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Singh B, Singh G, Oinam AS, Singh M, Katake A, Kumar V, Vashistha R, Singh PK, Mahajan R. Radiobiological modelling of radiation-induced acute skin toxicity (dermatitis): A single institutional study of breast carcinoma. J Cancer Res Ther 2023; 19:738-744. [PMID: 37470603 DOI: 10.4103/jcrt.jcrt_1844_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose The purpose of the study was to estimate the fitting parameters of the sigmoidal dose response (SDR) curve of radiation-induced acute dermatitis in breast cancer patients treated with intensity-modulated radiation therapy for calculation of normal tissue complication probability (NTCP). Materials and Methods Twenty-five breast cancer patients were enrolled to model the SDR curve for acute dermatitis. The acute radiation-induced (ARI) dermatitis toxicity was assessed weekly for all the patients, and their scores were determined using the common terminology criterion adverse events version 5.0. The radiobiological parameters n, m, TD50, and γ50 were derived using the fitted SDR curve obtained from breast cancer Patient's clinical data. Results ARI dermatitis toxicity in carcinoma of breast patients was calculated for the end point of acute dermatitis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade-1 dermatitis are found to be 0.03, 0.04, 28.65 ± 1.43 (confidence interval [CI] 95%) and 1.02 and for Grade-2 dermatitis are found to be 0.026, 0.028, 38.65 ± 1.93 (CI. 95%) and 1.01 respectively. Conclusion This research presents the fitting parameters for NTCP calculation of Grade-1 and Grade-2 acute radiation-induced skin toxicity in breast cancer for the dermatitis end point. The presented nomograms of volume versus complication probability and dose versus complication probability assist radiation oncologists in establishing the limiting dose to reduce acute toxicities for different grades of acute dermatitis in breast cancer patients.
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Affiliation(s)
- Balbir Singh
- Centre for Medical Physics, Panjab University, Chandigarh; Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Gaganpreet Singh
- Centre for Medical Physics, Panjab University; Department of Radiotherapy, PGIMER, Chandigarh, Punjab, India
| | | | - Maninder Singh
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Ajay Katake
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, Punjab, India
| | - Rajesh Vashistha
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Pankaj Kumar Singh
- Department of Radiation Oncology, Sharda Hospital, Greator Noida, Uttar Pradesh, India
| | - Rohit Mahajan
- Department of Radiation Oncology, AIIMS, Bathinda, Punjab, India
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Singh B, Singh G, Oinam AS, Singh M, Kumar V, Vashistha R, Sidhu MS, Katake A. Radiobiological modeling of radiation-induced acute proctitis: A single-institutional study of prostate carcinoma. J Cancer Res Ther 2023; 19:664-670. [PMID: 37470591 DOI: 10.4103/jcrt.jcrt_1048_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose To estimate the fitting parameters of the sigmoidal dose response (SDR) curve of radiation-induced acute proctitis in prostate cancer patients treated with intensity modulated radiation therapy (IMRT) for the calculation of normal tissue complication probability (NTCP). Materials and Methods Twenty-five prostate cancer patients were enrolled and evaluated weekly for acute radiation-induced (ARI) proctitis toxicity. Their scoring was performed as per common terminology criteria for adverse events version 5.0. The radiobiological parameters namely n, m, TD50, and γ50 were calculated from the fitted SDR curve obtained from the clinical data of prostate cancer patients. Results ARI toxicity for rectum in carcinoma of prostate patients was calculated for the endpoint of acute proctitis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade 1 and Grade 2 acute proctitis are found to be 0.13, 0.10, 30.48 ± 1.52 (confidence interval [CI] 95%), 3.18 and 0.08, 0.10, 44.37 ± 2.21 (CI 95%), 4.76 respectively. Conclusion This study presents the fitting parameters for NTCP calculation of Grade-1 and Grade-2 ARI rectum toxicity for the endpoint of acute proctitis. The provided nomograms of volume versus complication and dose versus complication for different grades of acute proctitis in the rectum help radiation oncologists to decide the limiting dose to reduce the acute toxicities.
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Affiliation(s)
- Balbir Singh
- Centre for Medical Physics, Panjab University, Chandigarh; Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Gaganpreet Singh
- Centre for Medical Physics, Panjab University; Department of Radiotherapy, PGIMER, Chandigarh, Punjab, India
| | | | - Maninder Singh
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, Punjab, India
| | - Rajesh Vashistha
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Manjinder Singh Sidhu
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
| | - Ajay Katake
- Department of Radiation Oncology, Max Superspeciality Hospital, Bathinda, Punjab, India
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Hammers J, Lindsay D, Narayanasamy G, Sud S, Tan X, Dooley J, Marks LB, Chen RC, Das SK, Mavroidis P. Evaluation of the clinical impact of the differences between planned and delivered dose in prostate cancer radiotherapy based on CT-on-rails IGRT and patient-reported outcome scores. J Appl Clin Med Phys 2022; 24:e13780. [PMID: 36087039 PMCID: PMC9859987 DOI: 10.1002/acm2.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To estimate the clinical impact of differences between delivered and planned dose using dose metrics and normal tissue complication probability (NTCP) modeling. METHODS Forty-six consecutive patients with prostate adenocarcinoma between 2010 and 2015 treated with intensity-modulated radiation therapy (IMRT) and who had undergone computed tomography on rails imaging were included. Delivered doses to bladder and rectum were estimated using a contour-based deformable image registration method. The bladder and rectum NTCP were calculated using dose-response parameters applied to planned and delivered dose distributions. Seven urinary and gastrointestinal symptoms were prospectively collected using the validated prostate cancer symptom indices patient reported outcome (PRO) at pre-treatment, weekly treatment, and post-treatment follow-up visits. Correlations between planned and delivered doses against PRO were evaluated in this study. RESULTS Planned mean doses to bladder and rectum were 44.9 ± 13.6 Gy and 42.8 ± 7.3 Gy, while delivered doses were 46.1 ± 13.4 Gy and 41.3 ± 8.7 Gy, respectively. D10cc for rectum was 64.1 ± 7.6 Gy for planned and 60.1 ± 9.3 Gy for delivered doses. NTCP values of treatment plan were 22.3% ± 8.4% and 12.6% ± 5.9%, while those for delivered doses were 23.2% ± 8.4% and 9.9% ± 8.3% for bladder and rectum, respectively. Seven of 25 patients with follow-up data showed urinary complications (28%) and three had rectal complications (12%). Correlations of NTCP values of planned and delivered doses with PRO follow-up data were random for bladder and moderate for rectum (0.68 and 0.67, respectively). CONCLUSION Sensitivity of bladder to clinical variations of dose accumulation indicates that an automated solution based on a DIR that considers inter-fractional organ deformation could recommend intervention. This is intended to achieve additional rectum sparing in cases that indicate higher than expected dose accumulation early during patient treatment in order to prevent acute severity of bowel symptoms.
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Affiliation(s)
- Jacob Hammers
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Daniel Lindsay
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Ganesh Narayanasamy
- Department of Radiation OncologyUniversity of Arkansas for Medical SciencesArkansasUSA
| | - Shivani Sud
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Xianming Tan
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina HospitalsChapel HillNorth CarolinaUSA
| | - John Dooley
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Lawrence B. Marks
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Ronald C. Chen
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Shiva K. Das
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Panayiotis Mavroidis
- Department of Radiation OncologyUniversity of North Carolina at Chapel HillNorth CarolinaUSA
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Toussaint L, Brandal P, Embring A, Engellau J, Evensen ME, Griskeviskius R, Hansen J, Hietala H, Wickart Johansson G, Jørgensen M, Kramer PH, Kristensen I, Lehtio K, Magelssen H, Maraldo MV, Marienhagen K, Martinsson U, Nilsson K, Peters S, Plaude S, Seiersen K, Sendiuliene D, Smulders B, Edvardsen T, Søbstad JM, Taheri Z, Vaalavirta L, Vestergaard A, Timmermann B, Lassen-Ramshad Y. Inter-observer variation in target delineation and dose trade-off for radiotherapy of paediatric ependymoma. Acta Oncol 2022; 61:235-238. [PMID: 34970940 DOI: 10.1080/0284186x.2021.2022202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Laura Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Anna Embring
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Engellau
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | | | | | - Jolanta Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Henna Hietala
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | | | - Morten Jørgensen
- Department of Oncology, Rigshospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Paul-Heinz Kramer
- West German Proton Therapy Centre Essen, Essen University Hospital, Essen, Germany
| | - Ingrid Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Kaisa Lehtio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | | | - Maja Vestmø Maraldo
- Department of Oncology, Rigshospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ulla Martinsson
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Kristina Nilsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, Essen, Germany
| | - Sandija Plaude
- West German Proton Therapy Centre Essen, Essen University Hospital, Essen, Germany
| | - Klaus Seiersen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Daiva Sendiuliene
- Department of External Beam Radiotherapy, National Cancer Institute, Vilnius, Lithuania
| | - Bob Smulders
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Rigshospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tone Edvardsen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | | | - Zarah Taheri
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Leila Vaalavirta
- Department of Oncology, Helsinki University Hospital, Helsinki, Finland
| | - Anne Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Beate Timmermann
- West German Proton Therapy Centre Essen, Essen University Hospital, Essen, Germany
- Department of Particle Therapy, University Hospital Essen, Essen, Germany
- West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
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Oinam A, Singh B, Singh G, Kumar V, Vashistha R, Sidhu M, Singh M. Radiobiological modeling of radiation-induced acute mucosal toxicity (oral mucositis and pharyngeal mucositis): A single-institutional study of head-and-neck carcinoma. J Cancer Res Ther 2021; 19:S0-S1715. [PMID: 37147947 DOI: 10.4103/jcrt.jcrt_504_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose/Objective(s) This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H and N) cancer patients treated with Intensity Modulated Radiation Therapy (IMRT) for the calculation of normal tissue complication probability (NTCP). Materials and Methods Thirty H-and-N cancer patients were enrolled to model the SDR curve for oral and pharyngeal mucositis. The patients were evaluated weekly for acute radiation-induced (ARI) oral and pharyngeal mucositis toxicity, and their scoring was performed as per the common terminology criteria adverse events version 5.0. The radiobiological parameters, namely n, m, TD50, and γ50 were calculated from the fitted SDR curve obtained from the clinical data of H-and-N cancer patients. Results ARI toxicity for oral and pharyngeal mucosa in carcinoma of H-and-N cancer patients was calculated for the endpoint oral mucositis and pharyngeal mucositis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade 1 and Grade 2 oral mucositis were found to be [0.10, 0.32, 12.35 ± 3.90 (confidence interval [CI] 95%) and 1.26] and [0.06, 0.33, 20.70 ± 6.95 (CI 95%) and 1.19] respectively. Similarly for pharyngeal mucositis, n, m, TD50, and γ50 parameters for Grade 1 and Grade 2 were found to be [0.07, 0.34, 15.93 ± 5.48 (CI. 95%) and 1.16 ] and [0.04, 0.25, 39.02 ± 9.98(CI. 95%) and 1.56] respectively. Conclusion This study presents the fitting parameters for NTCP calculation of Grade 1 and Grade 2 ARI toxicity for the endpoint of oral and pharyngeal mucositis. The provided nomograms of volume versus complication and dose versus complication for different grades of oral mucositis and pharyngeal mucositis help radiation oncologists to decide the limiting dose to reduce the acute toxicities.
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