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Le Roy T, Wallet J, Barthoulot M, Leguillette C, Lacornerie T, Pasquier D, Lartigau E, Le Tinier F. IMRT in the treatment of locally advanced or inoperable NSCLC in the pre-durvalumab era: clinical outcomes and pattern of relapses, experience from the Oscar Lambret Center. Front Oncol 2023; 13:1236361. [PMID: 37810972 PMCID: PMC10554937 DOI: 10.3389/fonc.2023.1236361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background Intensity-modulated conformal radiotherapy (IMRT) has become the technique of choice for the treatment of locally advanced or inoperable non-small cell lung cancer (NSCLC). Nevertheless, this technique presents dosimetric uncertainties, particularly in treating moving targets such as pulmonary neoplasms. Moreover, it theoretically increases the risk of isolated nodal failure (INF) due to reduced incidental irradiation. Objective The objective of this study was to evaluate the efficacy and safety of IMRT in patients with inoperable NSCLC and to describe the pattern of relapses. Methods Patients with locally advanced NSCLC treated with radiotherapy and chemotherapy between 2015 and 2018 at the Oscar Lambret Center were retrospectively included in the study. Overall and progression-free survival were estimated using the Kaplan-Meier method. The cumulative incidence of the different components of relapse was estimated using the Kalbfleisch and Prentice method. Prognostic factors for relapse/death were investigated using the Cox model. A comparison with literature data was performed using a one-sample log-rank test. Results Seventy patients were included, and 65 patients (93%) had stage III disease. All the patients received chemotherapy, most frequently with cisplatin and navelbine. The dose received was 66 Gy administered in 33 fractions. The median follow-up and survival were 49.1 and 39.1 months, respectively. A total of 35 deaths and 43 relapses, including 29 with metastatic components, were reported. The overall survival rates at 1 and 2 years were 80.2% (95% confidence interval 68.3%-88.0%) and 67.2% (95% confidence interval 54.2%-77.3%), respectively. Locoregional relapse was observed in 14 patients, including two INF, one of which was located in the lymph node area adjacent to the clinical target volume. Median relapse-free survival was 15.2 months. No variable was statistically associated with the risk of relapse/death in multivariate analysis. Seven patients (10%) experienced grade 3 or higher toxicity. Conclusion The use of IMRT for locally advanced or inoperable NSCLC led to favorable long-term clinical outcomes. The rate of locoregional relapse, particularly isolated lymph node failure, was low and comparable with that of the three-dimensional radiotherapy series, as was the rate of early and late toxicities.
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Affiliation(s)
- Thomas Le Roy
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Jennifer Wallet
- Department of Biostatistics, Centre Oscar Lambret, Lille, France
| | - Maël Barthoulot
- Department of Biostatistics, Centre Oscar Lambret, Lille, France
| | | | | | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - Eric Lartigau
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - Florence Le Tinier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
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Zheng T, Shi X, Nie S, Yin L, Zhu J, Yu E, Shen H, Mo F. Effects of Chinese herbal diet on hematopoiesis, immunity, and intestines of mice exposed to different doses of radiation. Heliyon 2023; 9:e15473. [PMID: 37131450 PMCID: PMC10149268 DOI: 10.1016/j.heliyon.2023.e15473] [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: 02/12/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
Radiotherapy causes a series of side effects in patients with malignant tumors. Polygonati Rhizoma, Achyranthis Bidentatae Radix, and Epimedii Folium are all traditional Chinese herbs with varieties of functions such as anti-radiation and immune regulation. In this study, the above three herbs were used as a herbal diet to study their effects on the hematopoietic, immune, and intestinal systems of mice exposed to three doses of radiation. Our study showed that the diet had no radiation-protective effect on the hematopoietic and immune systems. However, at the radiation dose of 4 Gy and 8 Gy, the diet showed an obvious radiation-protective effect on intestinal crypts. At the dose of 8 Gy, we also found that the Chinese herbal diet had an anti-radiation effect on reducing the loss of the inhibitory nNOS+ neurons in the intestine. That provides a new diet for relieving the symptoms of hyperperistalsis and diarrhea in patients after radiotherapy.
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Affiliation(s)
- Tianyu Zheng
- Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Xiaohui Shi
- Department of Colorectal Surgery, The First Affiliated Hospital of Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Shuang Nie
- Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Lifeng Yin
- Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Jian Zhu
- Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Enda Yu
- Department of Colorectal Surgery, The First Affiliated Hospital of Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
| | - Hui Shen
- Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
- Corresponding author. Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Rd, Shanghai 200433, China.
| | - Fengfeng Mo
- Department of Colorectal Surgery, The First Affiliated Hospital of Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
- Corresponding author. Department of Naval Nutrition and Food Hygiene, Faculty of Naval Medicine, Naval Medical University, 800 Xiangyin Rd, Shanghai 200433, China.
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Wang R, Shang S, Huang X, Nie Y, Wang F, Yu J, Chen D. Patients with Lower Positive Lymph Nodes Ratio May Benefit from Preoperative Radiotherapy in Stage III Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2023; 22:15330338231173498. [PMID: 37157831 DOI: 10.1177/15330338231173498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although preoperative radiotherapy (PORT) is a promising therapeutic option for stage III non-small cell lung cancer (NSCLC), the efficacy of this treatment remains controversial. The positive lymph node ratio (PLNR) is recognized as an independent prognostic factor for survival. However, no previous studies have focused on the association between PLNR and PORT in stage III NSCLC. METHODS Data were collected from the Surveillance, Epidemiology and End Results (SEER) database, and all patients enrolled in this analysis were diagnosed during 2010-2015. The primary endpoint was overall survival (OS). Univariate and multivariate Cox regression analysis was used to identify factors associated with survival before and after case-control matching. PLNR was defined as the ratio of the number of positive lymph nodes to the total number of retrieved or examined lymph nodes. A cutoff value for PLNR was calculated using an X-tile model. RESULTS Overall, 391 patients with PORT and 2814 patients without PORT were enrolled in this study. The cohort after 1:1 case-control matching included 322 patients who received PORT and 322 patients without PORT. PORT was not associated with a significant effect on OS (HR = 1.14; 95% CI: 0.91-1.43; P = 0.825). Multivariate Cox regression analysis showed that PLNR (P < 0.001) was independently associated with OS in patients with stage III NSCLC. An X-tile model was used to identify a cutoff value for PLNR: the risk of death was significantly lower in patients with PLNR ≤0.41 who received PORT than in those with PLNR >0.41 who received PORT (HR = 0.59; 95% CI: 0.38-0.91; P = 0.015). CONCLUSION PLNR may be a prognostic factor for survival in patients with stage III NSCLC who undergo PORT. Lower PLNR is a predictor of better OS and thus warrants further study.
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Affiliation(s)
- Ruiyang Wang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shijie Shang
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong, China
| | - Xinyi Huang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yu Nie
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Fei Wang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jinming Yu
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong, China
- Research Unit of Radiation Oncology, Chinese Academy of Medical Sciences, Jinan, Shandong, China
| | - Dawei Chen
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, Shandong, China
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Eriguchi T, Takeda A, Nemoto T, Tsurugai Y, Sanuki N, Tateishi Y, Kibe Y, Akiba T, Inoue M, Nagashima K, Horita N. Relationship between Dose Prescription Methods and Local Control Rate in Stereotactic Body Radiotherapy for Early Stage Non-Small-Cell Lung Cancer: Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:3815. [PMID: 35954478 PMCID: PMC9367274 DOI: 10.3390/cancers14153815] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Variations in dose prescription methods in stereotactic body radiotherapy (SBRT) for early stage non-small-cell lung cancer (ES-NSCLC) make it difficult to properly compare the outcomes of published studies. We conducted a comprehensive search of the published literature to summarize the outcomes by discerning the relationship between local control (LC) and dose prescription sites. We systematically searched PubMed to identify observational studies reporting LC after SBRT for peripheral ES-NSCLC. The correlations between LC and four types of biologically effective doses (BED) were evaluated, which were calculated from nominal, central, and peripheral prescription points and, from those, the average BED. To evaluate information on SBRT for peripheral ES-NSCLC, 188 studies were analyzed. The number of relevant articles increased over time. The use of an inhomogeneity correction was mentioned in less than half of the articles, even among the most recent. To evaluate the relationship between the four BEDs and LC, 33 studies were analyzed. Univariate meta-regression revealed that only the central BED significantly correlated with the 3-year LC of SBRT for ES-NSCLC (p = 0.03). As a limitation, tumor volume, which might affect the results of this study, could not be considered due to a lack of data. In conclusion, the central dose prescription is appropriate for evaluating the correlation between the dose and LC of SBRT for ES-NSCLC. The standardization of SBRT dose prescriptions is desirable.
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Affiliation(s)
- Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura 247-0056, Japan
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura 247-0056, Japan
| | - Takafumi Nemoto
- Department of Radiation Oncology, Keio University Hospital, Shinjuku, Tokyo 160-8582, Japan
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura 247-0056, Japan
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura 247-0056, Japan
| | - Yudai Tateishi
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Yuichi Kibe
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura 247-0056, Japan
| | - Takeshi Akiba
- Department of Radiation Oncology, Tokai University Hachioji Hospital, Hachioji 192-0032, Japan
| | - Mari Inoue
- Department of Respiratory Medicine, Ofuna Chuo Hospital, Kamakura 247-0056, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku, Tokyo 160-8582, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama 236-0004, Japan
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Katakura S, Murakami S. Clinically-meaningful improvements in therapy for unresectable NSCLC. Expert Rev Anticancer Ther 2022; 22:927-937. [PMID: 35838638 DOI: 10.1080/14737140.2022.2102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The ideal management of patients with unresectable non-small-cell lung cancer (NSCLC) is still developing. Unresectable NSCLC has a high mortality rate and poor prognosis, but the development of immune checkpoint inhibitors (ICIs) and molecular-targeted therapies has been a breakthrough in the treatment. The correct treatment of this patient population is crucial to maximize the clinical benefits without compromising their quality of life (QOL). AREAS COVERED We review the chemoradiotherapies, cytotoxic chemotherapies, immunotherapies, and molecular-targeted therapies available for unresectable NSCLC, focusing on their effects on overall survival, progression-free survival, and QOL. EXPERT OPINION Although cure is the ultimate goal of cancer treatment, it is often difficult to achieve in advanced NSCLC. Biomarker surveillance techniques, such as next-generation sequencing, have made it possible to provide the most appropriate treatment for each patient. This has led to clinically-meaningful improvements in therapies for unresectable NSCLC. The development of new molecular-targeted therapies and the establishment of treatment for patients who acquired drug resistance after initial treatment have a positive impact on patients' long-term survival. ICIs lead the long-term survival that can be considered a cure of some patients with advanced NSCLC, but such curative survival is difficult to achieve with cytotoxic chemotherapies and molecular-targeted therapies.
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Affiliation(s)
- Seigo Katakura
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Shuji Murakami
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
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Cao X, Liu P, Gao XS, Shang S, Liu J, Wang Z, Su M, Ding X. Redefine the Role of Proton Beam Therapy for the Locally-Advanced Non-Small Cell Lung Cancer Assisting the Reduction of Acute Hematologic Toxicity. Front Oncol 2022; 12:812031. [PMID: 35847952 PMCID: PMC9280487 DOI: 10.3389/fonc.2022.812031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
PurposeTo investigate the potential clinical benefit of utilizing intensity-modulated proton therapy (IMPT) to reduce acute hematologic toxicity for locally advanced non-small cell lung cancer (LA-NSCLC) patients and explore the feasibility of a model-based patient selection approach via the normal tissue complication probability (NTCP).MethodsTwenty patients with LA-NSCLC were retrospectively selected. Volumetric modulated arc photon therapy (VMAT) and IMPT plans were generated with a prescription dose of 60 Gy in 30 fractions. A wide range of cases with varied tumor size, location, stations of metastatic lymph nodes were selected to represent the general cancer group. Contouring and treatment planning followed RTOG-1308 protocol. Doses to thoracic vertebral bodies (TVB) and other organ at risks were compared. Risk of grade ≥ 3 acute hematologic toxicity (HT3+) were calculated based on the NTCP model, and patients with a reduction on NTCP of HT3+ from VMAT to IMPT (△NTCP_HT3+) ≥ 10% were considered to ‘significantly benefit from proton therapy.’ResultsCompared to VMAT, IMPT significantly reduced the dose to the TVB, the lung, the heart, the esophagus and the spinal cord. Tumor distance to TVB was significantly associated with △NTCP _HT3+ ≥ 10%. For the patients with tumor distance ≤ 0.7 cm to TVB, the absolute reduction of dose (mean, V30 and V40) to TVB was significantly lower than that in patients with tumor distance > 0.7 cm.ConclusionIMPT decreased the probability of HT3+ compared to VMAT by reducing the dose to the TVB in LA-NSCLC patients. Patients with tumor distance to TVB less than 0.7 cm are likely to benefit most from proton over photon therapy.
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Affiliation(s)
- Xi Cao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Peilin Liu
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Xian-shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- *Correspondence: Xuanfeng Ding, ; Xian-shu Gao,
| | - Shiyu Shang
- Department of Oncology, Hebei North University, Zhangjiakou, China
| | - Jiayu Liu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Zishen Wang
- Department of Radiation Oncology, Hebei Yizhou Tumor Hospital, Zhuozhou, China
| | - Mengmeng Su
- Department of Radiation Oncology, Peking University International Hospital, Beijing, China
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, United States
- *Correspondence: Xuanfeng Ding, ; Xian-shu Gao,
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Fornacon-Wood I, Chan C, Bayman N, Banfill K, Coote J, Garbett A, Harris M, Hudson A, Kennedy J, Pemberton L, Salem A, Sheikh H, Whitehurst P, Woolf D, Price G, Faivre-Finn C. Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer. Front Oncol 2022; 12:835844. [PMID: 35712515 PMCID: PMC9197586 DOI: 10.3389/fonc.2022.835844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Lung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. In this study, we evaluated whether the introduction of IMRT had an influence on the proportion of patients treated with curative-intent radiotherapy over time, and whether this had an effect on patient survival. Materials and Methods Patients treated with thoracic radiotherapy at our institute between 2005 and 2020 were retrospectively identified and grouped into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012 (selective use of IMRT), and C) 2013-2020 (full access to IMRT). Data on performance status (PS), stage, age, gross tumour volume (GTV), planning target volume (PTV) and survival were collected. The proportion of patients treated with a curative dose between these periods was compared. Multivariable survival models were fitted to evaluate the hazard for patients treated in each time period, adjusting for PS, stage, age and tumour volume. Results 12,499 patients were included in the analysis (n=2675 (A), n=3127 (B), and n=6697 (C)). The proportion of patients treated with curative-intent radiotherapy increased between the 3 time periods, from 38.1% to 50.2% to 65.6% (p<0.001). When stage IV patients were excluded, this increased to 40.1% to 58.1% to 82.9% (p<0.001). This trend was seen across all PS and stages. The GTV size increased across the time periods and PTV size decreased. Patients treated with curative-intent during period C had a survival improvement compared to time period A when adjusting for clinical variables (HR=0.725 (0.632-0.831), p<0.001). Conclusion IMRT was associated with to more patients receiving curative-intent radiotherapy. In addition, it facilitated the treatment of larger tumours that historically would have been treated palliatively. Despite treating larger, more complex tumours with curative-intent, a survival benefit was seen for patients treated when full access to IMRT was available (2013-2020). This study highlights the impact of IMRT on thoracic oncology practice, accepting that improved survival may also be attributed to a number of other contributing factors, including improvements in staging, other technological radiotherapy advances and changes to systemic treatment.
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Affiliation(s)
| | - Clara Chan
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Neil Bayman
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Kathryn Banfill
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Alex Garbett
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew Hudson
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Jason Kennedy
- Radiotherapy Related Research, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Laura Pemberton
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Ahmed Salem
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Hamid Sheikh
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Gareth Price
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Christie Medical Physics and Engineering, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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Shang S, Wang R, Wang F, Wu M, Chen D, Yu J. Treatment Patterns for Patients With Unresected Stage III NSCLC: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database. Front Oncol 2022; 12:874022. [PMID: 35785183 PMCID: PMC9248867 DOI: 10.3389/fonc.2022.874022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRecently, immunotherapy (IO) has shown striking survival improvement in unresectable stage III non-small cell lung cancer (NSCLC). However, the role of chemo-radiotherapy (CRT) for improvement in outcomes should not be disregarded. This study aimed to compare the treatment patterns and illustrate the impact of radiotherapy on the cancer-specific survival (CSS) and overall survival (OS) of patients with unresected locally advanced stage III NSCLC.MethodsWe retrospectively analyzed the data of patients with stage III NSCLC patients who did not undergo surgery from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database between 2001 and 2016, and three continuous years were regarded as one unit. Using the Kaplan-Meier method, we identified the CSS and OS. Then, a linear regression model was graphed to analyze the correlation between median survival of CSS or OS and calendar years in the radiotherapy alone, chemotherapy alone, and CRT groups.ResultsA total of 20986 patients were included in this study. In the overall cohort, CSS and OS improved consistently. To explore the reason for the improved survival, patients were divided into three different cohorts: radiotherapy alone, chemotherapy alone, and CRT. From 2001 to 2015, the median CSS improved persistently, 7, 8, 8, 9, and 11 months in the radiotherapy alone group and 12, 13, 15, 17, 19 months in the CRT group, but improvement in outcomes was less consistent in the chemotherapy alone group (10, 9, 11, 12, 12 months). To better visualize the correlation between CSS and calendar year, linear regression was performed, yielding r2 = 0.8032, P = 0.0395 for the radiotherapy alone group; r2 = 0.7206, P = 0.0689 for the chemotherapy alone group; and r2 = 0.9878, P = 0.0006 for the CRT group. Similar findings were observed in the OS data. In addition to this, we also analyzed different pathological types and also obtained the same results.ConclusionsThe survival of patients with unresectable stage III NSCLC has improved substantially, and the most pronounced and consistent improvements were observed in the CRT group. In addition to IO, radiotherapy played an essential role in the treatment of unresectable stage III NSCLC in the past years and should be considered in the design of clinical trials.
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Affiliation(s)
- Shijie Shang
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, China
| | - Ruiyang Wang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fei Wang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Meng Wu
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Dawei Chen
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, China
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Dawei Chen, ; Jinming Yu,
| | - Jinming Yu
- Department of Radiation Oncology, Shandong University Cancer Center, Jinan, China
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Research Unit of Radiation Oncology, Chinese Academy of Medical Sciences, Jinan, China
- *Correspondence: Dawei Chen, ; Jinming Yu,
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Mikami N, Takeda A, Hashimoto A, Takeda T, Kimura Y, Oku Y, Aoki Y, Eriguchi T, Tsurugai Y, Saeki N, Enomoto T, Kuribayashi H, Masuda M, Kaneko T. CT findings and treatment outcomes of ground-glass opacity predominant lung cancer after stereotactic body radiotherapy. Clin Lung Cancer 2022; 23:428-437. [DOI: 10.1016/j.cllc.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022]
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10
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Chughtai K, Negrete L, Vitzthum LK. Jumping to conclusions: Misdiagnosing radiation induced sarcoma as recurrent breast cancer. Clin Imaging 2022; 84:110-112. [DOI: 10.1016/j.clinimag.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
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Adachi T, Nagasawa R, Nakamura M, Kakino R, Mizowaki T. Vulnerabilities of radiomic features to respiratory motion on four-dimensional computed tomography-based average intensity projection images: A phantom study. J Appl Clin Med Phys 2022; 23:e13498. [PMID: 35088515 PMCID: PMC8906211 DOI: 10.1002/acm2.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/11/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the influence of respiratory motion on the robustness of radiomic features on four-dimensional computed tomography (4DCT)-based average intensity projection (AIP) images by employing an anthropomorphic chest phantom. METHODS Three spherical objects (φ30 mm), namely, acrylic (100 Hounsfield unit [HU], homogeneous), rubber (-140 HU, homogeneous), and cork (-630 HU, heterogeneous), were moved with motion amplitudes of 0, 1, 2.5, 4, 6, 8, and 10 mm in the phantom, and 4DCT scans were repeated at four different locations. Thereafter, the AIP images were generated considering the average of the 10 respiratory phases of the 4DCT images. Further, the targets were manually delineated on the AIP images in the lung window setting. A total of 851 radiomic features, including 107 unfiltered features and 744 wavelet filter-based features, were extracted from the region of interest for each material. The feature robustness among the different target motion amplitude (ε) was evaluated by normalizing the feature variability of the target motion relative to the variability of data from 573 patients with early-stage non-small cell lung cancer. The features with absolute ε values ≤0.5 were considered highly robust to target motions. RESULTS The percentage of robust unfiltered and wavelet filter-based features with a motion amplitude of 1 mm was greater than 83.2% and 93.4%, respectively; however, the percentage decreased by more than 24.3% and 17.6%, respectively, for motion amplitudes greater than 2.5 mm. The movement of cork had a small effect on the feature robustness compared to that of acrylic and rubber, regardless of the target motion amplitudes. CONCLUSIONS Our phantom study demonstrated that target motion amplitudes ≤1 mm led to the robustness of radiomic features on the 4DCT-based AIP images of thoracic regions. The frequency components and directions of the wavelet filters may be essential factors in 4DCT-based radiomic analysis.
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Affiliation(s)
- Takanori Adachi
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Ryoko Nagasawa
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Ryo Kakino
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
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12
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Ganti AK, Klein AB, Cotarla I, Seal B, Chou E. Update of Incidence, Prevalence, Survival, and Initial Treatment in Patients With Non-Small Cell Lung Cancer in the US. JAMA Oncol 2021; 7:1824-1832. [PMID: 34673888 DOI: 10.1001/jamaoncol.2021.4932] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Updated estimates of non-small cell lung cancer (NSCLC) in the US are needed. Objective To calculate the most recent epidemiologic estimates of NSCLC in the US. Design, Setting, and Participants This cross-sectional epidemiological analysis used the most recently released data from US cancer registries. The population-based US Cancer Statistics (USCS) database (2010-2017), comprised of the Surveillance, Epidemiology, and End Results (SEER) program and the National Program of Cancer Registries (NPCR) (collectively, SEER-NPCR) provided the NSCLC incidence estimate. The SEER-18 database provided data for incidence, prevalence, survival, and initial treatment by NSCLC stage. Adults aged 18 years or older diagnosed with NSCLC identified by International Classification of Diseases for Oncology, Third Edition, morphology codes were included. Main Outcomes and Measures Annual age-adjusted NSCLC incidence per 100 000 persons; annual prevalence per 100 000 persons; survival rate; initial treatment. Due to database release delays, incidence data were available through 2017, and other parameters through 2016. The analysis was conducted from June 2020 to July 2020. Results There were 1.28 million new NSCLC cases recorded during 2010 to 2017 in the US (SEER-NPCR: 53% male; 67% ≥ 65 years). From 2010 to 2017, NSCLC incidence per 100 000 decreased from 46.4 to 40.9 overall (age <65 years: 15.5 to 13.5; age ≥65 years: 259.9 to 230.0); the incidence of stage II, IIIA, and IIIB NSCLC was stable, and stage IV decreased slightly from 21.7 to 19.6, whereas stage I incidence increased from 10.8 to 13.2. From 2010 to 2016, NSCLC prevalence per 100 000 increased from 175.3 to 198.3 (nationwide projection of SEER-18); prevalence increased among younger patients (77.5 to 87.9) but decreased among older patients (825.1 to 812.4). Period survival analysis found that 26.4% of patients survived 5 years, which is higher than previously reported. The proportion of stage I NSCLC treated with radiation as single initial treatment rose markedly from 14.7% in 2010 to 25.7% in 2016. Patients with stage IV NSCLC aged 65 years or older were most likely to be untreated (38.3%). Conclusions and Relevance The findings of this cross-sectional epidemiological analysis suggest that the increased incidence of stage I NSCLC at diagnosis likely reflected improved evaluation of incidental nodules. A smaller proportion of patients aged 65 years or older with stage IV NSCLC were treated. Earlier detection and availability of effective treatments may underlie increased overall NSCLC prevalence, and higher than previously reported survival.
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Affiliation(s)
- Apar Kishor Ganti
- VA Nebraska Western Iowa Health Care System, Omaha, Nebraska.,University of Nebraska Medical Center, Omaha
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13
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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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14
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Dosimetry, Efficacy, Safety, and Cost-Effectiveness of Proton Therapy for Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13184545. [PMID: 34572772 PMCID: PMC8465697 DOI: 10.3390/cancers13184545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common malignancy which requires radiotherapy (RT) as an important part of its multimodality treatment. With the advent of the novel irradiation technique, the clinical outcome of NSCLC patients who receive RT has been dramatically improved. The emergence of proton therapy, which allows for a sharper dose of build-up and drop-off compared to photon therapy, has potentially improved clinical outcomes of NSCLC. Dosimetry studies have indicated that proton therapy can significantly reduce the doses for normal organs, especially the lung, heart, and esophagus while maintaining similar robust target volume coverage in both early and advanced NSCLC compared with photon therapy. However, to date, most studies have been single-arm and concluded no significant changes in the efficacy for early-stage NSCLC by proton therapy over stereotactic body radiation therapy (SBRT). The results of proton therapy for advanced NSCLC in these studies were promising, with improved clinical outcomes and reduced toxicities compared with historical photon therapy data. However, these studies were also mainly single-arm and lacked a direct comparison between the two therapies. Currently, there is much emerging evidence focusing on dosimetry, efficacy, safety, and cost-effectiveness of proton therapy for NSCLC that has been published, however, a comprehensive review comparing these therapies is, to date, lacking. Thus, this review focuses on these aspects of proton therapy for NSCLC.
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15
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Xu JK. Effect of Intensity Modulated Radiotherapy (IMRT) on the immunity, physical status and clinical effect of locally advanced NSCLC patients. Pak J Med Sci 2021; 37:1480-1485. [PMID: 34475934 PMCID: PMC8377908 DOI: 10.12669/pjms.37.5.4188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: To evaluate the clinical value of radiotherapy combined with Camrelizumab in treating locally advanced non-small cell lung cancer (NSCLC) patients. Methods: 80 locally advanced NSCLC patients were randomly divided into two groups (n=40). The control group was administered with intensity modulated radiation therapy (IMRT), whereas the experimental group with Camrelizumab in addition to IMRT. All the patients underwent clinical efficacy evaluation in terms of adverse drug reaction (ADR), physical status improvement after the treatment, and changes in T lymphocyte subpopulations (incl. CD3+, CD4+, CD8+, CD4+/CD8+). Results: The efficacy was found to be 70% and 47.5 in experimental group and control group, respectively, with the former being significantly better than the latter (p=0.03). The ADR rates were 50% and 37.5% in the experimental group and control group, respectively; but the difference remained insignificant (p=0.26). As for physical status improvement, experimental group evidently excelled the control group (p=0.04). The post-treatment indicators such as CD3+, CD4+, CD8+, CD4+/CD8+ were significantly more improved in the experimental group than the control group (CD3+, p=0.02; CD4+, p=0.00; and CD4+/CD8+, p=0.01). However, the changes in CD8+ were not significant at all (p=0.46). Conclusions: The combined therapy of IMRT with Camrelizumab appeared effective in dealing with the locally advanced NSCLC patients, as such patients presented significantly better immune state and physical status improvement but not increased ADR. The therapy is both safe and effective.
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Affiliation(s)
- Jun-Kai Xu
- Jun-kai Xu Department of Radiotherapy, The Affiliated Hospital (Group) of Putian University, Putian, 351100, P.R. China
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16
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Dosimetric impact of positron emission tomography-based gross tumour volume (GTV) delineation over conventional CT-based GTV delineation for carcinoma oesophagus. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:The aim of the study was to find the dosimetric impact of positron emission tomography (PET)-based gross tumour volume (GTV) delineation over computed tomography (CT)-based GTV delineation for carcinoma oesophagus.Methods:Fifteen patients with carcinoma oesophagus were retrospectively selected. Two sets of GTVs in CT plain images were generated, one with the help of intravenous and oral contrast (GTV CT) and the other with only using PET uptake with the standardised uptake value (simple way of determining the activity in PET) (SUV) > 2.5 (GTV PET). Corresponding PTVs were generated. For all patients, rapid arc plans were generated. Changes in target volumes and critical structure doses were evaluated. The Wilcoxon signed-rank test was used for statistical analysis, and p value < 0.05 was assumed as statistically significant.Results:Mean reduction in GTV was 5.76 ± 19.35 cc. Mean reduction in PTV 45 Gy was 42.40 ± 76.39 cc. Mean reduction in heart mean dose was 1.53 ± 2.16 Gy. Mean reductions in left lung V20% and V10% were 2.43 ± 4.28 and 3.25 ± 5.09 Gy, respectively. Mean reductions in right lung V20% and V10% were 3.11 ± 4.91 and 2.80 ± 4.51 Gy, respectively. Mean reduction in total lung mean dose was 1.00 ± 1.19 Gy.Finding:PET-based GTV contouring reduces the treatment volume and critical structure doses significantly over CT-based GTV contouring for carcinoma oesophagus.
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17
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Konefał A, Bieniasiewicz M, Wendykier J, Adamczyk S, Wrońska A. Additional radiation sources in a treatment and control room of medical linear accelerators. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Khanna L, Prasad SR, Yedururi S, Parameswaran AM, Marcal LP, Sandrasegaran K, Tirumani SH, Menias CO, Katabathina VS. Second Malignancies after Radiation Therapy: Update on Pathogenesis and Cross-sectional Imaging Findings. Radiographics 2021; 41:876-894. [PMID: 33891523 DOI: 10.1148/rg.2021200171] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A wide spectrum of second cancers occur as late complications of radiation therapy (RT) used to treat various malignancies. In addition to the type and dose of radiation, lifestyle, environmental, and genetic factors are important to the development of second malignancies in cancer survivors. Typically, RT-induced malignancies (RTIMs) are biologically aggressive cancers with a variable period of 5-10 years for hematologic malignancies and 10-60 years for solid tumors between RT and the development of the second cancer. Although carcinomas and leukemias commonly develop after low-dose RT, sarcomas occur in tissues or organs that receive high-dose RT. Angiosarcomas and unclassified pleomorphic sarcomas are the two most common RT-associated sarcomas; other sarcomas include malignant peripheral nerve sheath tumors, leiomyosarcomas, osteosarcomas, chondrosarcomas, and dedifferentiated or pleomorphic liposarcomas. Select RTIMs show tumor genetic characteristics that allow accurate diagnosis. Nearly all cutaneous angiosarcomas after RT for breast cancer and 90% of RT-associated malignant peripheral nerve sheath tumors are characterized by MYC gene amplifications and loss of H3 K27me3 expression, respectively. Classic papillary thyroid carcinomas that develop after RT frequently harbor RET/PTC rearrangements and have a favorable prognosis, despite their advanced stage at patient presentation. Select RTIMs demonstrate characteristic imaging findings and typically develop in the prior radiation field. Imaging is essential to early diagnosis, characterization, localization, and staging of RTIMs. Familiarity of radiologists with the diverse spectrum of RTIMs is essential for early diagnosis and optimal management. An invited commentary by Shapiro is available online. ©RSNA, 2021.
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Affiliation(s)
- Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Sireesha Yedururi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Anand M Parameswaran
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Leonardo P Marcal
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Kumar Sandrasegaran
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Sree Harsha Tirumani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.)
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Or M, Liu B, Lam J, Vinod S, Xuan W, Yeghiaian-Alvandi R, Hau E. A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer. Sci Rep 2021; 11:5939. [PMID: 33723301 PMCID: PMC7971013 DOI: 10.1038/s41598-021-85131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
Treatment-related toxicity is an important component in non-small cell lung cancer (NSCLC) management decision-making. Our aim was to evaluate and compare the toxicity rates of curative and palliative radiotherapy with and without chemotherapy. This meta-analysis provides better quantitative estimates of the toxicities compared to individual trials. A systematic review of randomised trials with > 50 unresectable NSCLC patients, treated with curative or palliative conventional radiotherapy (RT) with or without chemotherapy. Data was extracted for oesophagitis, pneumonitis, cardiac events, pulmonary fibrosis, myelopathy and neutropenia by any grade, grade ≥ 3 and treatment-related deaths. Mantel–Haenszel fixed-effect method was used to obtain pooled risk ratio. Forty-nine trials with 8609 evaluable patients were included. There was significantly less grade ≥ 3 acute oesophagitis (6.4 vs 22.2%, p < 0.0001) and any grade oesophagitis (70.4 vs 79.0%, p = 0.04) for sequential CRT compared to concurrent CRT, with no difference in pneumonitis (grade ≥ 3 or any grade), neutropenia (grade ≥ 3), cardiac events (grade ≥ 3) or treatment-related deaths. Although the rate of toxicity increased with intensification of treatment with RT, the only significant difference between treatment regimens was the rate of oesophagitis between the use of concurrent and sequential CRT. This can aid clinicians in radiotherapy decision making for NSCLC.
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Affiliation(s)
- M Or
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia.
| | - B Liu
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
| | - J Lam
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - S Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - W Xuan
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - R Yeghiaian-Alvandi
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
| | - E Hau
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, NSW, 2145, Australia
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McGunigal M, Lischalk JW, Randolph-Jackson P, Khaitan PG. Radiation Modalities Used in Lung Cancer: An Overview for Thoracic Surgeons. Semin Thorac Cardiovasc Surg 2021; 33:1114-1121. [PMID: 33705939 DOI: 10.1053/j.semtcvs.2021.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Radiation is a constantly evolving technology which plays a role in the management of lung cancer in a variety of settings: as an adjunct to surgery, definitively, and palliatively. Key aspects of radiation oncology-including acute and chronic toxicities of thoracic radiation and rationale for choosing one modality of radiation over another-may be obscure to those outside the field. We aim to provide a useful overview relevant for the thoracic surgeon of radiation technology and delivery. A review was performed of salient articles identifying radiation technologies used in lung cancer which were summarized and expounded upon with focus on integrating their history, evolution, and landmark trials establishing basis of their use. This article reviews the four fundamental means of external beam radiation employed in managing lung cancer and provides visual examples of comparison plans. We also touch on potential practice-changing developments in regards to proton therapy and radiation in the era of immunotherapy. Radiation oncology has evolved considerably over time to become a critical part of lung cancer management, particularly in early-stage inoperable disease and locally advanced disease. Maximizing tumor control while minimizing toxicity drives treatment strategies. Knowledge of these fundamentals will help the thoracic surgeon answer many questions patients pose regarding radiation.
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Affiliation(s)
- Mary McGunigal
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Jonathan W Lischalk
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Pamela Randolph-Jackson
- Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, District of Columbia.
| | - Puja Gaur Khaitan
- Department of Surgery, Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
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21
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Effects of glutamine for prevention of radiation-induced esophagitis: a double-blind placebo-controlled trial. Invest New Drugs 2021; 39:1113-1122. [PMID: 33580845 DOI: 10.1007/s10637-021-01074-w] [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: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 11/12/2022]
Abstract
Purpose Acute radiation-induced esophagitis (ARIE) leads to treatment delays, decreased quality of life (QOL), and secondary adverse events such as weight loss. Grade 3 ARIE occurs in 15%-30% of patients undergoing radiotherapy to the esophagus, leading to disruption or discontinuation of treatment. The purpose of this study was to assess the effects of glutamine, a common nutritional supplement, on ARIE in patients with thoracic malignancies. Patients and methods This double-blind, placebo-controlled trial enrolled patients with advanced thoracic malignancies receiving concurrent chemotherapy/radiotherapy or radiotherapy alone, with radiation doses to the esophagus ≥45 Gy. Patients were randomized (1:1) to receive 4 g of glutamine or glycine placebo twice daily. The primary objective was to determine whether glutamine decreases the severity of ARIE in these patients. Secondary objectives included assessment of the effects of glutamine on other measures of ARIE, weight, symptom burden measure assessed by the MD Anderson Symptom Inventory (MDASI-HN) questionnaire and the toxicity profile of glutamine. Results At the time of interim analysis, 53 patients were enrolled: 27 in the glutamine arm and 26 in the placebo arm. There was no difference in the incidence of esophagitis in the first 6 weeks of radiotherapy between the glutamine and placebo arms (74% versus 68%; P = 1.00). There were no significant differences between the two arms for time to onset of esophagitis. The duration of ARIE was shorter (6.3 versus 7.1 weeks; P = 0.54) and median weight loss was lower (0.9 kg versus 2.8 kg; p = 0.83) in the glutamine arm versus the placebo arm. The groups differ significantly in core symptom severity (2.1 vs 1.5, p < .03) but not in head and neck specific symptom severity (1.2 vs 1.1, p < .60) nor in symptom interference (2.1 vs 1.7, p < .22). There was no grade 3 or higher adverse event at least possibly related to glutamine. The study was terminated for futility following interim analysis. Conclusion Oral glutamine was not associated with significant improvement in severity of ARIE, weight loss, head and neck specific symptoms or symptom interference compared with placebo in patients with advanced thoracic malignancies receiving radiotherapy to the esophagus.Clinical trial information. NCT01952847, and date of registration is September 30, 2013.
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22
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Nie X, Rimner A, Li G. Feasibility of MR-guided radiotherapy using beam-eye-view 2D-cine with tumor-volume projection. Phys Med Biol 2021; 66:045020. [PMID: 33361569 DOI: 10.1088/1361-6560/abd66a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Current magnetic resonance imaging (MRI) guided radiotherapy (MRgRT) applies sagittal/coronal 2D-cine to monitor major tumor motions, however, the beam eye's view (BEV) with volumetric tumor projection would be the best measure for radiation beam conformality, independent of tumor through-plane motion. The goal is to assess the feasibility, accuracy, and performance of the BEV approach. METHODS Beam-specific BEV 2D-cine with volume-projected tumor contours were simulated to establish a 2D/3D tumor match against a tumor-motion library based on multi-breath time-resolved (TR) 4DMRI images. Two BEV-library-matching methods were developed: (1) fast screening with tumor center-of-mass (∆COM), in-plane area ratio, and DICE similarity, and finalizing with the highest DICE score and (2) DICE screening for top-3 candidates and finalizing with rigid registration. A 4D-XCAT digital phantom and 8 lung-cancer patients were used for assessment. For each patient, 3 sets of 40 s TR-4DMRI were acquired at 2 Hz and 6 representative BEV were created with the isocenter set at tumor COM in mid-respiration. One TR-4DMRI set (40 × 2 = 80-images) was used to simulate BEV 2D-cine and the other two (160-images) were used to create a library. The matching result was validated against the ground truth within the test set. Using a leave-one-out strategy, the success rate, accuracy, and speed of tumor matching were assessed for volume-projected tumors over 11520 time-points (=8patients•3sets•80images•6BEVs). RESULTS Volume-projected tumor contour area on the 6 BEVs varies by 60% ± 8% and [Formula: see text] (in-plane/volume-projected) varies by 82% ± 9%. The [Formula: see text] changes with tumor shape, orientation, and through-plane motion. Method-1 produces 96% matching success (ΔCOM = 0.7 ± 0.2 mm, [Formula: see text]=1.01 ± 0.02, Dice=0.92 ± 0.02) with the computational time of 15 ± 1 ms/match, while method-2 produces 94% ± 1% success (ΔCOM = 0.2 ± 0.1 mm, [Formula: see text]=1.00 ± 0.01, Dice = 0.94 ± 0.02) with 223 ± 13 ms/match. CONCLUSION This study has demonstrated the feasibility, accuracy, and benefits of BEV 2D-cine imaging with tumor-volume projection, allowing real-time tumor motion monitoring and beam conformality checking. Further clinical evaluation is necessary before MRgRT applications.
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Affiliation(s)
- Xingyu Nie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States of America
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23
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Patel NV, Yu NY, Koroulakis A, Diwanji T, Sawant A, Sio TT, Mohindra P. Proton therapy for thoracic malignancies: a review of oncologic outcomes. Expert Rev Anticancer Ther 2021; 21:177-191. [PMID: 33118427 DOI: 10.1080/14737140.2021.1844567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Radiotherapy is an integral component in the treatment of the majority of thoracic malignancies. By taking advantage of the steep dose fall-off characteristic of protons combined with modern optimization and delivery techniques, proton beam therapy (PBT) has emerged as a potential tool to improve oncologic outcomes while reducing toxicities from treatment.Areas covered: We review the physical properties and treatment techniques that form the basis of PBT as applicable for thoracic malignancies, including a brief discussion on the recent advances that show promise to enhance treatment planning and delivery. The dosimetric advantages and clinical outcomes of PBT are critically reviewed for each of the major thoracic malignancies, including lung cancer, esophageal cancer, mesothelioma, thymic cancer, and primary mediastinal lymphoma.Expert opinion: Despite clear dosimetric benefits with PBT in thoracic radiotherapy, the improvement in clinical outcomes remains to be seen. Nevertheless, with the incorporation of newer techniques, PBT remains a promising modality and ongoing randomized studies will clarify its role to determine which patients with thoracic malignancies receive the most benefit. Re-irradiation, advanced disease requiring high cardio-pulmonary irradiation volume and younger patients will likely derive maximum benefit with modern PBT.
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Affiliation(s)
- Nirav V Patel
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Antony Koroulakis
- Department of Radiation Oncology, University of Maryland School of Medicine and Maryland Proton Treatment Center, Baltimore, MD, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine and Maryland Proton Treatment Center, Baltimore, MD, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine and Maryland Proton Treatment Center, Baltimore, MD, USA
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24
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Ribeiro CO, Terpstra J, Janssens G, Langendijk JA, Both S, Muijs CT, Wijsman R, Knopf A, Meijers A. Evaluation of continuous beam rescanning versus pulsed beam in pencil beam scanned proton therapy for lung tumours. Phys Med Biol 2020; 65:23NT01. [PMID: 33120367 DOI: 10.1088/1361-6560/abc5c8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The treatment of moving targets with pencil beam scanned proton therapy (PBS-PT) may rely on rescanning strategies to smooth out motion induced dosimetric disturbances. PBS-PT machines, such as Proteus®Plus (PPlus) and Proteus®One (POne), deliver a continuous or a pulsed beam, respectively. In PPlus, scaled (or no) rescanning can be applied, while POne implies intrinsic 'rescanning' due to its pulsed delivery. We investigated the efficacy of these PBS-PT delivery types for the treatment of lung tumours. In general, clinically acceptable plans were achieved, and PPlus and POne showed similar effectiveness.
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Affiliation(s)
- Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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25
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Diwanji T, Sawant A, Sio TT, Patel NV, Mohindra P. Proton stereotactic body radiation therapy for non-small cell lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1198. [PMID: 33241047 PMCID: PMC7576051 DOI: 10.21037/atm-20-2975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tejan Diwanji
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.,Maryland Proton Treatment Center Baltimore, MD, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Nirav V Patel
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.,Maryland Proton Treatment Center Baltimore, MD, USA
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26
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Burgess JT, Rose M, Boucher D, Plowman J, Molloy C, Fisher M, O'Leary C, Richard DJ, O'Byrne KJ, Bolderson E. The Therapeutic Potential of DNA Damage Repair Pathways and Genomic Stability in Lung Cancer. Front Oncol 2020; 10:1256. [PMID: 32850380 PMCID: PMC7399071 DOI: 10.3389/fonc.2020.01256] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
Despite advances in our understanding of the molecular biology of the disease and improved therapeutics, lung cancer remains the most common cause of cancer-related deaths worldwide. Therefore, an unmet need remains for improved treatments, especially in advanced stage disease. Genomic instability is a universal hallmark of all cancers. Many of the most commonly prescribed chemotherapeutics, including platinum-based compounds such as cisplatin, target the characteristic genomic instability of tumors by directly damaging the DNA. Chemotherapies are designed to selectively target rapidly dividing cells, where they cause critical DNA damage and subsequent cell death (1, 2). Despite the initial efficacy of these drugs, the development of chemotherapy resistant tumors remains the primary concern for treatment of all lung cancer patients. The correct functioning of the DNA damage repair machinery is essential to ensure the maintenance of normal cycling cells. Dysregulation of these pathways promotes the accumulation of mutations which increase the potential of malignancy. Following the development of the initial malignancy, the continued disruption of the DNA repair machinery may result in the further progression of metastatic disease. Lung cancer is recognized as one of the most genomically unstable cancers (3). In this review, we present an overview of the DNA damage repair pathways and their contributions to lung cancer disease occurrence and progression. We conclude with an overview of current targeted lung cancer treatments and their evolution toward combination therapies, including chemotherapy with immunotherapies and antibody-drug conjugates and the mechanisms by which they target DNA damage repair pathways.
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Affiliation(s)
- Joshua T Burgess
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Maddison Rose
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Didier Boucher
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Jennifer Plowman
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Christopher Molloy
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Mark Fisher
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Connor O'Leary
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Derek J Richard
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Kenneth J O'Byrne
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Emma Bolderson
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
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27
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Reda M, Bagley AF, Zaidan HY, Yantasee W. Augmenting the therapeutic window of radiotherapy: A perspective on molecularly targeted therapies and nanomaterials. Radiother Oncol 2020; 150:225-235. [PMID: 32598976 DOI: 10.1016/j.radonc.2020.06.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022]
Abstract
Radiation therapy is a cornerstone of modern cancer therapy alongside surgery, chemotherapy, and immunotherapy, with over half of all cancer patients receiving radiation therapy as part of their treatment regimen. Development of novel radiation sensitizers that can improve the therapeutic window of radiation therapy are sought after, particularly for tumors at an elevated risk of local and regional recurrence such as locally-advanced lung, head and neck, and gastrointestinal tumors. This review discusses clinical strategies to enhance radiotherapy efficacy and decrease toxicity, hence, increasing the overall therapeutic window. A focus is given to the molecular targets that have been identified and their associated mechanisms of action in enhancing radiotherapy. Examples include cell survival and proliferation signaling such as the EGFR and PI3K/AKT/mTOR pathways, DNA repair genes including PARP and ATM/ATR, angiogenic growth factors, epigenetic regulators, and immune checkpoint proteins. By manipulating various mechanisms of tumor resistance to ionizing radiation (IR), targeted therapies hold significant value to increase the therapeutic window of radiotherapy. Further, the use of novel nanoparticles to enhance radiotherapy is also reviewed, including nanoparticle delivery of chemotherapies, metallic (high-Z) nanoparticles, and nanoparticle delivery of targeted therapies - all of which may improve the therapeutic window of radiotherapy by enhancing the tumor response to IR or reducing normal tissue toxicity.
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Affiliation(s)
- Moataz Reda
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, United States; PDX Pharmaceuticals, Portland, OR 97239, United States
| | - Alexander F Bagley
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | | | - Wassana Yantasee
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, United States; PDX Pharmaceuticals, Portland, OR 97239, United States.
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28
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Jeong JU, Jeon W, Ahn SJ, Kim YC, Oh IJ, Park CK, Yoon MS, Song JY, Nam TK, Chung WK. Treatment time to the end of thoracic radiotherapy has more predictive power for survival than radiation dose intensity in patients with limited-stage small-cell lung cancer receiving concurrent chemoradiation of more than 45 Gy. Oncol Lett 2020; 19:239-246. [PMID: 31897135 PMCID: PMC6924076 DOI: 10.3892/ol.2019.11107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/07/2019] [Indexed: 11/07/2022] Open
Abstract
The optimal protocol for thoracic radiotherapy (TRT) in combination with chemotherapy in patients with limited-stage small-cell lung cancer (LS-SCLC) remains elusive. The present study aimed to evaluate radiation parameters in association with survival outcomes. A total of 101 patients with LS-SCLC who completed TRT at ≥45 Gy and concurrent chemotherapy were retrospectively reviewed. The median dose and duration of TRT were 50 Gy and 38 days, respectively. The median duration from the start of either therapy to the end of TRT (SER) was 60 days. The median survival for all patients was 26.9 months. The 3-year local control (LC), progression-free survival (PFS) and overall survival (OS) rates were 52.0, 29.5 and 37.6%, respectively, and the 5-year LC, PFS and OS rates were 50.1, 28.3 and 26.7%, respectively. Univariate analysis revealed that patient age, tumor stage, timing and dose of TRT, SER, prophylactic cranial irradiation (PCI), and tumor response were significantly associated with treatment outcomes. Multivariate analysis revealed that stage was the only significant prognostic factor for LC (P=0.011), PFS (P<0.001) and OS (P<0.001). Tumor response (P=0.014), PCI (P=0.007) and SER (P=0.005) were significant predictors of OS. OS was improved in patients who achieved complete response, and their SER was ≤70 days (P<0.001). Short treatment duration (SER ≤70 days) was a significant predictor of OS in patients with LS-SCLC who completed planned TRT at ≥45 Gy with concurrent chemoradiotherapy.
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Affiliation(s)
- Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Wan Jeon
- Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Gijang-gun, Busan 46033, Republic of Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Chul-Kyu Park
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Ju-Young Song
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do 58128, Republic of Korea
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29
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Yuan HB, Wang XY, Sun JY, Xie FF, Zheng XX, Tao GY, Pan L, Hogarth DK. Flexible bronchoscopy-guided microwave ablation in peripheral porcine lung: a new minimally-invasive ablation. Transl Lung Cancer Res 2019; 8:787-796. [PMID: 32010557 DOI: 10.21037/tlcr.2019.10.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Transbronchial lung biopsy is an important approach to diagnose peripheral lung cancer, but bronchoscopy based treatment options are limited and poorly studied. A flexible bronchoscopy-guided water-cooled microwave ablation (MWA) catheter was developed to evaluate the feasibility and safety both in ex vivo and in vivo porcine models. Methods Using direct penetration of the catheter through the surface of ex vivo porcine lung, ablations (n=9) were performed at 70, 80, 90 W for 10 minutes. Temperatures of the catheter and 10, 15, 20 mm away from the tip were measured. Under bronchoscopy conditions in porcine lung, ablations (n=18, 6 in ex vivo and 12 in vivo) were performed at 80 W for 5 minutes. Computed tomography (CT) was acquired perioperative, 24 hours, 2 weeks, and 4 weeks post ablation. Ablation zones were excised at 24 hours and 4 weeks respectively. Long-axis diameter (Dl) and short-axis diameter (Ds) were measured and tissues were sectioned for pathological examination. Results In-ex vivo lung, the temperature at 20 mm removed was over 60 °C at 80 W for 288±26 seconds. The ablations under bronchoscopic conditions were successful in-ex vivo and in vivo lung. No complications occurred during the procedures. Coagulation necrosis was visible at 24 hours, and repaired fibrous tissue was seen at 4 weeks. Conclusions The flexible bronchoscopy-guided water-cooled MWA is feasible and safe. This early animal data holds promise of MWA becoming a potential therapeutic tool for Peripheral Lung Cancers.
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Affiliation(s)
- Hai-Bin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiang-Yu Wang
- Department of Respiration, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 451200, China
| | - Jia-Yuan Sun
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Fang-Fang Xie
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Xiao-Xuan Zheng
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Guang-Yu Tao
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Pan
- Department of Respiration, Shanghai Public Health Clinic Center, Fudan University, Shanghai 201058, China
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30
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Ren J, Gong G, Yao X, Yin Y. Dosimetric comparison of dose accumulation between rigid registration and deformation registration in intensity-modulated radiation therapy for large volume non-small cell lung cancer. Transl Cancer Res 2019; 8:2878-2885. [PMID: 35117045 PMCID: PMC8798251 DOI: 10.21037/tcr.2019.11.15] [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: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022]
Abstract
Background To evaluate the cumulative dose to the target volumes and organs at risk (OARs) after replanning during intensity-modulated radiation therapy (IMRT) for large volume non-small cell lung cancer (NSCLC) based on rigid registration and deformation registration technologies. Methods Thirty patients with large volume NSCLC who were treated with IMRT were selected, and two four-dimensional computed tomography (4DCT) scans were acquired before radiotherapy and after 20 fractions of radiotherapy. The initial treatment plan (Plan1) based on the average density projection CT (CT1-avg) of the first 4DCT images and the second treatment plan (Plan2) based on CT2-avg of the second 4DCT images were calculated. Then, the dose distributions of Plan2 and Plan1 were accumulated based on rigid and deformation registration technologies to obtain Planrig and Plandef, respectively. Finally, the volume changes of the gross tumor volume (GTV) and OARs between the two CT scans, and the dose-volume parameters among Plan1, Plan2, Planrig and Plandef were compared. Results Compared with those on the first CT, the mean GTV and heart volume on the second CT decreased by 44.2% and 5.5%, respectively, while the mean volumes of the ipsilateral lung, contralateral lung and total lung increased by 5.2%, 6.2% and 5.8%, respectively. The differences in the above volume parameters between the two CT scans were statistically significant (P<0.05). Compared with those in Plan1, the D95, D98 and V100% values of the IGTV (GTV fusion of 10 CT phases) and planning target volume (PTV) in Plan2 did not change significantly (P>0.05), and those of Planrig and Plandef decreased slightly (P<0.05). The dose-volume parameters of the spinal cord, heart, ipsilateral lung and total lung in Plan2, Planrig and Plandef were significantly lower than those in Plan1 (P<0.05). Among these parameters, V30 and the mean dose to the heart in Plan2, Planrig and Plandef decreased by 27.3%, 16.5%, and 15.3% and 15.2%, 6.6%, and 5.6% compared to those in Plan1, respectively; V20 and the mean dose to the total lung in Plan2, Planrig and Plandef decreased by 15.6%, 4.5%, and 3.7% and 15.7%, 6.2%, and 5.1% compared to those in Plan1, respectively. Some dose-volume parameters (including D95 and D98 to the target volume, V40 of the heart, V20 and the mean dose to the ipsilateral lung and the total lung) of Plandef were slightly higher than those in Planrig (P<0.05). The Dice similarity coefficients (DSCs) of the OARs after deformation registration were significantly higher than those after rigid registration (P<0.05). Conclusions The dose-volume parameters of OARs in Plan2 were noticeably different from those in Plan1, so all of these parameters have large deviations in evaluating the actual dose to the OARs. And, the dose-volume parameters obtained by deformation registration can better predict the actual dose than those obtained by rigid registration.
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Affiliation(s)
- Jianxin Ren
- School of Physics and Technology, Wuhan University, Wuhan 430072, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Guanzhong Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Xinsen Yao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
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Kumar SS, McGarry RC. Management of local recurrences and regional failure in early stage non-small cell lung cancer after stereotactic body radiation therapy. Transl Lung Cancer Res 2019; 8:S213-S221. [PMID: 31673526 DOI: 10.21037/tlcr.2019.09.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is a very effective way to treat early stage non-small cell lung cancer (NSCLC) and small oligometastatic lung lesions with consistently high rates of local control, but both local and regional/distant recurrences still occur. The management of recurrences remains unsettled and may entail repeat SBRT, conventionally fractionated external beam RT (EF-EBRT), chemotherapy or surgery. Most patients with local recurrences [within the initial planning target volume (PTV)] can be salvaged successfully with good cancer specific survival. Nonetheless, proximity of the initial SBRT delivery to organs at risk (ribs, blood vessels, airways) may make retreatment more difficult. With attention to detail and careful patient selection, both surgery and reirradiation can be performed safely and effectively. Strategies for management of regional (nodal) recurrences may require conventional therapies tailored to the patterns of failure. The role of immunotherapy in salvage has not been elucidated as yet. We review here data on the available literature concerning salvage of SBRT lung patients.
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Affiliation(s)
- Sameera S Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ronald C McGarry
- Department of Radiation Oncology, University of Kentucky, Lexington, KY, USA
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Wang S, Xing HX, Li J, Zhang YJ, Fan TY, Yuan SH, Hu XD, Xu M. Correlation of displacement of mediastinal metastatic lymph nodes with adjacent organs in non-small cell lung cancer on four-dimensional computed tomography. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Suzhen Wang
- Shandong Cancer Hospital Affiliated to Shandong University; Department of Radiation Oncology; Shandong China
| | - Huai-Xin Xing
- Shandong Cancer Hospital & Institute; Department of Anesthesiology; Shandong China
| | - Jianbin Li
- Shandong Cancer Hospital Affiliated to Shandong University; Department of Radiation Oncology; Shandong Cancer Hospital & Institute; Shandong China
| | | | - Ting-Yong Fan
- Shandong Cancer Hospital & Institute; Shandong China
| | | | - Xu-Dong Hu
- Shandong Cancer Hospital & Institute; Shandong China
| | - Min Xu
- Shandong Cancer Hospital & Institute; Shandong China
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33
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Tsoutsou P, Montay-Gruel P, Vozenin MC. The Era of Modern Radiation Therapy: Innovations to Spare Normal Tissues. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_70-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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34
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Abstract
Curative-intent lung cancer radiation therapy either alone (RT) or combined with immuno-chemotherapy is associated with potential risk of serious radiation-induced lung injury. This review provides a summary of the role of SPECT ventilation perfusion (V/Q) imaging as an emerging adjunct to lung cancer RT planning and treatment dosimetry. Denoted "functional lung avoidance RT" it is hypothesized that preferential dosimetric avoidance of physiologically functional lung may reduce the frequency of radiation-induced lung injury. SPECT V/Q imaging datasets available during the planning process allows the prioritization (or "personalization') of RT dose to minimize the volume of functional lung probabilistically exposed to injurious radiation dose. Selective escalation of target dose and adaptive planning and replanning is also enabled. The emergent importance of the tumor-lung microenvironment and its biologic relationship to local immune effectors in lung cancer provides further incentive to individualize RT planning and delivery. This review examines important normal tissue dosimetric constraints that are part of current standards-of-care and the new dosimetric parameters associated with functional lung avoidance RT. SPECT V/Q has been a valuable tool in investigating the feasibility and efficacy of functional lung avoidance RT but is yet to become main stream due to the lack of large clinical trials. It is encouraging however that functional lung avoidance is feasible in RT dose-target delineation and some of the more promising studies are discussed.
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Affiliation(s)
- Enid M Eslick
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Mark J Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Dale L Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
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35
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Zhao XH, Wang D, Wang F, Zhu SC. Comparison of the effect of postoperative radiotherapy with surgery alone for esophagus squamous cell carcinoma patients: A meta-analysis. Medicine (Baltimore) 2018; 97:e13168. [PMID: 30461614 PMCID: PMC6393104 DOI: 10.1097/md.0000000000013168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to evaluate the effect of postoperative radiotherapy for patients having esophagus squamous cell carcinoma after radical surgery. METHODS A comprehensive research was performed in Pubmed, Embase and Cochrane Library electronic databases from inception until December 10, 2017. We collected all published full articles about comparison of surgery plus postoperative radiotherapy with surgery alone. RESULTS Four randomized-controlled trials (RCTs) with 1050 participants and 8 non-randomized-controlled trials with 3248 participants were included and evaluated separately. The risk ratio rate and its 95% confidence interval (CI) were calculated. Both RCTs and non-randomized-controlled trials (NRCTs) groups showed a significant increase in 3-year overall survival (OS) rate (RRRCT = 0.89, 95% CI: 0.80-0.99; RRNRCT = 0.82, 95% CI: 0.76-0.88) and decrease locoregional recurrence rate (RRRCT = 0.53, 95% CI: 0.43-0.66; RRNRCT = 0.47, 95% CI: 0.32-0.69) after postoperative radiotherapy compared with surgery alone. The 5-year OS rate in the group of NRCTs was markedly enhanced (RR = 0.87, 95% CI: 0.82-0.92), while that of the RCTs group was not enhanced in a significant way (RR = 0.84, 95% CI: 0.70-1.02). Subgroup analysis based on pathological lymph node status revealed that postoperative radiotherapy could improve OS regardless of pathological lymph node status (pathological lymph node positive patients: RR5-year os-RCT = 0.81, 95% CI: 0.70-0.93; RR5-year os-NRCT = 0.87, 95% CI: 0.80-0.94; Pathological lymph node negative patients: RR3-year os-RCT = 0.76, 95% CI: 0.59-0.96; RR3-year os-NRCT = 0.52, 95% CI: 0.30-0.89). No effect on distant recurrence rate was detected. Adverse effects induced by postoperative radiotherapy were comparatively modest and tolerable. CONCLUSION Polled results yielded that postoperative radiotherapy was promising in improving OS and reducing the locoregional recurrence rate. More large-scale up-to-date RCTs are needed to further validate the use of postoperative radiotherapy in modern practice.
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Affiliation(s)
- Xiao-han Zhao
- Department of Radiation Oncology, The Fourth Hospital Attached to Hebei Medical University
| | - Duo Wang
- Hebei Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology, College of Life Sciences, Hebei Normal University, Shijiazhuang, China
| | - Fang Wang
- Hebei Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology, College of Life Sciences, Hebei Normal University, Shijiazhuang, China
| | - Shu-chai Zhu
- Department of Radiation Oncology, The Fourth Hospital Attached to Hebei Medical University
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36
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Trnková P, Knäusl B, Actis O, Bert C, Biegun AK, Boehlen TT, Furtado H, McClelland J, Mori S, Rinaldi I, Rucinski A, Knopf AC. Clinical implementations of 4D pencil beam scanned particle therapy: Report on the 4D treatment planning workshop 2016 and 2017. Phys Med 2018; 54:121-130. [PMID: 30337001 DOI: 10.1016/j.ejmp.2018.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022] Open
Abstract
In 2016 and 2017, the 8th and 9th 4D treatment planning workshop took place in Groningen (the Netherlands) and Vienna (Austria), respectively. This annual workshop brings together international experts to discuss research, advances in clinical implementation as well as problems and challenges in 4D treatment planning, mainly in spot scanned proton therapy. In the last two years several aspects like treatment planning, beam delivery, Monte Carlo simulations, motion modeling and monitoring, QA phantoms as well as 4D imaging were thoroughly discussed. This report provides an overview of discussed topics, recent findings and literature review from the last two years. Its main focus is to highlight translation of 4D research into clinical practice and to discuss remaining challenges and pitfalls that still need to be addressed and to be overcome.
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Affiliation(s)
- Petra Trnková
- HollandPTC, P.O. Box 5046, 2600 GA Delft, the Netherlands; Erasmus MC, P.O. Box 5201, 3008 AE Rotterdam, the Netherlands
| | - Barbara Knäusl
- Department of Radiation Oncology, Division of Medical Radiation Physics, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/AKH Vienna, Austria
| | - Oxana Actis
- Paul Scherrer Institute (PSI), 5232 Villigen, Switzerland
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Aleksandra K Biegun
- KVI-Center for Advanced Radiation Technology, University of Groningen, Groningen, the Netherlands
| | - Till T Boehlen
- Paul Scherrer Institute (PSI), 5232 Villigen, Switzerland
| | - Hugo Furtado
- Department of Radiation Oncology, Division of Medical Radiation Physics, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/AKH Vienna, Austria
| | - Jamie McClelland
- Centre for Medical Image Computing, Dept. Medical Physics and Biomedical, University College London, London, UK
| | - Shinichiro Mori
- National Institute of Radiological Sciences for Charged Particle Therapy, Chiba, Japan
| | - Ilaria Rinaldi
- Lyon 1 University and CNRS/IN2P3, UMR 5822, 69622 Villeurbanne, France; MAASTRO Clinic, P.O. Box 3035, 6202 NA Maastricht, the Netherlands
| | | | - Antje C Knopf
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
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37
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Molitoris JK, Diwanji T, Snider JW, Mossahebi S, Samanta S, Badiyan SN, Simone CB, Mohindra P. Advances in the use of motion management and image guidance in radiation therapy treatment for lung cancer. J Thorac Dis 2018; 10:S2437-S2450. [PMID: 30206490 PMCID: PMC6123191 DOI: 10.21037/jtd.2018.01.155] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/26/2018] [Indexed: 12/22/2022]
Abstract
The development of advanced radiation technologies, including intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and proton therapy, has resulted in increasingly conformal radiation treatments. Recent evidence for the importance of minimizing dose to normal critical structures including the heart and lungs has led to incorporation of these advanced treatment modalities into radiation therapy (RT) for non-small cell lung cancer (NSCLC). While such technologies have allowed for improved dose delivery, implementation requires improved target accuracy with treatments, placing increasing importance on evaluating tumor motion at the time of planning and verifying tumor position at the time of treatment. In this review article, we describe issues and updates related both to motion management and image guidance in the treatment of NSCLC.
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Affiliation(s)
- Jason K. Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James W. Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Santanu Samanta
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Shahed N. Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
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38
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Vyfhuis MAL, Rice S, Remick J, Mossahebi S, Badiyan S, Mohindra P, Simone CB. Reirradiation for locoregionally recurrent non-small cell lung cancer. J Thorac Dis 2018; 10:S2522-S2536. [PMID: 30206496 PMCID: PMC6123190 DOI: 10.21037/jtd.2017.12.50] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/14/2022]
Abstract
Locoregional failure in non-small cell lung cancer (NSCLC) remains high, and the management for recurrent disease in the setting of prior radiotherapy is difficult. Retreatment options such as surgery or systemic therapy are typically limited or frequently result in suboptimal outcomes. Reirradiation (reRT) of thoracic malignancies may be an optimal strategy for providing definitive local control and offering a new chance of cure. Yet, retreatment with radiation therapy can be challenging for fear of excessive toxicities and the inability to safely deliver definitive (≥60 Gy) doses of reRT. However, with recent improvements in radiation delivery techniques and image-guidance, dose-escalation with reRT is possible and outcomes are encouraging. Here, we present a review of various radiation techniques, clinical outcomes and associated toxicities in patients with locoregionally recurrent NSCLC treated primarily with reRT.
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Affiliation(s)
- Melissa A L Vyfhuis
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Stephanie Rice
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jill Remick
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sina Mossahebi
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Shahed Badiyan
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Pranshu Mohindra
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Charles B Simone
- Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
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39
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Kesner A, Pan T, Zaidi H. Data-driven motion correction will replace motion-tracking devices in molecular imaging-guided radiation therapy treatment planning. Med Phys 2018; 45:3477-3480. [PMID: 29679489 DOI: 10.1002/mp.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/14/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Adam Kesner
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tinsu Pan
- Department of Imaging Physics, The University of Texas, M D Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1352, Houston, TX, 77030-4009, USA
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40
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A dosimetric phantom study of thoracic radiotherapy based on three-dimensional modeling of mediastinal lymph nodes. Oncol Lett 2018; 15:5634-5642. [PMID: 29556300 PMCID: PMC5844048 DOI: 10.3892/ol.2018.8084] [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: 06/12/2017] [Accepted: 11/16/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the optimal strategy and dosimetric measurement of thoracic radiotherapy based on three-dimensional (3D) modeling of mediastinal lymph nodes (MLNs). A 3D model of MLNs was constructed from a Chinese Visible Human female dataset. Image registration and fusion between reconstructed MLNs and original chest computed tomography (CT) images was conducted in the Eclipse™ treatment planning system (TPS). There were three plans, including 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT), which were designed based on 10 cases of simulated lung lesions (SLLs) and MLNs. The quality of these plans was evaluated via examining indexes, including conformity index (CI), homogeneity index and clinical target volume (CTV) coverage. Dose-volume histogram analysis was performed on SLL, MLNs and organs at risk (OARs). A Chengdu Dosimetric Phantom (CDP) was then drilled at specific MLNs according to 20 patients with thoracic tumors and of a medium-build. These plans were repeated on fused MLNs and CDP CT images in the Eclipse™ TPS. Radiation doses at the SLLs and MLNs of the CDP were measured and compared with calculated doses. The established 3D MLN model demonstrated the spatial location of MLNs and adjacent structures. Precise image registration and fusion were conducted between reconstructed MLNs and the original chest CT or CDP CT images. IMRT demonstrated greater values in CI, CTV coverage and OAR (lungs and spinal cord) protection, compared with 3D-CRT and VMAT (P<0.05). The deviation between the measured and calculated doses was within ± 10% at SLL, and at the 2R and 7th MLN stations. In conclusion, the 3D MLN model can benefit plan optimization and dosimetric measurement of thoracic radiotherapy, and when combined with CDP, it may provide a tool for clinical dosimetric monitoring.
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41
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Vyfhuis MA, Onyeuku N, Diwanji T, Mossahebi S, Amin NP, Badiyan SN, Mohindra P, Simone CB. Advances in proton therapy in lung cancer. Ther Adv Respir Dis 2018; 12:1753466618783878. [PMID: 30014783 PMCID: PMC6050808 DOI: 10.1177/1753466618783878] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
Lung cancer remains the leading cause of cancer deaths in the United States (US) and worldwide. Radiation therapy is a mainstay in the treatment of locally advanced non-small cell lung cancer (NSCLC) and serves as an excellent alternative for early stage patients who are medically inoperable or who decline surgery. Proton therapy has been shown to offer a significant dosimetric advantage in NSCLC patients over photon therapy, with a decrease in dose to vital organs at risk (OARs) including the heart, lungs and esophagus. This in turn, can lead to a decrease in acute and late toxicities in a population already predisposed to lung and cardiac injury. Here, we present a review on proton treatment techniques, studies, clinical outcomes and toxicities associated with treating both early stage and locally advanced NSCLC.
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Affiliation(s)
- Melissa A.L. Vyfhuis
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Nasarachi Onyeuku
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Tejan Diwanji
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Sina Mossahebi
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Neha P. Amin
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Shahed N. Badiyan
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Pranshu Mohindra
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, Baltimore, MD, USA
| | - Charles B. Simone
- Maryland Proton Treatment Center, University of
Maryland School of Medicine, 850 West Baltimore Street, Baltimore, MD 21201,
USA
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42
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Sorokin M, Kholodenko R, Grekhova A, Suntsova M, Pustovalova M, Vorobyeva N, Kholodenko I, Malakhova G, Garazha A, Nedoluzhko A, Vasilov R, Poddubskaya E, Kovalchuk O, Adamyan L, Prassolov V, Allina D, Kuzmin D, Ignatev K, Osipov A, Buzdin A. Acquired resistance to tyrosine kinase inhibitors may be linked with the decreased sensitivity to X-ray irradiation. Oncotarget 2017; 9:5111-5124. [PMID: 29435166 PMCID: PMC5797037 DOI: 10.18632/oncotarget.23700] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/11/2017] [Indexed: 01/08/2023] Open
Abstract
Acquired resistance to chemotherapy and radiation therapy is one of the major obstacles decreasing efficiency of treatment of the oncologic diseases. In this study, on the two cell lines (ovarian carcinoma SKOV-3 and neuroblastoma NGP-127), we modeled acquired resistance to five target anticancer drugs. The cells were grown on gradually increasing concentrations of the clinically relevant tyrosine kinase inhibitors (TKIs) Sorafenib, Pazopanib and Sunitinib, and rapalogs Everolimus and Temsirolimus, for 20 weeks. After 20 weeks of culturing, the half-inhibitory concentrations (IC50) increased by 25 – 186% for the particular combinations of the drugs and cell types. We next subjected cells to 10 Gy irradiation, a dose frequently used in clinical radiation therapy. For the SKOV-3, but not NGP-127 cells, for the TKIs Sorafenib, Pazopanib and Sunitinib, we noticed statistically significant increase in capacity to repair radiation-induced DNA double strand breaks compared to naïve control cells not previously treated with TKIs. These peculiarities were linked with the increased activation of ATM DNA repair pathway in the TKI-treated SKOV-3, but not NGP-127 cells. Our results provide a new cell culture model for studying anti-cancer therapy efficiency and evidence that there may be a tissue-specific radioresistance emerging as a side effect of treatment with TKIs.
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Affiliation(s)
- Maxim Sorokin
- D. Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Moscow 117198, Russia.,National Research Centre "Kurchatov Institute", Centre for Convergence of Nano-, Bio-, Information and Cognitive Sciences and Technologies, Moscow 123182, Russia.,Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow 117997, Russia
| | - Roman Kholodenko
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow 117997, Russia
| | - Anna Grekhova
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia
| | - Maria Suntsova
- D. Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Moscow 117198, Russia.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Margarita Pustovalova
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia
| | - Natalia Vorobyeva
- D. Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Moscow 117198, Russia.,State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia
| | - Irina Kholodenko
- Orekhovich Institute of Biomedical Chemistry, Moscow 119121, Russia
| | - Galina Malakhova
- National Research Centre "Kurchatov Institute", Centre for Convergence of Nano-, Bio-, Information and Cognitive Sciences and Technologies, Moscow 123182, Russia
| | - Andrew Garazha
- D. Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Moscow 117198, Russia.,OmicsWay Corp., Walnut, CA 91789, USA
| | - Artem Nedoluzhko
- National Research Centre "Kurchatov Institute", Centre for Convergence of Nano-, Bio-, Information and Cognitive Sciences and Technologies, Moscow 123182, Russia
| | - Raif Vasilov
- National Research Centre "Kurchatov Institute", Centre for Convergence of Nano-, Bio-, Information and Cognitive Sciences and Technologies, Moscow 123182, Russia
| | | | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, AB T1K3M4, Canada
| | - Leila Adamyan
- Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow 127206, Russia
| | - Vladimir Prassolov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Daria Allina
- Pathology Department, Morozov Children's City Hospital, Moscow 119049, Russia
| | | | - Kirill Ignatev
- Republic Oncological Hospital, Petrozavodsk 185000, Russia
| | - Andreyan Osipov
- D. Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Moscow 117198, Russia.,State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow 123098, Russia
| | - Anton Buzdin
- National Research Centre "Kurchatov Institute", Centre for Convergence of Nano-, Bio-, Information and Cognitive Sciences and Technologies, Moscow 123182, Russia.,Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Moscow 117997, Russia.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia.,OmicsWay Corp., Walnut, CA 91789, USA
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