis M, Fiandra C, Guarneri A, Arcadipane F, Richetto V, Ricardi U, Giglioli FR. Helical tomotherapy and two types of volumetric modulated arc therapy: dosimetric and clinical comparison for several cancer sites. Radiol Phys Technol 2023; 16:272-283. [PMID: 37084071 DOI: 10.1007/s12194-023-00716-3] [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: 12/12/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023]
Abstract
Radiotherapy accelerators have undergone continuous technological developments. We investigated the differences between Radixact™ and VMAT treatment plans. Sixty patients were included in this study. Dosimetric comparison between the Radixact™ and VMAT plans was performed for six cancer sites: whole-brain, head and neck, lymphoma, lung, prostate, and rectum. The VMAT plans were generated with two Elekta linear accelerators (Synergy® and Versa HD™). The planning target volume (PTV) coverage, organs-at-risk dose constraints, and four dosimetric indexes were considered. The deliverability of the plans was assessed using quality assurance (gamma index evaluation) measurements; clinical judgment was included in the assessment. The mean AAPM TG218 (3%-2 mm, global normalization) gamma index values were 99.4%, 97.8%, and 96.6% for Radixact™, Versa HD™, and Synergy®, respectively. Radixact™ performed better than Versa HD™ in terms of dosimetric indexes, hippocampi D100%, spinal cord Dmax, rectum V38.4 Gy, bladder V30 Gy, and V40 Gy. Versa HD™ saved more of the (lungs-PTV) V5 Gy and (lungs-PTV) Dmean, heart Dmean, breasts V4 Gy, and bowel V45 Gy. Regarding Synergy®, the head and neck Radixact™ plan saved more of the parotid gland, oral cavity, and supraglottic larynx. From a clinical point of view, for the head and neck, prostate, and rectal sites, the Radixact™ and Versa HD™ plans were similar; Radixact™ plans were preferable for the head and neck and rectum to Synergy® plans. The quality of linac plans has improved, and differences with tomotherapy have decreased. However, tomotherapy continues to be an essential add-on in multi-machine departments.
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Affiliation(s)
- Elena Gallio
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy.
| | - Anna Sardo
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy
| | - Serena Badellino
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Cristina Mantovani
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Mario Levis
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Christian Fiandra
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Alessia Guarneri
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Francesca Arcadipane
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Veronica Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, Via Santena 5 Bis, 10126, Turin, TO, Italy
| | - Francesca Romana Giglioli
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, TO, Italy
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Xie K, Gao L, Zhang H, Zhang S, Xi Q, Zhang F, Sun J, Lin T, Sui J, Ni X. Inpainting truncated areas of CT images based on generative adversarial networks with gated convolution for radiotherapy. Med Biol Eng Comput 2023:10.1007/s11517-023-02809-y. [PMID: 36897469 DOI: 10.1007/s11517-023-02809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
This study aimed to inpaint the truncated areas of CT images by using generative adversarial networks with gated convolution (GatedConv) and apply these images to dose calculations in radiotherapy. CT images were collected from 100 patients with esophageal cancer under thermoplastic membrane placement, and 85 cases were used for training based on randomly generated circle masks. In the prediction stage, 15 cases of data were used to evaluate the accuracy of the inpainted CT in anatomy and dosimetry based on the mask with a truncated volume covering 40% of the arm volume, and they were compared with the inpainted CT synthesized by U-Net, pix2pix, and PConv with partial convolution. The results showed that GatedConv could directly and effectively inpaint incomplete CT images in the image domain. For the results of U-Net, pix2pix, PConv, and GatedConv, the mean absolute errors for the truncated tissue were 195.54, 196.20, 190.40, and 158.45 HU, respectively. The mean dose of the planning target volume, heart, and lung in the truncated CT was statistically different (p < 0.05) from those of the ground truth CT ([Formula: see text]). The differences in dose distribution between the inpainted CT obtained by the four models and [Formula: see text] were minimal. The inpainting effect of clinical truncated CT images based on GatedConv showed better stability compared with the other models. GatedConv can effectively inpaint the truncated areas with high image quality, and it is closer to [Formula: see text] in terms of image visualization and dosimetry than other inpainting models.
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Affiliation(s)
- Kai Xie
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Liugang Gao
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Heng Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Sai Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Qianyi Xi
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Fan Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Jiawei Sun
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Tao Lin
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Jianfeng Sui
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Xinye Ni
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China.
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China.
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China.
- Key Laboratory of Medical Physics, Changzhou, 213000, China.
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Houlihan OA, Ntentas G, Cutter DJ, Daly P, Gillham C, McArdle O, Duane FK. Predicted cardiac and second cancer risks for patients undergoing VMAT for mediastinal Hodgkin lymphoma. Clin Transl Oncol 2022; 25:1368-1377. [PMID: 36585562 PMCID: PMC10119211 DOI: 10.1007/s12094-022-03034-z] [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: 10/06/2022] [Accepted: 11/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE To predict treatment-related cardiovascular disease (CVD) and second cancer 30-year absolute mortality risks (AMR30) for patients with mediastinal Hodgkin lymphoma in a large multicentre radiation oncology network in Ireland. MATERIAL AND METHODS This study includes consecutive patients treated for mediastinal lymphoma using chemotherapy and involved site radiotherapy (RT) 2016-2019. Radiation doses to heart, left ventricle, cardiac valves, lungs, oesophagus, carotid arteries and female breasts were calculated. Individual CVD and second cancer AMR30 were predicted using Irish background population rates and dose-response relationships. RESULTS Forty-four patients with Hodgkin lymphoma were identified, 23 females, median age 28 years. Ninety-eight percent received anthracycline, 80% received 4-6 cycles ABVD. Volumetric modulated arc therapy (VMAT) ± deep inspiration breath hold (DIBH) was delivered, median total prescribed dose 30 Gy. Average mean heart dose 9.8 Gy (range 0.2-23.8 Gy). Excess treatment-related mean AMR30 from CVD was 2.18% (0.79, 0.90, 0.01, 0.13 and 0.35% for coronary disease, heart failure, valvular disease, stroke and other cardiac diseases), 1.07% due to chemotherapy and a further 1.11% from RT. Excess mean AMR30 for second cancers following RT were: lung cancer 2.20%, breast cancer in females 0.34%, and oesophageal cancer 0.28%. CONCLUSION For patients with mediastinal lymphoma excess mortality risks from CVD and second cancers remain clinically significant despite contemporary chemotherapy and photon-RT. Efforts to reduce the toxicity of combined modality treatment, for example, using DIBH, reduced margins and advanced RT, e.g. proton beam therapy, should be continued to further reduce potentially fatal treatment effects.
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Affiliation(s)
- Orla A Houlihan
- St Luke's Radiation Oncology Network, Dublin, Ireland. .,Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK.
| | - Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David J Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Patricia Daly
- St Luke's Radiation Oncology Network, Dublin, Ireland.,Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Charles Gillham
- St Luke's Radiation Oncology Network, Dublin, Ireland.,Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla McArdle
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Frances K Duane
- St Luke's Radiation Oncology Network, Dublin, Ireland.,Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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Peschel DP, Düsberg M, Peeken JC, Kaiser JC, Borm KJ, Sommer K, Combs SE, Münch S. Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT. Sci Rep 2022; 12:22333. [PMID: 36567356 PMCID: PMC9790887 DOI: 10.1038/s41598-022-26641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022] Open
Abstract
The extent of elective nodal irradiation (ENI) in patients undergoing definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this dosimetric study was to evaluate the extent of incidental nodal irradiation using modern radiation techniques. A planning target volume (PTV) was generated for 30 patients with node-negative esophageal carcinoma (13 cervical/upper third, 7 middle third, 10 lower third/abdomen). Thereby, no elective nodal irradiation (ENI) was intended. Both three-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT) treatment plans (50 Gy in 25 fractions) were calculated for all patients. Fifteen nodal stations were contoured according to the definitions of the AJCC and investigated in regard to dosimetric parameters. Compared to 3D-CRT, VMAT was associated with lower dose distribution to the organs at risk (lower Dmean, V20 and V30 for the lungs and lower Dmean and V30 for the heart). For both techniques, the median Dmean surpassed 40 Gy in 12 of 15 (80%) nodal stations. However, VMAT resulted in significantly lower Dmeans and equivalent uniform doses (EUD) compared to 3D-CRT for eight nodal stations (1L, 2L, 2R, 4L, 7, 8L, 10L, 15), while differences did not reach significance for seven nodal station (1R, 4R, 8U, 8M, 10R, 16). For dCRT of ESCC, the use of VMAT was associated with significantly lower median (incidental) doses to eight of 15 regional lymph node areas compared to 3D-CRT. However, given the small absolute differences, these differences probably do not impair (regional) tumor control rates.
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Affiliation(s)
- David Paul Peschel
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Mathias Düsberg
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jan Christian Kaiser
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Kai Joachim Borm
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Katharina Sommer
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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Jones KS, Webster A, Ntentas G, Brady JL, Mikhaeel NG. Deep inspiration breath-hold for mediastinal lymphoma patients: Evaluation of a 5-year service. Tech Innov Patient Support Radiat Oncol 2022; 22:26-29. [PMID: 35450274 PMCID: PMC9018138 DOI: 10.1016/j.tipsro.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
There is little published data on the use of DIBH and Butterfly volumetric arc therapy for the treatment of mediastinal lymphoma. Experience of a 5 year service was analysed looking into immobilisaiton, IGRT, patient compliance, and completion of the patient pathway without interruption. It is noted that a successful service has been implemented with minimal disruption to the patient pathway and optimal treatment delivered.
Deep inspiration breath-hold (DIBH) is an advanced radiotherapy technique that has been shown to have dosimetric benefits in the treatment of patients with mediastinal lymphoma. Whilst there is much published data on the use of DIBH in breast radiotherapy, reports on the use of the technique in mediastinal lymphoma patients remain limited. As the first NHS centre in the UK to implement DIBH in this pt group, we have evaluated our experience and success in using this technique over a 5 year period.
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Introduction of deep inspirational breath-hold and Butterfly-VMAT techniques into clinical practice for the treatment of mediastinal lymphoma – Lessons learned from an experienced centre. Tech Innov Patient Support Radiat Oncol 2022; 22:22-25. [PMID: 35434387 PMCID: PMC9010782 DOI: 10.1016/j.tipsro.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
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Maraldo MV, Levis M, Andreis A, Armenian S, Bates J, Brady J, Ghigo A, Lyon AR, Manisty C, Ricardi U, Aznar MC, Filippi AR. An integrated approach to cardioprotection in lymphomas. Lancet Haematol 2022; 9:e445-e454. [PMID: 35512725 DOI: 10.1016/s2352-3026(22)00082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
In potentially curable cancers, long-term survival depends not only on the successful treatment of the malignancy but also on the risks associated with treatment-related toxicity, especially cardiotoxicity. Malignant lymphomas affect patients at any age, with acute and late toxicity risks that could have a severe effect on morbidity, mortality, and quality of life. Although our understanding of chemotherapy-associated and radiotherapy-associated cardiovascular disease has advanced considerably, new drugs with potential cardiotoxicity have been introduced for the treatment of lymphomas. In this Review, we summarise the mechanisms of treatment-related cardiac injury, available clinical data, and protocols for optimising cardioprotection in lymphomas. We discuss ongoing research strategies to advance our knowledge of the molecular basis of drug-induced and radiation-induced toxicity. Additionally, we emphasise the potential for personalised follow-up and early detection, including the role of biomarkers and novel diagnostic tests, highlighting the role of the cardio-oncology team.
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Affiliation(s)
- Maja V Maraldo
- Department of Clinical Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mario Levis
- Department of Clinical Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alessandro Andreis
- Division of Cardiology, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Saro Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James Bates
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jessica Brady
- Guy's Cancer Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Alexander R Lyon
- Imperial College London and Cardio-oncology Service, Royal Brompton Hospital, London, UK
| | - Charlotte Manisty
- Department of Cardio-oncology, Barts Heart Centre and University College London, London, UK
| | | | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester and Department of Radiotherapy-Related Research, The Christie NHS, Manchester, UK.
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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10
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Shbib Dabaja B, Boyce-Fappiano D, Dong W, Damron E, Fang P, Gunther J, Rodriguez MA, Strati P, Steiner R, Nair R, Lee H, Abou Yehia Z, Shihadeh F, Pinnix C, Ng AK. Second Malignancies in Patients with Hodgkin’s Lymphoma: Half a Century of Experience. Clin Transl Radiat Oncol 2022; 35:64-69. [PMID: 35601797 PMCID: PMC9121058 DOI: 10.1016/j.ctro.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Therapeutic improvements for Hodgkin’s Lymphoma (HL) has resulted in excellent survival outcomes. Thus, patients are increasing susceptible to developing secondary malignancy (SM) a feared iatrogenic complication. Materials & Methods We evaluated the SM risk in a cohort of patients with HL treated over a 50-year period. In total, 1653 patients were treated for HL from 1956 to 2009 at a tertiary-cancer-center. A cumulative incidence function was used to quantify SM risk and the Fine and Gray competing risk model was used to identify disease and treatment related correlates. Results Two-hundred-ninety patients (19%) developed SMs. Paradoxically, SM risk was higher in the modern era with 20-year cumulative incidence rates of 11.1%, 11.9%, 17% and 21.8%, for patients treated <1970, 1971–1986, 1986–1995 and 1996–2009, respectively. We hypothesized that the disproportionately high rate of early deaths in the early era may skew the assessment of SM risks, a much-delayed event. When the analysis was restricted to patients with early-stage favorable HL treated >1980, we found a reversal of the trend, especially on the risk of solid tumor, with a hazard ratio of 0.57 (p = 0.0651) in patients treated after 1996. Conclusion Our findings highlight the limitations of comparing the risk of a late event between groups with disparate rates of early deaths, despite the use of a competing risk model. When partially corrected for, patients treated in the more recent time period experienced a lower solid tumor risk.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author at: Department of Radiation Oncology, Division of Radiation Oncology Incident Commander, University of Texas MD Anderson Cancer Center, Director of Research of the International Lymphoma Radiation Oncology Group (ILROG), 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - David Boyce-Fappiano
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wenli Dong
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Damron
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Penny Fang
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jill Gunther
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria A. Rodriguez
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Strati
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raphael Steiner
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ranjit Nair
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun Lee
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, Rutgers Robertwood Johnson Medical Center, Houston, TX, USA
| | - Ferial Shihadeh
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea Pinnix
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea K. Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Houston, TX, USA
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11
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Late Cardiological Sequelae and Long-Term Monitoring in Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors: A Systematic Review by the Fondazione Italiana Linfomi. Cancers (Basel) 2021; 14:cancers14010061. [PMID: 35008222 PMCID: PMC8750391 DOI: 10.3390/cancers14010061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/25/2021] [Accepted: 12/20/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary The multidisciplinary team of Fondazione Italiana Linfomi researchers conducted a systematic review of the literature (PubMed, EMBASE, Cochrane database) regarding incidence, comparison between systemic therapies and radiotherapy (RT) (old versus modern techniques), and the better monitoring of long-term classical Hodgkin lymphoma and diffuse large B-cell lymphoma survivors on late cardiological sequelae. The research focused on patients treated in adulthood and with first- or second-line antineoplastic therapies, including autologous stem cell transplant. Our purpose was to provide an overall and updated picture of the incidence of the phenomenon, the risk factors, and the updated early detection and follow-up strategies. Abstract Cardiotoxicity represents the most frequent cause with higher morbidity and mortality among long-term sequelae affecting classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) patients. The multidisciplinary team of Fondazione Italiana Linfomi (FIL) researchers, with the methodological guide of Istituto di Ricerche Farmacologiche “Mario Negri”, conducted a systematic review of the literature (PubMed, EMBASE, Cochrane database) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in order to analyze the following aspects of cHL and DLBCL survivorship: (i) incidence of cardiovascular disease (CVD); (ii) risk of long-term CVD with the use of less cardiotoxic therapies (reduced-field radiotherapy and liposomal doxorubicin); and (iii) preferable cardiovascular monitoring for left ventricular (LV) dysfunction, coronary heart disease (CHD) and valvular disease (VHD). After the screening of 659 abstracts and related 113 full-text papers, 23 publications were eligible for data extraction and included in the final sample. There was an increased risk for CVD in cHL survivors of 3.6 for myocardial infarction and 4.9 for congestive heart failure (CHF) in comparison to the general population; the risk increased over the years of follow-up. In addition, DLBCL patients presented a 29% increased risk for CHF. New radiotherapy techniques suggested reduced risk of late CVD, but only dosimetric studies were available. The optimal monitoring of LV function by 2D-STE echocardiography should be structured according to individual CV risk, mainly considering as risk factors a cumulative doxorubicine dose >250 mg per square meter (m2) and mediastinal radiotherapy >30 Gy, age at treatment <25 years and age at evaluation >60 years, evaluating LV ejection fraction, global longitudinal strain, and global circumferential strain. The evaluation for asymptomatic CHD should be offered starting from the 10th year after mediastinal RT, considering ECG, stress echo, or coronary artery calcium (CAC) score. Given the suggested increased risks of cardiovascular outcomes in lymphoma survivors compared to the general population, tailored screening and prevention programs may be warranted to offset the future burden of disease.
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Ferrer C, Huertas C, Plaza R, de la Monja P, Ocanto A, Escribano A, Pérez A, Sáez M. Simple template-based optimization for pediatric total lymphoid irradiation (TLI) radiotherapy treatments. Med Dosim 2021; 46:201-207. [PMID: 33309515 DOI: 10.1016/j.meddos.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Total lymphoid irradiation (TLI) is used in the management of pediatric allogeneic hematopoietic stem cell transplantation (HSCT. This work aims to simplify the treatment planning process for TLI via a proposed template using the volumetric modulated arc therapy (VMAT) technique. Fifteen pediatric patients were planned, prescribed to 8 Gy in 4 fractions. Cost functions included in the template were the ones for the planning target volume (PTV), and conformality cost function (CCF) for the rest of the patient's volume. Conformity index (CI), homogeneity index (HI), conformation number (CN), gradient index (GI), integral dose, and doses to the organs at risk achieved with the template were reported. Cost function influence over various indexes was studied by Wilcoxon signed ranks test. Same 15 patients were planned with 3-dimensional conventional radiotherapy (3D-CRT) technique for comparison. Mean CI and HI were 1.33 and 0.13, respectively, which indicates good dose conformation and homogeneity. Mean CN and GI values were 0.69 and 4.51, respectively. Mean PTV coverage was reached (V100% > 95%). No correlation between the CCF and indexes values was found (p > 0.05). Doses to organs at risk (OARs) were as low as possible without losing PTV coverage. VMAT plan showed higher levels of conformation and similar homogeneity as 3D-CRT plans. Doses to OARs were inferior with VMAT except for the right kidney. The proposed template simplifies the planning of TLI treatments, and it is able to create acceptable plans with little modification in order to reduce doses to certain organs like the kidneys or the heart. VMAT technique showed higher conformation and lower doses to OAR compared to 3D-CRT.
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Affiliation(s)
- C Ferrer
- Department of Medical Physics and Radiation Protection, Hospital Universitario La Paz, Madrid, Spain.
| | - C Huertas
- Department of Medical Physics and Radiation Protection, Hospital Universitario La Paz, Madrid, Spain
| | - R Plaza
- Department of Medical Physics and Radiation Protection, Hospital Universitario La Paz, Madrid, Spain
| | - P de la Monja
- Department of Medical Physics and Radiation Protection, Hospital Universitario La Paz, Madrid, Spain
| | - A Ocanto
- Radiation Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - A Escribano
- Radiation Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - A Pérez
- Pediatric Hematology-Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Sáez
- Department of Medical Physics and Radiation Protection, Hospital Universitario La Paz, Madrid, Spain
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13
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Aznar M, Ntentas G, Enmark M, Flampouri S, Meidhal Petersen P, Ricardi U, Levis M. The role of motion management and position verification in lymphoma radiotherapy. Br J Radiol 2021; 94:20210618. [PMID: 34677090 PMCID: PMC8553184 DOI: 10.1259/bjr.20210618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
In the last decades, the substantial technical progress in radiation oncology offered the opportunity for more accurate planning and delivery of treatment. At the same time, the evolution of systemic treatment and the advent of modern diagnostic tools allowed for more accurate staging and consequently a safe reduction of radiotherapy (RT) target volumes and RT doses in the treatment of lymphomas. As a result, incidental irradiation of organs at risk was reduced, with a consequent reduction of severe late toxicity in long-term lymphoma survivors. Nevertheless, these innovations warrant that professionals pay attention to concurrently ensure precise planning and dose delivery to the target volume and safe sparing of the organs at risk. In particular, target and organ motion should be carefully managed in order to prevent any compromise of treatment efficacy. Several aspects should be taken into account during the treatment pathway to minimise uncertainties and to apply a valuable motion management strategy, when needed. These include: reliable image registration between diagnostic and planning radiologic exams to facilitate the contouring process, image guidance to limit positioning uncertainties and to ensure the accuracy of dose delivery and management of lung motion through procedures of respiratory gating and breath control. In this review, we will cover the current clinical approaches to minimise these uncertainties in patients treated with modern RT techniques, with a particular focus on mediastinal lymphoma. In addition, since uncertainties have a different impact on the dose deposition of protons compared to conventional x-rays, the role of motion management and position verification in proton beam therapy (PBT) will be discussed in a separate section.
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Affiliation(s)
| | | | | | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | | | - Mario Levis
- Department of Oncology, University of Torino, Turin, Italy
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14
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Kumar G, Dutta P, Parihar VK, Chamallamudi MR, Kumar N. Radiotherapy and Its Impact on the Nervous System of Cancer Survivors. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 19:374-385. [PMID: 32640964 DOI: 10.2174/1871527319666200708125741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/12/2022]
Abstract
Radiotherapy is routinely used for the treatment of nearly all brain tumors, but it may lead to progressive and debilitating impairments of cognitive function. The growing evidence supports the fact that radiation exposure to CNS disrupts diverse cognitive functions including learning, memory, processing speed, attention and executive functions. The present review highlights the types of radiotherapy and the possible mechanisms of cognitive deficits and neurotoxicity following radiotherapy. The review summarizes the articles from Scopus, PubMed, and Web of science search engines. Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells, with minimal damage to healthy cells. While radiotherapy has yielded relative success in the treatment of cancer, patients are often plagued with unwanted and even debilitating side effects from the treatment, which can lead to dose reduction or even cessation of treatment. Little is known about the underlying mechanisms responsible for the development of these behavioral toxicities; however, neuroinflammation is widely considered as one of the major mechanisms responsible for radiotherapy-induced toxicities. The present study reviews the different types of radiotherapy available for the treatment of various types of cancers and their associated neurological complications. It also summarizes the doses of radiations used in the variety of radiotherapy, and their early and delayed side effects. Special emphasis is given to the effects of various types of radiations or late side effects on cognitive impairments.
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Affiliation(s)
- Gautam Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Priyadarshini Dutta
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Vipan K Parihar
- Department of Radiation Oncology, University of California, Irvine, CA 92697- 2695, United States
| | - Mallikarjuna R Chamallamudi
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Nitesh Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
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15
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Buglione M, Guerini AE, Filippi AR, Spiazzi L, Pasinetti N, Magli A, Toraci C, Borghetti P, Triggiani L, Alghisi A, Costantino G, Bertagna F, Giaj Levra N, Pegurri L, Magrini SM. A Systematic Review on Intensity Modulated Radiation Therapy for Mediastinal Hodgkin's Lymphoma. Crit Rev Oncol Hematol 2021; 167:103437. [PMID: 34358649 DOI: 10.1016/j.critrevonc.2021.103437] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/20/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Secondary malignant neoplasms (SMNs) and cardiovascular diseases induced by chemotherapy and radiotherapy represent the main cause of excess mortality for early-stage Hodgkin lymphoma patients, especially when the mediastinum is involved. Conformal radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) could allow a reduction of the dose to the organs-at-risk (OARs) and therefore limit long-term toxicity. METHODS We performed a systematic review of the current literature regarding comparisons between IMRT and conventional photon beam radiotherapy, or between different IMRT techniques, for the treatment of mediastinal lymphoma. RESULTS AND CONCLUSIONS IMRT allows a substantial reduction of the volumes of OARs exposed to high doses, reducing the risk of long-term toxicity. This benefit is conterbalanced by the increase of volumes receiving low doses, that could potentially increase the risk of SMNs. Treatment planning should be personalized on patient and disease characteristics. Dedicated techniques such as "butterfly" VMAT often provide the best trade-off.
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Affiliation(s)
- Michela Buglione
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Andrea Emanuele Guerini
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
| | - Luigi Spiazzi
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Nadia Pasinetti
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy; Radiation Oncology Service, ASST Valcamonica Esine, Italy.
| | - Alessandro Magli
- Department of Radiation Oncology, Udine General Hospital, Udine, Italy.
| | - Cristian Toraci
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Borghetti
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Luca Triggiani
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Alessandro Alghisi
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy.
| | | | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and Spedali Civili of Brescia, Brescia, Italy.
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Italy.
| | - Ludovica Pegurri
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Maria Magrini
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
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Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives. Cancers (Basel) 2021; 13:cancers13153744. [PMID: 34359644 PMCID: PMC8345082 DOI: 10.3390/cancers13153744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Hodgkin lymphoma (HL) is a highly curable disease; proton therapy for mediastinal HL irradiation might theoretically reduce late toxicities compared with classical radiotherapy techniques. However, optimal patient selection for this technique is subject to debate. While implementation at a larger scale of proton therapy for HL may face organizational, political, and societal challenges, new highly effective systematic drugs are being widely evaluated for this disease. Abstract Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with technological advances in treatment techniques currently allows efficient organs-at-risk sparing without altering tumoral control. Recently, proton therapy has been evaluated for mediastinal HL treatment due to its potential to significantly reduce the dose to organs-at-risk, such as cardiac substructures. This is expected to limit late radiation-induced toxicity and possibly, second-neoplasm risk, compared with last-generation intensity-modulated radiation therapy. However, the democratization of this new technique faces multiple issues. Determination of which patient may benefit the most from proton therapy is subject to intense debate. The development of new effective systemic chemotherapy and organizational, societal, and political considerations might represent impediments to the larger-scale implementation of HL proton therapy. Based on the current literature, this critical review aims to discuss current challenges and controversies that may impede the larger-scale implementation of mediastinal HL proton therapy.
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Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence. Cancers (Basel) 2021; 13:cancers13153746. [PMID: 34359647 PMCID: PMC8345146 DOI: 10.3390/cancers13153746] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Consolidative radiation therapy (RT) is of prime importance for early-stage Hodgkin lymphoma (HL) management since it significantly increases progression-free survival (PFS). Nevertheless, first-generation techniques, relying on large irradiation fields, delivered significant radiation doses to critical organs-at-risk (OARs, such as the heart, to the lung or the breasts) when treating mediastinal HL; consequently, secondary cancers, and cardiac and lung toxicity were substantially increased. Fortunately, HL RT has drastically evolved and, nowadays, state-of-the-art RT techniques efficiently spare critical organs-at-risks without altering local control or overall survival. Recently, proton therapy has been evaluated for mediastinal HL treatment, due to its possibility to significantly reduce integral dose to OARs, which is expected to limit second neoplasm risk and reduce late toxicity. Nevertheless, clinical experience for this recent technique is still limited worldwide. Based on current literature, this critical review aims to examine the current practice of proton therapy for mediastinal HL irradiation.
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Radiobiological assessment of nasopharyngeal cancer IMRT using various collimator angles and non-coplanar fields. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396919000943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:The aim of this study was to evaluate clinical efficacy and radiobiological outcome of intensity-modulated radiation therapy (IMRT) modalities using various collimator angles and non-coplanar fields for nasopharyngeal cancer (NPC).Materials and methods:A 70-Gy planning target volume dose was administered for 30 NPC patients referred for IMRT. Standard IMRT plans were constructed based on the target and organs at risk (OARs) volume; and dose constraints recommended by Radiation Therapy Oncology Group (RTOG). Using various collimator angles and non-coplanar fields, 11 different additional IMRT protocols were investigated. Homogeneity indexes (HIs) and conformation numbers (CNs) were calculated. Poisson and relative seriality models were utilised for estimating tumour control probability (TCP) and normal tissue complication probabilities (NTCPs), respectively.Results:Various collimator angles and non-coplanar fields had no significant effect on HI, CN and TCP, while significant effects were noted for some OARs, with a maximum mean dose (Dmax). No significant differences were observed among the calculated NTCPs of all the IMRT protocols. However, the protocol with 10° collimator angle (for five fields out of seven) and 8° couch angle had the lowest NTCP. Furthermore, the standard and some of non-coplanar IMRT protocols led to the reduction in OARs Dmax.Conclusions:Using appropriate standard/non-coplanar IMRT protocols for NPC treatment could potentially reduce the dose to the OARs and the probability of inducing secondary cancer in patients.
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19
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Rossi L, Cambraia Lopes P, Marques Leitão J, Janus C, van de Pol M, Breedveld S, Penninkhof J, Heijmen BJM. On the Importance of Individualized, Non-Coplanar Beam Configurations in Mediastinal Lymphoma Radiotherapy, Optimized With Automated Planning. Front Oncol 2021; 11:619929. [PMID: 33937025 PMCID: PMC8082440 DOI: 10.3389/fonc.2021.619929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Literature is non-conclusive regarding selection of beam configurations in radiotherapy for mediastinal lymphoma (ML) radiotherapy, and published studies are based on manual planning with its inherent limitations. In this study, coplanar and non-coplanar beam configurations were systematically compared, using a large number of automatically generated plans. Material and Methods An autoplanning workflow, including beam configuration optimization, was configured for young female ML patients. For each of 25 patients, 24 plans with different beam configurations were generated with autoplanning: 11 coplanar CP_x plans and 11 non-coplanar NCP_x plans with x = 5 to 15 IMRT beams with computer-optimized, patient-specific configurations, and the coplanar VMAT and non-coplanar Butterfly VMAT (B-VMAT) beam angle class solutions (600 plans in total). Results Autoplans compared favorably with manually generated, clinically delivered plans, ensuring that beam configuration comparisons were performed with high quality plans. There was no beam configuration approach that was best for all patients and all plan parameters. Overall there was a clear tendency towards higher plan quality with non-coplanar configurations (NCP_x≥12 and B-VMAT). NCP_x≥12 produced highly conformal plans with on average reduced high doses in lungs and patient and also a reduced heart Dmean, while B-VMAT resulted in reduced low-dose spread in lungs and left breast. Conclusions Non-coplanar beam configurations were favorable for young female mediastinal lymphoma patients, with patient-specific and plan-parameter-dependent dosimetric advantages of NCP_x≥12 and B-VMAT. Individualization of beam configuration approach, considering also the faster delivery of B-VMAT vs. NCP_x≥12, can importantly improve the treatments.
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Affiliation(s)
- Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Cecile Janus
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Marjan van de Pol
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Joan Penninkhof
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Ben J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Houlihan OA, Rangaswamy G, Dunne M, Rohan C, O'Neill L, Chalke S, Daly P, Gillham C, McArdle O. Deep inspiration breath hold versus free breathing technique in mediastinal radiotherapy for lymphoma. BJR Open 2021; 3:20200067. [PMID: 33718767 PMCID: PMC7931409 DOI: 10.1259/bjro.20200067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. Methods: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. Results: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). Conclusion: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. Advances in knowledge: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.
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Affiliation(s)
| | | | - Mary Dunne
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | | | | | - Patricia Daly
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Orla McArdle
- St. Luke's Radiation Oncology Network, Dublin, Ireland
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21
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Pepper NB, Oertel M, Kittel C, Kröger KJ, Elsayad K, Haverkamp U, Eich HT. Impact of radiation techniques on lung toxicity in patients with mediastinal Hodgkin's lymphoma. Strahlenther Onkol 2021; 197:56-62. [PMID: 32945894 PMCID: PMC7499413 DOI: 10.1007/s00066-020-01682-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Mediastinal radiotherapy (RT), especially when combined with bleomycin, may result in substantial pulmonary morbidity and mortality. The use of modern RT techniques like intensity-modulated radiotherapy (IMRT) is gaining interest to spare organs at risk. METHODS We evaluated 27 patients who underwent RT for Hodgkin's lymphoma between 2009 and 2013 at our institution. For each patient, three different treatment plans for a 30-Gy involved-field RT (IFRT) were created (anterior-posterior-posterior-anterior setup [APPA], 5‑field IMRT, and 7‑field IMRT) and analyzed concerning their inherent "normal tissue complication probability" (NTCP) for pneumonitis and secondary pulmonary malignancy. RESULTS The comparison of different radiation techniques showed a significant difference in favor of standard APPA (p < 0.01). The risk of lung toxicity was significantly higher in plans using 7‑field IMRT than in plans using 5‑field IMRT. The absolute juxtaposition showed an increase in risk for radiation pneumonitis of 1% for plans using 5‑field IMRT over APPA according to QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) parameters (Burman: 0.15%) and 2.6% when using 7‑field IMRT over APPA (Burman: 0.7%) as well as 1.6% when using 7‑field IMRT over 5‑field IMRT (Burman: 0.6%). Further analysis showed an increase in risk for secondary pulmonary malignancies to be statistically significant (p < 0.01); mean induction probability for pulmonary malignoma was 0.1% higher in plans using 5‑field IMRT than APPA and 0.19% higher in plans using 7‑field IMRT than APPA as well as 0.09% higher in plans using 7‑field IMRT than 5‑field IMRT. During a median follow-up period of 65 months (95% confidence interval: 53.8-76.2 months), only one patient developed radiation-induced pneumonitis. No secondary pulmonary malignancies have been detected to date. CONCLUSION Radiation-induced lung toxicity is rare after treatment for Hodgkin lymphoma but may be influenced significantly by the RT technique used. In this study, APPA RT plans demonstrated a decrease in potential radiation pneumonitis and pulmonary malignancies. Biological planning using NTCP may have the potential to define personalized RT strategies.
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Affiliation(s)
- Niklas Benedikt Pepper
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Kai Jannes Kröger
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
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22
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Role of Radiotherapy in Post-transplant Lymphoproliferative Disorders: Three Case Reports and Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e309-e316. [PMID: 33257284 DOI: 10.1016/j.clml.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/05/2020] [Indexed: 12/22/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is an aggressive malignancy that occurs in patients who have undergone solid organ transplantation or hematopoietic stem cell transplantation. It develops as the result of uncontrolled cell proliferations owing to reduced immunological surveillance. PTLD may occur with a various spectrum of clinical presentations, including both localized and extensive disease. Management can be significantly variable according both to the clinical presentation and to the histologic features. The most important systemic treatment strategies are reduction of immunosuppressive therapy, chemotherapy, anti B-cell antibodies, especially rituximab and cytokine-based therapies. The localized form of PTLD could be efficiently treated, and potentially cured, with surgery or radiotherapy (RT). Involved site RT may be a feasible effective option for the treatment of patients with PTLD, given the excellent radio-sensitivity of lymphoid disorders. In this report, we describe 3 adult patients with PTLD treated with moderate-dose RT (24-36 Gy) having a good local control with negligible toxicity. We also review the literature data on the role of radiation therapy in this particular setting.
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23
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Zhang J, Peng Y, Ding S, Zhu J, Liu Y, Chen M, Sun W, Zhou L, Deng X. Comparison of Different Combinations of Irradiation Mode and Jaw Width in Helical Tomotherapy for Nasopharyngeal Carcinoma. Front Oncol 2020; 10:598. [PMID: 32391275 PMCID: PMC7190867 DOI: 10.3389/fonc.2020.00598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose: To aid in the selection of a suitable combination of irradiation mode and jaw width in helical tomotherapy (HT) for the treatment of nasopharyngeal carcinoma (NPC). Materials and Methods: Twenty patients with NPC who underwent radiotherapy were retrospectively selected. Four plans using a jaw width of 2.5 or 5-cm in dynamic jaw (DJ) or fix jaw (FJ) modes for irradiation were designed (2.5DJ, 2.5FJ, 5.0DJ, and 5.0FJ). The dose parameters of planning target volume (PTV) and organs at risk (OARs) of the plans were compared and analyzed, as well as the beam on time (BOT) and monitor unit (MU). The plans in each group were ranked by scoring the doses received by the OARs and the superity was assessed in combination with the planned BOT and MU. Results: The prescribed dose coverage of PTV met the clinical requirements for all plans in the four groups. The groups using a 2.5-cm jaw width or a DJ mode provided better protection to most OARs, particularly for those at the longitudinal edges of the PTV (P < 0.05). The 2.5DJ group had the best ranking for OAR-dose, followed by the 2.5FJ and 5.0DJ groups with a same score. The BOT and MU of the groups using a 5.0-cm jaw width reduced nearly 45% comparing to those of the 2.5-cm jaw groups. Conclusion: 2.5DJ has the best dose distribution, while 5.0DJ has satisfactory dose distribution and less BOT and MU that related to the leakage dose. Both 2.5DJ or 5DJ were recommended for HT treatment plan for NPC based on the center workload.
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Affiliation(s)
- Jun Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yinglin Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Shouliang Ding
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jinhan Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yimei Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Meining Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wenzhao Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Xiaowu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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24
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Hoppe BS, Bates JE, Mendenhall NP, Morris CG, Louis D, Ho MW, Hoppe RT, Shaikh M, Li Z, Flampouri S. The Meaningless Meaning of Mean Heart Dose in Mediastinal Lymphoma in the Modern Radiation Therapy Era. Pract Radiat Oncol 2020; 10:e147-e154. [DOI: 10.1016/j.prro.2019.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/10/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
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25
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Filippi AR, Meregalli S, DI Russo A, Levis M, Ciammella P, Buglione M, Guerini AE, De Marco G, De Sanctis V, Vagge S, Ricardi U, Simontacchi G. Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin's lymphoma involving the mediastinum. Radiat Oncol 2020; 15:62. [PMID: 32164700 PMCID: PMC7066773 DOI: 10.1186/s13014-020-01504-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/21/2020] [Indexed: 12/14/2022] Open
Abstract
Aim Advances in therapy have resulted in improved cure rates and an increasing number of long-term Hodgkin's lymphoma (HL) survivors. However, radiotherapy (RT)-related late effects are still a significant issue, particularly for younger patients with mediastinal disease (secondary cancers, heart diseases). In many Centers, technological evolution has substantially changed RT planning and delivery. This consensus document aims to analyze the current knowledge of Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) for mediastinal HL and formulate practical recommendations based on scientific evidence and expert opinions. Methods A dedicated working group was set up within the Fondazione Italiana Linfomi (FIL) Radiotherapy Committee in May 2018. After a first meeting, the group adopted a dedicated platform to share retrieved articles and other material. Two group coordinators redacted a first document draft, that was further discussed and finalized in two subsequent meetings. Topics of interest were: 1) Published data comparing 3D-conformal radiotherapy (3D-CRT) and IMRT 2) dose objectives for the organs at risk 3) IGRT protocols and motion management. Results Data review showed that IMRT might allow for an essential reduction in the high-dose regions for all different thoracic OAR. As very few studies included specific dose constraints for lungs and breasts, the low-dose component for these OAR resulted slightly higher with IMRT vs. 3D-CRT, depending on the technique used. We propose a set of dose objectives for the heart, breasts, lungs, and thyroid. The use of IGRT is advised for margin reduction without specific indications, such as the use of breath-holding techniques. An individual approach, including comparative planning and considering different risk factors for late morbidity, is recommended for each patient. Conclusions As HL therapy continues to evolve, with an emphasis on treatment reduction, radiation oncologists should use at best all the available tools to minimize the dose to organs at risk and optimize treatment plans. This document provides indications on the use of IMRT/IGRT based on expert consensus, providing a basis for clinical implementation and future development.
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Affiliation(s)
- Andrea Riccardo Filippi
- Radiation Oncology Department, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | | | - Anna DI Russo
- Fondazione IRCCS Policlinico San Matteo and University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
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26
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Dewan A, Chufal KS, Tandon S, Ahmad I, Suresh T, Dewan A, Pahuja A. A case report evaluating combined effect of intensity-modulated radiotherapy and deep inspiratory breath-hold for mediastinal lymphoma: A dosimetric analysis. Lung India 2020; 37:57-62. [PMID: 31898622 PMCID: PMC6961102 DOI: 10.4103/lungindia.lungindia_88_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Excellent survival has been reported after combined modality treatment in bulky mediastinal Hodgkin's lymphoma. Late effects such as cardiac morbidity and secondary cancers have been reported after radiotherapy (RT), especially in young adults. Advanced RT techniques such as deep inspiratory breath-hold (DIBH), intensity-modulated RT (IMRT), and volumetric arc therapy have been used recently to reduce these late effects with encouraging results. We hereby present a case report evaluating combined effect of DIBH and IMRT in a young adult with mediastinal lymphoma.
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Affiliation(s)
- Abhinav Dewan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kundan Singh Chufal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - T Suresh
- Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ajay Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali Pahuja
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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27
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Abstract
Radiation therapy plays a critical role in the management of a wide range of hematologic malignancies. The optimal radiation dose and target volume, and safe and effective ways of integrating radiation with systemic agents, vary depending on the histologic subtypes, stage at presentation, patient performance status, response to systemic therapy if given, treatment intent, and patient preferences. Limiting doses to surrounding organs without sacrificing disease control is of paramount importance. Reducing radiation doses and treatment volume in selected cases, and the use of advanced radiotherapy technology, can improve the therapeutic ratio of patients receiving radiation therapy for hematologic malignancies.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, Seattle Cancer Care Alliance Proton Therapy Center, University of Washington School of Medicine, 1570 North 115th Street, Seattle, WA 98133, USA
| | - Andrea K Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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28
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Lautenschlaeger S, Iancu G, Flatten V, Baumann K, Thiemer M, Dumke C, Zink K, Hauswald H, Vordermark D, Mauz-Körholz C, Engenhart-Cabillic R, Eberle F. Advantage of proton-radiotherapy for pediatric patients and adolescents with Hodgkin's disease. Radiat Oncol 2019; 14:157. [PMID: 31477141 PMCID: PMC6721251 DOI: 10.1186/s13014-019-1360-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/16/2019] [Indexed: 01/26/2023] Open
Abstract
Abstract Radiotherapy is frequently used in the therapy of lymphoma. Since lymphoma, for example Hodgkin’s disease, frequently affect rather young patients, the induction of secondary cancer or other long-term adverse effects after irradiation are important issues to deal with. Especially for mediastinal manifestations numerous organs and substructures at risk play a role. The heart, its coronary vessels and cardiac valves, the lungs, the thyroid and, for female patients, the breast tissue are only the most important organs at risk. In this study we investigated if proton-radiotherapy might reduce the dose delivered to the organs at risk and thus minimize the therapy-associated toxicity. Methods In this work we compared the dose delivered to the heart, its coronary vessels and valves, the lungs, the thyroid gland and the breast tissue by different volumetric photon plans and a proton plan, all calculated for a dose of 28.8 Gy (EURO-NET-PHL-C2). Target Volumes have been defined by F18-FDG PET-positive areas, following a modified involved node approach. Data from ten young female patients with mediastinal lymphoma have been evaluated. Three different modern volumetric IMRT (VMAT) photon plans have been benchmarked against each other and against proton-irradiation concepts. For plan-evaluation conformity- and homogeneity-indices have been calculated as suggested in ICRU 83. The target volume coverage as well as the dose to important organs at risk as the heart with its substructures, the lungs, the breast tissue, the thyroid and the spinal cord were calculated and compared. For statistical evaluation mean doses to organs at risk were evaluated by non- parametric Kruskal-Wallis calculations with pairwise comparisons. Results Proton-plans and three different volumetric photon-plans have been calculated. Proton irradiation results in significant lower doses delivered to organ at risk. The median doses and the mean doses could be decreased while PTV coverage is comparable. As well conformity as homogeneity are slightly better for proton plans. For several organs a risk reduction for secondary malignancies has been calculated using literature data as reference. According to the used data derived from literature especially the secondary breast cancer risk, the secondary lung cancer risk and the risk for ischemic cardiac insults can be reduced significantly by using protons for radiotherapy of mediastinal lymphomas. Conclusion Irradiation with protons for mediastinal Hodgkin-lymphoma results in significant lower doses for almost all organs at risk and is suitable to reduce long term side effects for pediatric and adolescent patients. Electronic supplementary material The online version of this article (10.1186/s13014-019-1360-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Lautenschlaeger
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.
| | - G Iancu
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - V Flatten
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - K Baumann
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - M Thiemer
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - C Dumke
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - K Zink
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - H Hauswald
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Klinik für Radio-Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
| | - D Vordermark
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - C Mauz-Körholz
- Abteilung für Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Gießen, Gießen, Germany.,Department für operative und konservative Kinder- und Jugendmedizin, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - R Engenhart-Cabillic
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
| | - F Eberle
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
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29
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Levis M, Filippi AR, Fiandra C, De Luca V, Bartoncini S, Vella D, Ragona R, Ricardi U. Inclusion of heart substructures in the optimization process of volumetric modulated arc therapy techniques may reduce the risk of heart disease in Hodgkin’s lymphoma patients. Radiother Oncol 2019; 138:52-58. [DOI: 10.1016/j.radonc.2019.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/25/2022]
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30
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Abbassi LM, Goudjil F, Arsène-Henry A, Dendale R, Kirova YM. Protontherapy versus best photon for mediastinal Hodgkin lymphoma: Dosimetry comparison and treatment using ILROG guidelines. Cancer Radiother 2019; 23:922-925. [PMID: 31257097 DOI: 10.1016/j.canrad.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/15/2022]
Abstract
The purpose of this work was reducing treatment-related toxicity for Hodgkin lymphomas using practical procedure inspired by the ILROG guidelines. Reporting the first case of localized Hodgkin lymphoma treated with protontherapy in France. A 24-year-old female with mediastinal, bulky, localized, mixed-cellularity, classic Hodgkin lymphoma required an involved-site radiation therapy after complete response following polychemotherapy. Three-dimensional conformal radiation therapy was not acceptable due to high doses to breasts, heart and lungs. We realized a four-dimensional computed tomography (CT) to evaluate target movements and another CT with gating and breath-hold technique. Delineation was performed on both CT using the initial fluorodeoxyglucose positron-emission tomography/CT. One dosimetric plan with rotational intensity-modulated radiation therapy with a helical Tomotherapy© was realized and compared to another one with conformational protontherapy. Ninety-five percent of the planning target volume was covered by 98 and 99% of the prescribed dose with protontherapy and helical Tomotherapy©. Protontherapy provided the best organ at risk protection. Lung and heart protections were better with protontherapy: lung mean dose (3.7Gy vs. 8.4Gy) and median dose (0.002Gy vs. 6.9Gy), heart mean dose (2.6Gy vs. 3.7Gy). Breast sparing was better for both breasts using protontherapy: right breast mean dose (2.4Gy vs. 4.4Gy) and left (1.9Gy vs. 4.6Gy). The biggest difference was seen with low doses, which were better with protontherapy: volume of lung receiving 5Gy was 17.5% vs. 54.2% with Helical Tomotherapy©. In view of these results, we decided to treat our patient with protontherapy using respiratory assessment. We delivered 30Gy (15 fractions) using protontherapy with one direct anterior field using pencil beam scanning and deep inspiration breath-hold technique. We observed only grade 1 skin erythema during treatment and no toxicity during early follow-up.
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Affiliation(s)
- L M Abbassi
- Department of radiation oncology, institut Curie Paris-Orsay, 26, rue d'Ulm, 75005 Paris, France.
| | - F Goudjil
- Department of radiation oncology, institut Curie Paris-Orsay, 26, rue d'Ulm, 75005 Paris, France
| | - A Arsène-Henry
- Department of radiation oncology, institut Curie Paris-Orsay, 26, rue d'Ulm, 75005 Paris, France
| | - R Dendale
- Department of radiation oncology, institut Curie Paris-Orsay, 26, rue d'Ulm, 75005 Paris, France
| | - Y M Kirova
- Department of radiation oncology, institut Curie Paris-Orsay, 26, rue d'Ulm, 75005 Paris, France
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31
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Postmastectomy radiotherapy for left-sided breast cancer patients: Comparison of advanced techniques. Med Dosim 2019; 45:34-40. [PMID: 31129035 DOI: 10.1016/j.meddos.2019.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 12/25/2022]
Abstract
Postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival for invasive breast cancer patients, and many advanced radiotherapy technologies were adopted for PMRT. The purpose of our study is to compare various advanced PMRT techniques including fixed-beam intensity-modulated radiotherapy (IMRT), non-coplanar volumetric modulated arc therapy (NC-VMAT), multiple arc VMAT (MA-VMAT), and tomotherapy (TOMO). Results of standard VMAT and mixed beam therapy that were published by our group previously were also included in the plan comparisons. Treatment plans were produced for nine PMRT patients previously treated in our clinic. The plans were evaluated based on planning target volume (PTV) coverage, dose homogeneity index (DHI), conformity index (CI), dose to organs at risk (OARs), normal tissue complication probability (NTCP) of pneumonitis, lifetime attributable risk (LAR) of second cancers, and risk of coronary events (RCE). All techniques produced clinically acceptable PMRT plans. Overall, fixed-beam IMRT delivered the lowest mean dose to contralateral breast (1.56 ± 0.4 Gy) and exhibited lowest LAR (0.6 ± 0.2%) of secondary contralateral breast cancer; NC-VMAT delivered the lowest mean dose to lungs (7.5 ± 0.8 Gy), exhibited lowest LAR (5.4 ± 2.8%) of secondary lung cancer and lowest NTCP (2.1 ± 0.4%) of pneumonitis; mixed beam therapy delivered the lowest mean dose to heart (7.1 ± 1.3 Gy) and exhibited lowest RCE (8.6 ± 7.1%); TOMO plans provided the most optimal target coverage while delivering higher dose to OARs than other techniques. Both NC-VMAT and MA-VMAT exhibited lower values of all OARs evaluation metrics compare to standard VMAT. Fixed-beam IMRT, NC-VMAT, and mixed beam therapy could be the optimal radiation technique for certain breast cancer patients after mastectomy.
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Ntentas G, Dedeckova K, Andrlik M, Aznar MC, George B, Kubeš J, Darby SC, Cutter DJ. Clinical Intensity Modulated Proton Therapy for Hodgkin Lymphoma: Which Patients Benefit the Most? Pract Radiat Oncol 2019; 9:179-187. [PMID: 30708133 PMCID: PMC6493042 DOI: 10.1016/j.prro.2019.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation therapy (RT) improves control of Hodgkin lymphoma (HL), but patients who undergo RT are at risk for late effects, including cardiovascular disease and second cancers, because of radiation doses to organs at risk (OARs). Proton therapy (PT) can reduce OAR doses compared with conventional photon RT. However, access to PT is currently limited, so referrals must be appropriately selective. We aimed to identify subgroups of patients with HL who could benefit the most dosimetrically from RT with PT based on the prechemotherapy disease characteristics. METHODS AND MATERIALS Normal tissue radiation doses were calculated for 21 patients with HL who were treated with deep-inspiration breath-hold pencil-beam scanning (PBS) PT and compared with doses from 3-dimensional conformal (3D-CRT) and partial arc volumetric modulated (PartArc) photon RT. Prechemotherapy disease characteristics associated with significant dosimetric benefits from PBS compared with photon RT were identified. RESULTS Treatment with PBS was well tolerated and provided with good local control. PBS provided dosimetric advantages for patients whose clinical treatment volume extended below the seventh thoracic level and for female patients with axillary disease. In addition, an increasing dosimetric benefit for some OARs was observed for increasing target volume. PBS significantly reduced the mean dose to the heart, breast, lungs, spinal cord, and esophagus. Dose homogeneity and conformity within the target volume were also superior with PBS, but some high-dose measures and hot spots were increased with PBS compared with partial arc volumetric modulated photon RT. CONCLUSIONS PBS gives good target coverage and local control while providing reductions in radiation dose to OARs for individuals who receive RT for HL compared with advanced photon RT. Our findings highlight groups of patients who would be expected to gain more dosimetric benefit from PBS. These findings facilitate the selection of patients who should be considered a priority for PT.
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Affiliation(s)
- Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | | | - Michal Andrlik
- Proton Therapy Center Czech s.r.o., Prague, Czech Republic
| | - Marianne C Aznar
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Ben George
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Jiří Kubeš
- Proton Therapy Center Czech s.r.o., Prague, Czech Republic
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David J Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Blais E, Vendrely V, Sargos P, Créhange G, Huguet F, Maingon P, Simon JM, Bourdais R, Ozsahin M, Bourhis J, Clément-Colmou K, Belghith B, Proudhom Briois MA, Gilliot O, Dujols JP, Peyras A, Dupin C, Riet FG, Canova CH, Huertas A, Troussier I. [Chemoradiation for oesophageal cancer: A critical review of the literature]. Cancer Radiother 2019; 23:62-72. [PMID: 30639379 DOI: 10.1016/j.canrad.2018.05.003] [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: 04/09/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 10/27/2022]
Abstract
Locally advanced oesophageal cancer treatment requires a multidisciplinary approach with the combination of chemotherapy and radiotherapy for preoperative and definitive strategy. Preoperative chemoradiation improves the locoregional control and overall survival after surgery for locally advanced oesophageal cancer. Definitive chemoradiation can also be proposed for non-resectable tumours or medically inoperable patients. Besides, definitive chemoradiation is considered as an alternative option to surgery for locally advanced squamous cell carcinomas. Chemotherapy regimen associated to radiotherapy consists of a combination of platinum derived drugs (cisplatinum or oxaliplatin) and 5-fluorouracil or a weekly scheme combination of carboplatin and paclitaxel according to CROSS protocol in a neoadjuvant strategy. Radiation doses vary from 41.4Gy to 45Gy for a preoperative strategy or 50 to 50.4Gy for a definitive treatment. The high risk of lymphatic spread due to anatomical features could justify the use of an elective nodal irradiation when the estimated risk of microscopic involvement is higher than 15% to 20%. An appropriate delineation of the gross tumour volume requires an exhaustive and up-to-date evaluation of the disease. Intensity-modulated radiation therapy represents a promising approach to spare organs-at-risk. This critical review of the literature underlines the roles of radiotherapy for locally advanced oesophageal cancers and describes doses, volumes of treatment, technical aspects and dose constraints to organs-at-risk.
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Affiliation(s)
- E Blais
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - V Vendrely
- Service de radiothérapie, CHU de Bordeaux-Haut Lévêque, avenue du Haut-Lévêque, 33600 Pessac, France
| | - P Sargos
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - G Créhange
- Service de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - F Huguet
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Maingon
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-M Simon
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Bourdais
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Ozsahin
- Service de radio-oncologie, CHUV, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - J Bourhis
- Service de radio-oncologie, CHUV, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - K Clément-Colmou
- Service de radiothérapie, institut de cancérologie de l'Ouest (ICO) centre René-Gauducheau, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France
| | - B Belghith
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M-A Proudhom Briois
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - O Gilliot
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - J-P Dujols
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - A Peyras
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - C Dupin
- Service de radiothérapie, CHU de Bordeaux-Haut Lévêque, avenue du Haut-Lévêque, 33600 Pessac, France
| | - F-G Riet
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C-H Canova
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Huertas
- Service de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - I Troussier
- Service de radio-oncologie, hôpitaux universitaires de Genève, rue Gabrielle-Perret-Gentil 4, 1205 Genève, Suisse
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Edvardsson A, Kügele M, Alkner S, Enmark M, Nilsson J, Kristensen I, Kjellén E, Engelholm S, Ceberg S. Comparative treatment planning study for mediastinal Hodgkin's lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy. Acta Oncol 2019; 58:95-104. [PMID: 30280626 DOI: 10.1080/0284186x.2018.1512153] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Late effects induced by radiotherapy (RT) are of great concern for mediastinal Hodgkin's lymphoma (HL) patients and it is therefore important to reduce normal tissue dose. The aim of this study was to investigate the impact on the normal tissue dose and target coverage, using various combinations of intensity modulated proton therapy (IMPT), volumetric modulated arc therapy (VMAT) and 3-dimensional conformal RT (3D-CRT), planned in both deep inspiration breath hold (DIBH) and free breathing (FB). MATERIAL AND METHODS Eighteen patients were enrolled in this study and planned with involved site RT. Two computed tomography images were acquired for each patient, one during DIBH and one during FB. Six treatment plans were created for each patient; 3D-CRT in FB, 3D-CRT in DIBH, VMAT in FB, VMAT in DIBH, IMPT in FB and IMPT in DIBH. Dosimetric impact on the heart, left anterior descending (LAD) coronary artery, lungs, female breasts, target coverage, and also conformity index and integral dose (ID), was compared between the different treatment techniques. RESULTS The use of DIBH significantly reduced the lung dose for all three treatment techniques, however, no significant difference in the dose to the female breasts was observed. Regarding the heart and LAD doses, large individual variations were observed. For VMAT, the mean heart and LAD doses were significantly reduced using DIBH, but no significant difference was observed for 3D-CRT and IMPT. Both IMPT and VMAT resulted in improved target coverage and more conform dose distributions compared to 3D-CRT. IMPT generally showed the lowest organs at risk (OAR) doses and significantly reduced the ID compared to both 3D-CRT and VMAT. CONCLUSIONS The majority of patients benefited from treatment in DIBH, however, the impact on the normal tissue dose was highly individual and therefore comparative treatment planning is encouraged. The lowest OAR doses were generally observed for IMPT in combination with DIBH.
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Affiliation(s)
- Anneli Edvardsson
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Malin Kügele
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Sara Alkner
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Marika Enmark
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Joakim Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Ingrid Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Elisabeth Kjellén
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Sofie Ceberg
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
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Starke A, Bowden J, Lynn R, Hall K, Hudson K, Rato A, Aldridge E, Robb D, Steele P, Brady J, Mikhaeel NG. Comparison of butterfly volumetric modulated arc therapy to full arc with or without deep inspiration breath hold for the treatment of mediastinal lymphoma. Radiother Oncol 2018; 129:449-455. [DOI: 10.1016/j.radonc.2018.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
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Clemente S, Oliviero C, Palma G, D'Avino V, Liuzzi R, Conson M, Pacelli R, Cella L. Auto- versus human-driven plan in mediastinal Hodgkin lymphoma radiation treatment. Radiat Oncol 2018; 13:202. [PMID: 30340604 PMCID: PMC6194601 DOI: 10.1186/s13014-018-1146-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background Technological advances in Hodgkin lymphoma (HL) radiation therapy (RT) by high conformal treatments potentially increase control over organs-at-risk (OARs) dose distribution. However, plan optimization remains a time-consuming task with great operator dependent variability. Purpose of the present study was to devise a fully automated pipeline based on the Pinnacle3 Auto-Planning (AP) algorithm for treating female supradiaphragmatic HL (SHL) patients. Methods CT-scans of 10 female patients with SHL were considered. A “butterfly” (BF) volumetric modulated arc therapy was optimized using SmartArc module integrated in Pinnacle3 v. 9.10 using Collapsed Cone Convolution Superposition algorithm (30 Gy in 20 fractions). Human-driven (Manual-BF) and AP-BF optimization plans were generated. For AP, an optimization objective list of Planning Target Volume (PTV)/OAR clinical goals was first implemented, starting from a subset of 5 patients used for algorithm training. This list was then tested on the remaining 5 patients (validation set). In addition to the BF technique, the AP engine was applied to a 2 coplanar disjointed arc (AP-ARC) technique using the same objective list. For plan evaluation, dose-volume-histograms of PTVs and OARs were extracted; homogeneity and conformity indices (HI and CI), OARs dose-volume metrics and odds for different toxicity endpoints were computed. Non-parametric Friedman and Dunn tests were used to identify significant differences between groups. Results A single AP objective list for SHL was obtained. Compared to the manual plan, both AP-plans offer comparable CIs while AP-ARC also achieved comparable HIs. All plans fulfilled the clinical dose criteria set for OARs: both AP solutions performed at least as good as Manual-BF plan. In particular, AP-ARC outperformed AP-BF in terms of heart sparing involving a lower risk of coronary events and radiation-induced lung fibrosis. Hands-on planning time decreased by a factor of 10 using AP on average. Conclusions Despite the high interpatient PTV (size and position) variability, it was possible to set a standard SHL AP optimization list with a high level of generalizability. Using the implemented list, the AP module was able to limit OAR doses, producing clinically acceptable plans with stable quality without additional user input. Overall, the AP engine associated to the arc technique represents the best option for SHL.
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Affiliation(s)
| | | | - Giuseppe Palma
- National Research Council, Institute of Biostructures and Bioimaging, Naples, Italy
| | - Vittoria D'Avino
- National Research Council, Institute of Biostructures and Bioimaging, Naples, Italy
| | - Raffaele Liuzzi
- National Research Council, Institute of Biostructures and Bioimaging, Naples, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Laura Cella
- National Research Council, Institute of Biostructures and Bioimaging, Naples, Italy.
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Dabaja BS, Hoppe BS, Plastaras JP, Newhauser W, Rosolova K, Flampouri S, Mohan R, Mikhaeel NG, Kirova Y, Specht L, Yahalom J. Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines. Blood 2018; 132:1635-1646. [PMID: 30108066 PMCID: PMC6212652 DOI: 10.1182/blood-2018-03-837633] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/19/2018] [Indexed: 12/25/2022] Open
Abstract
Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Jacksonville, FL
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Wayne Newhauser
- Department of Radiation Physics, University of Louisiana, Baton Rouge, LA
| | - Katerina Rosolova
- Proton Therapy Department, Proton Therapy Center Czech, Prague, Czech Republic
- Department of Oncology, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, FL
| | - Radhe Mohan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N George Mikhaeel
- Department of Radiation Oncology, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Martini S, Arcadipane F, Strignano P, Spadi R, Contu V, Fiandra C, Ragona R, Catalano G, Satolli MA, Camandona M, Romagnoli R, Ricardi U, Franco P. Volumetric modulated arc therapy (VMAT) in the treatment of esophageal cancer patients. Med Oncol 2018; 35:150. [PMID: 30284647 DOI: 10.1007/s12032-018-1211-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 02/08/2023]
Abstract
The aim of the study is to evaluate feasibility, safety, toxicity profile, and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver definitive or pre-operative radiation in locally advanced esophageal cancer patients. A total of 68 patients were treated with VMAT between March 2014 and March 2018 (44% vs 56% for definitive and neoadjuvant settings, respectively). Dose prescription differed depending on the clinical scenario (54-60 Gy in 30 fractions for definitive treatments; 41.4/45 Gy in 23-25 fractions in the pre-operative setting). Most of the patients were given concurrent chemotherapy. Two coplanar and one non-coplanar arcs were employed for VMAT delivery. Treatment was generally well tolerated. Acute toxicity was generally mild. In patients treated with definitive intent, ≥ G3 toxicities were observed for esophagitis (30%), anorexia (26.7%), fatigue (26.7%), nausea (6.7%), and vomiting (3.3%). In patients treated within a neoadjuvant approach, ≥ G3 anorexia (21%), esophagitis (15.8%), fatigue (13.3%), nausea (5.3%), and vomiting (2.6%) were observed. Dosimetric results were consistent in term of both target coverage and normal tissue sparing. In conclusion, VMAT proved to be a feasible, safe, and effective strategy to deliver definitive or pre-operative radiation in locally advanced esophageal cancer patients.
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Affiliation(s)
- Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | | | - Paolo Strignano
- Department of Surgery, General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Rosella Spadi
- Department of Oncology, Medical Oncology 1, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Viviana Contu
- Department of Oncology, Medical Oncology 2, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Christian Fiandra
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Riccardo Ragona
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Giorgia Catalano
- Department of Surgery, General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Citta' della Salute e della Scienza, Turin, Italy
| | | | | | - Renato Romagnoli
- Department of Surgery, General Surgery 2U and Liver Transplantation Center, University of Turin, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy. .,Department of Oncology - Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
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Boros A, Ribrag V, Deutsch É, Chargari C, Izar F. [Radiation therapy planning for Hodgkin lymphoma: Focus on intensity-modulated radiotherapy, gating, protons. Which techniques to best deliver radiation?]. Cancer Radiother 2018; 22:404-410. [PMID: 30076071 DOI: 10.1016/j.canrad.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
The optimization of radiotherapy in these young and long-lived survivors raises the question about the interest of using modern techniques to allow a better distribution of the dose. The choice of the irradiation technique must take into account the incidence of side effects related to radiation. In this context, the definition of the target volumes as well as the verification and monitoring of the delivered processing are essential. International recommendations for treatment fields are based on the "involved node radiotherapy" concept. The best irradiation technique to use remains to be defined. The use of intensity-modulated radiotherapy improves the coverage and reduces the dose to the organs at risk with a variable gain depending on the topography of the lymph nodes: upper or lower mediastinum, right or left lateralization, the techniques used. The deep inspiration breath-hold technique allows an increase of the pulmonary volume, extension of the mediastinum with an up down of the heart which make possible to move the planning target volume away from the cardiac structures. The volumetric-modulated arctherapy technique with several arches can be particularly interesting to reduce the dose to the breasts, as well as tomotherapy when bulky disease. Proton therapy with the Bragg peak specificity can play a key role in limiting doses to organs at risk, when robust planning that will take into account geometric and physical uncertainties is available. The heterogeneity of Hodgkin lymphomas in terms of volume, shape and initial location are the key elements to take into account when choosing the preferred radiotherapy technique.
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Affiliation(s)
- A Boros
- Département de radiothérapie, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Université Paris Sud, université Paris Saclay, 94270 Le Kremlin-Bicêtre, France.
| | - V Ribrag
- Département d'hématologie, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Département des innovations thérapeutiques et essais précoces, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - É Deutsch
- Département de radiothérapie, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Université Paris Sud, université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; U1030, Inserm, molecular radiotherapy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - C Chargari
- Département de radiothérapie, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Université Paris Sud, université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; D19, institut de recherche biomédicale des armées, 91220 Brétigny-sur-Orge, France; Service de santé des armées, école du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - F Izar
- Département de radiothérapie, Institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Dabaja BS, Specht L, Yahalom J. Lymphoblastic Lymphoma: Guidelines From the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys 2018; 102:508-514. [PMID: 30238900 DOI: 10.1016/j.ijrobp.2018.05.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/19/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
Presentation with a large mediastinal mass is a hallmark of acute lymphoblastic lymphoma, a disease that is treated in the same way as acute lymphoblastic leukemia even in the absence of marrow involvement. The role of mediastinal radiation for patients who achieve complete remission after chemotherapy has been overlooked and controversial. This document presents current knowledge on the role of radiation for lymphoblastic lymphoma and best practices for addressing how to deliver mediastinal radiation with modern technology.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Levis M, De Luca V, Fiandra C, Veglia S, Fava A, Gatti M, Giorgi M, Bartoncini S, Cadoni F, Garabello D, Ragona R, Filippi AR, Ricardi U. Plan optimization for mediastinal radiotherapy: Estimation of coronary arteries motion with ECG-gated cardiac imaging and creation of compensatory expansion margins. Radiother Oncol 2018; 127:481-486. [PMID: 29729845 DOI: 10.1016/j.radonc.2018.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/14/2018] [Accepted: 04/11/2018] [Indexed: 12/25/2022]
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Carella AM, Corradini P, Mussetti A, Ricardi U, Vitolo U, Viviani S. Treatment of classical Hodgkin lymphoma in the era of brentuximab vedotin and immune checkpoint inhibitors. Ann Hematol 2018; 97:1301-1315. [PMID: 29802458 DOI: 10.1007/s00277-018-3366-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/06/2018] [Indexed: 12/19/2022]
Abstract
The majority of Hodgkin lymphoma patients are now cured with conventional first-line therapy; however, 10-15% of early-stage disease and less than 30% of advanced-stage patients are refractory(rare) or relapsed. Salvage second-line therapy combined with high-dose therapy and autologous stem-cell transplantation can cure 40-50% of patients. Recently novel agents (Brentuximab Vedotin and Immune Checkpoint inhibitors) have demonstrated evidence of therapeutic activity and are potential bridge to an allogeneic stem-cell transplantation. The review is aimed to present not only salvage strategies; indeed, the paper contains paragraphs about therapy and new treatment options at diagnosis.
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Affiliation(s)
- A M Carella
- Division of Hematology and BMT Unit, Ospedale Policlinico San Martino, Genoa, Italy.
| | - P Corradini
- Division of Hematology and BMT Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mussetti
- Division of Hematology and BMT Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - U Ricardi
- Department of Oncology, Università di Torino, Turin, Italy
| | - U Vitolo
- AOU Citta' della Salute e della Scienza, Turin, Italy
| | - S Viviani
- Division of Hematology and BMT Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Franco P, Zeverino M, Migliaccio F, Torielli P, Angelini V, Sciacero P, Girelli G, Cante D, Arrichiello C, Borca VC, Numico G, La Porta MR, Tofani S, Ricardi U. Minimizing a Tricky Situation in Breast Irradiation with Helical Tomotherapy. TUMORI JOURNAL 2018; 100:e35-40. [DOI: 10.1177/030089161410000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on a patient with breast cancer undergoing adjuvant intensity-modulated whole breast and lymph node irradiation with static angle tomotherapy (TomoDirect), who experienced a traumatic ipsilateral humeral fracture and was able to continue radiotherapy with helical tomotherapy and daily dosimetric monitoring by means of the Planned Adaptive module.
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Affiliation(s)
- Pierfrancesco Franco
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Michele Zeverino
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Fernanda Migliaccio
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Paolo Torielli
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Veronica Angelini
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Piera Sciacero
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Giuseppe Girelli
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Domenico Cante
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Cecilia Arrichiello
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | | | - Gianmauro Numico
- Medical Oncology Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Maria Rosa La Porta
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Santi Tofani
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Umberto Ricardi
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
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Intensity Modulated Radiation Therapy and Second Cancer Risk in Adults. Int J Radiat Oncol Biol Phys 2018; 100:17-20. [DOI: 10.1016/j.ijrobp.2017.09.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/09/2017] [Accepted: 09/18/2017] [Indexed: 11/19/2022]
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Xu LM, Kang ML, Jiang B, Liu QF, Li YX. A study of the dosimetric characteristics between different fixed-field IMRT and VMAT in early-stage primary mediastinal B-cell lymphoma. Med Dosim 2017; 43:91-99. [PMID: 28935521 DOI: 10.1016/j.meddos.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
This analysis was designed to compare dosimetric parameters among different fixed-field intensity-modulated radiation therapy (IMRT) solutions and volumetric-modulated arc therapy (VMAT) to identify which can achieve the lowest risk of organs at risk (OARs) and treatment delivery efficiently. A total of 16 patients (8 male and 8 female) with early-stage primary mediastinal large B-cell lymphoma (PMBCL) were enrolled with planned gross tumor volume (PGTV) 45 Gy and planning target volume (PTV) 40 Gy. Four different plans were generated: 5-, 7, 9-field IMRT, and VMAT. The dose distributions for PGTV and PTV OARs (lungs, left ventricle, heart, thyroid gland, and breasts) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. Mean conformity index (CI) and homogeneity index (HI) for PGTV in 5F-, 7F-, 9F-IMRT, and VMAT were 1.01 and 1.10, 1.01 and 1.10, 1.01 and 1.10, and 1.01 and 1.11 (p = 0.963 and 0.843), whereas these 2 indices for PTV were 1.04 and 1.22, 1.03 and 1.19, 1.03 and 1.17, and 1.08 and 1.14 (p = 0.964 and 0.969), respectively. Dmean (Gy), V4 (%), D50 (Gy), and D80 (Gy) to the left and right breasts increased by 0.7 Gy and 0.1 Gy, 6.8% and 7.7%, 0.9 Gy and 1.7 Gy, and 1.0 Gy and 1.5 Gy in VMAT, respectively. The 9-beam IMRT plan had the highest MUs (25,762.4 MUs) and the longest treatment delivery time (10.7 minutes); whereas, the VMAT had the lowest MUs (13,345.0) and the shortest treatment delivery time (5.9 minutes). Seven- and 9-field IMRT and VMAT provide improved tumor coverage compared with 5F-IMRT, whereas VMAT shows higher treatment delivery efficiency than IMRT technique. Seven- and 9-field IMRT slightly reduce the low dose radiation exposure of breasts compared with VMAT technique. The 7- and 9-field IMRT and VMAT techniques both can be safely and efficiently delivered to patients with PMBCL.
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Affiliation(s)
- Li-Ming Xu
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China; Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
| | - Ming-Lei Kang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China; Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Bo Jiang
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qing-Feng Liu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
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Ricardi U, Dabaja B, Hodgson D. Proton therapy in mediastinal Hodgkin lymphoma: moving from dosimetric prediction to clinical evidence. Ann Oncol 2017; 28:2049-2050. [DOI: 10.1093/annonc/mdx356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rechner LA, Maraldo MV, Vogelius IR, Zhu XR, Dabaja BS, Brodin NP, Petersen PM, Specht L, Aznar MC. Life years lost attributable to late effects after radiotherapy for early stage Hodgkin lymphoma: The impact of proton therapy and/or deep inspiration breath hold. Radiother Oncol 2017; 125:41-47. [PMID: 28838605 PMCID: PMC5844950 DOI: 10.1016/j.radonc.2017.07.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Due to the long life expectancy after treatment, the risk of late effects after radiotherapy (RT) is of particular importance for patients with Hodgkin lymphoma (HL). Both deep inspiration breath hold (DIBH) and proton therapy have been shown to reduce the dose to normal tissues for mediastinal HL, but the impact of these techniques in combination is unknown. The purpose of this study was to compare the life years lost (LYL) attributable to late effects after RT for mediastinal HL using intensity modulated radiation therapy (IMRT) in free breathing (FB) and DIBH, and proton therapy in FB and DIBH. MATERIALS AND METHODS Plans for each technique were created for 22 patients with HL. Doses were extracted and the risk of late effects and LYL were estimated. RESULTS We found that the use of DIBH, proton therapy, and the combination significantly reduced the LYL compared to IMRT in FB. The lowest LYL was found for proton therapy in DIBH. However, when IMRT in DIBH was compared to proton therapy in FB, no significant difference was found. CONCLUSIONS Patient-specific plan comparisons should be used to select the optimal technique when comparing IMRT in DIBH and proton therapy in FB.
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Affiliation(s)
- Laura Ann Rechner
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark; Niels Bohr Insitute, University of Copenhagen, Denmark.
| | | | | | - Xiaorong Ronald Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nils Patrik Brodin
- Institute for Onco-Physics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, USA
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Marianne Camille Aznar
- Niels Bohr Insitute, University of Copenhagen, Denmark; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Abstract
This topic addresses the treatment of newly diagnosed patients with favorable prognosis stage I and II Hodgkin lymphoma. In most cases, combined modality therapy (chemotherapy followed by involved site radiation therapy) constitutes the current standard of care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the appropriate use of combined modality therapy for favorable prognosis stage I and II Hodgkin lymphoma. Increasing information about the late effects of treatment has led to attempts to decrease toxicity by using less chemotherapy (decreased duration and/or intensity or different agents) and less radiation therapy (reduced volume and/or dose) while maintaining excellent efficacy.
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Stewart MH, Jahangir E, Polin NM. Valvular Heart Disease in Cancer Patients: Etiology, Diagnosis, and Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:53. [PMID: 28547673 DOI: 10.1007/s11936-017-0550-6] [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] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Cardiac valvular disease as consequence of radiation and chemotherapy during treatment for malignancy is growing in its awareness. While the overwhelming emphasis in this population has been on the monitoring and preservation of left ventricular systolic function, we are now developing a greater appreciation for the plethora of cardiac sequelae beyond this basic model. To this end many institutions across the country have developed cardio-oncology programs, which are collaborative practices between oncologists and cardiologists in order to minimize a patient's cardiovascular risk while allowing them to receive the necessary treatment for their cancer. These programs also help to recognize early nuanced treatment complications such as valvular heart disease, and provide consultation for the most appropriate course of action. In this article we will discuss the etiology, prevalence, diagnosis, and current treatment options of valvular heart disease as the result of chemotherapy and radiation.
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Affiliation(s)
- Merrill H Stewart
- John Ochsner Heart and Vascular Institute, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA.
| | - Eiman Jahangir
- Division of Cardiology, Kaiser Permanente Northern California, 401 Bicentennial Drive, Santa Rosa, CA, 95403, USA
| | - Nichole M Polin
- John Ochsner Heart and Vascular Institute, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Filippi AR, Levis M, Parikh R, Hoppe B. Optimal Therapy for Early-Stage Hodgkin's Lymphoma: Risk Adapting, Response Adapting, and Role of Radiotherapy. Curr Oncol Rep 2017; 19:34. [PMID: 28365830 DOI: 10.1007/s11912-017-0592-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The aim of this article is to discuss the current role of radiotherapy (RT) for early-stage Hodgkin's lymphoma (HL) in the context of risk-adapted and response-adapted treatment strategy, and describe changes in RT technical approach. RECENT FINDINGS In low-risk patients, RT could be omitted but, at the price of a lower progression-free survival, and its role is still debated. Ongoing trials are combining new agents with chemotherapy alone or response-adapted combined modality therapy, and results are awaited. Modern RT incorporates lower doses and smaller fields, together with the implementation of sophisticated delivery techniques aimed to reducing the dose to critical structures such as the heart. The role of RT for early-stage HL is still under debate, and new combinations are emerging; an individualized approach should be recommended, considering all RT technical opportunities to minimize toxicity while maintaining efficacy.
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Affiliation(s)
- Andrea Riccardo Filippi
- Department of Oncology, San Luigi Gonzaga University Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Mario Levis
- Department of Oncology, San Luigi Gonzaga University Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Bradford Hoppe
- Department of Radiation Oncology, University of Florida, Gainesville, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, USA
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