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Mercado M, Leung L, Gallagher M, Shah S, Kulstad E. Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions. Biomed Eng Online 2020; 19:77. [PMID: 33046057 PMCID: PMC7552446 DOI: 10.1186/s12938-020-00821-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Esophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation. Existing methods to prevent esophageal injury have various limitations in deployment and uncertainty in efficacy. A new esophageal heat transfer device currently available for whole-body cooling or warming may offer an additional option to prevent esophageal injury. We sought to develop a mathematical model of this process to guide further studies and clinical investigations and compare results to real-world clinical data. RESULTS The model predicts that the esophageal cooling device, even with body-temperature water flow (37 °C) provides a reduction in esophageal thermal injury compared to the case of the non-protected esophagus, with a non-linear direct relationship between lesion depth and the cooling water temperature. Ablation power and cooling water temperature have a significant influence on the peak temperature and the esophageal lesion depth, but even at high RF power up to 50 W, over durations up to 20 s, the cooling device can reduce thermal impact on the esophagus. The model concurs with recent clinical data showing an 83% reduction in transmural thermal injury when using typical operating parameters. CONCLUSIONS An esophageal cooling device appears effective for esophageal protection during atrial fibrillation, with model output supporting clinical data. Analysis of the impact of ablation power and heart wall dimensions suggests that cooling water temperature can be adjusted for specific ablation parameters to assure the desired myocardial tissue ablation while keeping the esophagus protected.
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Affiliation(s)
- Marcela Mercado
- Bioengineering Department, Engineering Faculty, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellin, Colombia.
| | - Lisa Leung
- St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Mark Gallagher
- St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | | | - Erik Kulstad
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
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Ayadi M, Baudier T, Bouilhol G, Dupuis P, Boissard P, Pinho R, Krason A, Rit S, Claude L, Sarrut D. Mid-position treatment strategy for locally advanced lung cancer: a dosimetric study. Br J Radiol 2020; 93:20190692. [PMID: 32293191 PMCID: PMC10993224 DOI: 10.1259/bjr.20190692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The internal target volume (ITV) strategy generates larger planning target volumes (PTVs) in locally advanced non-small cell lung cancer (LA-NSCLC) than the Mid-position (Mid-p) strategy. We investigated the benefit of the Mid-p strategy regarding PTV reduction and dose to the organs at risk (OARs). METHODS 44 patients with LA-NSCLC were included in a randomized clinical study to compare ITV and Mid-p strategies. GTV were delineated by a physician on maximum intensity projection images and on Mid-p images from four-dimensional CTs. CTVs were obtained by adding 6 mm uniform margin for microscopic extension. CTV to PTV margins were calculated using the van Herk's recipe for setup and delineation errors. For the Mid-p strategy, the mean target motion amplitude was added as a random error. For both strategies, three-dimensional conformal plans delivering 60-66 Gy to PTV were performed. PTVs, dose-volume parameters for OARs (lung, esophagus, heart, spinal cord) were reported and compared. RESULTS With the Mid-p strategy, the median of volume reduction was 23.5 cm3 (p = 0.012) and 8.8 cm3 (p = 0.0083) for PTVT and PTVN respectively; the median mean lung dose reduction was 0.51 Gy (p = 0.0057). For 37.1% of the patients, delineation errors led to smaller PTV with the ITV strategy than with the Mid-p strategy. CONCLUSION PTV and mean lung dose were significantly reduced using the Mid-p strategy. Delineation uncertainty can unfavorably impact the advantage. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first dosimetric comparison study between ITV and Mid-p strategies for LA-NSCLC.
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Affiliation(s)
- M. Ayadi
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - T. Baudier
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - G. Bouilhol
- Department of Radiotherapy, Hartmann Radiotherapy Center,
American Hospital of Paris,
Neuilly, France
| | - P. Dupuis
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - P. Boissard
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - R. Pinho
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - A. Krason
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - S. Rit
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
| | - L. Claude
- Radiotherapy and Physics Department, Leon Berard Cancer Center,
28, rue Laennec F-69373, Lyon,
France
| | - D. Sarrut
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm,
Centre Léon Bérard, CREATIS UMR 5220, U1206,
F-69373, Lyon,
France
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Ishikura S, Kondo T, Murai T, Ozawa Y, Yanagi T, Sugie C, Miyakawa A, Shibamoto Y. Definitive chemoradiotherapy for squamous cell carcinoma of the esophagus: outcomes for borderline-resectable disease. J Radiat Res 2020; 61:464-469. [PMID: 32249307 PMCID: PMC7299256 DOI: 10.1093/jrr/rraa008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Indexed: 05/14/2023]
Abstract
Definitive chemoradiotherapy (dCRT) is the standard treatment for unresectable esophageal cancer. Induction chemotherapy has been actively investigated for borderline-resectable and unresectable disease, but the superiority over dCRT has yet to be confirmed. The purpose of this study was to evaluate the outcome of dCRT with special interest in borderline-resectable disease. Patients with esophageal cancer treated with dCRT between January 2004 and November 2016 were included in this retrospective analysis. Chemotherapy consisted of two cycles of cisplatin (70-75 mg/m2) on day 1 and 5-fluorouracil (700-1000 mg/m2 per day) on days 1-4 or low-dose cisplatin (10 mg/m2 per day) and 5-fluorouracil (175 mg/m2 per day) for 20 days. Radiotherapy was given with a daily fraction of 1.8-2 Gy to a total dose of 50-70 Gy. A total of 104 patients were included: 34 were resectable, 35 were borderline-resectable and 35 were unresectable. Complete response was achieved in 44 patients (42%). Eighteen patients (17%) suffered Grade 2 or greater cardiopulmonary toxicity and seven patients (7%) suffered Grade 3 cardiopulmonary toxicity. At the time of this analysis, 59 patients were dead and 45 were censored. The 3-year overall survival proportions for resectable, borderline-resectable and unresectable patients were 64%, 46% and 21%, respectively. The overall survival for borderline-resectable patients with complete response and noncomplete response was significantly different (P < 0.001), with 3-year survival of 70% and 8%, respectively. The overall survival for complete response patients with borderline-resectable disease was encouraging. Further investigation to find a subgroup fit for esophagus-preserving treatment is warranted.
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Affiliation(s)
- Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
- Corresponding author. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan. Tel: +81-52-853-8276; Fax: +81-52-852-5244;
| | - Takuhito Kondo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Takeshi Yanagi
- Department of Proton, Narita Memorial Proton Center, Toyohashi, Aichi 441-8021, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya Daini Red Cross Hospital, Nagoya, Aichi 466-8650, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi 460-0001, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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Jelvehgaran P, Steinberg JD, Khmelinskii A, Borst G, Song JY, de Wit N, de Bruin DM, van Herk M. Evaluation of acute esophageal radiation-induced damage using magnetic resonance imaging: a feasibility study in mice. Radiat Oncol 2019; 14:188. [PMID: 31666092 PMCID: PMC6822441 DOI: 10.1186/s13014-019-1396-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thoracic and head and neck cancer radiation therapy (RT) can cause damage to nearby healthy organs such as the esophagus, causing acute radiation-induced esophageal damage (ARIED). A non-invasive method to detect and monitor ARIED can facilitate optimizing RT to avoid ARIED while improving local tumor control. Current clinical guidelines are limited to scoring the esophageal damage based on the symptoms of patients. Magnetic resonance imaging (MRI) is a non-invasive imaging modality that may potentially visualize radiation-induced organ damage. We investigated the feasibility of using T2-weighted MRI to detect and monitor ARIED using a two-phased study in mice. METHODS The first phase aimed to establish the optimal dose level at which ARIED is inducible and to determine the time points where ARIED is detectable. Twenty four mice received a single dose delivery of 20 and 40 Gy at proximal and distal spots of 10.0 mm (in diameter) on the esophagus. Mice underwent MRI and histopathology analysis with esophageal resection at two, three, and 4 weeks post-irradiation, or earlier in case mice had to be euthanized due to humane endpoints. In the second phase, 32 mice received a 40 Gy single dose and were studied at two, three, and 7 days post-irradiation. We detected ARIED as a change in signal intensity of the MRI images. We measured the width of the hyperintense area around the esophagus in all mice that underwent MRI prior to and after irradiation. We conducted a blind qualitative comparison between MRI findings and histopathology as the gold standard. RESULTS/CONCLUSIONS A dose of 40 Gy was needed to induce substantial ARIED. MRI detected ARIED as high signal intensity, visible from 2 days post-irradiation. Quantitative MRI analysis showed that the hyperintense area around the esophagus with severe ARIED was 1.41 mm wider than with no damage and MRI-only mice. The overall sensitivity and specificity were 56 and 43% respectively to detect any form of ARIED. However, in this study MRI correctly detected 100% of severe ARIED cases. Our two-phased preclinical study showed that MRI has the potential to detect ARIED as a change in signal intensity and width of enhancement around the esophagus.
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Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Physics and Astronomy, Institute for Laser Life and Biophotonics Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey D. Steinberg
- Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Artem Khmelinskii
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Gerben Borst
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Ji-Ying Song
- Department of Experimental Animal Pathology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Niels de Wit
- Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Jelvehgaran P, de Bruin DM, Khmelinskii A, Borst G, Steinberg JD, Song J, de Vos J, van Leeuwen TG, Alderliesten T, de Boer JF, van Herk M. Optical coherence tomography to detect acute esophageal radiation-induced damage in mice: A validation study. J Biophotonics 2019; 12:e201800440. [PMID: 31058437 PMCID: PMC7065648 DOI: 10.1002/jbio.201800440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/28/2018] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 05/19/2023]
Abstract
Radiation therapy for patients with non-small-cell lung cancer is hampered by acute radiation-induced toxicity in the esophagus. This study aims to validate that optical coherence tomography (OCT), a minimally invasive imaging technique with high resolution (~10 μm), is able to visualize and monitor acute radiation-induced esophageal damage (ARIED) in mice. We compare our findings with histopathology as the gold standard. Irradiated mice receive a single dose of 40 Gy at proximal and distal spots of the esophagus of 10.0 mm in diameter. We scan mice using OCT at two, three, and seven days post-irradiation. In OCT analysis, we define ARIED as a presence of distorted esophageal layering, change in backscattering signal properties, or change in the esophageal wall thickness. The average esophageal wall thickness is 0.53 mm larger on OCT when ARIED is present based on histopathology. The overall sensitivity and specificity of OCT to detect ARIED compared to histopathology are 94% and 47%, respectively. However, the overall sensitivity of OCT to assess ARIED is 100% seven days post-irradiation. We validate the capability of OCT to detect ARIED induced by high doses in mice. Nevertheless, clinical studies are required to assess the potential role of OCT to visualize ARIED in humans.
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Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of Radiation OncologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of Physics and AstronomyInstitute for Laser Life and Biophotonics AmsterdamAmsterdamthe Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of UrologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Artem Khmelinskii
- Department of Radiation OncologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Gerben Borst
- Department of Radiation OncologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Jeffrey D. Steinberg
- Mouse Clinic for Cancer and Aging (MCCA) Imaging UnitThe Netherlands Cancer InstituteAmsterdamthe Netherlands
| | - Ji‐Ying Song
- Department of Experimental Animal PathologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Judith de Vos
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Ton G. van Leeuwen
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Tanja Alderliesten
- Department of Radiation OncologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Johannes F. de Boer
- Department of Physics and AstronomyInstitute for Laser Life and Biophotonics AmsterdamAmsterdamthe Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine, and HealthUniversity of Manchester, Manchester Academic Health Sciences CentreManchesterUK
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Kawasaki T, Sakakubo M, Ito K. ESTIMATION OF ORGAN DOSES AND EFFECTIVE DOSES BASED ON IN-PHANTOM DOSIMETRY FOR INFANT DIAGNOSTIC CARDIAC CATHETERISATIONS WITH NOVEL X-RAY IMAGING TECHNOLOGY. Radiat Prot Dosimetry 2019; 183:528-533. [PMID: 30289542 DOI: 10.1093/rpd/ncy174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/29/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
The present study evaluated the organ and effective doses in infant diagnostic cardiac catheterisation performed using a modern x-ray imaging unit by in-phantom dosimetry. In addition, conversion factors from dose-area product (DAP) to effective dose were determined. The organ and effective doses in 1-year old during diagnostic cardiac catheterisations were measured using radiophotoluminescence glass dosemeters implanted into an infant anthropomorphic phantom. The mean effective doses, evaluated according to the International Commission on Radiologic Protection Publication 103, were 4.0 mSv (range: 1.5-8.7 mSv). The conversion factors from DAP to effective dose were 2 and 3.5 mSv (Gy cm2)-1 for posteroanterior and lateral fluoroscopy, respectively, and 1.8 and 3.3 mSv (Gy cm2)-1 for posteroanterior and lateral cineangiography, respectively. The dose data and conversion factors evaluated in the present study may be useful for estimating radiation exposure in infants during diagnostic cardiac catheterisation.
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Affiliation(s)
- Toshio Kawasaki
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Masami Sakakubo
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
| | - Kanako Ito
- Department of Radiological Technology, Kanagawa Children's Medical Centre, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan
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Zhang H, Hua Y, Jiang Z, Yue J, Shi M, Zhen X, Zhang X, Yang L, Zhou R, Wu S. Cancer-associated Fibroblast–promoted LncRNA DNM3OS Confers Radioresistance by Regulating DNA Damage Response in Esophageal Squamous Cell Carcinoma. Clin Cancer Res 2018; 25:1989-2000. [PMID: 30463848 DOI: 10.1158/1078-0432.ccr-18-0773] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 09/15/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Hongfang Zhang
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China
| | - Yuhui Hua
- Department of Pharmacy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Zhenzhen Jiang
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China
| | - Jing Yue
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China
| | - Ming Shi
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Xiaoli Zhen
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China
| | - Xiaoyan Zhang
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China
| | - Ling Yang
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China
| | - Rongjing Zhou
- Department of Pathology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Shixiu Wu
- Hangzhou Cancer Institution, Hangzhou Cancer Hospital, Hangzhou, China.
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Dumane VA, Bakst R, Green S. Dose to organs in the supraclavicular region when covering the Internal Mammary Nodes (IMNs) in breast cancer patients: A comparison of Volumetric Modulated Arc Therapy (VMAT) versus 3D and VMAT. PLoS One 2018; 13:e0205770. [PMID: 30339705 PMCID: PMC6195271 DOI: 10.1371/journal.pone.0205770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/01/2018] [Indexed: 01/25/2023] Open
Abstract
During breast/chest wall and regional nodal irradiation (RNI), standard 3D conformal techniques can fail to meet the dosimetric constraints for the heart and ipsilateral lung. VMAT can improve the dosimetric sparing of the heart and lungs. However the unnecessary increase in dose to the organs in the supraclavicular region as a result of using VMAT can be avoided. In this work we investigate potential dosimetric advantages of combining 3D with VMAT to improve sparing of these organs. Ten breast cancer patients requiring radiation therapy to the breast/chest wall and RNI including the IMNs, and who did not have a viable 3D conformal plan were chosen for the study. Each patient was planned with VMAT and with a combination of 3D for the supraclavicular region and VMAT for the breast/chest wall followed by a dosimetric comparison. Prescription dose was 50.4 Gy in 28 fractions. For similar coverage to the PTV and IMNs, doses to the esophagus and cord were reduced by 17.8 Gy and 15.5 Gy while mean dose to the thyroid and larynx were also reduced by 16.5 Gy and 11.7 Gy respectively. Maximum brachial plexus dose was the same in both techniques. The ipsilateral lung V20Gy increased by 3.1% but was still < 30%. No significant differences were noted in doses to the heart, total lung and contralateral breast. However V5Gy to the contralateral lung was reduced by 8.5% with the combined plan. Using 3D conformal planning for the supraclavicular region and VMAT over the breast/chest wall improves sparing of the esophagus, cord, thyroid and larynx while reducing low dose exposure to the contralateral lung and does not compromise doses to the heart, ipsilateral lung and total lung.
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Affiliation(s)
- Vishruta A. Dumane
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Sheryl Green
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Cheng YJ, Jing SW, Zhu LL, Wang J, Wang L, Liu Q, Yang CR, Wang Y, Cao F, Jiao WP, Wu YJ. Comparison of elective nodal irradiation and involved-field irradiation in esophageal squamous cell carcinoma: a meta-analysis. J Radiat Res 2018; 59:604-615. [PMID: 30085197 PMCID: PMC6151636 DOI: 10.1093/jrr/rry055] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/27/2018] [Indexed: 05/07/2023]
Abstract
It remains controversial whether radical radiotherapy in patients with esophageal squamous cell carcinoma (ESCC) still requires elective nodal irradiation (ENI), or only involved-field irradiation (IFI). In this study, a meta-analysis was conducted to compare ENI and IFI in the treatment of ESCC, in order to provide guidance for clinical practice. Literature on the use of ENI and IFI in the treatment of ESCC was retrieved, and the last access date was 31 December 2017. A meta-analysis was performed to evaluate the relative advantages and disadvantages of using ENI and IFI. Ten studies, involving a total of 1348 patients, were included in this analysis; of these, 605 patients underwent radiotherapy only, and 743 underwent radiochemotherapy. There was no significant difference in the 1-, 2- or 3-year local control rates between ENI and IFI, or in the 1-, 2- or 3-year overall survival rates. However, the incidences of ≥Grade 3 acute esophagitis and pneumonia were significantly lower in the IFI group. There were no differences in the rates of ≥Grade 3 myelosuppression or of out-field recurrence or metastasis between these two groups. Thus, neither local control rates nor overall survival rates differed significantly between the ENI and IFI groups, but in the latter group, incidences of severe radiation esophagitis and pneumonia were significantly lower. IFI was not associated with an increase in out-field recurrence or metastasis.
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Affiliation(s)
- Yun-jie Cheng
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Shao-wu Jing
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Ling-ling Zhu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Jun Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Long Wang
- Department of Family and Consumer Sciences, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, California, USA
| | - Qing Liu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Cong-rong Yang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Yi Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Feng Cao
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Wen-peng Jiao
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Ya-jing Wu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, Hebei, China
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Jelvehgaran P, de Bruin DM, Salguero FJ, Borst GR, Song JY, van Leeuwen TG, de Boer JF, Alderliesten T, van Herk M. Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models. J Biomed Opt 2018; 23:1-12. [PMID: 29651825 DOI: 10.1117/1.jbo.23.4.046004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/26/2018] [Indexed: 05/25/2023]
Abstract
Lung cancer survival is poor, and radiation therapy patients often suffer serious treatment side effects. The esophagus is particularly sensitive leading to acute radiation-induced esophageal damage (ARIED). We investigated the feasibility of optical coherence tomography (OCT) for minimally invasive imaging of the esophagus with high resolution (10 μm) to detect ARIED in mice. Thirty mice underwent cone-beam computed tomography imaging for initial setup assessment and dose planning followed by a single-dose delivery of 4.0, 10.0, 16.0, and 20.0 Gy on 5.0-mm spots, spaced 10.0 mm apart in the esophagus. They were repeatedly imaged using OCT up to three months postirradiation. We compared OCT findings with histopathology obtained three months postirradiation qualitatively and quantitatively using the contrast-to-background-noise ratio (CNR). Histopathology mostly showed inflammatory infiltration and edema at higher doses; OCT findings were in agreement with most of the histopathological reports. We were able to identify the ARIED on OCT as a change in tissue scattering and layer thickness. Our statistical analysis showed significant difference between the CNR values of healthy tissue, edema, and inflammatory infiltration. Overall, the average CNR for inflammatory infiltration and edema damages was 1.6-fold higher and 1.6-fold lower than for the healthy esophageal wall, respectively. Our results showed the potential role of OCT to detect and monitor the ARIED in mice, which may translate to humans.
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Affiliation(s)
- Pouya Jelvehgaran
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, Amsterdam, The Netherlands
| | - Daniel Martijn de Bruin
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Academic Medical Center, Department of Urology, Amsterdam, The Netherlands
| | - F Javier Salguero
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Gerben Roelof Borst
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Ji-Ying Song
- The Netherlands Cancer Institute, Department of Experimental Animal Pathology, Amsterdam, The Netherlands
| | - Ton G van Leeuwen
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Johannes F de Boer
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Marcel van Herk
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
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11
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Kim JW, Kim TH, Kim JH, Lee IJ. Predictors of post-treatment stenosis in cervical esophageal cancer undergoing high-dose radiotherapy. World J Gastroenterol 2018; 24:862-869. [PMID: 29467556 PMCID: PMC5807944 DOI: 10.3748/wjg.v24.i7.862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/25/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate toxicity and treatment outcome of high-dose radiotherapy (RT) for cervical esophageal cancer (CEC).
METHODS We reviewed a total of 62 consecutive patients who received definitive RT for stage I to III cervical esophageal cancer between 2001 and 2015. Patients who received < 45 Gy, treated for lesions below sternal notch, treated with palliative aim, treated with subsequent surgical resection, or diagnosed with synchronous hypopharyngeal cancer were excluded. Treatment failures were divided into local (occurring within the RT field), outfield-esophageal, and regional [occurring in regional lymph node(s)] failures. Factors predictive of esophageal stenosis requiring endoscopic dilation were analyzed.
RESULTS Grade 1, 2, and 3 esophagitis occurred in 19 (30.6%), 39 (62.9%), and 4 patients (6.5%), respectively, without grade ≥ 4 toxicities. Sixteen patients (25.8%) developed post-RT stenosis, of which 7 cases (43.8%) were malignant. Four patients (6.5%) developed tracheoesophageal fistula (TEF), of which 3 (75%) cases were malignant. Factors significantly correlated with post-RT stenosis were stage T3/4 (P = 0.001), complete circumference involvement (P < 0.0001), stenosis at diagnosis (P = 0.024), and endoscopic complete response (P = 0.017) in univariate analysis, while complete circumference involvement was significant in multivariate analysis (P = 0.003). A higher dose (≥ 60 Gy) was not associated with occurrence of post-RT stenosis or TEF. With a median follow-up of 24.3 (range, 3.4-152) mo, the 2 y local control, outfield esophageal control, progression-free survival, and overall survival (OS) rates were 78.9%, 90.2%, 49.6%, and 57.3%, respectively. Factors significantly correlated with OS were complete circumference involvement (P = 0.023), stenosis at diagnosis (P < 0.0001), and occurrence of post-RT stenosis or TEF (P < 0.001) in univariate analysis, while stenosis at diagnosis (P = 0.004) and occurrence of post-RT stenosis or TEF (P = 0.023) were significant in multivariate analysis.
CONCLUSION Chemoradiation for CEC was well tolerated, and a higher dose was not associated with stenosis. Patients with complete circumferential involvement require close follow-up.
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Affiliation(s)
- Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
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12
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Aloreidi K, Patel B. Radiation Therapy Induced Esophageal Ulcer. S D Med 2018; 71:70. [PMID: 29990415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Khalil Aloreidi
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Bhavesh Patel
- Department of Gastroenterology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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13
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Tabibian N, Umbreen A, Swehli E, Boyd A, Tabibian JH. Radiation therapy: Managing GI tract complications. J Fam Pract 2017; 66:E1-E7. [PMID: 28783769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Here's how to recognize radiation-related adverse effects so that you can expedite care and help preserve your patient's quality of life.
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Affiliation(s)
- Neshan Tabibian
- Kaweah Delta Family Medicine Residency Program, Visalia, CA, USA
| | - Aisha Umbreen
- Kaweah Delta Family Medicine Residency Program, Visalia, CA, USA
| | - Ehab Swehli
- Kaweah Delta Family Medicine Residency Program, Visalia, CA, USA
| | - Anne Boyd
- Kaweah Delta Family Medicine Residency Program, Visalia, CA, USA
| | - James H Tabibian
- Division of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA, USA.
- Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, CA, USA
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14
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Zimmermann MH, Beckmann G, Jung P, Flentje M. Hypopharyngeal and upper esophageal ulceration after cervical spine radiotherapy concurrent with crizotinib. Strahlenther Onkol 2017; 193:589-592. [PMID: 28444429 DOI: 10.1007/s00066-017-1135-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Abstract
Herein, the authors describe the case of a 31-year-old female patient with primary metastatic adenocarcinoma of the lung referred for radiation therapy of newly diagnosed intramedullary spinal cord metastasis at C4/5 and an adjacent osteolytic lesion. Radiotherapy of the cervical spine level C3 to C5, including the whole vertebra, was performed with 30 Gy in 10 fractions. The patient's systemic therapy with crizotinib 250 mg twice daily was continued. After 8 fractions of radiation the patient developed increasing dysphagia. Ulceration of the hypopharynx and the upper esophagus were obvious in esophagoscopy and CT. Hospitalization for analgesia and percutaneous endoscopic gastrostomy (PEG) was required. First oral intake was possible 3 weeks after the onset of symptoms. The early onset, severity, and duration of mucositis seemed highly unusual in this case. A review of the literature failed to identify any reference to increased mucositis after radiation therapy concurrent with crizotinib, although references to such an effect with other tyrosine kinase inhibitors (TKI) were found. Nevertheless, the authors presume that a considerable risk of unexpected interactions exists. When crizotinib and radiotherapy are combined, heightened attention toward intensified reactions seems to be warranted.
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Affiliation(s)
- Marcus H Zimmermann
- Department of Radiation Oncology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Gabriele Beckmann
- Department of Radiation Oncology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Pius Jung
- Department of Pneumonology, Medical Clinic I, University Hospital of Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
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Persson GF, Scherman Rydhög J, Josipovic M, Maraldo MV, Nygård L, Costa J, Berthelsen AK, Specht L, Aznar MC. Deep inspiration breath-hold volumetric modulated arc radiotherapy decreases dose to mediastinal structures in locally advanced lung cancer. Acta Oncol 2016; 55:1053-6. [PMID: 26935017 DOI: 10.3109/0284186x.2016.1142115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Gitte F Persson
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Jonas Scherman Rydhög
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- b Faculty of Science , Niels Bohr Institute, Copenhagen University , Copenhagen , Denmark
| | - Mirjana Josipovic
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- b Faculty of Science , Niels Bohr Institute, Copenhagen University , Copenhagen , Denmark
| | - Maja V Maraldo
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Lotte Nygård
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Junia Costa
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- c Department of Clinical Physiology, Nuclear Medicine and PET , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Anne K Berthelsen
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- c Department of Clinical Physiology, Nuclear Medicine and PET , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Lena Specht
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- d Faculty of Medical Sciences , Panum Institute, Copenhagen University , Copenhagen , Denmark
| | - Marianne C Aznar
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- b Faculty of Science , Niels Bohr Institute, Copenhagen University , Copenhagen , Denmark
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16
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Gharzai L, Verma V, Denniston KA, Bhirud AR, Bennion NR, Lin C. Radiation Therapy and Cardiac Death in Long-Term Survivors of Esophageal Cancer: An Analysis of the Surveillance, Epidemiology, and End Result Database. PLoS One 2016; 11:e0158916. [PMID: 27428362 PMCID: PMC4948887 DOI: 10.1371/journal.pone.0158916] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/23/2016] [Indexed: 12/21/2022] Open
Abstract
Objective Radiation therapy (RT) for esophageal cancer often results in unintended radiation doses delivered to the heart owing to anatomic proximity. Using the Surveillance, Epidemiology, and End Results (SEER) database, we examined late cardiac death in survivors of esophageal cancer that had or had not received RT. Methods 5,630 patients were identified that were diagnosed with esophageal squamous cell carcinoma (SCC) or adenocarcinoma (AC) from 1973–2012, who were followed for at least 5 years after therapy. Examined risk factors for cardiac death included age (≤55/56-65/66-75/>75), gender, race (white/non-white), stage (local/regional/distant), histology (SCC/AC), esophageal location (<18cm/18-24cm/25-32cm/33-40cm from incisors), diagnosis year (1973-1992/1993-2002/2003-2012), and receipt of surgery and/or RT. Time to cardiac death was evaluated using the Kaplan-Meier method. A Cox model was used to evaluate risk factors for cardiac death in propensity score matched data. Results Patients who received RT were younger, diagnosed more recently, had more advanced disease, SCC histology, and no surgery. The RT group had higher risk of cardiac death than the no-RT group (log-rank p<0.0001). The median time to cardiac death in the RT group was 289 months (95% CI, 255–367) and was not reached in the no-RT group. The probability of cardiac death increased with age and decreased with diagnosis year, and this trend was more pronounced in the RT group. Multivariate analysis found RT to be associated with higher probability of cardiac death (OR 1.23, 95% CI 1.03–1.47, HR 1.961, 95% CI 1.466–2.624). Lower esophageal subsite (33–40 cm) was also associated with a higher risk of cardiac death. Other variables were not associated with cardiac death. Conclusions Recognizing the limitations of a SEER analysis including lack of comorbidity accountability, these data should prompt more definitive study as to whether a possible associative effect of RT on cardiac death could potentially be a causative effect.
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Affiliation(s)
- Laila Gharzai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
- * E-mail:
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Kyle A. Denniston
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Abhijeet R. Bhirud
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Nathan R. Bennion
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
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17
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Li Q, Tanaka Y, Saitoh Y, Miwa N. Effects of Platinum Nanocolloid in Combination with Gamma Irradiation on Normal Human Esophageal Epithelial Cells. J Nanosci Nanotechnol 2016; 16:5345-5352. [PMID: 27483929 DOI: 10.1166/jnn.2016.12362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Our previous study demonstrated that platinum nanocolloid (Pt-nc), combined with lower-dose gamma irradiation at 3, 5, and 7 Gy significantly decreased proliferation and accelerated apoptosis of the human esophageal squamous cell carcinoma-derived cell line KYSE-70. The aim of the present study was to determine, under the same conditions as our previous study where gamma rays combined with Pt-nc were carcinostatic to KYSE-70 cells, if we could induce a radioprotective or the radiation-sensitizing effect on the human normal esophageal epithelial cells (HEEpiC). HEEpiC were treated with various Pt-nc concentrations and then irradiated with various gamma-ray doses. The proliferative status of HEEpiC was evaluated using trypan blue dye-exclusion and WST-8 assays. The cellular and nucleic morphological features were determined using crystal violet and Hoechst 33342 stainings, respectively. The intracellular level of reactive oxygen species (ROS) in HEEpiC was evaluated with a nitro blue tetrazolium (NBT) assay. The apoptotic status was detected with caspase-3, Bax, and Bcl-2 by Western blotting. Either Pt-nc or gamma irradiation could inhibit the growth of HEEpiC; however, their combined use exerted a significant proliferation-inhibitory effect in a Pt-nc dose-dependent manner than gamma irradiation alone. Pt-nc resulted in radiation sensitization rather than radiation protection on HEEpiC in vitro similar to KYSE-70 cells, when Pt-nc was administrated alone or combined with gamma irradiation. Thus, Pt-nc has an inhibitory effect on cell proliferation, a facilitative effect on apoptosis, and a certain degree of toxicity against HEEpiC.
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18
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Chuong MD, Hallemeier CL, Jabbour SK, Yu J, Badiyan S, Merrell KW, Mishra MV, Li H, Verma V, Lin SH. Improving Outcomes for Esophageal Cancer using Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2016; 95:488-497. [PMID: 27084662 PMCID: PMC10862360 DOI: 10.1016/j.ijrobp.2015.11.043] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 12/15/2022]
Abstract
Radiation therapy (RT) plays an essential role in the management of esophageal cancer. Because the esophagus is a centrally located thoracic structure there is a need to balance the delivery of appropriately high dose to the target while minimizing dose to nearby critical structures. Radiation dose received by these critical structures, especially the heart and lungs, may lead to clinically significant toxicities, including pneumonitis, pericarditis, and myocardial infarction. Although technological advancements in photon RT delivery like intensity modulated RT have decreased the risk of such toxicities, a growing body of evidence indicates that further risk reductions are achieved with proton beam therapy (PBT). Herein we review the published dosimetric and clinical PBT literature for esophageal cancer, including motion management considerations, the potential for reirradiation, radiation dose escalation, and ongoing esophageal PBT clinical trials. We also consider the potential cost-effectiveness of PBT relative to photon RT.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jen Yu
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Shahed Badiyan
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Heng Li
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
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Zhang Y, Feng Y, Ahmad M, Ming X, Zhou L, Deng J. Intermediate Megavoltage Photon Beams for Improved Lung Cancer Treatments. PLoS One 2015; 10:e0145117. [PMID: 26672752 PMCID: PMC4682946 DOI: 10.1371/journal.pone.0145117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/28/2015] [Indexed: 02/05/2023] Open
Abstract
The goal of this study is to evaluate the effects of intermediate megavoltage (3-MV) photon beams on SBRT lung cancer treatments. To start with, a 3-MV virtual beam was commissioned on a commercial treatment planning system based on Monte Carlo simulations. Three optimized plans (6-MV, 3-MV and dual energy of 3- and 6-MV) were generated for 31 lung cancer patients with identical beam configuration and optimization constraints for each patient. Dosimetric metrics were evaluated and compared among the three plans. Overall, planned dose conformity was comparable among three plans for all 31 patients. For 21 thin patients with average short effective path length (< 10 cm), the 3-MV plans showed better target coverage and homogeneity with dose spillage index R50% = 4.68±0.83 and homogeneity index = 1.26±0.06, as compared to 4.95±1.01 and 1.31±0.08 in the 6-MV plans (p < 0.001). Correspondingly, the average/maximum reductions of lung volumes receiving 20 Gy (V20Gy), 5 Gy (V5Gy), and mean lung dose (MLD) were 7%/20%, 9%/30% and 5%/10%, respectively in the 3-MV plans (p < 0.05). The doses to 5% volumes of the cord, esophagus, trachea and heart were reduced by 9.0%, 10.6%, 11.4% and 7.4%, respectively (p < 0.05). For 10 thick patients, dual energy plans can bring dosimetric benefits with comparable target coverage, integral dose and reduced dose to the critical structures, as compared to the 6-MV plans. In conclusion, our study indicated that 3-MV photon beams have potential dosimetric benefits in treating lung tumors in terms of improved tumor coverage and reduced doses to the adjacent critical structures, in comparison to 6-MV photon beams. Intermediate megavoltage photon beams (< 6-MV) may be considered and added into current treatment approaches to reduce the adjacent normal tissue doses while maintaining sufficient tumor dose coverage in lung cancer radiotherapy.
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Affiliation(s)
- Ying Zhang
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Yuanming Feng
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
| | - Munir Ahmad
- Department of Radiation Oncology, William W. Backus Hospital, Norwich, Connecticut, United States of America
| | - Xin Ming
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Li Zhou
- Center for Radiation Physics and Technology, West China Hospital Cancer Center, Sichuan University, Chengdu, China
| | - Jun Deng
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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Affiliation(s)
- M V Graham
- Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
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Blom GJ, Verbakel WFAR, Dahele M, Hoffmans D, Slotman BJ, Senan S. Improving radiotherapy planning for large volume lung cancer: a dosimetric comparison between hybrid-IMRT and RapidArc. Acta Oncol 2015; 54:427-32. [PMID: 25383450 DOI: 10.3109/0284186x.2014.963888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gerrit J Blom
- Department of Radiation Oncology, VU University Medical Center , Amsterdam , The Netherlands
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22
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Hoogeveen RC, Rottke D, van der Stelt PF, Berkhout WER. Dose reduction in orthodontic lateral cephalography: dosimetric evaluation of a novel cephalographic thyroid protector (CTP) and anatomical cranial collimation (ACC). Dentomaxillofac Radiol 2015; 44:20140260. [PMID: 25564885 PMCID: PMC4628428 DOI: 10.1259/dmfr.20140260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 12/19/2014] [Accepted: 01/06/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To test the dose-reducing capabilities of a novel thyroid protection device and a recently introduced cranial collimator to be used in orthodontic lateral cephalography. METHODS Cephalographic thyroid protector (CTP) was designed to shield the thyroid while leaving the cervical vertebrae depicted. Using a RANDO(®) head phantom (The Phantom Laboratory, Salem, NY) equipped with dosemeters and a Proline XC (Planmeca, Helsinki, Finland) cephalograph, lateral cephalograms were taken, and the effective dose (ED) was calculated for four protocols: (1) without shielding; (2) with CTP; (3) with CTP and anatomical cranial collimator (ACC); and (4) with a thyroid collar (TC). RESULTS The ED for the respective protocols was (1) 8.51; (2) 5.39; (3) 3.50; and (4) 4.97 µSv. The organ dose for the thyroid was reduced from 30.17 to 4.50 µSv in Protocols 2 and 3 and to 3.33 µSv in Protocol 4. CONCLUSIONS The use of just the CTP (Protocol 2) resulted in a 36.8% reduction of the ED of a lateral cephalogram. This was comparable to the classical TC (Protocol 4). A 58.8% reduction of the ED was obtained when combining CTP and ACC (Protocol 3). The dose to the radiosensitive thyroid gland was reduced by 85% in Protocols 2 and 3 and by 89% in Protocol 4.
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Affiliation(s)
- R C Hoogeveen
- Section of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam ACTA, Amsterdam, Netherlands
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Krstic D, Markovic VM, Jovanovic Z, Milenkovic B, Nikezic D, Atanackovic J. Monte Carlo calculations of lung dose in ORNL phantom for boron neutron capture therapy. Radiat Prot Dosimetry 2014; 161:269-273. [PMID: 24435912 DOI: 10.1093/rpd/nct365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Monte Carlo simulations were performed to evaluate dose for possible treatment of cancers by boron neutron capture therapy (BNCT). The computational model of male Oak Ridge National Laboratory (ORNL) phantom was used to simulate tumours in the lung. Calculations have been performed by means of the MCNP5/X code. In this simulation, two opposite neutron beams were considered, in order to obtain uniform neutron flux distribution inside the lung. The obtained results indicate that the lung cancer could be treated by BNCT under the assumptions of calculations.
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Affiliation(s)
- D Krstic
- Faculty of Science, University of Kragujevac, R. Domanovica 12, Kragujevac 34000, Serbia
| | - V M Markovic
- Faculty of Science, University of Kragujevac, R. Domanovica 12, Kragujevac 34000, Serbia
| | - Z Jovanovic
- Faculty of Science, University of Kragujevac, R. Domanovica 12, Kragujevac 34000, Serbia
| | - B Milenkovic
- Faculty of Science, University of Kragujevac, R. Domanovica 12, Kragujevac 34000, Serbia
| | - D Nikezic
- Faculty of Science, University of Kragujevac, R. Domanovica 12, Kragujevac 34000, Serbia
| | - J Atanackovic
- Chalk River Laboratories, Atomic Energy of Canada Limited, Chalk River, Ontario, Canada K0J 1J0
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Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) has been increasingly employed for treating head and neck (H&N) tumours due to its ability to produce isodoses suitable for the complex anatomy of the region. The aim of this study was to assess possible differences between IMRT and conformal radiation therapy (CRT) with regard to risk of radiation-induced secondary malignancies for H&N tumours. MATERIAL AND METHODS IMRT and CRT plans were made for 10 H&N adult patients and the resulting treatment planning data were used to calculate the risk of radiation-induced malignancies in four different tissues. Three risk models with biologically relevant parameters were used for calculations. The influence of scatter radiation and repeated imaging sessions has also been investigated. RESULTS The results showed that the total lifetime risks of developing radiation-induced secondary malignancies from the two treatment techniques, CRT and IMRT, were comparable and in the interval 0.9-2.5%. The risk contributions from the primary beam and scatter radiation were comparable, whereas the contribution from repeated diagnostic imaging was considerably smaller. CONCLUSION The results indicated that the redistribution of the dose characteristic to IMRT leads to a redistribution of the risks in individual tissues. However, the total levels of risk were similar between the two irradiation techniques considered.
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MESH Headings
- Adult
- Algorithms
- Diagnostic Imaging/adverse effects
- Esophagus/radiation effects
- Female
- Head and Neck Neoplasms/radiotherapy
- Humans
- Hypopharyngeal Neoplasms/radiotherapy
- Lung/radiation effects
- Male
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Second Primary/etiology
- Organs at Risk/radiation effects
- Parotid Gland/radiation effects
- Phantoms, Imaging
- Photons/therapeutic use
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Radiotherapy, Image-Guided/adverse effects
- Radiotherapy, Image-Guided/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Risk
- Scattering, Radiation
- Sex Factors
- Tongue Neoplasms/radiotherapy
- Tonsillar Neoplasms/radiotherapy
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Affiliation(s)
- Oscar Ardenfors
- Medical Radiation Physics, Department of Physics, Stockholm University , Stockholm , Sweden
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Alongi F, De Bari B, Scorsetti M. Could single-high-dose radiotherapy be considered the new frontier of stereotactic ablative radiation therapy? Tumori 2014; 100:e92-3. [PMID: 25076259 DOI: 10.1700/1578.17244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Epperly MW, Goff JP, Franicola D, Wang H, Wipf P, Li S, Greenberger JS. Esophageal radioprotection by swallowed JP4-039/F15 in thoracic-irradiated mice with transgenic lung tumors. In Vivo 2014; 28:435-440. [PMID: 24982207 PMCID: PMC6436097] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM To determine whether Gramicidin S (GS)-nitroxide, JP4-039, esophageal radiation protection protected lung tumors in a transgenic model, LoxP-Stoop-LoxP Kristen Rat Sarcoma Viral oncogene (LSL-K-RAS) mice were administered intra-tracheal- Carbapenem-resistant Enterobacteriaceae (CRE) recombinase, bilateral lung tumors were confirmed at 11 weeks, then thoracic irradiation was delivered. MATERIALS AND METHODS Mice received single-fraction 15 Gy or 24 Gy to both lungs, in subgroups receiving intraesophageal administration 10 min before irradiation of JP4-039 (in F15 emulsion) tumor size reduction and survival were investigated. Mice were followed for survival, and reduction in tumor size. RESULTS There was no evidence of tumor radioprotection in mice receiving JP4-039/F15. CONCLUSION Intraesophageal radioprotective small-molecule antioxidant therapy protects normal tissue but not tumor tissue in mice with transgenic lung tumors.
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Affiliation(s)
- Michael W Epperly
- Department of Radiation Oncology, UPCI Cancer Institute, Pittsburgh, PA, USA
| | - Julie P Goff
- Department of Radiation Oncology, UPCI Cancer Institute, Pittsburgh, PA, USA
| | - Darcy Franicola
- Department of Radiation Oncology, UPCI Cancer Institute, Pittsburgh, PA, USA
| | - Hong Wang
- Department of Radiation Oncology, UPCI Cancer Institute, Pittsburgh, PA, USA
| | - Peter Wipf
- Department of Chemistry, University of Pittsburgh, Pittsburgh, PA, U.S.A. Center for Chemical Methodologies & Library Development, University of Pittsburgh, Pittsburgh, PA, U.S.A
| | - Song Li
- Department of Pharmaceutical Science, University of Pittsburgh, Pittsburgh, PA, U.S.A
| | - Joel S Greenberger
- Department of Radiation Oncology, UPCI Cancer Institute, Pittsburgh, PA, USA
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Encheva E, Kolev N, Tonev A, Ignatov V, Shterev S, Petrov D, Zlatarov A, Koleva I, Chaushev B, Kirilova T, Ivanov K. Radiotherapy in the multimodality management of esophageal cancer. Khirurgiia (Mosk) 2014:12-19. [PMID: 25799618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Squamous cell carcinoma and adenocarcinoma of the esophagus represent more than 90% of all cases of esophageal carcinoma. Although the incidence of squamous cell carcinoma has decreased, a continues increase in the incidence of adenocarcinoma has been observed, due to the increasing rate of obesity and gastroesophageal reflux disease. Treatment of carcinoma of the esophagus is complex and include surgery, chemotherapy and radiotherapy. The authors investigate the role of radiotherapy in the modern multimodality treatment of esophageal carcinomain order to derive recommendations for its implementation. The results of clinical trials and meta-analysis dealing with the radiotherapy application alone or as chemoradiation in preoperative, postoperative or definitive settings are summarized. When summarizing the data from the clinical trials and the meta-analyzes in esophageal carcinoma radiotherapy recommendations are drawn up. As a single modality radiotherapy is recommended only in palliative setting. Current data indicates that the neoadjuvant chemoradiation followed by the surgery is accepted as a standard treatment achieving 3-year overall survival rateraging between 30% and 60%. No improvement in local control or survival is observed when total irradiation dose is increased over 50.4Gy. Neoadjuvant or definitive chemoradiation became a standard treatmentin locally advanced tumors of the esophagus. Preoperative chemoradiation has proven contribution to improving treatment results when compared to surgery alone in both squamous cell and adenocarcinoma of esophagus. There is also a trend towards improved survival when neoadjuvant chemoradiation is applied compared to neoadjuvant chemotherapy alone. Data in favor of definitive radiotherapy as radical treatment are limited and its use is recommended only in case of palliation.
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28
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Jørgensen AYS, Maraldo MV, Brodin NP, Aznar MC, Vogelius IR, Rosenschöld PMA, Petersen PM, Specht L. The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma. Acta Oncol 2013; 52:1559-65. [PMID: 24047340 DOI: 10.3109/0284186x.2013.813636] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. MATERIAL AND METHODS We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. RESULTS Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p < 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p < 0.001). CONCLUSIONS The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.
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Affiliation(s)
- Anni Y S Jørgensen
- Department of Radiation Oncology, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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29
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Palma DA, Senan S, Oberije C, Belderbos J, de Dios NR, Bradley JD, Barriger RB, Moreno-Jiménez M, Kim TH, Ramella S, Everitt S, Rengan R, Marks LB, De Ruyck K, Warner A, Rodrigues G. Predicting esophagitis after chemoradiation therapy for non-small cell lung cancer: an individual patient data meta-analysis. Int J Radiat Oncol Biol Phys 2013; 87:690-6. [PMID: 24035329 DOI: 10.1016/j.ijrobp.2013.07.029] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/25/2013] [Accepted: 07/25/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Concurrent chemoradiation therapy (CCRT) improves survival compared with sequential treatment for locally advanced non-small cell lung cancer, but it increases toxicity, particularly radiation esophagitis (RE). Validated predictors of RE for clinical use are lacking. We performed an individual-patient-data meta-analysis to determine factors predictive of clinically significant RE. METHODS AND MATERIALS After a systematic review of the literature, data were obtained on 1082 patients who underwent CCRT, including patients from Europe, North America, Asia, and Australia. Patients were randomly divided into training and validation sets (2/3 vs 1/3 of patients). Factors predictive of RE (grade≥2 and grade≥3) were assessed using logistic modeling, with the concordance statistic (c statistic) used to evaluate the performance of each model. RESULTS The median radiation therapy dose delivered was 65 Gy, and the median follow-up time was 2.1 years. Most patients (91%) received platinum-containing CCRT regimens. The development of RE was common, scored as grade 2 in 348 patients (32.2%), grade 3 in 185 (17.1%), and grade 4 in 10 (0.9%). There were no RE-related deaths. On univariable analysis using the training set, several baseline factors were statistically predictive of RE (P<.05), but only dosimetric factors had good discrimination scores (c>.60). On multivariable analysis, the esophageal volume receiving ≥60 Gy (V60) alone emerged as the best predictor of grade≥2 and grade≥3 RE, with good calibration and discrimination. Recursive partitioning identified 3 risk groups: low (V60<0.07%), intermediate (V60 0.07% to 16.99%), and high (V60≥17%). With use of the validation set, the predictive model performed inferiorly for the grade≥2 endpoint (c=.58) but performed well for the grade≥3 endpoint (c=.66). CONCLUSIONS Clinically significant RE is common, but life-threatening complications occur in <1% of patients. Although several factors are statistically predictive of RE, the V60 alone provides the best predictive ability. Efforts to reduce the V60 should be prioritized, with further research needed to identify and validate new predictive factors.
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Affiliation(s)
- David A Palma
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
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Kishi K, Iida T, Ojima T, Sonomura T, Shirai S, Nakai M, Sato M, Yamaue H. Esophageal gel-shifting technique facilitating eradicative boost or reirradiation to upper mediastinal targets of recurrent nerve lymph node without damaging esophagus. J Radiat Res 2013; 54:748-754. [PMID: 23436229 PMCID: PMC3709665 DOI: 10.1093/jrr/rrs137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 06/01/2023]
Abstract
We developed a new technique using hyaluronic gel injection as a spacer to safely move the esophagus away from the high-dose area during interstitial brachytherapy of a mediastinal target close to the esophagus. We percutaneously injected a high-molecular-weight hyaluronic gel mixed with contrast medium to create a space between the esophagus and the target during interstitial brachytherapy. We applied this technique to two cases of relapsed recurrent nerve lymph node metastasis from esophageal cancer: one refractory tumor after 50 Gy of radiotherapy, and one recurrence after mediastinal radiotherapy of total 64 Gy. We prescribed 20 Gy and 18 Gy in one fraction to each target, with calculated esophageal D2cc (the minimum dose to the most irradiated volume of 2 cc) of 4.0 Gy and 6.8 Gy, respectively. Calculated enhancement factor by gel shifting in equivalent dose was 2.69 and 2.34, respectively. In each patient, accumulated esophageal D1cc (minimum dose to the most irradiated volume of p cc. minimum dose to the most irradiated volume of 1 cc) was 74.4 Gy and 85.6 Gy without shifting, and 59.1 Gy and 37.6 Gy with shifting, respectively. There were no procedure-related complications. Four months after the brachytherapy, each tumor was remarkably diminished. No evidence of recurrences or late complications were observed 8 months and 9 months after the procedure, respectively. The esophageal gel-shifting technique may facilitate eradicative brachytherapy to upper mediastinal targets without damaging the esophagus, and can be used in conjunction with boost irradiation or reirradiation to overcome the problem of salvage failure.
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Affiliation(s)
- Kazushi Kishi
- Department of Radiation Oncology, Wakayama Medical University, Wakayama City, 64-8510 Japan
| | - Takeshi Iida
- Second Department of Surgery, Wakayama Medical University, Wakayama City, 641-8510 Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, Wakayama Medical University, Wakayama City, 641-8510 Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama City, 641-8510 Japan
| | - Shintaro Shirai
- Department of Radiology, Wakayama Medical University, Wakayama City, 641-8510 Japan
| | - Motoki Nakai
- Department of Radiology, Wakayama Medical University, Wakayama City, 641-8510 Japan
| | - Morio Sato
- Department of Radiology, Wakayama Medical University, Wakayama City, 641-8510 Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama City, 641-8510 Japan
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31
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Park PC, Cheung JP, Zhu XR, Lee AK, Sahoo N, Tucker SL, Liu W, Li H, Mohan R, Court LE, Dong L. Statistical assessment of proton treatment plans under setup and range uncertainties. Int J Radiat Oncol Biol Phys 2013; 86:1007-13. [PMID: 23688812 DOI: 10.1016/j.ijrobp.2013.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/25/2013] [Accepted: 04/05/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate a method for quantifying the effect of setup errors and range uncertainties on dose distribution and dose-volume histogram using statistical parameters; and to assess existing planning practice in selected treatment sites under setup and range uncertainties. METHODS AND MATERIALS Twenty passively scattered proton lung cancer plans, 10 prostate, and 1 brain cancer scanning-beam proton plan(s) were analyzed. To account for the dose under uncertainties, we performed a comprehensive simulation in which the dose was recalculated 600 times per given plan under the influence of random and systematic setup errors and proton range errors. On the basis of simulation results, we determined the probability of dose variations and calculated the expected values and standard deviations of dose-volume histograms. The uncertainties in dose were spatially visualized on the planning CT as a probability map of failure to target coverage or overdose of critical structures. RESULTS The expected value of target coverage under the uncertainties was consistently lower than that of the nominal value determined from the clinical target volume coverage without setup error or range uncertainty, with a mean difference of -1.1% (-0.9% for breath-hold), -0.3%, and -2.2% for lung, prostate, and a brain cases, respectively. The organs with most sensitive dose under uncertainties were esophagus and spinal cord for lung, rectum for prostate, and brain stem for brain cancer. CONCLUSIONS A clinically feasible robustness plan analysis tool based on direct dose calculation and statistical simulation has been developed. Both the expectation value and standard deviation are useful to evaluate the impact of uncertainties. The existing proton beam planning method used in this institution seems to be adequate in terms of target coverage. However, structures that are small in volume or located near the target area showed greater sensitivity to uncertainties.
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Affiliation(s)
- Peter C Park
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gomez DR, Gillin M, Liao Z, Wei C, Lin SH, Swanick C, Alvarado T, Komaki R, Cox JD, Chang JY. Phase 1 study of dose escalation in hypofractionated proton beam therapy for non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2013; 86:665-70. [PMID: 23688815 DOI: 10.1016/j.ijrobp.2013.03.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/26/2013] [Accepted: 03/30/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Many patients with locally advanced non-small cell lung cancer (NSCLC) cannot undergo concurrent chemotherapy because of comorbidities or poor performance status. Hypofractionated radiation regimens, if tolerable, may provide an option to these patients for effective local control. METHODS AND MATERIALS Twenty-five patients were enrolled in a phase 1 dose-escalation trial of proton beam therapy (PBT) from September 2010 through July 2012. Eligible patients had histologically documented lung cancer, thymic tumors, carcinoid tumors, or metastatic thyroid tumors. Concurrent chemotherapy was not allowed, but concurrent treatment with biologic agents was. The dose-escalation schema comprised 15 fractions of 3 Gy(relative biological effectiveness [RBE])/fraction, 3.5 Gy(RBE)/fraction, or 4 Gy(RBE)/fraction. Dose constraints were derived from biologically equivalent doses of standard fractionated treatment. RESULTS The median follow-up time for patients alive at the time of analysis was 13 months (range, 8-28 months). Fifteen patients received treatment to hilar or mediastinal lymph nodes. Two patients experienced dose-limiting toxicity possibly related to treatment; 1 received 3.5-Gy(RBE) fractions and experienced an in-field tracheoesophageal fistula 9 months after PBT and 1 month after bevacizumab. The other patient received 4-Gy(RBE) fractions and was hospitalized for bacterial pneumonia/radiation pneumonitis 4 months after PBT. CONCLUSION Hypofractionated PBT to the thorax delivered over 3 weeks was well tolerated even with significant doses to the lungs and mediastinal structures. Phase 2/3 trials are needed to compare the efficacy of this technique with standard treatment for locally advanced NSCLC.
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Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, USA.
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Uyterlinde W, Chen C, Kwint M, de Bois J, Vincent A, Sonke JJ, Belderbos J, van den Heuvel M. Prognostic parameters for acute esophagus toxicity in intensity modulated radiotherapy and concurrent chemotherapy for locally advanced non-small cell lung cancer. Radiother Oncol 2013; 107:392-7. [PMID: 23647749 DOI: 10.1016/j.radonc.2013.04.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to correlate clinical and dosimetric variables with acute esophageal toxicity (AET) following Intensity Modulated Radiotherapy (IMRT) with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC). In addition, timeline of AET was reported. MATERIAL AND METHODS 153 patients with locally advanced NSCLC treated with 66 Gy/2.75 Gy/24 fractions of radiotherapy and concurrent daily low dose cisplatin were selected. Medical records and treatments of these patients were retrospectively reviewed. Maximum AET grade ≥2 and maximum grade 3 were the endpoints of this study. Dates for onset, maximum and recovery (to baseline) of AET were reported. Univariate and multivariate analysis were applied to correlate clinical, tumor, dosimetric and chemotherapy dose variables to AET grade ≥2 and grade 3. RESULTS AET grade 2 occurred in 37% and grade 3 in 20% of the patients. The median onset of AET was around day 15 for all grades. The median onset of the maximum grade was day 30 for both grades 2 and 3. The median duration was 43 days for grade 1, 50 days for grade 2 and >80 days for grade 3. Of the grade 3 AET patients, 48% recovered within 3 months. Esophagus V50, ethnic background, and the number of cisplatin administrations were significantly correlated with grade 3 AET. CONCLUSIONS For NSCLC patients treated with concurrent chemotherapy and IMRT A higher number of cisplatin administrations, non-Caucasian background and higher V50oes were associated with grade 3 AET. The median onset of AET grade 3 is 15 days after the start of treatment, maximized at day 30, with a median duration of >80 days.
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Affiliation(s)
- Wilma Uyterlinde
- Department of Thoracic Oncology, NKI-AVL, Amsterdam, The Netherlands.
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Lee B, Lee J, Kang S, Cho H, Shin G, Lee JW, Choi J. Calculation of patient effective dose and scattered dose for dental mobile fluoroscopic equipment: application of the Monte Carlo simulation. Radiat Prot Dosimetry 2013; 153:80-84. [PMID: 22645385 DOI: 10.1093/rpd/ncs082] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to evaluate the patient effective dose and scattered dose from recently developed dental mobile equipment in Korea. The MCNPX 2.6 (Los Alamos National Laboratory, USA) was used in a Monte Carlo simulation to calculate both the effective and scattered doses. The MCNPX code was constructed identically as in the general use of equipment and the effective dose and scattered dose were calculated using the KTMAN-2 digital phantom. The effective dose was calculated as 906 μSv. The equivalent doses per organ were calculated via the MCNPX code, and were 32 174 and 19 μSv in the salivary gland and oesophagus, respectively. The scattered dose of 22.5-32.6 μSv of the tube side at 25 cm from the centre in anterior and posterior planes was measured as 1.4-3 times higher than the detector side of 10.5-16.0 μSv.
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Affiliation(s)
- Boram Lee
- Department of Radiologic Science, College of Health Science, Korea University, Seoul, Korea
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Osti MF, Agolli L, Valeriani M, Falco T, Bracci S, De Sanctis V, Enrici RM. Image guided hypofractionated 3-dimensional radiation therapy in patients with inoperable advanced stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2012. [PMID: 23182393 DOI: 10.1016/j.ijrobp.2012.10.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Hypofractionated radiation therapy (HypoRT) can potentially improve local control with a higher biological effect and shorter overall treatment time. Response, local control, toxicity rates, and survival rates were evaluated in patients affected by inoperable advanced stage non-small cell lung cancer (NSCLC) who received HypoRT. METHODS AND MATERIALS Thirty patients with advanced NSCLC were enrolled; 27% had stage IIIA, 50% had stage IIIB, and 23% had stage IV disease. All patients underwent HypoRT with a prescribed total dose of 60 Gy in 20 fractions of 3 Gy each. Radiation treatment was delivered using an image guided radiation therapy technique to verify correct position. Toxicities were graded according to Radiation Therapy Oncology Group morbidity score. Survival rates were estimated using the Kaplan-Meier method. RESULTS The median follow-up was 13 months (range, 4-56 months). All patients completed radiation therapy and received the total dose of 60 Gy to the primary tumor and positive lymph nodes. The overall response rate after radiation therapy was 83% (3 patients with complete response and 22 patients with partial response). The 2-year overall survival and progression-free survival rates were 38.1% and 36%, respectively. Locoregional recurrence/persistence occurred in 11 (37%) patients. Distant metastasis occurred in 17 (57%) patients. Acute toxicities occurred consisting of grade 1 to 2 hematological toxicity in 5 patients (17%) and grade 3 in 1 patient; grade 1 to 2 esophagitis in 12 patients (40%) and grade 3 in 1 patient; and grade 1 to 2 pneumonitis in 6 patients (20%) and grade 3 in 2 patients (7%). Thirty-three percent of patients developed grade 1 to 2 late toxicities. Only 3 patients developed grade 3 late adverse effects: esophagitis in 1 patient and pneumonitis in 2 patients. CONCLUSIONS Hypofractionated curative radiation therapy is a feasible and well-tolerated treatment for patients with locally advanced NSCLC. Randomized studies are needed to compare HypoRT to conventional treatment.
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Affiliation(s)
- Mattia Falchetto Osti
- Institute of Radiation Oncology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy
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Eisbruch A, Kim HM, Feng FY, Lyden TH, Haxer MJ, Feng M, Worden FP, Bradford CR, Prince ME, Moyer JS, Wolf GT, Chepeha DB, Ten Haken RK. Chemo-IMRT of oropharyngeal cancer aiming to reduce dysphagia: swallowing organs late complication probabilities and dosimetric correlates. Int J Radiat Oncol Biol Phys 2011; 81:e93-9. [PMID: 21592678 PMCID: PMC3158965 DOI: 10.1016/j.ijrobp.2010.12.067] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [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: 09/28/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Assess dosimetric correlates of long-term dysphagia after chemo-intensity-modulated radiotherapy (IMRT) of oropharyngeal cancer (OPC) sparing parts of the swallowing organs. PATIENTS AND METHODS Prospective longitudinal study: weekly chemotherapy concurrent with IMRT for Stages III/IV OPC, aiming to reduce dysphagia by sparing noninvolved parts of swallowing-related organs: pharyngeal constrictors (PC), glottic and supraglottic larynx (GSL), and esophagus, as well as oral cavity and major salivary glands. Dysphagia outcomes included patient-reported Swallowing and Eating Domain scores, Observer-based (CTCAEv.2) dysphagia, and videofluoroscopy (VF), before and periodically after therapy through 2 years. Relationships between dosimetric factors and worsening (from baseline) of dysphagia through 2 years were assessed by linear mixed-effects model. RESULTS Seventy-three patients participated. Observer-based dysphagia was not modeled because at >6 months there were only four Grade ≥2 cases (one of whom was feeding-tube dependent). PC, GSL, and esophagus mean doses, as well as their partial volume doses (V(D)s), were each significantly correlated with all dysphagia outcomes. However, the V(D)s for each organ intercorrelated and also highly correlated with the mean doses, leaving only mean doses significant. Mean doses to each of the parts of the PCs (superior, middle, and inferior) were also significantly correlated with all dysphagia measures, with superior PCs demonstrating highest correlations. For VF-based strictures, most significant predictor was esophageal mean doses (48±17 Gy in patients with, vs 27±12 in patients without strictures, p = 0.004). Normal tissue complication probabilities (NTCPs) increased moderately with mean doses without any threshold. For increased VF-based aspirations or worsened VF summary scores, toxic doses (TDs)(50) and TD(25) were 63 Gy and 56 Gy for PC, and 56 Gy and 39 Gy for GSL, respectively. For both PC and GSL, patient-reported swallowing TDs were substantially higher than VF-based TDs. CONCLUSIONS Swallowing organs mean doses correlated significantly with long-term worsening of swallowing. Different methods assessing dysphagia resulted in different NTCPs, and none demonstrated a threshold.
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Affiliation(s)
- Avraham Eisbruch
- Department of Radiation Oncology, 1500 E. Medical Center Drive, UH B2C490 SPC 5010, Ann Arbor, MI 48109, USA.
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Bernard ME, Kim H, Rwigema JC, Epperly MW, Kelley EE, Murdoch GH, Dixon T, Wang H, Greenberger JS. Role of the esophageal vagus neural pathway in ionizing irradiation-induced seizures in nitric oxide synthase-1 homologous recombinant negative NOS1-/- mice. In Vivo 2011; 25:861-869. [PMID: 22021678 PMCID: PMC3593194] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM We sought to define the mechanism of total body irradiation (TBI)-induced seizures in NOS1(-/-) mice and amelioration by intra-esophageal manganese superoxide dismutase-plasmid liposomes (MnSOD-PL). MATERIALS AND METHODS We evaluated the role of vagus nerve pathways in irradiation-induced seizures using biochemical, physiologic, and histopathologic techniques. RESULTS Heterozygous NOS1(+/-) mice demonstrated radioresistance similar to wild-type C57BL/6NHsd mice (p=0.9269). Irradiation-induced lipid peroxidation in fetal brain cultures from NOS1(-/-) or wild-type mice was reduced by MnSOD-PL. Right-sided vagotomy did not alter the TBI radiation response of wild-type or reverse the radiosensitivity of NOS1(-/-) mice. Excised esophagus from irradiated NOS1(-/-) mice demonstrated an increased histopathologic inflammatory response compared to C57BL/6NHsd mice. CONCLUSION NOS1(-/-) mice represent a model system for dissecting the developmental abnormalities leading to esophageal-mediated TBI-induced seizures.
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Affiliation(s)
- Mark E Bernard
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
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Farkas R, Pozsgai E, Bellyei S, Cseke L, Szigeti A, Vereczkei A, Marton S, Mangel L, Horvath OP, Papp A. Correlation between tumor-associated proteins and response to neoadjuvant treatment in patients with advanced squamous-cell esophageal cancer. Anticancer Res 2011; 31:1769-1775. [PMID: 21617238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Possible predictive markers of response to neoadjuvant radiochemotherapy (NRCT) of esophageal cancer have been identified. PATIENTS AND METHODS Patient biopsies were obtained from both tumor and normal tissue before the NRCT of locally advanced esophageal squamous cell carcinoma. Protein solutions were separated and immunoblot analysis was performed with heat shock protein (Hsp)16.2, heme-binding protein 2 (SOUL), BCL2-associated X protein (Bax), B-cell-associated leukemia protein 2 (Bcl-2) and heat shock protein 90 (Hsp90) antibodies. Following NRCT, the patients were restaged according to the Response Evaluation Criteria In Solid Tumors (RECIST). Following resections the pathological down-staging was evaluated. RESULTS Clinical restaging revealed a response rate of 65%. Pathological examination revealed down-staging in 30% and 25% of the cases for the T and N categories respectively. Compared to the normal esophageal mucosa, a decreased expression of Hsp16.2, Hsp90 and SOUL proteins and an increased Bax/Bcl-2 ratio was found in the responding tumors. CONCLUSION Hsp16,2, Hsp90 and SOUL expression and Bax/ Bcl-2 ratio correlates to the efficacy of NRCT and predict outcome in patients with locally advanced squamous-cell esophageal cancer.
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Affiliation(s)
- R Farkas
- Departments of Oncology, University of Pécs, Hungary
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Epperly MW, Goff JP, Li S, Gao X, Wipf P, Dixon T, Wang H, Franicola D, Shen H, Rwigema JCM, Kagan V, Bernard M, Greenberger JS. Intraesophageal administration of GS-nitroxide (JP4-039) protects against ionizing irradiation-induced esophagitis. In Vivo 2010; 24:811-9. [PMID: 21164038 PMCID: PMC3521523] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIM this study evaluated esophageal radioprotection by the Gramicidin S (GS) derived-nitroxide, JP4-039, a mitochondrial targeting peptide-isostere covalently-linked to 4-amino-Tempo, delivered in a novel swallowed oil-based (F15) formulation. MATERIALS AND METHODS C57BL/6HNsd female mice received intraesophageal F15 formulation containing JP4-039 (4 mg/ml in 100 microl volumes) 10 minutes before 28 or 29 Gy upper body irradiation compared to MnSOD-PL (100 microl containing 100 microg plasmid) 24 hours prior to irradiation. Subgroups received 1 × 10(7) C57BL/6HNsd, GFP(+) male bone marrow cells intravenously 5 days after irradiation. RESULTS JP4-039/F15 or MnSOD-PL increased survival compared to irradiated controls (p<0.0001 for either). Marrow injection further increased survival (p=0.0462 and 0.0351, respectively). Esophagi removed at 1, 3, 7, 14, 24, or 60 days showed bone marrow-derived cells in the esophagi. CONCLUSION intraesophageal GS-nitroxide radioprotection is mediated primarily through recovery of endogenous esophageal progenitor cells.
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Affiliation(s)
- Michael W Epperly
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, U.S.A
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Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB. Radiation dose-volume effects in the esophagus. Int J Radiat Oncol Biol Phys 2010; 76:S86-93. [PMID: 20171523 DOI: 10.1016/j.ijrobp.2009.05.070] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 04/30/2009] [Accepted: 05/02/2009] [Indexed: 12/12/2022]
Abstract
Publications relating esophageal radiation toxicity to clinical variables and to quantitative dose and dose-volume measures derived from three-dimensional conformal radiotherapy for non-small-cell lung cancer are reviewed. A variety of clinical and dosimetric parameters have been associated with acute and late toxicity. Suggestions for future studies are presented.
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Affiliation(s)
- Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5097, USA.
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Carabe-Fernandez A, Dale RG, Jones B. The incorporation of the concept of minimum RBE (RBEmin) into the linear-quadratic model and the potential for improved radiobiological analysis of high-LET treatments. Int J Radiat Biol 2009; 83:27-39. [PMID: 17357437 DOI: 10.1080/09553000601087176] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The formulation of relative biological effectiveness (RBE) for high linear energy transfer (high-LET) radiation treatments is revisited. The effects of changed production of sub-lethal damage with varying LET is now considered via the RBEmin concept, where RBEmin represents the lower limit to which RBE tends at high doses per fraction. MATERIALS AND METHODS An existing linear-quadratic formulation for calculating RBE variations with fractional dose for high-LET radiations is modified to incorporate the twin concepts of RBEmax (which represents the value of RBE at an effective dose-per-fraction of 0 Gy) and RBEmin. RESULTS Fits of the model to data showed RBEmin values in the range of 0.1- 2.27. In all cases the raw data was a better statistical fit to the model which included RBEmin, although this was only very highly significant in one case. In the case of the mouse oesophagus it is shown that, if change in the beta-radiosensitivity coefficient with LET is considered as trivial, an underestimation > 5% in RBE can be expected at X-ray doses of 2 Gy/fraction if RBEmin is not considered. To ensure that the results were not biased by the statistical method used to obtain the parameter values relevant to this analysis (i.e., using fraction-size effect or Fe-plots), an alternative method was used which provided very similar correlation with the data. CONCLUSIONS If the production of sublethal damage is considered independent of LET, there will be a risk that non-corrected evaluation of RBE will lead to an over- or under-estimate of RBE at low doses per fractions (the clinically relevant region).
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Affiliation(s)
- Alejandro Carabe-Fernandez
- Department of Radiation Physics and Radiobiology, Imperial College School of Medicine, Hammersmith Hospitals NHS Trust, Charing Cross Hospital, London, UK.
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42
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Giever T, Gottlieb K, Merg A. Endoscopic repair of a complete post-radiation esophageal obstruction. J Gastrointestin Liver Dis 2008; 17:335-338. [PMID: 18836631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe a 64-year-old man with squamous cell carcinoma of the esophagus who presented with an obstruction of the esophagus following radiation therapy and chemotherapy. Initial upper gastrointestinal barium swallow studies showed a complete stoppage of the barium column, not unlike that of a congenital esophageal atresia. Therapeutic endoscopy was performed using a two-endoscope, two-operator system that reestablished patency of the esophagus. Repeated endoscopy was then used to continue esophageal dilation with eventual placement of a permanent stent. A video and a comprehensive review of the literature regarding combined antegrade-retrograde dilation techniques used to date are also provided.
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Zhang X, Epperly MW, Kay MA, Chen ZY, Dixon T, Franicola D, Greenberger BA, Komanduri P, Greenberger JS. Radioprotection in vitro and in vivo by minicircle plasmid carrying the human manganese superoxide dismutase transgene. Hum Gene Ther 2008; 19:820-6. [PMID: 18699723 PMCID: PMC2914206 DOI: 10.1089/hum.2007.141] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Manganese superoxide dismutase plasmid liposomes (MnSOD-PL) confer organ-specific in vivo ionizing irradiation protection. To prepare for potential intravenous clinical trials of systemic MnSOD-PL for radioprotection in humans, plasmid and bacterial sequences were removed and a new minicircle construct was tested. Minicircle MnSOD was purified and then cotransfected into 32D cl 3 murine interleukin-3-dependent hematopoietic progenitor cells along with another plasmid carrying the neo gene. Cells were selected in G418 (50 microg/ml) and cloned by limiting dilution. Biochemical analysis of minicircle MnSOD-transfected cells showed an MnSOD biochemical activity level of 5.8 +/- 0.5 U/mg compared with 2.7 +/- 0.1 U/mg for control 32D cl 3 cells (p = 0.0039). 32D-mc-MnSOD cells were as radioresistant as full-length MnSOD-PL transgene-expressing 2C6 cells, relative to 32D cl 3 parent cells, with an increased shoulder on the radiation survival curve (n = 4.8 +/- 0.2 and n = 4.6 +/- 0.2, respectively, compared with 1.5 +/- 0.5 for 32D cl 3 cells; p = 0.007). C57BL/6NHsd mice received intraoral mc-MnSOD-PL, mc-DsRed-PL control, full-length MnSOD-PL, or blank-PL and then were irradiated 24 hr later with 31 Gy to the esophagus. Mice receiving mc-MnSOD-PL showed increased survival compared with control mice or mice treated with mc-DsRed-PL (p = 0.0003 and 0.039, respectively), and comparable to full-length MnSOD-PL. Intravenous, systemic administration of mc-MnSOD-PL protected mice from total body irradiation (9.75 Gy). Therefore, minicircle DNA containing the human MnSOD transgene confers undiminished radioprotection in vitro and in vivo.
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Affiliation(s)
- Xichen Zhang
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
| | - Michael W. Epperly
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
| | - Mark A. Kay
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Zhi-Ying Chen
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Tracy Dixon
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
| | - Darcy Franicola
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
| | - Benjamin A. Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
| | - Paavani Komanduri
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
| | - Joel S. Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213
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Pogue BW, Sheng C, Benevides J, Forcione D, Puricelli B, Nishioka N, Hasan T. Protoporphyrin IX fluorescence photobleaching increases with the use of fractionated irradiation in the esophagus. J Biomed Opt 2008; 13:034009. [PMID: 18601554 PMCID: PMC3787899 DOI: 10.1117/1.2937476] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [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] [Indexed: 05/18/2023]
Abstract
Fluorescence measurements have been used to track the dosimetry of photodynamic therapy (PDT) for many years, and this approach can be especially important for treatments with aminolevulinic-acid-induced protoporphyrin IX (ALA-PpIX). PpIX photobleaches rapidly, and the bleaching is known to be oxygen dependent, and at the same time, fractionation or reduced irradiance treatments have been shown to significantly increase efficacy. Thus, in vivo measurement of either the bleaching rate and/or the total bleaching yield could be used to track the deposited dose in tissue and determine the optimal treatment plans. Fluorescence in rat esophagus and human Barrett's esophagus are measured during PDT in both continuous and fractionated light delivery treatment, and the bleaching is quantified. Reducing the optical irradiance from 50 to 25 mWcm did not significantly alter photobleaching in rat esophagus, but fractionation of the light at 1-min on and off intervals did increase photobleaching up to 10% more (p value=0.02) and up to 25% more in the human Barrett's tissue (p value<0.001). While two different tissues and two different dosimetry systems are used, the data support the overall hypothesis that light fractionation in ALA-PpIX PDT esophageal treatments should have a beneficial effect on the total treatment effect.
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Affiliation(s)
- Brian W Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire 03755, USA.
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45
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Nguyen NP, Smith HJ, Moltz CC, Frank C, Millar C, Dutta S, Lee H, North D, Karlsson U, Vos P, Nguyen LM, Sallah S. Prevalence of pharyngeal and esophageal stenosis following radiation for head and neck cancer. J Otolaryngol Head Neck Surg 2008; 37:219-224. [PMID: 19128616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To evaluate the risk and outcome of pharyngoesophageal stenosis in patients who complained of dysphagia following radiation for head and neck cancer. DESIGN Retrospective study. SETTING Veterans Administration hospital. PATIENTS Patients who complained of persistent dysphagia following radiation alone or combined with surgery or chemotherapy for head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. All patients had modified barium swallow (MBS) and an endoscopic examination for initial evaluation of their dysphagia. Traditional barium swallow was requested when there was a suspicion of pharyngoesophageal stenosis on MBS. RESULTS Two hundred twenty-two patients underwent MBS for evaluation of dysphagia posttreatment. Traditional barium swallow confirmed the diagnosis of pharyngeal (n = 2) or esophageal (n = 14) stenosis in 16 patients. Eight patients had esophageal stenosis on endoscopic examination. All patients underwent dilatation for relief of their dysphagia. The number of dilatations performed was, respectively, one in 12 patients, two in 4 patients, three in 3 patients, four in 3 patients, five in one patient, and six in one patient. CONCLUSION Pharyngeal and/or cervical esophageal stenosis may be the cause of dysphagia following radiation for head and neck cancer. Esophageal dilatations often offer temporary relief of the dysphagia.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, AZ 85724-5081, USA.
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Vujaskovic Z, Thrasher BA, Jackson IL, Brizel MB, Brizel DM. Radioprotective effects of amifostine on acute and chronic esophageal injury in rodents. Int J Radiat Oncol Biol Phys 2007; 69:534-40. [PMID: 17869666 DOI: 10.1016/j.ijrobp.2007.05.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 04/30/2007] [Accepted: 05/25/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was performed to evaluate the protective benefit of amifostine against esophageal injury from fractionated radiation in a rodent model. METHODS Fractionated or sham esophageal irradiation was administered to Fisher-344 rats for 5 consecutive daily fractions of 9 Gy using 150 kV X-rays. Animals received an intraperitoneal injection of amifostine or placebo 30 min before each fraction. Histopathologic analyses for mucosal thickness, submucosal collagen deposition, activation of macrophages, oxidative stress and expression/activation of integrinalphavbeta6 and transforming growth factor (TGF)-beta were performed 5 days and 10 weeks after irradiation. RESULTS Pre-RT mean mucosal thickness was 35 microm in both the placebo and the amifostine groups. Five days post-RT, mean mucosal thicknesses were 30 microm in the placebo group versus 37 microm in the amifostine group (p = 0.024). At 10 weeks post-RT, the group receiving amifostine experienced a significant decrease in tunica muscularis damage (p = 0.002), submucosal collagen deposition (p = 0.027), and macrophage accumulation (p = 0.026) when compared with the placebo group. The levels of immunoreactivity for oxidative stress, TGF-beta, and integrinalphavbeta6 were significantly decreased 10 weeks post-RT in the group receiving amifostine treatment compared with placebo group. CONCLUSIONS This study demonstrates that amifostine given before each radiation fraction protects against acute and chronic esophageal injury in a rodent model. Protection of the mucosal epithelium integrity by amifostine prevents integrinalphavbeta6 expression which reduces TGF-beta activation and subsequent development of chronic esophageal injury in this model. Further investigation is necessary to determine the clinical relevance of these findings.
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Affiliation(s)
- Zeljko Vujaskovic
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
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47
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Marks LB, Ma J. Challenges in the clinical application of advanced technologies to reduce radiation-associated normal tissue injury. Int J Radiat Oncol Biol Phys 2007; 69:4-12. [PMID: 17707263 DOI: 10.1016/j.ijrobp.2007.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 05/07/2007] [Accepted: 05/07/2007] [Indexed: 11/21/2022]
Affiliation(s)
- Lawrence B Marks
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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Li FM, Luo W, He ZC, Zhang L, Sun Y, Qin WJ, Lu LX, Han F, Liu XQ, Liu MZ. [Dosimetric analysis of radiotherapy with middle shielding blocks of different widths at the lower cervical supraclavicular field for stage N2-3 nasopharyngeal carcinoma]. Ai Zheng 2007; 26:1127-1132. [PMID: 17927886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND & OBJECTIVE Anterior tangential field irradiation with middle shielding block at the lower cervical and supraclavicular region is needed in the conventional radiotherapy for stage N2-3 nasopharyngeal carcinoma (NPC), but there are still some disagreements on block width. This study was to explore a reasonable block width by dosimetric analysis of anterior tangential field irradiation with middle shielding blocks of different widths designed by the 3-dimensional treatment planning system (3D-TPS) at the lower cervical supraclavicular region for stage N2-3 NPC. METHODS Ten untreated patients with stage N2-3 NPC received 3D-TPS-designed irradiation plan. For every patient, a gradual shrinking field technique was adopted. Single anterior tangential fields were set at the lower cervical and supraclavicular region and irradiated with middle shielding blocks of different widths: 0 cm (Plan A), 2.1 cm (Plan B), 2.5 cm (Plan C), and 3 cm (Plan D) for the first 40 Gy, then 3 cm for residual dose for all 4 plans. The prescribed doses were the same for 4 plans for every patient. The irradiated volumes and doses of target volumes and organs at risk among the 4 plans were compared. RESULTS The high dose coverage (V95 and V90) of plan target volume (PTV) for the subclinical lesion region at the lower cervical supraclavicular region (PTV50a) was significantly higher in Plan A than in Plans B, C, and D (82.44% vs. 78.21%, 77.10% and 73.80% for V95, 87.89% vs. 84.03%, 82.68% and 77.50% for V90, P<0.05), and significantly higher in Plans B and C than in Plan D (P<0.05), but there was no difference between Plans B and C (P>0.05). There was no significant difference in high dose coverage (V95 and V90) of PTV for the primary gross tumor region (PTVnx), PTV for the cervical metastatic nodes (PTVnd), PTV for the high risk region around primary gross tumor (PTVnx60), PTV for the high risk region around metastatic nodes (PTVnd60), and subclinical lesion region above cricoid cartilage (PTV50b) among the 4 plans. There was no difference in the doses for the spinal cord and larynx among the 4 plans. The maximal doses for 50% volumes of target organs (D50) were significantly higher in Plan A than in Plans B, C, and D (49.47 Gy vs. 41.95 Gy, 38.73 Gy, and 26.82 Gy for the thyroid gland, 44.52 Gy vs. 8.41 Gy, 7.03 Gy, and 5.63 Gy for the esophagus, 44.18 Gy vs. 10.16 Gy, 8.55 Gy, and 7.60 Gy for the trachea, P<0.05), and higher in Plans B and C than in Plan D (P<0.05), but there was no difference between Plans B and C (P>0.05). The normal tissue complication probability (NTCP) of the thyroid gland was significantly higher in Plan A than in Plans B, C, and D (7.9% vs. 4.8%, 4.3%, and 3.0%, P<0.05), and higher in Plans B and C than in Plan D, but there was no difference between Plans B and C (P>0.05). There were no difference in the doses for the spinal cord and larynx among the 4 plans. The maximal doses for 50% volumes of target organs (D50) were significantly higher in Plan A than in Plans B, C, and D (49.47 Gy vs. 41.95 Gy, 38.73 Gy, and 26.82 Gy for the thyroid gland, 44.52 Gy vs. 8.41 Gy, 7.03 Gy, and 5.63 Gy for the esophagus, 44.18 Gy vs. 10.16 Gy, 8.55 Gy, and 7.60 Gy for the trachea, P<0.05), and higher in Plans B and C than in Plan D (P<0.05), but there was no difference between Plans B and C (P>0.05). The normal tissue complication probability (NTCP) of the thyroid gland was significantly higher in Plan A than in Plans B, C, and D (7.9% vs. 4.8%, 4.3%, and 3.0%, P<0.05), and higher in Plans B and C than in Plan D, but there was no difference between Plans B and C (P>0.05). There were no difference in the NTCP of other organs at risk among the 4 plans (P>0.05). CONCLUSIONS Not obviously increasing the irradiation doses for critical organs at risk, Plan A has the best high dose coverage at the subclinical lesion region of the lower cervical and supraclavicular region, while Plan D the worst. We recommend to use no middle shielding block in the anterior tangential field for the first 40 Gy, then use individual middle shielding blocks of 2.1-2.5 cm in the institutes at where set up error is small.
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Affiliation(s)
- Fang-Ming Li
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China
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49
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Abstract
An improved method to estimate dose to esophageal tissue was investigated in the setting of photodynamic therapy with aminolevulinic acid-induced protoporphyrin IX (PpIX) treatment. A model of treatment-induced edema in the esophagus mucosa proved to be a well controlled and useful way to test the dosimetry model, and the light from the treatment laser together with the PpIX fluorescence intensity could be quantified reliably in real time. Dosimetry calculations based upon the detected fluorescence and bleaching kinetics were used to calculate the "effective" dose to the tissue, and a correlation was shown to exist between this metric and the edema induced in the esophagus. The difference between animals with no detectable treatment effect and those with significant edema was predictable based upon the dose calculation. The underlying assumption in the interpretation of the data is that rapid photobleaching of PpIX occurs when there is ample oxygen supply, and this bleaching is not present when oxygen is limited. This leads to the prediction that integration of the light and drug dose, in intervals where appreciable photobleaching occurs, should provide a prediction of the relative dose of singlet oxygen produced. This detection system and rodent model can be used for prospective dosimetry studies that focus on optimization of esophageal PDT.
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Affiliation(s)
- Chao Sheng
- Thayer School of Engineering, Dartmouth College, Harvard Medical School, Boston, MA, USA
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Stewart CJR, Hillery S. Mucosal endocrine cell micronests and single endocrine cells following neo-adjuvant therapy for adenocarcinoma of the distal oesophagus and oesophagogastric junction. J Clin Pathol 2007; 60:1284-9. [PMID: 17893119 PMCID: PMC2095480 DOI: 10.1136/jcp.2007.047449] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS To determine the frequency of endocrine cell micronests (ECM) and single endocrine cells (SEC) within the glandular mucosa of the distal oesophagus and oesophagogastric junction (OGJ) following neo-adjuvant therapy for adenocarcinoma. METHODS The resection specimens from 11 patients with adenocarcinoma of the distal oesophagus or OGJ who had undergone preoperative chemotherapy or chemoradiotherapy (CRT) were reviewed and stained immunohistochemically for cytokeratin and chromogranin. The presence of ECM and/or SEC within the mucosa adjacent to the tumour was noted, and the results correlated with the extent of tumour regression. The corresponding pretreatment endoscopic biopsy specimens were reviewed in 6 cases, and the results were also compared to 10 tumour resections from patients with no history of neo-adjuvant treatment. RESULTS ECM and/or SEC were identified in 8/11 resection specimens after chemotherapy or CRT. The endocrine cells were typically located within the deep lamina propria or muscularis mucosae and were associated with varying degrees of glandular atrophy and inflammation. The appearances were most consistent with endocrine cell preservation (pseudo-hyperplasia) following treatment. Isolated endocrine elements were not seen in the pretreatment biopsy specimens, while rare SEC without ECM were identified in only 2/10 control resection specimens. CONCLUSIONS Endocrine cell pseudo-hyperplasia may be seen within atrophic glandular mucosa following neo-adjuvant therapy of distal oesophageal/OGJ adenocarcinomas. The changes are analogous to those seen in chronic atrophic gastritis and should not be misinterpreted as those of residual tumour.
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Affiliation(s)
- Colin J R Stewart
- Division of Anatomical Pathology, Sir Charles Gairdner Hospital and SJOG Pathology, Perth, Western Australia.
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