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Dekura Y, Yasuda K, Minatogawa H, Uchinami Y, Tsushima N, Suzuki T, Kano S, Mori T, Nishioka K, Kobashi K, Katoh N, Homma A, Aoyama H. Daily fraction dose-adjusted radiotherapy policy to avoid prolonging the overall treatment time for early glottic squamous cell carcinoma: a single-institutional retrospective study. J Radiat Res 2024; 65:63-70. [PMID: 37952082 PMCID: PMC10803170 DOI: 10.1093/jrr/rrad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/24/2023] [Indexed: 11/14/2023]
Abstract
The objective of this study was to determine the outcomes of radical radiotherapy for early glottic squamous cell carcinoma (EGSCC) with the policy of increasing the fraction size during radiotherapy when the overall treatment time (OTT) was expected to be prolonged. Patients diagnosed with clinical T1-2N0M0 EGSCC, who were treated with radical radiotherapy between 2008 and 2019 at Hokkaido University Hospital, were included. Patients received 66 Gy in 33 fractions for T1 disease and 70 Gy in 35 fractions for T2 disease as our standard regimen (usual group [UG]). If the OTT was expected to extend for >1 week, the dose fraction size was increased from 2.0 to 2.5 Gy from the beginning or during radiotherapy (adjusted group [AG]). At this time, we performed a statistical analysis between UG and AG. In total, 116 patients were identified, and the treatment schedules of 29 patients were adjusted. The median follow-up was 60.9 months. In the T1 group, the cumulative 5-year local failure rate was 12.0% in the AG and 15.4% in the UG, and in the T2 group, the rate was 40.7% in the AG and 25.3% in the UG. There were no significant differences between the AG and UG. Similarly, no significant differences were observed for overall survival and progression-free survival rates. Our single-institutional retrospective analysis of EGSCC patients suggested that a method of adjusting the radiotherapy schedule to increase fraction size from the beginning or during the course may be effective in maintaining treatment outcomes.
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Affiliation(s)
- Yasuhiro Dekura
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
- Department of Radiation Oncology, Kin-ikyo Chuo Hospital, 1-9-1 Higashinaebo5, Higashi-ku, Sapporo, Hokkaido 007-0805 , Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Hideki Minatogawa
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Nayuta Tsushima
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Takayoshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Kentaro Nishioka
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
- Department of Radiation Medical Science and Engineering, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Keiji Kobashi
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Kita15, Nishi7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
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Burger H, Wyrley-Birch B, Joubert N, Trauernicht CJ, Valentim JM, Groll J, Berz S, Vowles N, Parkes J. Bridging the Radiotherapy Education Gap in Africa: Lessons Learnt from the Cape Town Access to Care Training Programme Over the Past 5 Years (2015-2019). J Cancer Educ 2022; 37:1662-1668. [PMID: 33928527 PMCID: PMC8084586 DOI: 10.1007/s13187-021-02010-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
The role of radiotherapy (RT) in cancer care is well described, with a clear correlation between access to radiotherapy and overall survival. Cancer mortality rates in Africa are substantially higher than those of the rest of the world, which may be partly attributed to lack of RT access and insufficient human resources. The Access to Care (A2C) Cape Town RT training programme was created in 2014 with the aim of supplementing practical RT training in the region, focusing on clinics moving from 2 to 3D conformal radiotherapy (3DCRT). The programme makes use of hybrid teaching methods, including pre-course e-learning followed by 17 on-site days of free-thinking design exercises, didactic learning, hands-on treatment planning computer sessions (39% of total teaching time), virtual simulation training and departmental demonstration sessions. Email support is offered to all teams for 3 months after each course to develop clinical protocols. Thirteen teams (radiation oncologist, medical physicist and radiation therapy technologist) from Africa attended the course between 2015 and 2019, with additional participants from seven South African and four international centres. E-learning done on the LäraNära training platform was only successful once formal progress tracking was introduced in 2019 (34% vs. 76% test completion rate). Delays between course attendance and initial clinical use of equipment proved to be detrimental to knowledge retention, with some centres having to send a second team for training. The course will be modified for remote teaching in 2021, to make provision for the global changes in travel due to Covid-19.
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Affiliation(s)
- Hester Burger
- Division of Medical Physics, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
| | - Bridget Wyrley-Birch
- Department of Radiation Technology, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Nanette Joubert
- Division of Medical Physics, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Christoph Jan Trauernicht
- Division of Medical Physics, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
- Division of Medical Physics, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | | | - Jens Groll
- Varian Medical Systems, Steinhausen, Switzerland
| | - Stefan Berz
- Varian Medical Systems, Steinhausen, Switzerland
| | - Natalia Vowles
- Department of Radiation Technology, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Jeannette Parkes
- Department Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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Alem-Bezoubiri A, Suleiman SA, Behidj I, Mazrou H, Chami AC. Monte Carlo study of organ doses and related risk for cancer in Algeria from scattered neutrons in prostate treatment involving 3D-CRT. Appl Radiat Isot 2021; 180:110065. [PMID: 34933226 DOI: 10.1016/j.apradiso.2021.110065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
Abstract
The present study aimed to evaluate organ doses and related risk for cancer from scattered neutrons involving 3D Conformational Radiotherapy (3D-CRT) for patients with prostate cancer in Algeria based on Monte Carlo technique and to estimate the secondary cancer risks. To this purpose, a detailed geometric Monte Carlo (MC) modeling of the LINAC Varian 2100C combined with a computational whole-body phantom was carried out. The neutron equivalent doses were calculated in-field and out-of field of patient's organs using the phase-space method. The obtained neutron equivalent doses were used to estimate the Lifetime Attributable Risks (LARs) for cancer incidence in out of field organs. LARs was evaluated assuming Biological Effects of Ionizing Radiation VII (BEIR VII) risk model for exposure age in the range 35-70 years, according to the interval's age of treated patients in Algeria. The baselines cancer risks and survival data were associated with the statistical data for the Algerian population. The results showed that the neutrons equivalent doses per prescribed dose (Photon Dose) mostly depend on the distance of organs from the treated volume. The highest and lowest equivalent doses of 1.18 mSv/Gy and 0.25 mSv/Gy were recorded in the bladder and heart, respectively. The highest estimated lifetime attributable risk per 100,000 population was found for 35 yrs' exposure age in colon 49.94, lung 16.63 and stomach 11.17. The lowest risks were found for 70 yrs' age, in spine 0.06 and thyroid 0.14. The results showed that LARs values decrease with the increase of the exposure age and cancer incidence risk is lower than the baseline cancer risk incidence for all organs. The present study may help in providing a database on the impact of radiotherapy-induced secondary cancer incidence during 3D-CRT for prostate cancer in Algeria.
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Affiliation(s)
- Asma Alem-Bezoubiri
- Medical Physics Department, Radiological Physics Division, Algiers Nuclear Research Center (CRNA), 02 Boulevard Frantz-Fanon, BP 399 Alger-RP, 16000, Algiers, Algeria.
| | - Suleiman Ameir Suleiman
- Radiation Control Directorate, Tanzania Atomic Energy Commission, P.O BOX 743, Arusha, Tanzania
| | - Ikram Behidj
- Radiotherapy Service, Central Army Hospital, Algiers, Algeria
| | - Hakim Mazrou
- Division of Environment, Safety, and Radioactive Waste, Algiers Nuclear Research Center (CRNA), 02 Boulevard Frantz-Fanon, BP 399 Alger-RP, 16000, Algiers, Algeria
| | - Ahmed Chafik Chami
- Faculty of Physics, University of Science and Technology Houari Boumediene, USTHB, BP 32 EL ALIA, BAB EZZOUAR, Algiers, Algeria
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Maddalo M, D'Angelo E, Fiorica F, Argenone A, Scricciolo M, Cozzi S, Nardangeli A, Dionisi F, Costantino G, Vagge S, Pontoriero A, Donato V, Massaccesi M. Thoracic re-irradiation with 3D-conformal or more advanced techniques: A systematic review of treatment safety by the Re-irradiation Study Group of the Italian Association of Radiation and Oncology AIRO. Crit Rev Oncol Hematol 2021; 167:103500. [PMID: 34688894 DOI: 10.1016/j.critrevonc.2021.103500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/20/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022] Open
Abstract
Re-irradiation (re-RT) is a treatment modality that has been actively investigated in recurrent lung cancer or in lung metastases appeared in previously irradiated areas. A literature search, according PRISMA recommendations and a meta-analysis technique were performed with the aims to identify possible factors related to the toxicity incidence and severity of ≥ G3 acute toxicity. 1243 patients and 36 studies, met inclusion criteria. Our results, showed that there was no difference in ≥ G3 acute (10,5%) toxicity rate with respect to different radiation techniques, cumulative dose and re-irradiation total dose and fractionation. Factors eventually related to severe toxicity were described. The frequent lack of a sufficient description of the treatment's intent, the heterogeneity in technique and radiotherapy regimen, makes balancing risk and benefit of re-RT based on published data even more difficult.
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Affiliation(s)
- Marta Maddalo
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Elisa D'Angelo
- Department of Radiotherapy, University Hospital of Modena, L. del Pozzo 71, 41121, Modena, Italy.
| | - Francesco Fiorica
- Department of Radiation Oncology and Nuclear Medicine, State Hospital Mater Salutis AULSS 9, 37045, Legnago (VR), Italy.
| | - Angela Argenone
- Radiotherapy Unit, AORN San PIO, Via dell'Angelo, 82100, Benevento, Italy.
| | - Melissa Scricciolo
- Radiation Therapy Unit, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Venezia, Italy.
| | - Salvatore Cozzi
- Radiation Therapy Unit, Azienda USL-IRCCS di Reggio Emilia, 42122, Reggio Emilia, Italy.
| | - Alessia Nardangeli
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, L. Gemelli 1, 00168, Roma, Italy.
| | - Francesco Dionisi
- Department of Research and Advanced Technology, Radiation Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Roma, Italy.
| | - Gianluca Costantino
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria San Martino di Genova-IST, Istituto Nazionale Ricerca sul Cancro, Genoa, Italy.
| | - Antonio Pontoriero
- Dept. of Radiation Oncology, University of Messina, 98125, Messina, Italy.
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Speciality Medicine Department, San Camillo-Forlanini Hospital, 00152, Roma, Italy.
| | - Mariangela Massaccesi
- Radiation Oncology Department, Gemelli-ART, Università Cattolica S. Cuore, L. Gemelli 1, 00168, Roma, Italy.
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Solis JA, Rosenberg IP, Olivares J, Tudela B, Veillon G, Lazcano G. Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality. Rep Pract Oncol Radiother 2021; 26:360-366. [PMID: 34277089 PMCID: PMC8281917 DOI: 10.5603/rpor.a2021.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background The treatment of early stage cervical cancer has different therapeutic options. Adjuvant external beam radiotherapy for surgically treated intermediate risk cervical cancer patients has shown acceptable oncological outcomes with a low incidence of toxicity. The aim of this study was to analyze the oncological outcomes and safety of adjuvant small pelvic field radiotherapy in surgically treated stage IB1-2 cervical cancer patients who met the Sedlis intermediate-risk criteria. Materials and methods A retrospective cohort study was carried out with 28 patients treated from 2007 to November 2019 with biopsy proven intermediate risk stage IB1–2 cervical cancer previously treated with radical hysterectomy and bilateral lymphadenectomy who received adjuvant small pelvic field radiotherapy. The primary endpoints were local and distant control and overall survival. Secondary endpoints were acute and late gastrointestinal and genitourinary toxicity. Survival curves were analyzed using the Kaplan-Meier method. Results After a median follow up period of 41.5 (27.5–80.5) months, adjuvant small pelvic field radiotherapy showed a 100% overall survival rate, 81.82% disease free survival and 86.36% local recurrence-free survival with no incidence of grade 3 or 4 acute or late toxicity. Three patients suffered from relapse, 1 in the vaginal cuff, 1 in the retrovesical area and 1 patient in the retroperitoneal area. Conclusions Adjuvant small pelvic field radiotherapy is an efficient and safe treatment option that offers excellent oncological outcomes to surgically treated intermediate-risk stage IB1–2 cervical cancer patients with an excellent toxicity profile.
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Affiliation(s)
- José Antonio Solis
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Ilan Perrot Rosenberg
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Jorge Olivares
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Benjamin Tudela
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Gabriel Veillon
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Gabriel Lazcano
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
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Possiel J, Ammon HE, Guhlich M, Conradi LC, Ghadimi M, Wolff HA, Schirmer MA, Samel S, Mügge M, Rieken S, Leu M, Dröge LH. Volumetric Modulated Arc Therapy Improves Outcomes in Definitive Radiochemotherapy for Anal Cancer Whilst Reducing Acute Toxicities and Increasing Treatment Compliance. Cancers (Basel) 2021; 13:cancers13112533. [PMID: 34064061 PMCID: PMC8196749 DOI: 10.3390/cancers13112533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
Simple Summary Intensity-modulated radiotherapy (IMRT) is the standard of care in definitive chemoradiotherapy (CRT) for anal cancer. Only a limited number of studies have analyzed the clinical results with VMAT (volumetric modulated arc therapy, the advanced form of IMRT). We conducted a retrospective study on patients treated at our institution. We compared the outcomes of VMAT-treated and 3DCRT (3D conformal radiotherapy)-treated patients. VMAT reduced acute toxicities (i.e., primarily dermatitis and enteritis) to a great extent. Additionally, VMAT relevantly improved treatment compliance (i.e., less CRT interruptions/delays, shorter overall treatment time, and higher absolute 5-fluorouracil dose applied). Finally, we found improved cancer-specific survival and distant control in VMAT-treated patients. The present study underlines the great progress that has been achieved with IMRT/VMAT in the CRT of anal cancer. Our study is the first to demonstrate an improvement in treatment compliance and outcomes with VMAT. Future studies could address whether VMAT is advantageous when compared to conventional IMRT. Abstract Background: Intensity-modulated radiotherapy (IMRT) is the standard of care in chemoradiotherapy (CRT) for anal cancer. Until now, only a limited number of studies have analyzed the results with VMAT (volumetric modulated arc therapy). We conducted a retrospective study on patients treated at our institution. Patients and Methods: We included patients who received curative CRT for anal cancer. We compared VMAT-treated and 3DCRT (3D conformal radiotherapy)-treated patients. We analyzed toxicities (acute: CTCAE criteria; late: LENT/SOMA criteria), treatment compliance, overall survival, cancer-specific survival (CSS), distant control (DC), and locoregional control. Results: A total of 149 patients (3DCRT: n = 87, VMAT: n = 62) were included. The median follow-up was longer in 3DCRT-treated patients (3DCRT: 61.3 months; VMAT: 39.1 months; p < 0.05). VMAT-treated patients had more G3 tumors (3DCRT: 12/87 (13.8%); VMAT: 18/62 (29.0%), p < 0.001). VMAT reduced acute toxicities ≥grade 3 (3DCRT: n = 48/87 (55.2%); VMAT: n = 11/62 (17.7%), p < 0.001). VMAT improved treatment compliance (less interruptions/delays) (3DCRT: 37/87, 42.5%; VMAT: 4/62, 6.5%; p < 0.001), provided a shorter median overall treatment time (3DCRT: 41 days; VMAT: 38 days; p = 0.02), and gave a higher median absolute 5-fluorouracil dose (3DCRT: 13,700 mg; VMAT: 14,400 mg; p = 0.001). Finally, we found improved CSS (p = 0.02; 3DCRT: 81.9% at 3 years; VMAT: 94.1% at 3 years) and DC (p = 0.01; 3DCRT: 89.4% at 3 years; VMAT: 100.0% at 3 years) with VMAT. Summary: Our study is the first to demonstrate improved treatment compliance and outcomes with VMAT for anal cancer. Previous studies have indicated that organs at risk sparing might be more improved with the use of VMAT vs. with conventional IMRT. Future studies should address whether these advantages lead to a further reduction in CRT-associated morbidity.
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Affiliation(s)
- Jacqueline Possiel
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
| | - Hanne Elisabeth Ammon
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
| | - Manuel Guhlich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
| | - Lena-Christin Conradi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.-C.C.); (M.G.)
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.-C.C.); (M.G.)
| | - Hendrik Andreas Wolff
- University Medical Center Göttingen, 37075 Göttingen, Germany;
- Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, 80333 Munich, Germany
- Department of Radiotherapy and Radiation Oncology, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Markus Anton Schirmer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
| | - Stephan Samel
- Praxis für Koloproktologie und chirurgische Endoskopie, Waldweg 1, 37073 Göttingen, Germany; (S.S.); (M.M.)
| | - Michael Mügge
- Praxis für Koloproktologie und chirurgische Endoskopie, Waldweg 1, 37073 Göttingen, Germany; (S.S.); (M.M.)
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
| | - Martin Leu
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
| | - Leif Hendrik Dröge
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (J.P.); (H.E.A.); (M.G.); (M.A.S.); (S.R.); (M.L.)
- Correspondence: ; Tel.: +49-551-398-866
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Ferini G, Molino L, Tripoli A, Valenti V, Illari SI, Marchese VA, Cravagno IR, Borzi GR. Anatomical Predictors of Dosimetric Advantages for Deep-inspiration-breath-hold 3D-conformal Radiotherapy Among Women With Left Breast Cancer. Anticancer Res 2021; 41:1529-1538. [PMID: 33788746 DOI: 10.21873/anticanres.14912] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to analyze the dosimetric gain of the deep-inspiration-breath-hold (DIBH) technique over the free-breathing (FB) one in left breast cancer (LBC) 3D-conformal-radiotherapy (3D-CRT), and simultaneously investigate the anatomical parameters related to heart RT-exposure. PATIENTS AND METHODS Treatment plans were generated in both DIBH and FB scenarios for 116 LBC patients monitored by the Varian RPM™ respiratory gating system for delivery of conventional or moderately hypofractionated schedules (±sequential boost). For comparison, we considered cardiac and ipsilateral lung doses and volumes. RESULTS A significant reduction of cardiac and pulmonary doses using DIBH technique was achieved compared to FB plans. Larger clinical target volumes generally need longer distance between medial and lateral entrances of tangent fields at body surface, thus conditioning a worse heart RT-exposure. CONCLUSION The DIBH technique reduces cardiac and pulmonary doses for LBC patients. Through easily detectable anatomical parameters, it is possible to predict which patients benefit most from DIBH-RT.
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Affiliation(s)
| | - Laura Molino
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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Kucuktulu E, Yurekli AF, Topbas M, Kece C, Guner A, Kucuktulu U. Comparisons between the Dosimetric and Clinical Outcomes of Tomotherapy and 3D Conformal Radiotherapy in Gastric Cancer Treatment. Asian Pac J Cancer Prev 2019; 20:595-599. [PMID: 30806065 PMCID: PMC6897030 DOI: 10.31557/apjcp.2019.20.2.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Previous studies comparing tomotherapy (TOMO) and three dimensional (3D) conformal radiotherapy (3DCRT) in gastric radiotherapy are limited and tend to be based on dosimetry. The aim of the present study was to evaluate the clinical outcomes of these two treatment modalities. Methods: A total of 51 patients diagnosed with gastric cancer who were treated with postoperative adjuvant chemoradiotherapy and had subtotal/total gastrectomy and D2 lymphatic dissection were recruited to the present study: 30 patients were treated with TOMO and 21 patients were treated with 3DCRT. Results: The 3DCRT and TOMO treatment regimens were compared. There was no difference in planning target volume (PTV) 95%, but TOMO was statistically significant in regard to PTV 105% (P<0.05). TOMO was also significantly different when compared with 3DCRT when evaluating liver mean dose, liver V40, right/left kidneys mean dose, right/left kidneys V20 and spinal cord mean dose values (P<0.05). Grade 2 acute side effects were more frequent (85.7%) following 3DCRT. In addition, the median overall survival time for TOMO treated patients was 62 months while in 3DCRT treated patients it was 22.05 months. The difference in disease free survival was also significantly increased in patients treated with TOMO (66.7% vs. 19.0%; P<0.05). Conclusion: TOMO treatment resulted in lower acute side effects with better patient survival following gastric cancer radiotherapy.
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Affiliation(s)
- E Kucuktulu
- Consultant Oncologist, University of Health Sciences, Kanuni Research and Training Hospital, Dept of Radiation Oncology, Trabzon, Turkey.
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Adeberg S, Harrabi SB, Bougatf N, Verma V, Windisch P, Bernhardt D, Combs SE, Herfarth K, Debus J, Rieken S. Dosimetric Comparison of Proton Radiation Therapy, Volumetric Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy Based on Intracranial Tumor Location. Cancers (Basel) 2018; 10:E401. [PMID: 30373115 DOI: 10.3390/cancers10110401] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Selecting patients that will benefit the most from proton radiotherapy (PRT) is of major importance. This study sought to assess dose reductions to numerous organs-at-risk (OARs) with PRT, as compared to three-dimensional conformal radiotherapy (3DCRT) and volumetric-modulated arc therapy (VMAT), as a function of tumor location. (2) Materials/Methods: Patients with intracranial neoplasms (all treated with PRT) were stratified into five location-based groups (frontal, suprasellar, temporal, parietal, posterior cranial fossa; n = 10 per group). Each patient was re-planned for 3DCRT and intensity-modulated radiotherapy (IMRT) using similar methodology, including the originally planned target and organ-at-risk (OAR) dose constraints. (3) Results: In parietal tumors, PRT showed the most pronounced dose reductions. PRT lowered doses to nearly every OAR, most notably the optical system and several contralateral structures (subventricular zone, thalamus, hippocampus). For frontal lobe cases, the greatest relative dose reductions in mean dose (Dmean) with PRT were to the infratentorial normal brain, contralateral hippocampus, brainstem, pituitary gland and contralateral optic nerve. For suprasellar lesions, PRT afforded the greatest relative Dmean reductions to the infratentorial brain, supratentorial brain, and the whole brain. Similar results could be observed in temporal and posterior cranial fossa disease. (4) Conclusions: The effectiveness and degree of PRT dose-sparing to various OARs depends on intracranial tumor location. These data will help to refine selection of patients receiving PRT, cost-effectiveness, and future clinical toxicity assessment.
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Regnier A, Ulbrich J, Münch S, Oechsner M, Wilhelm D, Combs SE, Habermehl D. Comparative Analysis of Efficacy, Toxicity, and Patient-Reported Outcomes in Rectal Cancer Patients Undergoing Preoperative 3D Conformal Radiotherapy or VMAT. Front Oncol 2017; 7:225. [PMID: 28979889 PMCID: PMC5611394 DOI: 10.3389/fonc.2017.00225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background Locally advanced rectal cancer (LARC) patients are usually treated within a multimodal therapy regime, in which the tumor resection plays the major role. This treatment ideally includes 5-fluorouracile (5FU)-based chemoradiation (CRT) leading to significantly improved local control rates. Local therapy as radiotherapy (RT) is required to be adapted referring to side effects and efficacy. Purpose of this study is the comparison of dosimetric parameters, acute and late toxicity, and quality of life in terms of patient-reported outcome (PRO) in patients treated with VMAT or 3D conformal radiotherapy (3DCRT) for LARC. Methods Pelvic RT for LARC was performed with a prescription dose of 45 Gy in 1.8 Gy per fraction, 50.4 Gy in 1.8 Gy per fraction, or 50 Gy in 2 Gy per fraction. Chemotherapy included 5FU or 5FU/Oxaliplatin or Capecitabine-based RT. Acute and late toxicity were evaluated via National Institute Common Terminology Criteria for Adverse Events version (CTCAE) v4.03 and the Scoring System Late effects of Normal Tissue. Quality of life was established via EORTC QLQCR29. Results After a median follow-up of 38 months (VMAT) and 78 months (3DCRT) there was no significant difference in progression-free survival (p = 0,85) but a significant difference in overall survival (p = 0.032). Regarding dose–volume parameters, patients treated with VMAT plans had a lower V20 of the bladder than 3DCRT-treated patients (p = 0.004). VMAT plans can also reduce Dmean of the right (p = 0.002) and left (p < 0.001) femoral head. Acute side effects between the VMAT and 3DCRT patients showed no significant difference. But concerning long-term effects, VMAT-treated patients had a significant lower appearance of high grade anal incontinence (p = 0.032). Quality of life (PRO) showed no significant different between the patients except of hair loss and worrying about weight. Conclusion VMAT treatment of LARC in preoperative CRT revealed a reduction of dose to organs at risk (OARs) as bladder and femoral heads. However, no changes in acute and long-term toxicity profiles were detectable. For late toxicity and quality of life data longer follow-up times are required.
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Affiliation(s)
- Antonia Regnier
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jana Ulbrich
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, TU München, München, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Neuherberg, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Neuherberg, Germany
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Sharma S, Narayanasamy G, Przybyla B, Webber J, Boerma M, Clarkson R, Moros EG, Corry PM, Griffin RJ. Advanced Small Animal Conformal Radiation Therapy Device. Technol Cancer Res Treat 2017; 16:45-56. [PMID: 26792490 PMCID: PMC5616115 DOI: 10.1177/1533034615626011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/01/2015] [Accepted: 12/16/2015] [Indexed: 11/16/2022] Open
Abstract
We have developed a small animal conformal radiation therapy device that provides a degree of geometrical/anatomical targeting comparable to what is achievable in a commercial animal irradiator. small animal conformal radiation therapy device is capable of producing precise and accurate conformal delivery of radiation to target as well as for imaging small animals. The small animal conformal radiation therapy device uses an X-ray tube, a robotic animal position system, and a digital imager. The system is in a steel enclosure with adequate lead shielding following National Council on Radiation Protection and Measurements 49 guidelines and verified with Geiger-Mueller survey meter. The X-ray source is calibrated following AAPM TG-61 specifications and mounted at 101.6 cm from the floor, which is a primary barrier. The X-ray tube is mounted on a custom-made "gantry" and has a special collimating assembly system that allows field size between 0.5 mm and 20 cm at isocenter. Three-dimensional imaging can be performed to aid target localization using the same X-ray source at custom settings and an in-house reconstruction software. The small animal conformal radiation therapy device thus provides an excellent integrated system to promote translational research in radiation oncology in an academic laboratory. The purpose of this article is to review shielding and dosimetric measurement and highlight a few successful studies that have been performed to date with our system. In addition, an example of new data from an in vivo rat model of breast cancer is presented in which spatially fractionated radiation alone and in combination with thermal ablation was applied and the therapeutic benefit examined.
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Affiliation(s)
- Sunil Sharma
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Beata Przybyla
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jessica Webber
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marjan Boerma
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Richard Clarkson
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eduardo G. Moros
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Peter M. Corry
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert J. Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Merzenich H, Bartkowiak D, Schmidberger H, Schmidt M, Schwentner L, Wiegel T, Woeckel A, Wollschläger D, Blettner M. 3D conformal radiotherapy is not associated with the long-term cardiac mortality in breast cancer patients: a retrospective cohort study in Germany (PASSOS-Heart Study). Breast Cancer Res Treat 2017; 161:143-52. [PMID: 27804053 DOI: 10.1007/s10549-016-4042-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE In breast cancer patients treated in the 1970s and 1980s, radiation therapy (RT) for left-sided tumors has been associated with an elevated risk of cardiac mortality. In recent years, improved RT techniques have reduced radiation exposure of the heart and major coronary vessels, but some exposure remains unavoidable. In a retrospective cohort study, we investigated the long-term cardiac mortality risk of breast cancer survivors treated with modern RT in Germany. METHODS A total of 11,982 women were included who were treated for breast cancer between 1998 and 2008. A systematic mortality follow-up was conducted until December 2012. The effect of breast cancer laterality on cardiac mortality and on overall mortality was investigated as a surrogate measure of exposure. Using Cox regression, we analyzed survival time as the primary outcome measure, taking potential confounding factors into account. RESULTS We found no evidence for an effect of tumor laterality on mortality in irradiated patients (N = 9058). For cardiac mortality, the hazard ratio was 0.94 (95% CI 0.64-1.38) for left-sided versus right-sided tumors. For all causes of death, the hazard ratio was 0.95 (95% CI 0.85-1.05). A diagnosis of cardiac illness prior to breast cancer treatment increased both cardiac mortality risk and overall mortality risk. CONCLUSIONS Contemporary RT seems not to be associated with an increased risk of cardiac mortality or overall mortality for left-sided breast cancer relative to right-sided RT. However, an extended follow-up period and exact dosimetry might be necessary to confirm this observation.
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Silva SR, Surucu M, Steber J, Harkenrider MM, Choi M. Clinical Application of a Hybrid RapidArc Radiotherapy Technique for Locally Advanced Lung Cancer. Technol Cancer Res Treat 2016; 16:224-230. [PMID: 27680023 DOI: 10.1177/1533034616670273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Radiation treatment planning for locally advanced lung cancer can be technically challenging, as delivery of ≥60 Gy to large volumes with concurrent chemotherapy is often associated with significant risk of normal tissue toxicity. We clinically implemented a novel hybrid RapidArc technique in patients with lung cancer and compared these plans with 3-dimensional conformal radiotherapy and RapidArc-only plans. MATERIALS/METHODS Hybrid RapidArc was used to treat 11 patients with locally advanced lung cancer having bulky mediastinal adenopathy. All 11 patients received concurrent chemotherapy. All underwent a 4-dimensional computed tomography planning scan. Hybrid RapidArc plans concurrently combined static (60%) and RapidArc (40%) beams. All cases were replanned using 3- to 5-field 3-dimensional conformal radiotherapy and RapidArc technique as controls. RESULTS Significant reductions in dose were observed in hybrid RapidArc plans compared to 3-dimensional conformal radiotherapy plans for total lung V20 and mean (-2% and -0.6 Gy); contralateral lung mean (-2.92 Gy); and esophagus V60 and mean (-16.0% and -2.2 Gy; all P < .05). Contralateral lung doses were significantly lower for hybrid RapidArc plans compared to RapidArc-only plans (all P < .05). Compared to 3-dimensional conformal radiotherapy, heart V60 and mean dose were significantly improved with hybrid RapidArc (3% vs 5%, P = .04 and 16.32 Gy vs 16.65 Gy, P = .03). However, heart V40 and V45 and maximum spinal cord dose were significantly lower with RapidArc plans compared to hybrid RapidArc plans. Conformity and homogeneity were significantly better with hybrid RapidArc plans compared to 3-dimensional conformal radiotherapy plans ( P < .05). Treatment was well tolerated, with no grade 3+ toxicities. CONCLUSION To our knowledge, this is the first report on the clinical application of hybrid RapidArc in patients with locally advanced lung cancer. Hybrid RapidArc permitted safe delivery of 60 to 66 Gy to large lung tumors with concurrent chemotherapy and demonstrated advantages for reduction in low-dose lung volumes, esophageal dose, and mean heart dose.
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Affiliation(s)
- Scott R Silva
- 1 Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Murat Surucu
- 1 Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Jennifer Steber
- 1 Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew M Harkenrider
- 1 Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mehee Choi
- 1 Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
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Yu Y, Guan H, Xing LG, Xiang YB. Role of gross tumor volume in the prognosis of non-small cell lung cancer treated with 3D conformal radiotherapy: a meta-analysis. Clin Ther 2015; 37:2256-66. [PMID: 26293808 DOI: 10.1016/j.clinthera.2015.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Three-dimensional conformal radiotherapy (3D-CRT) has become widely applied in patients with non-small cell lung cancer (NSCLC), and gross tumor volume (GTV) is a reliable index for predicting prognosis in patients with NSCLC. This meta-analysis investigated the association between GTV and prognosis in patients with NSCLC after 3D-CRT. METHODS Electronic bibliographic databases were searched to identify articles related to NSCLC and 3D-CRT. The search results were carefully screened, using predetermined selection criteria, to select the most relevant studies. Newcastle-Ottawa Scale criteria were applied by 2 reviewers independently to evaluate the quality of the methodology of each included article., Based on GTV, each patient was assigned to either the study group (large GTV [≥112 cm(3)]) or the control group (small GTV [<112 cm(3)]), and the mean rates of overall survival (OS) and survival at 1, 3, and 5 years were calculated in each group. Summary hazard ratio (HR) with 95% CI was calculated. FINDINGS The data from 10 cohort studies were incorporated into the current meta-analysis (1473 patients; study group, 773; control group, 700). The OS in the study group was significantly less than that in the control group (HR = 1.52; 95% CI, 1.10-1.94; P < 0.01). The study and control groups also had significantly different survival rates at 1 year (HR = 1.27; 95% CI, 1.10-1.46, P = 0.01), 3 years (HR = 2.06; 95% CI, 1.63-2.61; P < 0.01), and 5 years (HR = 2.25; 95% CI, 1.63-3.10; P < 0.01). Findings from funnel plots and Egger tests of the OS and 3-year survival rate suggested no publication bias. With respect to the 1- and 5-year survival rates, however, the funnel plots and Egger tests demonstrated publication bias among the included studies. IMPLICATIONS The relatively small number of studies and small sample size, as well as the lack of a specific and standard method of defining small and large GTV, may have influenced the credibility and reliability of our results. The findings suggest that GTV influences prognosis in patients with NSCLC after 3D-CRT. However, further studies with larger sample sizes are needed to confirm our finding that a larger GTV is negatively associated with NSCLC prognosis after 3D-CRT.
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Affiliation(s)
- Yang Yu
- Department of Radiation Oncology, Shandong's Key Laboratory of Radiation Oncology
| | - Hui Guan
- Department of Radiation Oncology, Shandong's Key Laboratory of Radiation Oncology
| | - Li-Gang Xing
- Department of Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan.
| | - Yong-Bing Xiang
- Department of Oncology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Tramacere F, Arcangeli S, Pignatelli A, Castagna R, Portaluri M. Hypofractionated Dose Escalated 3D Conformal Radiotherapy for Prostate Cancer: Outcomes from a Mono-Institutional Phase II Study. Anticancer Res 2015; 35:3049-3054. [PMID: 25964594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Based on a radiobiological assumption of a low alpha/beta (α/β) ratio for prostate cancer, hypofractionated radiotherapy has increasingly gained traction in the clinical practice and recent guidelines have confirmed the non-inferiority of this approach. Nevertheless, the largest studies that have used hypofractionation so far, employed image-guided radiation therapy/intensity modulated radiation therapy (IGRT/IMRT) facilities that might have overcome the radiobiological advantages, which remain to be fully confirmed. The aim of this trial was to evaluate the feasibility of a hypofractionated schedule delivered with 3D-Conformal Radiotherapy to prostate and seminal vesicles in combination with hormonal therapy. PATIENTS AND METHODS The study included 97 consecutive patients with localized prostate cancer (PCa), irrespective of risk class, treated with a schedule of 62 Gy in 20 fractions over 5 weeks (4 fractions of 3.1 Gy each per week). According to National Comprehensive Cancer Network (NCCN) prognostic classification, patients were divided into a favourable group (19%), intermediate group (41%) and unfavourable group (40%). Early and late toxicities were scored using the radiation toxicity grading/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) criteria. Additionally, the international prostate symptom index (IPSS) for benign prostate hypertrophy was used to evaluate obstructive urinary symptoms. Biochemical outcome was reported according to the Phoenix definition for biochemical failure. Hormonal therapy (HT) was administrated in 92% of patients. RESULTS After a median follow-up of 39 months (range=25-52), maximum ≥G2 late genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 8% and 11% patients, respectively. The corresponding figures for acute toxicities were 24% and 15%. Patients with higher IPSS score before enrolment had significantly worse urinary function after treatment. Only 2% of patients died from PCa. Biochemical non-evidence of disease (bNED) was 83% for all patients. CONCLUSION Our study confirms that 3D conformal radiotherapy (3DCRT) remains a safe and effective method to deliver a dose-escalated hypofractionated regimen for PCa patients in all risk classes with acceptable toxicity rates and optimal biochemical control.
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Affiliation(s)
| | - Stefano Arcangeli
- U.O.C Radioterapia Oncologica Az. Ospedaliera S. Camillo-Forlanini, Roma, Italy
| | | | - Roberta Castagna
- S.C.Radioterapia, ASLBR Ospedale "A. Perrino" Brindisi, Brindisi, Italy
| | - Maurizio Portaluri
- S.C.Radioterapia, ASLBR Ospedale "A. Perrino" Brindisi, Brindisi, Italy Associate Researcher National Council of Research, Institute of Clinical Physiology, Pisa, Italy
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Srinivas C, Kumar PS, Ravichandran R, Banerjee S, Saxena PU, Kumar ESA, Pai DK. Dose verification in carcinoma of uterine cervix patients undergoing 3D conformal radiotherapy with Farmer type ion chamber. J Med Phys 2014; 39:247-50. [PMID: 25525313 PMCID: PMC4258733 DOI: 10.4103/0971-6203.144492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 11/30/2022] Open
Abstract
External beam radiotherapy (EBRT) for carcinoma of uterine cervix is a basic line of treatment with three dimensional conformal radiotherapy (3DCRT) in large number of patients. There is need for an established method for verification dosimetry. We tried to document absorbed doses in a group of carcinoma cervix patients by inserting a 0.6 cc Farmer type ion chamber in the vaginal cavity. A special long perspex sleeve cap is designed to cover the chamber for using in the patient's body. Response of ionization chamber is checked earlier in water phantom with and without cap. Treatment planning was carried out with X-ray computed tomography (CT) scan and with the chamber along with cap in inserted position, and with the images Xio treatment planning system. Three measurements on 3 days at 5-6 fraction intervals were recorded in 12 patients. Electrometer measured charges are converted to absorbed dose at the chamber center, in vivo. Our results show good agreement with planned dose within 3% against prescribed dose. This study, is a refinement over our previous studies with transmission dosimetry and chemicals in ampules. This preliminary work shows promise that this can be followed as a routine dose check with special relevance to new protocols in the treatment of carcinoma cervix with EBRT.
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Affiliation(s)
- Challapalli Srinivas
- Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India
| | - P Suman Kumar
- Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India
| | - Ramamoorthy Ravichandran
- Department of Medical Physics Unit, National Oncology Center, Royal Hospital, Muscat, Sultanate of Oman
| | - S Banerjee
- Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India
| | - P U Saxena
- Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India
| | - E S Arun Kumar
- Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India
| | - Dinesh K Pai
- Department of Radiotherapy and Oncology, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India
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Mok G, Gauthier I, Jiang H, Huang SH, Chan K, Witterick IJ, O'Sullivan B, Waldron JN, Bayley AJ, Cho BCJ, Cummings BJ, Dawson LA, Hope AJ, Kim JJ, Ringash J. Outcomes of intensity-modulated radiotherapy versus conventional radiotherapy for hypopharyngeal cancer. Head Neck 2014; 37:655-61. [PMID: 24590756 DOI: 10.1002/hed.23649] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/14/2013] [Accepted: 02/24/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to discuss if the adoption of intensity-modulated radiotherapy (IMRT) for hypopharyngeal squamous cell carcinoma (SCC) has improved the outcome. METHODS We compared 3-dimensional (3D) radiotherapy (RT) and IMRT in all patients with hypopharyngeal SCC treated with curative intent RT or chemoradiation therapy (CRT) from January 1, 2000, to February 28, 2010. Locoregional control, overall survival (OS), distant relapse rate, larynx preservation rate, and enteral feeding tube duration were analyzed. RESULTS Of 181 consecutive patients, 90 received 3D-RT and 91 received IMRT. At 3 years, the IMRT group had higher locoregional control compared with the 3D-RT group (75% vs 58%; p = .003), but similar OS (50% vs 52%; p = .99), distant relapse rate (23% vs 20%; p = .79), and larynx-preservation rate (90% vs 86%; p = .16). The 2-year enteral feeding tube dependency rate was similar in both groups (19% vs 18%; p = .12). CONCLUSION Patients with hypopharyngeal SCC treated with IMRT showed a higher locoregional control compared with 3D-RT. However, distant-relapse rate and OS remain comparable between treatment techniques.
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Affiliation(s)
- Gary Mok
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Elson A, Bovi J, Kaur K, Maas D, Sinson G, Schultz C. Effect of treatment modality on the hypothalamic-pituitary function of patients treated with radiation therapy for pituitary adenomas: hypothalamic dose and endocrine outcomes. Front Oncol 2014; 4:73. [PMID: 24782984 PMCID: PMC3988389 DOI: 10.3389/fonc.2014.00073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both fractionated external beam radiotherapy and single fraction radiosurgery for pituitary adenomas are associated with the risk of hypothalamic-pituitary (HP) axis dysfunction. OBJECTIVE To analyze the effect of treatment modality (Linac, TomoTherapy, or gamma knife) on hypothalamic dose and correlate these with HP-axis deficits after radiotherapy. METHODS Radiation plans of patients treated post-operatively for pituitary adenomas using Linac-based 3D-conformal radiotherapy (CRT) (n = 11), TomoTherapy-based intensity modulated radiation therapy (IMRT) (n = 10), or gamma knife stereotactic radiosurgery (n = 12) were retrospectively reviewed. Dose to the hypothalamus was analyzed and post-radiotherapy hormone function including growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, prolactin, and gonadotropins (follicle stimulating hormone/luteinizing hormone) were assessed. RESULTS Post-radiation, 13 of 27 (48%) patients eligible for analysis developed at least one new hormone deficit, of which 8 of 11 (72%) occurred in the Linac group, 4 of 8 (50%) occurred in the TomoTherapy group, and 1 of 8 (12.5%) occurred in the gamma knife group. Compared with fractionated techniques, gamma knife showed improved hypothalamic sparing for DMax Hypo and V12Gy. For fractionated modalities, TomoTherapy showed improved dosimetric characteristics over Linac-based treatment with hypothalamic DMean (44.8 vs. 26.8 Gy p = 0.02), DMax (49.8 vs. 39.1 Gy p = 0.04), and V12Gy (100 vs. 76% p = 0.004). CONCLUSION Maximal dosimetric avoidance of the hypothalamus was achieved using gamma knife-based radiosurgery followed by TomoTherapy-based IMRT, and Linac-based 3D conformal radiation therapy, respectively.
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Affiliation(s)
- Andrew Elson
- Department of Radiation Oncology, Medical College of Wisconsin , Milwaukee, WI , USA
| | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin , Milwaukee, WI , USA
| | - Kawaljeet Kaur
- Division of Endocrinology, Metabolism, and Clinical Nutrition, Medical College of Wisconsin , Milwaukee, WI , USA
| | - Diana Maas
- Division of Endocrinology, Metabolism, and Clinical Nutrition, Medical College of Wisconsin , Milwaukee, WI , USA
| | - Grant Sinson
- Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, WI , USA
| | - Chris Schultz
- Department of Radiation Oncology, Medical College of Wisconsin , Milwaukee, WI , USA
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