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Tambe NS, Pires IM, Moore C, Wieczorek A, Upadhyay S, Beavis AW. Predicting personalised optimal arc parameter using knowledge-based planning model for inoperable locally advanced lung cancer patients to reduce organ at risk doses. Biomed Phys Eng Express 2021; 7. [PMID: 34517350 DOI: 10.1088/2057-1976/ac2635] [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: 06/18/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022]
Abstract
Objectives. Volumetric modulated arc therapy (VMAT) allows for reduction of organs at risk (OAR) volumes receiving higher doses, but increases OAR volumes receiving lower radiation doses and can subsequently increasing associated toxicity. Therefore, reduction of this low-dose-bath is crucial. This study investigates personalizing the optimization of VMAT arc parameters (gantry start and stop angles) to decrease OAR doses.Materials and Methods. Twenty previously treated locally advanced non-small cell lung cancer (NSCLC) patients treated with half-arcs were randomly selected from our database. These plans were re-optimized with seven different arcs parameters; optimization objectives were kept constant for all plans. All resulting plans were reviewed by two clinicians and the optimal plan (lowest OAR doses and adequate target coverage) was selected. Furthermore, knowledge-based planning (KBP) model was developed using these plans as 'training data' to predict optimal arc parameters for individual patients based on their anatomy. Treatment plan complexity scores and deliverability measurements were performed for both optimal and original clinical plans.Results.The results show that different arc geometries resulted in different dose distributions to the OAR but target coverage was mostly similar. Different arc geometries were required for different patients to minimize OAR doses. Comparison of the personalized against the standard (2 half-arcs) plans showed a significant reduction in lung V5(lung volume receiving 5 Gy), mean lung dose and mean heart doses. Reduction in lung V20and heart V30were statistically insignificant. Plan complexity and deliverability measurements show the test plans can be delivered as planned.Conclusions.Our study demonstrated that personalizing arc parameters based on an individual patient's anatomy significantly reduces both lung and heart doses. Dose reduction is expected to reduce toxicity and improve the quality of life for these patients.
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Affiliation(s)
- Nilesh S Tambe
- Radiotherapy Physics, Queen's Centre for Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, HU16 5JQ, United Kingdom.,Faculty of Health Sciences, University of Hull, Cottingham road, Hull, HU16 7RX, United Kingdom
| | - Isabel M Pires
- Faculty of Health Sciences, University of Hull, Cottingham road, Hull, HU16 7RX, United Kingdom
| | - Craig Moore
- Radiotherapy Physics, Queen's Centre for Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, HU16 5JQ, United Kingdom
| | - Andrew Wieczorek
- Clinical Oncology, Queen's Centre for Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, HU16 5JQ, United Kingdom
| | - Sunil Upadhyay
- Clinical Oncology, Queen's Centre for Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, HU16 5JQ, United Kingdom
| | - Andrew W Beavis
- Radiotherapy Physics, Queen's Centre for Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, HU16 5JQ, United Kingdom.,Faculty of Health Sciences, University of Hull, Cottingham road, Hull, HU16 7RX, United Kingdom.,Faculty of Health and Well Being, Sheffield-Hallam University, Collegiate Crescent, Sheffield, S10 2BP, United Kingdom
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2
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Ghemiş DM, Marcu LG. Progress and prospects of flattening filter free beam technology in radiosurgery and stereotactic body radiotherapy. Crit Rev Oncol Hematol 2021; 163:103396. [PMID: 34146680 DOI: 10.1016/j.critrevonc.2021.103396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
The aim of this work is to summarize and evaluate the current status of knowledge on flattening filter free (FFF) beams and their applications in stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). A PubMed search was undertaken in order to identify relevant publications using FFF and stereotactic radiotherapy as keywords. On a clinical aspect, lung tumors treated with FFF SBRT show promising results in terms of local control and overall survival with acute toxicities consistent with those that occur with standard radiotherapy. Beside lung, SBRT is suitable for different anatomical sites such as liver, prostate, cervix, etc. offering similar results: reduced treatment time, good tumor control and mild acute toxicities. Regarding brain tumors, the employment of SRS with FFF beams significantly reduces treatment time and provides notable normal tissue sparing due to the sharp dose fall-off outside the tumor.
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Affiliation(s)
- Diana M Ghemiş
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; MedEuropa, Oradea, Romania
| | - Loredana G Marcu
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea, 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
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3
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Irazola L, Sánchez-Nieto B, García-Hernández MT, Terrón JA, Roselló J, Ortiz-Seidel M, Béjar MJ, Linares R, Vélazquez S, Sánchez-Doblado F. 10-MV SBRT FFF IRRADIATION TECHNIQUE IS ASSOCIATED TO THE LOWEST PERIPHERAL DOSE: THE OUTCOME OF 142 TREATMENT PLANS FOR THE 10 MOST COMMON TUMOUR LOCATIONS. RADIATION PROTECTION DOSIMETRY 2019; 185:183-195. [PMID: 30649534 DOI: 10.1093/rpd/ncy292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/06/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
There is a growing interest in the combined use of Stereotactic Body Radiation Therapy (SBRT) with Flattening Filter Free (FFF) due to the high local control rates and reduced treatment times, compared to conventionally fractionated treatments. It has been suggested that they may also provide a better radiation protection to radiotherapy patients as a consequence of the expected decrease in peripheral doses. This work aims to determine this reduction in unattended out-of-field regions, where no CT information is available but an important percentage of second primary cancers occur. For that purpose, ten different cases suitable for SBRT were chosen. Thus, 142 different treatment plans including SBRT, as well as 3D-CRT, IMRT and VMAT (with standard fractionation) in low and high energies for Varian (FF and FFF), Siemens and Elekta machines were created. Then, photon and neutron peripheral dose in 14 organs were assessed and compared using two analytical models. For the prostate case, uncomplicated and cancer free control probability estimation was also carried out. As a general behavior, SBRT plans led to the lowest peripheral doses followed by 3D-CRT, VMAT and IMRT, in this order. Unflattened beams proved to be the most effective in reducing peripheral doses, especially for 10 MV. The obtained results suggest that FFF beams for SBRT with 10 MV represent the best compromise between dose delivery efficiency and peripheral dose reduction.
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Affiliation(s)
- L Irazola
- Departamento de Fisiología Médica y Biofísica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
- Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - B Sánchez-Nieto
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - J A Terrón
- Departamento de Fisiología Médica y Biofísica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
- Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Roselló
- Servicio de Radiofísica ERESA, Hospital General Universitario, Valencia, Spain
| | - M Ortiz-Seidel
- Departamento de Fisiología Médica y Biofísica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
- Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M J Béjar
- Servicio de Radiofísica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Linares
- Servicio de Radiofísica, Hospital Infanta Luisa, Sevilla, Spain
| | - S Vélazquez
- Servicio de Radiofísica, Hospital Universitario Virgen del Rocío, Sevilla Spain
| | - F Sánchez-Doblado
- Departamento de Fisiología Médica y Biofísica, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
- Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Wang L, Li Y, Zhang X, Li H. Characteristics of nosocomial infection and its effects on the survival of chemotherapy patients with advanced non-small cell lung cancer. Oncol Lett 2017; 14:7379-7383. [PMID: 29344177 PMCID: PMC5755245 DOI: 10.3892/ol.2017.7144] [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: 06/01/2017] [Accepted: 09/27/2017] [Indexed: 12/17/2022] Open
Abstract
The present study was planned to investigate the characteristics of nosocomial infection and its effects on the survival in advanced non-small cell lung cancer (NSCLC) patients. Retrospective analysis was performed for the 169 chemotherapy patients with NSCLC and nosocomial infection during hospitalization in Binzhou City Central Hospital from March, 2013 to January, 2015. In addition, 170 patients without nosocomial infection were also involved as a control group. The distribution of major drug resistance of Gram-negative (G−) and Gram-positive (G+) were analyzed. The survival conditions of the patients were analyzed according to the nosocomial infection occurrence. The risk factors of nosocomial infection in patients with NSCLC were analyzed by univariate and multivariate logistic analysis. The percentage of G+ infection was 45.6% while G− infection was 54.4%. Nosocomial infections were most common in respiratory system. The median survival time of the observation group was shorter than that of the control group (P<0.05). G− infection was the most common type of infection in nosocomial infection of the patients with NSCLC. The occurrence of infection seriously affected the survival time of patients. Attention is required to the patients older than 60 years undergoing treatment with glucocorticoids as well as immunosuppressive agents.
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Affiliation(s)
- Lili Wang
- Department III of Oncology, Binzhou City Central Hospital, Binzhou, Shandong 251700, P.R. China
| | - Yan Li
- Department of Hospital Infection-Control, Binzhou City Central Hospital, Binzhou, Shandong 251700, P.R. China
| | - Xia Zhang
- Department of Obstetrics, Binzhou City Central Hospital, Binzhou, Shandong 251700, P.R. China
| | - Hongxia Li
- Department of Senior Cadres, Binzhou City Central Hospital, Binzhou, Shandong 251700, P.R. China
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Yuan S, Qiao T, Zhuang X, Chen W, Xing N, Zhang Q. Knockdown of the M2 Isoform of Pyruvate Kinase (PKM2) with shRNA Enhances the Effect of Docetaxel in Human NSCLC Cell Lines In Vitro. Yonsei Med J 2016; 57:1312-23. [PMID: 27593857 PMCID: PMC5011261 DOI: 10.3349/ymj.2016.57.6.1312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 01/22/2016] [Accepted: 03/15/2016] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The aim of our study was to explore the relationships between the M2 isoform of pyruvate kinase (PKM2) and the sensitivity of human non-small cell lung cancer (NSCLC) cells to docetaxel in vitro. MATERIALS AND METHODS With the method of plasmid transfection, we silenced the expression of PKM2 successfully in A549 and H460 cells. Western blotting and real-time PCR were applied to detect PKM2 expression at protein and gene levels. Cell viability was examined by CCK8 assay. Cell cycle distribution and apoptosis were examined by flow cytometry. P21 and Bax were detected. RESULTS Expression of PKM2 mRNA and protein were significantly decreased by shRNA targeting PKM2. Silencing of PKM2 increased docetaxel sensitivity of human NSCLC A549 and H460 cells in a collaborative manner, resulting in strong suppression of cell viability. The results of flow cytometric assays suggested that knockdown of PKM2 or docetaxel treatment, whether used singly or in combination, blocked the cells in the G2/M phase, which is in consistent with the effect of the two on the expression of p21. Cells with PKM2 silencing were more likely to be induced into apoptosis by docetaxel although knockdown of PKM2 alone can't induce apoptosis significantly, which is in consistent with the effect of the two on Bax expression. CONCLUSION The results suggest that PKM2 knockdown could serve as a chemosensitizer to docetaxel in non-small lung cancer cells through targeting PKM2, leading to inhibition of cell viability, increase of cell arrest of G2/M phase and apoptosis.
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Affiliation(s)
- Sujuan Yuan
- Department of Oncology, Jinshan Hospital, Medical Center of Fudan University, Shanghai, China
| | - Tiankui Qiao
- Department of Oncology, Jinshan Hospital, Medical Center of Fudan University, Shanghai, China.
| | - Xibing Zhuang
- Department of Oncology, Jinshan Hospital, Medical Center of Fudan University, Shanghai, China
| | - Wei Chen
- Department of Oncology, Jinshan Hospital, Medical Center of Fudan University, Shanghai, China
| | - Na Xing
- Department of Radiotherapy, Donghua Hospital of Sun Yat-sen University, Dongguan, China
| | - Qi Zhang
- Department of Oncology, Jinshan Hospital, Medical Center of Fudan University, Shanghai, China
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Ko YE, Cho B, Kim SS, Song SY, Choi EK, Ahn SD, Yi B. Improving Delivery Accuracy of Stereotactic Body Radiotherapy to a Moving Tumor Using Simplified Volumetric Modulated Arc Therapy. PLoS One 2016; 11:e0158053. [PMID: 27333199 PMCID: PMC4917108 DOI: 10.1371/journal.pone.0158053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/09/2016] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To develop a simplified volumetric modulated arc therapy (VMAT) technique for more accurate dose delivery in thoracic stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS For each of the 22 lung SBRT cases treated with respiratory-gated VMAT, a dose rate modulated arc therapy (DrMAT) plan was retrospectively generated. A dynamic conformal arc therapy plan with 33 adjoining coplanar arcs was designed and their beam weights were optimized by an inverse planning process. All sub-arc beams were converted into a series of control points with varying MLC segment and dose rates and merged into an arc beam for a DrMAT plan. The plan quality of original VMAT and DrMAT was compared in terms of target coverage, compactness of dose distribution, and dose sparing of organs at risk. To assess the delivery accuracy, the VMAT and DrMAT plans were delivered to a motion phantom programmed with the corresponding patients' respiratory signal; results were compared using film dosimetry with gamma analysis. RESULTS The plan quality of DrMAT was equivalent to that of VMAT in terms of target coverage, dose compactness, and dose sparing for the normal lung. In dose sparing for other critical organs, DrMAT was less effective than VMAT for the spinal cord, heart, and esophagus while being well within the limits specified by the Radiation Therapy Oncology Group. Delivery accuracy of DrMAT to a moving target was similar to that of VMAT using a gamma criterion of 2%/2mm but was significantly better using a 2%/1mm criterion, implying the superiority of DrMAT over VMAT in SBRT for thoracic/abdominal tumors with respiratory movement. CONCLUSION We developed a DrMAT technique for SBRT that produces plans of a quality similar to that achieved with VMAT but with better delivery accuracy. This technique is well-suited for small tumors with motion uncertainty.
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Affiliation(s)
- Young Eun Ko
- Department of Radiation Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byongyong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Huang BT, Lin Z, Lin PX, Lu JY, Chen CZ. Monitor unit optimization in stereotactic body radiotherapy for small peripheral non-small cell lung cancer patients. Sci Rep 2015; 5:18453. [PMID: 26679747 PMCID: PMC4683452 DOI: 10.1038/srep18453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/18/2015] [Indexed: 02/05/2023] Open
Abstract
The increasingly attractive stereotactic body radiotherapy (SBRT) treatment for stage I lung cancer is concomitant with a large amount of monitor units (MU), leading to excessive out-of-field dose and prolonged beam-on time. The study aims to reduce the MU number and shorten the beam-on time by optimizing the planning parameters. Clinically acceptable treatment plans from fourteen patients suffered from peripheral stage I non-small cell lung cancer (NSCLC) were created in the study. Priority for the upper objective of the target (PUOT), strength and Max MU setting in the MU objective function (MUOF) were adjusted respectively to investigate their effect on MU number, organs at risk (OARs) sparing and beam-on time. We found that the planning parameters influenced the MU number in a PUOT, strength and Max MU dependent manner. Combined with high priority for the UOT (HPUOT) and MUOF, the MU number was reduced from 443 ± 25 to 228 ± 22 MU/Gy without compromising the target coverage and OARs sparing. We also found beam-on time was proportional to MU number and it could be shortened from 7.9 ± 0.5 to 4.1 ± 0.4 minutes.
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Affiliation(s)
- Bao-Tian Huang
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| | - Zhu Lin
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| | - Pei-Xian Lin
- The Second Affiliated Hospital of Shantou University Medical College, Department of Nosocomial Infection Management, Shantou, 515041, China
| | - Jia-Yang Lu
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
| | - Chuang-Zhen Chen
- Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, 515031, China
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Huang BT, Lu JY, Lin PX, Chen JZ, Li DR, Chen CZ. Radiobiological modeling analysis of the optimal fraction scheme in patients with peripheral non-small cell lung cancer undergoing stereotactic body radiotherapy. Sci Rep 2015; 5:18010. [PMID: 26657569 PMCID: PMC4676016 DOI: 10.1038/srep18010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/10/2015] [Indexed: 02/07/2023] Open
Abstract
This study aimed to determine the optimal fraction scheme (FS) in patients with small peripheral non-small cell lung cancer (NSCLC) undergoing stereotactic body radiotherapy (SBRT) with the 4 × 12 Gy scheme as the reference. CT simulation data for sixteen patients diagnosed with primary NSCLC or metastatic tumor with a single peripheral lesion ≤3 cm were used in this study. Volumetric modulated arc therapy (VMAT) plans were designed based on ten different FS of 1 × 25 Gy, 1 × 30 Gy, 1 × 34 Gy, 3 × 15 Gy, 3 × 18 Gy, 3 × 20 Gy, 4 × 12 Gy, 5 × 12 Gy, 6 × 10 Gy and 10 × 7 Gy. Five different radiobiological models were employed to predict the tumor control probability (TCP) value. Three other models were utilized to estimate the normal tissue complication probability (NTCP) value to the lung and the modified equivalent uniform dose (mEUD) value to the chest wall (CW). The 1 × 30 Gy regimen is recommended to achieve 4.2% higher TCP and slightly higher NTCP and mEUD values to the lung and CW compared with the 4 × 12 Gy schedule, respectively. This regimen also greatly shortens the treatment duration. However, the 3 × 15 Gy schedule is suggested in patients where the lung-to-tumor volume ratio is small or where the tumor is adjacent to the CW.
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Affiliation(s)
- Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515031, China
| | - Jia-Yang Lu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515031, China
| | - Pei-Xian Lin
- Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, 69 North Dongsha Road, Shantou 515041, China
| | - Jian-Zhou Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515031, China
| | - De-Rui Li
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515031, China
| | - Chuang-Zhen Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515031, China
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