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Garg P, Singhal S, Kulkarni P, Horne D, Malhotra J, Salgia R, Singhal SS. Advances in Non-Small Cell Lung Cancer: Current Insights and Future Directions. J Clin Med 2024; 13:4189. [PMID: 39064229 PMCID: PMC11278207 DOI: 10.3390/jcm13144189] [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: 06/17/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
The leading cause of cancer deaths worldwide is attributed to non-small cell lung cancer (NSCLC), necessitating a continual focus on improving the diagnosis and treatment of this disease. In this review, the latest breakthroughs and emerging trends in managing NSCLC are highlighted. Major advancements in diagnostic methods, including better imaging technologies and the utilization of molecular biomarkers, are discussed. These advancements have greatly enhanced early detection and personalized treatment plans. Significant improvements in patient outcomes have been achieved by new targeted therapies and immunotherapies, providing new hope for individuals with advanced NSCLC. This review discusses the persistent challenges in accessing advanced treatments and their associated costs despite recent progress. Promising research into new therapies, such as CAR-T cell therapy and oncolytic viruses, which could further revolutionize NSCLC treatment, is also highlighted. This review aims to inform and inspire continued efforts to improve outcomes for NSCLC patients globally, by offering a comprehensive overview of the current state of NSCLC treatment and future possibilities.
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Affiliation(s)
- Pankaj Garg
- Department of Chemistry, GLA University, Mathura 281406, Uttar Pradesh, India
| | - Sulabh Singhal
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA 19104, USA
| | - Prakash Kulkarni
- Departments of Medical Oncology & Therapeutics Research, Beckman Research Institute of City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA 91010, USA
| | - David Horne
- Departments of Molecular Medicine, Beckman Research Institute of City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA 91010, USA
| | - Jyoti Malhotra
- Departments of Medical Oncology & Therapeutics Research, Beckman Research Institute of City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA 91010, USA
| | - Ravi Salgia
- Departments of Medical Oncology & Therapeutics Research, Beckman Research Institute of City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA 91010, USA
| | - Sharad S. Singhal
- Departments of Medical Oncology & Therapeutics Research, Beckman Research Institute of City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA 91010, USA
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He S, Yu H, He L, Liu M, He Y, Peng X, Ai P. Risk factors associated with ototoxicity in long-term nasopharyngeal carcinoma survivors. Oral Oncol 2024; 154:106827. [PMID: 38735130 DOI: 10.1016/j.oraloncology.2024.106827] [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] [Received: 02/10/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To investigate patient-reported outcomes among long-term survivors and to analyze their associated risk factors to provide better treatment and symptom management for nasopharyngeal carcinoma patients. MATERIALS AND METHODS This retrospective study collected patients diagnosed with nasopharyngeal carcinoma who received radical intensity-modulated radiotherapy in our hospital from June 2009 to June 2016. The patients' disease status and patient-reported outcomes were analyzed by follow-up. The ototoxicity was graded according to CTCAE 5.0. RESULTS A total of 223 patients were included in the study. Among the enrolled patients, the median follow-up time was 8.4 (6.0-13.0) years. Based on the patient-reported outcomes, ototoxicity was the most common symptom (52.9 %). After univariable and multivariable logistic regression, age ≥ 50 years old (OR, 4.066; 95 % CI, 1.799-9.190; P = .001), diabetes (OR, 3.520; 95 % CI, 1.442-8.591; P = .006), D2 ≥ 69 Gy (OR, 3.715; 95 % CI, 1.064-12.969; P = . 040) and V35 ≥ 91.5 % (OR, 3.398; 95 % CI, 1.113-10.372; P = .032) were associated with a higher incidence of grade 3-4 ototoxicity. Then, we constructed the individual nomogram and the C index of the graph was 0.815. By univariable logistic regression, we found that grade 3-4 ototoxicity was associated with an increased risk of multiple other symptoms, dysmasesia, tongue dysfunction, hoarseness, dysphagia and ocular toxicity. CONCLUSION In long-term survivors of nasopharyngeal carcinoma patients receiving IMRT, the most common patient-reported outcome was ototoxicity. Age ≥ 50 years, diabetes, ear exposure dose of D2 ≥ 69 Gy and V35 ≥ 91.5 % are independent risk factors for grade 3-4 ototoxicity.
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Affiliation(s)
- Shuangshuang He
- Department of Radiation Oncology and Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hang Yu
- Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Mengyuan Liu
- Department of Radiation Oncology and Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan He
- Department of Oncology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
| | - Ping Ai
- Department of Radiation Oncology and Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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Chen Y, Yang W, Lu J, Sun J, Rao L, Zhao H, Peng X, Ni D. A modified U-net with graph representation for dose prediction in esophageal cancer radiotherapy plans. Comput Med Imaging Graph 2024; 111:102318. [PMID: 38088017 DOI: 10.1016/j.compmedimag.2023.102318] [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] [Received: 05/19/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024]
Abstract
The manual design of esophageal cancer radiotherapy plan is time-consuming and labor-intensive. Automatic planning (AP) is prevalent nowadays to increase physicists' work efficiency. Because of the intuitiveness of dose distribution in AP evaluation, obtaining reasonable dose prediction provides effective guarantees to generate a satisfactory AP. Existing fully convolutional network-based methods for predicting dose distribution in esophageal cancer radiotherapy plans often capture features in a limited receptive field. Additionally, the correlations between voxel pairs are often ignored. This work modifies the U-net architecture and exploits graph convolution to capture long-range information for dose prediction in esophageal cancer plans. Meanwhile, attention mechanism gets correlations between planning target volume (PTV) and organs at risk, and adaptively learns their feature weights. Finally, a novel loss function that considers features between voxel pairs is used to highlight the predictions. 152 subjects with prescription doses of 50 Gy or 60 Gy are collected in this study. The mean absolute error and standard deviation of conformity index, homogeneity index, and max dose for PTV achieved by the proposed method are 0.036 ± 0.030, 0.036 ± 0.027, and 0.930 ± 1.162, respectively, which outperform other state-of-the-art models. The superior performance demonstrates that our proposed method has great potential for AP generation.
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Affiliation(s)
- Yanlin Chen
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen University, Shenzhen, China
| | - Wei Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Jiayang Lu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Jinyan Sun
- School of Medicine, Foshan University, Foshan, China
| | - Linshang Rao
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Huanmiao Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Xun Peng
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China; Medical UltraSound Image Computing (MUSIC) Lab, Shenzhen University, Shenzhen, China.
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Duan L, Qi W, Chen Y, Cao L, Chen J, Zhang Y, Xu C. Evaluation of complexity and deliverability of IMRT treatment plans for breast cancer. Sci Rep 2023; 13:21474. [PMID: 38052915 PMCID: PMC10698170 DOI: 10.1038/s41598-023-48331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023] Open
Abstract
This study aimed to predict the outcome of patient specific quality assurance (PSQA) in IMRT for breast cancer using complexity metrics, such as MU factor, MAD, CAS, MCS. Several breast cancer plans were considered, including LBCS, RBCS, LBCM, RBCM, left breast, right breast and the whole breast for both Edge and TrueBeam LINACS. Dose verification was completed by Portal Dosimetry (PD). The receiver operating characteristic (ROC) curve was employed to determine whether the treatment plans pass or failed. The area under the curve (AUC) was used to assess the classification performance. The correlation of PSQA and complexity metrics was examined using Spearman's rank correlation coefficient (Rs). For LINACS, the most suitable complexity metric was found to be the MU factor (Edge Rs = - 0.608, p < 0.01; TrueBeam Rs = - 0.739, p < 0.01). Regarding the specific breast cancer categories, the optimal complexity metrics were as follows: MAD (AUC = 0.917) for LBCS, MCS (AUC = 0.681) for RBCS, MU factor (AUC = 0.854) for LBCM and MAD (AUC = 0.731) for RBCM. On the Edge LINAC, the preferable method for breast cancers was MCS (left breast, AUC = 0.938; right breast, AUC = 0.813), while on the TrueBeam LINAC, it became MU factor (left breast, AUC = 0.950) and MCS (right breast, AUC = 0.806), respectively. Overall, there was no universally suitable complexity metric for all types of breast cancers. The choice of complexity metric depended on different cancer types, locations and treatment LINACs. Therefore, when utilizing complexity metrics to predict PSQA outcomes in IMRT for breast cancer, it was essential to select the appropriate metric based on the specific circumstances and characteristics of the treatment.
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Affiliation(s)
- Longyan Duan
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weixiang Qi
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yibin Zhang
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Saroj DK, Yadav S, Paliwal N. Does Fluence Smoothing Reduce the Complexity of the Intensity-Modulated Radiation Therapy Treatment Plan? A Dosimetric Analysis. J Med Phys 2022; 47:336-343. [PMID: 36908492 PMCID: PMC9997531 DOI: 10.4103/jmp.jmp_81_22] [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: 09/06/2022] [Revised: 10/17/2022] [Accepted: 11/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background Intensity-modulated radiation therapy (IMRT) may have too many peaks and valleys, making the treatment plan undeliverable. When there are too many fluency differences between adjacent pixels in the X or Y directions, the X and Y smoothing factors are utilized as weighting factors to penalize this behavior. Generally, a high degree of complexity is accompanied by many monitor units (MUs), large number of segments, small sized segments, and complex segment shapes. The degree of plan delivery uncertainty can all increase with a higher detailed fluence map. Aim This study aims to evaluate the dosimetric effects of various smoothing levels on the planning target volume (PTV) and organs at risk (OARs) for cervix cancer. Materials and Methods IMRT treatment plans were re-optimized by combining several values of the X and Y penalty between 0 and 100. The dose-volume histogram assessed various dosimetric indicators for PTV and OARs. Additionally, gamma passing rates were evaluated and noted as an indicator of the complex treatment plan. Results At X = 60, Y = 60 fluence map penalty, the conformity index (CI) value reached its highest value of 0.996 ± 0.004. At X = 0, Y = 0, the homogeneity index (HI) was determined to have a maximum value of 0.0628 ± 0.0235. The highest and lowest MU values were 2424.30 ± 471.12 and 1087.80 ± 91.57, respectively, with X = 0, Y = 0 and X = 100, Y = 100. At X = 100, Y = 100, the gamma passing rate reaches its highest value of 99.28% ± 0.44% and minimum value of 85.93% ± 3.87% at X = 0, Y = 0. Conclusion The CI and HI values showed no discernible fluctuation, and the OAR doses were barely affected as smoothing was increased. When the smoothing factor was raised, the number of MUs sharply dropped, and a decrease in the number of segments and higher gamma passing rates were also seen.
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Affiliation(s)
- Dinesh Kumar Saroj
- Department of Radiotherapy, Alexis Multispecialty Hospital, Nagpur, Maharashtra, India
- Department of Physics, Rabindranath Tagore University, Bhopal, Madhya Pradesh, India
| | - Suresh Yadav
- Department of Radiation Oncology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Neetu Paliwal
- Department of Physics, Rabindranath Tagore University, Bhopal, Madhya Pradesh, India
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Deng Z, Xu X, Iordachita I, Dehghani H, Zhang B, Wong JW, Wang KKH. Mobile bioluminescence tomography-guided system for pre-clinical radiotherapy research. BIOMEDICAL OPTICS EXPRESS 2022; 13:4970-4989. [PMID: 36187243 PMCID: PMC9484421 DOI: 10.1364/boe.460737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Due to low imaging contrast, a widely-used cone-beam computed tomography-guided small animal irradiator is less adept at localizing in vivo soft tissue targets. Bioluminescence tomography (BLT), which combines a model of light propagation through tissue with an optimization algorithm, can recover a spatially resolved tomographic volume for an internal bioluminescent source. We built a novel mobile BLT system for a small animal irradiator to localize soft tissue targets for radiation guidance. In this study, we elaborate its configuration and features that are indispensable for accurate image guidance. Phantom and in vivo validations show the BLT system can localize targets with accuracy within 1 mm. With the optimal choice of threshold and margin for target volume, BLT can provide a distinctive opportunity for investigators to perform conformal biology-guided irradiation to malignancy.
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Affiliation(s)
- Zijian Deng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21287, USA
- Biomedical Imaging and Radiation Technology Laboratory (BIRTLab), Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
- These authors contributed equally to this work
| | - Xiangkun Xu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21287, USA
- Biomedical Imaging and Radiation Technology Laboratory (BIRTLab), Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
- These authors contributed equally to this work
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Hamid Dehghani
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Bin Zhang
- School of Biomedical Engineering, Dalian University of Technology, Dalian, Liaoning 116024, China
| | - John W Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21287, USA
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21287, USA
- Biomedical Imaging and Radiation Technology Laboratory (BIRTLab), Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Dosimetric Comparison between Volumetric Modulated Arc Therapy (VMAT) and Intensity-Modulated Radiotherapy (IMRT) for Dental Structures of Head and Neck Cancer Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4998997. [PMID: 35422981 PMCID: PMC9005284 DOI: 10.1155/2022/4998997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
Background This retrospective study aimed to evaluate the radiation dose delivered to dental structures in intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) without dental dose constraints, compare the dosimetry differences of dental structures between the two radiation techniques, and determine whether dental structures should be one of the organs at risk for IMRT and VMAT plans according to the dosimetric analysis. Materials and Methods A total of 138 head and neck cancer patients (nasopharyngeal, oral cavity, pharyngeal, hypopharynx, and larynx), who underwent IMRT (69 patients) or VMAT (69 patients) from March 2016 to March 2021 in our hospital, were included to assess the dosimetry difference between two radiotherapy techniques for dental structures. Results The radiation dose delivered by IMRT and the mean maximum doses delivered by VMAT to the maxillary teeth of nasopharyngeal cancer patients were significantly higher than the dose received by the mandibular teeth. In contrast, the mandibular teeth of oral cavity cancer, oropharynx cancer, and laryngeal cancer received higher radiation doses than maxillary teeth. Except for mandibular teeth of oral cancer patients, the molars received significantly high-dose radiation than premolars and/or incisors in both radiotherapy techniques. No significant difference was observed between IMRT and VMAT in the dosimetric comparison of dental structures, except that oral cavity cancer patients treated with VMAT received a significantly higher mean average dose than those treated with IMRT. When PTV included level Ib, the radiation doses of the mandibular teeth delivered by both radiotherapy techniques were significantly higher than that in PTV when level Ib was excluded. Conclusion Without dental dose constraints, no major difference was observed between IMRT and VMAT plans in tooth dose distribution. We suggest that dental structures should be delineated as part of the organ at risk (OAR) when IMRT and VMAT are planned. Meanwhile, attention should be paid to dental structures that might have a high-dose area according to the specific tumor location.
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Gebrie AG, Bedane DS. A simple computational algorithm with inertial extrapolation for generalized split common fixed point problems. Heliyon 2021; 7:e08373. [PMID: 34816051 PMCID: PMC8593458 DOI: 10.1016/j.heliyon.2021.e08373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/23/2021] [Accepted: 11/09/2021] [Indexed: 10/31/2022] Open
Abstract
In the present paper, we explore operator norm independent inertial type accelerated iterative algorithm solving generalized split common fixed point problem, which is the problem of finding a point that belongs to the intersection of a finite family of fixed point sets of demimetric mappings such that its image under a finite number of linear transformations belongs to the intersection of another finite family of fixed point sets of demimetric mappings in the image space. We adopt rules for selecting the step size such that the implementation of our proposed algorithm does not need any prior information about the operator norms. The strong convergence result is analyzed and some applications of our proposed algorithm are demonstrated. Our result in this paper will improve and generalize many results in the literature. Numerical experiments show that our iteration method is very effective for approximating the solution point of problem under consideration.
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Affiliation(s)
- Anteneh Getachew Gebrie
- Department of Mathematics, College of Computational and Natural Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Dejene Shewakena Bedane
- Department of Mathematics, College of Computational and Natural Science, Debre Berhan University, Debre Berhan, Ethiopia
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Lee J, Kim WC, Yoon WS, Rim CH. Implications of Radiotherapy Utilization in Korea from 2010 to 2019. J Korean Med Sci 2021; 36:e117. [PMID: 33975394 PMCID: PMC8111041 DOI: 10.3346/jkms.2021.36.e117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study was to assess the rate of radiotherapy (RT) utilization according to the modality in South Korea to identify the implications of contemporary RT patterns. METHODS We collected information from claims and reimbursement records of the National Health Insurance Service from 2010 to 2019. We classified the location of each institution as capital (Seoul, Incheon, and Gyeonggi-do) and non-capital areas. RESULTS The rate of RT utilization in total cancer patients nationwide was 24.5% in 2010, which consistently has increased to 36.1% in 2019 (annual increase estimate [AIE], 4.5%). There was an abrupt increase in patients receiving intensity-modulated RT (IMRT), with an AIE of 33.5%, and a steady decline in patients receiving three-dimensional conformal RT (3DCRT), with an AIE of -7.1%. The commonest RT modality was IMRT (44.5%), followed by 3DCRT and stereotactic RT (SRT) (37.2% and 13.5%) in 2019. An increasing trend of advanced RT (such as IMRT and SRT) utilization was observed regardless of the region, although the AIE in the capital areas was slightly higher than that in non-capital areas. CONCLUSION The utilization of overall RT application and especially of advanced modalities remarkably increased from 2010 to 2019. We also found gaps in their AIEs between capital and non-capital areas. We should ensure that advanced RT is accessible to all cancer patients across South Korea.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
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Sun L, Hu W, Lai S, Shi L, Chen J. In Vivo 3-D Dose Verification Using PET/CT Images After Carbon-Ion Radiation Therapy. Front Oncol 2021; 11:621394. [PMID: 33791210 PMCID: PMC8006088 DOI: 10.3389/fonc.2021.621394] [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: 10/26/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the usefulness of positron emission tomography (PET) images obtained after carbon-ion irradiation for dose verification in carbon-ion radiotherapy. Methods and Materials An anthropomorphic head phantom was used in this study. Three cubes with volumes of 1, 4, and 10 ml were contoured as targets in the phantom CT through a treatment planning system. Treatment plans with six prescriptions from 2.5 to 10 Gy (2.5, 3, 5, 6, 8, and 10 Gy effective dose) were designed and delivered by 90° fixed carbon-ion beams, respectively. After irradiation of the phantom, a PET/CT scan was performed to fuse the treatment-planning CT image with the PET/CT image. The relationship between target volume and the standard uptake value (SUV) in PET/CT was evaluated for corresponding plan prescription. The MIM Maestro software was used for the image fusion and data analysis. Results SUV in the target had an approximate linear relationship with the effective dose. The same effective dose could generate a roughly equal SUV for different target volumes (p < 0.05). Conclusions It is feasible to verify the actual 3-D dose distribution of carbon-ion radiotherapy by the approach in this study.
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Affiliation(s)
- Lining Sun
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Songtao Lai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Leijun Shi
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Junchao Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Bohara G, Sadeghnejad Barkousaraie A, Jiang S, Nguyen D. Using deep learning to predict beam-tunable Pareto optimal dose distribution for intensity-modulated radiation therapy. Med Phys 2020; 47:3898-3912. [PMID: 32621789 PMCID: PMC7821384 DOI: 10.1002/mp.14374] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/19/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Many researchers have developed deep learning models for predicting clinical dose distributions and Pareto optimal dose distributions. Models for predicting Pareto optimal dose distributions have generated optimal plans in real time using anatomical structures and static beam orientations. However, Pareto optimal dose prediction for intensity-modulated radiation therapy (IMRT) prostate planning with variable beam numbers and orientations has not yet been investigated. We propose to develop a deep learning model that can predict Pareto optimal dose distributions by using any given set of beam angles, along with patient anatomy, as input to train the deep neural networks. We implement and compare two deep learning networks that predict with two different beam configuration modalities. METHODS We generated Pareto optimal plans for 70 patients with prostate cancer. We used fluence map optimization to generate 500 IMRT plans that sampled the Pareto surface for each patient, for a total of 35 000 plans. We studied and compared two different models, Models I and II. Although they both used the same anatomical structures - including the planning target volume (PTV), organs at risk (OARs), and body - these models were designed with two different methods for representing beam angles. Model I directly uses beam angles as a second input to the network as a binary vector. Model II converts the beam angles into beam doses that are conformal to the PTV. We divided the 70 patients into 54 training, 6 validation, and 10 testing patients, thus yielding 27 000 training, 3000 validation, and 5000 testing plans. Mean square loss (MSE) was taken as the loss function. We used the Adam optimizer with a default learning rate of 0.01 to optimize the network's performance. We evaluated the models' performance by comparing their predicted dose distributions with the ground truth (Pareto optimal) dose distribution, in terms of dose volume histogram (DVH) plots and evaluation metrics such as PTV D98 , D95 , D50 , D2 , Dmax , Dmean , Paddick Conformation Number, R50, and Homogeneity index. RESULTS Our deep learning models predicted voxel-level dose distributions that precisely matched the ground truth dose distributions. The DVHs generated also precisely matched the ground truth. Evaluation metrics such as PTV statistics, dose conformity, dose spillage (R50), and homogeneity index also confirmed the accuracy of PTV curves on the DVH. Quantitatively, Model I's prediction error of 0.043 (confirmation), 0.043 (homogeneity), 0.327 (R50), 2.80% (D95), 3.90% (D98), 0.6% (D50), and 1.10% (D2) was lower than that of Model II, which obtained 0.076 (confirmation), 0.058 (homogeneity), 0.626 (R50), 7.10% (D95), 6.50% (D98), 8.40% (D50), and 6.30% (D2). Model I also outperformed Model II in terms of the mean dose error and the max dose error on the PTV, bladder, rectum, left femoral head, and right femoral head. CONCLUSIONS Treatment planners who use our models will be able to use deep learning to control the trade-offs between the PTV and OAR weights, as well as the beam number and configurations in real time. Our dose prediction methods provide a stepping stone to building automatic IMRT treatment planning.
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Affiliation(s)
- Gyanendra Bohara
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Azar Sadeghnejad Barkousaraie
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Steve Jiang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Dan Nguyen
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
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12
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Chiavassa S, Bessieres I, Edouard M, Mathot M, Moignier A. Complexity metrics for IMRT and VMAT plans: a review of current literature and applications. Br J Radiol 2019; 92:20190270. [PMID: 31295002 PMCID: PMC6774599 DOI: 10.1259/bjr.20190270] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 12/21/2022] Open
Abstract
Modulated radiotherapy with multileaf collimators is widely used to improve target conformity and normal tissue sparing. This introduced an additional degree of complexity, studied by multiple teams through different properties. Three categories of complexity metrics were considered in this review: fluence, deliverability and accuracy metrics. The first part of this review is dedicated to the inventory of these complexity metrics. Different applications of these metrics emerged. Influencing the optimizer by integrating complexity metrics into the cost function has been little explored and requires more investigations. In modern treatment planning system, it remains confined to MUs or treatment time limitation. A large majority of studies calculated metrics only for analysis, without plan modification. The main application was to streamline the patient specific quality assurance workload, investigating the capability of complexity metrics to predict patient specific quality assurance results. Additionally complexity metrics were used to analyze behaviour of TPS optimizer, compare TPS, operators and plan properties, and perform multicentre audit. Their potential was also explored in the context of adaptive radiotherapy and automation planning. The second part of the review gives an overview of these studies based on the complexity metrics.
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Affiliation(s)
- Sophie Chiavassa
- Department of Medical Physics, Institut de Cancérologie de l’Ouest Centre René Gauducheau, 44805 Saint-Herblain, France
| | - Igor Bessieres
- Departement of Medical Physics, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21000 Dijon, France
| | - Magali Edouard
- Department of Radiation Oncology, Gustave Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
| | - Michel Mathot
- Liege University Hospital, Domaine du Sart Tilman - B.35 - B-4000 LIEGE1, Belgium
| | - Alexandra Moignier
- Department of Medical Physics, Institut de Cancérologie de l’Ouest Centre René Gauducheau, 44805 Saint-Herblain, France
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13
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Lee B, Jeong S, Chung K, Yoon M, Park HC, Han Y, Jung SH. Feasibility of a GATE Monte Carlo platform in a clinical pretreatment QA system for VMAT treatment plans using TrueBeam with an HD120 multileaf collimator. J Appl Clin Med Phys 2019; 20:101-110. [PMID: 31544350 PMCID: PMC6806485 DOI: 10.1002/acm2.12718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose To evaluate the quality of patient‐specific complicated treatment plans, including commercialized treatment planning systems (TPS) and commissioned beam data, we developed a process of quality assurance (QA) using a Monte Carlo (MC) platform. Specifically, we constructed an interface system that automatically converts treatment plan and dose matrix data in digital imaging and communications in medicine to an MC dose‐calculation engine. The clinical feasibility of the system was evaluated. Materials and Methods A dose‐calculation engine based on GATE v8.1 was embedded in our QA system and in a parallel computing system to significantly reduce the computation time. The QA system automatically converts parameters in volumetric‐modulated arc therapy (VMAT) plans to files for dose calculation using GATE. The system then calculates dose maps. Energies of 6 MV, 10 MV, 6 MV flattening filter free (FFF), and 10 MV FFF from a TrueBeam with HD120 were modeled and commissioned. To evaluate the beam models, percentage depth dose (PDD) values, MC calculation profiles, and measured beam data were compared at various depths (Dmax, 5 cm, 10 cm, and 20 cm), field sizes, and energies. To evaluate the feasibility of the QA system for clinical use, doses measured for clinical VMAT plans using films were compared to dose maps calculated using our MC‐based QA system. Results A LINAC QA system was analyzed by PDD and profile according to the secondary collimator and multileaf collimator (MLC). Values for MC calculations and TPS beam data obtained using CC13 ion chamber (IBA Dosimetry, Germany) were consistent within 1.0%. Clinical validation using a gamma index was performed for VMAT treatment plans using a solid water phantom and arbitrary patient data. The gamma evaluation results (with criteria of 3%/3 mm) were 98.1%, 99.1%, 99.2%, and 97.1% for energies of 6 MV, 10 MV, 6 MV FFF, and 10 MV FFF, respectively. Conclusions We constructed an MC‐based QA system for evaluating patient treatment plans and evaluated its feasibility in clinical practice. We observed robust agreement between dose calculations from our QA system and measurements for VMAT plans. Our QA system could be useful in other clinical settings, such as small‐field SRS procedures or analyses of secondary cancer risk, for which dose calculations using TPS are difficult to verify.
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Affiliation(s)
- Boram Lee
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | - Seonghoon Jeong
- Department of Bio-convergence Engineering, Korea University, Seoul, Korea
| | - Kwangzoo Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myonggeun Yoon
- Department of Bio-convergence Engineering, Korea University, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology,, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Hoon Jung
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
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Höfel S, Fix MK, Zwicker F, Sterpin E, Drescher M. EPR imaging of magnetic field effects on radiation dose distributions around millimeter-size air cavities. Phys Med Biol 2019; 64:175013. [PMID: 31307018 DOI: 10.1088/1361-6560/ab325b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
New hybrid radiotherapy treatment systems combining an MRI scanner with a source of ionizing radiation are being introduced in the clinic. The strong magnetic fields of MRI considerably affect radiation dose distributions, especially at tissue-air interfaces due to the electron return effect (ERE). Experimental investigation of the ERE within a sub-millimeter thick surface layer is still highly challenging. In the present work, we examine and quantify the magnetic field induced perturbations of dose distributions within a 0.5 mm layer surrounding millimeter-size air cavities by applying electron paramagnetic resonance imaging (EPRI). Air-filled fused quartz tubes (inner diameter 3 or 4 mm) mimic small air cavities and serve as model systems. The tubes were irradiated inside a PMMA phantom by a 6 MV photon beam. The irradiations were performed in the presence or absence of a transverse, magnetic field providing a magnetic field strength of 1.0 Tesla. The spatial distributions of radiation induced paramagnetic defects in the quartz tubes were subsequently determined by applying field-swept echo-detected EPRI and were then converted to relative dose distributions. The transverse magnetic field leads to considerable local dose enhancements and reductions (up to 35%) with respect to the mean dose within the quartz tubes. The experimentally determined dose distributions are in good quantitative agreement with Monte Carlo radiation transport simulations. The results of this work demonstrate the feasibility of field-swept echo-detected EPRI to measure magnetic field induced perturbations of dose distributions within a sub-millimeter thick surface layer at the dosimeter-air interface.
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Affiliation(s)
- Sebastian Höfel
- Department of Chemistry and Konstanz Research School Chemical Biology, University of Konstanz, Konstanz, Germany. Klinik und Praxis für Strahlentherapie am Klinikum Konstanz, Konstanz, Germany
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15
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Gupta A, Wang L, Zhang SJ, Zhang CP. In vivo and in vitro neck dissection specimen labelling: a new method for precise orientation of specimens. Int J Oral Maxillofac Surg 2019; 49:166-168. [PMID: 31280903 DOI: 10.1016/j.ijom.2019.06.004] [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: 12/28/2018] [Revised: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
As the main anatomical and radiological landmarks are lacking in neck dissection specimens, orientation and labelling of the lymph node levels becomes very important for precise histopathological reporting. A few labelling techniques for neck dissection specimens have been described previously, which can aid the histopathologist in orienting the specimen. However, a combined method of specimen labelling in which the ND specimen is labelled during the operation and once it has been resected would improve specimen orientation. This article describes a technique of in vivo and in vitro labelling of neck dissection specimens that specifies the levels of the lymph nodes with proper anatomical landmarks. This technique eliminates the grey areas between levels II and III and between levels III and IV, which are difficult to identify precisely in neck dissection specimens. This technique is easily reproducible and represents a useful tool in attaining precise pathological reporting.
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Affiliation(s)
- A Gupta
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; Department of Dentistry, Government Medical College & Hospital, Chandigarh, India.
| | - L Wang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
| | - S-J Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
| | - C-P Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Centre for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
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16
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Miki K, Saito A, Nakashima T, Murakami Y, Kimura T, Nishibuchi I, Nagata Y. Evaluation of optimization workflow using design of experiment (DoE) for various field configurations in volumetric-modulated arc therapy. Phys Med 2018; 54:34-41. [PMID: 30337008 DOI: 10.1016/j.ejmp.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/14/2018] [Accepted: 09/20/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In volumetric-modulated arc therapy (VMAT), field configurations such as couch or arc angles are defined manually or using a template. A field configuration is reselected through trial-and-error in the case of undesirable resultant planning. To efficiently plan for desirable quality, configurations should be assessed before dose calculation. Design of experiments (DoE) is an optimization technique that efficiently reveals the influence of inputs on outputs. We developed an original tool using DoE to determine the field configuration selection and evaluated the efficacy of this workflow for clinical practice. METHODS Computed-tomography scans of 17 patients and target structures were acquired retrospectively from a brain tumor treated using a dual-arc VMAT plan. The configurations of the couch, arc, collimator angles, field sizes, and beam energy were determined using DoE. The resultant dose distributions obtained using the DoE-selected configuration were compared with the clinical plan. RESULTS The averaged differences between the DoE and clinical plan for 17 patients of doses to 50% of the planning target volume (PTV-D50%), Brain-D60%, Brain-D30%, Brain stem-D1%, Left eye-D1%, Right eye-D1%, Optic nerve-D1%, and Chiasm-D1% were 0.2 ± 0.5%, -1.0 ± 4.6%, 1.7 ± 3.5%, -2.5 ± 6.7%, -0.2 ± 4.9%, -1.2 ± 3.6%, -2.8 ± 7.3%, and -2.1 ± 5.7%, respectively. CONCLUSIONS Our optimization workflow obtained using DoE for various field configurations provided the same or slightly superior plan quality compared with that created by experts. This process is feasible for clinical practice and will efficiently improve treatment quality while removing the influence of the planner's experience.
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Affiliation(s)
- Kentaro Miki
- Department of Radiation Oncology, Hiroshima University Hospital, Japan.
| | - Akito Saito
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Takeo Nakashima
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University Hospital, Japan
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17
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Rim CH, Lee J, Kim WC, Yang D, Yoon WS, Koom WS, Kim CY. A Survey of Radiation Therapy Utilization in Korea from 2010 to 2016: Focusing on Use of Intensity-Modulated Radiation Therapy. J Korean Med Sci 2018; 33:e67. [PMID: 29441739 PMCID: PMC5811661 DOI: 10.3346/jkms.2018.33.e67] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/11/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study aimed to assess the recent changes of radiation therapy (RT) modalities in Korea. In particular, we focused on intensity-modulated radiation therapy (IMRT) utilization as the main index, presenting the application status of advanced RT. METHODS We collected information from the Korean Health and Insurance Review and Assessment Service data based on the National Health Insurance Service claims and reimbursements records by using treatment codes from 2010 to 2016. We classified locating region of each institution as capital vs. non-capital areas and metropolitan vs. non-metropolitan areas to assess the regional difference in IMRT utilization in Korea. RESULTS IMRT use has been steadily increased in Korea, with an annual increase estimate (AIE) of 37.9% from 2011 to 2016 (P < 0.001) resulting in IMRT being the second most common RT modality following three-dimensional conformal radiotherapy. In general, an increasing trend of IMRT utilization was observed, regardless of the region. The rate of AIE in the capital areas or metropolitan areas was higher than that in non-capital areas or non-metropolitan areas (40.7% vs. 31.9%; P < 0.001 and 39.7% vs. 29.4%; P < 0.001, respectively). DISCUSSION The result of our survey showed that IMRT has become one of the most common RT modalities. IMRT is becoming popular in both metropolitan and non-metropolitan areas, while metropolitan area has faster AIE possibly due to concentration of medical resources and movement of advanced patients.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Inha University Hospital, Incheon, Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Incheon, Korea
| | - DaeSik Yang
- Department of Radiation Oncology, Korea University Guro Hospital, Seoul, Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Yong Kim
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, Korea.
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He J, Xiao J, Peng X, Duan B, Li Y, Ai P, Yao M, Chen N. Dose escalation by image-guided intensity-modulated radiotherapy leads to an increase in pain relief for spinal metastases: a comparison study with a regimen of 30 Gy in 10 fractions. Oncotarget 2017; 8:112330-112340. [PMID: 29348828 PMCID: PMC5762513 DOI: 10.18632/oncotarget.18979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/18/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Under the existing condition that the optimum radiotherapy regimen for spinal metastases is controversial, this study investigates the benefits of dose escalation by image-guided intensity-modulated radiotherapy (IG-IMRT) with 60-66 Gy in 20-30 fractions for spinal metastases. RESULTS In the dose-escalation group, each D50 of planning gross tumor volume (PGTV) was above 60 Gy and each Dmax of spinal cord planning organ at risk volume (PRV) was below 48 Gy. The median biological effective dose (BED) of Dmax of spinal cord was lower in the dose-escalation group compared with that in the 30-Gy group (69.70 Gy vs. 83.16 Gy, p < 0.001). After one month and three months of the radiotherapy, pain responses were better in the dose-escalation group than those in the 30-Gy group (p = 0.005 and p = 0.024), and the complete pain relief rates were respectively 73.69% and 34.29% (p = 0.006), 73.69% and 41.38% (p = 0.028) in two compared groups. In the dose-escalation group, there is a trend of a longer duration of pain relief, a longer overall survival and a lower incidence of acute radiation toxicities. No late radiation toxicities were observed in both groups. MATERIALS AND METHODS Dosimetric parameters and clinical outcomes, including pain response, duration of pain relief, radiation toxicities and overall survival, were compared among twenty-five metastatic spinal lesions irradiated with the dose-escalation regimen and among forty-four lesions treated with the 30-Gy regimen. CONCLUSIONS Conventionally-fractionated IG-IMRT for spinal metastases could escalate dose to the vertebral lesions while sparing the spinal cord, achieving a better pain relief without increasing radiation complications.
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Affiliation(s)
- Jinlan He
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xingchen Peng
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Baofeng Duan
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ping Ai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Min Yao
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Nianyong Chen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Chitapanarux I, Nobnop W, Sripan P, Chumachote A, Tharavichitkul E, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B, Janlaor S, Kayan P, Traisathit P, Van Gestel D. The Outcome of the First 100 Nasopharyngeal Cancer Patients in Thailand Treated by Helical Tomotherapy. Radiol Oncol 2017; 51:351-356. [PMID: 28959172 PMCID: PMC5612000 DOI: 10.1515/raon-2017-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background The aim of the study was to analyse of two-year loco-regional failure free survival (LRFFS), distant metastasis free survival (DMFS), overall survival (OS), and toxicity outcomes of the first 100 nasopharyngeal carcinoma patients in Thailand treated by helical tomotherapy. Patients and methods Between March 2012 and December 2015, 100 patients with non-metastatic nasopharyngeal carcinoma were treated by helical tomotherapy. All patients were treated by platinum-based concurrent chemoradiotherapy and adjuvant or neo-adjuvant chemotherapy. Results The median age was 51 years (interquartile ranges [IQR]: 42.5–57.0). The mean ± SD of D95% of planning target volume (PTV) 70, 59.4 and 54 were 70.2 ± 0.5, 59.8 ± 0.6, and 54.3 ± 0.8 Gy, respectively. The mean ± SD of conformity index, and homogeneity index were 0.89 ± 0.13 and 0.06 ± 0.07. Mean ± SD of D2 % of spinal cord and brainstem were 34.1 ± 4.4 and 53.3 ±6.3 Gy. Mean ± SD of D50 of contralateral and ipsilateral parotid gland were 28.4 ± 6.7 and 38.5 ± 11.2 Gy. At a median follow-up of 33 months (IQR: 25–41), the 2-year LRFFS, DMFS, OS were 94% (95%CI: 87–98%), 96% (95% CI: 89–98%), and 99% (95% CI: 93–100%), respectively. Acute grade 3 dermatitis, pharyngoesophagitis, and mucositis occurred in 5%, 51%, and 37%, respectively. Late pharyngoesophagitis grade 0 and 1 were found in 98% and 2% of patients. Late xerostomia grade 0, 1 and 2 were found in 17%, 78% and 5%, respectively. Conclusions Helical tomotherapy offers good dosimetric performance and achieves excellent treatment outcome in nasopharyngeal carcinoma patients.
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Affiliation(s)
- Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wannapha Nobnop
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ausareeya Chumachote
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pitchayaponne Klunklin
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wimrak Onchan
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bongkot Jia-Mahasap
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suwapim Janlaor
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patcharawadee Kayan
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Dirk Van Gestel
- Department of Radiation Oncology, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
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Fredman ET, Abdel-Wahab M, Kumar AMS. Influence of radiation treatment technique on outcome and toxicity in anal cancer. ACTA ACUST UNITED AC 2017; 6:413-421. [PMID: 29213359 PMCID: PMC5700990 DOI: 10.1007/s13566-017-0326-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/09/2017] [Indexed: 01/26/2023]
Abstract
Objective Intensity-modulated radiation therapy (IMRT) has largely supplanted three-dimensional conformal radiation (3D-CRT) for definitive anal cancer treatment due to decreased toxicity and potentially improved outcomes. Convincing data demonstrating its advantages, however, remain limited. We compared outcomes and toxicity with concurrent chemotherapy and IMRT vs 3D-CRT for anal cancer. Methods We performed a single-institution retrospective review of patients treated with IMRT or 3D-CRT as part of definitive mitomycin-C/5-fluorouricil-based chemoradiation for anal cancer from January 2003 to December 2012. Results One hundred sixty-five patients were included, with 61 and 104 receiving IMRT and 3D-CRT, respectively. Overall, 92.7% had squamous cell carcinoma. The mean initial pelvic dose was 48.3 and 44 Gy for IMRT and 3D-CRT, respectively. Complete response, partial response, and disease progression rates were similar (IMRT 83.6, 8.2, 8.2%; 3D-CRT 85.6, 6.7, 7.7%; p = 0.608, p = 0.728, p = 0.729). There was no significant difference in overall survival (p = 0.971), event-free survival (p = 0.900), or local or distant recurrence rates (p = 0.118, p = 0.373). IMRT caused significantly less acute grade 1–2 incontinence (p = 0.035), grade 3–4 pain (p = 0.033), and fatigue (p = 0.030). IMRT patients had significantly fewer chronic post-treatment toxicities (p = 0.008), outperforming 3D-CRT in six of eight toxicities reviewed. Though total treatment length was comparable (43.6 and 44.5 days), IMRT recipients had fewer (27.9 vs 41.3% of patients, p = 0.89), shorter treatment breaks (mean 2.9 vs 4.1 days, p = 0.229). Conclusion This report represents the largest series directly comparing concurrent chemotherapy with IMRT vs 3D-CRT for definitive treatment of anal cancer. IMRT significantly reduced acute and post-treatment toxicities and allowed for safe and effective pelvic dose escalation.
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Affiliation(s)
- Elisha T Fredman
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106 USA
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency's (IAEA) Division of Human Health, Vienna, Austria
| | - Aryavarta M S Kumar
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106 USA.,University Hospitals Parma Seidman Cancer Center, Parma, OH USA
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Aselmaa A, van Herk M, Laprie A, Nestle U, Götz I, Wiedenmann N, Schimek-Jasch T, Picaud F, Syrykh C, Cagetti LV, Jolnerovski M, Song Y, Goossens RH. Using a contextualized sensemaking model for interaction design: A case study of tumor contouring. J Biomed Inform 2017; 65:145-158. [DOI: 10.1016/j.jbi.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/02/2016] [Accepted: 12/04/2016] [Indexed: 12/28/2022]
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Ghosh G, Tallari R, Malviya A. Toxicity Profile of IMRT Vs. 3D-CRT in Head and Neck Cancer: A Retrospective Study. J Clin Diagn Res 2016; 10:XC01-XC03. [PMID: 27790562 DOI: 10.7860/jcdr/2016/21457.8583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Role of radiotherapy in comprehensive management of head and neck cancer for achieving tumour control and organ preservation is now well established and radiotherapy is routinely used in adjuvant setting after surgery, concurrently with chemotherapy or targeted agents and for palliation. Development of linear accelerator with Multileaf Collimator (MLC) have revolutionized radiation delivery techniques, allowing conformal and Intensity Modulated Radiotherapy (IMRT) to deliver highly conformal sculpted radiation dose to a very complex structure with improved sparing of adjoining critical structures like salivary glands, spinal cord, eyes, brainstem and larynx amounting to better therapeutic gain. AIM This retrospective study was to compare toxicity profile of IMRT with Three Dimensional Conformal Radiotherapy (3D CRT) in head and neck cancer. MATERIALS AND METHODS Total of 80 patients from January 2013 to July 2015 with proven head and neck cancer who underwent radiotherapy on linac 2300 C/D machine were included in the study, IMRT group and 3D-CRT group comprised of 40 patients each. We have searched patient's radiotherapy details in record section of our institute and observations were noted down. Patients received 70Gy/35 fractions, Monday to Friday as radical treatment and 60 Gy/30 fractions as adjuvant treatment were included. RESULTS The 3D-CRT group demonstrated significantly more acute toxic effects compared with the IMRT group in our analysis. Acute Grade 3 or greater toxic effects to the skin occurred in 5 of 40 (12.5%), patients in the 3D-CRT group compared with 3 of 40 (7.5%) patients in the IMRT group. Acute Grade 3 or greater toxic effects to the mucous membranes occurred in 23 of 40 (57.5%) patients in the 3D-CRT group and only 16 of 40 (40%) patients in the IMRT group. Statistically significant dysphagia developed in 34 of 40 (85%), patients in 3D-CRT group compared with 23 of 40 (57.5%) patients in IMRT group, while statistically significant xerostomia developed in 29 of 40 patients in 3D-CRT group (72.5%), compared with18 of 40 (45%) patients in IMRT group. CONCLUSION In our analysis, IMRT was associated with a significantly lower incidence of Grade 3 or greater xerostomia, acute toxic effects to skin and mucous membranes than 3D-CRT. In addition, compared to 3D-CRT, IMRT had lower rates of Grade 3 or greater mucositis and skin toxicity as well as less feeding tube use during radiotherapy. Our analysis showed potentially less toxicity in patients treated with IMRT in comparision to 3D-CRT.
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Affiliation(s)
- Gopa Ghosh
- Associate Professor, Department of Radiotherapy, Chirayu Medical College and Hospital, Bhopal; Consultant (Radiotherapy) Jawaharlal Nehru Cancer Hospital and Research Centre , Bhopal, Madhya Pradesh, India
| | - Ramanjis Tallari
- Postgraduate Resident, Department of Radiotherapy, Gandhi Medical College, Jawaharlal Nehru Cancer Hospital , Bhopal, Madhya Pradesh, India
| | - Anupam Malviya
- Postgraduate Resident, Department of Radiotherapy, Gandhi Medical College, Jawaharlal Nehru Cancer Hospital , Bhopal, Madhya Pradesh, India
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Lan XW, Zou XB, Xiao Y, Tang J, OuYang PY, Su Z, Xie FY. Retrospective Analysis of the Survival Benefit of Induction Chemotherapy in Stage IVa-b Nasopharyngeal Carcinoma. PLoS One 2016; 11:e0160758. [PMID: 27509025 PMCID: PMC4980057 DOI: 10.1371/journal.pone.0160758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/25/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose The value of adding induction chemotherapy to chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains controversial, yet high-risk patients with LA-NPC have poor outcomes after chemoradiotherapy. We aimed to assess the survival benefits of induction chemotherapy in stage IVa-b NPC. Patients and Methods A total of 602 patients with stage IVa-b NPC treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy with or without induction chemotherapy were retrospectively analyzed. Overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method, log-rank test and Cox regression analysis. Results In univariate analysis, 5-year OS was 83.2% for induction chemotherapy plus concurrent chemotherapy and 74.8% for concurrent chemotherapy alone, corresponding to an absolute risk reduction of 8.4% (P = 0.022). Compared to concurrent chemotherapy alone, addition of induction chemotherapy improved 5-year DMFS (83.2% vs. 74.4%, P = 0.018) but not 5-year LRFS (83.7% vs. 83.0%, P = 0.848) or PFS (71.9% vs. 66.0%, P = 0.12). Age, T category, N category, chemotherapy strategy and clinical stage were associated with 5-year OS (P = 0.017, P = 0.031, P = 0.007, P = 0.022, P = 0.001, respectively). In multivariate analysis, induction chemotherapy plus concurrent chemotherapy was an independent favorable prognostic factor for OS (HR, 0.62; 95% CI, 0.43–0.90, P = 0.012) and DMFS (HR, 0.57; 95% CI, 0.38–0.83, P = 0.004). In subgroup analysis, induction chemotherapy significantly improved 5-year DMFS in stage IVa (86.8% vs. 77.3%, P = 0.008), but provided no significant benefit in stage IVb. Conclusions In patients with stage IVa-b NPC treated with IMRT, addition of induction chemotherapy to concurrent chemotherapy significantly improved 5-year OS and 5-year DMFS. This study provides a basis for selection of high risk patients in future clinical therapeutic trials.
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Affiliation(s)
- Xiao-Wen Lan
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
| | - Xue-Bin Zou
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
| | - Yao Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
| | - Pu-Yun OuYang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhen Su
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
| | - Fang-Yun Xie
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, People's Republic of China
- * E-mail:
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Zhang LL, Wang XJ, Zhou GQ, Tang LL, Lin AH, Ma J, Sun Y. Dose-volume relationships for moderate or severe neck muscle atrophy after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma. Sci Rep 2015; 5:18415. [PMID: 26678599 PMCID: PMC4683446 DOI: 10.1038/srep18415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/17/2015] [Indexed: 12/15/2022] Open
Abstract
This study aimed to identify the dosimetric parameters and radiation dose tolerances associated with moderate or severe sternocleidomastoid muscle (SCM) atrophy after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). We retrospectively analysed 138 patients treated with IMRT between 2011 and 2012 for whom IMRT treatment plans and pretreatment and 3-year post-IMRT MRI scans were available. The association between mean dose (Dmean), maximum dose (Dmax), VX (% SCM volume that received more than X Gy), DX (dose to X% of the SCM volume) at X values of 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80 and SCM atrophy at 3 years after IMRT were analyzed. All dosimetric parameters, except V40, V50 and V80, were significantly associated with moderate or severe SCM atrophy. Multivariate analysis showed that V65 was an independent predictor of moderate or severe SCM atrophy (P < 0.001). Receiver operating characteristic (ROC) curve indicated a V65 of 21.47% (area under ROC curves, 0.732; P < 0.001) was the tolerated dose for moderate or severe SCM atrophy. We suggest a limit of 21.47% for V65 to optimize NPC treatment planning, whilst minimizing the risk of moderate or severe SCM atrophy.
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Affiliation(s)
- Lu-Lu 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, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Xiao-Ju Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ying 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, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
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Abstract
Radiation therapy plays an increasingly important role in the treatment of hepatic malignancies. There is convincing evidence of safety and efficacy employing brachytherapy (yttrium-90), three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy (SBRT), and proton beam therapy (PBT) in all stages of primary and metastatic involvement in the liver. Technologic advances in tumor imaging, real-time tracking of moving targets during radiotherapy delivery, and superb radiation dose deposition control have enabled treatment of previously unapproachable lesions. Recently completed and ongoing clinical trials are refining optimal dose fractionation schedules for SBRT as monotherapy. Radioembolization as part of first-line therapy in metastatic colorectal tumors is being tested in large international trials combined with FOLFOX6 and bevacizumab, as well as in hepatocellular carcinoma with sorafenib. PBT is becoming more available as new facilities open in many countries providing particle beam therapy, which delivers unparalleled control of radiation dose close to critical structures. A major point of research is understanding how best to safely destroy tumors in the background of often fragile hepatic function from cirrhosis or heavily pretreated chemotherapy liver parenchyma. Fortunately, serious complications from radiotherapy are rare, acute toxicities are typically Common Terminology Criteria for Adverse Events v4.0 grade 1-2, with consistent response rates of 50% to 97% in the modern era.
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Affiliation(s)
- Andrew S Kennedy
- From Radiation Oncology, Sarah Cannon Research Institute, Nashville, TN
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The potential role of modern radiotherapy techniques in the treatment of malignant spinal cord compression: a dose planning study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAimTo investigate the doses given to the kidneys and the small intestines for three radiation therapy techniques [anterior–posterior (APPA) fields, three fields and volumetric-modulated arc therapy (VMAT)] for spinal cord compression (SCC) patients with metastatic disease in the lower thoracic or lumbar spine and to monitor the time spent by clinicians and dose planners.IntroductionRadiation therapy is one of the main treatment modalities for SCC. Typical palliative radiation therapy techniques have used APPA fields or a three-field technique.However, as delivery techniques have evolved dramatically over the past decades, VMAT has gained wide acceptance. VMAT allows for a dose reduction in the organs at risk. Such a dose reduction may result in less toxicity.The use of the VMAT technique may require more time for contouring and planning compared with the APPA and three-field techniques. Any potential dosimetric benefit of VMAT must not be outweighed by large amounts of extra time spent by clinicians and dose planners.Materials and methodsFor 20 patients treated with radiation therapy for SCC at our hospital, we created a VMAT plan, and the more traditionally used APPA and three-field plans. The mean kidney doses and the volume of bowel, which received 20 Gy, were extracted for each plan. The correlations between parameters for three techniques were determined.Furthermore, the time required for contouring targets for five patients; and the time required to plan five patients, was recorded.ResultsVMAT lead to the most conformal distributions: the high-dose areas were restricted to the target volume, whereas the healthy tissue, especially the bowel, received a lower dose. In contrast, the APPA plan lead to a larger volume of bowel being irradiated, whereas the three-field technique spared the bowel at the expense of a higher dose to the kidneys.The average contouring time was 16 minutes, the average planning time was 38 minutes.ConclusionPatients treated for SCC in the lower thoracic or lumbar region may benefit from VMAT treatment, as it reduces the dose to the bowel and kidneys compared with APPA or three-field treatments.
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Songthong AP, Kannarunimit D, Chakkabat C, Lertbutsayanukul C. A randomized phase II/III study of adverse events between sequential (SEQ) versus simultaneous integrated boost (SIB) intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma; preliminary result on acute adverse events. Radiat Oncol 2015; 10:166. [PMID: 26253488 PMCID: PMC4554369 DOI: 10.1186/s13014-015-0472-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate acute and late toxicities comparing sequential (SEQ-IMRT) versus simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) in nasopharyngeal carcinoma (NPC) patients. METHODS Newly diagnosed stage I-IVB NPC patients were randomized to receive SEQ-IMRT or SIB-IMRT, with or without chemotherapy. SEQ-IMRT consisted of two sequential radiation treatment plans: 2 Gy x 25 fractions to low-risk planning target volume (PTV-LR) followed by 2 Gy x 10 fractions to high-risk planning target volume (PTV-HR). In contrast, SIB-IMRT consisted of only one treatment plan: 2.12 Gy and 1.7 Gy x 33 fractions to PTV-HR and PTV-LR, respectively. Toxicities were evaluated according to CTCAE version 4.0. RESULTS Between October 2010 and November 2013, 122 eligible patients were randomized between SEQ-IMRT (54 patients) and SIB-IMRT (68 patients). With median follow-up time of 16.8 months, there was no significant difference in toxicities between the two IMRT techniques. During chemoradiation, the most common grade 3-5 acute toxicities were mucositis (15.4% vs 13.6%, SEQ vs SIB, p = 0.788) followed by dysphagia (9.6% vs 9.1%, p = 1.000) and xerostomia (9.6% vs 7.6%, p = 0.748). During the adjuvant chemotherapy period, 25.6% and 32.7% experienced grade 3 weight loss in SEQ-IMRT and SIB-IMRT (p = 0.459). One-year overall survival (OS) and progression-free survival (PFS) were 95.8% and 95.5% in SEQ-IMRT and 98% and 90.2% in SIB-IMRT, respectively (p = 0.472 for OS and 0.069 for PFS). CONCLUSION This randomized, phase II/III trial comparing SIB-IMRT versus SEQ-IMRT in NPC showed no statistically significant difference between both IMRT techniques in terms of acute adverse events. Short-term tumor control and survival outcome were promising.
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Affiliation(s)
- Anussara P Songthong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
| | - Danita Kannarunimit
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
| | - Chakkapong Chakkabat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
| | - Chawalit Lertbutsayanukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
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A simple technique for orientation of neck dissection specimens. J Plast Reconstr Aesthet Surg 2015; 68:594-5. [DOI: 10.1016/j.bjps.2014.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/07/2014] [Indexed: 11/24/2022]
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Long-term Clinical Outcome of Intensity-modulated Radiation Therapy for Locally Advanced Esophageal Squamous Cell Carcinoma. TUMORI JOURNAL 2015; 101:168-73. [PMID: 25791535 DOI: 10.5301/tj.5000234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
Abstract
Purpose This study evaluated the effectiveness and safety of intensity-modulated radiation therapy (IMRT) for locally advanced esophageal squamous cell carcinoma (ESCC). Methods Between August 2009 and December 2011, 112 patients with pathologically confirmed ESCC treated with IMRT at Jiangsu Province People's Hospital and Nantong Tumor Hospital were included in a retrospective analysis. Patients received either IMRT alone (group A) or concurrent chemoradiotherapy (CRT) (group B). A radiation dose of 60–66 Gy administered in 30–33 fractions was delivered to the tumor. The patients in group B simultaneously received 2 cycles of cisplatin-based doublets with either 5-fluorouracil or taxotere. The Kaplan-Meier method was used to compute the survival time. Early and late toxicities were scored according to CTCAE v.3.0. Results The response rate of group B (91.07%) was not significantly greater than that of group A (89.29%) (X2 = 0.10, p = 0.75). The 1- and 3-year survival rates of group B (87.5% and 57.14%, respectively) were greater than those of group A (69.64% and 37.50%, respectively). The difference in overall survival was statistically significant between groups A and B (x2 = 5.30, p = 0.02; x2 = 4.33, p = 0.04). Hematological toxicity, gastrointestinal toxicity, and treatment-related esophagitis were significantly higher in group B than group A (16.07% vs. 33.93%, p = 0.04; 10.71% vs. 26.79%, p = 0.03; 19.64% vs. 44.64%, p = 0.01). However, intergroup differences in terms of late toxicity were not significant. Conclusions IMRT was a practical and feasible technique to treat ESCC. Concurrent CRT could increase local tumor control and long-term survival. The CRT regimen was associated with a higher incidence of acute gastrointestinal and hematological toxicity.
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Labranche L, Johnson M, Palma D, D'Souza L, Jaswal J. Integrating anatomy training into radiation oncology residency: considerations for developing a multidisciplinary, interactive learning module for adult learners. ANATOMICAL SCIENCES EDUCATION 2015; 8:158-165. [PMID: 25045151 DOI: 10.1002/ase.1472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/18/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
Radiation oncologists require an in-depth understanding of anatomical relationships for modern clinical practice, although most do not receive formal anatomy training during residency. To fulfill the need for instruction in relevant anatomy, a series of four multidisciplinary, interactive learning modules were developed for a cohort of radiation oncology and medical physics residents. Instructional design was based on established learning theories, with the intent of integrating knowledge of specific anatomical regions with radiology and radiation oncology practice. Each session included presentations by a radiologist and a radiation oncologist, as well as hands-on exploration of anatomical specimens with guidance from anatomists. Pre- and post-tests distributed during each session showed significant short-term knowledge retention. According to qualitative surveys and exit interviews, participants felt more comfort' with delineating structures, gross anatomy, and radiograph interpretation at the end of each session. Overall participant experience was positive, and the modules were considered effective for learning radiologic anatomy. Suggestions for future interventions include more time, increased clinical application, additional contouring practice and feedback, and improved coordination between each of the three disciplines. Results and conclusions from this study will be used to inform the design of a future multi-day national workshop for Canadian radiation oncology residents.
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Affiliation(s)
- Leah Labranche
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
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Amin A, Kelaney M, Elshamndy S, Guirguis O. Impact of different IMRT techniques to improve conformity and normal tissue sparing in upper esophageal cancer. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0301.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ahmed M, Eller S, Schnell E, Ahmad S, Akselrod M, Hanson O, Yukihara E. Development of a 2D dosimetry system based on the optically stimulated luminescence of Al2O3. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.01.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Domachevsky L, Jacene HA, Sakellis CG, Kim CK. Postradiation changes in tissues: evaluation by imaging studies with emphasis on fluorodeoxyglucose-PET/computed tomography and correlation with histopathologic findings. PET Clin 2014; 9:217-35. [PMID: 25030284 DOI: 10.1016/j.cpet.2013.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Efforts have been made to minimize the damage to adjacent normal tissues during radiotherapy, primarily by shifting from the use of conventional radiotherapy to more advanced techniques. Reviewing the overall pattern on combined anatomic and functional imaging can enhance diagnostic accuracy. Several radiotracers can be used; [(18)F]fluorodeoxyglucose is the most common. Familiarity with the type and timing of previous radiation therapy, the spectrum of imaging findings after radiation injury, and the appropriate use of the different radiotracers can be crucial. This article summarizes postradiation histologic findings and multimodality imaging findings, with emphasis on PET/computed tomography.
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Affiliation(s)
- Liran Domachevsky
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Chun K Kim
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Wu Z, Xie C, Hu M, Han C, Yi J, Zhou Y, Yuan H, Jin X. Dosimetric benefits of IMRT and VMAT in the treatment of middle thoracic esophageal cancer: is the conformal radiotherapy still an alternative option? J Appl Clin Med Phys 2014; 15:93–101. [PMID: 24892336 PMCID: PMC5711052 DOI: 10.1120/jacmp.v15i3.4641] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/25/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study is to investigate the dosimetric differences among conformal radiotherapy (CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated radiotherapy (VMAT) in the treatment of middle thoracic esophageal cancer, and determine the most appropriate treatment modality. IMRT and one-arc VMAT plans were generated for eight middle thoracic esophageal cancer patients treated previous with CRT. The planning target volume (PTV) coverage and protections on organs at risk of three planning schemes were compared. All plans have sufficient PTV coverage and no significant differences were observed, except for the conformity and homogeneity. The lung V5, V10, and V13 in CRT were 47.9% ± 6.1%, 36.5% ± 4.6%, and 33.2% ± 4.2%, respectively, which were greatly increased to 78.2% ± 13.7% (p < 0.01), 80.8% ± 14.9% (p < 0.01), 48.4% ± 8.2% (p = 0.05) in IMRT and 58.6% ± 10.5% (p = 0.03), 67.7% ± 14.0% (p < 0.01), and 53.0% ± 10.1% (p < 0.01) in VMAT, respectively. The lung V20 (p = 0.03) in VMAT and the V30 (p = 0.04) in IMRT were lower than those in CRT. Both IMRT and VMAT achieved a better protection on heart. However, the volumes of the healthy tissue outside of PTV irradiated by a low dose were higher for IMRT and VMAT. IMRT and VMAT also had a higher MU, optimization time, and delivery time compared to CRT. In conclusion, all CRT, IMRT, and VMAT plans are able to meet the prescription and there is no clear distinction on PTV coverage. IMRT and VMAT can only decrease the volume of lung and heart receiving a high dose, but at a cost of delivering low dose to more volume of lung and normal tissues. CRT is still a feasible option for middle thoracic esophageal cancer radiotherapy, especially for the cost-effective consideration.
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Affiliation(s)
- Zhiqin Wu
- the 1st Affiliated Hospital of Wenzhou Medical College.
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Ohno T, Kakinuma S, Kato S, Tsujii H, Shimada Y. Risk of second cancers after radiotherapy for cervical cancer. Expert Rev Anticancer Ther 2014; 6:49-57. [PMID: 16375644 DOI: 10.1586/14737140.6.1.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Radiotherapy for cervical cancer has both beneficial and detrimental effects: improvement of patient survival and potential induction of a second cancer among long-term survivors. Large epidemiological studies have demonstrated small, but significant, increases of second cancers with radiotherapy compared with the general population. The risk of second cancer has been characterized by organ sites, dose, time since radiotherapy and age at the time of radiotherapy. Analyses of genetic susceptibility and molecular carcinogenesis can be used to develop more appropriate strategies for radiation therapy for cervical cancers.
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Affiliation(s)
- Tatsuya Ohno
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba, Japan.
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Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K. The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters. BIOMED RESEARCH INTERNATIONAL 2013; 2013:401261. [PMID: 24228247 PMCID: PMC3818806 DOI: 10.1155/2013/401261] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/08/2013] [Accepted: 08/22/2013] [Indexed: 12/16/2022]
Abstract
A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.
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Affiliation(s)
- Vassilis Kouloulias
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Stella Thalassinou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Kalliopi Platoni
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Anna Zygogianni
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - John Kouvaris
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - Christos Antypas
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - Efstathios Efstathopoulos
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Kelekis Nikolaos
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
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Volumetric-modulated arc therapy with RapidArc(®): An evaluation of treatment delivery efficiency. Rep Pract Oncol Radiother 2013; 18:383-6. [PMID: 24416583 DOI: 10.1016/j.rpor.2013.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/08/2013] [Indexed: 11/20/2022] Open
Abstract
AIM/BACKGROUND To evaluate how the use of volumetric-modulated arc therapy (VMAT) with RapidArc(®) can improve treatment delivery efficiency based on the analysis of the beam-on times and monitor units (MU) needed to deliver therapy for multiple clinical applications in a large patient population. MATERIALS AND METHODS A total of 898 treatment courses were delivered in 745 patients treated from October 2008 to March 2013 using RapidArc® treatment plans generated in Eclipse™ TPS. All patients were treated with curative or palliative intent using different techniques including conventional fractionation (83%) and radiosurgery or SBRT (17%), depending on the clinical indications. Treatment delivery was evaluated based on measured beam-on time and recorded MU values delivered on a Varian Trilogy™ linear accelerator. RESULTS For conventional fractionation treatments using RapidArc®, the delivery times ranged from 38 s to 4 min and 40 s (average 2 min and 6 s). For radiosurgical treatments the delivery times ranged from 1 min and 42 s to 9 min and 22 s (average 4 min and 4 s). The average number of MU per Gy was 301 for the entire group, with 285 for the conventional group and 317 for the radiosurgical group. CONCLUSIONS In this study with a large heterogeneous population, treatments using RapidArc® were delivered with substantially less beam-on time and fewer MUs than conventional fractionation. This was highly advantageous, increasing flexibility of the scheduling allowing treatment of radiosurgery patients during the regular daily work schedule. Additionally, reduction of leakage radiation dose was achieved.
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Abstract
Treatment for patients with head and neck cancer requires a multidisciplinary approach. Radiotherapy is employed as a primary treatment or as an adjuvant to surgery. Each specific subsite dictates the appropriate radiotherapy techniques, fields, dose, and fractionation scheme. Quality of life is also an important issue in the management of head and neck cancer. The radiation-related complications have a tremendous impact on the quality of life. Modern radiotherapy techniques, such as intensity-modulated radiotherapy and image-guided radiotherapy, can offer precise radiation delivery and reduce the dose to the surrounding normal tissues without compromise of target coverage. In the future, efforts should be made in the exploration of novel strategies to improve treatment outcome in patients with head and neck cancer.
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Affiliation(s)
- Shyh-An Yeh
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung, Taiwan
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Xu J, Wei Q. Use of a peptide enhancing the ability of radiation therapy to kill cancer cells: a patent evaluation of WO2012016918. Expert Opin Ther Pat 2012; 22:1485-7. [PMID: 22871163 DOI: 10.1517/13543776.2012.711816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Faulty apoptosis is a known mechanism that leads to resistance to radiotherapy. The application (WO2012016918A1) deals with a peptide useful for disrupting this resistance mechanism and enhancing the efficiency of radiotherapy. METHODS A peptide consisting essentially of the N2 sequence of the RasGAP protein is conjugated to the HIV-TAT(48-57) cell permeation sequence. The DNA sequence encoding the peptide (TAT-RasGAP(317-326)) is synthesized and introduced into the host cells. RESULTS TAT-RasGAP(317-326) is demonstrated to potentiate the efficacy of γ-irradiation-mediated cell killing both in tumor cell lines and in mouse tumor models, disregarding the status of p53, but not in non-cancer cells. CONCLUSION TAT-RasGAP(317-326) peptide favors apoptosis of tumor cells, but not normal cells in response to radiotherapy. The invention provides a specific method that is probably to be used in cancers that are radio-resistant.
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Affiliation(s)
- Jing Xu
- Zhejiang University School of Medicine, The Second Affiliated Hospital and Cancer Institute (National Ministry of Education Key Laboratory of Cancer Prevention and Intervention), Department of Radiation Oncology, Hangzhou 310009, P.R. China
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Image Guidance During Head-and-Neck Cancer Radiation Therapy: Analysis of Alignment Trends With In-Room Cone-Beam Computed Tomography Scans. Int J Radiat Oncol Biol Phys 2012; 83:712-9. [DOI: 10.1016/j.ijrobp.2011.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 07/21/2011] [Accepted: 08/01/2011] [Indexed: 11/21/2022]
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AlDuhaiby EZ, Breen S, Bissonnette JP, Sharpe M, Mayhew L, Tyldesley S, Wilke DR, Hodgson DC. A national survey of the availability of intensity-modulated radiation therapy and stereotactic radiosurgery in Canada. Radiat Oncol 2012; 7:18. [PMID: 22309806 PMCID: PMC3339388 DOI: 10.1186/1748-717x-7-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 02/07/2012] [Indexed: 11/21/2022] Open
Abstract
Background The timely and appropriate adoption of new radiation therapy (RT) technologies is a challenge both in terms of providing of optimal patient care and managing health care resources. Relatively little is known regarding the rate at which new RT technologies are adopted in different jurisdictions, and the barriers to implementation of these technologies. Methods Surveys were sent to all radiation oncology department heads in Canada regarding the availability of RT equipment from 2006 to 2010. Data were collected concerning the availability and use of Intensity Modulated Radiation Therapy (IMRT) and stereotactic radiosurgery (SRS), and the obstacles to implementation of these technologies. Results IMRT was available in 37% of responding centers in 2006, increasing to 87% in 2010. In 2010, 72% of centers reported that IMRT was available for all patients who might benefit, and 37% indicated that they used IMRT for "virtually all" head and neck patients. SRS availability increased from 26% in 2006 to 42.5% in 2010. Eighty-two percent of centers reported that patients had access to SRS either directly or by referral. The main barriers for IMRT implementation included the need to train or hire treatment planning staff, whereas barriers to SRS implementation mostly included the need to purchase and/or upgrade existing planning software and equipment. Conclusions The survey showed a growing adoption of IMRT and SRS in Canada, although the latter was available in less than half of responding centers. Barriers to implementation differed for IMRT compared to SRS. Enhancing human resources is an important consideration in the implementation of new RT technologies, due to the multidisciplinary nature of the planning and treatment process.
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Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. Lancet Oncol 2011; 13:172-80. [PMID: 22178121 DOI: 10.1016/s1470-2045(11)70303-5] [Citation(s) in RCA: 241] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed to improve the outcomes for locoregionally advanced nasopharyngeal carcinoma by testing the feasibility and safety of the addition of bevacizumab to chemoradiotherapy. METHODS We enrolled patients older than 18 years with stage IIB-IVB nasopharyngeal carcinoma from 19 centres in North America and Hong Kong. Treatment consisted of three cycles of bevacizumab (15 mg/kg) and cisplatin (100 mg/m(2)) both given on days 1, 22, and 43 of radiation (70 Gy) with intensity-modulated radiation therapy delivered over 33 days on a daily basis, Monday through Friday. Patients then received three cycles of bevacizumab (15 mg/kg) and cisplatin (80 mg/m(2)), both given on days 64, 85, and 106 after radiation, and three cycles of fluorouracil (1000 mg/m(2) per day), given on days 64-67, 85-88, and 106-109 after radiation. The primary endpoint was the occurrence of treatment-related grade 4 haemorrhage or any grade 5 adverse event in the first year. Analyses were done with all eligible patients who started protocol treatment. The trial is registered at ClinicalTrials.gov, number NCT00408694. FINDINGS From Dec 13, 2006, to Feb 5, 2009, we enrolled 46 patients, of whom 44 were eligible for analysis. We recorded no grade 3-4 haemorrhages or grade 5 adverse events; nine patients (20%) had a treatment-related grade 1-2 haemorrhage. Nine patients had one or more grade 4 blood or bone marrow-related complication (grade 4 leucopenia was noted in six patients, grade 4 lymphopenia in five, grade 4 neutrophils in five, and grade 4 anaemia in one). One patient had two grade 4 infections with grade 3-4 neutrophils. One patient reported grade 4 tinnitus, one patient reported grade 4 thrombosis, one reported grade 4 radiation mucositis, and two reported grade 4 pharyngolaryngeal pain. With a median follow-up of 2·5 years (IQR 2·1-2·9), the estimated 2 year locoregional progression-free interval was 83·7% (95% CI 72·6-94·9), the 2 year distant metastasis-free interval was 90·8% (82·2-99·5), the 2 year progression-free survival was 74·7% (61·8-87·6), and 2 year overall survival was 90·9% (82·3-99·4). INTERPRETATION The addition of bevacizumab to standard chemoradiation treatment for patients with nasopharyngeal carcinoma is feasible, and might delay the progression of subclinical distant disease. FUNDING National Cancer Institute, USA.
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Analysis of dose–volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT. Jpn J Radiol 2011; 30:18-24. [DOI: 10.1007/s11604-011-0002-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
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Riad S, Biau D, Holt GE, Werier J, Turcotte RE, Ferguson PC, Griffin AM, Dickie CI, Chung PW, Catton CN, O'sullivan B, Wunder JS. The clinical and functional outcome for patients with radiation-induced soft tissue sarcoma. Cancer 2011; 118:2682-92. [DOI: 10.1002/cncr.26543] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/01/2011] [Accepted: 08/02/2011] [Indexed: 11/12/2022]
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Delouya G, Igidbashian L, Houle A, Bélair M, Boucher L, Cohade C, Beaulieu S, Filion EJ, Coulombe G, Hinse M, Martel C, Després P, Nguyen-Tan PF. ¹⁸F-FDG-PET imaging in radiotherapy tumor volume delineation in treatment of head and neck cancer. Radiother Oncol 2011; 101:362-8. [PMID: 21885143 DOI: 10.1016/j.radonc.2011.07.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 06/29/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the impact of (18)F-fluorodeoxyglucose positron emission tomography (PET) in radiotherapy target delineation and patient management for head and neck squamous cell carcinoma (HNSCC) compared to computed tomography (CT) alone. MATERIALS AND METHODS Twenty-nine patients with HNSCC were included. CT and PET/CT obtained for treatment planning purposes were reviewed respectively by a neuroradiologist and a nuclear medicine specialist who were blinded to the findings from each other. The attending radiation oncologist together with the neuroradiologist initially defined all gross tumor volume of the primary (GTVp) and the suspicious lymph nodes (GTVn) on CT. Subsequently, the same radiation oncologist and the nuclear medicine specialist defined the GTVp and GTVn on (18)F-FDG-PET/CT. Upon disagreement between CT and (18)F-FDG-PET on the status of a particular lymph node, an ultrasound-guided fine needle aspiration was performed. Volumes based on CT and (18)F-FDG-PET were compared with a paired Student's t-test. RESULTS For the primary disease, four patients had previous diagnostic tonsillectomy and therefore, FDG uptake occurred in 25 patients. For these patients, GTVp contoured on (18)F-FDG-PET (GTVp-PET) were smaller than the GTVp contoured on CT (GTVp-CT) in 80% of the cases, leading to a statistically significant volume difference (p=0.001). Of the 60 lymph nodes suspicious on PET, 55 were also detected on CT. No volume change was observed (p=0.08). Ten biopsies were performed for lymph nodes that were discordant between modalities and all were of benign histology. Distant metastases were found in two patients and one had a newly diagnosed lung adenocarcinoma. CONCLUSIONS GTVp-CT was significantly larger when compared to GTVp-PET. No such change was observed for the lymph nodes. (18)F-FDG-PET modified treatment management in three patients, including two for which no curative radiotherapy was attempted. Larger multicenter studies are needed to ascertain whether combined (18)F-FDG-PET/CT in target delineation can influence the main clinical outcomes.
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Affiliation(s)
- Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
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Ren G, Du L, Ma L, Feng LC, Zhou GX, Qu BL, Xu SP, Xie CB, Ou GM, Li F, Zhang XX, Yang J. Clinical observation of 73 nasopharyngeal carcinoma patients treated by helical tomotherapy: the China experience. Technol Cancer Res Treat 2011; 10:259-66. [PMID: 21517132 DOI: 10.7785/tcrt.2012.500201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The preliminary short-term clinical outcome of 73 nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy at our cancer institute has been evaluated. Between September 2007 and September 2009, 73 newly diagnosed NPC patients were treated with helical tomotherapy. The distributions of clinical stages according to the UICC 2002 Staging System were: 6, 27, 24, and 16 for Stage I, IIa-b, III, and IVa-b, respectively. The prescription dose was 70-74 Gy/33F to planning gross tumor volume containing the primary tumor and positive lymph nodes, with 60-62.7 Gy/33F to high risk planning target volume, while delivering 52-56 Gy/33F to low risk planning target volume. Twenty-four patients were treated with radiation therapy as single modality, 25 with concurrent cisplatin-based chemotherapy with or without anti-EGFR monoclonal antibody therapy, and 24 with concurrent anti-EGFR monoclonal antibody therapy. Setup errors were analyzed. Side-effects were evaluated with the established RTOG/EORTC criteria. Average beam-on-time was 468.8 sec/F (396.7-696.1 sec). The setup errors in the lateral, longitudinal and vertical directions were 0.00 ± 1.79 mm, -0.55± 2.17 mm and 0.38 ± 1.43 mm, corresponding to 3.80 mm, 4.20 mm, and 2.46 mm as the CTV-PTV margin in these directions. The grade 0, 1, 2 and 3 acute skin toxicity was 2.7%, 76.7%, 13.8% and 6.8%; the grade 0, 1, 2 and 3 acute mucositis was 1.4%, 32.9%, 60.2% and 5.5%; and the grade 0, 1, 2 and 3 acute xerostomia was 4.0%, 45.3%, 50.7% and 0, respectively. Only 5 patients suffered from grade 3 or 4 leucopenia. Xerostomia resolved with passing of time and no grade 2 or more xerostomia was noted one year after radiation therapy. Concurrent chemotherapy significantly increased incidence of severe acute toxicities. One month after radiation therapy the remission rates of primary tumor and positive lymph nodes were 91.8% and 98.1%, respectively. The median follow-up was 14.8 months. The one-year relapse-free survival, distant metastasis-free survival and overall survival was 95.6%, 97.2% and 94.8%, respectively. In conclusion, the incidence of severe acute toxicities and late xerostomia was relatively infrequent for NPC patients treated with helical tomotherapy. The long-term clinical outcome for these patients is under investigation.
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Affiliation(s)
- G Ren
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing 100853, China.
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Ghasemi M, Kakuee O, Fathollahi V, Shahvar A, Mohati M, Ghafoori M. Physical dose distribution due to multi-sliced kV X-ray beam in labeled tissue-like media: An experimental approach. Appl Radiat Isot 2011; 69:482-91. [DOI: 10.1016/j.apradiso.2010.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 10/06/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
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Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F, Jefferies SJ, Scrase C, Yap BK, A'Hern RP, Sydenham MA, Emson M, Hall E. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 2011; 12:127-36. [PMID: 21236730 PMCID: PMC3033533 DOI: 10.1016/s1470-2045(10)70290-4] [Citation(s) in RCA: 1192] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Xerostomia is the most common late side-effect of radiotherapy to the head and neck. Compared with conventional radiotherapy, intensity-modulated radiotherapy (IMRT) can reduce irradiation of the parotid glands. We assessed the hypothesis that parotid-sparing IMRT reduces the incidence of severe xerostomia. Methods We undertook a randomised controlled trial between Jan 21, 2003, and Dec 7, 2007, that compared conventional radiotherapy (control) with parotid-sparing IMRT. We randomly assigned patients with histologically confirmed pharyngeal squamous-cell carcinoma (T1–4, N0–3, M0) at six UK radiotherapy centres between the two radiotherapy techniques (1:1 ratio). A dose of 60 or 65 Gy was prescribed in 30 daily fractions given Monday to Friday. Treatment was not masked. Randomisation was by computer-generated permuted blocks and was stratified by centre and tumour site. Our primary endpoint was the proportion of patients with grade 2 or worse xerostomia at 12 months, as assessed by the Late Effects of Normal Tissue (LENT SOMA) scale. Analyses were done on an intention-to-treat basis, with all patients who had assessments included. Long-term follow-up of patients is ongoing. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN48243537. Findings 47 patients were assigned to each treatment arm. Median follow-up was 44·0 months (IQR 30·0–59·7). Six patients from each group died before 12 months and seven patients from the conventional radiotherapy and two from the IMRT group were not assessed at 12 months. At 12 months xerostomia side-effects were reported in 73 of 82 alive patients; grade 2 or worse xerostomia at 12 months was significantly lower in the IMRT group than in the conventional radiotherapy group (25 [74%; 95% CI 56–87] of 34 patients given conventional radiotherapy vs 15 [38%; 23–55] of 39 given IMRT, p=0·0027). The only recorded acute adverse event of grade 2 or worse that differed significantly between the treatment groups was fatigue, which was more prevalent in the IMRT group (18 [41%; 99% CI 23–61] of 44 patients given conventional radiotherapy vs 35 [74%; 55–89] of 47 given IMRT, p=0·0015). At 24 months, grade 2 or worse xerostomia was significantly less common with IMRT than with conventional radiotherapy (20 [83%; 95% CI 63–95] of 24 patients given conventional radiotherapy vs nine [29%; 14–48] of 31 given IMRT; p<0·0001). At 12 and 24 months, significant benefits were seen in recovery of saliva secretion with IMRT compared with conventional radiotherapy, as were clinically significant improvements in dry-mouth-specific and global quality of life scores. At 24 months, no significant differences were seen between randomised groups in non-xerostomia late toxicities, locoregional control, or overall survival. Interpretation Sparing the parotid glands with IMRT significantly reduces the incidence of xerostomia and leads to recovery of saliva secretion and improvements in associated quality of life, and thus strongly supports a role for IMRT in squamous-cell carcinoma of the head and neck. Funding Cancer Research UK (CRUK/03/005).
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Abstract
Since the discovery of X-rays, the goal of radiotherapy has been to deliver an optimal dose in the target volume and the lowest possible dose in the normal tissues. The history of radiotherapy can be divided in three periods. The Kilovoltage era (1900-1939) where only superficial and radiosensitive tumours could be controlled, the Megavoltage era (1950-1995) where Telecobalt and linear accelerators could deliver high doses in all parts of the body. Radiotherapy has since been playing an important curative and conservative role for most cancers. The Computer-Assisted Radiotherapy era (1995-2010) now provides the capacity to optimise the dose distribution in three dimensions. Dose is better conformed to the target volume and organ at risk are better preserved. intensity modulated radio-therapy (IMRT) allows to "shape" concave isodoses and to spare the parotids when irradiating oropharyngeal tumours. Moving targets (lung, liver etc.) are efficiently irradiated using "on-line tracking" and "image-guided radiotherapy". Stereotactic irradiation, first initiated for brain lesions, is now performed for extra-cranial tumours and due to its millimetric precision opens the way back to hypo-fractionated treatments. The next period, already ongoing, is Hadrontherapy with protons and soon helium or carbon ions techniques. In a multidisciplinary strategy, progress in radiotherapy is based on a global approach of the patient and tailored/personalized well targeted treatment of the tumour.
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Joiner MC, Mogili N, Marples B, Burmeister J. Significant dose can be lost by extended delivery times in IMRT with x rays but not high-LET radiations. Med Phys 2010; 37:2457-65. [DOI: 10.1118/1.3425792] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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